Describing Pediatric Hospital Discharge Planning Care Processes Using the Omaha System

Purpose Although discharge planning (DP) is recognized as a critical component of hospital care, national initiatives have focused on older adults, with limited focus on pediatric patients. We aimed to describe patient problems and targeted interventions as documented by social workers or DP nurses providing specialized DP services in a children\u27s hospital. Methods Text from 67 clinical notes for 28 patients was mapped to a standardized terminology (Omaha System). Data were deductively analyzed. Results A total of 517 phrases were mapped. Eleven of the 42 Omaha System problems were identified. The most frequent problem was health care supervision (297/517; 57.4%). Three Omaha System intervention categories were used (teaching, guidance, and counseling; case management; and surveillance). Intervention targets are varied by role. Conclusion The findings provide a rich description of the nature of DP for complex pediatric patients and increase our understanding of the work of DP staff and the influence of the DP practice model

An Informatics Approach to Interprofessional Management of Low Back Pain: A Feasibility Study using the Omaha System

Background: Low back pain (LBP) is a complex health care issue that often involves multiple providers across various care settings. Health information technology (HIT) holds promise to improve care delivery by providing infrastructure for communication, clinical documentation, and management of patient data. Standardized terminology is essential for interoperability and enables evaluation of clinical data generated by documentation in an electronic health record (EHR).Objective: The purpose of this study was to demonstrate the feasibility of mapping evidence-based practice for conservative management of low back pain to the Omaha System and foster inter-professional communication and collaboration among diverse practitioners and patients.Methods: Evidence-based practice (EBP) guidelines for non-invasive treatment of low back pain were mapped to the Omaha System using a clinical expert approach with attention to content feasibility, linguistic validity, and granularity of terms. Results: A clinical guideline for low back pain management was developed consisting of 13 interventions for Pain and Neuro-musculo-skeletal problems. The most common intervention categories were Case management followed by Treatments and procedures, Teaching, guidance, and counseling and Surveillance. Scope of practice overlap was identified between primary care, chiropractic, and physical therapy practice.Conclusion: Use of the guideline may facilitate clinical documentation using the Omaha System for low back pain management, and has potential to generate meaningful data to evaluate clinical effectiveness and promote quality research. The use of encoded EBP evidence within an EHR can increase use of available evidence, enable interprofessional communication, improve quality of care, and enhance usability of data across care settings

Angiographic progression of coronary artery disease and the development of myocardial infarction

AbstractThere are few data on angiographic coronary artery anatomy in patients whose coronary artery disease progresses to myocardial infarction. In this retrospective analysis, progression of coronary artery disease between two cardiac catheterization procedures is described in 38 patients: 23 patients (Group I) who had a myocardial infarction between the two studies and 15 patients (Group II) who presented with one or more new total occlusions at the second study without sustaining an intervening infarction.In Group I the median percent stenosis on the initial angiogram of the artery related to the infarct at restudy was significantly less than the median percent stenosis of lesions that subsequently were the site of a new total occlusion in Group II (48 versus 73.5%, p < 0.05). In the infarctrelated artery in Group I, only 5 (22%) of 23 lesions were initially >70%, whereas in Group II, 11 (61%) of 18 lesions that progressed to total occlusion were initially >70% (p < 0.01). In Group I, patients who developed a Q wave infarction had less severe narrowing at initial angiography in the subsequent infarct-related artery (34%) than did patients who developed a non-Q wave infarction (80%) (p < 0.05). Univariate and multivariate analysis of angiographic and clinical characteristics present at initial angiography in Group I revealed proximal lesion location as the only significant predictor of evolution of lesions ≥ 50% to infarction.This irrespective study suggests that myocardial infarction frequently develops from previously nonsevere lesions. In addition, it is often difficult to predict the location of a subsequent infarct from analysis of the first coronary angiogram. Non-Q wave infarction is usually preceded by a more severe pre-existing stenosis than is a Q wave infarction, perhaps indicating some degree of prior myocardial protection. A prospective evaluation will be necessary to confirm these findings

Twinned-domain-induced magnonic modes in epitaxial LSMO/STO films

The use of periodic magnetic structures to control the magneto-dynamic properties of materials-Magnonics-is a rapidly developing field. In the last decade, a number of studies have shown that metallic films can be patterned or combined in patterns that give rise to well-defined magnetization modes, which are formed due to band folding or band gap effects. To explore and utilize these effects in a wide frequency range, it is necessary to pattern samples at the sub-micrometer scale. However, it is still a major challenge to produce low-loss magnonic structures with periodicities at such length scales. Here, we show that for a prototypical perovskite, La0.7 Sr0.3MnO3, the twinned structural order can be used to induce a magnetic modulation with a period smaller than 100 nm, demonstrating a bottomup approach for magnonic crystal growt

The Effects of Heterospecific Mating Frequency on the Strength of Cryptic Reproductive Barriers

Heterospecific mating frequency is critical to hybrid zone dynamics and can directly impact the strength of reproductive barriers and patterns of introgression. The effectiveness of post-mating prezygotic (PMPZ) reproductive barriers, which include reduced fecundity via heterospecific matings and conspecific sperm precedence, may depend on the number, identity and order of mates. Studies of PMPZ barriers suggest that they may be important in many systems, but whether these barriers are effective at realistic heterospecific mating frequencies has not been tested. Here, we evaluate the strength of cryptic reproductive isolation in two leaf beetles (Chrysochus auratus and C. cobaltinus) in the context of a range of heterospecific mating frequencies observed in natural populations. We found both species benefited from multiple matings, but the benefits were greater in C. cobaltinus and extended to heterospecific matings. We found that PMPZ barriers greatly limited hybrid production by C. auratus females with moderate heterospecific mating frequencies, but that their effectiveness diminished at higher heterospecific mating frequencies. In contrast, there was no evidence for PMPZ barriers in C. cobaltinus females at any heterospecific mating frequency. We show that integrating realistic estimates of cryptic isolation with information on relative abundance and heterospecific mating frequency in the field substantially improves our understanding of the strong directional bias in F1 production previously documented in the Chrysochus hybrid zone. Our results demonstrate that heterospecific mating frequency is critical to understanding the impact of cryptic post-copulatory barriers on hybrid zone structure and dynamics, and that future studies of such barriers should incorporate field-relevant heterospecific mating frequencies

Nanostructured MnGa films on Si/SiO2 with 20.5 kOe room temperature coercivity

This article may be downloaded for personal use only. Any other use requires prior permission of the author and the American Institute of Physics.Nanostructured Mn67Ga33 films exhibiting high room temperature coercivity (HC = 20.5 kOe) have been prepared by sputtering onto thermally oxidized Si substrates. Both the morphology and the coercivity of the films can be tuned by varying the growth parameters. The low deposition rate film, sputtered at a reduced power and working pressure, demonstrates a discontinuous island-like growth and the highest HC. The large HC is linked to the presence of the high anisotropy DO22 Mn3Ga phase and the single domain character of the exchange isolated, dipolar interacting, single crystal islands

Comparing school nurses' roles in supporting children who are bullied.

This systematic literature review explores the role of school nurses n helping children being bullied in three countries, Norway, Scotland and the United States (US). Comparisons were made of the way school nurses were trained and employed to better understand how this reflects their roles and responsibilities within the context of bullying among school children. Different systems used to support children affected by bullying were explored and examples of good practice shared. The challenges faced by school nurses due to their limited numbers compared to pupils they support was a common phenomenon in all three countries. This in itself challenges school nurses to explore more creative ways of working to ensure that the needs of school children are being met. Recommendations were made on possible cross-cultural research that can explore existing best practice creating a community of learning. This systematic literature review could provide a starting point for futurecollaborations in this field

One-dimensional spin texture of Bi(441): Quantum spin Hall properties without a topological insulator

The high index (441) surface of bismuth has been studied using Scanning Tunnelling Microscopy (STM), Angle Resolved Photoemission Spectroscopy (APRES) and spin-resolved ARPES. The surface is strongly corrugated, exposing a regular array of (110)-like terraces. Two surface localised states are observed, both of which are linearly dispersing in one in-plane direction ($k_x$), and dispersionless in the orthogonal in-plane direction ($k_y$), and both of which have a Dirac-like crossing at $k_x$=0. Spin ARPES reveals a strong in-plane polarisation, consistent with Rashba-like spin-orbit coupling. One state has a strong out-of-plane spin component, which matches with the miscut angle, suggesting its {possible} origin as an edge-state. The electronic structure of Bi(441) has significant similarities with topological insulator surface states and is expected to support one dimensional Quantum Spin Hall-like coupled spin-charge transport properties with inhibited backscattering, without requiring a topological insulator bulk