Development of the Surgical Patient safety Observation Tool (SPOT)

Background: A Surgical Patient safety Observation Tool (SPOT) was developed and tested in a multicentre observational pilot study. The tool enables monitoring and benchmarking perioperative safety performance across departments and hospitals, covering international patient safety goals. Methods: Nineteen perioperative patient safety observation topics were selected from Dutch perioperative patient safety guidelines, which also cover international patient safety goals. All items that measured these selected topics were then extracted from available local observation checklists of the participating hospitals. Experts individually prioritized the best measurement items per topic in an initial written Delphi round. The second (face to face) Delphi round resulted in consensus on the content of SPOT, after which the measurable elements (MEs) per topic were defined. Finally, the tool was piloted in eight hospitals for measurability, applicability, improvement potential, discriminatory capacity and feasibility. Results: The pilot test showed good measurability for all 19 patient safety topics (range of 8-291 MEs among topics), with good applicability (median 97 (range 11.8-100) per cent). The overall improvement potential appeared to be good (median 89 (range 72.5-100) per cent), and at topic level the tool showed good discriminatory capacity (variation 27.5 per cent, range in compliance 72.5-100 per cent). Overall scores showed relatively little variation between the participating hospitals (variation 13 per cent, range in compliance 83-96 per cent). All eight auditors considered SPOT a straightforward and easy-to-use tracer tool. Conclusion: A comprehensive tool to measure safety of care was developed and validated using a systematic, stepwise method, enabling hospitals to monitor, benchmark and improve perioperative safety performance

Relationship satisfaction in couples confronted with colorectal cancer: the interplay of past and current spousal support

Based on attribution theory, this study hypthesized that past spousal supportiveness may act as a moderator of the link between one partner’s current support behavior and the other partner’s relationship satisfaction. A sample of 88 patients with colorectal cancer and their partners completed questionnaires approximately 3 and 9 months after diagnosis. The data were analyzed employing dyadic data analytic approaches. In the short-term, spousal active engagement—which involved discussing feelings and engaging in joint problem solving—was positively associated with relationship satisfaction in patients as well as in partners, but only when past spousal support was relatively low. Spousal protective buffering—which involved hiding worries and fears and avoiding talking about the disease—was negatively associated with relationship satisfaction in patients, again only when past spousal support was relatively low. If past spousal support was high, participants rated the quality of their relationship relatively high, regardless of their partner’s current support behavior. Over time, past spousal supportiveness was not found to mitigate the negative association between spousal protective buffering and relationship satisfaction. Overall, our results indicate that relationship satisfaction can be maintained if past spousal supportiveness is high even if the partner is currently not very responsive to the individual’s needs, at least in the short-term

Perioperative PET/CT lymphoscintigraphy and fluorescent real-time imaging for sentinel lymph node mapping in early staged colon cancer

Contains fulltext : 207332.pdf (publisher's version ) (Open Access

A short delirium caregiver questionnaire for triage of elderly outpatients with cognitive impairment:a development and test accuracy study

OBJECTIVES: Delirium is often missed in older outpatients. Caregivers can give valuable information that might improve identification rates. The aim of this study was to develop a short and sensitive delirium caregiver questionnaire (DCQ) for triage of elderly outpatients with cognitive impairment by telephone.DESIGN, SETTING, AND PARTICIPANTS: The pilot questionnaire was administered to 112 caregivers of patients who were referred for dementia screening to our clinic for geriatric psychiatry, and the final DCQ to 234 other caregivers.MEASUREMENTS: In phase I (2013-2014), we tested a pilot questionnaire with 17 items. Health professionals who established delirium diagnoses were blinded to the results. We then used the results and other information available at referral to construct the final DCQ with seven items. During phase II (2015-2016), we investigated the test accuracy of the final DCQ in a subsequent cohort. In both phases, the patients received a structured diagnostic workup. Time between referral and first visit was a secondary outcome.RESULTS: The final DCQ consisted of the following items: emergency visit required, sleeping disorder, fluctuating course, hallucinations, suspicious thoughts, previous delirium, and recent discharge from hospital. DCQ results indicated that urgent intake was required in 85 of 234 patients. Sensitivity was 73.5% (95% CI: 58.9-85.1%) and specificity 73.5% (95% CI: 66.5-79.7%). The mean number of days to first visit dropped from 31.6 to 11.2 in delirious patients (p = 0.001).CONCLUSIONS: Triage with the easy-to-use DCQ among patients referred for cognitive screening leads to earlier assessment and higher detection rates of delirium.</p

Biliary tract visualization using near-infrared imaging with indocyanine green during laparoscopic cholecystectomy: results of a systematic review

Contains fulltext : 174508.pdf (publisher's version ) (Open Access)BACKGROUND: Near-infrared imaging with indocyanine green (ICG) has been extensively investigated during laparoscopic cholecystectomy (LC). However, methods vary between studies, especially regarding patient selection, dosage and timing. The aim of this systematic review was to evaluate the potential of the near-infrared imaging technique with ICG to identify biliary structures during LC. METHODS: A comprehensive systematic literature search was performed. Prospective trials examining the use of ICG during LC were included. Primary outcome was biliary tract visualization. Risk of bias was assessed using ROBINS-I. Secondly, a meta-analysis was performed comparing ICG to intraoperative cholangiography (IOC) for identification of biliary structures. GRADE was used to assess the quality of the evidence. RESULTS: Nineteen studies were included. Based upon the pooled data from 13 studies, cystic duct (Lusch et al. in J Endourol 28:261-266, 2014) visualization was 86.5% (95% CI 71.2-96.6%) prior to dissection of Calot's triangle with a 2.5-mg dosage of ICG and 96.5% (95% CI 93.9-98.4%) after dissection. The results were not appreciably different when the dosage was based upon bodyweight. There is moderate quality evidence that the CD is more frequently visualized using ICG than IOC (RR 1.16; 95% CI 1.00-1.35); however, this difference was not statistically significant. CONCLUSION: This systematic review provides equal results for biliary tract visualization with near-infrared imaging with ICG during LC compared to IOC. Near-infrared imaging with ICG has the potential to replace IOC for biliary mapping. However, methods of near-infrared imaging with ICG vary. Future research is necessary for optimization and standardization of the near-infrared ICG technique

Having Fun in Learning Formal Specifications

There are many benefits in providing formal specifications for our software. However, teaching students to do this is not always easy as courses on formal methods are often experienced as dry by students. This paper presents a game called FormalZ that teachers can use to introduce some variation in their class. Students can have some fun in playing the game and, while doing so, also learn the basics of writing formal specifications in the form of pre- and post-conditions. Unlike existing software engineering themed education games such as Pex and Code Defenders, FormalZ takes the deep gamification approach where playing gets a more central role in order to generate more engagement. This short paper presents our work in progress: the first implementation of FormalZ along with the result of a preliminary users' evaluation. This implementation is functionally complete and tested, but the polishing of its user interface is still future work

Upconversion in solar cells

Abstract The possibility to tune chemical and physical properties in nanosized materials has a strong impact on a variety of technologies, including photovoltaics. One of the prominent research areas of nanomaterials for photovoltaics involves spectral conversion. Modification of the spectrum requires down-and/or upconversion or downshifting of the spectrum, meaning that the energy of photons is modified to either lower (down) or higher (up) energy. Nanostructures such as quantum dots, luminescent dye molecules, and lanthanide-doped glasses are capable of absorbing photons at a certain wavelength and emitting photons at a different (shorter or longer) wavelength. We will discuss upconversion by lanthanide compounds in various host materials and will further demonstrate upconversion to work for thin-film silicon solar cells

Molecules as tracers of galaxy evolution: an EMIR survey. I. Presentation of the data and first results

We investigate the molecular gas properties of a sample of 23 galaxies in order to find and test chemical signatures of galaxy evolution and to compare them to IR evolutionary tracers. Observation at 3 mm wavelengths were obtained with the EMIR broadband receiver, mounted on the IRAM 30 m telescope on Pico Veleta, Spain. We compare the emission of the main molecular species with existing models of chemical evolution by means of line intensity ratios diagrams and principal component analysis. We detect molecular emission in 19 galaxies in two 8 GHz-wide bands centred at 88 and 112 GHz. The main detected transitions are the J=1-0 lines of CO, 13CO, HCN, HNC, HCO+, CN, and C2H. We also detect HC3N J=10-9 in the galaxies IRAS 17208, IC 860, NGC 4418, NGC 7771, and NGC 1068. The only HC3N detections are in objects with HCO+/HCN<1 and warm IRAS colours. Galaxies with the highest HC3N/HCN ratios have warm IRAS colours (60/100 {\mu}m>0.8). The brightest HC3N emission is found in IC 860, where we also detect the molecule in its vibrationally excited state.We find low HNC/HCN line ratios (<0.5), that cannot be explained by existing PDR or XDR chemical models. Bright HC3N emission in HCO+-faint objects may imply that these are not dominated by X-ray chemistry. Thus the HCN/HCO+ line ratio is not, by itself, a reliable tracer of XDRs. Bright HC3N and faint HCO+ could be signatures of embedded starformation, instead of AGN activity

High-lying OH Absorption, [C_(II)] Deficits, and Extreme L_(FIR)/M_(H2) Ratios in Galaxies

Herschel/PACS observations of 29 local (ultra)luminous infrared galaxies, including both starburst and active galactic nucleus (AGN) dominated sources as diagnosed in the mid-infrared/optical, show that the equivalent width of the absorbing OH 65 μm Π_(3/2) J = 9/2-7/2 line (W_(eq)(OH65)) with lower level energy E_(low) ≈ 300 K, is anticorrelated with the [C II]158 μm line to far-infrared luminosity ratio, and correlated with the far-infrared luminosity per unit gas mass and with the 60-to-100 μm far-infrared color. While all sources are in the active L_(IR)/M_(H2) > 50L_☉/M_☉ mode as derived from previous CO line studies, the OH65 absorption shows a bimodal distribution with a discontinuity at L_(FIR)/M_(H2) ≈ 100 L_☉/M_☉. In the most buried sources, OH65 probes material partially responsible for the silicate 9.7 μm absorption. Combined with observations of the OH 71 μm Π_(1/2) J = 7/2-5/2 doublet (E_(low) ≈ 415 K), radiative transfer models characterized by the equivalent dust temperature, T_(dust), and the continuum optical depth at 100 μm, τ_(100), indicate that strong [C_(II)]158 μm deficits are associated with far-IR thick (τ_(100) ≳ 0.7, N_H ≳ 10^(24) cm^(–2)), warm (T_(dust) ≳ 60 K) structures where the OH 65 μm absorption is produced, most likely in circumnuclear disks/tori/cocoons. With their high L_(FIR)/M_(H2) ratios and columns, the presence of these structures is expected to give rise to strong [C_(II)] deficits. W_(eq)(OH65) probes the fraction of infrared luminosity arising from these compact/warm environments, which is ≳ 30%-50% in sources with high W_(eq)(OH65). Sources with high W_(eq)(OH65) have surface densities of both L_(IR) and M_(H2) higher than inferred from the half-light (CO or UV/optical) radius, tracing coherent structures that represent the most buried/active stage of (circum)nuclear starburst-AGN co-evolution