Implementation of a Deconditioning Prevention Program: Getting Dressed Makes a Difference

Implementation of a Deconditioning Prevention Program: Getting Dressed Makes a Difference Seleem R. Choudhury MSN, MBA, RN, CEN, FAEN Purpose. Deconditioning by immobility or bed rest affects essential body systems and diminishes functional capacity. Individuals age 65 and older have more hospital stays than any other age group. they also account for one out of three hospital admissions costing healthcare over $330 Billion annually. Numerous studies demonstrate this age group often struggle to get back to normal level of activity. . Empowering patients to dress and wear their own clothes can prevent deconditioning. Benefits to hospitals include reduced cost through admissions, improved patient flow by reducing their length of stay (LOS) which can lead to timelier admissions for other patients. A longer LOS also raises the probability of a hospital-acquired condition (HAC), which is an undesirable situation or condition that affects a patient during a hospital stay. Finally, patients who get dressed may feel more satisfied with the care they receive. Methods. To prevent deconditioning through the development of promoting activity by getting patients dressed which reduces the risk of deconditioning as measured by three outcomes: 1) LOS, 2) HAC, 3)Patient Satisfaction. LOS and HAC data were collected from chart review. Patient satisfaction was evaluated by HCAHPS metrics. Results. Three months of data were analyzed and compared in 2016 and 2017. The data were also segregated into age groups to analyze any benefit to over 65-year-olds. The comparison did not demonstrate clear correlation that the deconditioning program impacted the LOS and Patient Satisfaction. LOS comparison (n-832) showed improvement in month three in ages 18-59 and over 75. The ages 55-74 showed no decrease in LOS however recalculating the data from median versus mean showed all age groups LOS did decrease. Patient Satisfaction metrics (n-207) showed no clear inference or consistent pattern that deconditioning program improved satisfaction. Scores stayed comparable to previous years, especially among 18-54 age group. The 75 plus age group did see a decline in scores. Hospital Acquired Complications (HAC) was not a reliable indicator with only one incident in a two-year period. Methodological flaws in unreliable data and insufficient ability to separate variables within the electronic health record confounded comparison. Finally, the multi-faceted nature of discharges limited all of the indicators’ validity. Conclusions. The importance of being active is universally understood, yet hospitals struggle to implement this action. Data of 1-year mortalities of over 65 support that hospitals need to do more to improve this outcome. A simple program of getting dressed everyday has the potential to reduce LOS and with further study, improve 1-year mortality. This study also showed that whilst patient satisfaction is not increased, it also does not significantly decrease therefore it’s possible to assume that our patients want hospital staff to be assertive with preventing Deconditioning Syndrome. Finally, whilst not supported in this study future work, could analyze staff’s perception of patient readiness for discharge alongside data gradually demonstrating a decrease of LOS of 75-year old

Knowledge, Attitudes, and Practices Associated with Brucellosis in Livestock Owners in Jordan

We evaluated livestock owners' knowledge, attitudes, and practices regarding brucellosis in Jordan. A questionnaire was administered and biological samples were examined to verify the serological status of animals. Seroprevalence estimates indicated that 18.1% (95% CI: 11–25.3) of cattle herds and 34.3% (95% CI: 28.4–40.4) of small ruminant flocks were seropositive. The results showed that 100% of the interviewed livestock keepers were aware of brucellosis: 87% indicated a high risk of infection if unpasteurized milk is consumed and 75% indicated a high risk if unpasteurized dairy products are consumed. Awareness of the risk of infection through direct contact with fetal membranes or via physical contact with infected livestock is considerably lower, 19% and 13%, respectively. These knowledge gaps manifest in a high frequency of high-risk practices such as assisting in animal parturition (62%), disposing aborted fetuses without protective gloves (71.2%) or masks (65%), and not boiling milk before preparation of dairy products (60%). When brucellosis is suspected, basic hygiene practices are often disregarded and suspect animals are freely traded. Public health education should be enhanced as the disease is likely to remain endemic in the ruminant reservoir as long as a suitable compensation program is not established and trust on available vaccines is regained

Development of vertical diffusion solar stills utilizing folded sheets technology

Fresh water shortage is now a global problem the world is facing, and solar stills address a sustainable solution towards such crisis. This study entails the importance of desalination, specifically solar distillation. Diffusion stills have been effective in water desalination. This work presents a model of the distillation process using vertical single-effect diffusion stills. In the provided models, two geometry patterns have been utilized: the flat sheets and the folded sheets. This study aims to evaluate the applicability of utilizing folded sheets on the performance of the still using wick and without wick. A semi-analytical model utilizing the flat sheet and the folded sheet have been developed to analyze the diffusion process. Furthermore, a software computer code using Engineering Equation Solver (EES) issued to solve the equations of the developed semi-analytical model. An experimental test rig has been constructed, and used for the validation of the semi-analytical model to find its best range of validity. Also, it is validated against former literature results. A good agreement is reached with feed rates of flow up to 0.0211 kg/m2-s. Moreover, a parametric study for the still utilizing flat sheets model is carried out to assess the performance of the still; it is found that the controllable parameters are:(i) hot plate temperature; (ii) cold plate temperature;(iii) diffusion gap thickness;(iv)feed water temperature; and (v) feed rate of flow; have an impact on the still’s productivity. The most dominant parameters that influence the productivity of the still are the hot plate temperature that ranges from (55- 90 °C), the diffusion gap thickness in range of (5-10 mm), the feed water temperature (20-50 °C), and the feed flow rate in range of (0.00694-0.0211 kg/m2-s). The experimental work utilizing folded-chevron pattern sheets, both with wick and wickless, have been carried out and have been compared to the flat sheets to assess still’s productivity. A comparative analysis has been conducted to evaluate the productivity; it is found that the folded sheet with wick has a higher productivity among other sheets. It indicates the superiority of the wicked folded over the wickless folded and the flat sheet. The folded pattern showed a higher performance by an average increase in the condensate to feed ratio by 27 % through the operating hot plate temperature that ranges from 60 to 90°C

Brucellosis remains a neglected disease inthe developing world: a call forinterdisciplinary action

Brucellosis places significant burdens on the human healthcare system and limits the economic growth of individuals, communities, and nations where such development is especially important to diminish the prevalence of poverty. The implementation of public policy focused on mitigating the socioeconomic effects of brucellosis in human and animal populations is desperately needed. When developing a plan to mitigate the associated consequences, it is vital to consider both the abstract and quantifiable effects. This requires an interdisciplinary and collaborative, or One Health, approach that consists of public education, the development of an infrastructure for disease surveillance and reporting in both veterinary and medical fields, and campaigns for control in livestock and wildlife species

A corpus analysis of stance marker use in international and Egyptian medical research articles

The need for stance expression and making the position of the writers clear about what they are reporting is well documented in the literature (Biber, 2006; Kelly & Bazerman, 2003; Hyland, 2005; 2008; Molino, 2010; Myers, 1989; Williams, 2006). Even hard knowledge disciplines that were traditionally expected to sound objective and detached employ stance projection strategies by which researchers express their opinions, degree of certainty or ownership of the different claims that are stated in their work (Harwood, 2005 ; Hyland, 2005). Authors of research who are writing in English as their second language (L2) are reported to find difficulty in making their voice heard in their research articles (RAs) (Flowerdew, 2001). Differences in the frequency and the accuracy of using stance markers in RAs written by L2 writers of research and native speakers (NSs) have been detected in numerous studies (Hendersson & Barr, 2010; Hyland, 2002; Jafarpour & Taki, 2012; Maurannen, 1993 ; Molino, 2010 ; Orta, 2010). Meeting the needs of almost 30% of research producers at Cairo University, this study detects the differences between stance markers in Egyptian RAs compared to internationally published RAs in the field of medicine. Differences are diagnosed and patterns of the “acceptable use of stance markers are listed in order to help Egyptian doctors write more professionally and gain acceptance in international publishing. In this corpus-based study, 47 RAs published in local Egyptian medical journals representing different medical schools and institutions across the country were examined and compared to the Corpus of Contemporary American English (COCA). The use of direct self-reference using first person pronouns I, me, my, we us and our compared to the more impersonal “it ‚ that structure was examined in both corpora. The study showed a tendency in the Egyptian RAs to sound more distant and cautious. The use of first person pronouns in Egyptian RAs was generally less frequent. Egyptian medical researchers avoided using the singular first person pronoun in their RAs but they sometimes directly referred to themselves when they wrote in a group. Egyptian researchers also showed higher frequency of the more mitigated and impersonal structures such as “it , that structures, the passive structure and doubt adverbs. On the other hand, Egyptian researchers showed awareness with the preferred verb tenses collocating with the first person pronoun we as well as an awareness of the different structures of the “it , that structures despite its complexity. The Egyptian Medical Research Articles corpus (EMRA) showed a lack of variety in some of the lexical collocates of the first person pronouns as well as “it , that structures

Fibrin glue for pilonidal sinus disease

Background Pilonidal sinus disease is a common condition that mainly affects young adults. This condition can cause significant pain and impairment of normal activities. No consensus currently exists on the optimum treatment for pilonidal sinus and current therapies have various advantages and disadvantages. Fibrin glue has emerged as a potential treatment as both monotherapy and an adjunct to surgery. Objectives To assess the effects of fibrin glue alone or in combination with surgery compared with surgery alone in the treatment of pilonidal sinus disease. Search methods In December 2016 we searched: the Cochrane Wounds Specialised Register; CENTRAL; MEDLINE; Embase and CINAHL Plus. We also searched clinical trials registries and conference proceedings for ongoing and unpublished studies and scanned reference lists to identify additional studies. There were no restrictions with respect to language, date of publication or study setting. Selection criteria We included randomised controlled trials (RCTs) only. We included studies involving participants of all ages and studies conducted in any setting. We considered studies involving people with both new and recurrent pilonidal sinus. We included studies which evaluated fibrin glue monotherapy or as an adjunct to surgery. Data collection and analysis Two study authors independently extracted data and assessed risk of bias. We used standard methods expected by Cochrane. Main results We included four RCTs with 253 participants, all were at risk of bias. One unpublished study evaluated fibrin glue monotherapy compared with Bascom's procedure, two studies evaluated fibrin glue as an adjunct to Limberg flap and one study evaluated fibrin glue as an adjunct to Karydakis flap. For fibrin glue monotherapy compared with Bascom's procedure, there were no data available for the primary outcomes of time to healing and adverse events. There was low-quality evidence of less pain on day one after the procedure with fibrin glue monotherapy compared with Bascom's procedure (mean difference (MD) -2.50, 95% confidence interval (CI) -4.03 to -0.97) (evidence downgraded twice for risk of performance and detection bias). Fibrin glue may reduce the time taken to return to normal activities compared with Bascom's procedure (mean time 42 days with surgery and 7 days with glue, MD -34.80 days, 95% CI -66.82 days to -2.78 days) (very low-quality evidence, downgraded as above and for imprecision). Fibrin glue as an adjunct to the Limberg flap may reduce the healing time from 22 to 8 days compared with the Limberg flap alone (MD -13.95 days, 95% CI -16.76 days to -11.14 days) (very low-quality evidence, downgraded twice for risk of selection, performance and detection bias and imprecision). It is uncertain whether use of fibrin glue affects the incidence of postoperative seroma (an adverse event) (risk ratio (RR) 0.27, 95% CI 0.05 to 1.61; very low-quality evidence, downgraded twice for risk of selection, performance and detection bias and imprecision). There was low-quality evidence that fibrin glue, as an adjunct to Limberg flap, may reduce postoperative pain (median 2 versus 4; P < 0.001) and time to return to normal activities (median 8 days versus 17 days; P < 0.001). The addition of fibrin glue to the Limberg flap may reduce the length of hospital stay (MD -1.69 days, 95% CI -2.08 days to -1.29 days) (very low-quality evidence, downgraded twice for risk of selection, performance and detection bias and for unexplained heterogeneity). A single RCT evaluating fibrin glue as an adjunct to the Karydakis flap did not report data for the primary outcome of time to healing. It is uncertain whether fibrin glue with the Karydakis flap affects the incidence of postoperative seroma (adverse event) (RR 3.00, 95% CI 0.67 to 13.46) (very low-quality evidence, downgraded twice for risk of selection, performance and detection bias and for imprecision). Fibrin glue as an adjunct to Karydakis flap may reduce length of stay but this is highly uncertain (mean 2 days versus 3.7 days; P < 0.001, low-quality evidence downgraded twice for risk of selection, performance and detection bias). Authors' conclusions Current evidence is uncertain regarding any benefits associated with fibrin glue either as monotherapy or as an adjunct to surgery for people with pilonidal sinus disease. We identified only four RCTs and each was small and at risk of bias resulting in very low-quality evidence for the primary outcomes of time to healing and adverse events. Future studies should enrol many more participants, ensure adequate randomisation and blinding, whilst measuring clinically relevant outcomes

Transition metal complexes of an isatinic quinolyl hydrazone

<p>Abstract</p> <p>Background</p> <p>The importance of the isatinic quinolyl hydrazones arises from incorporating the quinoline ring with the indole ring in the same compound. Quinoline ring has therapeutic and biological activities. On the other hand, isatin (1H-indole-2,3-dione) and its derivatives exhibit a wide range of biological activities. Also, the indole ring occurs in Jasmine flowers and Orange blossoms. Recently, the physiological and biological activities of quinolyl hydrazones arise from their tendency to form metal chelates with transition metal ions. In this context, we have reported to isolate, characterize and study the biological activity of some transition metal complexes of an isatinic quinolyl hydrazone; 3-[2-(4-methyl quinolin-2-yl)hydrazono] indolin-2-one.</p> <p>Results</p> <p>Mono- and binuclear as well as dimeric chelates were obtained from the reaction of a new isatinic quinolyl hydrazone with Fe(III), Co(II), Ni(II), Cu(II), VO(II) and Pd(II) ions. The ligand showed a variety of modes of bonding <it>viz</it>. (NNO)^2-, (NO)^-and (NO) per each metal ion supporting its ambidentate and flexidentate characters. The mode of bonding and basicity of the ligand depend mainly on the type of the metal cation and its counter anion. All the obtained Pd(II)- complexes have the preferable square planar geometry (D_4h- symmetry) and depend mainly on the mole ratio (M:L).</p> <p>Conclusion</p> <p>The effect of the type of the metal ion for the same anion (Cl^-) is obvious from either structural diversity of the isolated complexes (O_h, T_dand D_4h) or the various modes of bonding. The isatinic hydrazone uses its lactim form in all complexes (Cl^-) except complex <b>5 </b>(SO₄^2-) in which it uses its lactam form. The obtained Pd(II)- complexes (dimeric, mono- and binuclear) are affected by the mole ratio (M:L) and have the square planar (D_4h) geometry. Also, the antimicrobial activity is highly influenced by the nature of the metal ion and the order for <it>S. aureus </it>bacteria is as follows: Nickel(II) > Vanadyl(II) > Cobalt(II) > Copper(II) ≈ Palladium(II) >> Iron(III).</p

The ligational behavior of an isatinic quinolyl hydrazone towards copper(II)- ions

<p>Abstract</p> <p>Background</p> <p>The importance of the isatinic quinolyl hydrazones arises from incorporating the quinoline ring with the indole ring. Quinoline ring has therapeutic and biological activities whereas, the indole ring occurs in Jasmine flowers and Orange blossoms. As a ligand, the isatin moiety is potentially ambidentate and can coordinate the metal ions either through its lactam or lactim forms. In a previous study, the ligational behavior of a phenolic quinolyl hydrazone towards copper(II)- ions has been studied. As continuation of our interest, the present study is planned to check the ligational behavior of an isatinic quinolyl hydrazone.</p> <p>Results</p> <p>New homo- and heteroleptic copper(II)- complexes were obtained from the reaction of an isatinic quinolyl hydrazone (HL) with several copper(II)- salts <it>viz. </it>Clˉ, Brˉ, NO₃ˉ, ClO₄^-, SO₄^2-and AcO^-. The obtained complexes have O_h, T_dand D_4h- symmetry and fulfill the strong coordinating ability of Clˉ, Brˉ, NO₃ˉ and SO₄^2-anions. Depending on the type of the anion, the ligand coordinates the copper(II)- ions either through its lactam (NO₃ˉ and ClO₄^-) or lactim (the others) forms.</p> <p>Conclusion</p> <p>The effect of anion for the same metal ion is obvious from either the geometry of the isolated complexes (O_h, T_dand D_4h) or the various modes of bonding. Also, the obtained complexes fulfill the strong coordinating ability of Clˉ, Brˉ, NO₃ˉ and SO₄^2-anions in consistency with the donor ability of the anions. In case of copper(II)- acetate, a unique homoleptic complex (<b>5</b>) was obtained in which the AcO^-anion acts as a base enough to quantitatively deprotonate the hydrazone. The isatinic hydrazone uses its lactim form in most complexes.</p