Incomplete Assessment Research Articles

Multi-scale neural decoding and analysis

Objective. Complex spatiotemporal neural activity encodes rich information related to behavior and cognition. Conventional research has focused on neural activity acquired using one of many different measurement modalities, each of which provides useful but incomplete assessment of the neural code. Multi-modal techniques can overcome tradeoffs in the spatial and temporal resolution of a single modality to reveal deeper and more comprehensive understanding of system-level neural mechanisms. Uncovering multi-scale dynamics is essential for a mechanistic understanding of brain function and for harnessing neuroscientific insights to develop more effective clinical treatment. Approach. We discuss conventional methodologies used for characterizing neural activity at different scales and review contemporary examples of how these approaches have been combined. Then we present our case for integrating activity across multiple scales to benefit from the combined strengths of each approach and elucidate a more holistic understanding of neural processes. Main results. We examine various combinations of neural activity at different scales and analytical techniques that can be used to integrate or illuminate information across scales, as well the technologies that enable such exciting studies. We conclude with challenges facing future multi-scale studies, and a discussion of the power and potential of these approaches. Significance. This roadmap will lead the readers toward a broad range of multi-scale neural decoding techniques and their benefits over single-modality analyses. This Review article highlights the importance of multi-scale analyses for systematically interrogating complex spatiotemporal mechanisms underlying cognition and behavior.

Microbiological etiology and management approach of febrile neutropenia

Many etiologies have been proposed to predispose neutropenic fever, and infections have been reported in less than one-third of the reported cases. However, etiologies might have a significant impact on the prognostic, and can even lead to mortality. In this literature review, the aim to discuss the different microbiological etiologies of neutropenic fever, and the management approaches of such conditions, including the proper assessment and evaluation of patients. Additionally, the goal of this literature review to discuss the appropriate treatment and prophylaxis measures based on the assessment results. Many bacterial pathogens could be isolated from patients suffering from neutropenic fever, including both the gram-positive and negative organisms, such as pseudomonas aeruginosa, E. coli, Klebsiella spp, actinobacteria spp, in addition to many other bacteria such as staph. Nevertheless, Aureus was commonly isolated from the infected patients, and it has been reported with increased morbidity and mortality rates. Assessment of the severity of the condition and identification of the microbiological activity can significantly lead to enhance management of the infected patients. Detailed information about the etiology and management are provided within the main text of this study. Further efforts are needed to increase awareness related to the hazards of the inadequate and incomplete assessments of patients with neutropenic fever, which might lead to delayed or inadequate management and worsened prognosis.

Satisfaction Survey of Patients and Medical Staff for Telephone-Based Telemedicine During Hospital Closing Due to COVID-19 Transmission.

Introduction: Telephone-based telemedicine was temporarily permitted in Korea during the COVID-19 pandemic. The purpose of this study was to assess satisfaction with the telemedicine done during temporary hospital closing when in-person visits were not allowed due to in-hospital COVID-19 transmission.Methods: Survey questionnaires partially taken from a telehealth usability questionnaire (TUQ) were sent to 6,840 patients who used telephone-based telemedicine from February 24 to March 7, 2020. Questionnaires sent to patients and additionally created questionnaires to evaluate telemedicine were sent to medical staff (182 doctors and 138 nurses).Results: Response rates of patients and medical staff were 13.2% and 17.2%, respectively. Patients' satisfaction with telemedicine was significantly greater than medical staff's satisfaction for all five components taken from TUQ (all p = 0.000). In addition, created questionnaires showed good reliability, obtaining similar results between doctors and nurses (all p > 0.05). More than 85% of medical staff replied that telemedicine was needed in COVID-19, whereas more than 80% of them worried about incomplete assessment and communication of medical condition. Overall satisfaction with telemedicine by medical staff was 49.7%. The strength of telephone-based telemedicine was patients' convenience (53.4%). However, incomplete assessment of patients' condition (55.0%) was its weakness.Conclusion: Satisfaction with telephone-based telemedicine by patients was significantly greater than that by medical staff (doctors and nurses). Negative views for safety and inconvenience resulted in a greater proportion of dissatisfaction among medical staff. For safe application of telemedicine, medical staff insisted that developing a platform and creating guidelines should be needed.

Reconstructing Bioinvasion Dynamics Through Micropaleontologic Analysis Highlights the Role of Temperature Change as a Driver of Alien Foraminifera Invasion

Invasive alien species threaten biodiversity and ecosystem structure and functioning, but incomplete assessments of their origins and temporal trends impair our ability to understand the relative importance of different factors driving invasion success. Continuous time-series are needed to assess invasion dynamics, but such data are usually difficult to obtain, especially in the case of small-sized taxa that may remain undetected for several decades. In this study, we show how micropaleontologic analysis of sedimentary cores coupled with radiometric dating can be used to date the first arrival and to reconstruct temporal trends of foraminiferal species, focusing on the alien Amphistegina lobifera and its cryptogenic congener A. lessonii in the Maltese Islands. Our results show that the two species had reached the Central Mediterranean Sea several decades earlier than reported in the literature, with considerable implications for all previous hypotheses of their spreading patterns and rates. By relating the population dynamics of the two foraminifera with trends in sea surface temperature, we document a strong relationship between sea warming and population outbreaks of both species. We conclude that the micropaleontologic approach is a reliable procedure for reconstructing the bioinvasion dynamics of taxa having mineralized remains, and can be added to the toolkit for studying invasions.

Retrospective single-centre analysis of diagnostic approach to adult-onset haemophagocytic lymphohistiocytosis.

Haemophagocytic lymphohistiocytosis (HLH) is a rare disorder with a poor prognosis characterised by substantial immune activation leading to end-organ failure. In childhood, genetic defects that impair cytotoxic function of natural killer cells and T cells. (HLH) are often identified. In adults, clinical manifestations are similar to those observed in children but the aetiology is often unclear. To evaluate whether poor prognosis for adult HLH is in part due to lack of awareness of the disorder, which results in incomplete investigation and failure to implement timely treatment. We performed a retrospective case series of adult-onset HLH in a tertiary hospital in Australia. We evaluated clinical characteristics, treatment and outcome, and related these to application of standard diagnostic criteria for HLH. In our centre, incomplete assessment of HLH criteria was common. Serum ferritin was the criterion most commonly assessed. Hyperferritinaemia ≥10 000 μg/L was highly sensitive in detecting patients with adult-onset HLH; however, the majority of patients who had hyperferritinaemia ≥10 000 μg/L did not have adult-onset HLH. The present study highlights the importance of comprehensive application of diagnostic criteria to improve accuracy and timelines of the diagnosis of adult onset HLH.

Cell-free DNA captures tumor heterogeneity and driver alterations in rapid autopsies with pre-treated metastatic cancer

In patients with metastatic cancer, spatial heterogeneity of somatic alterations may lead to incomplete assessment of a cancer’s mutational profile when analyzing a single tumor biopsy. In this study, we perform sequencing of cell-free DNA (cfDNA) and distinct metastatic tissue samples from ten rapid autopsy cases with pre-treated metastatic cancer. We show that levels of heterogeneity in genetic biomarkers vary between patients but that gene expression signatures representative of the tumor microenvironment are more consistent. Across nine patients with plasma samples available, we are able to detect 62/62 truncal and 47/121 non-truncal point mutations in cfDNA. We observe that mutation clonality in cfDNA is correlated with the number of metastatic lesions in which the mutation is detected and use this result to derive a clonality threshold to classify truncal and non-truncal driver alterations with reasonable specificity. In contrast, mutation truncality is more often incorrectly assigned when studying single tissue samples. Our results demonstrate the utility of a single cfDNA sample relative to that of single tissue samples when treating patients with metastatic cancer.

The Social Experiences and Uses of Post-War Modernist Urban Heritage Conservation and Regeneration: London’s Southbank Centre

Since the 1960s, post-war modernist heritage has been largely criticised and victimised by the public opinion because of its material failures and elitist social projects. Despite these critiques, post-war modernist heritage is being reassessed, revalued and in some places successfully rehabilitated. There is a growing recognition that most of the critiques have often been the result of subjective and biased value and taste judgments or incomplete assessments that neither considered the urban design nor the users’ experiences. This paper aims to contribute to these reassessments of post-war modernist urban heritage legacies. To do so, it places the user’s social experiences and uses, and the urban design at the centre of the analysis, by using a combination of ethnographic methods and urban design analysis and focusing on the public spaces of Southbank Centre in London, the UK’s largest and most iconic and contested post-war modernist ensemble with a long history of conservation and regeneration projects. Taken together, the findings demonstrate the importance of including the users’ social experiences and uses in the conservation and regeneration agendas if we want to achieve more objective and inclusive assessments.

Exploring Barriers and Facilitators of Inter-Organizational Management in Response to Mass Casualty Traffic Incidents: A Qualitative Study.

Objective:To investigate and understand the current status of inter-organizational management in relief organizations as well as the relief organizations personnel behavior when facing mass traffic incidents (MCTI). The inter-organizational barriers and facilitators are also discussed in response to MCTI management and in order to help direct future actions to improve pre-hospital emergency services.Methods:The current qualitative study was performed through face-to-face, semi-structured interviews with 31 individuals from pre-hospital emergency services authorities and personnel, Red Crescent and Yazd, Kohgiluyeh and Boyer-Ahmad, Fars, and Qom provinces police. These provinces were selected by purposive sampling in 2018-2019. The conventional content analysis method was applied to analyze the data in this research. Results:Three main categories and 14 subcategories were determined. The categories are including relief organizations coordination (having four subcategories: independent relief organizations, interdepartmental services integration, insufficient knowledge of organizations about one other, and performance based on job descriptions), resource and infrastructure management (having four subcategories: adverse information management, proper information management, lack of medical resources and capacities considered, and upgrading of medical resources and capacities considered), and response management of relief organizations (having six subcategories: incomplete assessment, improving the quality of assessment, weakness in establishing scene security, scene security management, poor response, and cooperation in response).Conclusion:Relief organizations need to perform under a unified command. It has inter-organizational cooperation and provide integration of interdepartmental services in order to manage responsiveness at the scene. It also prevents an independent, chaos, and inability of the injured to properly understand and needs in MCTI.

The interaction of cognitive and brain reserve with frailty in the association with mortality: an observational cohort study

A higher cognitive reserve and brain reserve could decrease mortality risk, but the interaction of these factors with general age-related loss of physical fitness (eg, frailty) remains unclear with regards to mortality. We investigated the associations of cognitive and brain reserve with mortality and the interaction of cognitive and brain reserve with frailty within these associations. Within the observational population-based cohort of the Rotterdam Study, we included participants who visited the research centre for a cognitive assessment between March 2, 2009, and March 1, 2012. Participants with an incomplete assessment of cognition, no data on education attainment, no MRI or an MRI of insufficient quality, three or more missing frailty criteria, or a dementia diagnosis were excluded. Participants were followed up until their death or May 1, 2019. Cognitive reserve was defined as a latent variable that captures variance across five cognitive tests. Brain reserve was defined as the proportion of healthy-appearing brain volume relative to total intracranial volume measured with 1·5 Tesla MRI. Frailty was defined according to Fried's frailty phenotype; participants meeting at least one of the five criteria were considered frail. Hazard ratios (HRs) for associations of cognitive reserve, brain reserve, frailty, and reserve-frailty interactions with the risk of mortality were estimated using Cox regression models. 2878 individuals in the Rotterdam Study who visited the research centre for a cognitive assessment were considered eligible. 1388 individuals were excluded due to incomplete or missing data or a dementia diagnosis. 1490 participants with valid information on cognitive reserve, brain reserve, and frailty were included (mean age 74·3 years [SD 5·5]; 815 [55%] female participants). 810 (54%) participants were classified as frail. A higher cognitive reserve (HR 0·87 per SD, 95% CI 0·76-0·99, p=0·036) and a higher brain reserve (0·85 per SD, 0·72-1·00, p=0·048) were associated with a lower risk of mortality, after adjusting for sex, age, educational level, body-mass index, smoking status, and number of comorbidities. The association between cognitive reserve and mortality was more pronounced (0·77 per SD, 0·66-0·90, p=0·0012) when the cognitive reserve-frailty interaction (p=0·0078) was included, indicating that higher cognitive reserve is related to lower mortality in individuals with frailty. The brain reserve-frailty interaction was non-significant. Higher cognitive reserve and higher brain reserve were associated with a lower mortality risk. Additionally, cognitive reserve and frailty interact in the association with mortality, such that higher cognitive reserve is particularly associated with lower mortality in frail participants. Netherlands Organization for Health Research and Development and EU Horizon 2020 research programme.

Evaluating the risk exposure of sustainable freight transportation: a two-phase solution approach

A combination of sustainability-related regulations and increased demand from stakeholders has pressed firms to adequately address sustainability-related risks. This issue is particularly important, and challenging, for the freight transportation sector due to its exposure to a large number of inherent sustainability risks. Despite the growing significance of sustainability risks, there is a lack of research related to sustainability risk management, which may be due to the difficulties in identifying and evaluating sustainability risks. We aim to fill this research gap by identifying, measuring and modelling sustainability risks in the context of freight transportation. Our research makes three primary contributions. First, we introduce the concept of a sustainability risk index (SRI) to understand the risk exposure of freight transportation systems (FTSs) in the context of India, an emerging market. The SRI is a mathematical tool used to measure sustainability risks and to quantify a firm’s exposure to sustainability-related risks. Second, we propose an integrated two-phase model based on an interval 2-tuple linguistic model and a digraph matrix approach to calculate the SRI. In contrast to other existing techniques, the proposed approach can effectively deal with uncertain and incomplete linguistic assessments without suffering a loss of information. Third, we propose a framework for calculating both the disruption scores and influencing power of sustainability risks to evaluate the associated criticality and triggering power. For a robustness check, we also conduct a sensitivity analysis of the impact of risk variations on the SRI. Unlike conventional perceptions, our results show that organisational and governmental risks, which are mostly behavioural and skills-induced, are more significant for sustainable FTSs compared to financial risks. Our research helps the managerial community in the freight transportation sector in emerging markets to engage in more informed decision-making to proactively mitigate sustainability risks, which have potentially devastating financial, environmental and societal impacts.

Reducing the Incidence of Medical Device-Related Pressure Injuries From Use of CPAP/BiPAP Masks: A Quality Improvement Project.

The purpose of this work was to reduce the number of hospital-acquired pressure injuries on the nasal bridge resulting from the use of continuous positive airway pressure (CPAP) and bilevel positive airway pressure (BiPAP) therapy. Patients with medical device-related pressure injuries (MDRPI) receiving continuous/intermittent CPAP/BiPAP in a 12-bed critical care unit in a Magnet-designated, 182-bed community hospital in the mid-Atlantic region of the United States. An interprofessional team collaborated to assess factors contributing to an increase in MDRPI development in critical care unit patients using CPAP/BiPAP. Patient dependency on the high-pressurized oxygen results in nurse reluctance to remove the mask and consequently, conduct a partial or incomplete skin assessment. The project consisted of conducting a literature search on MDRPI, developing a standard work process for skin assessment and documentation in the medical record, using skin protection under the mask, and evaluating whether a different model of mask would minimize pressure on the nasal bridge. Through active collaboration, the interprofessional team implemented standard work processes, completed product evaluation of masks, and monitored key process indicators related to documentation of daily and every 4-hour skin assessments, implementation of a thin foam dressing under the CPAP/BiPAP mask for any nonblanchable or blanchable erythema, and escalation to the certified wound, ostomy, and continence nurse. In 2016, the unit identified 4 CPAP/BiPAP mask-related MDRPIs. By December 2017, only 1 stage 1 injury was identified and it resolved quickly after appropriate assessment and prompt interventions. This showed a 75% reduction in actual injuries with a zero escalation to stage 2 or greater injuries. An interprofessional team approach to CPAP/BiPAP-related MDRPI improved patient outcomes in critical care unit patients.

Does Exercise Influence the Susceptibility to Arterial Thrombosis? An Integrative Perspective.

Arterial thrombosis is the primary cause of death worldwide, with the most important risk factors being smoking, unhealthy diet, and physical inactivity. However, although there are clear indications in the literature of beneficial effects of physical activity in lowering the risk of cardiovascular events, exercise can be considered a double-edged sword in that physical exertion can induce an immediate pro-thrombotic environment. Epidemiological studies show an increased risk of cardiovascular events after acute exercise, a risk, which appear to be particularly apparent in individuals with lifestyle-related disease. Factors that cause the increased susceptibility to arterial thrombosis with exercise are both chemical and mechanical in nature and include circulating catecholamines and vascular shear stress. Exercise intensity plays a marked role on such parameters, and evidence in the literature accordingly points at a greater susceptibility to thrombus formation at high compared to light and moderate intensity exercise. Of importance is, however, that the susceptibility to arterial thrombosis appears to be lower in exercise-conditioned individuals compared to sedentary individuals. There is currently limited data on the role of acute and chronic exercise on the susceptibility to arterial thrombosis, and many studies include incomplete assessments of thrombogenic clotting profile. Thus, further studies on the role of exercise, involving valid biomarkers, are clearly warranted.

Irritable Mood and Subthreshold Hypomanic Episodes Correlate with More Severe Major Depression

Introduction: Irritable mood (IM) and subthreshold hypomanic symptoms are reported in half and two-fifths of major depressed subjects respectively, but their clinical and prognostic meanings remain unclear. The aim of this study was to test the clinical usefulness of 2 specifiers in DSM-IV major depressive disorder (MDD): IM occurring during an index episode (IM+) and lifetime episodes of elated mood or IM with at least 2 concurrent hypomanic symptoms (subthreshold hypomanic episodes [SHEs]). Method: We included 482 outpatients with MDD participating in the Combining Medications to Enhance Depression Outcome study (mean age 43.14 ± 12.46 years, 144 males – 30%). The main aim of the original study was to test whether 2 different medications when given in combination as the first treatment step, compared to 1 medication, would improve antidepressant response. Results: IM + subjects (N = 349; 70%) were younger and more often females, with a more severe depression, a more marked social impairment, and more psychiatric comorbidities. The IM + group was also characterized by higher levels of suicidal ideation and more cases of emotional abuse. The combination of IM+ and SHEs was associated with an even more severe clinical picture. Limitations include the post hoc method, incomplete assessment of bipolar validators (e.g., family history of bipolar illness), personality disorders and suicide attempts. Conclusions: The presence of IM and SHEs in MDD correlate with an overall more severe clinical condition.

Effects of diminished positive mood and depressed mood upon verbal learning and memory among people with multiple sclerosis

ABSTRACT Objective: Cognitive impairment affects as many as 65% of people with multiple sclerosis (PWMS), and memory impairment confers greater severity of disability and functional impairment. Depression is also common among PWMS, and lifetime prevalence rates are as high as 50%. Research has yet to clearly define the relationship between memory dysfunction and depression among PWMS, and may reflect incomplete assessment of depressive symptoms. The present study examined different aspects of depressive symptoms including anhedonia (i.e., diminished positive mood) and their relationships with verbal learning and memory among PWMS. Method: Participants were 48 healthy individuals and 96 PWMS. They were primarily Caucasian (90.3%) and female (75.0%). Participants completed the California Verbal Learning Test-2 (CVLT-2) to assess verbal learning and memory and the Chicago Multiscale Depression inventory to assess depressed mood (CMDI-Mood) and diminished positive mood (CMDI-DPM). Results: Linear regression revealed that the main effect of CMDI-DPM and the interaction of CMDI-DPM and CMDI-Mood significantly explained variance across learning, recall, and recognition CVLT-2 indices. Follow-up analyses indicated that CMDI-DPM was only significant in the absence of high CMDI-Mood scores. CMDI-Mood explained variance in only CVLT-2 Trial B. Conclusions: Depressed mood had little direct effect upon memory performance in PWMS. In the absence of severe depressed mood, higher levels of positive mood corresponded to better memory performance. However, the impact of diminished positive mood was rendered null among those endorsing high levels of depressed mood. These data may imply that anhedonia corresponds with poorer memory function among PWMS, and suggests that investigators and clinicians should assess multiple mood dimensions among PWMS.

Prevalence of pediatric eye diseases in Assam, India — a hospital-based retrospective data

Background: In a hospital setting, paediatric eye disease manifests itself in a complex network. It is essential to comprehend the scope of many common eye disorders in order to develop new evidence-based strategies for mitigating such disorders. The study aimed to investigate the hospital-based prevalence of pediatric ocular disorders of patients attending a tertiary eye care hospital. Material and methods: A three-year data from 2017–19 were extracted from the electronic medical records of Chandraprabha Eye Hospital, Assam, India. Refining the data was further carried out using the age criteria up to 18 years. The diagnosis for all the study subjects was taken into consideration and was further analyzed. The inclusion criteria included subjects within the range of 0–18 years reporting to the hospital during the study period. Subjects diagnosed with non-ocular problems, incomplete ophthalmological assessments, and those aged more than 18 years were excluded. Results: A total of 11807 relevant medical records were reviewed. Among the study subjects, 58.52% (n = 6910) were males. The mean (SD) age was 11.9 (4.8) years. Of the subjects 21.28% (n = 2513) were in age group 0–5 years, 42.39% (n = 5006) — in 6–11 years, and 36.31% (n = 4288) in 12–18 years. A total number of 152 pediatric ocular abnormalities were identified from the reviewed files. Myopia alone accounted for 19% of all, followed by vernal keratoconjunctivitis with 14.7%, followed by asthenopic presentation associated with non-strabismic binocular vision anomalies (7.4%), congenital nasolacrimal duct obstruction (2.9%), amblyopia (2.8%), and ocular injuries (2.7%). Conclusions: Refractive errors, allergic conjunctivitis, ocular injuries, amblyopia and squint, uveitis, congenital cataract, and non-strabismic binocular vision anomalies were identified as the most common pediatric ocular abnormalities seen in routine clinical practice, laying the groundwork for a standard protocol to evaluate and assess visual function in any case of pediatric anomaly.

A More-Than-Human History of Apartheid-Era Planning in Etosha-Kaokoveld, Namibia, c.1960–1970s

ABSTRACT Following the release and implementation of the ‘Report of the Commission of Enquiry into South West Africa Affairs’ (Odendaal Plan) in 1964, humans and non-humans in Etosha-Kaokoveld (northwest Namibia) undermined South African rule. Drawing on published, archival, government, and limited-circulation sources, this more-than-human history examines how responses among scientists, pastoralists, and wildlife revealed the technocratic state’s incomplete assessment of human–non-human relationships in its efforts to spatially rearrange the landscape. In response to South African volkekunde ‘science’, former Etosha ecologist Ken Tinley presented an ecologically informed alternative to the Odendaal Plan. Herero pastoralists, led by Headman Kephas Muzuma, resisted new land designations by continuing to practice semi-nomadic pastoralism. Within Etosha, ungulates died in unprecedented numbers, exposing the non-human effects of apartheid technocratic planning. The legacies of South Africa’s flawed approaches to governing humans and non-humans persist. Drawing on Emily O'Gorman and Andrea Gaynor's argument for the importance of more-than-human histories, Latour's concept of the collective and call for developing perspectives relevant to the Anthropocene, and Scott’s critique of the high modernist state, this article contributes to human–animal histories and the historiography of Namibia and the South African empire, and discusses the need for subaltern perspectives in the Anthropocene.

Commentary on “Multi-Component Care Bundle in Geriatric Fracture Hip for Reducing Postoperative Delirium”

The letter to the editor suggested several questions regarding the methodology of the recent article by Lam et al who determined effect of multicomponent care bundle on the development of postoperative delirium. This article is published in Geriatric Orthopaedic Surgery & Rehabilitation. 2021; 12:21514593211004530. Our concerns included the incomplete preoperative assessment, possible influences of anaesthetic and intraoperative managements on the development of postoperative delirium, bias effect of postoperative analgesia on the primary and secondary findings, and real clinical value of multicomponent care bundle to decrease the risk of postoperative delirium. We believe that clarifying these issues would improve the transparency of this study and interpretation of findings.

Cognitive impairment in racially/ethnically diverse older adults: Accounting for sources of diagnostic bias.

IntroductionThe Kaiser Healthy Aging and Diverse Life Experiences (KHANDLE) study enrolled Asian, Black, Latino, and White adults ages 65+ without prior dementia diagnosis (N = 1709). We evaluated the prevalence of cognitive impairment (mild cognitive impairment or dementia) accounting for potential biases.MethodsA random subgroup (N = 541) received clinical evaluation and others were evaluated if they failed a cognitive screen. Diagnoses were made under two conditions: (1) demographics‐blind, based on clinical exam and demographically adjusted neuropsychological test scores; and (2) all available information (clinical exam, demographics, and adjusted and unadjusted test scores).ResultsCognitive impairment prevalence was 28% for blinded‐adjusted diagnosis and 25% using all available information. Black participants had higher impairment rates than White (both conditions) and Latino (blinded‐adjusted diagnosis) participants. Incomplete assessments negatively biased prevalence estimates for White participants.DiscussionRacial/ethnic disparities in cognitive impairment were amplified by attrition bias in White participants but were unaffected by type of test norms and diagnosticians’ knowledge of demographics.

Assessing sleep quality in older adults: A comparison of three measurement approaches

Discrepancies between subjective and objective sleep measures have been reported for some time; however, it is critical to consider the implications of inaccurate or incomplete sleep assessment for frail older adults who are struggling to maintain independence. To compare sleep assessment methods, we collected objective sleep measurements (via wrist actigraphy), subjective measures via self-report sleep surveys (Pittsburgh Sleep Quality Index; Insomnia Severity Index, Sleep Hygiene Index), and qualitative data through semi-structured audio-recorded interviews, from 8 older adults who self-reported sleep problems while living in a retirement community in southwestern US. Participants’ objective sleep (Total Sleep Time, Sleep Onset Latency, Wake After Sleep Onset, and Sleep Efficiency) and qualitative narratives were congruent, but self-report measures failed to capture several unique sleep problems identified in the sample. Disordered sleep in older adults has been linked to increased incidence of falls, depression and anxiety, cognitive impairment, institutionalization, and mortality, but traditional sleep assessment instruments, designed for the general adult population, fail to capture many of the experiences and causes that are unique to older adults. functioning. A sleep assessment tool designed to measure older people’s sleep experiences could provide more accurate and sensitive data.

Low compliance to a vital sign safety protocol on general hospital wards: A retrospective cohort study

BackgroundPeriodic vital sign monitoring is commonly used to detect clinical deterioration. Incomplete assessment of Early Warning Score (EWS) and poor protocol compliance may negatively impact nurses’ responsiveness to critical situations. ObjectiveThis study assesses the quality of recorded EWSs and the degree of overall protocol compliance and protocol compliance in adverse event patients, in a centre that is an early adopter of an EWS safety protocol. DesignRetrospective single-centre cohort study. SettingGeneral hospital wards of a tertiary referral university medical centre. Participants48,864 patients admitted to general wards between 2015 and 2018. MethodsVital sign and Modified EWS (MEWS) data were collected from the electronic health record. MEWS completeness was evaluated by determining the proportion of missing values for each vital sign. To evaluate protocol compliance, we assessed whether the elapsed time between consecutive MEWSs was within the protocollary time as dictated by the MEWS protocol. Outcome measures were overall MEWS completeness, and both overall protocol compliance and protocol compliance specifically in the 24 h before adverse events. ResultsAll required items to calculate a MEWS were present in 76 percent of the 1,663,743 vital sign measurements. Overall protocol compliance was 62 percent. For the low, mid-range and high MEWS groups, protocol compliances were 67, 47 and 30 percent, respectively. Time-to-next-MEWS exceeded protocol-recommended timing by up to 9 h for a substantial amount of MEWSs in the mid- and high-range MEWS groups. In patients with adverse events, compliance to the MEWS protocol during the 24 h prior to the events was 66 percent in aggregate, ranging from 80% in low MEWS groups, 74% in the mid-range, and 49% in the high MEWS groups. In the high MEWS group, improvements in protocol compliance were primarily noted in five hours immediately preceding the event. ConclusionsEWS assessments were incomplete in one-quarter of measurements. Compliance to a MEWS safety protocol was generally low, specifically when the protocol mandated more frequent MEWS assessments. Although more MEWSs were recorded in patients with adverse events, the increase in vital sign measurements’ frequency mostly occurred shortly before the event manifested. This finding suggests missed opportunities to detect clinical deterioration.