Changes In Patient Status Research Articles

Considering passive mechanical properties and patient user motor performance in lower limb prosthesis design optimization to enhance rehabilitation outcomes

Background: Selection of prosthesis mechanical characteristics to restore function of persons with lower limb loss can be framed as an optimization problem to satisfy a given performance objective. However, the choice of a particular objective is critical, and considering only device and generalizable outcomes across users without accounting for inherent motor performance likely restricts a given patient from fully realizing the benefits of a prosthetic intervention. Objectives: This review presents methods for optimizing passive below-knee prosthesis designs to maximize rehabilitation outcomes and how considerations on patient motor performance may enhance these outcomes. Major Findings: Available literature supports that considering patient-specific variables pertaining to motor performance permits a multidimensional landscape relating device characteristics and user function, which may yield more accurate predictions of rehabilitation outcomes for individual patients. Moreover, the addition of targeted physical therapeutic interventions that encourage user self-organization may further improve these outcomes. We note the potential of existing paradigms to address these additional dimensions, and we encourage investigators to consider the many different performance objectives available for prosthesis optimization. Conclusions: By considering user motor performance in combination with prosthesis mechanical characteristics, a staged optimization approach can be formulated which acknowledges that device modifications may only improve outcomes to a certain extent and user self-organization is a critical component to complete rehabilitation. An iterative process that can be integrated within existing rehabilitative practices accounts for changes in patient status through combined targeted prosthetic solutions and physical therapeutic techniques, and embodies the concept of personalized intervention for patients with lower limb loss.

The Impact of Student-Centered Learning on NCLEX-RNN Success

In the complex and ever-evolving field of nursing, contemporary nurses must be capable of making customized decisions in rapidly changing situations. In order for nurses to be effective and to provide high quality, safe care, they must be able to utilize clinical reasoning to discern the importance of ongoing changes in patient status, (Benner, Sutphen, Leonard, & Day, 2010). Traditional teaching methods may not be appropriate to adequately prepare registered nurses for the level of clinical reasoning skill needed in today’s complex health care environment. The National Council Licensure Examination – Registered Nurse (NCLEX-RN®) indirectly measures clinical reasoning skills. This Doctor of Nursing Practice (DNP) project retrospectively analyzed NCLEX-RN® success rates, before and after the intervention of student-centered learning was employed in the associate degree nursing program. Student-centered learning is a strategy in which the faculty serves as a facilitator, and the students are actively engaged in learning through various activities (Weimar, 2013). Student-centered strategies result in deeper learning (Carrick, 2011). This deeper learning is important for the development of appropriate clinical reasoning skills. Chi-square analysis was performed to compare the distribution of differences between the data. This project adds to the body of knowledge related to effective teaching/ learning strategies for prelicensure registered nursing students.

Impact of Information and Communication Technologies on Nursing Care: Results of an Overview of Systematic Reviews.

BackgroundInformation and communication technologies (ICTs) are becoming an impetus for quality health care delivery by nurses. The use of ICTs by nurses can impact their practice, modifying the ways in which they plan, provide, document, and review clinical care.ObjectiveAn overview of systematic reviews was conducted to develop a broad picture of the dimensions and indicators of nursing care that have the potential to be influenced by the use of ICTs.MethodsQuantitative, mixed-method, and qualitative reviews that aimed to evaluate the influence of four eHealth domains (eg, management, computerized decision support systems [CDSSs], communication, and information systems) on nursing care were included. We used the nursing care performance framework (NCPF) as an extraction grid and analytical tool. This model illustrates how the interplay between nursing resources and the nursing services can produce changes in patient conditions. The primary outcomes included nurses’ practice environment, nursing processes, professional satisfaction, and nursing-sensitive outcomes. The secondary outcomes included satisfaction or dissatisfaction with ICTs according to nurses’ and patients’ perspectives. Reviews published in English, French, or Spanish from January 1, 1995 to January 15, 2015, were considered.ResultsA total of 5515 titles or abstracts were assessed for eligibility and full-text papers of 72 articles were retrieved for detailed evaluation. It was found that 22 reviews published between 2002 and 2015 met the eligibility criteria. Many nursing care themes (ie, indicators) were influenced by the use of ICTs, including time management; time spent on patient care; documentation time; information quality and access; quality of documentation; knowledge updating and utilization; nurse autonomy; intra and interprofessional collaboration; nurses’ competencies and skills; nurse-patient relationship; assessment, care planning, and evaluation; teaching of patients and families; communication and care coordination; perspectives of the quality of care provided; nurses and patients satisfaction or dissatisfaction with ICTs; patient comfort and quality of life related to care; empowerment; and functional status.ConclusionsThe findings led to the identification of 19 indicators related to nursing care that are impacted by the use of ICTs. To the best of our knowledge, this was the first attempt to apply NCPF in the ICTs’ context. This broad representation could be kept in mind when it will be the time to plan and to implement emerging ICTs in health care settings.Trial RegistrationPROSPERO International Prospective Register of Systematic Reviews: CRD42014014762; http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42014014762 (Archived by WebCite at http://www.webcitation.org/6pIhMLBZh)

Carotid systolic flow time with passive leg raise correlates with fluid status changes in patients undergoing dialysis

Corrected carotid systolic flow time (CFTc) has been proposed as a measure of volume status in acutely ill patients. This study endeavors to determine whether the change in CFTc with passive leg raise (PLR) maneuver correlates with volume status changes.Dialysis patients at Kingston General Hospital (Kingston, Canada) underwent point-of-care carotid ultrasonography at the beginning and the end of dialysis. With each measurement, 2 values were recorded: the absolute CFTc, and the difference in CFTc before and after the PLR maneuver.A total of 49 measurements were collected during the study period. CFTc changed with PLR by 5±22milliseconds (2.0%) pre-dialysis and by 40±19milliseconds (13.0%) post-dialysis (P<.0001). Incorporating PLR to the CFTc measurement improved the area under the ROC from 0.64 to 0.91. Particularly, in our sample of patients, a 30milliseconds increase in CFTc with PLR predicted the post-dialysis volume state (LR+=11) whereas an increase of less than 20milliseconds argued against it (LR−=0.079).The assessment of CFTc pre- and post-PLR correlates with intravascular volume changes in patients undergoing dialysis. Alternative to the currently available bedside modalities, this technique is non-invasive, objective, simple to perform at the bedside, and reversible with respect to volume challenge.

Computational Modeling of Neurotransmitter Release Evoked by Electrical Stimulation: Nonlinear Approaches to Predicting Stimulation-Evoked Dopamine Release.

Neurochemical changes evoked by electrical stimulation of the nervous system have been linked to both therapeutic and undesired effects of neuromodulation therapies used to treat obsessive-compulsive disorder, depression, epilepsy, Parkinson's disease, stroke, hypertension, tinnitus, and many other indications. In fact, interest in better understanding the role of neurochemical signaling in neuromodulation therapies has been a focus of recent government- and industry-sponsored programs whose ultimate goal is to usher in an era of personalized medicine by creating neuromodulation therapies that respond to real-time changes in patient status. A key element to achieving these precision therapeutic interventions is the development of mathematical modeling approaches capable of describing the nonlinear transfer function between neuromodulation parameters and evoked neurochemical changes. Here, we propose two computational modeling frameworks, based on artificial neural networks (ANNs) and Volterra kernels, that can characterize the input/output transfer functions of stimulation-evoked neurochemical release. We evaluate the ability of these modeling frameworks to characterize subject-specific neurochemical kinetics by accurately describing stimulation-evoked dopamine release across rodent (R2 = 0.83 Volterra kernel, R2 = 0.86 ANN), swine (R2 = 0.90 Volterra kernel, R2 = 0.93 ANN), and non-human primate (R2 = 0.98 Volterra kernel, R2 = 0.96 ANN) models of brain stimulation. Ultimately, these models will not only improve understanding of neurochemical signaling in healthy and diseased brains but also facilitate the development of neuromodulation strategies capable of controlling neurochemical release via closed-loop strategies.

Indications of intermittent and continuous hemodialysis

Intermittent hemodialysis (HDI) is a useful and effective way of feasible improvement in dog and cat kidney analyzes that do not respond adequately to medical management Decision to choose hemodialysis in patients with acute or acute kidney disease with chronic tendency should be taken as soon as possible to improve the probability of a successful result. The goal of HDI is make dramatic changes in patient status in regarding uremia, acidosis and overloading withf luids for short periods of time. continue therapy by renal substitution (TCSR) is a more recently developed method of purifying blood. HDI can be considered appropriate when medical management does not manages to achieve the goals outlined above. Therefore, HDI is indicated in cases of significant uremia or even increasing, electrolyte imbalances or acidosis, who do not answer medical management. HDI is, also indicated in cases where oliguria and / or Anuria does not respond to adequate medical management with diuretics. TCSR can be used for patients with leptospirosis, tumor lysis syndrome, insolation, support pre- and postoperative ureteral obstruction, as well as in aminoglycoside and melamine poisoning. TCSR can be also used to remove from the body certain drugs and toxins. TCSR indications in dog include severe uremia with fluid overload, sepsis and other inflammatory syndromes. TCSR is a continuous process and, once the treatment is started, therapy continues to when renal function returns or the patient is transferred to intermittent dialysis. TCSR has several advantages significant compared to HDI. Slow and gradual nature of the technique provides better control of electrolytes and the like acid-base balance. This continuous process is approaching more than the functionality of a normal kidney. The use convection in TCSR confers a significant advantage in removing molecules larger than by diffusion.

Exploring Risk Factors of Patient Falls: A Retrospective Hospital Record Study in Japan.

Patient falls are common adverse medical events in hospitals. The objectives of this study were to clarify the factors of patient falls at hospitalization or transfer to another ward, which could be assumed that patients experience new environment. Patients who were hospitalized or transferred to another ward at a hospital in Japan, between January 14 and February 14, 2014 were included. We used a risk assessment sheet and applied stepwise regression analysis to identify factors of patient falls. We also investigated changes in patient conditions on the risk assessment sheet by the chi-square test. A total of 1,362 patients (53.2% female; mean age, 57.1 ± 18.0 years) were eligible for analysis, and 38 (2.8%) fell during the study period. The fallers were significantly older than the non-fallers (63.8 ± 18.0 vs. 56.9 ± 18.7 years, P = 0.03), but no significant difference was seen in sex (55.3% vs. 53.1% female). "History of falls", "Tubes inserted", "Need assistance/supervision for toileting" and "Excretion more than two times per night" were significantly related to patient falls (adjusted odds ratios [95% confidence interval]: 2.41 [1.05-5.53], 3.64 [1.57-8.43], 4.52 [2.00-10.23] and 3.92 [1.38-11.09]). Among 30 fallers, "Overestimation or non-understanding of own physical abilities" was significantly more frequent after falls (30.0%) than before falls (6.7%, P = 0.02). The factors found in this study might be useful for identifying patients at higher risk of falls.

Evaluation of Quality Indicators of Integrated Care in a Regional Psychiatry Budget – A Pre-Post Comparison by Secondary Data Analysis

The Regional Psychiatry Budget (RPB), as a special arrangement within the German Federal Hospital Refund Regulation, is based on the capitation principle. A lump sum is allocated to a major inpatient care provider in a large region on a yearly basis. Under this model, the provider is free to offer all forms of treatment and to construct individual models of integrated care that specifically suit the region and the needs of community members.The present study aimed to evaluate selected aspects that represent a change in the psychiatric health status of patients in the covered region under the conditions of the RPB.We performed a secondary data analysis of administrative data of 19,913 cases generated by the hospital in a pre-post comparison of the periods before and under RPB conditions.The average length of an inpatient stay was reduced by approximately 22 % and could be partially replaced by day care. Selected indicators suggest equal or higher quality of care with stable cost in the population in need of psychiatric care in the district.

Biological variability of lipoprotein-associated phospholipase A2 activity in healthy individuals

ObjectivesMeasuring lipoprotein-associated phospholipase A2 (Lp-PLA2) activity can aid in identifying individuals at higher risk of coronary heart disease. However, the biological variation of Lp-PLA2 activity and corresponding reference change value (RCV) is unknown which limits interpretation of results. In this study we aim to define the intra- and inter-individual variability of Lp-PLA2 activity in a healthy reference population. MethodsA total of 24 healthy individuals (22–47years of age) were prospectively collected at several time points: daily for five days (after overnight fast), daily for three days (while non-fasting), weekly for four weeks (after overnight fast), and monthly for 6months (after overnight fast). Intra-individual and inter-individual variability was determined. The index of individuality (IoI) and reference change value (RCV) were calculated for each time period. ResultsVariability in Lp-PLA2 activity was not different in fasting versus non-fasting states and also did not change in daily versus monthly testing. The RCV for monthly Lp-PLA2 activity was found to be 17%. More than 90% of the variability was attributable to between person differences while analytic variability comprised <9% of the variability and within-person variability was low at <0.7%. The index of individuality for monthly testing was 0.30 ConclusionsIn a healthy population, Lp-PLA2 activity displays low analytical and within-person variability and higher inter-individual variability. The change required to differentiate a true change in patient status was determined to be 17% for monthly measurements. The between individual variability and corresponding RCV for the activity assay are lower than previously reported results for the Lp-PLA2 mass assay.

Development and validation of a specific questionnaire to assess health-related quality of life in patients with home enteral nutrition: NutriQoL® development.

IntroductionHome enteral nutrition (HEN) is indicated in patients with a functional gastrointestinal tract but who are unable to meet their nutritional requirements with normally consumed foodstuffs. HEN allows patients to remain in their social and family environment, thus reducing complications and costs associated with hospital admission, while increasing health-related quality of life (HRQoL). HRQoL in patients with HEN is mainly evaluated by generic instruments, which are not sensitive enough to identify certain specific patient-related outcomes of HEN.ObjectiveTo develop a specific instrument to measure HRQoL in patients receiving HEN whose results allow interpretation regardless of the underlying disease and nutritional support administration route: the NutriQoL® questionnaire.Materials and methodsThe development of the NutriQoL entailed a literature review, focus groups with experts, semistructured interviews with patients, an assessment of face validity and feasibility, and Rasch analysis conducted on data from a sample of 141 patients and 24 caregivers.ResultsOf the 52 items initially proposed on the basis of the literature review, expert focus group, and semi-structured interviews with patients and caregivers, 17 items were finally selected through the development process to make up the final version of the NutriQoL, as well as a visual analog scale for global HRQoL scoring. The selected items were evaluated as adequate for frequency, importance, and clarity. Furthermore, they have been shown to be independent of the underlying condition and HEN administration route.ConclusionA new instrument for measuring the HRQoL of patients with HEN in Spain has been developed, whose results are independent of the underlying condition and administration route. The next step will be the validation of the questionnaire to ensure that the instrument is valid, reliable, and sensitive to health status changes in patients, to be used periodically in usual clinical practice.

Utility of Repeat Head Computed Tomography for Intracranial Hemorrhage After Trauma and Importance of Direct Patient Care.

At many institutions, it is common practice for trauma patients with traumatic intracranial hemorrhage (ICH) to receive routine repeat head computed tomographic (CT) scans after the initial CT scan, regardless of symptoms, to evaluate progression of the injury. The purpose of this study was to assess quantifiable risk factors (age, anticoagulation, gender) that could place patients at greater risk for progression of injury, thus requiring surgical intervention (craniotomy, craniectomy) for which serial CT scanning would be useful. From January 2014 to June 2015, a total of 211 patients presented with traumatic ICH and 198 were eligible for inclusion. Twenty-six patients required operative intervention for ICH. One of 26 patients went to the operating room as a result of repeat head CT scans without associated mental status change, change in neurological examination, or associated symptoms such as nausea or vomiting. Significant changes in patient management due to routine repeat CT scans were not observed. There were no statistically significant risk factors identified to place patients at higher risk for progression of disease. The data from this analysis emphasized the importance of nursing care in identifying and relaying changes in patient condition to the trauma team.

Diabetic Ketoacidosis in the Obstetric Population: A Simulation Scenario for Anesthesia Providers

Abstract Introduction This simulation on diabetic ketoacidosis (DKA) in the obstetric population presents learners with one of the more commonly encountered etiologies of critical illness in the pr...

OC10 - Inter-rater agreement of the Paediatric Early Warning Score tools used in the central Denmark region.

Theme: Patient safety Background: Paediatric Early Warning Score (PEWS) tools can assist healthcare providers in the rapid detection and recognition of changes in patient condition. In the central Denmark region two different PEWS tools tested in large-scale RCT study. However, data from PEWS instruments are only as reliable and accurate as the caregiver who obtains and documents the parameters. The purpose was to evaluate the inter-rater agreement among nurses using the PEWS systems. The study was conducted in five paediatrics departments. Inter-observer reliability was investigated through simultaneous blinded PEWS assessment on the same patients by two nurses. Fleiss' kappa was utilized to determine the level of agreement among the raters. With a paucity of published reliability testing studies, this research attempts to address identified research gaps and will thus inform nursing practice.

Nursing physical assessment for patient safety in general wards: reaching consensus on core skills.

To determine consensus across acute care specialty areas on core physical assessment skills necessary for early recognition of changes in patient status in general wards. Current approaches to physical assessment are inconsistent and have not evolved to meet increased patient and system demands. New models of nursing assessment are needed in general wards that ensure a proactive and patient safety approach. A modified Delphi study. Focus group interviews with 150 acute care registered nurses at a large tertiary referral hospital generated a framework of core skills that were developed into a web-based survey. We then sought consensus with a panel of 35 senior acute care registered nurses following a classical Delphi approach over three rounds. Consensus was predefined as at least 80% agreement for each skill across specialty areas. Content analysis of focus group transcripts identified 40 discrete core physical assessment skills. In the Delphi rounds, 16 of these were consensus validated as core skills and were conceptually aligned with the primary survey: (Airway) Assess airway patency; (Breathing) Measure respiratory rate, Evaluate work of breathing, Measure oxygen saturation; (Circulation) Palpate pulse rate and rhythm, Measure blood pressure by auscultation, Assess urine output; (Disability) Assess level of consciousness, Evaluate speech, Assess for pain; (Exposure) Measure body temperature, Inspect skin integrity, Inspect and palpate skin for signs of pressure injury, Observe any wounds, dressings, drains and invasive lines, Observe ability to transfer and mobilise, Assess bowel movements. Among a large and diverse group of experienced acute care registered nurses consensus was achieved on a structured core physical assessment to detect early changes in patient status. Although further research is needed to refine the model, clinical application should promote systematic assessment and clinical reasoning at the bedside.

Neuro-Psychiatry Diseases Predisposing to Mental Status Changes in Patients with Community-Acquired Pneumonia (P1.313)

Neuro-Psychiatry Diseases Predisposing to Mental Status Changes in Patients with Community-Acquired Pneumonia (P1.313)

Avaliação nutricional e o uso da levodopa com refeições proteicas em pacientes com doença de Parkinson do município de Macaé, Rio de Janeiro

Resumo A doença de Parkinson (DP) é caracterizada pela redução da dopamina no sistema nervoso central. Apresenta progressão gradativa e é conhecida, principalmente, por tremores e dificuldade em realizar movimentos. Estudos demonstram que há significativa alteração do estado nutricional nos pacientes com DP. O principal medicamento utilizado no tratamento dos pacientes é a levodopa e a sua administração, sem respeitar o intervalo de no mínimo 30 minutos antes ou uma hora após as refeições, pode diminuir o efeito farmacológico da substância devido à interação droga-nutriente. Este estudo objetivou identificar, no município de Macaé-RJ, pacientes com DP em risco nutricional e o consumo proteico associado ao uso da levodopa. Trata-se de um estudo transversal, quantitativo e descritivo.Os instrumentos utilizados foram a Mini Avaliação Nutricional (MAN) e o registro alimentar estimado de três dias. A análise foi descritiva. Para compor a amostra, foi realizado um levantamento do número de pacientes com diagnóstico de DP de dois programas da Secretaria de Saúde e da Associação Parkinson de Macaé. Foram avaliados 40 indivíduos, desses, 57,5% eram do sexo masculino. Apresentaram risco de desnutrição ou desnutrição pela MAN 62,5% dos pacientes, caracterizando déficit nutricional. A ingestão proteica da população foi de 1,4g/Kg/dia. A maior ingestão de proteínas foi no período do dia, considerando as refeições compreendidas entre o café da manhã e o lanche da tarde. O consumo pela população nesse período foi de 74,7% da proteína total. Dos idosos, 75,0% ingeriam seus medicamentos compostos de levodopa simultaneamente às refeições ou não, seguindo o intervalo recomendado pela ANVISA. O estudo verificou que a maioria dos indivíduos apresentou risco nutricional, a maior parte realizava uma ingestão diária total hiperproteica, sendo o conteúdo proteico mal distribuído nas refeições ao longo do dia, além do não cumprimento ao intervalo recomendado da levodopa.

Sensing kuuki among visiting nurses.

This study aimed to explore how visiting nurses in Japan sense Kuuki (mood or atmosphere) in the homes of patients and families. Participants were 15 Japanese visiting nurses with experience sensing kuuki in homes of patients and families. Data were collected through two 90 min focus group interviews with experienced visiting nurses, and a qualitative content analysis was performed. The qualitative analysis showed that experienced visiting nurses sensed kuuki in eight ways. Kuuki differs based on type of illness, state of health and number of visits. Sensitivity to kuuki is thought to be linked to understanding of patient and family feelings, changes in the physical condition of patients and evaluation of nursing care delivery. Perception of kuuki also contributes to care planning especially on the very first home visit and when visiting terminally ill patients.

Immune status changes in patients with phlegmon in the maxillofacial region relation with purulent process prevalence

Introduction. Significant portion of patients with acute purulent-inflammatory diseases of the face and neck often has a pronounced secondary immunodeficiency. One manifestation of violation of protective functions in this group of patients are changes in the synthesis of interleukin blood. Knowledge about the of the immune changes in the early stages of the face and neck abscesses development can be used for choosing the right timely empirical therapy. However, the currently available data regarding immune abnormalities in this pathology are controversial. Perhaps this is due to the influence of geographical, environmental and socio-economic factors on the immune status of patients and the results of studies. Thus, to obtain an objective picture of the nature of changes in the body's defenses of patients with inflammatory processes of the face and neck, it is advisable to carry out the study of the state of immunity for each region separately, and that was the basis for this study Aim. to improve pyoinflammatory facial diseases diagnostics on the background of the status study. Materials and Methods. Serum cytokines (IL-1, TNFα, IL-6, IL-8, IL-4) concentration in 60 patients with maxillofacial phlegmon were determined with ELISA method. All patients were residents of Zaporozhye and the Zaporozhye area. Patients were divided into III groups: the 1st included 40 (66.7%) patients with a checkered phlegmons space; 2 nd group – 15 (25.0%) patients with phlegmons of the more than one space; the 3 rd group – 5 (8.3%) patients with diffuse face and neck phlegmon, and with mediastinitis. The average age of patients was 37.0±7 years. 21 healthy subjects were included into control group. 5 ml of the peripheral blood was taken from the antecubital vein under aseptic conditions; and was placed in sterile tubes containing 25 IU of heparin per 1ml. Blood was centrifuged at 3000 rev./min for 10 minutes. Serum was dispensed at 0.3 ml. in plastic tubes, frozen and stored before use at minus 20°C. cytokines concentration was determined with commercial test systems OOO cytokine Vector-Best (St. Petersburg). The results were recorded according to absorbance measured in a spectrophotometer – analyzer Sunrise (Austria) at 450 nm. The cytokines were determined by constructing a calibration curve using the computer program «Calibration» in picogram per milliliter (pg/ml) units. The results and discussion. All phlegmons of the maxillofacial region, regardless of their degree of prevalence are accompanied by an increase in the blood levels of pro-inflammatory interleukins majority. IL-4 concentration in the blood of patients with phlegmones was close to normal range (0.43±0.03, р>0.5). Serum IL4 concentration was increased only in patient with pyoinflammatory changes in more than one area. This indicates adequate response of the immune system against massive antigen load of the immune system (0.93±0.05, p<0.001). IL 4 serum levels in patient with mediastinitis were lower than in the control group (0.25±0.03, p<0.01). this indicated immunosupression in such cases.

Abstract 186: PROs in Clinical Practice: SIS-16 Better at Detecting Change in Functional Status Than the Modified Rankin

Background: To evaluate the benefits of collecting patient-reported outcome measures (PROMs) in clinical practice, we assessed the ability of the SIS-16 to detect changes over time compared to the provider-reported modified Rankin scale. Methods: Observational cohort study of 3,308 ischemic stroke patients seen in a cerebrovascular clinic 9/14/12 - 6/16/15 who completed the routinely collected PROMs: Stroke Impact Scale 16 (SIS-16), EQ-5D, PHQ-9, PROMIS Physical Function (PF), and PROMIS Fatigue. Providers completed the NIHSS and modified Rankin (mRankin). We calculated spearman correlations for all outcome measures. For the 1,455 patients with ≥ 2 visits, we calculated the proportion with meaningful change (SIS-16 ≥8, PROMIS PF and Fatigue ≥ 5, NIHSS ≥2, mRankin ≥1, PHQ-9 ≥ 5, EQ-5D ≥ 0.11). To provide insight on whether changes seen in the SIS-16 and mRankin represented true change in patient status, we calculated the proportion of change in other measures among subgroups with change in SIS-16 and no change in mRankin and for those with a change in mRankin and no change in SIS-16. Results: Median SIS16 was 85.9, median mRankin was2. Correlations between mRankin and PROMs was highest for SIS-16 (r= -0.64). Of patients with worsening or improvement in SIS-16 and no change in mRankin, significantly more patients had worsening or improvement in other measures, respectively, compared to those with stable SIS-16 and mRankin. In contrast, in those with worsening or improvement in mRankin but no change in SIS-16, there was no corresponding increase in % with change in other measures compared to those with stable SIS-16 and mRankin. (Figure) Conclusion: PROMs provide additional information compared to the mRankin alone. Changes in the SIS-16 corresponded to changes in other outcome measures, while changes in mRankin did not. This may be due to better ability of SIS-16 to identify change in functional status.

Interprofessional Learning: An Old Idea in a New Package.

Interdisciplinary education is a modern term that started to appear in the medical and nursing literature between the late 1960s and early 1970s. Its meaning has changed over time from one profession teaching another, to learning together or from each other in informal settings, to our current, more structured, and formal understanding. In 2001, the Institute of Medicine (IOM) report, To Err is Human, reignited interest in the concept as a way to provide better quality care to the American public. The report identified the need for a common vision across professions that could only be achieved if health professionals learned and worked together in a more defined and structured way.1 Picking up on the recommendations of To Err is Human, the 2003 IOM report, Health Professions Education: The Bridge to Quality further refined the definition of interdisciplinary education. The report suggested that when different disciplines learned together, knowledge and practice changed. The report also recommended formal courses and structured joint clinical experiences as part of an interdisciplinary curriculum.2Recently, interdisciplinary education has become the new magic bullet for improving the quality of care to patients. The Affordable Care Act, the IOM report on the Future of Nursing, as well as multiple reports and workshops have used the idea of working in teams as a proxy for interdisciplinary care, and indirectly, reinforced the need for interdisciplinary education.3 Although the concept is typically nested in the relationships of nurses and physicians, in its broadest and perhaps most usable form, interdisciplinary education should encompass multiple providers of health services, such as social workers, physician assistants, and physical therapists, and the patient.4 Even so, in this article I will focus on interdisciplinary learning (rather than formal education) between nurses and physicians and will use historical examples from my earlier work on critical care nurses and nurse practitioners to illustrate how interdisciplinary learning is an historical idea that has been reshaped to meet modern health-care concerns.5From an historical vantage point, interdisciplinary learning is not a new idea. Nurses and doctors learned from each other across time and place. They practiced together on an informal basis sometimes out of necessity, other times out of preference. There are many examples, and a number of common themes emerge that characterize informal interdisciplinary learning: The process could be multidirectional even in the presence of power differentials, learning was opportunistic and time and place dependent, and it was risky. Intentions of interdisciplinary learning also differed, sometimes significantly, from reality.Multidirectional LearningThe early intensive care units of the 1950s fostered multidirectional learning- physicians learned from nurses and nurses learned from physicians, sometimes individually and sometimes as a group. The units were small spaces where physicians and nurses worked closely together both spatially and intellectually. Nurses and physicians sat together and learned how to read electrocardiograms, interpret laboratory studies, and associate what they saw on the tracings and reports to the status of the patient in the bed. Physicians learned firsthand how nurses could determine a change in patient status without looking at the monitors, how nurses worked, what they did, and how they managed patients. As nurses learned how to read cardiac tracings, they also taught physicians how to think about stress and how to evaluate a patient's pain. These informal learning sessions were critical in an environment rapidly integrating new therapies and providers experimenting to see what new drugs and treatments would do. Having the data on treatment response and accurate patient updates helped nurses and physicians develop a sense of trust and logistical capability to give patients the care they needed. …