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BACKGROUND AND RELEVANCE: Early recognition of delirium mobilizes nurses to intervene in a timely manner to minimize cognitive, physical, and mental health burdens. The life-altering challenges of unrecognized delirium in intensive care unit (ICU) patients motivated a group of Massachusetts ICU nurse leaders to form a collaborative and improve delirium screening accuracy in 4 area hospitals. LOCAL PROBLEM: Baseline audits confirmed a lack of delirium screening accuracy across multiple institutions. The purpose of this article is to describe how our collaborative was developed and to outline our delirium accuracy assessment program. METHODS: In March of 2015, 2 graduates from the Clinical Scene Investigator Academy contacted members within the Boston cohort to form a regional collaborative to improve patient outcomes. The purpose of our project was to improve our delirium assessment accuracy to greater than 80% in patients across our ICUs. Using a successful project, we scaled this work based on the needs of each institution. A preaudit-postaudit design was used to evaluate the effectiveness of our programs. RESULTS: Data showed an improved overall accuracy assessment of 88.3% (P < .01), whereas the patients with an altered Richmond Agitation Sedation Scale markedly improved to 87.7% (P < .01). CONCLUSIONS: Every ICU in the United States is working on improving reportable quality metrics, but all too often, this work is being done in silos. When critical care nurses have the knowledge, skills, and time to work together, they can begin to transform health care.
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Delirio , Enfermeras y Enfermeros , Cuidados Críticos , Delirio/diagnóstico , Hospitales , Humanos , Unidades de Cuidados IntensivosRESUMEN
Past literature in the area of employee-customer interactions suggests that being mistreated by customers is deemed one of the most important work-related stressors for service employees. However, little is known about the effects of customer mistreatment on the family domain. In a representative sample of 221 front-line employees in the East China hairdressing industry using three separate surveys administered 1 month apart respectively, the current study explores the mediation effects of work-to-family conflict (WFC) and the moderation effects of psychological detachment (PD) and leader-member exchange (LMX) on the relationship between customer mistreatment and family satisfaction (FS). The research revealed that the employees confronted with intensive customer mistreatment tended to experience high levels of WFC, and WFC mediated the effects of customer mistreatment on FS. In addition, both PD and LMX attenuated customer mistreatment's direct effects on WFC and indirect effects on FS (via WFC). This study contributes to the managerial psychology literature related to the customer mistreatment construct and a better understanding of how PD and LMX act as a work-family spillover effect moderator of customer mistreatment on individuals.
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Premature cervical remodeling is a critical precursor of spontaneous preterm birth, and the remodeling process is characterized by an increase in tissue hydration. Nevertheless, current clinical measurements of cervical remodeling are subjective and detect only late events, such as cervical effacement and dilation. Here, we present a photoacoustic endoscope that can quantify tissue hydration by measuring near-infrared cervical spectra. We quantify the water contents of tissue-mimicking hydrogel phantoms as an analog of cervical connective tissue. Applying this method to pregnant women in vivo, we observed an increase in the water content of the cervix throughout pregnancy. The application of this technique in maternal healthcare may advance our understanding of cervical remodeling and provide a sensitive method for predicting preterm birth.
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Cuello del Útero/diagnóstico por imagen , Tejido Conectivo/diagnóstico por imagen , Procesamiento de Imagen Asistido por Computador/métodos , Técnicas Fotoacústicas/métodos , Espectroscopía Infrarroja Corta/métodos , Adulto , Diseño de Equipo , Femenino , Humanos , Fantasmas de Imagen , Técnicas Fotoacústicas/instrumentación , Embarazo , Espectroscopía Infrarroja Corta/instrumentaciónRESUMEN
Photoacoustic endoscopy offers in vivo examination of the visceral tissue using endogenous contrast, but its typical B-scan rate is â¼10 Hz, restricted by the speed of the scanning unit and the laser pulse repetition rate. Here, we present a transvaginal fast-scanning optical-resolution photoacoustic endoscope with a 250-Hz B-scan rate over a 3-mm scanning range. Using this modality, we not only illustrated the morphological differences of vasculatures among the human ectocervix, uterine body, and sublingual mucosa but also showed the longitudinal and cross-sectional differences of cervical vasculatures in pregnant women. This technology is promising for screening the visceral pathological changes associated with angiogenesis.
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Endoscopía/instrumentación , Técnicas Fotoacústicas , Adulto , Cuello del Útero/diagnóstico por imagen , Diseño de Equipo , Femenino , Humanos , Técnicas Fotoacústicas/instrumentación , Técnicas Fotoacústicas/métodos , Embarazo , Adulto JovenRESUMEN
In part because of aging equipment and reduced reimbursement for imaging services in the last several years, nuclear cardiologists who remain in private practice face challenges in maintaining high quality and in reducing radiation exposure to patients. We review patient-centered approaches and affordable software solutions employed in our practice combined with supine-prone myocardial perfusion imaging to achieve increased interpretive confidence with reduced radiation exposure to patients.