Software Application That Evaluates the Diagnostic Accuracy of Nursing Students

PURPOSE: Apply the educational software Fuzzy Kitten with undergraduate Brazilian nursing students. METHODS: This software, based on fuzzy logic, generates performance scores that evaluate the ability to identify defining characteristics/risk factors present in clinical cases, relate them with nursing diagnoses, and determine the diagnoses freely or using a decision support model. FINDINGS: There were differences in student performance compared to the year of the course. The time to perform the activity did not present a significant relation to the performance. The students' scores in the diagnoses indicated by the model was superior (p = .01). CONCLUSIONS: The software was able to evaluate the diagnostic accuracy of students. IMPLICATIONS: The software enables an objective evaluation of diagnostic accuracy.

Teaching of the Integrated Management of Childhood Illness strategy in undergraduate nursing programs

Objective: To describe and analyze the teaching of the Integrated Management of hildhood Illness (IMCI) strategy on Brazilian undergraduate nursing programs. Method: Integrating an international multicentric study, a cross-sectional online survey was conducted between May and October 2010 with 571 undergraduate nursing programs in Brazil Results: Responses were received from 142 programs, 75% private and 25% public. 64% of them included the IMCI strategy in the theoretical content, and 50% of the programs included IMCI as part of the students’ practical experience. The locations most used for practical teaching were primary health care units. The ‘treatment’ module was taught by the fewest number of programs, and few programs had access to the IMCI instructional manuals. All programs used exams for evaluation, and private institutions were more likely to include class participation as part of the evaluation. Teaching staff in public institutions were more likely to have received training in teaching IMCI. Conclusion: In spite of the relevance of the IMCI strategy in care of the child, its content is not addressed in all undergraduate programs in Brazil, and many programs do not have access to the IMCI teaching manuals and have not provide training in IMCI to their teaching staff.

Challenges for nursing education in Angola: the perception of nurse leaders affiliated with professional education institutions

Background: Angola is one of the African countries with the highest morbidity and mortality rates and a devastating lack of human resources for health, including nursing. The World Health Organization stimulates and takes technical cooperation initiatives for human resource education and training in health and education, with a view to the development of countries in the region. The aim in this study was to identify how nurses affiliated with nursing education institutions perceive the challenges nursing education is facing in Angola. Methods: After consulting the National Directory of Human Resources in Angola, the nurse leaders affiliated with professional nursing education institutions in Angola were invited to participate in the study by email. Data were collected in February 2009 through the focus group technique. The group of participants was focused on the central question: what are the challenges faced for nursing education in your country? To register and understand the information, besides the use of a recorder, the reporters elaborated an interpretative report. Data were coded using content analysis. Results: Fourteen nurses participated in the meeting, most of whom were affiliated with technical nursing education institutions. It was verified that the nurse leaders at technical and higher nursing education institutions in Angola face many challenges, mainly related to the lack of infrastructure, absence of trained human resources, bureaucratic problems to regularize the schools and lack of material resources. On the opposite, the solutions they present are predominantly centered on the valuation of nursing professionals, which implies cultural and attitude changes. Conclusions: Public health education policies need to be established in Angola, including action guidelines that permit effective nursing activities. Professional education institutions need further regularizations and nurses need to be acknowledged as key elements for the qualitative enhancement of health services in the country.

Nursing Activities Score e demanda de trabalho de enfermagem em terapia intensiva

OBJETIVO: Medir e caracterizar a carga de trabalho de enfermagem em Unidade de Terapia Intensiva (UTI) por meio da aplicação do Nursing Activities Score (NAS). MÉTODOS: Estudo descritivo quantitativo, retrospectivo, realizado em uma das UTIs de um Hospital Filantrópico de Teresina- PI, de setembro a outubro de 2010, com amostra de 66 pacientes. Foram realizadas 285 medidas do escore NAS. RESULTADOS: Quanto à carga de trabalho de enfermagem, foi verificada uma média do escore total do NAS de 68,1% (51,5% e 108,3%), correspondendo à porcentagem de tempo gasto pelo profissional de enfermagem na assistência direta ao paciente nas 24 horas. Houve correlação estatística entre NAS e desfecho clínico (p= 0,001). Já entre NAS e tempo de internação (p= 0,073) e NAS e idade (p=0,952), não houve significância estatística. CONCLUSÃO: Os resultados mostraram que os pacientes apresentaram elevada necessidade de cuidados, refletida pela média elevada do NAS.

Nursing intervention in insulin administration: telephone follow-up

OBJECTIVE: To analyze the competency of people with diabetes mellitus to perform the insulin administration process, before and after telephone monitoring. METHODS: A quantitative, observational, longitudinal, comparative study. Participants were 26 people enrolled in the at-home capillary glycemia self-monitoring program. Data collection occurred in three phases, in January and February of 2010, for a period of 30 days for each person, by means of interview guided by a data collection instrument and an intervention manual. RESULTS: Of the 38 (100%) questions referring to the insulin administration process, telephone monitoring was demonstrated to be efficient in 30 (78.9%), but in 19 (50%) the intervention was statistically significant (p<0.05), in 11 (28.9%) there were no errors in responses to the final competency evaluation, and seven (18.4%) were not amenable to intervention. CONCLUSION: Telephone mornitoring was effective, as a nursing intervention strategy for the insulin administration process in the home.

Nursing care time in the Intensive Care Unit: evaluation of the parameters proposed in COFEN Resolution Nº 293/04

This study aimed to evaluate the parameters established in COFEN Resolution 293/04 concerning nursing staff dimensioning in adult intensive care units (AICU). The research was conducted in six hospitals in São Paulo City. The daily quantitative average of professionals needed for patient care was calculated according to the parameters established by COFEN. The obtained results were compared with the existing number of daily staff members in these units. It was observed that the proportions recommended by COFEN for the nurse category are superior to those used in the hospitals studied, which represents a challenge for Brazilian nursing. Mean care time values were found appropriate and represent important standards for dimensioning the minimum number of professionals in AICU. This study contributed to the validation of the parameters indicated in Resolution 293/04 for nursing staff dimensioning in the AICU.

The use of remote sensing imagery for monitoring recovery in the aftermath of a natural disaster: the Hurricane Katrina Case

Although Recovery is often defined as the less studied and documented phase of the Emergency Management Cycle, a wide literature is available for describing characteristics and sub-phases of this process. Previous works do not allow to gain an overall perspective because of a lack of systematic consistent monitoring of recovery utilizing advanced technologies such as remote sensing and GIS technologies. Taking into consideration the key role of Remote Sensing in Response and Damage Assessment, this thesis is aimed to verify the appropriateness of such advanced monitoring techniques to detect recovery advancements over time, with close attention to the main characteristics of the study event: Hurricane Katrina storm surge. Based on multi-source, multi-sensor and multi-temporal data, the post-Katrina recovery was analysed using both a qualitative and a quantitative approach. The first phase was dedicated to the investigation of the relation between urban types, damage and recovery state, referring to geographical and technological parameters. Damage and recovery scales were proposed to review critical observations on remarkable surge- induced effects on various typologies of structures, analyzed at a per-building level. This wide-ranging investigation allowed a new understanding of the distinctive features of the recovery process. A quantitative analysis was employed to develop methodological procedures suited to recognize and monitor distribution, timing and characteristics of recovery activities in the study area. Promising results, gained by applying supervised classification algorithms to detect localization and distribution of blue tarp, have proved that this methodology may help the analyst in the detection and monitoring of recovery activities in areas that have been affected by medium damage. The study found that Mahalanobis Distance was the classifier which provided the most accurate results, in localising blue roofs with 93.7% of blue roof classified correctly and a producer accuracy of 70%. It was seen to be the classifier least sensitive to spectral signature alteration. The application of the dissimilarity textural classification to satellite imagery has demonstrated the suitability of this technique for the detection of debris distribution and for the monitoring of demolition and reconstruction activities in the study area. Linking these geographically extensive techniques with expert per-building interpretation of advanced-technology ground surveys provides a multi-faceted view of the physical recovery process. Remote sensing and GIS technologies combined to advanced ground survey approach provides extremely valuable capability in Recovery activities monitoring and may constitute a technical basis to lead aid organization and local government in the Recovery management.

Lifelines in case of Natural Disaster Emergencies

In order to handle Natural disasters, emergency areas are often individuated over the territory, close to populated centres. In these areas, rescue services are located which respond with resources and materials for population relief. A method of automatic positioning of these centres in case of a flood or an earthquake is presented. The positioning procedure consists of two distinct parts developed by the research group of Prof Michael G. H. Bell of Imperial College, London, refined and applied to real cases at the University of Bologna under the coordination of Prof Ezio Todini. There are certain requirements that need to be observed such as the maximum number of rescue points as well as the number of people involved. Initially, the candidate points are decided according to the ones proposed by the local civil protection services. We then calculate all possible routes from each candidate rescue point to all other points, generally using the concept of the "hyperpath", namely a set of paths each one of which may be optimal. The attributes of the road network are of fundamental importance, both for the calculation of the ideal distance and eventual delays due to the event measured in travel time units. In a second phase, the distances are used to decide the optimum rescue point positions using heuristics. This second part functions by "elimination". In the beginning, all points are considered rescue centres. During every interaction we wish to delete one point and calculate the impact it creates. In each case, we delete the point that creates less impact until we reach the number of rescue centres we wish to keep.

Progettazione e implementazione di una rete di sensori mobili Arduino per scenari di Disaster Recovery

Sommario Il progetto descritto in questo documento consiste nella realizzazione di una prima applicazione pratica di uno specifico studio di ricerca rivolto al ripristino di reti wireless in scenari post-calamità naturali. In principio è stata descritta un’ampia analisi delle problematiche di rete che si vengono a creare in seguito ad eventi catastrofici. Successivamente, analizzando le varie tecniche e tecnologie oggetto di studio di diversi gruppi di ricerca, si è scelto di collaborare con il progetto STEM-Mesh, essendo ancora in fase sperimentale, il quale affronta il problema di ristabilire la connettività di rete in questi particolari scenari, attraverso l’utilizzo di tecnologie Cognitive Radio (CR), mobilità controllata e principi di reti auto-organizzanti. Di questo primo approccio pratico sono state poi descritte le fasi di progettazione, implementazione e testing. Nella fase di progettazione sono state studiate le componenti hardware e software che rispettassero il più possibile i requisiti e le caratteristiche dei dispositivi “staminali” STEM-Node cuore del progetto STEM-Mesh, ovvero dei dispositivi wireless altamente auto-riconfiguranti ed auto-organizzanti che possono diventare dispositivi sostituivi ai nodi compromessi in una rete, riconfigurandosi appunto in base alle funzionalità interrotte. Nella fase di implementazione si è passati alla stesura del codice, in Python e Wiring, abilitante il dispositivo STEM-Node. Infine nella fase di testing si è verificato che i risultati fossero quelli desiderati e che il sistema realizzato funzionasse come previsto.

Studio, Realizzazione e Simulazione di SaveMe, un'applicazione Android per il Disaster Recovery

Quando avvengono disastri naturali, spesso la copertura dati viene a mancare e le infrastutture o sono danneggiate o sono sovraccariche; in questo modo è difficile comunicare sia da parte delle persone che hanno bisogno di aiuto, sia da parte dei soccorritori che cercano di organizzare i soccorsi. Con questa tesi si è voluto realizzare un'applicazione Android che permetta agli utenti di segnalare il proprio bisogno di aiuto, anche se il device non ha una connessione internet attiva. L'applicazione, sfruttando il Wi-Fi e il Wi-Fi Direct, cercherà di formare una rete di dispositivi, attraverso la quale i messaggi di aiuto degli utenti verranno scambiati tra i device. Questa rete, man mano, si allargherà fino ad arrivare ad includere device che avranno una connessione dati attiva. Questi comunicheranno con il mio server, al quale manderanno tutti i messaggi che gli sono arrivati. I dati del server, ossia i messaggi che sono stati mandati dagli utenti, verranno mostrati sul sito ltw1528.web.cs.unibo.it. Attraverso questo sito, i soccorritori potranno vedere la posizione degli utenti in stato di bisogno, cosicché potranno mandarli un messaggio di soccorso, che si propagherà nella rete formatasi in precedenza, ed organizzare i soccorsi in maniera ottimale. Si è anche voluto fare uno studio simulativo per testare la scalabilità dell'applicazione e per raccogliere dati statistici, quali il delay medio tra l'arrivo del messaggio al device con connessione dati e il tempo in cui è stato creato, l'influenza sulla batteria del numero dei messaggi scambiati e il numero degli host, il delay tra il tempo di invio e il tempo di arrivo nello scambio di messaggi al variare del numero degli host.

Reduction of inappropriate medications among older nursing-home residents: a nurse-led, pre/post-design, intervention study

Background: Medication-related problems are common in the growing population of older adults and inappropriate prescribing is a preventable risk factor. Explicit criteria such as the Beers criteria provide a valid instrument for describing the rate of inappropriate medication (IM) prescriptions among older adults. Objective: To reduce IM prescriptions based on explicit Beers criteria using a nurse-led intervention in a nursing-home (NH) setting. Study Design: The pre/post-design included IM assessment at study start (pre-intervention), a 4-month intervention period, IM assessment after the intervention period (post-intervention) and a further IM assessment at 1-year follow-up. Setting: 204-bed inpatient NH in Bern, Switzerland. Participants: NH residents aged ≥60 years. Intervention: The intervention included four key intervention elements: (i) adaptation of Beers criteria to the Swiss setting; (ii) IM identification; (iii) IM discontinuation; and (iv) staff training. Main Outcome Measure: IM prescription at study start, after the 4-month intervention period and at 1-year follow-up. Results: The mean±SD resident age was 80.3±8.8 years. Residents were prescribed a mean±SD 7.8±4.0 medications. The prescription rate of IMs decreased from 14.5% pre-intervention to 2.8% post-intervention (relative risk [RR] = 0.2; 95% CI 0.06, 0.5). The risk of IM prescription increased nonstatistically significantly in the 1-year follow-up period compared with post-intervention (RR = 1.6; 95% CI 0.5, 6.1). Conclusions: This intervention to reduce IM prescriptions based on explicit Beers criteria was feasible, easy to implement in an NH setting, and resulted in a substantial decrease in IMs. These results underscore the importance of involving nursing staff in the medication prescription process in a long-term care setting.

Delirium upon admission to Swiss nursing homes

QUESTIONS UNDER STUDY: We wished to investigate the prevalence of delirium in patients upon admission to nursing homes and whether or not the previous place of residence predicts delirium. METHODS: The Resident Assessment Instrument Minimum Data Set (RAI-MDS) and the Nursing Home Confusion Assessment Method (NHCAM) were used to determine whether the previous place of residence (community, nursing home, acute care, psychiatric, rehabilitation hospital) predicted the prevalence of sub-syndromal or full delirium in nursing home residents in three Swiss cantons (n = 11745). RESULTS: 39.7% had sub-syndromal and 6.5% had full delirium. Lower cognitive performance and increased depressive symptoms were significant predictors of higher NHCAM values independent of previous residence. Age, civil status, continence, newly introduced drugs, and basic activities of daily living were predictors in some resident groups. The variance of NHCAM scores explained varied between 25.1% and 32.3% depending on previous residence. CONCLUSIONS: Sub-syndromal and full delirium are common upon nursing home admission. Increased dependence and depression are consistently associated with higher NHCAM scores. Patients from psychiatric settings have an increased risk of delirium. Although factors associated with delirium depend on a patient's previous residence, all patients must be carefully screened for sub-syndromal and full delirium.