A technology roadmap of assistive technologies for dementia care in Japan.

The number of elderly people in Japan is growing, which raises the issue of dementia, as the probability of becoming cognitively impaired increases with age. There is an increasing need for caregivers, who are well-trained, experienced and can pay special attention to the needs of people with dementia. Technology can play an important role in helping such people and their caregivers. A lack of mutual understanding between caregivers and researchers regarding the appropriate uses of assistive technologies is another problem. A vision of person-centred care based on the use of information and communication technology to maintain residents' autonomy and continuity in their lives is presented. Based on this vision, a roadmap and a list of challenges to realizing assistive technologies have been developed. The roadmap facilitates mutual understanding between caregivers and researchers, resulting in appropriate technologies to enhance the quality of life of people with dementia.

Monolithically integrated transceiver with novel Y-branch by bundle integrated waveguide for fibre optic gyroscope

A novel Y-branch based monolithic transceiver with a superluminescent diode and a waveguide photodiode (Y-SDL-PD) is designed and fabricated by the method of bundle integrated waveguide (BIG) as the scheme for monolithic integration and angled Y-branch as the passive bi-directional waveguide. The simulations of BIG and Y-branches show low losses and improved far-field patterns, based on the beam propagation method (BPM). The amplified spontaneous emission of the device is up to 10mW at 120mA with no threshold and saturation. Spectral characteristics of about 30 nm width and less than 1 dB modulation are achieved using the built-in anti-lasing ability of Y-branch. The beam divergence angles in horizontal and vertical directions are optimized to as small as 12 degrees x 8 degrees, resulting in good fibre coupling.

Superluminescent diode monolithically integrated with novel Y-branch by bundle integrated waveguide for fiber optic gyroscope - art. no. 68380D

We have developed a novel InP-based, ridge-waveguide photonic integrated circuit (PIC), which consists of a 1.1-um wavelength Y-branch optical waveguide with low loss and improved far field pattern and a 1.3-um wavelength strained InGaAsP-InP multiple quantum-well superluminescent diode, with bundle integrated guide (BIG) as the scheme for monolithic integration. The simulations of BIG and Y-branches show low losses and improved far-field patterns, based on the beam propagation method (BPM). The amplified spontaneous emission of the device is up to 10 mW at 120 mA with no threshold and saturation. Spectral characteristics of about 30 nm width and less than I dB modulation are achieved using the built-in anti-lasing ability of Y-branch. The beam divergence angles in horizontal and vertical directions are optimized to as small as 12 degrees x8 degrees, resulting in good fiber coupling. The compactness, simplicity in fabrication, good superluminescent performance, low transmission loss and estimated low coupling loss prove the BIG and Y-branch method to be a feasible way for integration and make the photonic integrated circuit of Y-branch and superluminescent diode an promising candidate for transmitter and transceiver used in fiber optic gyroscope.

Tunable Distributed Bragg Reflector Laser Fabricated by Bundle Integrated Guide

The tunable BIG-RW distributed Bragge reflector lasers with two different coupling coefficient gratings are proposed and fabricated.The threshold current of the laser is 38mA and the output power is more than 8mW.The tunable range of tthe laser is 3.2nm and the side moded suppression ratio is more than 30dB.The variation of the output power within the tunable wavelength range is less than 0.3dB

Evaluation of a national evidence-based health care course via teleconference in a developing country

Rationale, aims and objectives Continuing health education is essential but challenged. in 2006, the Brazilian Cochrane Center, in collaboration with the Ministry of Health, launched a mass teaching initiative in evidence-based health care (EBH) for public-sector professionals via teleconferencing. This 152-hour, interactive EBH course has enrolled over 4500 professionals. This study aimed to assess the acquisition EBH knowledge and skills, as well as the attitudes and perceptions of a sample of students enrolled in the 2009 course via teleconferencing.Methods This prospective cohort study analyzed three aspects of this 152-hour EBH course that recruited 1040 volunteer participants, all public health sector employees working in 131 different hospitals or health agencies. Pre- and post-course tests using a modified version of the Berlin questionnaire with 20 multiple-choice questions were used to examine knowledge acquisition in a sample of 297 students. Tests were completed upon registration and at course completion. the research projects submitted by 872 participants were evaluated to assess skill acquisition. Answers to an anonymous survey assessed the attitudes and perceptions of 914 participants.Results There was a significant increase in knowledge from baseline to course completion (mean scores 8.2 +/- 3.3 versus 13.7 +/- 3.0, P < 0.001). Over 90% of the research projects were judged to be of adequate quality (appropriate rationale for the study, well-formulated research question and feasible execution); over 95% of the participants were satisfied with the course.Conclusion the Brazilian EBH course via teleconference improved the knowledge and skills of public-sector health professionals and was approved by the vast majority of students.

Cloud Computing - health care's silver lining.

Cloud computing is the technology prescription that will help the UK’s National Health Service (NHS) beat the budget constraints imposed as a consequence of the credit crunch. The internet based shared data and services resource will revolutionise the management of medical records and patient information while saving the NHS millions of pounds.

A review of the effectiveness and meaningfulness of education interventions to enable children, young people and their families to self-care for their gastrostomy tubes in the community.

A systematic review of qualitative and quantitative evidence of the effectiveness and meaningfulness of education interventions to enable children, young people and their families to self-care for their gastrostomy tubes in the community

Activity in Geriatric acute CARe (AGECAR): Rationale, design and methods

The Activity in GEriatric acute CARe (AGECAR) is a randomised control trial to assess the effectiveness of an intrahospital strength and walk program during short hospital stays for improving functional capacity of patients aged 75 years or older. Patien

Development of process control methodology for tracking the quality and safety of pain, agitation and sedation management in critical care units

Objective: To develop sedation, pain, and agitation quality measures using process control methodology and evaluate their properties in clinical practice. Design: A Sedation Quality Assessment Tool was developed and validated to capture data for 12-hour periods of nursing care. Domains included pain/discomfort and sedation-agitation behaviors; sedative, analgesic, and neuromuscular blocking drug administration; ventilation status; and conditions potentially justifying deep sedation. Predefined sedation-related adverse events were recorded daily. Using an iterative process, algorithms were developed to describe the proportion of care periods with poor limb relaxation, poor ventilator synchronization, unnecessary deep sedation, agitation, and an overall optimum sedation metric. Proportion charts described processes over time (2 monthly intervals) for each ICU. The numbers of patients treated between sedation-related adverse events were described with G charts. Automated algorithms generated charts for 12 months of sequential data. Mean values for each process were calculated, and variation within and between ICUs explored qualitatively. Setting: Eight Scottish ICUs over a 12-month period. Patients: Mechanically ventilated patients. Interventions: None. Measurements and Main Results: The Sedation Quality Assessment Tool agitation-sedation domains correlated with the Richmond Sedation Agitation Scale score (Spearman [rho] = 0.75) and were reliable in clinician-clinician (weighted kappa; [kappa] = 0.66) and clinician-researcher ([kappa] = 0.82) comparisons. The limb movement domain had fair correlation with Behavioral Pain Scale ([rho] = 0.24) and was reliable in clinician-clinician ([kappa] = 0.58) and clinician-researcher ([kappa] = 0.45) comparisons. Ventilator synchronization correlated with Behavioral Pain Scale ([rho] = 0.54), and reliability in clinician-clinician ([kappa] = 0.29) and clinician-researcher ([kappa] = 0.42) comparisons was fair-moderate. Eight hundred twenty-five patients were enrolled (range, 59-235 across ICUs), providing 12,385 care periods for evaluation (range 655-3,481 across ICUs). The mean proportion of care periods with each quality metric varied between ICUs: excessive sedation 12-38%; agitation 4-17%; poor relaxation 13-21%; poor ventilator synchronization 8-17%; and overall optimum sedation 45-70%. Mean adverse event intervals ranged from 1.5 to 10.3 patients treated. The quality measures appeared relatively stable during the observation period. Conclusions: Process control methodology can be used to simultaneously monitor multiple aspects of pain-sedation-agitation management within ICUs. Variation within and between ICUs could be used as triggers to explore practice variation, improve quality, and monitor this over time

Understanding nurses’ decision-making when managing weaning from mechanical ventilation: a study of novice and experienced critical care nurses in Scotland and Greece.

Aim and objectives To examine how nurses collect and use cues from respiratory assessment to inform their decisions as they wean patients from ventilatory support. Background Prompt and accurate identification of the patient's ability to sustain reduction of ventilatory support has the potential to increase the likelihood of successful weaning. Nurses' information processing during the weaning from mechanical ventilation has not been well-described. Design A descriptive ethnographic study exploring critical care nurses' decision-making processes when weaning mechanically ventilated patients from ventilatory support in the real setting. Methods Novice and expert Scottish and Greek nurses from two tertiary intensive care units were observed in real practice of weaning mechanical ventilation and were invited to participate in reflective interviews near the end of their shift. Data were analysed thematically using concept maps based on information processing theory. Ethics approval and informed consent were obtained. Results Scottish and Greek critical care nurses acquired patient-centred objective physiological and subjective information from respiratory assessment and previous knowledge of the patient, which they clustered around seven concepts descriptive of the patient's ability to wean. Less experienced nurses required more encounters of cues to attain the concepts with certainty. Subjective criteria were intuitively derived from previous knowledge of patients' responses to changes of ventilatory support. All nurses used focusing decision-making strategies to select and group cues in order to categorise information with certainty and reduce the mental strain of the decision task. Conclusions Nurses used patient-centred information to make a judgment about the patients' ability to wean. Decision-making strategies that involve categorisation of patient-centred information can be taught in bespoke educational programmes for mechanical ventilation and weaning. Relevance to clinical practice Advanced clinical reasoning skills and accurate detection of cues in respiratory assessment by critical care nurses will ensure optimum patient management in weaning mechanical ventilation

Evaluation of the KA24 (Knowledge Access 24) service for health and social care staff in London and the South-East of England. Part 1: Quantitative

Cumbers, B., Urquhart, C. & Durbin, J. (2006). Evaluation of the KA24 (Knowledge Access 24) service for health and social care staff in London and the South-East of England. Part 1: Quantitative. Health Information and Libraries Journal, 23(2), 133-139 Sponsorship: KA24 - NHS Trusts, London