Uptake of new treatment strategies for deep vein thrombosis: an international audit.

OBJECTIVE: Study of the uptake of new medical technologies provides useful information on the transfer of published evidence into usual practice. We conducted an audit of selected hospitals in three countries (Canada, France, and Switzerland) to identify clinical predictors of low-molecular-weight (LMW) heparin use and outpatient treatment, and to compare the pace of uptake of these new therapeutic approaches across hospitals. DESIGN: Historical review of medical records. SETTING AND PARTICIPANTS: We reviewed the medical records of 3043 patients diagnosed with deep vein thrombosis (DVT) in five Canadian, two French, and two Swiss teaching hospitals from 1994 to 1998. Measures. We explored independent clinical variables associated with LMW heparin use and outpatient treatment, and determined crude and adjusted rates of LMW heparin use and outpatient treatment across hospitals. RESULTS: For the years studied, the overall rates of LMW heparin use and outpatient treatment in the study sample were 34.1 and 15.8%, respectively, with higher rates of use in later years. Many comorbidities were negatively associated with outpatient treatment, and risk-adjusted rates of use of these new approaches varied significantly across hospitals. CONCLUSION: There has been a relatively rapid uptake of LMW heparins and outpatient treatment for DVT in their early years of availability, but the pace of uptake has varied considerably across hospitals and countries.

Le Q-sort, un outil pour la recherche en soins le cas des représentations chez les infirmiers en psychiatrie de l'âge avancé [Q-sort, a useful research method in care in cases of psychiatric nursing of the aged]

Q-sort is a research method which allows defining profiles of attitudes toward a set of statements, ordered in relation to each other. Pertaining to the Q Methodology, the qualitative analysis of the Q-sorts is based on quantitative techniques. This method is of particular interest for research in health professions, a field in which attitudes of patients and professionals are very important. The method is presented in this article, along with an example of application in nursing in old age psychiatry.

Nursing Needs Assessment Tool - Users Guide 2002 (PDF 32 KB)

This assessment tool is designed to assess the registered nursing needs of a person needing long-term care. The tool is designed to encapsulate a systematic approach to assessment whilst at the same time embracing professional decision-making that takes place in the relationship between a nurse and another person. For this reason, the tool takes the assessment through a staged approach, moving from a general ‘narrative’ based assessment of ‘domains’ of care need, to a focused assessment of risk and complexity. åÊ

Delirium upon admission to Swiss nursing homes: a cross-sectional study.

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.

Effect Estimation of an Innovative Nursing Intervention to Improve Delirium among Home-Dwelling Older Adults: A Randomized Controlled Pilot Trial.

AIMS: Estimating the effect of a nursing intervention in home-dwelling older adults on the occurrence and course of delirium and concomitant cognitive and functional impairment. METHODS: A randomized clinical pilot trial using a before/after design was conducted with older patients discharged from hospital who had a medical prescription to receive home care. A total of 51 patients were randomized into the experimental group (EG) and 52 patients into the control group (CG). Besides usual home care, nursing interventions were offered by a geriatric nurse specialist to the EG at 48 h, 72 h, 7 days, 14 days, and 21 days after discharge. All patients were monitored for symptoms of delirium using the Confusion Assessment Method. Cognitive and functional statuses were measured with the Mini-Mental State Examination and the Katz and Lawton Index. RESULTS: No statistical differences with regard to symptoms of delirium (p = 0.085), cognitive impairment (p = 0.151), and functional status (p = 0.235) were found between the EG and CG at study entry and at 1 month. After adjustment, statistical differences were found in favor of the EG for symptoms of delirium (p = 0.046), cognitive impairment (p = 0.015), and functional status (p = 0.033). CONCLUSION: Nursing interventions to detect delirium at home are feasible and accepted. The nursing interventions produced a promising effect to improve delirium.

Edit du Roy, portant suppression des offices de contrôlleurs des bans de mariage qui avoient esté créez par l'Edit du mois de septembre 1697 . Et tarif des droits que Sa Majesté veut estre payez à l'avenir pour le contrôlle & l'enregistrement de chacune publication de ban de mariage conformement audit Edit. Donné à Versailles au mois de mars 1702. Registré en Parlement le 26 avril 1702.

[Acte royal. 1702-03-00. Versailles]

Arrêt du conseil d'état qui maintient et garde Monsieur le duc d'Orléans au droit de nommer et pourvoir aux offices de son apanage, terres patrimoniales, mentionnés audit arrêt ainsi qu'il faisait avant l'arrêt du conseil d'état du 25 septembre 1718 dans lequel Sa Majesté n'a entendu comprendre lesdits offices

[Acte. 1719-03-24. Paris]

Arrêt du grand conseil concernant les abbayes du royaume (qui condamne Denis Coignet, curé de St-Roch à Paris et prieur de Saint-Julien de Courcelles, à payer à Franç. des Bertrons de Crillon, évêque de Vienne, 29 années d'arrérages de la cense par lui due audit des Bertrons, en sa qualité d'abbé de St-Florent-lez-Saumur dont relève ledit prieuré de Saint-Julien.)

[Acte. 1719-03-04. Paris]

Arrêt du grand conseil qui décharge le Sr de Damas de la demande formée contre lui par la veuve et enfants du Sr Le Petit, secrétaire du roi, des droits seigneuriaux dûs à cause des terres de Marcenou et autres mouvantes du domaine du roi, adjugées sur eux audit Sr de Damas

[Acte. 1730-03-27. Paris]

Arrêt du grand conseil qui juge que les religieux du prieuré de Libons, quoiqu'ils ne soient actuellement qu'à pensions, ont le droit de faire chasser sur toutes les terres appartenant audit prieuré

[Acte. 1735-08-22. Paris]

Arrêt du grand conseil en faveur de Me Alain de Nicolas, Sr de la Coste, capitaine de cavalerie et garde du corps du roi, portant que les curé et marguilliers de l'église paroissiale d'Argentat, en Limousin, seront tenus d'accorder audit sieur de la Coste une place convenable et au-dessus de ceux qui lui sont inférieurs en qualité, dans le nef de ladite église, à l'effet d'y mettre un banc pour lui et sa famille

[Acte. 1754-02-13. Paris]

Arrêt du grand conseil en forme de règlement, entre le présidial de Caudebec, pour le bailliage de Caux et anciens ressorts et enclaves d'icelui, et les juges royaux et hauts-justiciers ressortissant audit Siège

[Acte. 1762-04-01. Paris]

(Arrêt du grand conseil qui déclare nul un arrêt du parlement de Rouen du 31 août 1775 par lequel défenses sont faites aux bailliages du ressort dudit parlement d'enregistrer aucuns édits, déclarations et lettres patentes qu'ils n'aient été préalablement vérifiés audit parlement.)

[Acte. 1776-04-25. Paris]