Examining adverse events after intensive care unit discharge : outcomes from a pilot questionnaire

Adverse events are common in acute clinical settings but little is known about these events occurring after Intensive Care discharge. This study aimed to develop a reliable and valid tool for exploring clinicians’ opinions of factors associated with post-Intensive Care adverse events. A convenience sample of Australian Intensive Care Liaison Nurses was invited to complete and appraise a questionnaire using structured guidelines. Content validity and internal consistency were assessed.

Twelve Intensive Care Liaison Nurses completed the questionnaire. Cronbach?s alpha coefficient showed high internal consistency for the questionnaire; all 24 items on the questionnaire had coefficients greater than 0.852. The content validity index of the questionnaire overall was 0.76.

The post-Intensive Care adverse events questionnaire demonstrated reliability and validity. It is a tool that can be used to explore clinicians? opinions of factors associated with these events. The tool is important as it facilitates further insight into the causes of post-Intensive Care adverse events.

Post-anaesthetic discharge scoring criteria: key findings from a systematic review

Background
Patient safety depends on nurses' clinical judgment. In post-anaesthetic care, objective scoring systems are commonly used to help nurses assess when a patient is ready to go back to the ward or be discharged home after day surgery. Although there are several criteria used to assess patient readiness for discharge from the post-anaesthetic care unit, evaluation of the validity and reliability of these criteria is scarce.

Aims
This article presents key findings from a systematic review conducted to identify the essential components of an effective and feasible scoring system to assess patients following surgical anaesthesia for discharge from the post-anaesthetic care unit.

Methods
The protocol for the systematic review of quantitative studies investigating assessment criteria for discharge of adult patients from the post-anaesthetic care unit was approved by the Joanna Briggs Institute and conducted consistent with the methodology of the Institute. Twelve databases and grey literature, such as conference proceedings, were searched for published studies between 1970 and 2010. Two reviewers independently assessed study eligibility for inclusion. Reference lists of included studies were appraised.

Results
Eight studies met the inclusion criteria; only one was a randomised controlled trial. Variables identified as essential when assessing a patient's readiness for discharge from the post-anaesthetic care unit were conscious state, blood pressure, nausea and vomiting, and pain. Assessment of psychomotor and cognitive recovery and other vital signs were also identified as relevant variables to consider.

Conclusions
There was limited high-quality research regarding criteria to assess patient readiness for discharge from the post-anaesthetic unit. The key recommendations, with moderate to high risk of bias, include that assessment of specific variables (pain, conscious state, blood pressure, and nausea and vomiting) should be made before patient discharge. These key findings have informed a subsequent study to reach international consensus on effective assessment criteria and a project to test the clinical reliability of a tool for use by nurses in assessing patient readiness for discharge from post-anaesthetic care.

Security concerns and remedy in a cloud based e-learning system

Cloud computing is an emerging technology and it utilizes the cloud power to many technical solutions. The e-learning solution is one of those technologies where it implements the cloud power in its existing system to enhance the functionality providing to e-learners. Cloud technology has numerous advantages over the existing traditional e-learning systems. However security is a major concern in cloud based e-learning. Therefore security measures are unavoidable to prevent the loss of users’ valuable data from the security vulnerabilities. This paper investigates various security issues involved in cloud based e-learning technology with an aim to suggest remedial in the form of security measures and security management standards. These will help to overcome the security threats in cloud based e-learning technology. Solving the key problems will also encourage the widespread adoption of cloud computing in educational institutes.

A hierarchical cloud pricing system

Cloud computing is experiencing phenomenal growth and there are now many vendors offering their cloud services. In cloud computing, cloud providers cooperate together to offer their computing resource as a utility and software as a service to customers. The demands and the price of cloud service should be negotiated between providers and users based on the Service Level Agreement (SLA). In order to help cloud providers achieving an agreeable price for their services and maximizing the benefits of both cloud providers and clients, this paper proposes a cloud pricing system consisting of hierarchical system, M/M/c queuing model and pricing model. Simulation results verify the efficiency of our proposed system.

A general cloud firewall framework with dynamic resource allocation

Cloud is becoming a dominant computing platform. However, we see few work on how to protect cloud data centers. As a cloud usually hosts many different type of applications, the traditional packet level firewall mechanism is not suitable for cloud platforms in case of complex attacks. It is necessary to perform anomaly detection at the event level. Moreover, protecting objects are more diverse than the traditional firewall. Motivated by this, we propose a general framework of cloud firewall, which features event level detection chain with dynamic resource allocation. We establish a mathematical model for the proposed framework. Moreover, a linear resource investment function is proposed for economical dynamical resource allocation for cloud firewalls. A few conclusions have been extracted for the reference of cloud service providers and designers.