Détection et prévention de l'état confusionnel aigu chez des personnes âgées à domicile après une hospitalisation ou maladie aiguë récente : une étude clinique randomisée pilote

Background: One third of hospitalized older-adults who developed a delirium are discharged prior to complete resolution of their symptoms. Others may develop symptoms shortly after their hospital discharge or an acute illness. Therefore, strategies for early detection and prevention of delirium at home must be created and implemented. Aims: The aim of the pilot study was two-fold. First, to develop and test the effectiveness of a nursing intervention to detect and prevent delirium among older- adults who were recently hospitalized or had an acute illness. Second, we assessed the feasibility and acceptability of this nursing intervention strategy with this specific population. Methods: A total of 114 patients age 65 and older were recruited in a home health service to participate between February and November 2012. Participants were randomized into an experimental group (n=56) or a control group (n=58). In addition to the control group which only receives standard home care, nursing interventions tailored to detect/prevent delirium were delivered to the experimental group at 5 time points following discharge (at 48 hours, 72 hours, 7 days, 14 days, and 21 days). Socio-demographic characteristics, body mass index, medications, comorbidities, delirium symptoms (Confusion Assessment Method), cognitive impairment (Mini- Mental State Examination) and functional status (Activities of Daily Living) were assessed at study entry (TT). Outcomes of delirium symptoms, cognitive impairment and functional status were assessed after one month (T2). Descriptive and bivariate methods were used to analyse the data. Results: The two groups were similar at baseline. At one month following discharge no statistical differences were observed between groups in terms of symptoms of delirium (p= 0.085), cognitive impairment (p= 0.151) and functional status (p= 0.235). However in the nursing intervention group, significant improvements in cognitive functioning (p= 0,005) and functional status (p= 0,000) as well as decreased delirium symptoms (p=0,003) were observed. The nursing intervention strategy was feasible and well received by the participants. Conclusion: Nursing intervention strategy to detect/prevent delirium appears to be effective but a larger clinical study is needed to confirm these preliminary findings. - Introduction : Un tiers des personnes âgées hospitalisées développent un état confusionnel aigu (ECA) et quittent l'hôpital sans que les symptômes ne soient résolus. D'autres peuvent développer des symptômes d'ECA à domicile après une hospitalisation ou une maladie aiguë. Pour ces raisons, des stratégies de détection et prévention précoces d'ECA doivent être développées, implantées et évaluées. But : Cette étude pilote avait pour but de développer et tester les effets d'une stratégie d'interventions infirmières pour détecter et prévenir l'ECA chez des personnes âgées à domicile après une hospitalisation ou une maladie récente. Dans un deuxième temps, la faisabilité et l'acceptabilité de l'implantation de cette stratégie auprès de cette population spécifique ainsi que de l'étude ont été évaluées. Méthode : Au total 114 personnes 65 ans) ont été recrutées entre février et novembre 2012. Les participants ont été randomisés, soit dans le groupe expérimental (GE, n=56), soit dans le groupe témoin (GT, n=58). En complément des soins usuels, une stratégie d'interventions de détection/prévention d'ECA a été dispensée au GE à 48 heures, 72 heures, 7 jours, 14 jours et 21 jours après le retour à domicile ou une maladie récente. Des données sociodémographiques et de santé (Indice de Masse Corporelle, relevé de la médication, comorbidités), la présence de symptômes d'ECA (Confusion Assessment Method), de troubles cognitifs (Mini évaluation de l'état mental) et de déficit fonctionnel (Activités de la vie quotidienne et instrumentales) ont été évalués à l'entrée de l'étude (T,). L'effet de la stratégie d'interventions a été mesuré sur le nombre de symptômes d'ECA, du déficit/état cognitif (Mini évaluation de l'état mental) et du déficit/état fonctionnel (Activités de la vie quotidienne) après un mois (T2). Des analyses descriptives et bivariées ont été effectuées. Résultats : Les deux groupes étaient équivalents au début de l'étude. Aucune différence significative n'a été retrouvée après un mois entre le GE et le GT par rapport au nombre de symptômes d'ECA (p= 0,085), au déficit cognitif (p= 0,151) et fonctionnel (p= 0,235). Toutefois, une amélioration significative a été observée dans le GE par rapport aux symptômes d'ECA (p= 0,003), aux déficits cognitifs (p= 0,005) et fonctionnels (p= 0,000) à un mois. La stratégie d'interventions s'avère faisable et a été bien acceptée par les participants. Conclusion : La stratégie d'interventions infirmières de détection/prévention d'ECA à domicile semble prometteuse, mais des études cliniques à large échelle sont nécessaires pour confirmer ces résultats préliminaires.

Etude prospective d'évaluation psychiatrique et pédagogique dans un service pour adolescents de la Fondation Santé des Etudiants de France. Méthodologie et résultats préliminaires [Prospective study of psychiatric and pedagogic evaluation of the adolescent service of the Student Health Foundation of France. Methodology and preliminary results].

The present prospective study, with a five-year follow-up, presents an extensive psychiatric and educational assessment of an adolescent population (N = 30) in the age range 14-20, suffering from several psychiatric disorders, though apt to follow a normal academic program. The residential settings where the study took place provide both psychiatric and schooling facilities. In this environment, what is the effectiveness of long-term hospitalization? Are there any criteria for predicting results? After discharge, could social adjustments difficulties be prevented? Assessment instruments are described and the results of one preliminary study are presented. The actual data seems to confirm the impact of the special treatment facilities combining schooling and psychiatric settings on the long term outcome of adolescents.

The Use of Remote Sensing Techniques Compared to Traditional Archaeological Phase II Testing Methods: A Cost-Benefit Analysis, HR-524, 1986

Remote sensing was utilized in the Phase II Cultural Resources Investigation for this project in lieu of extensive excavations. The purpose of the present report is to compare the costs and benefits of the use of remote sensing to the hypothetical use of traditional excavation methods for this project. Estimates for this hypothetical situation are based on the project archaeologist's considerable past experience in conducting similar investigations. Only that part of the Phase II investigation involving field investigations is addressed in this report. Costs for literature review, laboratory analysis, report preparation, etc., are not included. The project manager proposed the use of this technique for the fol lowing logistic, safety and budgetary reasons.

Auto-évaluation de la qualité d'un site Internet de pharmacie hospitalière

Introduction: L'unité d'Assistance Pharmaceutique de la Pharmacie des HUG fonctionne comme centre d'information sur les médicaments et gère des informations mises à disposition sur le web. Celles-ci sont destinées prioritairement au personnel soignant des HUG et accessibles sur le site intranet/Internet (http://www.hcuge.ch/Pharmacie), mis en service en 1998. L'objectif de ce travail était d'évaluer la qualité de l'information du site intranet/Internet et d'y apporter les améliorations nécessaires. Méthode: Le site intranet/Internet de la pharmacie des HUG a été évalué en automne 2004 à l'aide de 2 outils : NetScoring : grille d'évaluation de la qualité de l'information de santé sur Internet (http://www.chu-rouen.fr/netscoring/). Elle comporte 49 critères répartis en 8 catégories. Chaque critère est noté sur une échelle de 5 occurrences puis pondéré selon son importance (multiplication par 3 si le critère est essentiel, par 2 s'il est important ou par 1 s'il est mineur). Analyse AMDEC : méthode permettant de séquencer un processus et d'en Analyser les Modes de Défaillance, leur Effet et leur Criticité (Qual Saf Health Care 2005 :14(2);93-98). Un score est attribué à chaque mode de défaillance identifié en terme de fréquence, de sévérité et de détectabilité. La multiplication des 3 scores fournit un résultat global de criticité (indice de criticité IC, max. 810), permettant de hiérarchiser les risques. Résultats: Etat des lieux NetScoring : La qualité globale du site intranet/Internet était bonne (202 pts/312). Les points forts concernaient la pertinence et l'utilité du site, la qualité du contenu, du moteur de recherche et du design, la rapidité de chargement du site, la sélection des liens externes proposés et le respect du secret médical. Les faiblesses résidaient dans l'absence de politique de mise à jour régulière, d'annotation systématique de l'état d'actualisation des documents, d'un comité éditorial et scientifique, de mots-clés en anglais et d'une liste permettant l'identification des auteurs. Analyse AMDEC : Quatre catégories (création du document, conversion, structure du site et publication du document) et 19 modes de défaillances ont été caractérisés. Trois modes de défaillance étaient associés à un IC important: erreurs lors de la création d'un document (IC 256), information inadéquate car pratique non validée ou recommandation non généralisable (IC 147) et absence de relecture après la conversion du document en format publiable (ex : PDF) (IC 144). Mesures correctives: Une procédure standard (SOP) a été élaborée pour la gestion du site intranet/Internet. Le format standard des informations (initiales de l'auteur, dates de création et de mise à jour, logo de la pharmacie), la validation et la politique de mise à jour des documents ainsi que la procédure d'archivage y sont clairement définis. Une fiche de suivi accompagnant chaque document a été créée pour la traçabilité de toutes les modifications effectuées et la fréquence de révision à respecter. Discussion et conclusion Cette étude a permis de déterminer et de quantifier les points critiques à améliorer sur le site intranet/Internet de la Pharmacie des HUG. Les mesures correctives entreprises doivent permettre d'améliorer les principales faiblesses et défaillances mises en évidence. La mise en place d'un comité éditorial et scientifique devra être évaluée à l'avenir. Le NetScoring et l'analyse AMDEC sont des outils utiles pour l'évaluation et l'amélioration continue de la qualité d'un site Internet, sous réserve d'une interprétation critique des résultats obtenus avant la mise en place de mesures correctives. Malgré une approche totalement différente, ces outils ont permis de mettre en évidence des lacunes similaires.

Development of In Situ Detection Methods for Materials-Related Distress (MRD) in Concrete Pavements: Phase 2, HR-1081, 2005

This project utilized information from ground penetrating radar (GPR) and visual inspection via the pavement profile scanner (PPS) in proof-of-concept trials. GPR tests were carried out on a variety of portland cement concrete pavements and laboratory concrete specimens. Results indicated that the higher frequency GPR antennas were capable of detecting subsurface distress in two of the three pavement sites investigated. However, the GPR systems failed to detect distress in one pavement site that exhibited extensive cracking. Laboratory experiments indicated that moisture conditions in the cracked pavement probably explain the failure. Accurate surveys need to account for moisture in the pavement slab. Importantly, however, once the pavement site exhibits severe surface cracking, there is little need for GPR, which is primarily used to detect distress that is not observed visually. Two visual inspections were also conducted for this study by personnel from Mandli Communications, Inc., and the Iowa Department of Transportation (DOT). The surveys were conducted using an Iowa DOT video log van that Mandli had fitted with additional equipment. The first survey was an extended demonstration of the PPS system. The second survey utilized the PPS with a downward imaging system that provided high-resolution pavement images. Experimental difficulties occurred during both studies; however, enough information was extracted to consider both surveys successful in identifying pavement surface distress. The results obtained from both GPR testing and visual inspections were helpful in identifying sites that exhibited materials-related distress, and both were considered to have passed the proof-of-concept trials. However, neither method can currently diagnose materials-related distress. Both techniques only detected the symptoms of materials-related distress; the actual diagnosis still relied on coring and subsequent petrographic examination. Both technologies are currently in rapid development, and the limitations may be overcome as the technologies advance and mature.

Sieve Analysis of Combined Aggregate Samples by Different Test Methods, MLR-84-05, 1982

This past winter the sieve analysis of combined aggregate was investigated. This study was given No. 26 by the Central Laboratory. The purpose of this work was to try and develop a sieve analysis procedure for combined aggregate which is less time consuming and has the same accuracy as the method described in I.M. 304. In an attempt to use a variety of aggregates for this investigation, a request was made to each District Materials Office to obtain at least 3 different combined aggregate samples in their respective districts. At the same time it was also requested that the field technician test these samples, prior to submitting them to the Central Laboratory. The field technician was instructed to test each sample as described in method I.M. 304 and also by a modified AASHTO T27 method which will be identified in the report as Method A. The modified AASHTO Method A was identical to T27 with the exception that a smaller sample is used for testing. The field technicians submitted the samples, test results and also comments regarding the modified AASHTO procedure. The general comments of the modified AASHTO procedure were: The method was much simpler to follow; however, it took about the same amount of time so there was no real advantage. After reviewing AASHTO T27, T164, I.M. 304 and Report No. FHWA-RD-77-53 another test method was purposed. Report No. FHWA-RD-77-53 is a report prepared by FHWA from data they gathered concerning control practices and shortcut or alternative test methods for aggregate gradation. A second test method was developed which also was very similar to AASHTO T27, The test procedure for this method is attached and is identified as Method B. The following is a summary of test results submitted by the Field Technicians and obtained by the aggregate section of the Central Laboratory.

Evaluation of Transverse Joint Forming Methods for PCC Pavement, TR-532, 2006

The members of the Iowa Concrete Paving Association, the National Concrete Pavement Technology Center Research Committee, and the Iowa Highway Research Board commissioned a study to examine alternative ways of developing transverse joints in portland cement concrete pavements. The present study investigated six separate variations of vertical metal strips placed above and below the dowels in conventional baskets. In addition, the study investigated existing patented assemblies and a new assembly developed in Spain and used in Australia. The metal assemblies were placed in a new pavement and allowed to stay in place for 30 days before the Iowa Department of Transportation staff terminated the test by directing the contractor to saw and seal the joints. This report describes the design, construction, testing, and conclusions of the project.

Rehabilitation of Concrete Pavements Utilizing Rubblization and Crack and Seat Methods (Phase II): Performance Evaluation of Rubblized Pavements in Iowa, TR-550, 2008

This Phase II follow-up study of IHRB Project TR-473 focused on the performance evaluation of rubblized pavements in Iowa. The primary objective of this study was to evaluate the structural condition of existing rubblized concrete pavements across Iowa through Falling Weight Deflectometer (FWD) tests, Dynamic Cone Penetrometer (DCP) tests, visual pavement distress surveys, etc. Through backcalculation of FWD deflection data using the Iowa State University's advanced layer moduli backcalculation program, the rubblized layer moduli were determined for various projects and compared with each other for correlating with the long-term pavement performance. The AASHTO structural layer coefficient for rubblized layer was also calculated using the rubblized layer moduli. To validate the mechanistic-empirical (M-E) hot mix asphalt (HMA) overlay thickness design procedure developed during the Phase I study, the actual HMA overlay thicknesses from the rubblization projects were compared with the predicted thicknesses obtained from the design software. The results of this study show that rubblization is a valid option to use in Iowa in the rehabilitation of portland cement concrete pavements provided the foundation is strong enough to support construction operations during the rubblization process. The M-E structural design methodology developed during Phase I can estimate the HMA overlay thickness reasonably well to achieve long-lasting performance of HMA pavements. The rehabilitation strategy is recommended for continued use in Iowa under those conditions conducive for rubblization.

Determination and Evaluation of Alternate Methods for Managing and Controlling Highway-Related Dust, TR-449, 2002

Road dust is caused by wind entraining fine material from the roadway surface and the main source of Iowa road dust is attrition of carbonate rock used as aggregate. The mechanisms of dust suppression can be considered as two processes: increasing particle size of the surface fines by agglomeration and inhibiting degradation of the coarse material. Agglomeration may occur by capillary tension in the pore water, surfactants that increase bonding between clay particles, and cements that bind the mineral matter together. Hygroscopic dust suppressants such as calcium chloride have short durations of effectiveness because capillary tension is the primary agglomeration mechanism. Somewhat more permanent methods of agglomeration result from chemicals that cement smaller particles into a mat or larger particles. The cements include lignosulfonates, resins, and asphalt products. The duration of the cements depend on their solubility and the climate. The only dust palliative that decreases aggregate degradation is shredded shingles that act as cushions between aggregate particles. It is likely that synthetic polymers also provide some protection against coarse aggregate attrition. Calcium chloride and lignosulfonates are widely used in Iowa. Both palliatives have a useful duration of about 6 months. Calcium chloride is effective with surface soils of moderate fine content and plasticity whereas lignin works best with materials that have high fine content and high plasticity indices. Bentonite appears to be effective for up to two years and works well with surface materials having low fines and plasticity and works well with limestone aggregate. Selection of appropriate dust suppressants should be based on characterization of the road surface material. Estimation of dosage rates for potential palliatives can be based on data from this report, from technical reports, information from reliable vendors, or laboratory screening tests. The selection should include economic analysis of construction and maintenance costs. The effectiveness of the treatment should be evaluated by any of the field performance measuring techniques discussed in this report. Novel dust control agents that need research for potential application in Iowa include; acidulated soybean oil (soapstock), soybean oil, ground up asphalt shingles, and foamed asphalt. New laboratory evaluation protocols to screen additives for potential effectiveness and determine dosage are needed. A modification of ASTM D 560 to estimate the freeze-thaw and wet-dry durability of Portland cement stabilized soils would be a starting point for improved laboratory testing of dust palliatives.

Methods for Estimating Annual Exceedance-Probability Discharges for Streams in Iowa, Based on Data through Water Year 2010, TR-519, 2013

A statewide study was performed to develop regional regression equations for estimating selected annual exceedance- probability statistics for ungaged stream sites in Iowa. The study area comprises streamgages located within Iowa and 50 miles beyond the State’s borders. Annual exceedanceprobability estimates were computed for 518 streamgages by using the expected moments algorithm to fit a Pearson Type III distribution to the logarithms of annual peak discharges for each streamgage using annual peak-discharge data through 2010. The estimation of the selected statistics included a Bayesian weighted least-squares/generalized least-squares regression analysis to update regional skew coefficients for the 518 streamgages. Low-outlier and historic information were incorporated into the annual exceedance-probability analyses, and a generalized Grubbs-Beck test was used to detect multiple potentially influential low flows. Also, geographic information system software was used to measure 59 selected basin characteristics for each streamgage. Regional regression analysis, using generalized leastsquares regression, was used to develop a set of equations for each flood region in Iowa for estimating discharges for ungaged stream sites with 50-, 20-, 10-, 4-, 2-, 1-, 0.5-, and 0.2-percent annual exceedance probabilities, which are equivalent to annual flood-frequency recurrence intervals of 2, 5, 10, 25, 50, 100, 200, and 500 years, respectively. A total of 394 streamgages were included in the development of regional regression equations for three flood regions (regions 1, 2, and 3) that were defined for Iowa based on landform regions and soil regions. Average standard errors of prediction range from 31.8 to 45.2 percent for flood region 1, 19.4 to 46.8 percent for flood region 2, and 26.5 to 43.1 percent for flood region 3. The pseudo coefficients of determination for the generalized leastsquares equations range from 90.8 to 96.2 percent for flood region 1, 91.5 to 97.9 percent for flood region 2, and 92.4 to 96.0 percent for flood region 3. The regression equations are applicable only to stream sites in Iowa with flows not significantly affected by regulation, diversion, channelization, backwater, or urbanization and with basin characteristics within the range of those used to develop the equations. These regression equations will be implemented within the U.S. Geological Survey StreamStats Web-based geographic information system tool. StreamStats allows users to click on any ungaged site on a river and compute estimates of the eight selected statistics; in addition, 90-percent prediction intervals and the measured basin characteristics for the ungaged sites also are provided by the Web-based tool. StreamStats also allows users to click on any streamgage in Iowa and estimates computed for these eight selected statistics are provided for the streamgage.

Evaluation of Design Flood Frequency Methods for Iowa Streams, TR-533, 2009

The objective of this project was to assess the predictive accuracy of flood frequency estimation for small Iowa streams based on the Rational Method, the NRCS curve number approach, and the Iowa Runoff Chart. The evaluation was based on comparisons of flood frequency estimates at sites with sufficiently long streamgage records in the Midwest, and selected urban sites throughout the United States. The predictive accuracy and systematic biases (under- or over-estimation) of the approaches was evaluated based on forty-six Midwest sites and twenty-one urban sites. The sensitivity of several watershed characteristics such as soil properties, slope, and land use classification was also explored. Recommendations on needed changes or refinements for applications to Iowa streams are made.

Improved Methods for Determining Wind Loads on Highway Sign and Traffic-Signal Structures, TR-559, 2007

The main objective of the proposed study is to use Computational Fluid Dynamics (CFD) tools to determine the wind loads by accurate numerical simulations of air flow characteristics around large highway sign structures under severe wind speeds conditions. Fully three-dimensional Reynolds- Averaged Navier-Stokes (RANS) simulations are used to estimate the total force on different panels, as well as the actual pressure distribution on the front and back faces of the panels. In particular, the present study investigates the effects of aspect ratio and sign spacing for regular panels, the effect of sign depth for the dynamic message signs that are now being used on Iowa highways, the effect induced by the presence of back-to-back signs, the effect of the presence of add-on exit signs, and the effect of the presence of trucks underneath the signs potentially creating “wind tunnel” effect.