Effects of computer reminders on complications of peripheral venous catheters and nurses' adherence to a guideline in paediatric care : a cluster randomised study

BACKGROUND: Reminder systems in electronic patient records (EPR) have proven to affect both health care professionals' behaviour and patient outcomes. The aim of this cluster randomised trial was to investigate the effects of implementing a clinical practice guideline (CPG) for peripheral venous catheters (PVCs) in paediatric care in the format of reminders integrated in the EPRs, on PVC-related complications, and on registered nurses' (RNs') self-reported adherence to the guideline. An additional aim was to study the relationship between contextual factors and the outcomes of the intervention. METHODS: The study involved 12 inpatient units at a paediatric university hospital. The reminders included choice of PVC, hygiene, maintenance, and daily inspection of PVC site. Primary outcome was documented signs and symptoms of PVC-related complications at removal, retrieved from the EPR. Secondary outcome was RNs' adherence to a PVC guideline, collected through a questionnaire that also included RNs' perceived work context, as measured by the Alberta Context Tool. Units were allocated into two strata, based on occurrence of PVCs. A blinded simple draw of lots from each stratum randomised six units to the control and intervention groups, respectively. Units were not blinded. The intervention group included 626 PVCs at baseline and 618 post-intervention and the control group 724 PVCs at baseline and 674 post-intervention. RNs included at baseline were 212 (65.4 %) and 208 (71.5 %) post-intervention. RESULTS: No significant effect was found for the computer reminders on PVC-related complications nor on RNs' adherence to the guideline recommendations. The complication rate at baseline and post-intervention was 40.6 % (95 % confidence interval (CI) 36.7-44.5) and 41.9 % (95 % CI 38.0-45.8), for the intervention group and 40.3 % (95 % CI 36.8-44.0) and 46.9 % (95 % CI 43.1-50.7) for the control. In general, RNs' self-rated work context varied from moderately low to moderately high, indicating that conditions for a successful implementation to occur were less optimal. CONCLUSIONS: The reminders might have benefitted from being accompanied by a tailored intervention that targeted specific barriers, such as the low frequency of recorded reasons for removal, the low adherence to daily inspection of PVC sites, and the lack of regular feedback to the RNs. TRIAL REGISTRATION: Current Controlled Trials ISRCTN44819426.

Major developments in conulariid research: problems of interpretation and future perspectives

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Locomotion problems of broiler chickens and its relationship with the gait score

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

The use of the two-body energy to study problems of escape/capture Ernesto Vieira Neto1

The problem of escape/capture is encountered in many problems of the celestial mechanics -the capture of the giants planets irregular satellites, comets capture by Jupiter, and also orbital transfer between two celestial bodies as Earth and Moon. To study these problems we introduce an approach which is based on the numerical integration of a grid of initial conditions. The two-body energy of the particle relative to a celestial body defines the escape/capture. The trajectories are integrated into the past from initial conditions with negative two-body energy. The energy change from negative to positive is considered as an escape. By reversing the time, this escape turns into a capture. Using this technique we can understand many characteristics of the problem, as the maximum capture time, stable regions where the particles cannot escape from, and others. The advantage of this kind of approach is that it can be used out of plane (that is, for any inclination), and with perturbations in the dynamics of the n-body problem. © 2005 International Astronomical Union.

The problems of intellectual property in Latin America and how to address them

Includes bibliography

Finding solutions to the debt problems of developing countries: report of the Executive Committee on Economic and Social Affairs of the United Nations (New York, 20 May 1999)

Includes bibliography

Entransy and its utilization in problems of thermodynamics and heat transfer

The concept of entransy was recently proposed in terms of the analogy to the electric energy stored in a capacitor. The entransy of a system describes its heat transfer ability, as the exergy of a system quantifies its work production potential. Hence, the concept of entransy can be useful in problems where the heat transfer is the main objective, as for example, in systems collecting solar energy. This concept is quite recent and there are only a few works related to this topic. It is expected, however, that this approach will soon be used more often in the analysis of problems in thermodynamics and heat transfer. The objective of this work is to present a review of the concept of entransy in a systematic way, beginning with its definition, balance equations and a few examples of simple applications. It is hoped that this concept of entransy becomes a useful tool in the analysis and design of more efficient thermal systems. © 2012 Praise Worthy Prize S.r.l.- All rights reserved.

The IPALCA Network: an answer to the problems of locating population information in Latin America and the Caribbean

Includes bibliography

Six problems of development planning in the Caribbean

Includes bibliography

Scope, objectives and special problems of planning for agricultural development with reference to Barbados

Describe la organización, metas y objetivos del proceso de planificación para el desarrollo de la agricultura en Barbados.

The external debt and the financial problems of Latin America

Se refiere a las magnitudes envueltas en los problemas financieros de America Latina, al aumento de la deuda externa latinoamericana, y las razones y consecuencias de ese aumento. Plantea las soluciones de emergencia y de mediano plazo, tanto a nivel nacional como internacional, y las perspectivas para el futuro cercano.