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Introduction: Geriatric emergency department (ED) guidelines emphasize timely identification of delirium. This article updates previous diagnostic accuracy systematic reviews of history, physical examination, laboratory testing, and ED screening instruments for the diagnosis of delirium as well as test–treatment thresholds for ED delirium screening. Methods: We conducted a systematic review to quantify the diagnostic accuracy of approaches to identify delirium. Studies were included if they described adults aged 60 or older evaluated in the ED setting with an index test for delirium compared with an acceptable criterion standard for delirium. Data were extracted and studies were reviewed for risk of bias. When appropriate, we conducted a meta‐analysis and estimated delirium screening thresholds. Results: Full‐text review was performed on 55 studies and 27 were included in the current analysis. No studies were identified exploring the accuracy of findings on history or laboratory analysis. While two studies reported clinicians accurately rule in delirium, clinician gestalt is inadequate to rule out delirium. We report meta‐analysis on three studies that quantified the accuracy of the 4 A's Test (4AT) to rule in (pooled positive likelihood ratio [LR+] 7.5, 95% confidence interval [CI] 2.7–20.7) and rule out (pooled negative likelihood ratio [LR−] 0.18, 95% CI 0.09–0.34) delirium. We also conducted meta‐analysis of two studies that quantified the accuracy of the Abbreviated Mental Test‐4 (AMT‐4) and found that the pooled LR+ (4.3, 95% CI 2.4–7.8) was lower than that observed for the 4AT, but the pooled LR− (0.22, 95% CI 0.05–1) was similar. Based on one study the Confusion Assessment Method for the Intensive Care Unit (CAM‐ICU) is the superior instrument to rule in delirium. The calculated test threshold is 2% and the treatment threshold is 11%. Conclusions: The quantitative accuracy of history and physical examination to identify ED delirium is virtually unexplored. The 4AT has the largest quantity of ED‐based research. Other screening instruments may more accurately rule in or rule out delirium. If the goal is to rule in delirium then the CAM‐ICU or brief CAM or modified CAM for the ED are superior instruments, although the accuracy of these screening tools are based on single‐center studies. To rule out delirium, the Delirium Triage Screen is superior based on one single‐center study. [ABSTRACT FROM AUTHOR]

Aim: Cultural appreciation is found within the arts, psychology, counseling, health disciplines, and education. Currently, in the literature, there is not a strong link between cultural appreciation, nursing, and Indigenous people. The aim of this concept analysis is to analyze the concept of cultural appreciation for nurse educators, nurse researchers, and nurse leaders to apply to culturally appreciate Indigenous people within their geographical areas which can result in meeting their wholistic care needs. Design: This concept analysis of cultural appreciation uses Walker & Avant's (2019) approach to define cultural appreciation, antecedents, empirical referents, and consequences. Results: The antecedents of cultural appreciation are cultural appropriation, oppression, cultural prejudice, privilege, and lack of knowledge to integrate the wholistic health of Indigenous people into practice, education, and research. The defining attributes of cultural appreciation are awareness, knowledge acquisition, and desire. The consequence of cultural appreciation is wholistic care of Indigenous people as defined by their ways of knowing and being. Conclusion: The concept analysis of cultural appreciation integrates Indigenous wholistic health beliefs and ways of knowing and being that can advance holistic nursing knowledge for nurses, educators, and researchers. [ABSTRACT FROM AUTHOR]

Copyright of Revista Brasileira de Oftalmologia is the property of Sociedade Brasileira de Oftalmologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Perceptions of patient education and readiness for hospital discharge following elective total hip or knee arthroplasty, and the impact on 30-day hospital readmission, are described. Evaluating patient education and readiness for hospital discharge can provide the healthcare team with a targeted focus on patients' struggle with energy, personal care, demands, and not feeling physically ready to go home. [ABSTRACT FROM AUTHOR]

Background The National Institutes of Health Stroke Scale (NIHSS) is used to quantify stroke severity. However, it favors detection of signs and symptoms indicative of anterior rather than posterior circulation strokes, especially in the middle cerebral artery. Purpose A prospective study explored the feasibility of use of the e-NIHSS by medical- surgical stroke nurse responders. Secondarily, it described the correlation between e-NIHSS findings and diagnosis of posterior circulation stroke determined by the neurologist based on clinical and neurodiagnostic results. Method A prospective, exploratory design was used to determine effectiveness of the e-NIHSS in identifying posterior circulation strokes in an urban emergency department. Results Nine patients were diagnosed with a posterior circulation stroke based on imaging, with three having trunk ataxia identified by nurse stroke responders. Subjective findings included complaints of nausea and vomiting, dizziness, lightheadedness, and headache. In 40 assessments, there were no positive findings using the e-NIHSS; in these 40 cases, neuroimaging was negative for acute stroke. Tongue deviation and trunk ataxia was noted in patients without pathology or posterior circulation stroke on imaging. Sensitivity was calculated at 33% and specificity 83%. Conclusion The additional six e-NIHSS items are easy to assess, except standing the patient was found to be challenging physically and required excessive time. Trunk ataxia, falling to one side when sitting up, suggested posterior circulation compromise. [ABSTRACT FROM AUTHOR]

Purpose : To determine the effect of Reiki on pain and anxiety in women in antepartum, intrapartum, postpartum, gynecology, and gyn/oncology, settings. Method : This exploratory, comparative study used a Likert-type scale of 0 to 10 to measure pain and anxiety, and a survey asking about lingering effects of treatment. Results : Mean pain scores after Reiki significantly decreased from 3.24 to 1.52 (n = 203; z = −11.67, p <.001). Mean anxiety scores after Reiki significantly decreased from 3.56 to 1.28 (n = 195; z = −11.42, p <.001). Women were asked if the effects lingered for any length of time post–Reiki treatment, and 91 of 101 responded affirmatively that decreased pain and/or anxiety continued. Conclusion : Findings from this study confirm the positive and lingering effects of Reiki in women hospitalized for obstetrical and gynecological conditions. [ABSTRACT FROM AUTHOR]

Background: Literature searches underlie the foundations of systematic reviews and related review types. Yet, the literature searching component of systematic reviews and related review types is often poorly reported. Guidance for literature search reporting has been diverse, and, in many cases, does not offer enough detail to authors who need more specific information about reporting search methods and information sources in a clear, reproducible way. This document presents the PRISMA-S (Preferred Reporting Items for Systematic reviews and Meta-Analyses literature search extension) checklist, and explanation and elaboration. Methods: The checklist was developed using a 3-stage Delphi survey process, followed by a consensus conference and public review process. Results: The final checklist includes 16 reporting items, each of which is detailed with exemplar reporting and rationale. Conclusions: The intent of PRISMA-S is to complement the PRISMA Statement and its extensions by providing a checklist that could be used by interdisciplinary authors, editors, and peer reviewers to verify that each component of a search is completely reported and therefore reproducible. [ABSTRACT FROM AUTHOR]

Generalized standard interventions based on level of risk are current practices for fall prevention, but not individualized. Dykes and colleagues (2017) developed and tested a patient-centered, individualized approach to fall prevention using an 11 x 17-inch wall poster to engage patients/families in fall prevention at the bedside. Aim Replicate the study by Dykes and coauthors (2017) on a medical telemetry unit, exploring adoption of a patient-centered fall prevention tool and its impact on patient knowledge of fall risk factors and interventions, fall rates, and injury rates. Method A pre- and post-intervention design was used to compare patients' perceived knowledge and actual fall rates before and after implementating the tool and processes. Thirty patients were interviewed before the study and at 1-, 3-, and 6-month time points during implementation (N=120). Number and rates of falls per 1,000 patient days were calculated. Audits were completed randomly to monitor adherence to the process. Results Patients were more knowledgeable about falls at months 1, 3, and 6 compared to pre-intervention (p=0.001-0.05). Fall rates fluctuated over the 6-month study, with overall reduction from 3.3% (pre-) to 1.9% (post-). Staff was 85% adherent with use of the laminated poster, with adherence increasing over time. Limitations and Implications Findings are limited to one hospital and one medical telemetry unit. Results support the potential for a best practice change. Plans are to disseminate this new process to other patient units. Conclusion Replication in patient units outside the medical telemetry arena is suggested. [ABSTRACT FROM AUTHOR]

A mixed methods design was used to facilitate an understanding of what early interventionists (EIs) experience when working with families living in poverty. EIs working in a large urban area (n = 306) completed an online survey and participated in a follow-up focus group (n = 7). EIs reported that logistical challenges and family/EIs stressors (e.g. domestic violence, personal safety concerns) impacted and often interrupted EI service delivery to families living in poverty. Implications for policy and professional development are described. [ABSTRACT FROM AUTHOR]

Copyright of EuroChoices is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Although dual independent review of search results by two reviewers is generally recommended for systematic reviews, there are not consistent recommendations regarding the timing of the use of the second reviewer. This study compared the use of a complete dual review approach, with two reviewers in both the title/abstract screening stage and the full‐text screening stage, as compared with a limited dual review approach, with two reviewers only in the full‐text stage. Methods: This study was performed within the context of a large systematic review. Two reviewers performed a complete dual review of 15 000 search results and a limited dual review of 15 000 search results. The number of relevant studies mistakenly excluded by highly experienced reviewers in the complete dual review was compared with the number mistakenly excluded during the full‐text stage of the limited dual review. Results: In the complete dual review approach, an additional 6.6% to 9.1% of eligible studies were identified during the title/abstract stage by using two reviewers, and an additional 6.6% to 11.9% of eligible studies were identified during the full‐text stage by using two reviewers. In the limited dual review approach, an additional 4.4% to 5.3% of eligible studies were identified with the use of two reviewers. Conclusions: Using a second reviewer throughout the entire study screening process can increase the number of relevant studies identified for use in a systematic review. Systematic review performers should consider using a complete dual review process to ensure all relevant studies are included in their review. [ABSTRACT FROM AUTHOR]

Distractions threaten patient safety and quality of care. The purpose of this study was to explore hospital nurses' perceptions about distractions to the delivery of patient-centered care. Staffing issues, telephone ringing, computer issues, and multitasking were the four highest-rated distractors. [ABSTRACT FROM AUTHOR]

Background: Dementia is underrecognized in older adult emergency department (ED) patients, which threatens operational efficiency, diagnostic accuracy, and patient satisfaction. The Society for Academic Emergency Medicine geriatric ED guidelines advocate dementia screening using validated instruments. Objectives: The objective was to perform a systematic review and meta‐analysis of the diagnostic accuracy of sufficiently brief screening instruments for dementia in geriatric ED patients. A secondary objective was to define an evidence‐based pretest probability of dementia based on published research and then estimate disease thresholds at which dementia screening is most appropriate. This systematic review was registered with PROSPERO (CRD42017074855). Methods: PubMed, EMBASE, CINAHL, CENTRAL, DARE, and SCOPUS were searched. Studies in which ED patients ages 65 years or older for dementia were included if sufficient details to reconstruct 2 × 2 tables were reported. QUADAS‐2 was used to assess study quality with meta‐analysis reported if more than one study evaluated the same instrument against the same reference standard. Outcomes were sensitivity, specificity, and positive and negative likelihood ratios (LR+ and LR–). To identify test and treatment thresholds, we employed the Pauker‐Kassirer method. Results: A total of 1,616 publications were identified, of which 16 underwent full text‐review; nine studies were included with a weighted average dementia prevalence of 31% (range, 12%–43%). Eight studies used the Mini Mental Status Examination (MMSE) as the reference standard and the other study used the MMSE in conjunction with a geriatrician's neurocognitive evaluation. Blinding to the index test and/or reference standard was inadequate in four studies. Eight instruments were evaluated in 2,423 patients across four countries in Europe and North America. The Abbreviated Mental Test (AMT‐4) most accurately ruled in dementia (LR+ = 7.69 [95% confidence interval {CI} = 3.45–17.10]) while the Brief Alzheimer's Screen most accurately ruled out dementia (LR– = 0.10 [95% CI = 0.02–0.28]). Using estimates of diagnostic accuracy for AMT‐4 from this meta‐analysis as one trigger for more comprehensive geriatric vulnerability assessments, ED dementia screening benefits patients when the prescreening probability of dementia is between 14 and 36%. Conclusions: ED‐based diagnostic research for dementia screening is limited to a few studies using an inadequate criterion standard with variable masking of interpreter's access to the index test and the criterion standard. Standardizing the geriatric ED cognitive assessment methods, measures, and nomenclature is necessary to reduce uncertainties about diagnostic accuracy, reliability, and relevance in this acute care setting. The AMT‐4 is currently the most accurate ED screening instrument to increase the probability of dementia and the Brief Alzheimer's Screen is the most accurate to decrease the probability of dementia. Dementia screening as one marker of vulnerability to initiate comprehensive geriatric assessment is warranted based on test–treatment threshold calculations. [ABSTRACT FROM AUTHOR]

From the foundation of self-determination theory and existing literature on forms of power, we empirically explored relationships between followers' perceptions of their leader's use of various forms of power, followers' self-reported motivational outlooks, and followers' favorable work intentions. Using survey data collected from two studies of working professionals, we apply path analysis and hierarchical multiple regression to analyze variance among constructs of interest. We found that followers' perceptions of hard power use by their leaders (i.e., reward, coercive, and legitimate power) was often related to higher levels of sub-optimal motivation in followers (i.e., amotivation, external regulation, and introjected regulation). However, followers who perceived their leaders used soft power (i.e., expert, referent, and informational power) often experienced higher levels of optimal motivation (i.e., identified regulation and intrinsic motivation), but further investigation of soft power use is warranted. The quality of followers' motivational outlooks was also related to intentions to perform favorably for their organizations. [ABSTRACT FROM AUTHOR]

The Problem. Leadership competencies are designed to equip leaders with the knowledge, skills, abilities, and other characteristics, required to effectively lead people toward the achievement of organizational goals. However, advances in motivation science, specifically the development of self-determination theory, suggest that many current leadership competency models contain outdated approaches to motivation that undermine their intended purpose of leadership effectiveness. The Solution. New motivation leadership competencies grounded in self-determination theory are recommended to promote leadership behaviors that support people's psychological needs. These foundational competencies take advantage of compelling motivation research to provide a filtering mechanism for culling outdated competencies proven to undermine effective performance, but also provide the basis for congruent leadership skills that promote flourishing in the workplace. The Stakeholders. Human resource development (HRD) practitioners will benefit from the rationale and recommendations for introducing a new set of competencies based on self-determination theory into their leadership development efforts. While executives or leaders in the team and organizational contexts will appreciate the consideration of expanding or rethinking their own leader behaviors, the new competencies are most relevant for leaders of individual contributors in the one-to-one context. [ABSTRACT FROM AUTHOR]

Summary: The recent discovery of completely nitrifying Nitrospira demands a re‐examination of nitrifying environments to evaluate their contribution to nitrogen cycling. To approach this challenge, tools are needed to detect and quantify comammox Nitrospira. We present primers for the simultaneous quantification and diversity assessement of both comammox Nitrospira clades. The primers cover a wide range of comammox diversity, spanning all available high quality sequences. We applied these primers to 12 groundwater‐fed rapid sand filters, and found comammox Nitrospira to be abundant in all filters. Clade B comammox comprise the majority (∼75%) of comammox abundance in all filters. Nitrosomonadaceae were present in all filters, although at low abundance (mean = 1.8%). Ordination suggests that temperature impacts the structure of nitrifying communities, and in particular that increasing temperature favours Nitrospira. The nitrogen content of the filter material, sulfate concentration and surface ammonium loading rates shape the structure of the comammox guild in the filters. This work provides an assay for simultaneous detection and diversity assessment of clades A and B comammox Nitrospira, expands our current knowledge of comammox Nitrospira diversity and demonstrates a key role for comammox Nitrospira in nitrification in groundwater‐fed biofilters. [ABSTRACT FROM AUTHOR]