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Objectives: To determine concordance between an explicit protocolized assessment of the Richmond Agitation‐Sedation Scale and an assessment performed during usual care nursing practice. Research Design: In an urban, safety‐net hospital, intensive care nurses previously trained in sedation assessment recorded a bedside Richmond Agitation‐Sedation Scale assessment, while study investigators used an explicit script to perform the assessment at a similar time point. Kappa indices determined concordance of the assessments. Bivariate analyses explored factors associated with discordance and unresponsiveness. Results: Twenty‐one subjects with 38 observations were analysed. Bedside nursing assessment was poorly concordant with protocolized assessment (ƙ = 0.21) with the former reporting significantly lighter sedation (median −2 vs. −5, p =.01). Bedside assessment was significantly less likely than protocolized assessment to categorize subjects as unresponsive (29 vs. 50%, p =.02). Conclusion: Methods used in usual clinical practice to assess adequacy of sedation frequently led to oversedation. We propose that care erosion, the deterioration of skills over time, may help explain this finding. Implications for Nursing Management: Results suggest sedation assessment may be particularly vulnerable to care erosion. Nurse managers should monitor for signs of care erosion and consider utilization of explicit scripts during sedation assessment and/or frequent education to ensure sedation assessment accuracy. [ABSTRACT FROM AUTHOR]

Relocation of large numbers of critically ill patients between hospitals is sometimes necessary and the risks associated with relocation may be high. In the setting of adherence to an interhospital intensive care unit (ICU) relocation protocol, we aimed to determine whether the interhospital relocation of all ICU patients in a single day is associated with changes in vital signs, device removal, and worse clinical outcomes. We conducted a prospective, observational, cohort study of all critically ill adults admitted to a tertiary medical center's ICUs on the day of a planned hospital relocation and exposed to interhospital ICU relocation compared with unexposed critically ill adults. Changes in vital signs were evaluated by the before-and-after interhospital relocation measurement of vital signs, and clinical outcomes were collected for all patients. A total of 699 patients were admitted to the ICU during the observation period, 24 of whom were exposed to interhospital ICU relocation on a single day. The median interhospital transport duration was 28 minutes (interquartile range: 24-35) and 29% of patients were receiving invasive mechanical ventilation. Patients exposed to interhospital ICU relocation had no significant change in any vital sign measurement and no devices were unintentionally removed. Inhospital mortality was similar (8.3%) to patients not exposed to interhospital ICU relocation (9.2%, P > .99). In the setting of adherence to an ICU relocation protocol, the interhospital ICU relocation of all critically ill adults during a single day is not associated with changes in vital signs, device removal, or worse clinical outcomes. [ABSTRACT FROM AUTHOR]

Knowledge of the effects of nutrient concentration on the composition and structure of photoautotrophic periphyton is essential to understand the impact of eutrophication on shallow lotic systems. Reaches of Sulphur Fork Creek upstream and downstream of effluent from Springfield Wastewater Treatment Plant in Middle Tennessee were sampled to assess the effects of trophic state on characteristics of photoautotrophic periphyton, including composition of diatom and soft-algae assemblages. Pearson's correlation coefficient (r) for log10-transformed concentrations of soluble reactive phosphorus (log10[SRP]) to percent composition was significant for 4 of 63 soft-algae taxa sampled from cobbles. Five algae trophic indices (ATIs) to assess the effects of trophic state on soft-algae assemblages were developed using different taxon-trophic indicators which included: (1)rvalues for log10[SRP] to percent composition (ATIr), (2) abundance-weighted averages of [SRP] (ATIA-WA [SRP]), (3) abundance-weighted averages of log10[SRP] (ATIA-WA log [SRP]), (4) weighted averages of log10[SRP] where the taxa occur, and (5) abundance-weighted ranks to phosphorus tolerance listed by the National Water-Quality Assessment Program. Eutrophication-induced impairment of Sulphur Fork Creek downstream of the effluent from the wastewater treatment plant was indicated by: (1) high concentrations of photoautotrophic periphyton, (2) low values for the pollution tolerance index of diatom assemblages, (3) positive values for the ATIr, and (4) high values for both the ATIA-WA [SRP]and ATIA-WA log [SRP]. Of the indices using soft-algae taxa evaluated, the ATIrexhibits the strongest and significant correlations to [SRP], [NO2+ NO3nitrogen], and the pollution tolerance index of diatom assemblages. The ATIraccurately reflects the trophic state of the sites studied and provides a novel additional tool to evaluate the effects of nutrient concentration on the structure of photoautotrophic-periphyton assemblages. [ABSTRACT FROM AUTHOR]