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Background A multicentre randomised trial demonstrated improved outcomes for intensive care unit (ICU) patients using early, goal-directed mobility implemented by nurses. Objectives The aim of the study was to evaluate barriers to nursing mobility, using a validated survey, during an ongoing quality improvement (QI) project (2019) in a medical ICU and determine changes from the pre-QI (2017) baseline. Methods Nurses, nurse practitioners, physician assistants, and clinical technicians completed the 26-item Patient Mobilization Attitudes and Beliefs Survey for the ICU (PMABS-ICU). An overall score and three subscale scores (knowledge, attitudes, behaviour), each ranging from 0 to 100, were calculated; higher scores indicated greater barriers. Results Seventy-five (93% response rate) nurses, eight (100%) nurse practitioners and physician assistants, and 11 (100%) clinical technicians completed the PMABS-ICU. For all respondents (N = 94), the mean (standard deviation) overall PMABS-ICU score was 32 (8) and the knowledge, attitudes and behaviour subscale scores were 22 (11), 33 (11), and 34 (8), respectively. Among all respondents completing the survey in both 2017 and 2019 (N = 46), there was improvement in the mean (95% confidence interval) overall score [−3.1 (−5.8, −0.5); p = .022] and in the knowledge [−5.1 (−8.9, −1.3); p = .010] and attitudes [−3.9 (−7.3, −0.6); p = .023] subscale scores. Among all respondents (N = 48) taking the PMABS-ICU for the first time in 2019 compared with those taking the survey before the QI project in 2017 (N = 99), there was improvement in the mean (95% confidence interval) overall score [−3.8 (−6.5, −1.1); p = .007] and in the knowledge [−6.9 (−11.0, –2.7); p = .001] and attitude [−4.3 (−8.1, –0.5); p = .027] subscale scores. Conclusions Using a validated survey administered to ICU nurses and other staff, before and during a structured QI project, there was a decrease in perceived barriers to mobility. Reduced barriers among those taking the survey for the first time during the QI project compared with those taking the survey before the QI project suggests a positive culture change supporting early, goal-directed mobility implemented by nurses.

Background Delirium in the intensive care unit is associated with poor patient outcomes. Recent studies support nonpharmacological therapy, including cognitive stimulation, to address delirium. Understanding barriers to cognitive stimulation implemented by nurses during clinical care is essential to translating evidence into practice. Objective To use qualitative methods through a structured quality improvement project to understand nurses’ perceived barriers to implementing a cognitive stimulation intervention in a medical intensive care unit. Methods Data were collected through semistructured interviews with nurses in a medical intensive care unit. Data were categorized into themes by using thematic analysis and the Consolidated Framework for Implementation Research. During cognitive stimulation, nurses reviewed with patients a workbook of evidence-based tasks (focused on math, alertness, motor skills, visual perception, memory, problem-solving, and language). Results The 23 nurses identified 62 barriers to and 26 facilitators of cognitive stimulation. These data were summarized into 12 barrier and 9 facilitator themes corresponding to the following Consolidated Framework for Implementation Research domains: Intervention Characteristics, Outer Setting, Inner Setting, and Characteristics of Individuals. Nurses also identified several facilitators within the Process domain. Patient-specific variables, including sedation, were the most frequently reported barriers. Other barriers included cognitive stimulation not being prioritized, nursing staff–related issues, documentation burden, and a lack of understanding of, or appreciation for, the evidence supporting cognitive stimulation. Conclusions Implementation of cognitive stimulation requires a multidisciplinary approach to address perceived barriers arising from the organization, context, and individuals associated with the intervention, as well as the intervention itself.

Background: Malnutrition remains a public health issue among children in resource poor countries where seasonality affects food availability, food consumption, and nutritional status of a population. The aim of this study was to determine prevalence of anemia, low vitamin A and associated factors in school-age children in dry and wet season in a peri-urban setting. Methods: This was a six months observational study where data and samples were collected from school age children 6–12 years in mid-March (dry season) and mid-August (rainy season) 2020. Data and biological samples collected, were analyzed to determine prevalence of adequate dietary intakes, anemia, low vitamin A, and under-nutrition among participants. Results: The study participants had 40.9% and 32.3% prevalence of anemia, 30.1% and 19.4% prevalence of low vitamin A, 12.9% and 10.8% level of wasting, and 63.4% and 94.6% level of adequate iron intake in the dry and wet seasons respectively. The cohort of anemic participants had mean hemoglobin concentrations as 10.6(1.7)ug/dl and 11.4(91.1)ug/dl in the dry and wet seasons respectively and significantly different at p = 0.001. The prevalence of anemia among them declined from 100.0% in the dry season to 79.0% in the wet season. They had mean serum retinol concentration as 22.4(6.4)ug/dl and 25.0(8.9)ug/dl, (significantly different at p = 0.014), prevalence of low vitamin A at 36.8% and 31.6%, prevalence of wasting as 23.7% and 18.4%, and prevalence of thinness as 10.2% and 7.9% in the dry and wet seasons respectively. Anemia associated significantly with parental monthly income of 1000–1500 cedis (180–269 USD), (OR:046, p = 0.039), and low vitamin A level (

Purpose: Early mobilization in the intensive care unit (ICU) can improve patient outcomes but has perceived barriers to implementation. As part of an ongoing structured quality improvement project to increase mobilization of medical ICU patients by nurses and clinical technicians, we adapted the existing, validated Patient Mobilization Attitudes & Beliefs Survey (PMABS) for the ICU setting and evaluated its performance characteristics and results. Materials and Methods: The 26-item PMABS adapted for the ICU (PMABS-ICU) was administered as an online survey to 163 nurses, clinical technicians, respiratory therapists, attending and fellow physicians, nurse practitioners, and physician assistants in one medical ICU. We evaluated the overall and subscale (knowledge, attitude, and behavior) scores and compared these scores by respondent characteristics (clinical role and years of work experience). Results: The survey response rate was 96% (155/163). The survey demonstrated acceptable discriminant validity and acceptable internal consistency for the overall scale (Cronbach α: 0.82, 95% confidence interval: 0.76-0.85), with weaker internal consistency for all subscales (Cronbach α: 0.62-0.69). Across all respondent groups, the overall barrier score (range: 1-100) was relatively low, with attending physicians perceiving the lowest barriers (median [interquartile range]: 30 [28-34]) and nurses perceiving the highest (37 [31-40]). Within the first 10 years of work experience, greater experience was associated with a lower overall barrier score (−0.8 for each additional year; P = 0.02). Conclusions: In our medical ICU, across 6 different clinical roles, there were relatively low perceived barriers to patient mobility, with greater work experience over the first 10 years being associated with lower perceived barriers. As part of a structured quality improvement project, the PMABS-ICU may be valuable in assisting to identify specific perceived barriers for consideration in designing mobility interventions for the ICU setting.

Background Nurse-facilitated mobility of patients in the intensive care unit can improve outcomes. However, a gap exists between research findings and their implementation as part of routine clinical practice. Such a gap is often attributed, in part, to the barrier of lack of time. The Translating Evidence Into Practice model provides a framework for research implementation, including recommendations for identifying barriers to implementation via direct observation of clinical care. Objectives To report on design, implementation, and outcomes of an approach to identify and understand lack of time as a barrier to nurse-facilitated mobility in the intensive care unit. Methods An interprofessional team designed the observational process and evaluated the resulting data by using qualitative content analysis. Results During three 4-hour observations of 2 nurses and 1 nursing technician, 194 distinct tasks were performed (ie, events). A total of 4 categories of nurses' work were identified: patient care (47% of observation time), provider communication (25%), documentation (18%), and down time (10%). In addition, 3 types of potential mobility events were identified: in bed, edge of bed, and out of bed. The 194 observed events included 34 instances (18%) of potential mobility events that could be implemented: in bed (53%), edge of bed (6%), and out of bed (41%). Conclusions Nurses have limited time for additional clinical activities but may miss potentially important opportunities for facilitating patient mobility during existing patient care. The proposed method is feasible and helpful in empirically investigating barriers to nurse-facilitated patient mobility in the intensive care unit.

Consuming small‐sized fish species whole, and bones of large fish could contribute significantly to reducing the level of micronutrient and protein malnutrition. These fish products are more affordable and could therefore meet the needs of poor, vulnerable groups, particularly in rural and urban areas where limited economic resources prevent dietary diversity. The objectives of the study were to produce fish powder from dried edible byproducts from fish processing factories, an underutilized fish species, burrito and to determine the physical, micromineral, macronutrient and microbiological quality of the dried fish powder. Edible fish processing byproducts and an underutilized fish, burrito (Brachydeuterus auritus) were cleaned thoroughly and dried with a Council for Scientific and Industrial Research‐Food Research Institute (CSIR‐FRI) gas‐fuelled oven at 55°C for 8 h or until dried. The dried products were milled into powder, and packaged into polythene bags. Proximate analysis of the fish powder was done Official Methods of Analysis (AOAC) methods. Minerals and heavy metals in the fish powder were determined by atomic absorption spectrophotometry (AAS). Microbiological quality was determined by Nordic Committee on Food Analysis Method (NMLK) methods. Tuna trimmings contained 80.71 g/100 g protein, whereas burrito contained 70.40 g/100 g protein. Concentrations of cadmium, arsenic, and mercury varied from

Moringa oleifera (M. oleifera), a green leafy vegetable, is a good source of minerals and vitamins which could be consumed as part of diet to improve human health and well‐being. Drying M. oleifera leaves could make it readily available for use as a food fortificant. The objectives of the study were to determine micromineral and β ‐carotene content of dried M. oleifera leaves, and leaf‐incorporated local dishes, and also assess school children's (4‐12 yr) acceptability of dried M. oleifera leaf‐incorporated local dishes and feasibility of introducing dried leaves into a school lunch menu. M. oleifera leaves were solar dried, milled into powder, and packaged into polythene bags. Moisture level in the dried leaves and pH were determined. Minerals in the leaf powder were determined by Atomic Absorption Spectrophotometry (AAS). Beta‐carotene levels were determined by spectrophotometry. Acceptability tests of dishes fortified with M. oleifera leaf powder were conducted with score sheets (Smileys) on a 5‐point hedonic scale of “Like Extremely” to “Dislike Extremely”, and dishes ranked to determine preference. Dried M. oleifera leaves contained high levels of micronutrients: 0.36 ± 0.04 mg/100 g Copper (Cu); 5.80 ± 0.68 mg/100 g Manganese (Mn); 20.96 ± 1.37 mg/100 g Iron (Fe); 6.79 ± 1.82 mg/100 g Zn; and 21.42 ± 1.67 mg/100 g β‐carotene. The dishes showed significant levels of these minerals compared to the nonfortified dishes (P < 0.05). M. oleifera leaf‐fortified dishes were also highly acceptable to the children (highest mean score of 5.0 ± 0 of 5 and lowest of 3.50 ± 1.43 of 5). M. oleifera leaf powder contains high levels of the micronutrients β‐carotene, Zn, Mn, and Fe, comparable to levels found in amaranth and spinach. M. oleifera leaf‐fortified local dishes were well accepted by children in Ada‐East district. M. oleifera leaf fortified dishes could be good sources of β‐carotene and other minerals for children vulnerable to malnutrition in Ghana.

Regulatory authorities in the US and EU recommend that pharmaceutical companies employ data monitoring committees (DMCs) to protect the safety of patients taking part in large randomized trials involving diseases with high morbidity or mortality and have provided guidance as to how such committees should be used. This article, whose authors have considerable experience in DMC membership, reviews the applicability of guidance to sponsors after 5 years and suggests that regulatory support for DMC members would be valuable. Advice is offered to members, often very experienced clinicians but inexperienced in pharmaceutical data review, as to how standard DMC data packages should be reviewed, which aspects of trial validity should be addressed, and how communication with the trial sponsor should be handled. It is suggested that DMCs could be supported by regulatory authorities in managing ethical and legal dilemmas to make DMC membership less exposed and more inviting.

With limited protein resources and depleting commercial fish species there is the need to improve utilization of some of the lesser known species which are underutilized, for example, big eye grunt (burrito), Bachydeuterus auritus, and the flying gurnard (Dactylopterus volitans), (other names Cephalocanthus volitans (local) Pampansre). This study was to characterize some of the proximate and biochemical properties of burrito and the flying gurnard so as to evaluate their potential for use in human nutrition and other value‐added products. Proximate and chemical analysis were determined by the methods of AOAC. Fatty acid profiles were determined following the method of Saaed and Howell (1999). Amino acid profiles for the species were determined according to Bidlingmeyer et al. (1987). The protein content of both the water soluble and salt soluble protein extracts of the fish species were determined by the Bradford Protein Assay method (Bradford 1976). Rancidity of the fish species was assessed by thiobarbituric acid reactive substances (TBARS) and Peroxide value (PV) as described by Saeed and Howell (1999). Burrito contained 18% protein, whereas the flying gurnard contained 22.3%. Calcium content was 296 mg/100 g for burrito and 185 mg/100 g for flying gurnard, whereas iron content was 4.1 mg/100 g and 1.0 mg/100 g for burrito and the flying gurnard, respectively. Palmitic acid (C16) was 27% and 14.3% for the flying gurnard and burrito, respectively. C17: 1ω8 was 3% in the flying gurnard and 0.2% in burrito. Oleic (C18:1ω9) was 17% in the flying gurnard and 6% in burrito. C20:4ω6 was 1.6% in the flying gurnard and 3% in burrito. Docosahexaenoic acid (C22:6ω3) was 4.9% in the flying gurnard and 4.0% in burrito. Both burrito and the flying gurnard are of high nutritional quality as they had a high protein content, good general amino acid profile and abundance of polyunsaturated fatty acids.

Boston's Community Medical Group (BCMG) was among the first primary care group practices to provide community-based continuous primary care to people with major disabling conditions, the first to rely on nurse-practitioners as primary care-givers, and one of the first to provide care on a prepaid capitated basis. With more than one thousand person-years' experience, BCMG has demonstrated that it is ethically and operationally feasible (1) to provide prepaid managed care to people with major disabling conditions; (2) to share financial risk for that care with providers; (3) to reinforce principles of independent living and consumer autonomy; (4) to assure high-quality clinical outcomes at reasonable costs.

SummaryAnaemia associated with pregnancy is a serious health problem and its control requires the initial identification of the major factors responsible. Haemoglobin (Hb) levels of 205 women, aged 15 to 49 years, in the last trimester of pregnancy and residing within 4 of 6 sub-districts in Sekyere West district of the Ashanti region of Ghana, were determined. Demographic characteristics, dietary habits and other information were obtained and analysed. Blood and stool samples were tested for the presence of malaria parasites and intestinal worms respectively. The data showed that, 57.1% of pregnant women had Hb10g/dl, the Ministry of Health cut off point for anaemia. Anaemia was more prevalent in rural compared to urban parts of the district (p=0.01). Low parity and young age were significantly associated with low Hb and high prevalence of maternal anaemia. Presence of malaria parasites in peripheral blood constituted a significant risk for low Hb (Hb = 9.2g/dL vs 9.5g/dL p=0.03). Independent of this, hookworm was even more strongly associated with low Hb (Hb = 8.3g/dL vs Hb=9.5g/dL, p=0.01). Contribution of dietary intake to the prevalence of anaemia cannot be inferred from the data generated under the current study.

Intergenerational visitation programs have demonstrated advantages for the young and old, but few programs last more than a year or two. Weaving long-term intergenerational programs into the fabric of both school curricula and community cultural life was the goal of a project launched in 1988 in Phoenix, Arizona. Classrooms of children visit weekly or biweekly with nearby nursing home residents, developing friendships while pursuing educational activities. Carefully planned and widespread community support through board participation, donations, and publicity has allowed the program to continue to expand, while the budget has decreased. Materials are available which facilitate program replication.

The objective of this study was to evaluate the sensory properties of porridge made from newly developed yam-legume flour blends and to determine preference among consumers. Thick porridge was prepared from 10 different yam-soybean-cowpea composite flours formulated using mixture design. Sensory evaluation employed 25-man panel to assess colour, aroma, mouthfeel, taste and overall acceptability of the 10 different porridge formulae on a 7-point Hedonic scale. Two highly ranked porridge formulations from the sensory evaluation were adopted for the consumer preference test involving 69 consumers.Sensory evaluation showed no significant difference (p>0.05) between different formulations for all sensory attributes but only taste influenced theoverall acceptability.Preparations with a combination of high amounts of yam flour and low levels of cowpea-soybean flour (8:1:1; 5.5:1:1) were ranked highest. Consumer preference survey showed a general preference for porridge formulation with the highest amount of yam flour (8:1:1), with taste, mouthfeel and appearance being the highest attributes selected by consumers.

Deep-fried crisps snack developed from yam (Dioscorearotundata) was evaluated for its sensory characteristics and consumer acceptability. The crisps were developed from two Ghanaian common varieties of white yam (pona and dente) using eight different seasonings. These were subjected to a sensory evaluation using 25 trained panelists to assess colour, crispiness, aroma, taste and overall acceptability. Subsequently, the two most preferred yam seasoned crisps were selected for a consumer acceptability survey using 158 respondents. In the sensory evaluation, significant difference (p 0.05), although more respondents preferred the ginger seasoned crisps. Preference for the two seasoned crisps was markedly different among males and females but quite akin, considering other demographic parameters.

A prospective study of the medical care utilization experience of 205 severely-disabled independently-living adults in Eastern Massachusetts shows that there was a mean of 0.83 ± 1.26 hospital admissions, 9.9 ± 22.7 hospital days, 1.5 ± 2.31 emergency room (ER) visits, and 26.88 ± 44.4 outpatient contacts per person per year. Among those hospitalized, the mean experience was 16.2 ± 27.1 days per person per year; mean length-of-stay was 9.3 ± 14.7 days per admission. Regression analysis indicates that those with spinal cord injuries as major disabling conditions were significantly more likely to be hospitalized. So were those with lower self-assessments of health, higher levels of depressions, and more baseline ER visits. Self-assessment of health is a significant predictor of hospital days for the total cohort (including those with no admissions); so are age at onset of disability (greater age; higher risk), and bed disability days in the month before the baseline survey (more disability days; higher risk). Among those hospitalized, the total number of days hospitalized is significantly related to both age at onset of disability (later onset; more days) and baseline days hospitalized (greater number; more days). Lengths-of-stay are significantly related to two factors; age and age at onset of disability (in both cases, greater age associated with longer stays). Prior ER visits are a significant predictor of subsequent ER visits (more baseline; more subsequent); so are respondents' reported satisfaction with their participation in their medical care (lower reported satisfaction; more ER visits), organizational affiliations, and frequencies of contacts with friends or relatives. Higher levels of social interaction (.e. organizational affiliation and more frequent social contacts) were associated with more ER visits. Prior contacts with physicians, nurse-practitioners, or physician-assistants was the most powerful predictor of subsequent outpatient contacts (more baseline;,more subsequent). There were also significant relationships between subsequent contacts and respondents' assessments of their health relative to others with similar disabilities (relatively worse health; more contacts), age (greater age; more contacts), and baseline ER visits (more visits; more contacts).

We conducted an 18-month longitudinal evaluation of a model-managed medical care program for severely disabled, independently living adults. Regression analyses using an additive model (no interaction effects) suggest that persons in the study group did not have statistically significantly different utilization experiences than members of the comparison group. Regression analyses that include interaction effects suggest that, for certain segments of the cohort, the study group's utilization experience was significantly lower than that of members of the comparison group. Persons in the study group with higher baseline emergency room (ER) utilization had significantly fewer hospital admissions (P = 0.0055). The participants with better self-assessments of health experienced significantly fewer hospital days per person (P = 0.0075) and days per person hospitalized (P = 0.0056), and persons with organizational affiliations reported significantly fewer ER visits (P = 0.0264).

The management of atopic dermatitis (AD) traditionally involves the use of topical and, occasionally, systemic steroids. This treatment poses a major problem with adolescents with severe AD, who in our experience are very much at risk from the growth-limiting effects of corticosteroids. In the last few years we have therefore treated this category of patients with PUVA with gratifying results. We have now treated 15 children (mean age 12–6 years, range 9–16 years), of whom 10 had heights on or below the 3rd centile. Fourteen of these showed a good response, with more or less complete clearance. Five patients have enjoyed persistent remission. One patient failed to respond and treatment was withdrawn. The other nine remain on maintenance therapy, six of these requiring only one treatment per week. All the children under treatment show at least normal growth velocity, and six showed an acceleration in growth velocity during the treatment. We believe that PUVA has an important role in treating atopic dermatitis when it is severe during adolescence of the critical importance of growth at this stage.

Summary Of 270 patients who had a cone biopsy of the cervix, 50 subsequently achieved a total of 68 pregnancies. The outcome of these pregnancies is described.