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Prompt recognition of frailty in the emergency department (ED) is important to identify patients at higher risk of adverse outcomes. Despite this, few studies examine the diagnostic accuracy of screening instruments for frailty, instead focusing on predictive validity. We compared three commonly used, short frailty screens to an independent comprehensive geriatric assessment (CGA) in an urban University Hospital ED. Consecutive attendees aged ≥70 years were screened by trained raters, blind to the CGA, with the Variable Indicative of Placement risk (VIP), 3 and 4-item versions, Clinical Frailty Scale (CFS) and PRISMA-7. Accuracy was measured from the area under the ROC curve (AUROC). In total, 197 patients were included, median age 79 (±10); 46% were female. Half (49%) were confirmed as frail after CGA. All instruments differentiated frail from non-frail states, although the CFS (AUROC: 0.91) and PRISMA-7 (AUROC: 0.90) had higher accuracy compared to the VIP-4 (AUROC: 0.84) and VIP-3 (AUROC: 0.84). The CFS was significantly more accurate than the VIP-3 (p = 0.026) or VIP-4 (p = 0.047). There was no significant difference between the CFS and PRISMA-7 (p = 0.90). The CFS and PRISMA-7 were more accurate and should be considered in preference to the VIP (3 or 4-item versions) to identify frailty in EDs.

Background Urinary incontinence (UI) is defined by the International Continence Society as “any involuntary leakage of urine.” UI can negatively impact patients' physical and mental wellbeing and quality of life. Since older adults constitute a growing hospital population, evaluation and improvement of this patient group's quality of care is recognized as a priority in the study hospital. A continence assessment helps to determine what the problem is and what management is required. This audit aims to determine whether appropriate assessments of continence in older adults presenting to the hospital setting were completed and documented. Methods An audit tool was adapted from the Royal College of Physicians National Continence Audit tool and the hospital's own elimination documentation pathway. On a chosen day a general medical ward and a specialist geriatric medicine ward were assessed. Medical charts, nursing notes, emergency department proforma, frailty intervention team proforma and skin integrity proforma were reviewed. Documentation of continence status, symptoms, type, investigations, continence wear, catheterisation and management were assessed. Continence care plans and evidence of communication/discussion with patients were also assessed. Results Thirty-one sets of documentation were reviewed. Twenty-four patients were aged over 65. Of these patients 12 were male and 12 were female. Four patients had no continence status documented. Forty-two percent of those reviewed over 65 had documented incontinence and of these only 40% had the elimination section of their nursing proforma fully completed. Six of the patients with documented incontinence had their symptoms/type of incontinence documented. Two Patients had urinary catheters, the indications for these catheters were documented Conclusion This audit found that overall the assessment and documentation of continence in older adults was sub-optimal. Based on this audit an assessment tool and education program will be introduced to the specialist geriatric medicine ward with the goal of improving assessment of continence and optimal management.

Background For many people an admission to an acute hospital can be a stressful and overwhelming experience. During admission it can be difficult to process and understand the information provided by members of the multi-disciplinary team (MDT). Patient information leaflets (PILS) are important in educating and empowering patients in the management of their own health and wellbeing. PILs are frequently provided to patients by MDT members during their admission. These valuable resources are not always consulted by patients or their families and in many cases are not brought home from hospital. Methods Using Plan Do Study Act (PDSA) methodology patient information folders named “My healthcare information” were provided to in-patients by MDT members. Patients were encouraged to put all PILs provided by the MDT in these folders and bring them home for future reference. Questionnaires were administered to patients to ascertain if they found the folders useful and would be likely to use them going forward. Two PDSA cycles have been completed to date. Results ​The results were largely positive. A significant amount of those questioned found it difficult to understand and remember what was said to them by hospital staff (5 of 15 respondents or 33%) and felt they did not receive enough written information about their condition (6 of 15 respondents or 40%). A high proportion of those asked stated they found the folder useful and would be likely to use it at home going forward (22 of 23 respondents or 96%). Conclusion My healthcare information folders are a potentially useful tool in empowering patients and educating them about their own health and wellbeing. Further PDSA cycles and staff education is required to continue the project. The next PDSA cycle will focus on the MDT member’s experience of using the folders.

With this editorial I am happy to introduce the first issue of the second volume of the ARISE Journal. The purpose of this editorial is to briefly discuss authentic or ‘real-world’ science, its place in society, in the classroom and how it can support and explicitly link to students’ perception of scientific careers and potentially enhance uptake of science subjects.

Background It is reported that more than 128 million patients are seen in emergency departments (EDs) annually. Patient overcrowding had been associated with an increased occurrence of medication errors. Purpose Due to increased patient volume and the need for improved patient safety, a 24-hour pharmacy service was established for our institution's ED. The purpose of the study is to quantify and demonstrate the impact of a 24-hour pharmacy service in an urban ED. Methods This was a retrospective descriptive study conducted at a regional level 1 trauma center. The study period occurred between December 2012 and July 2013. The following variables were quantified and analyzed: number of medication orders reviewed, number of intravenous medications compounded, and number of clinical interventions that were recommended by the ED pharmacy team (EDPT) and accepted by ED clinicians. Results A total of 3,779 medication orders were reviewed by the EDPT. Of these orders, 3,482 (92%) were prospectively reviewed. A total of 3,068 (81.2%) and 711 (18.8%) orders were reviewed for the adult and pediatric ED, respectively. During the study period, the EDPT procured 549 intravenous admixtures and conducted 642 clinical interventions. Most of the interventions involved providing drug information for physicians and nurses (45.9%), adjusting drug dosages (21.1%), and recommending antimicrobial therapy (15.1%). Conclusion The implementation of a 24-hour pharmacy service at our institution was an innovative practice that increased the role of pharmacists in the ED. The EDPT conducted prospective medication review, procured intravenous admixtures from a sterile environment, and provided therapeutic recommendations for the ED interdisciplinary team.

This introductory chapter addresses the challenges and opportunities that come with teaching the History of the English Language (HEL). HEL is a traditional course whose instructors are tasked with balancing a great number of institutional, curricular, and student needs. Additionally, the course’s prodigious subject poses challenges for new as well as veteran instructors, few of whom have comprehensive training in English linguistics, literature, and the language’s historical varieties. The course encompasses a broad chronological, geographic, and disciplinary scope and, in the twenty-first-century classroom, has come to account for English’s transformative relationship with the internet and social media. In Approaches to Teaching the History of the English Language, experienced instructors explain the influences and ingenuity behind their own successful pedagogical practices. This introduction explains the value of that approach. Additionally, it includes a survey of the volume’s scope and organization.

Instructors teaching the History of the English Language (HEL) will well recognize the challenge of covering its broad chronological scope. Additionally, convenient fictions about discrete historical periods and the uniformity of linguistic changes across synchronic varieties make chronological organization of a HEL course a problematic device. This chapter speaks to how an instructor could engage students in thinking critically about HEL’s chronological conventions by framing the course around a specific diachronic textual tradition. The author offers a practical example: a sequence of exercises based on vernacular translations of the “Shepherd Psalm.” Additionally, the chapter demonstrates how an instructor teaching HEL to literature students can get them to attend more closely to questions about language.

To examine the impact of the first nurse-implemented tele-intensive care unit (tele-ICU) staffing model, with the intent that shared nursing vigilance and collaboration can decrease patient complications potentially impacting patient outcomes.A quantitative study used a pre-post program design of 90 staff nurses in the Adult Critical Care Unit, 10 tele-ICU nurses, and 1,308 patient participants at Providence Alaska Medical Center (Anchorage, AK). Twelve months of baseline data were collected: Acute Physiology and Chronic Health Evaluation severity-adjusted ICU length of stay (LOS), ICU mortality, protocols for the prevention of ventilator-associated pneumonia (VAP), ventilator bundle compliance (stress ulcer and venous thrombosis prophylaxis), and glucose control. Follow-up data were obtained using the same outcomes examined for baseline: 9 months for the nurse and only an additional 3 months with the addition of physician monitoring services.Data demonstrated post-tele-ICU implementation improvements as follows: severity-adjusted LOS decrease, 15% (222 patient-days saved); severity-adjusted ICU mortality decrease, 14% (20 lives saved); compliance improvement of "at-risk" patients, restraint documentation 26% improvement; ventilator bundle compliance, 6% increase; and VAP, 13% decrease in patient-days.Collaboration between bedside and remote nurses in conjunction with the use of tele-ICU program technology positively impacts critical care patient outcomes. Effective nursing collaboration and communication and improved patient outcomes can be attained through nursing vigilance and attention to best practices or health system protocols and the use of smart technology such as the population management tools in the tele-ICU program.

(ProQuest: ... denotes non-US-ASCII text omitted.)Miserere Mei: The Penitential Psalms in Late Medieval and Early Modern England . By Clare Costley King'oo . Reformations: Medieval and Early Modern. Notre Dame, Ind. : University of Notre Dame , 2012. xix + 283 pp.Book Reviews and NotesReaders of Church History will perhaps be familiar with Clare Costley King'oo's first monograph, which won the Book of the Year award from the Conference on Christianity and Literature in 2012. King'oo's study distinguishes itself among other excellent scholarly works on the Psalter (such as those by Hannibal Hamlin, Michael P. Kuczynski, and Rivkah Zim) for its carefully considered focus on the unique textual tradition of the Seven Penitential Psalms. King'oo compellingly demonstrates the Penitential Psalms' reflexive relationship to a changing religious climate through her thoughtful treatment of their circulation in books of hours, theological commentaries, political polemic, funerary rites, songs, and lyric poems. Given King'oo's training as a literary scholar, her attention to the Penitential Psalms' form, genre, language, and even the material texts in which they were available yields exciting interpretations of their nuanced revisions and their implied audiences. Miserere Mei , like other works in Notre Dame's Reformations series, adroitly rethinks the conventional distinction between the "medieval" and "early modern" periods and thus serves as an inspired example of a diachronic study. In the narrative that she patiently tracks, King'oo shows that the Penitential Psalms traditionally used in medieval worship were not suppressed by the Reformers but rather appropriated and resignified by them.Chapter 1 ("Illustrating the Penitential Psalms") examines late medieval and early modern books of hours with special attention to images of David's legendary penance (found more often in earlier books) and David peering at the naked Bathsheba (found more often in later books). King'oo works to "denaturalize the connection between the Penitential Psalms and images of David's voyeurism" (31) to consider more carefully this trope's development. Invoking Foucault, she explains this change as a part of a larger campaign, namely, the "organization of confession and other penitential practices around sin and sexuality" (52). King'oo's discovery that David's sin came to be coded as sexual fruitfully complicates her argument when she turns to explaining its illustration in the New England Primer , which was used to teach children in colonial America how to read. She describes the cultural contexts in which this suggestive image circulated, concluding that it was not perceived as inappropriate for "innocent children" until the 19th century. For its meticulous attention to the complicated textual history of David's penance in the Penitential Psalms and their associated illustrations, this chapter stands out as the strongest in an excellent book.For its study of the Penitential Psalms' endurance in early America, the first chapter sets up how Miserere Mei will likewise appraise early modern revisions of these conventional medieval texts. Chapter 2 ("The Conflict over Penance") analyzes two early sixteenth-century theological commentaries: John Fisher's This treatise concernynge the fruytfull saynges of Dauyd in the seuen penytencyall psalms (1504) and Luther's Die sieben Buspsalmen (written in 1517, revised in 1525). …

This article examines subaudial voiced reading in selected Old English riddles of The Exeter Book. In these texts, objects that are normally silent "speak" when the reader ventriloquizes their words and, more importantly, those of the written text. These riddles reflect a desire to recuperate an elusive author figure, present at the scene of reading through his voice, which, as the medieval notion of authorial voces paginarum implies, was contained in the written page. This practice of voiced reading has deeper implications in riddles narrated by holy objects that represent Christ. Voiced reading of Christ's words provides a means of evoking his enigmatic presence in the Bible and the Eucharist, a curious notion that nonetheless suggests the long-standing affiliation of the voice and soul that Aristotle proposed.

In the Summoner's Tale Chaucer presents a satirical portrait of a glutton- ous friar who—to put it bluntly—spreads the Word as a means of enhancing his own flesh. Friar John's sermon to his lay charge Thomas, an excessive performance that consumes more than half of the tale, shows that he preaches in order to get donations from lay people and, more broadly, to exert his authority over them. As has often been noted, Friar John's preaching style reveals his particular affection for glossing, a form of scriptural interpretation that, according to the friar, compen- sates for the comprehension problems that will indubitably confront his lay audience. 1 The friar thus evokes late fourteenth- and early fifteenth- century debates on scriptural glossing and vernacular translation, prac- tices that, in accommodating popular understanding, seemed to entail a loss of clerical control over sacred texts. 2 Although Friar John speaks to these medieval lay-centered initiatives, he himself does not gloss to enable lay access to scriptural meaning but rather to secure his clerical power, which is evident, for instance, in his appeal to a nonexistent scrip- tural passage that contains Christ's special blessing of friars. 3 Scriptural interpretations meant to sanction the friar's own authority pervade his sermon to Thomas, who responds by presenting Friar John with an equally illustrious, if vulgar, gift. Thomas's donation, a fart delivered into the friar's hand, has inspired a great deal of scholarship, some of which has regarded it as an echo of the friar's own long-winded performance. 4 Following this critical impulse to read the fart as a defiant response to the friar's sermon, I consider what else their exchange discloses about how clerical and lay subjects speak, hear, and control sacred discourse. In this essay I contend that the Summoner's Tale reflects Chaucer's investment in representing sacred verbal performances, which perhaps is most obvious in the friar's self-serving sermon yet also apparent in the tale's allusions to a specific type of medieval devotional ritual: eucharistic prayers. To understand the significance of Chaucer's refer- ences to eucharistic prayers in the Summoner's Tale, we must first acknowledge how they were performed in the medieval liturgy. From

This study assessed mail survey return rates published in seven general health education journals for the 13-year period, 1990–2002: American Journal of Health Behavior, American Journal of Health Education, American Journal of Health Promotion, Health Education & Behavior, Health Education Research, Journal of American College Health, and the Journal of School Health. A significant difference in mail survey return rates across the seven journals was found. Also, published mail survey return rates significantly increased from 1990–1995 (M=61.8%) to 1997–2002 (M=65.5%). All of the journals had published a noteworthy percentage (10–26%) of their mailed survey research studies with return rates of less than 50%. Finally, there was not a significant association between sample size and return rates of published mail survey studies. Researchers reporting mail survey research results in health education journals should expect to have return rates of 60% or greater. Yet, such return rates may still be co...

Alabama faced an oral health crisis, with decreasing dental provider participation and increasing enrollment of Medicaid-eligible children. In response, the Smile Alabama! initiative was designed to improve oral health care services for Medicaid-eligible children by increasing the number of participating dentists by 15% and the number of children receiving dental care annually by 5% by January 31, 2004. The initiative is composed of 4 specific components: claims processing, dental reimbursement, provider education and recruitment, and recipient education. Specific interventions were implemented for each component. From fiscal year 1999 to fiscal year 2002, enrollment of targeted Medicaid children increased 32.7%. During this same period, the number of participating dental providers in the Alabama Medicaid dental program increased by 127 providers, a 38.7% increase. The number of children receiving dental services increased from 82 600 in fiscal year 1999 to 130 208 in fiscal year 2002, a 57.1% total increase, with a 4.8% increase in the annual dental visit rate. The experience suggests that access to oral health care services can be improved through a multidimensional, strategically planned dental outreach initiative in spite of dramatic increases in Medicaid enrollment

This qualitative study has been designed to examine chronic sorrow in a population of individuals with type 1 diabetes. Teel1 defines chronic sorrow as ‘a recurring sadness interwoven with periods of neutrality; satisfaction and happiness’. The sample chosen are five adult subjects with type 1 diabetes for an average of 22.4 years. Data was collected using audio taped, semi-structured, interviews. Tapes were transcribed and analysed. Four themes emerged; fear of the future, negative attitudes of others, regrets and difficulties in managing the condition. The study discusses the causes of sadness. Results are of relevance to people with diabetes, and those who care for them. Copyright © 2001 John Wiley & Sons, Ltd.

If the underlying problem is really underfunding, then making these issues explicit can only contribute to a better informed debate about the proportion of GNP which is allocated to health care.37 Managing underfunding by making hidden and possibly ill-informed calculations about who shall live and who shall die on criteria which are not purely clinical, and which are therefore outside both the competence and the legitimacy of the doctor, is not an answer to the question. It might usefully be asked whether classiifying decisions in this area as 'medical law' and as part of some emerging body of medical jurisprudence actually helps or hinders the cause of getting the issues into the public domain. If there is such a thing as medical law, it has not so far succeeded in elaborating the circumstances in which health authorities should be accountable, in a public law sense, for spending and allocation decisions. Requiring health authorities to give reasons for their decisions and to show that they have engaged in a rational process in precisely the same way that we require of other public bodies would better enable us to establish, first, the extent to which they have or have not reached a decision which no reasonable authority could have reached and, secondly, the extent to which we should recognise any special claims or limitations resulting from the particular ethical dilemmas which they face.

A knowledge of adolescents' leisure time activities and their interests are important for understanding the adolescents' social world and their individual needs. The aim of the study is to measure the interest and participation in various leisure activities and to find the correlation between interest and participation. The study also aimed to find whether a gender difference exists in leisure time pursuits. The subjects in the study were 211 school-going adolescents from an urban disadvantaged area of Dublin, Ireland. The results revealed a high correlation between participation and interest in leisure pursuits and a considerable difference between the sexes.

In the Old English life of Saint Andrew, a late tenth-century Vercelli Book text known as Andreas, the ability to recognize the divine voice is a criterion by which believers are distinguished from non-believers. These two discursive communities are embodied in Andrew himself, who preaches Christian doctrine yet initially balks at a request made by Christ himself to go rescue his fellow apostle Matthew from the Mermedonians, cannibalistic heathens who live in Ethiopia. Andrew assents but still has divine payback to face because of his resistance to obeying Christ’s command. Christ adopts the form of the sea captain taking Andrew and his disciples on the dreaded trip to Mermedonia. As the two men talk, the conversation turns to the subject of Andrew’s master—the one who preached and performed miracles. The apostle falls for the sailor’s trick and proceeds to tell him stories about Christ until the ship lands. Once in Mermedonia, Andrew gives conflicting reports about his lengthy conversation with this sea captain. To his men, the apostle alleges that even though Christ had disguised his form (856, þeh he his maegwlite besiðen haefde), he recognized Christ’s speech (855, word).1 A short time later, however, Andrew makes no such claim to Christ himself. Instead, he asks Christ why he was unable to recognize him on the sea voyage.

How could the talking objects in The Exeter Book riddles not impress their reading audience? Consider what happens in many of these riddles, a series of over 90 Old English poetic texts written down in the tenth century. An object or creature that normally cannot speak introduces itself in its own words, in its own voice. A tough audience (or, one that expected this enigmatic convention) might choose to overlook how marvelous it is that these objects should be able to speak, let alone speak in riddles. This prodigious talent, however, is not lost on the riddling objects themselves. Many of them self-identify foremost as sound makers, portraying themselves in terms of the curious means by which they use their voices. The Exeter Book’s nightingale (#8), for example, tells how it flaunts its wide vocal register: “Through my mouth, I speak in many voices, sing with modulated notes, often change my speech” (1–3a, “Ic þurh muþ sprece mongum reordum/wrencum singe wrixle geneahhe/heafodwoþe”).1 Less mellifluous yet equally engaging is the performance of the magpie (#24), which explains that it can modulate its voice to sound like other animals: “I vary my voice. Sometimes bark like a dog, sometimes bleat like a goat, sometimes shriek like a goose, sometimes scream like a hawk” (1–3, “wraesne mine stefne/hwilum beorce swa hund hwilum blaetne swa gat/hwilum graede swa gos hwilum gielle swa hafoc”).

As a field of inquiry, ventriloquism allows us to examine manifold and even disparate types of vocal performances: reading, pagan oracular revelations, preaching, confession, the liturgy, and biblical plays. All of these performances have one important thing in common: the divine voice’s mediation through human organs, in which we see a Christian resignification of ventriloquism’s traditional pagan meaning. In the devotional scenes implied in the texts that this book studies, the ventriloquized divine voice functions as a conceit for human relationships with the divine as well as mundane relationships between clerical speakers and lay audiences. This book tracks a line of inquiry that begins with a perfect, fantastic view of the voice’s ventriloquism purveying divine presence and power, then examines the ironic lability of the clerical voice as it became identified as an organ for sacred speech, and culminates in a study of texts that represent not only lay ventriloquism of the clerical voice but also uniquely lay performances capable of divine communications. Scholars of medieval literature have studied verbal performances for the agency that they connote but, with some exceptions, have been less attentive to how the voice was used in actual performance scenes. This book corrects for this oversight by exploring the divine voice’s mediation in actual devotional contexts and its imagined effect on real medieval people.

The text known as N-Town Passion Play I is a series of dramas that represent biblical and extra-scriptural events from Palm Sunday through Holy Thursday.1 Stephen Spector suggests that the manuscript was first compiled in the mid to late fifteenth century and continued to be revised, quite possibly, into the sixteenth century.2 The most liturgical of the extant cycles, N-Town’s provenance has been associated, as Gail McMurray Gibson points out, with Bury St. Edmunds in East Anglia, an area known for its vibrant orthodox and heterodox religious cultures.3 As Penelope Granger argues, the cycle was probably performed for lay audiences, as it most likely traveled to towns in the southwest Norfolk-Suffolk border, which saw a high concentration of dramatic performances.4 Although the N-Town plays perhaps exhibit some level of monastic input, Colin Fewer argues that “they were being produced primarily for a wealthy and urbanized lay audience.”5 Indeed, Gibson sees in the plays a “hybrid blend of monastic and lay spirituality that is such a signature of fifteenth-century Suffolk and Norfolk culture.”6