Accuracy of influenza vaccination rate estimates in United States nursing home residents.

The US Center for Medicare and Medicaid Services (CMS) requires nursing homes and long-term-care facilities to document residents' vaccination status on the Resident Assessment Instrument (RAI). Vaccinating residents can prevent costly hospital admissions and deaths. CMS and public health officials use RAI data to measure vaccination rates in long-term-care residents and assess the quality of care in nursing homes. We assessed the accuracy of RAI data against medical records in 39 nursing homes in Florida, Georgia, and Wisconsin. We randomly sampled residents in each home during the 2010-2011 and 2011-2012 influenza seasons. We collected data on receipt of influenza vaccination from charts and RAI data. Our final sample included 840 medical charts with matched RAI records. The agreement rate was 0·86. Using the chart as a gold standard, the sensitivity of the RAI with respect to influenza vaccination was 85% and the specificity was 77%. Agreement rates varied within facilities from 55% to 100%. Monitoring vaccination rates in the population is important for gauging the impact of programmes and policies to promote adherence to vaccination recommendations. Use of data from RAIs is a reasonable approach for gauging influenza vaccination rates in nursing-home residents.

Intimate partner violence screening in the emergency department.

BACKGROUND AND AIMS: Every year between 1.5 and 4 million women are abused by a partner in the United States and many abused women turn to the Emergency Department (ED) as their first source of care. Even though the vast majority of patients would feel comfortable disclosing intimate partner violence (IPV) to their physician, identification and referral is inconsistent . AIMS: The aim of this paper was to discuss prevalence statistics of IPV, current screening recommendations and practices in ED settings, and future directions to improve the screening and identifying of victims of IPV that present to the ED. MATERIAL AND METHODS: The authors conducted a Medline search for articles discussing IPV screening in the ED. RESULTS: Intimate partner violence results in approximately 1,300 deaths and 2,000,000 injuries annually among women and up to a third of ED patients have a history of IPV. Despite patients' reported willingness to disclose this information, identification of IPV by healthcare practitioners remains very low, with some estimates ranging between 4-10%. CONCLUSIONS: If we do not identify victims of IPV in the ED, this may result in continuation of the abuse, routine returns to the ED for treatment of injuries, and possibly even death.

The Discipline for doing spiritual care: variations on a theme.

This article describes the writers introduction to The Discipline and his decision to utilize selected aspects of it in direct care and in an educational milieu. The first section describes adaptation of the Profile (Concepts of Holy, Meaning, Hope, and Community) in the writer's work with addicted persons on a Recovery Center. The second section presents the employment of this Profile as a way to introduce CPE interns to the art of pastoral assessment.

CT-guided antegrade pyelography and percutaneous nephrostomy.

Percutaneous antegrade pyelography and percutaneous nephrostomy can be easily performed using CT guidance. CT provides cross-sectional images which facilitate accurate needle placement into the renal pelvis. CT is capable of detecting subtle density differences within the tissues so that even renal pelvises which do not contain contrast material and are not dilated can be accurately punctured. In addition to these procedures, CT accurately displays the perinephric space so that assessment of complications is possible. Four of five attempted percutaneous nephrostomies and two antegrade pyelograms were successfully performed using CT gudance.

Optical quality of pulsed electron-beam sustained lasers.

The optical quality of a pulsed atmospheric CO(2) electric laser is investigated. The density disturbances in the optical cavity are caused by edge waves originating at the anode and cathode. Volumetric heating effects associated with a nonuniform electric discharge are shown to be negligible. The disturbance propagating from the cathode results from a discontinuity in the spatial heating and the cathode fall. The wave emanating from the anode is associated with the presence of a solid surface that prevents the gas from expanding. As a result, lasers have to be designed with pulse durations much less than the acoustic transit time across the cavity.