Performance of a Commonly Used Pressure Injury Risk Model Under Changing Incidence.

BACKGROUND: Hospital-acquired pressure injuries (HAPIs) cause patient harm and increase health care costs. We sought to evaluate the performance of the Braden QD Scale-associated changes in HAPI incidence. METHODS: Using electronic health records data from a quaternary children's hospital, we evaluated the association between Braden QD scores and patient risk of HAPI. We analyzed how this relationship changed during a hospitalwide quality HAPI reduction initiative. RESULTS: Of 23,532 unique patients, 108 (0.46%, 95% confidence interval [CI] = 0.38%-0.55%) experienced a HAPI. Every 1-point increase in the Braden QD score was associated with a 41% increase in the patient's odds of developing a HAPI (odds ratio [OR] = 1.41, 95% CI = 1.36-1.46, p < 0.001). HAPI incidence declined significantly following implementation of a HAPI-reduction initiative (ß = -0.09, 95% CI = -0.11 - -0.07, p < 0.001), as did Braden QD positive predictive value (ß = -0.29, 95% CI = -0.44 - -0.14, p < 0.001) and specificity (ß = -0.28, 95% CI = -0.43 - -0.14, p < 0.001), while sensitivity (ß = 0.93, 95% CI = 0.30-1.75, p = 0.01) and the concordance statistic (ß = 0.18, 95% CI = 0.15-0.21, p < 0.001) increased significantly. CONCLUSION: Decreases in HAPI incidence following a quality improvement initiative were associated with (1) significant deterioration in threshold-dependent performance measures such as specificity and precision and (2) significant improvements in threshold-independent performance measures such as the concordance statistic. The performance of the Braden QD Scale is more stable as a tool that continuously measures risk than as a prediction tool.

Key Drivers in Reducing Hospital-acquired Pressure Injury at a Quaternary Children's Hospital.

INTRODUCTION: Despite being a participating Solutions for Patient Safety (SPS) children's hospital and having attempted implementation of the SPS hospital-acquired pressure injuries (HAPIs) prevention bundle, our hospital remained at a HAPI rate that was 3 times the mean for SPS participating children's hospitals. This performance led to the launch of an enterprise-wide HAPI reduction initiative in our organization. The purpose of this article is to describe the improvement initiative, the key drivers, and the resulting decrease in the SPS-reportable HAPI rate. METHODS: We designed a hospital-wide HAPI reduction initiative with actions grouped into 3 key driver areas: standardization, data transparency, and accountability. We paused all individual hospital unit-based HAPI reduction initiatives. We calculated the rate of SPS-reportable HAPIs per 1,000 patient days during both the pre- and postimplementation phases and compared mean rates using a 2-sided t test assuming unequal variances. RESULTS: The mean SPS-reportable HAPI rate for the preimplementation phase was 0.3489, and the postimplementation phase was 0.0609. The difference in rates was statistically significant (P < 0.00032). This result equates to an 82.5% reduction in HAPI rate. CONCLUSIONS: Having an institutional pause and retooled initiative to reduce HAPI with key drivers in the areas of standardization, data transparency, and accountability had a statistically significant reduction in our organization's SPS-reportable HAPI rate.

Ovarian germinal epithelium, oocyte development and the secretory epithelium in monkfish (Lophius americanus Valenciennes).

Histological examination of ovarian morphology was conducted on the monkfish, Lophius americanus. The ovary is of the cystovarian type, that is, with a lumen. However, ovarian morphology is quite unique, compared to other fishes, in that ovarian lamellae only originate along the ventral ovarian wall rather than around the periphery. They may branch at their base, but are otherwise unbranching. Furthermore, the germinal epithelium that is, the site of germ cell production, is described for the first time in L. americanus. The germinal epithelium is uniquely restricted around the base of each lamellae rather than being distributed along lamellar epithelia. Folliculogenesis, the process whereby ovarian follicles are formed, is completed in the Perinucleolar Step of the Primary Growth Stage. As oocytes grow and mature, they are increasingly observed towards the apex of the unbranched lamellae where ovulation occurs. The appearance of small vesicles within yolk at the vegetal pole was observed in oocytes during maturation. Prior to ovulation, cells of the ovarian epithelium produce a mucogelatinous matrix that forms the veil in which eggs, after fertilization, become suspended in the water column until hatching.

Sun-related behaviors among individuals previously diagnosed with non-melanoma skin cancer.

Compared to the general population, the risk of developing non-melanoma skin cancer is considerably higher among individuals with a previous history of this condition. Protection from ultraviolet (UV) radiation is the primary evidence-based approach for minimizing this risk. This review was aimed to assess the prevalence of sun-safe behaviors in non-melanoma skin cancer survivors. Searches were conducted in six electronic databases including PubMed, Psyclnfo, CINAHL, EMBASE, ERIC and Science Direct. A narrative approach was adopted to synthesize the data. The findings demonstrated that respondents do not protect themselves optimally from UV radiation exposure. Low levels of perceived skin cancer risk, a lack of knowledge about effective sun protection strategies and the inconvenience associated with sun-safe behaviors appear to explain this finding. A note of caution is required here, as there is a potential for publication bias. Moreover, the results of this study cannot be generalized to all non-melanoma skin cancer patients. Skin cancer survivors must be educated about their increased risk of future skin cancers. Behavioral interventions must be developed to increase the adoption of skin protective behaviors in this high-risk population group.

Risk Factors for Low Bone Mineral Density in Institutionalized Individuals with Developmental Disabilities.

BACKGROUND: Persons with intellectual/developmental disabilities (IDD) are exposed to several factors, which have been determined as risks for osteoporosis. Many of these individuals are non-ambulatory, resulting in lack of weight bearing activity, which is well established as a major contributor to bone loss. The purpose of this study was to investigate risk factors for low bone mineral density (BMD) in persons with IDD residing in residential facilities. METHODS: This cross-sectional study was conducted at an Intermediate Care Facility for individuals with Intellectual and Developmental Disabilities (ICF/IDD). Medical records data were used from 69 individuals, including heal scan T-scores, nutritional, pharmacologic and other risk factors. Chi-Square analysis was used to determine relationships between the variables. RESULTS: BMD measures were not significantly associated with age, gender, height, weight, or BMI for this population (P > 0.05). The association between BMD diagnoses and DSM-IV classification of mental retardation approached significance (P = 0.063). A significant association was found with anti-seizure medication (P = 0.009). CONCLUSION: Follow-up studies should focus on how supplementation and medication changes may or may not alter BMD. Persons with IDD are experiencing longer life expectancies, and therefore, studies ascertaining information on diseases associated with this aging population are warranted.

Predictors of bone mineral density in african-american and caucasian college-aged women.

BACKGROUND: Research regarding risk factors and prevalence of low bone mineral density (BMD) among African-American and Caucasian college-aged women are limited. The objective of this cross-sectional study was to determine if selected predictors of BMD in African-American and Caucasian college-aged women differ by race. METHODS: A total of 101 local African-American (n=50) and Caucasian (n=51) females, ages 18 to 30 years, were in this study. All data were collected in the Bone Density and Body Composition Laboratory. BMD was measured using DXA technology. Race, family history of osteoporosis, BMI, current physical activity, osteoporosis knowledge, length of time on oral contraceptives, age at menarche and calcium intake were included in the multiple regression analyses with spinal and femoral BMD as dependent variables. RESULTS: Overall, 38.6% had low spinal BMD and 7.9% had low femoral BMD. BMI (ß=0.073, R(2) = .148, P = .001, 95% CI [0.030, 0.116]) and current physical activity (ß=0.071, R(2) = .148, P = .017, 95% CI [0.013, 0.129]) were the only variables that were statistically significant in predicting spinal BMD. BMI (ß=0.056, R(2) = .13, P = .010, 95% CI [0.014, 0.098]) and current physical activ-ity (ß=0.078, R(2) = .13, P = .007, 95% CI [0.022, 0.134]) were also the only varia-bles that were statistically significant in predicting femoral BMD. Race was not a significant predictor of spinal or femoral BMD. CONCLUSION: It is imperative for both African-American and Caucasian women to engage in osteoporosis-preventive behaviors.

Comparative visual ecophysiology of mid-Atlantic temperate reef fishes.

The absolute light sensitivities, temporal properties, and spectral sensitivities of the visual systems of three mid-Atlantic temperate reef fishes (Atlantic spadefish [Ephippidae: Chaetodipterus faber], tautog [Labridae: Tautoga onitis], and black sea bass [Serranidae: Centropristis striata]) were studied via electroretinography (ERG). Pelagic Atlantic spadefish exhibited higher temporal resolution but a narrower dynamic range than the two more demersal foragers. The higher luminous sensitivities of tautog and black sea bass were similar to other benthic and demersal coastal mid-Atlantic fishes. Flicker fusion frequency experiments revealed significant interspecific differences at maximum intensities that correlated with lifestyle and habitat. Spectral responses of the three species spanned 400-610 nm, with high likelihood of cone dichromacy providing the basis for color and contrast discrimination. Significant day-night differences in spectral responses were evident in spadefish and black sea bass but not tautog, a labrid with characteristic structure-associated nocturnal torpor. Atlantic spadefish responded to a wider range of wavelengths than did deeper-dwelling tautog or black sea bass. Collectively, these results suggest that temperate reef-associated fishes are well-adapted to their gradient of brighter to dimmer photoclimates, representative of their unique ecologies and life histories. Continuing anthropogenic degradation of water quality in coastal environments, at a pace faster than the evolution of visual systems, may however impede visual foraging and reproductive signaling in temperate reef fishes.