THE PREVALENCE OF INSOMNIA AND SLEEP APNEA IN DISCHARGE ABSTRACT DATA: A CALL TO IMPROVE DATA QUALITY.

Insomnia and sleep apnea are associated with a variety of comorbid conditions and carry a symptom burden to patients. As the prevalence of insomnia and sleep apnea continue to rise, it is imperative that appropriate tools are implemented to accurately capture their prevalence in acute care settings. A retrospective chart review was conducted on 3,074 inpatient charts in Calgary, Alberta. The estimated prevalence of insomnia was 10.36 percent, and sleep apnea was 6.56 percent in inpatient visits between January 1, 2015, and June 30, 2015. The sensitivity of insomnia and sleep apnea were low, and the specificity was high when comparing the chart review to the ICD-10. As both insomnia and sleep apnea were associated with various comorbid conditions, it would be imperative that alternate methods are identified to capture and code them. This would enable clinicians to better identify and treat them, and ultimately improve patient care.

Renal Association Clinical Practice Guideline on Haemodialysis.

This guideline is written primarily for doctors and nurses working in dialysis units and related areas of medicine in the UK, and is an update of a previous version written in 2009. It aims to provide guidance on how to look after patients and how to run dialysis units, and provides standards which units should in general aim to achieve. We would not advise patients to interpret the guideline as a rulebook, but perhaps to answer the question: "what does good quality haemodialysis look like?"The guideline is split into sections: each begins with a few statements which are graded by strength (1 is a firm recommendation, 2 is more like a sensible suggestion), and the type of research available to back up the statement, ranging from A (good quality trials so we are pretty sure this is right) to D (more like the opinion of experts than known for sure). After the statements there is a short summary explaining why we think this, often including a discussion of some of the most helpful research. There is then a list of the most important medical articles so that you can read further if you want to - most of this is freely available online, at least in summary form.A few notes on the individual sections: 1. This section is about how much dialysis a patient should have. The effectiveness of dialysis varies between patients because of differences in body size and age etc., so different people need different amounts, and this section gives guidance on what defines "enough" dialysis and how to make sure each person is getting that. Quite a bit of this section is very technical, for example, the term "eKt/V" is often used: this is a calculation based on blood tests before and after dialysis, which measures the effectiveness of a single dialysis session in a particular patient. 2. This section deals with "non-standard" dialysis, which basically means anything other than 3 times per week. For example, a few people need 4 or more sessions per week to keep healthy, and some people are fine with only 2 sessions per week - this is usually people who are older, or those who have only just started dialysis. Special considerations for children and pregnant patients are also covered here. 3. This section deals with membranes (the type of "filter" used in the dialysis machine) and "HDF" (haemodiafiltration) which is a more complex kind of dialysis which some doctors think is better. Studies are still being done, but at the moment we think it's as good as but not better than regular dialysis. 4. This section deals with fluid removal during dialysis sessions: how to remove enough fluid without causing cramps and low blood pressure. Amongst other recommendations we advise close collaboration with patients over this. 5. This section deals with dialysate, which is the fluid used to "pull" toxins out of the blood (it is sometimes called the "bath"). The level of things like potassium in the dialysate is important, otherwise too much or too little may be removed. There is a section on dialysate buffer (bicarbonate) and also a section on phosphate, which occasionally needs to be added into the dialysate. 6. This section is about anticoagulation (blood thinning) which is needed to stop the circuit from clotting, but sometimes causes side effects. 7. This section is about certain safety aspects of dialysis, not seeking to replace well-established local protocols, but focussing on just a few where we thought some national-level guidance would be useful. 8. This section draws together a few aspects of dialysis which don't easily fit elsewhere, and which impact on how dialysis feels to patients, rather than the medical outcome, though of course these are linked. This is where home haemodialysis and exercise are covered. There is an appendix at the end which covers a few aspects in more detail, especially the mathematical ideas. Several aspects of dialysis are not included in this guideline since they are covered elsewhere, often because they are aspects which affect non-dialysis patients too. This includes: anaemia, calcium and bone health, high blood pressure, nutrition, infection control, vascular access, transplant planning, and when dialysis should be started.

Efficiency of automated literature search mechanisms.

This article explores the efficiency of automated literature search techniques to facilitate literature accessibility. It presents three related studies using the National Library of Medicine ( NLM ) literature search on nurse practitioners (1980) as the point of reference. The studies investigate three questions: Is the search reproducible, does it locate the most important articles pertaining to nurse practitioner effectiveness, and can a system be developed to decide efficiently which articles in a voluminous search output should actually be obtained? Results indicate that the NLM search is reproducible but that it lists only a small proportion of available studies. Neither the NLM document nor a computer search using the parameters it cites located a high proportion of critically nominated studies. However, based upon classification of their titles, a workable system can be developed to identify those articles in a search output that are relevant and should be retrieved.

Internal psychometric characteristics of the quality patient care scale.

This study sought to clarify the subdimensions of the domain of quality nursing care as measured by the Quality Patient Care Scale. The care received by 269 surgical patients over a predetermined period was assessed by nonparticipant nurse observers using the methodology. The instrument contains six subscales. The data analyses showed them to be internally homogeneous and capable of providing reliable measurements. The unrotated first factor for each subscale is strong and items correlate with it and with the respective subscale totals. However, in the Psychosocial Individual, Physical, and General areas, enough clustering of items within subscales emerged to support the contention that there are several conceptually discrete, yet interdependent, sources of variation in each subdomain. The factor analyses identified the clustering of items, but, in the present exploratory mode of research, the ability to understand the apparent complexity of subdomains is limited. Future researchers should elaborate these complexities to determine if they represent consistent and discrete sources of variance that can be replicated and used to provide more accurate assessments. The subscales moderately intercorrelated, and evidenced discriminant validity.

Development and validation of a measure of attitudes toward malocclusion.

The Orthodontic Attitude Survey was designed to assess children's and their parents' attitudes toward malocclusion and orthodontic treatment. Five consistent clusters of attitudes had discriminant validity, and were significantly related to plans for orthodontic treatment and to objective and subjective indicators of the child's occlusal status and appearance.

A patient satisfaction measure as a criterion to evaluate primary nursing.

The Risser Patient Satisfaction Scale was used to evaluate the effectiveness of implementing the key concepts of primary nursing. An experimental control design was used. Forty-six subjects from two units completed the questionnaire. Estimates of reliability and homogeneity are reported. There is reason to question the discriminant validity of the subscales. No significant differences were obtained between the units on any of the subscales or total scale score. A number of explanations are offered for interpreting the measuring of the nonsignificance of the differences. Work need to continue on revising existing patient satisfaction measures or developing new ones. Other criteria with theoretical importance should be used in conjunction with satisfaction measures in assessing the effects of primary nursing.

Variables discriminating individuals who seek orthodontic treatment.

Overall, these results support the view that dental-facial esthetics and self-perceptions of occlusal appearance, as well as attitudes toward malocclusion and orthodontic treatment, are important factors in the individual's decision to obtain orthodontic treatment. The data indicate that psychosocial variables not directly related to occlusal problems and treatment, do not add significantly to the description of differences between those who seek treatment and those who do not. While these analyses did not include a number of variables--such as socioeconomic factors or attitudes of significant others--which may also be important in predicting individual response to malocclusion, they do suggest strongly that psychosocial factors directly related to need for treatment are probably most productively assessed in terms of self-perceptions of occlusal appearance and attitudes regarding dental malrelations and their treatment.

Reliability and stability of the orthodontic Patient Cooperation Scale.

Patient cooperation is recognized as an important factor in the outcome of orthodontic treatment. In order to predict patient cooperation, there have been numerous studies which have examined its correlates in orthodontic treatment. However, few, if any, of these studies have considered the reliability or stability of their patient cooperation measures. Hence, the correlates found or not found are suspect. The present article reports on the internal consistency and stability of the Orthodontic Patient Cooperation Scale (OPCS). Using the responses of practicing orthodontists, a list was generated of ten patient behaviors frequently considered in evaluating a patient's cooperation. Subjects were eighth- and ninth-grade students undergoing orthodontic treatment, who were rated by their own orthodontists after 2 months and 6 months of treatment. The internal consistency for the scale was estimated to be 0.71 (N = 44) at 2 months and 0.80 (N = 45) at 6 months. The correlation between scores at 2 months and at 6 months was 0.58 (N = 44), which may be considered to be a conservative estimate of the long-term stability of the scale. In summary, the OPCS has adequate internal consistency and reasonably stable scores over a 4-month period. As such, it should prove useful in studies looking for predictors of patient cooperation and in studies examining the relationship of patient cooperation and outcome of treatment.