Exploring the value of multi-sensory aids in co-designing assistive home devices for older adults with cognitive impairment.

In this study, we aimed to investigate the benefits of co-design prompts/aids in the development of assistive devices for and with older adults who have cognitive impairment (CI), with the goal of improving their ability to live independently at home. We conducted a series of co-design workshops and utilized eight sets of multi-sensory aids to explore their values and effectiveness in engaging older adults with CI in co-design processes. Our findings revealed that the co-design aids had several benefits, including: (1) increasing the exchange of knowledge and awareness between older adults and designers; (2) eliciting insightful information through multi-sensorial aids, and (3) generating novel assistive design solutions to support seniors' independent living at home. We discuss our findings in relation to the multi-sensorial attributes of co-design aids, which empower older adults with CI to express their opinions and actively participate in co-designing assistive devices that meet their needs/expectations.

Designing highly reliable adverse-event detection systems to predict subsequent claims.

BACKGROUND: To respond proactively to patient safety events, many healthcare organizations have been enhancing and customizing their event reporting systems. Yet an indiscriminate expansion of the range and number of event reports may reduce, rather than raise, risk managers' ability to detect events that warrant a response. To avoid becoming overwhelmed by too many event reports that have little immediate operational value, risk managers therefore require a concurrent and complementary refinement of their data-processing capabilities. OBJECTIVE: To examine the extent to which adverse event reports can predict subsequent claims. DATA AND METHODS: The study sample included all adverse event reports and all records of closed claims that related to patient care episodes between July 1, 2006, and May 31, 2009, at a large hospital system in northern Virginia. After matching closed claims to event reports, we fitted multivariate predictive models to identify event report entries that predict future claims. RESULTS: During the period under study, 20 151 event reports and 94 claims were filed across the health system. We were able to match 60 claims (63.8%) to at least 1 preceding event report, implying that only 0.3% of event reports preceded a subsequent matching claim. The superior prediction model identified 90% of eventual matched claims by retaining only 20% of all event reports. CONCLUSION: Simple prediction algorithms can supplement expert judgment by screening for reports that are likely to result in a claim, thereby enabling risk managers to evaluate adverse event reports more expeditiously and to identify, and ultimately prevent, serious safety lapses more reliably.

Apolipoprotein(A) expression in intracranial aneurysms.

OBJECTIVE: Elevated serum levels of lipoprotein(a), a risk factor for atherosclerosis (AS), are also associated with the presence of asymptomatic intracranial aneurysms. AS is present in some aneurysms, but its contribution to aneurysm formation and growth is unclear. Apolipoprotein(a) [apo(a)], the active moiety of lipoprotein(a), is present in atherosclerotic circle of Willis vessels but not in normal circle of Willis vessels. We wished to determine whether apo(a) is present in intracranial aneurysms independently of AS. METHODS: With a purified anti-apo(a) monoclonal antibody, aneurysms (n = 25) and feeding vessels (n = 23) were examined for apo(a) expression by immunohistochemical analysis. Circle of Willis arteries with and without AS (n = 19), cavernous angiomas (n = 5), and arteriovenous malformations (n = 6) acted as control samples. RESULTS: AS was present in 32% of aneurysms, and all of those aneurysms demonstrated mural immunopositivity for apo(a). However, aneurysms devoid of AS also demonstrated apo(a) immunopositivity. Apo(a) was demonstrated in 86% of available feeding vessels. Apo(a) deposition was not observed in cavernous angiomas but was present in arteriovenous malformations. Eleven Circle of Willis arteries (57.9%) were devoid of AS and demonstrated no apo(a) immunostaining, whereas the eight (42.1%) with AS were immunopositive for apo(a). CONCLUSION: Apo(a) expression in intracranial aneurysms may occur independently of AS. Apo(a) in feeding vessels suggests a possible role for apo(a) in early events leading to aneurysm formation. Multilayered transmural apo(a) deposition in established aneurysms suggests apo(a) involvement in aneurysm growth, possibly via cycles of injury and repair. The absence of apo(a) in cavernous angiomas suggests that such injury might be pressure-mediated.