Predictors of Second Medical Emergency Team Activation Within 24 Hours of Index Event.

This study explored the trajectory of patients who remained on a general unit after medical emergency team activation. Of those who had a second activation within 24 hours, 80% occurred within 12 hours of the baseline activation. Chest pain and recent intensive care unit discharge were associated with having a second activation. There were statistically, not clinically, significant associations between mean vital signs and second activations; however, the patterns of change may be clinically useful.

Assessing the environmental impacts of halving food loss and waste along the food supply chain.

Reducing food loss and waste (FLW) is widely recognized as an important lever for lowering the environmental impacts of food systems. The United Nations Sustainable Development Agenda includes a goal to reduce FLW by 50% by 2030. Given differences in resource inputs along the food supply chain (FSC), the environmental benefits of FLW reduction will vary by stage of the FSC. Here, we identify the points along the supply chain where a 50% FLW reduction could yield the largest potential environmental benefits, assuming that decreases in consumption propagate back up the supply chain to reduce production. We use an environmentally extended input-output (EEIO) model combined with data on rates of FLW to calculate the scale of the total environmental impacts of the U.S. food system resulting from lost or wasted food. We evaluate the maximum potential environmental benefit resulting from 50% FLW reduction at all possible combinations of six supply chain stages (agricultural production, food processing, distribution/retail, restaurant foodservice, institutional foodservice, and households). We find that FLW reduction efforts should target the foodservice (restaurant) sector, food processing sector, and household consumption. Halving FLW in the foodservice sector has the highest potential to reduce greenhouse gas output and energy use. Halving FLW in the food processing sector could reduce the most land use and eutrophication potential, and reducing household consumption waste could avert the most water consumption. In contrast, FLW reduction at the retail, institutional foodservice, and farm level averts less environmental impact. Our findings may help determine optimal investment in FLW reduction strategies.

A systems approach to assessing environmental and economic effects of food loss and waste interventions in the United States.

Reducing food loss and waste (FLW) is critical for achieving healthy diets from sustainable food systems. Within the United States, 30% to 50% of food produced is lost or wasted. These losses occur throughout multiple stages of the food supply chain from production to consumption. Reducing FLW prevents the waste of land, water, energy, and other resources embedded in food and is therefore essential to improving the sustainability of food systems. Despite the increasing number of studies identifying FLW reduction as a societal imperative, we lack the information needed to assess fully the effectiveness of interventions along the supply chain. In this paper, we synthesize the available literature, data, and methods for estimating the volume of FLW and assessing the full environmental and economic effects of interventions to prevent or reduce FLW in the United States. We describe potential FLW interventions in detail, including policy changes, technological solutions, and changes in practices and behaviors at all stages of the food system from farms to consumers and approaches to conducting economic analyses of the effects of interventions. In summary, this paper comprehensively reviews available information on the causes and consequences of FLW in the United States and lays the groundwork for prioritizing FLW interventions to benefit the environment and stakeholders in the food system.

Framing the evidence for health smart homes and home-based consumer health technologies as a public health intervention for independent aging: a systematic review.

INTRODUCTION: There is a critical need for public health interventions to support the independence of older adults as the world's population ages. Health smart homes (HSH) and home-based consumer health (HCH) technologies may play a role in these interventions. METHODS: We conducted a systematic review of HSH and HCH literature from indexed repositories for health care and technology disciplines (e.g., MEDLINE, CINAHL, and IEEE Xplore) and classified included studies according to an evidence-based public health (EBPH) typology. RESULTS: One thousand, six hundred and thirty-nine candidate articles were identified. Thirty-one studies from the years 1998-2011 were included. Twenty-one included studies were classified as emerging, 10 as promising and 3 as effective (first tier). CONCLUSION: The majority of included studies were published in the period beginning in the year 2005. All 3 effective (first tier) studies and 9 of 10 of promising studies were published during this period. Almost all studies included an activity sensing component and most of them used passive infrared motion sensors. The three effective (first tier) studies all used a multicomponent technology approach that included activity sensing, reminders and other technologies tailored to individual preferences. Future research should explore the use of technology for self-management of health by older adults; social support; and self-reported health measures incorporated into personal health records, electronic medical records, and community health registries.

Electronic documentation of central venous catheter-days: validation is essential.

BACKGROUND: Measurement of central line-associated bloodstream infection (CLABSI) rates outside of intensive care units is challenged by the difficulty in reliably determining central venous catheter (CVC) use. The National Healthcare Safety Network (NHSN) allows for use of electronic data for determination of CVC-days, but validation of electronic data has not been studied systematically. OBJECTIVE: To design and validate a process to reliably measure CVC-days outside of the intensive care units that leverages electronic documentation. METHODS: Thirty-four inpatient wards at 2 academic hospitals using a common electronic platform for nursing documentation were studied. Electronic queries were created to capture patient and CVC information, and tools and processes for tracking and reporting errors in documentation were developed. Strategies to validate electronic data included comparisons with manual CVC-day determinations and automated data validation using customized tools. Interventions included redesign of documentation interface, real-time audit with feedback of errors, and education. The primary outcome was patient-level total error rate in electronic CVC-day measurement compared with manually counted CVC-days. RESULTS: At baseline, there were a mean (± standard deviation) of [Formula: see text] electronic CVC-day errors (omission and commission errors summed and counted equally) per manually counted CVC-day. After several process improvement cycles over 7 months, the error rate decreased to <0.05 errors per CVC-day and remained at or below this level for 2 years. CONCLUSIONS: Baseline electronic CVC-day counts had a high error rate. Stepwise interventions reduced errors to consistently low levels. Validation of electronic calculation of CVC-days is essential to ensure accuracy, particularly if these data will be used for interinstitutional comparison.

[Pharmaceutical revision of hospital drug administration]. / Farmasøytisk revisjon av legemiddelhåndtering i sykehus.

BACKGROUND: Quality audits of the implementation of drug administration procedures are carried out in order to determine objectively to what extent implementation conforms to procedures. METHODS: Since September 1997, the pharmacy at Rikshospitalet University Hospital in Norway has performed quality audits of drug administration at the hospital, using interviews and surveys. Staff members in the audited unit and the auditing pharmacist agree on prospects for quality improvements and review possible action. A survey was carried out in the autumn of 2000 in order to determine staff opinion of the quality audits. RESULTS: On the basis of the observations made, improvements have been carried out at all levels of the organisation. INTERPRETATION: The survey indicates that hospital staff members are satisfied with the quality audits performed by the pharmacy.