Improving Administration and Documentation of Enteral Nutrition Support Therapy in a Veteran Affairs Health Care System: Use of Medication Administration Record and Bar Code Scanning Technology.

OBJECTIVES: The goal of this project was to evaluate and improve the ordering, administration, documentation, and monitoring of enteral nutrition therapies within the inpatient setting in a Veteran's Health Administration system. METHODS: An interdisciplinary team of clinicians reviewed the literature for best practices and revised the process for enteral nutrition support for hospitalized veterans. Interventions included training staff, revising workflows to include scanning patients and products, including enteral nutrition orders within the medication administration record (MAR), and using the existing bar code medication administration system for administration, documentation, and monitoring. Baseline and postprocess improvement outcomes over a year period were collected and analyzed for quality improvement opportunities. RESULTS: Before process change, only 60% (33/55) of reviewed enteral nutrition orders were documented and 40% (22/55) were not documented in the intake flowsheet of the electronic health record. In the year after adding enteral nutrition therapies to the MAR and using bar code scanning, a total of 3807 enteral nutrition products were evaluated. One hundred percent of patients were bar code scanned, 3106/3807 (82%) products were documented as given, 447/3807 (12%) were documented as held (with comments), 12/3807 (<1%) were documented as missing/unavailable, and 242/3807 (6%) were documented as refused. CONCLUSIONS: Inclusion of enteral nutrition order sets on the MAR and using bar code scanning technology resulted in sustained improvements in safety, administration, and documentation of enteral therapies for hospitalized veterans.

Older and younger adults' accuracy in discerning health and competence in older and younger faces.

We examined older and younger adults' accuracy judging the health and competence of faces. Accuracy differed significantly from chance and varied with face age but not rater age. Health ratings were more accurate for older than younger faces, with the reverse for competence ratings. Accuracy was greater for low attractive younger faces, but not for low attractive older faces. Greater accuracy judging older faces' health was paralleled by greater validity of attractiveness and looking older as predictors of their health. Greater accuracy judging younger faces' competence was paralleled by greater validity of attractiveness and a positive expression as predictors of their competence. Although the ability to recognize variations in health and cognitive ability is preserved in older adulthood, the effects of face age on accuracy and the different effects of attractiveness across face age may alter social interactions across the life span.

ANIMAL ANALOGIES IN FIRST IMPRESSIONS OF FACES.

Analogies between humans and animals based on facial resemblance have a long history. We report evidence for reverse anthropomorphism and the extension of facial stereotypes to lions, foxes, and dogs. In the stereotype extension, more positive traits were attributed to animals judged more attractive than con-specifics; more childlike traits were attributed to those judged more babyfaced. In the reverse anthropomorphism, human faces with more resemblance to lions, ascertained by connectionist modeling of facial metrics, were judged more dominant, cold, and shrewd, controlling attractiveness, babyfaceness, and sex. Faces with more resemblance to Labradors were judged warmer and less shrewd. Resemblance to foxes did not predict impressions. Results for lions and dogs were consistent with trait impressions of these animals and support the species overgeneralization hypothesis that evolutionarily adaptive reactions to particular animals are overgeneralized, with people perceived to have traits associated with animals their faces resemble. Other possible explanations are discussed.

Neural activation to babyfaced men matches activation to babies.

Behavioral data supports the commonsense view that babies elicit different responses than adults do. Behavioral research also has supported the babyface overgeneralization hypothesis that the adaptive value of responding appropriately to babies produces a tendency for these responses to be overgeneralized to adults whose facial structure resembles babies. Here we show a neural substrate for responses to babies and babyface overgeneralization in the amygdala and the fusiform face area (FFA). Both regions showed greater percentage BOLD signal change compared with fixation when viewing faces of babies or babyfaced men than maturefaced men. Viewing the first two categories also yielded greater effective connectivity between the two regions. Facial qualities previously shown to elicit strong neural activation could not account for the effects. Babyfaced men were distinguished only by their resemblance to babies. The preparedness to respond to infantile facial qualities generalizes to babyfaced men in perceivers' neural responses just as it does in their behavioral reactions.