Thickness of the middle trapezius muscle measured by rehabilitative ultrasound imaging: description of the technique and reliability study

A technique is described for measuring the thickness of the middle trapezius muscle using rehabilitative ultrasound imaging (RUSI). A test–retest study was employed to investigate the reliability of the technique in a convenience sample of 16 asymptomatic participants aged 20–41 (12 women). The middle trapezius muscle was imaged using RUSI with participants in a standardized sitting position. The principal investigator took measurements on two consecutive days to examine intra‐rater reliability, and two additional investigators took measurements on the second day to investigate inter‐rater reliability of the measurement technique. Reliability was examined using intra‐class correlation coefficients (ICC), standard error of measurement (SEM), and Bland and Altman plots. The results demonstrated that inter‐rater reliability was good between raters (ICC_2,3 = 0·81, SEM = 0·94 mm) and was moderate for the same rater between days (ICC_3,2 = 0·67, SEM = 1·0 mm). This study demonstrates that RUSI can be used reliably to measure muscle thickness of the middle trapezius muscle following the procedure described.     

Reliability of the Respiratory Movement Measuring Instrument,RMMI

Introduction: A new instrument to measure breathing movements, Respiratory Movement Measuring Instrument (RMMI), has been developed. There is still a lack of knowledge about the reliability of the instrument. Objectives: The aim was to investigate reliability of the RMMI. Methods: In this trial, RMMI (ReMo Inc. Keldnaholt, Reykjavik, Iceland) was used. Inter‐ and intrarater reliability was performed on 30 volunteers who were tested three times in the supine position. Two of the tests were performed by one of the authors and the third test by the other. Intrasubject reliability was tested on 10 volunteers 12 times randomly during 1 h. Intra‐instrument reliability was performed by measuring 12 solid surfaces where the instrument was placed horizontally against a couch or vertically against a chair. Results: Intra‐rater reliability: The correlations were moderate to strong (r = 0·54–0·94) except for the left lower thoracic position r = 0·35. Inter‐rater reliability: The correlations were strong (r = 0·71–0·99) except for the left lower thoracic position r = 0·35. The strongest correlations were seen on the tests on abdominal breathing movements. Intra subject reliability: The over‐all difference within and between the participants and test was non‐significant (P = 0·98). The average difference between the tests was 1·4 mm. Intra instrument: The differences between the measurements were small (mean 0·15 mm). The over‐all difference was non‐significant (P = 0·79). Conclusion: The RMMI is a reliable instrument and usable in both clinical practice and research.     

Developing and testing a urine colour reference scale: a practice development project

Although it is a common reason for consulting a doctor, there is inconsistency in describing and discussing abnormally coloured urine. To produce a reliable visual urine colour rating scale that reflects and enables accurate reporting of varying degrees of concentrated urine and of macroscopic haematuria. A practice development project was undertaken in the Urology ward of an acute care private hospital. The project was patient focussed, multidisciplinary, actively engaged staff and was evolutionary. Initially a prototype chart was developed but was found to need redevelopment. Funding and ethics approval were obtained. Study 1 involved a second draft of the scale with three colours depicting hydration status and four depicting macroscopic haematuria, together with instructions for use. Study 2 demonstrated the need for and benefit of having a urine colour reference scale. Studies 3 and 4 demonstrated the very high intra‐rater (r = 0·8175–0·9999) and inter‐rater (r = 0·5886–0·9932) reliability of the scale. Following these studies it was decided to include a depiction of normal clear urine among the three colours depicting hydration status and the four depiction of macroscopic haematuria. A urine colour rating scale was developed and refined through repeated trials of efficacy and usability which may facilitate objective communication between patients, carers, nurses and doctors concerning the colour of urine (it also serves an educational function, giving prompts about the other factors likely to be of significance when management decisions are made). This scale can be used by healthcare workers and patients/carers when describing urine colour, especially during phone conversations to inform decisions concerning treatment.     

The contribution of patient interviews to the identification of drug‐related problems in home medication review

What is known and Objective: To determine to what extent patient interviews contribute to the identification of drug‐related problems (DRPs) in home medication reviews, in terms of number, type and clinical relevance. Methods: We performed a cross‐sectional study within the intervention arm of a randomized controlled trial. Patients were recruited from 10 Dutch community pharmacies. Patients were eligible if they were home‐dwelling, aged 65 years and over and used five or more different drugs, including at least one cardiovascular or antidiabetic drug. The community pharmacist interviewed the patient at home about the medicines and identified potential DRPs in combination with medication and clinical records. This medication review was assessed and modified by an independent pharmacist reviewers’ panel. Outcomes were the number and type of DRPs and recommendations and percentage of clinical relevant DRPs. Clinical relevance of DRPs was assessed by DRPs assigned a high priority, DRPs followed by recommendations for drug change and DRPs followed by implemented recommendations for drug change. Results: A total of 1565 potential DRPs and recommendations (10 per patient).were identified for 155 patients (median age, 76 years; 54% women). Fifty‐eight per cent of all recommendations involved a drug change; 27% of all DRPs were identified during patient interviews and 74% from medication and clinical records. Compared to DRPs identified from patient medication and clinical records, DRPs identified during patient interviews were more frequently assigned a high priority (OR = 1·8 [1·4–2·2]), were more frequently associated with recommendations for drug change (OR = 2·4 [1·9–3·1]) and were implemented recommendations for drug change (OR = 2·8 [2·1–3·7]). What is new and Conclusion: This study shows that more than a quarter of all DRPs were identified during patient interviews. DRPs identified during patient interviews were more frequently assigned a higher clinical relevance.     

Care dependency of children in Egypt

Aims. This study aimed to modify the Care Dependency Scale so that it could be used for children, to apply its Arabic version to Egyptian children to test the reliability and validity of the modified scale and to compare the care dependency of disabled and non‐disabled Egyptian children. Background. A higher dependence of children in their daily tasks undoubtedly places a greater burden on their caregivers. To estimate the extent of the problem of care dependency, data from different countries and proper standard instruments are required. Method. The Care Dependency Scale was modified for children by Delphi technique. This study assessed the care dependency of non‐disabled children compared with children with physical and mental disabilities using the modified version of the Care Dependency Scale for paediatrics. The total sample included 260 Egyptian school‐age children (50·8% of whom were disabled and 49·2% were non‐disabled). Results. Reliability was examined in terms of internal consistency using Cronbach's alpha (0·91). Inter‐rater reliability revealed moderate to very good Kappa statistics between 0·57–0·89. Content validity and criterion validity were evaluated. Differences regarding care dependency were found between disabled and non‐disabled children. Conclusion. The psychometric properties of the Care Dependency Scale for paediatrics support its usefulness in measuring the care dependency of children in Egypt. This study provides an Arabic version of the Care Dependency Scale for paediatrics that is easy to administer and may be useful to measure the care dependency in various Arabic countries. Relevance to clinical practice. The findings raise concerns regarding the extent to which disabled and also non‐disabled school‐age children are care dependent leading to an increased burden of care on nurses or on caregivers in general. The Care Dependency Scale for Paediatrics can help nurses conduct an appropriate assessment of children's care dependency so that any nursing care can be planned according to the children's needs.     

Tracer kinetics analysis of dynamic contrast‐enhanced CT and MR data in patients with squamous cell carcinoma of the upper aerodigestive tract: comparison of the results

Purpose: (i) To evaluate the feasibility of tracer kinetics analysis of dynamic contrast‐enhanced (DCE) CT and T2‐weighted MR data of squamous cell carcinoma (SCCA) of the upper aerodigestive tract. (ii) To compare functional parameters derived by both modalities and examine the interchangeability of them as well as the intra‐ and inter‐rater agreement. Materials and methods: Dynamic contrast‐enhanced‐CT and MR images of 23 patients with SCCA were postprocessed using a distributed‐parameter (DP) tracer kinetic model. The evaluated parameters included blood flow (F), intravascular blood volume (v₁), extravascular extracellular blood volume (v₂), intravascular mean transit time (t₁), lag time (t₀), permeability surface area product (PS) and extraction ratio (E). Mean perfusion values, based on region‐of‐interest analysis, of the tumors and the healthy muscle tissue were compared and correlated. Inter‐rater and intra‐rater variability were assessed. Interchangeability of the tumor functional parameters was tested using Pearson’s correlation coeficients and Bland–Altman plots. Results: The mean values in tumor and healthy muscle tissues were significantly different for each modality (0·0001≤P≤0·03). The mean values of all tumor perfusion parameters apart from v₂ and E were significantly different (0·001≤P≤0·009) between the two modalities. The intra‐rater variability was good to very good for all parameters. The inter‐rater variability was moderate to good. Bland–Altman plots of F, t₁, t₀, and v₂ showed moderate interchangeability. There was a proportionality error in v₁ and PS graphs. Conclusion: The estimation of functional parameters in SCCA is feasible using DCE‐CT and ‐MR with a DP model. The parameters are mostly significantly different and the interchangeability of them is limited.     

Reliability of the de Morton mobility index (DEMMI) in an older acute medical population

Background. The de Morton Mobility Index (DEMMI) is an instrument that accurately measures the mobility of older people across clinical settings. Purpose. To report the multiple reliability studies conducted during the development and validation of the DEMMI. Methods. Intra‐rater and inter‐rater reliability studies were conducted for the DEMMI in two independent samples (development and validation samples) of older acute medical patients (aged 65 years or older). Inter‐rater reliability studies were conducted between the test developer (a physiotherapist) and another experienced physiotherapist. Order of assessor administration was randomized by a coin toss. Patients who were fatigued after the first assessment were excluded from the inter‐rater reliability study. Intra‐rater reliability studies included participants with ‘unchanged’ mobility status between hospital admission and discharge. Scale reliability estimates were expressed as the minimal detectable change with 90% confidence (MDC₉₀). Item reliability was calculated using Kappa statistics and absolute percentage agreement. Results. The MDC₉₀ for the DEMMI development sample was 9.51 points (95% confidence interval [95% CI], 5.04–13.32; n = 21) and 7.84 (95% CI, 4.34–11.65; n = 16) on the 100‐point interval DEMMI scale for the inter‐rater and intra‐rater reliability studies, respectively. Similar estimates were obtained for the DEMMI validation samples of 8.90 (95% CI, 6.34–12.69; n = 35) and 13.28 points (95% CI, 8.08–20.87; n = 19). Items were not excluded from the DEMMI based on the results of item reliability. Conclusion. Reliability estimates for the DEMMI were consistent across independent samples of older acute medical patients using different reliability study methodology. Error represents approximately 9% of the DEMMI scale width. Copyright © 2010 John Wiley & Sons, Ltd.     

Test–retest reliability of the IDEEA system in the quantification of step parameters during walking and stair climbing

The aim of this investigation was to evaluate the inter‐ and intra‐session reliability of spatio‐temporal gait variables collected during walking and stair climbing with the Intelligent Device for Energy Expenditure and physical Activity (IDEEA) accelerometer‐based system. Eighteen healthy subjects (10 men, 8 women) completed a standardized indoor circuit comprised of walking and stair climbing. Intra‐and inter‐session reliability was investigated for several pertinent spatio‐temporal gait variables using intraclass correlations [ICC (3,1)]. Intra‐session reliability during walking showed a high reliability of the IDEEA with ICCs ranging between 0·84 (number of steps) and 0·97 (single limb support/double limb support). The ICCs for stair climbing were slightly lower than those during walking with values ranging between 0·74 (step duration) and 0·92 (number of steps). Inter‐session reliability during walking showed a high reliability of the IDEEA between all trials, with values ranging between 0·87 (speed) to 0·98 (step duration). The ICCs of stair climbing were again lower than those during walking with values ranging from 0·64 (swing duration) to 0·79 (number of steps). The IDEEA accelerometer‐based system provided a highly reliable measurement of spatio‐temporal variables, in healthy subjects, during walking with moderately reduced correlations during stair climbing.     

Midwifery care: development of an instrument to measure quality based on the World Health Organization's classification of care in normal birth

Aims and objectives. The aim of the study was to develop an instrument to measure midwifery care in relation to World Health Organization's classification of care in normal birth and to test the instrument for content validity and inter‐rater reliability. Methods. The Delphi method was used for development of the instrument and to elicit evidence of content validity. Six experts from three different geographical regions in Sweden, representing clinically working midwives, lecturers in midwifery and obstetricians, participated in the first part of the study. The instrument was tested for inter‐rater reliability in an exploratory study by two midwives and one of the authors. Data were analysed using percentage of agreement level and the Kappa coefficient. Results. Five expert rounds were needed to reach consensus for content validity. The inter‐rater reliability test showed high agreement levels (95.9, 94.2 and 95.7%) and good to very good Kappa coefficients (0.74–1.0). The final instrument consisted of 78 items divided into five sections: background (five items); practices which are demonstrably useful and should be encouraged (55 items); practices which are clearly harmful or ineffective and should be eliminated (five items); practices for which insufficient evidence exists to support a clear recommendation and which should be used with caution while further research clarifies the issue (four items); and finally practices which are frequently used inappropriately (nine items). Conclusions and relevance to clinical practice. The instrument can be used at a labour ward to measure documented care and quality of midwifery care. The results can be used to identify areas for improvements, to develop guidelines towards evidence‐based care and to improve documentation. However, the present study should be regarded as an exploratory study and the feasibility of the instrument remains to be tested in empirical studies.     

Validation of a method for recording pharmaceutical interventions

What is known and objective: The validation of a method for recording pharmaceutical interventions measures the instrument’s ability to provide consistent values when the same analysis is performed several times. Our aim was to validate the inter‐rater reliability of the method used to record pharmaceutical interventions in our hospital. Methods: We recorded interventions in a database, entering variables related to the patient, treatment and impact of the recommendation. We also recorded the type, cause and clinical significance of the negative outcome associated with use of the medicinal product (NOM). Twenty interventions performed during a 3‐year study period (2007–2009) were randomly tested for consistency to analyse the kappa (κ) coefficient statistic of the recommendations as coded by nine senior and junior clinical pharmacists. Results and discussion: There were 87·8% global consistency for NOM cause, 66·1% for intervention impact and 95·0% for NOM type. Agreement was substantial for ‘intervention reasons’, with a κ value of 0·74 (95%CI 0·61–0·87), fair for ‘intervention impact’, with a κ value of 0·24 (95%CI 0·15–0·32) and excellent for ‘NOM type’, with a κ value of 0·87 (95%CI 0·71–1·00), respectively. Our results are globally good, especially with regard to the analysis of intervention reasons and NOM type, which matches other authors’ findings. Furthermore, our validation method is suitable for recording and considering the impact of pharmaceutical interventions. What is new and conclusion: We describe a systematic method for clinical pharmacists to record their activities and assess their value. This methodology should help in the development of clinical pharmacy in Spain and should be translatable to other settings.     

Variability of automated carotid intima‐media thickness measurements by novice operators

Carotid intima‐media thickness (C‐IMT) measurements provide a non‐invasive assessment of subclinical atherosclerosis. The aim of the study was to assess the inter‐ and intra‐observer variability of automated C‐IMT measurements undertaken by two novice operators using the Panasonic CardioHealth Station. Participants were free from cardio‐metabolic disease, and each underwent serial bilateral C‐IMT ultrasound measurements. Immediate interoperator measurement variability was calculated by comparing initial measurements taken by two operators. Immediate retest variability was calculated from two consecutive measurements and longer term variability was assessed by conducting a further scan 1 week later. Fifty apparently healthy participants (n = 20 females), aged 26·2 ± 5·0 years, were recruited. Operator 1 recorded a median (interquartile range) right and left‐sided C‐IMT of 0·471 mm (0·072 mm) and 0·462 mm (0·047 mm). Female's right and left C‐IMT were 0·442 mm (0·049 mm) and 0·451 mm (0·063 mm), respectively. The limits of agreement (LoA) for immediate interoperator variability were ?0·063 to 0·056 mm (mean bias ?0·003 mm). Operator 1's immediate retest intra‐operator LoA were ?0·057 to 0·046 mm (mean bias was ?0·005 mm). One‐week LoA were ?0·057 to 0·050 mm (mean bias ?0·003 mm). Operator 2 recorded median right and left‐sided C‐IMT of 0·467 mm (0·089 mm) and 0·458 mm (0·046 mm) for males, respectively, whilst female measurements were 0·441 mm (0·052 mm) and 0·444 mm (0·054 mm), respectively. Operator 2's intra‐operator immediate retest LoA were ?0·056 to 0·056 (mean bias 相似文献   

Inter- and intra-observer (dis)agreement among nurses and doctors to classify colour and exudation of open surgical wounds according to the Red-Yellow-Black scheme

Aim and objectives. Primary: to study the level of agreement among nurses and doctors in classifying the colour and exudation of open wounds according to the Red‐Yellow‐Black scheme. Secondary: to check their agreement with an international expert panel on whether their classification was correct. Background. Nurses and doctors classify open wounds to assess systemic and local treatment options. Nowadays, several classification schemes are being used. The Red‐Yellow‐Black‐scheme is commonly used for classifying open wounds or is part of other, more intricate, wound classification models. Methods. Eighteen representative photographs of red, yellow and black wounds were presented to 63 nurses and 79 doctors from the Department of Surgery. They classified these open wounds for colour and amount of exudation. Group kappa's (κ) were calculated to assess inter‐ and intra‐observer agreement and their agreement with an expert panel. Results. Agreement among the 63 nurses on wound colour (κ = 0·61; 95% CI: 0·49–0·74) and exudation (κ = 0·49; 95% CI: 0·29–0·68) was moderate to good. Agreement among the 79 doctors was similar: κ = 0·61; 95% CI 0·49–0·73 for wound colour and κ = 0·48; 95% CI: 0·36–0·61 for exudation. Nurses’ and doctors’ agreement with the expert panel was also moderate to good: κ‐values ranged between 0·48 and 0·77. Conclusion. Based on the good to moderate inter‐observer agreement as found in this study, the Red‐Yellow‐Black ‐scheme appears to be a reliable and accurate classification scheme to assess open (surgical) wounds. Such a scheme may enable nurses and doctors to select the appropriate treatment modalities and evaluate the progress of the healing process. Relevance to clinical practice. The Red‐Yellow‐Black scheme is a helpful tool to classify all kinds of wounds and can be used as stand‐alone classification method or as part of wound management concepts.     

A new reliable tool (PVC assess) for assessment of peripheral venous catheters

Rationale and aims To evaluate the extensive use of peripheral venous catheters (PVCs), including catheter‐related complications, a reliable tool for PVC assessment is needed. The aim of this study was to develop such a tool to evaluate PVCs in relation to management, documentation and signs and symptoms of thrombophlebitis (TH), as well as to determine its inter‐rater and test‐retest reliability. Method The tool development included confirmation of content and face validity. Two groups of registered nurses used the new tool (PVC assess ) to assess PVC management and signs of TH independently. Group A (n = 3) assessed 26 items in 67 PVCs bedside (inter‐rater reliability). Group B (n = 3) assessed photographs (67 PVCs, 21 items) of the same PVCs as those in Group A with a 4‐week interval (test‐retest reliability). Proportion of agreement P(A) and Cohen's kappa were calculated to evaluate inter‐rater and test‐retest reliability. Results Among nurses assessing PVCs at bedside, the P(A) was good to excellent (0.80–1) in 96% of the items in PVC assess . In 80% of the items kappa was substantial to almost perfect (0.61–1). TH sign erythema fell into the fair range (kappa = 0.40). In test‐retest reliability analysis the P(A) was within the good and excellent range (0.80–1.0) and kappa varied from moderate to almost perfect (0.41–1.0) in 95% of the items. One item ‘outer dressing is clean’ was in fair range (0.21–0.40). Conclusions The PVC assess instrument shows satisfactory inter‐rater and test‐retest reliability. Reliability tests on reviewing documentation remain to be performed.     

Validation of the Italian version of the Discomfort Scale - Dementia of Alzheimer Type

Title. Validation of the Italian version of the Discomfort Scale – Dementia of Alzheimer Type. Aim. This paper is a report of a study to validate the Discomfort Scale – Dementia of Alzheimer Type in Italian. Background. Dementia is a long and highly debilitating illness with a slow course and a steadily rising prevalence. Improving the quality of life of patients with dementia requires instruments to measure their problems and symptoms, because they are unable to communicate and interact with others. In Italy, there are no validated scales to assess discomfort for this population. The Discomfort Scale – Dementia of Alzheimer Type was developed in the USA and has been further tested there as well as in Germany. Methods. The data were collected by 21 nurses during 2006 in five nursing homes with 71 patients with severe dementia. Face and content validity were evaluated in a focus group. Discriminant validity was assessed with the opposite‐group approach and internal consistency and inter‐rater reliability were measured. Results. The discriminant validity of the Italian Discomfort Scale – Dementia of Alzheimer Type showed its ability to detect patients with high and low levels of discomfort. Reliability testing gave positive results: the internal consistency level was satisfactory (0·814) and comparisons of overall discomfort scores across nurses show good reliability. Conclusion. These findings support the use of Discomfort Scale – Dementia of Alzheimer Type in a clinical setting for people with severe dementia for both research and practice. Its ease of use and comprehensibility, and the limited time required to observe patients renders the Discomfort Scale – Dementia of Alzheimer Type a practical instrument for assessment and choosing care interventions.     

Impact of a self-administration of medications programme on elderly inpatients' competence to manage medications: a pilot study

What is known and objectives: Changes to medication regimens and failure to involve patients in management of their medications whilst in hospital may result in medication errors or non‐adherence at home after discharge. Self‐administration of medications programmes (SAMP) have been used to address this issue. The objective of this study was to assess the impact of a SAMP on elderly hospital inpatients’ competence to manage medications and their medication adherence behaviours. Methods: The SAMP comprised three stages: education, progressing to supervised self‐administration and finally to independent self‐administration. Decisions to progress patients to the next level, and whether they passed or failed the SAMP, were made by the ward pharmacist and nursing staff. The Drug Regimen Unassisted Grading Scale (DRUGS) was used to assess patients’ competence to manage medications at various time points. Tablet count and the Tool for Adherence Behaviour Screening (TABS) were used as adherence measures. Results and discussion: Participants (n = 24) with a mean age of 77·4 years, were mainly female and generally had a high level of functioning. They were prescribed a mean of 9·0 medications at the time of commencing the SAMP. Twenty‐two of the 24 participants successfully completed the SAMP. DRUGS scores at discharge improved significantly (P < 0·001) compared with that before commencement of medication self‐administration. Participants reported a significant decrease (P = 0·02) in non‐adherent behaviour and a trend towards improved adherent behaviour (P = 0·08) after participation in the SAMP. What is new and conclusion: An inpatient SAMP improved elderly patients’ ability to competently manage and adhere to their prescribed medications regimen. This finding needs to be confirmed in a larger controlled trial.     

Drug-related problems on hospital admission: relationship to medication information transfer

BACKGROUND: Patients with end-stage renal disease (ESRD) are at risk for drug-related problems (DRPs), especially on hospital admission. OBJECTIVE: To identify and characterize the DRPs experienced by patients with ESRD on admission and investigate how these DRPs could be related to gaps in medication information transfer. METHODS: Patients with ESRD admitted to the hospital were prospectively identified and clinically assessed by a pharmacist to identify and categorize DRPs on admission. Each DRP was evaluated to determine whether it could have been caused by a gap in medication information transfer. For DRPs caused in this manner, the interface in the information transfer process where the gap may have occurred was determined. RESULTS: A total of 199 DRPs were identified in 47 patients with ESRD over a 12 week period. Ninety-two percent of patients had at least one DRP on admission, with an average of 4.2 +/- 2.2 DRPs per patient. The most common DRP identified was indication for drug therapy--patient requires drug but is not receiving it (51.3%). Of the total DRPs, 130 (65%) were related to gaps in medication information transfer, with 21.5% occurring between the inpatient hospital and the ambulatory clinic pharmacists and 17.7% between the admitting physician and the patient. CONCLUSIONS: Results of this study demonstrate that, in patients with ESRD, DRPs on admission are frequently related to gaps in medication information transfer between healthcare professionals and also between healthcare providers and patients. Improved communication is required at medication information transfer interfaces to prevent these DRPs.     

Use of non‐conventional nurses’ attire in a paediatric hospital: a quasi‐experimental study

Aims:  To test the impact of a multi‐coloured non‐conventional attire on a population of children admitted to a paediatric hospital. Design:  Quasi‐experimental before‐after controlled study. Background:  It has been suggested that non‐conventional nurses’ uniforms in paediatric settings may contribute to lowering children’s distrust towards healthcare providers and reduce fear. Little formal research has investigated on the impact of nursing attire in a paediatric setting. No study has so far analysed the effects in actual use of a non‐conventional, other than the traditional type of uniform, on a paediatric hospitalised population. Design:  A quasi‐experimental study. Methods:  We introduced multi‐coloured nurses’ attire in two wards of a paediatric hospital. Using open questions and semantic differential scales (SDS), we evaluated the effects of this non‐conventional attire on a group of hospitalised children, compared to sex‐and‐age‐matched controls interviewed before the introduction. Parents were also interviewed. Results:  One hundred and twelve hospitalised children and their parents (n = 112) were studied. The percentage of positive words used by children to define their nurse was higher in children interviewed after the introduction of non‐conventional uniforms (96·2% vs. 81·8%, p = 0·01). Children’s perception of nurses was significantly improved by the use of multi‐coloured attire (‘bad’–‘good’ SDS: p = 0·01; ‘disagreeable’–‘nice’ SDS: p = 0·001). Children’s perceptions regarding hospital environment did not change. Parents’ perception of nurses’ uniform adequacy to the role and capability to reassure resulted improved (p < 0·0001, p = 0·0003). Conclusions:  Multi‐coloured non‐conventional attire were preferred by hospitalised children and their parents. Their introduction improved the perception children have of their nurses. Moreover, the coloured uniforms improve the parents perception about the reliability of the nurse. Relevance to clinical practice:  The use of non‐conventional nurses’ attire can contribute to improve the child–nurse relation, which has the potential to ease the discomfort experienced by children due to hospitalisation.     

Inter-rater reliability of the EPUAP pressure ulcer classification system using photographs

Background. Many classification systems for grading pressure ulcers are discussed in the literature. Correct identification and classification of a pressure ulcer is important for accurate reporting of the magnitude of the problem, and for timely prevention. The reliability of pressure ulcer classification systems has rarely been tested. Aims and objectives. The purpose of this paper is to examine the inter‐rater reliability of classifying pressure ulcers according to the European Pressure Ulcer Advisory Panel classification system when using pressure ulcer photographs. Design. Survey was among pressure ulcer experts. Methods. Fifty‐six photographs were presented to 44 pressure ulcer experts. The experts classified the lesions as normal skin, blanchable erythema, pressure ulcer (four grades) or incontinence lesion. Inter‐rater reliability was calculated. Results. The multirater‐Kappa for the entire group of experts was 0.80 (P < 0.001). Various groups of experts obtained comparable results. Differences in classifications are mainly limited to 1 degree of difference. Incontinence lesions are most often confused with grade 2 (blisters) and grade 3 pressure ulcers (superficial pressure ulcers). Conclusions. The inter‐rater reliability of the European Pressure Ulcer Advisory Panel classification appears to be good for the assessment of photographs by experts. The difference between an incontinence lesion and a blister or a superficial pressure ulcer does not always seem clear. Relevance to clinical practice. The ability to determine correctly whether a lesion is a pressure ulcer lesion is important to assess the effectiveness of preventive measures. In addition, the ability to make a correct distinction between pressure ulcers and incontinence lesions is important as they require different preventive measures. A faulty classification leads to mistaken measures and negative results. Photographs can be used as a practice instrument to learn to discern pressure ulcers from incontinence lesions and to get to know the different grades of pressure ulcers. The Pressure Ulcer Classification software package has been developed to facilitate learning.