The internal consistency and intra-rater reliability of an assessment practice grid for community nurses

The development of instruments to measure clinical competence in nursing shows little evidence of a systematic approach and studies of reliability and validity are absent. The present study was carried out using data on practice assessment collected in the course of a post-registration nursing programme. The data were analysed for internal consistency and intra-rater reliability. The instrument used to assess practice in the present study is highly internally consistent and there is evidence to support intra-rater reliability. However, further development and testing of the instrument is required.     

Poster 31: Community-acquired pneumonia in veterans with spinal cord injury

Objective: To describe the characteristics of community-acquired pneumonia (CAP) in persons with spinal cord injury (SCI) and how management is related to outcomes. Design: Cross-sectional retrospective review of administrative and clinical data. Setting: Department of Veterans Affairs (VA) facilities, and for substudy, 3 VA SCI centers (October 1998-September 2000). Participants: Veterans with SCI: 260 inpatients with CAP; in the substudy, 41 inpatients and outpatients with CAP from 3 sites. Interventions: Not applicable. Main Outcome Measures: Percentage of patients with an etiologic diagnosis, mortality rate, mean length of stay (LOS), and number and types of procedures and treatments. Results: Of the 260 inpatients with SCI identified from administrative data with CAP, only 24% had an etiologic diagnosis. Etiologic diagnosis was not associated with mortality after adjusting for several factors (OR=1.38; CI, 0.45-4.20), however, it was associated with an increase in LOS (P=.024). For the substudy, almost 75% of the 41 patients were hospitalized (mean LOS=16.3d) and 3 patients died. Most received chest radiographs (85%), but up to 54% did not receive other tests standard for management of CAP during the first day of care (eg, blood cultures, CHEM 7). Of the 16 patients with sputum cultures, an organism was identified in 44% through microbiology testing. Over 90% received antibiotics within 24 hours of admission. Conclusions: Many patients do not receive the minimum recommended testing. Empiric treatment appears to have been the predominant type of management used in this population. Further research to assess the relationship between clinical characteristics and management with patient outcomes is     

Application of a shape memory alloy for internal artificial organs

Shape memory alloy (SMA) is an actuator with high efficiency, and for this reason, SMA is suitable for totally implantable artificial internal organs. We have thought about the various possible applications, and one is an artificial sphincter. Many patients with cancer have a stoma, with which control of excretion is, of course, difficult. It limits the quality of life (QOL) of patients with stomata. If there is a sphincter for the stoma, control becomes possible. Therefore, an artificial anal sphincter was developed. Energy will be supplied by the use of a transcutaneous energy transmission system (TETS). The energy is used to raise the temperature and this becomes the drive energy in the SMA. This system can achieve very high efficiency; therefore, this actuator may be suitable for artificial internal organs. This system is currently in the stage of animal experimentation. By opening and shutting an artificial anal sphincter, excretion becomes possible. Application of this totally implantable system to artificial myocardium is considered in this article. SMA thread was sewn together, and the artificial myocardium was applied to the outside of a heart. For improvement of the cooling time, Peltier elements were adopted in this artificial myocardium. By the use of Peltier elements, rapid cooling becomes possible. Using this artificial myocardium, cardiac contraction may be assisted. In this way, various applications of the SMA are being considered in Tohoku University.