Data Set (data + set)

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  • training data set
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  • Terms modified by Data Set

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  • Selected Abstracts

    The European Court, National Judges, and Legal Integration: A Researcher's Guide to the Data Set on Preliminary References in EC Law, 1958--98

    EUROPEAN LAW JOURNAL, Issue 2 2000
    Alec Stone Sweet
    We hope to stimulate more systematic research on all areas of legal integration by making available for free and open use a comprehensive data base on preliminary references in EC law. The Data Set, which has been under construction since 1996, is now online at various websites. The data are not publicly accessible elsewhere. In this article, we provide a brief summary of the data base and its potential uses. We begin by introducing the main features of the Data Set. We then discuss some of the dynamics of legal integration in light of our analyses of the data. [source]

    The Effect of State Medicaid Case-Mix Payment on Nursing Home Resident Acuity

    Zhanlian Feng
    Objective. To examine the relationship between Medicaid case-mix payment and nursing home resident acuity. Data Sources. Longitudinal Minimum Data Set (MDS) resident assessments from 1999 to 2002 and Online Survey Certification and Reporting (OSCAR) data from 1996 to 2002, for all freestanding nursing homes in the 48 contiguous U.S. states. Study Design. We used a facility fixed-effects model to examine the effect of introducing state case-mix payment on changes in nursing home case-mix acuity. Facility acuity was measured by aggregating the nursing case-mix index (NCMI) from the MDS using the Resource Utilization Group (Version III) resident classification system, separately for new admits and long-stay residents, and by an OSCAR-derived index combining a range of activity of daily living dependencies and special treatment measures. Data Collection/Extraction Methods. We followed facilities over the study period to create a longitudinal data file based on the MDS and OSCAR, respectively, and linked facilities with longitudinal data on state case-mix payment policies for the same period. Principal Findings. Across three acuity measures and two data sources, we found that states shifting to case-mix payment increased nursing home acuity levels over the study period. Specifically, we observed a 2.5 percent increase in the average acuity of new admits and a 1.3 to 1.4 percent increase in the acuity of long-stay residents, following the introduction of case-mix payment. Conclusions. The adoption of case-mix payment increased access to care for higher acuity Medicaid residents. [source]

    Does Prospective Payment Really Contain Nursing Home Costs?

    Li-Wu Chen
    Objective. To examine whether nursing homes would behave more efficiently, without compromising their quality of care, under prospective payment. Data Sources. Four data sets for 1994: the Skilled Nursing Facility Minimum Data Set, the Online Survey Certification and Reporting System file, the Area Resource File, and the Hospital Wage Indices File. A national sample of 4,635 nursing homes is included in the analysis. Study Design. Using a modified hybrid functional form to estimate nursing home costs, we distinguish our study from previous research by controlling for quality differences (related to both care and life) and addressing the issues of output and quality endogeneity, as well as using more recent national data. Factor analysis was used to operationalize quality variables. To address the endogeneity problems, instrumental measures were created for nursing home output and quality variables. Principal Findings. Nursing homes in states using prospective payment systems do not have lower costs than their counterpart facilities under retrospective cost-based payment systems, after quality differences among facilities are controlled for and the endogeneity problem of quality variables is addressed. Conclusions. The effects of prospective payment on nursing home cost reduction may be through quality cuts, rather than cost efficiency. If nursing home payments under prospective payment systems are not adjusted for quality, nursing homes may respond by cutting their quality levels, rather than controlling costs. Future outcomes research may provide useful insights into the adjustment of quality in the design of prospective payment for nursing home care. [source]

    Intercomparison of global cloud cover fields over oceans from the VOS observations and NCEP/NCAR reanalysis

    Ernst Bedacht
    Abstract The paper inter-compares the total cloud cover over the World Ocean from marine visual observations assimilated in the International Comprehensive Ocean-Atmosphere Data Set (ICOADS) and National Centers of Environmental Prediction/National Center of Atmospheric Research (NCEP-NCAR) reanalysis. The Intercomparison covers the period from 1948 to 2002. NCEP-NCAR reanalysis shows about 10% of fractional cloud cover smaller than the visual observations do. The largest differences are observed in the mid and sub-polar latitudes. In the tropics, NCEP-NCAR data show slightly higher cloud cover then ICOADS. These systematic differences are quite persistent through the year with somewhat stronger differences in summer. Comparison of the characteristics of inter-annual variability shows little consistency between visually observed total cloud cover and total cloudiness diagnosed by the reanalysis. Linear trends are primarily positive in the ICOADS cloud data, while in the NCEP-NCAR reanalysis they show downward trends in the tropics and upward tendencies in the mid and high latitudes. Analysis of the effect of sampling in ICOADS shows that sampling inhomogeneity cannot fully explain the disagreements observed. At the same time, the major climate variability patterns such as North Atlantic Oscillation (NAO) and El-Nino,Southern Oscillation (ENSO) are well captured in both ICOADS and NCEP-NCAR cloud cover data sets. Copyright © 2007 Royal Meteorological Society [source]

    Influence of seasonal pressure patterns on temporal variability of vegetation activity in Central Siberia

    Sergio M. Vicente-Serrano
    Abstract This paper analyses the spatial distribution of the inter-annual variability of vegetation activity in central Siberia and its relationship with atmospheric circulation variability. We used NOAA-AVHRR NDVI series from Pathfinder Land Data Set at 1° of spatial resolution, and we calculated the annual vegetation activity in each pixel (aNDVI) from 1982 to 2001. Principal component analysis (PCA) was used to determine the general spatial patterns of inter-annual variability of vegetation activity. We identified three main modes, which explain more than 50% of the total variance, each corresponding to a large region. By means of surface pressure grids, we analysed the main patterns of the seasonal atmospheric circulation in the study area: its variability was summarised by means of a few circulation modes and the patterns differ significantly between winter, spring and summer. However, a pattern with a North,South dipole structure represents the general spatial pattern of atmospheric circulation. We investigated the effect of seasonal atmospheric circulation patterns on the inter-annual variation of vegetation activity. In general, the strongest relationships between the atmospheric circulation variability, climate and the aNDVI variability were found in areas where the climatic characteristics are more limiting for the vegetation development, such as the northern regions. This may be explained by the fact that in these areas the variability of atmospheric circulation modes determines summer temperatures, which have a direct impact on vegetation activity. Copyright © 2006 Royal Meteorological Society. [source]

    ICOADS release 2.1 data and products

    Steven J. Worley
    Abstract The International Comprehensive Ocean,Atmosphere Data Set (ICOADS), release 2.1 (1784,2002), is the largest available set of in situ marine observations. Observations from ships include instrument measurements and visual estimates, and data from moored and drifting buoys are exclusively instrumental. The ICOADS collection is constructed from many diverse data sources, and made inhomogeneous by the changes in observing systems and recording practices used throughout the period of record, which is over two centuries. Nevertheless, it is a key reference data set that documents the long-term environmental state, provides input to a variety of critical climate and other research applications, and serves as a basis for many associated products and analyses. The observational database is augmented with higher level ICOADS data products. The observed data are synthesized to products by computing statistical summaries, on a monthly basis, for samples within 2° latitude × 2° longitude and 1° × 1° boxes beginning in 1800 and 1960 respectively. For each resolution the summaries are computed using two different data mixtures and quality control criteria. This partially controls and contrasts the effects of changing observing systems and accounts for periods with greater climate variability. The ICOADS observations and products are freely distributed worldwide. The standard ICOADS release is supplemented in several ways; additional summaries are produced using experimental quality control, additional observations are made available in advance of their formal blending into a release, and metadata that define recent ships' physical characteristics and instruments are available. Copyright © 2005 Royal Meteorological Society [source]

    Climate of the seasonal cycle in the North Pacific and the North Atlantic oceans

    Igor M. Yashayaev
    Abstract Time series of monthly sea-surface temperature (SST), air temperature (AT) and sea level pressure (SLP) were constructed from merged releases of the Comprehensive Ocean-Atmosphere Data Set (COADS). The time series were decomposed into seasonal and non-seasonal (short and long-term) components. The contribution of the seasonal cycle to the total variance of SST and AT exceeds 80% in the mid and in some high latitude locations and reaches its peak (>95%) in the centres of subtropical gyres. In most cases, a combination of annual and semiannual harmonics accounts for more than 95% of the seasonal variability. Amplitudes of SST and AT annual cycles are highest near the western boundaries of the oceans; annual phases of SST and AT increase toward the eastern tropical oceans, revealing a southeastern propagation of the annual cycle over the Northern Hemisphere oceans. The annual cycle of AT leads that of SST by 1,3 weeks. The largest phase differences are observed in the regions of western boundary currents in the North Pacific and the North Atlantic oceans. This is consistent with spatial patterns of integral air,sea heat fluxes. Annual phases of SST increase along the Gulf Stream and the Kuroshio Current. This points to the importance of signal transport by the major ocean currents. The lowest annual amplitudes of SLP are observed along the equator (0°,10°N) in both oceans. There are three distinct areas of high annual amplitudes of SLP in the North Pacific Ocean: Asian, Aleutian and Californian. Unlike the North Pacific, only one such area exists in the North Atlantic centred to the west of Iceland. A remarkable feature in the climate of the North Pacific is a maximum of semiannual SLP amplitudes, centred near 40°N and 170°W. It is also an absolute maximum in the entire Northern Hemisphere. Analysis of phases of harmonics of SLP seasonal cycle has revealed the trajectories of propagation of the annual and semiannual cycles. Analysis of semiannual to annual amplitudes ratio has revealed the regions of semiannual cycle dominance. Copyright © 2001 Royal Meteorological Society [source]

    The impact of personal characteristics on engagement in nursing home residents with dementia

    Jiska Cohen-Mansfield
    Abstract Objective To examine the impact of personal attributes on engagement in persons with dementia. Methods Participants were 193 residents of seven Maryland nursing homes. All participants had a diagnosis of dementia. Cognitive functioning was assessed via the Mini-Mental State Examination, and engagement was assessed via the Observational Measure of Engagement. Data pertaining to activities of daily living were obtained from the Minimum Data Set. Results Women had longer mean engagement duration than men, and significant results were not seen with the other demographic variables. Significant, positive correlations were found between higher cognitive functioning and longer engagement duration, more attention, a more positive attitude, and a higher refusal rate. There was a positive and significant correlation between the comorbidity index and engagement duration, and between the number of medications and attention. All functional status variables yielded significance in a positive direction. Participants with poor hearing had a higher refusal rate. Cognitive status was the most consistent and potent predictor of engagement in this population. Conclusion Despite a higher refusal rate among those with higher cognitive levels, their overall engagement with stimuli is higher. Caregivers should anticipate higher refusal rates in those with poor hearing, and therefore compensatory methods should be used in presenting stimuli in this population. The potent role of cognitive and functional status on engagement of persons with dementia underscores the importance of tailoring activities to nursing home residents' needs, interests, and limitations. Copyright © 2009 John Wiley & Sons, Ltd. [source]

    Comparison of the diagnostic accuracy of the Cognitive Performance Scale (Minimum Data Set) and the Mini-Mental State Exam for the detection of cognitive impairment in nursing home residents

    Louis Paquay
    Abstract Objective To compare the diagnostic accuracy of an outcome measurement scale of the Minimum Data Set of the Resident Assessment Instrument for nursing homes (MDS/RAI-NH), the Cognitive Performance Scale (CPS) and the Mini-Mental State Exam (MMSE) for the detection of cognitive impairment. The Cambridge Examination for Mental Disorders of the Elderly , Revised (CAMDEX-R) was used as the reference standard. Study design and setting This study was part of a larger prospective study (QUALIDEM) involving a diagnostic procedure and two-year follow-up on the quality of primary care for demented patients. CAMDEX-R and MDS/RAI-NH were administered to 198 residents, aged 65 or more, living in 42 low and high care institutions for aged people. Main outcome measures Indicators of diagnostic accuracy: sensitivity, specificity, predictive values, likelihood ratios, odds ratio and area under receiver operating characteristics curve (AUC). Results The CAMDEX-based prevalence of cognitive impairment was 75%. The diagnostic values of a CPS score of two or more for the detection of cognitive impairment were: sensitivity,=,0.81; specificity,=,0.80; PPV,=,0.92; NPV,=,0.57. The diagnostic values of a MMSE score of less than or equal 23 were: sensitivity,=,0.97; specificity,=,0.59; PPV,=,0.88; NPV,=,0.85. For CPS, the area under the receiver operating characteristic (ROC) curve was 0.87 (95% CI, 0.81,0.91), and not significantly different (p,=,0.63) from the MMSE score, 0.88 (0.83,0.93). Conclusions CPS and MMSE demonstrated similar performance to detect cognitive impairment in nursing home residents. Copyright © 2006 John Wiley & Sons, Ltd. [source]

    Use of antipsychotic medications among elderly residents in long-term institutional care: a three-year follow-up

    Hanna-Mari Alanen
    Abstract Objective To analyse the use of antipsychotic medications, change over time and associated factors in a three-year follow-up among elderly residents in long-term institutional care. Design Retrospective study was designed with three identical cross-sectional samples originating from the same long-term care facilities, and collected 1 July to 31 December in 2001, 2002 and 2003, in Finland. These were extracted from the Resident Assessment Instrument (RAI) database, based on Minimum Data Set (MDS) assessments. Setting Of the data providers 16 were hospital-based institutions and 25 residential homes. Participants Each of the data sets included 3662-3867 resident assessments. Results The prevalence use of one or more antipsychotic decreased from 42% in 2001 to 39% in 2003. The overall confounder-adjusted decrease in antipsychotic use was not statistically significant. However, the use of antipsychotics decreased among residents who had wandering as a behavioural problem (OR 0.79, 95% CI 0.63,0.99) and increased among residents with concomitant use of anxiolytic medications (OR 1.23, 95% CI 1.03,1.48). Conclusions The use of antipsychotic medications among residents in long-term institutional care was common and the caring patterns were quite stable during the observation period. Adequate indications may not have been achieved in all cases. More attention should be paid to the appropriate use of antipsychotics in this frail population. Copyright © 2006 John Wiley & Sons, Ltd. [source]

    The first Australian nurse practitioner census: A protocol to guide standardized collection of information about an emergent professional group

    Sandy Middleton RN PhD
    Middleton S, Gardner G, Gardner A, Della P, Gibb M, Millar L. International Journal of Nursing Practice 2010; 16: 517,524 The first Australian nurse practitioner census: A protocol to guide standardized collection of information about an emergent professional group Internationally, collection of reliable data on new and evolving health-care roles is crucial. We describe a protocol for design and administration of a national census of an emergent health-care role, namely nurse practitioners in Australia using databases held by regulatory authorities. A questionnaire was developed to obtain data on the role and scope of practice of Australian nurse practitioners. Our tool comprised five sections and included a total of 56 questions, using 28existing items from the National Nursing and Midwifery Labour Force Census and nine items recommended in the Nurse Practitioner Workforce Planning Minimum Data Set. Australian Nurse Registering Authorities (n = 6) distributed the survey on our behalf. This paper outlines our instrument and methods. The survey was administered to 238 authorized Australian nurse practitioners (85% response rate). Rigorous collection of standardized items will ensure health policy is informed by reliable and valid data. We will re-administer the survey 2 years following the first survey to measure change over time. [source]

    The Use of Nursing Diagnoses in Perioperative Documentation

    Kristiina Junttila PhD
    Hoitotyön kirjaaminen; hoitotyön diagnoosit; perioperatiivinen hoitotyö; Perioperative Nursing Data Set PURPOSE., To clinically validate the nursing diagnoses of the first Finnish version of Perioperative Nursing Data Set (PNDS) by using them in perioperative documentation. METHODS., Nursing diagnoses were used in documentation in four operating departments with 250 patients. In analysis, nonparametric tests were applied. FINDINGS., While intraoperatively nursing diagnoses focused on physiological concerns, postoperatively the focus shifted to that of recovery. CONCLUSIONS., The findings revealed the importance of safety-related routines in perioperative care. Nursing diagnoses in the Finnish version of PNDS are sensitive in describing the rationales for perioperative care. IMPLICATIONS FOR NURSING PRACTICE., Nursing classifications illustrate the nursing process in a structured form. Nursing diagnosis is an early step in the decision-making process that aims to achieve expected outcomes in nursing care. TARKOITUS:, Validoida PNDS-luokituksen suomalaisen version diagnoositermit käyttämällä niitä perioperatiivisen hoitotyön kirjaamisessa. MENETELMÄT:, Hoitotyön diagnooseja käytettiin kirjaamisessa 250 potilaan kohdalla. Aineiston analyysissä käytettiin ei-parametrisiä testejä. TULOKSET:, Hoidon intraoperatiivisessa vaiheessa korostuvat potilaan fysiologiaan liittyvät ja postoperatiivisessa vaiheessa potilaan toipumiseen liittyvät hoitotyön diagnoosit. JOHTOPÄÄTÖKSET:, Perioperatiivisessa hoitotyössä painottuvat potilaan hoidon turvallisuuteen tähtäävät rutiinit. PNDS-luokituksen suomalaisen version diagnoositermejä voidaan käyttää kuvaamaan leikkauspotilaiden hoidon tarpeita. TULOSTEN HYÖDYNNETTÄVYYS:, Hoitotyön prosessia voidaan kuvata rakenteisesti hoitotyön luokituksilla. Hoitotyön diagnoosin määrittäminen on osa päätöksentekoprosessia tavoitteena tunnistaa ja saavuttaa toivotut tulokset potilaan hoidossa. [source]

    Using Nursing Interventions Classification as a Framework to Revise the Belgian Nursing Minimum Data Set

    Koen Van den Heede PhD
    Nursing Interventions Classification (NIC); Minimale Verpleegkundige Gegevens; ontwikkeling van consensus PURPOSE., To develop the revised Belgian nursing minimum data set (B-NMDS). METHODS., The Nursing Interventions Classification (NIC, 2nd edition) was used as a framework. Six expert nurse panels (cardiology, oncology, intensive care, pediatrics, geriatrics, chronic care) were consulted. Seventy-nine panelists completed standardized e-mail questionnaires and discussed results in face-to-face meetings. FINDINGS., We initially selected 256 of 433 NIC interventions. After panel discussions, plenary meetings, and pretesting, the revised B-NMDS (alpha version) contained 79 items covering 22 NIC classes and 196 NIC interventions. CONCLUSIONS., Consensus building promoted acceptance of the B-NMDS, while the NIC provided a good theoretical basis and guaranteed international comparability. IMPLICATIONS FOR NURSING PRACTICE., The revised B-NMDS instrument can be used to visualize nursing activities in different applications (e.g., financing, staffing allocation). DOELSTELLING., Ontwikkeling van een nieuwe versie van de Minimale Verpleegkundige Gegevens (MVG). METHODE., De Nursing Interventions Classification (NIC, 2nd editie) werd gebruikt als raamwerk. Zes experten panels (cardiologie, oncologie, intensieve zorgen, pediatrie, geriatrie, chronische zorg) werden geraadpleegd. Zeven-en-negentig panelleden vulden gestandaardiseerde e-mail vragenlijsten in en bediscussieerden de resultaten in werkgroepvergaderingen. RESULTATEN., We selecteerden initieel 256 van de 433 NIC-interventies. Na panel-discussies, plenaire vergaderingen, en pre-tests, bevatte de herziene MVG (alpha versie) 79 items uit 22 NIC klassen en 196 NIC-interventies. CONCLUSIES., Het draagvlak voor de herziene versie van MVG werd gecreëerd door het nastreven van consensus. Het gebruik van NIC vormde hierbij een geode theoretische basis en verhoogt het internationaal karakter van de nieuwe MVG. IMPLICATIES VOOR DE VERPLEEGKUNDIGE PRAKTIJK., De nieuwe MVG kan gebruikt worden om de dagelijkse verpleegkundige praktijk zichtbaar te maken in verschillende beleidsdomeinen (e.g., financiering, toewijzing personeel). [source]

    Initial Validation of the Perioperative Nursing Data Set in Finland

    Kristiina Junttilla MNSc
    PURPOSE. To explore the relevance of the Perioperative Nursing Data Set (PNDS) in Finland. METHODS. A three-round Delphi technique (10 participants) and content analysis of 134 articles from the Journal of the Finnish Operating Room Nurses Association. FINDINCS. All the PNDS outcomes, 86% of the diagnoses, and 87% of the interventions were found to be relevant. The Delphi panel suggested, and content analysis revealed, 6 new outcomes, 43 new diagnoses, and 11 new interventions. Consensus was achieved on 77%. The phrases used in perioperative articles corresponded with those of PNDS 56%-78% of the time. CONCLUSIONS.PNDS can be used to describe perioperative nursing in Finland. Further conceptualization and validation are needed before using the data set in perioperative practice. IMPLICATIONS FOR PRACTICE. Although PNDS cannot be implemented in Finland as is, it is a valid structure for further development of the terminology, contents, methods, and practice of Finnish perioperative documentation. Première validation d'une base de données concernant les soins infirmiers périopératoires en Finlande BUT.Explorer la pertinence d'une base de données concernant les soins infirmiers périopératoires en Finlande. MÉTHODE.La méthode de Delphi à 3 tours (10 participants) et l'analyse de contenu de 134 articles publiés dans le Journal de l'Association Finlandaise des Infirmières de bloc opératoire. RÉSULTATS.Tous les résultats, 86% des diagnostics et 87% des interventions de la BDSIP se sont révélés pertinents. Le panel Delphi et l'analyse de contenu ont permis d'identifier 6 nouveaux résultats, 43 nouveaux diagnostics, et 11 nouvelles interventions. Le consensus a atteint 77%. Les phrases utilisées dans les articles sur les soins périopératoires correspondaient à l'ensemble de la BDSIP avec un écart de 56%-78%. CONCLUSIONS.La BDSIP peut être utilisée pour décrire les soins périopératoires en Finlande. II faut cependant poursuivre le processus de conceptualisation et de validation avant d'utiliser cette base de données dans le milieu clinique périopératoire. IMPLICATIONS POUR LA PRATIQUE. It Serait prématuré d'utiliser la BDSIP actuelle, en Finlande, mais elle constitue une structure valide pour développer la terminologie, les contenus, les méthodes et la pratique, tels qu'ils pourraient apparaître dans les dossiers des patients en périopératoire. Mots-clés:Base de données de soins infirmiers, dossiers, nomenclature, soins périopératoires ValidaçãTo Inicial do Conjunto de Dados de Enfermagem Perioperatória na Finlàndia OBJETIVO.Explorar a relevância do Conjunto de Dados de Enfermagem Perioperatória (PNDS) na Finlândia. MÉTODO.Técnica de Delphi em três rodadas (10 participantes) e análise de conteúdo de 134 artigos da Revista da AssociaçãTo Finlandesa de Enfermeiras de Centro Cirúrgico. ACHADOS.Todos os resultados esperados do PNDS, 86% dos diagnósticos e 87% das intervenções foram considerados relevantes. O painel Delphi sugeriu, e a análise de conteúdo revelou, 6 novos resultados esperados, 43 novos diagnósticos e 11 novas intervenções. Foi obtido consenso em 77%. As frases utilizadas em artigos perioperatórios corresponderam àquelas do PNDS de 56%-78% das vezes. CONCLUSÕTES.O PNDS pode ser utilizado para descrever a enfermagem perioperatória na Finlândia. É preciso ampliar a conceptualizaçãTo e validaçãTo antes de usar o conjunto de dados na prática perioperatória. IMPLICAÇÕTES PARA A PRÁTICA.Embora o PNDS não possa ser implementado na Finlândia como está, trata-se de uma estrutura válida para um maior desenvolvimento da terminologia, conteúdo, método e prática da documentaçõo perioperatória Finlandesa. Palavras para busca:Conjunto de dados de enfermagem, documentaçõo, enfermagem perioperatória, nomenclatura Validación Inicial del Conjunto Mínimo de Datos de la Enfermeria de Quirófano en Finlandia PROPÓSITO.Explorar la relevancia del Conjunto Mínimo de Datos de la Enfermería de Quirófano (PNDS) en Finlandia métodos. Una técnica Delphi a tres vueltas (10 participantes) y el análisis de contenido de 134 artículos de la Revista de la Asociación Finlandesa de Enfermeras de Quirófano. RESULTADOS.Todos los resultados del PNDS se encontraron relevantes el 86% de los diagnósticos y el 87% de las intervenciones. El panel Delphi sugirió, y el unúlisis de contenido reveló, seis nuevos resultados, 43 nuevos diagnósticos, y 11 nuevas intervenciones. El consenso general se logró en el 77%. Las frases utilizadas en los artículos, correspondieron con el PNDS en el 56%-78% de las ocasiones. CONCLUSIONES. El PNDS puede ser utilizado para describir la Enfermería de Quirófano en Finlandia. Conceptualización y validación posterior, son necesarias antes de usar el conjunto de datos en la práctica de quirófano. IMPLICACIONES PARA LA PRÁCTICA.Aunque el PNDS no puede llevarse a cabo en Finlandia tal como está, es una estructura válida para desarrollos posteriores de la terminología, contenidos, métodos y práctica de la documentación de quirófano finlandesa. Términos de búsqueda:Conjunto Mínimo de Datos de Enfermería, enfermería de quirófano, documentación, nomenclatura Search terms:Documentation, nomenclature, nursing data set, perioperative nursing [source]

    Preparing a large data set for analysis: using the Minimum Data Set to study perineal dermatitis

    Kay Savik MS
    Aim., The aim of this paper is to present a practical example of preparing a large set of Minimum Data Set records for analysis, operationalizing Minimum Data Set items that defined risk factors for perineal dermatitis, our outcome variable. Background., Research with nursing home elders remains a vital need as ,baby boomers' age. Conducting research in nursing homes is a daunting task. The Minimum Data Set is a standardized instrument used to assess many aspects of a nursing home resident's functional capability. United States Federal Regulations require a Minimum Data Set assessment of all nursing home residents. These large data would be a useful resource for research studies, but need to be extensively refined for use in most statistical analyses. Although fairly comprehensive, the Minimum Data Set does not provide direct measures of all clinical outcomes and variables of interest. Method., Perineal dermatitis is not directly measured in the Minimum Data Set. Additional information from prescribers' (physician and nurse) orders was used to identify cases of perineal dermatitis. The following steps were followed to produce Minimum Data Set records appropriate for analysis: (1) identification of a subset of Minimum Data Set records specific to the research, (2) identification of perineal dermatitis cases from the prescribers' orders, (3) merging of the perineal dermatitis cases with the Minimum Data Set data set, (4) identification of Minimum Data Set items used to operationalize the variables in our model of perineal dermatitis, (5) determination of the appropriate way to aggregate individual Minimum Data Set items into composite measures of the variables, (6) refinement of these composites using item analysis and (7) assessment of the distribution of the composite variables and need for transformations to use in statistical analysis. Results., Cases of perineal dermatitis were successfully identified and composites were created that operationalized a model of perineal dermatitis. Conclusion., Following these steps resulted in a data set where data analysis could be pursued with confidence. Incorporating other sources of data, such as prescribers' orders, extends the usefulness of the Minimum Data Set for research use. [source]

    Frequency of and indications for wholly compensatory nursing care related to enteral food intake: a secondary analysis of the Belgium National Nursing Minimum Data Set

    Georges Evers PhD RN
    Frequency of and indications for wholly compensatory nursing care related to enteral food intake: a secondary analysis of the Belgium National Nursing Minimum Data Set This study describes the frequency of and indications used for total feeding assistance and tube feeding in a national representative sample of Belgian hospital patients (n = 421 314). Data from the 1990 national minimum nursing data registration was used. Orem's self-care model was used to describe and categorize types of nursing care and related indications. The scope of wholly compensatory nursing care was limited to total feeding assistance and tube feeding. This type of nursing care is indicated when self-care agency is undeveloped or cannot be used and when self-care demands are significantly increased. Based on review of the literature, hypotheses to indicate nursing care were formulated and tested. Wholly compensatory nursing care related to enteral food intake is given to 14·4% of the total patient population in Belgian hospitals. If self-care demand increases due to malnutrition, then this is an indication for total feeding assistance. If self-care agency decreases due to blindness, mental retardation, disorientation or upper extremity dysfunction, then this is also an indication for total feeding assistance. If self-care agency decreases due to impaired chewing, then this is an indication for tube feeding. This study has generated the first representative national nursing statistics about total feeding assistance and tube feeding in hospitals. [source]

    A Cluster-Randomized Trial of an Educational Intervention to Reduce the Use of Physical Restraints with Psychogeriatric Nursing Home Residents

    Anna R. Huizing PhD RN
    OBJECTIVES: To investigate the effects of an educational intervention on the use of physical restraints with psychogeriatric nursing home residents. DESIGN: Cluster-randomized trial. SETTING: Fifteen psychogeriatric nursing home wards in the Netherlands. PARTICIPANTS: In total, 432 psychogeriatric nursing home residents from 15 psychogeriatric nursing home wards in seven nursing homes were selected for participation; 404 consented, and 371 of these were available at baseline. Two hundred forty-one from 14 wards had complete data and were included in the data analyses. INTERVENTION: The nursing home wards were assigned at random to educational intervention or control status. The educational intervention consisted of an educational program for nursing staff combined with consultation with a nurse specialist (registered nurse (RN) level). MEASUREMENTS: Data were collected at baseline and 1, 4, and 8 months postintervention. At each measurement, the use of physical restraints was measured using observations of blinded, trained observers on four separate occasions over a 24-hour period. Other resident characteristics, such as cognitive status, were determined using the Minimum Data Set. RESULTS: Logistic and linear regression analyses showed no treatment effect on restraint status, restraint intensity, or multiple restraint use in any of the three postintervention measurements. Furthermore, only small changes occurred in the types of restraints used with residents in the experimental group. CONCLUSION: An educational program for nursing staff combined with consultation with a nurse specialist (RN level) had no effect on the use of physical restraints with psychogeriatric nursing home residents. In addition to restraint education and consultation, new measures to reduce the use of physical restraints with psychogeriatric nursing home residents should be developed. [source]

    Effectiveness of Falls Clinics: An Evaluation of Outcomes and Client Adherence to Recommended Interventions

    Keith D. Hill PhD
    OBJECTIVES: To evaluate outcomes associated with falls clinic programs. DESIGN: Longitudinal. SETTING: Thirteen outpatient falls clinics in Victoria, Australia. PARTICIPANTS: Four hundred fifty-four people referred for clinic assessment (mean age±standard deviation 77.9±8.8; 73% female). INTERVENTION: After assessment, multifactorial interventions were organized to address identified risk factors. MEASUREMENTS: A Minimum Data Set was developed and used across all clinics to derive common data on falls, falls injuries, and secondary measures associated with falls risk, including balance, falls efficacy, gait, leg strength, function, and activity. All measures were repeated 6 months later. RESULTS: Clients had a high risk of falls, with 78% having had falls in the preceding 6 months (63% multiple fallers, 10% experiencing fractures from the falls). An average of 7.6±2.8 falls risk factors were identified per client. The clinic team organized an average of 5.7±2.3 new or additional interventions per client. Sixty-one percent of eligible clients returned for the 6-month assessment. At this time, there was more than a 50% reduction in falls, multiple falls, and fall injuries (P,.004) and small but significant improvements evident on secondary measures of balance, leg strength, gait speed, and confidence outcomes (P<.006). Average adherence to recommendations was 74.3%. Factors associated with higher adherence included being male, younger than 65, living with others, and having a caregiver (P<.05). CONCLUSION: This large multicenter study identified high falls risk of older people referred to falls clinics, the multifactorial nature of their presenting problems and provides preliminary evidence of positive outcomes after falls clinic management. [source]

    Transitioning Residents from Nursing Facilities to Community Living: Who Wants to Leave?

    (See editorial comments by Dr. Rosalie Kane, 165)., pp 16
    OBJECTIVES: To examine nursing facility residents' or their legal proxies' perspectives on transitioning out of nursing facilities by assessing residents' perceptions of their ability to live more independently, their preferences regarding leaving the facility, and the feasibility of transitioning with community support. DESIGN: Analysis of survey findings from the California Nursing Facility Transition Screen (CNFTS). SETTING: Eight nursing facilities in southern California. PARTICIPANTS: All chronic maintenance, long-stay residents receiving Medi-Cal (California's Medicaid program) were eligible for the study (n=218). Of these, 121 (56%) self-consenting residents or legal proxies were interviewed. No presumptions were made as to which residents were appropriate candidates for transition based on health or functional capacity. MEASUREMENTS: CNFTS contains 27 open- and closed-ended questions on preference, ability, and feasibility of transitioning. RESULTS: Twenty-three percent of residents and proxies believed that the resident had the ability to transition; 46% indicated a preference to transition; and after discussing potential living arrangements and services, 33% thought that transitioning would be feasible. Of those who consented to allow access to their Minimum Data Set 2.0 (MDS) information (n=41; 34% of the sample), agreement in the assessment of preference was found in 39% of cases. CONCLUSION: Transition decisions are complex and include preference, as well as perceptions of the resident's ability to live in a more independent setting and the feasibility of transitioning. Compared with the MDS, the screen identified a higher proportion of residents who want to transition, suggesting that a systematic approach to assessing the complex decision to transition is needed. [source]

    Preliminary Derivation of a Nursing Home Confusion Assessment Method Based on Data from the Minimum Data Set

    David Dosa MD
    OBJECTIVES: To develop a Nursing Home Confusion Assessment Method (NH-CAM) for diagnosing delirium using items found on the Minimum Data Set (MDS) and to compare its performance with that of the delirium Resident Assessment Protocol (RAP) trigger and to an additive score of six of the RAP items. DESIGN: Retrospective cohort study using MDS and Medicare claims data. SETTING: Free-standing NHs in urban markets in the 48 contiguous U.S. states. PARTICIPANTS: Long-stay residents who returned to their NHs after acute hospitalizations between April and September 2000 (N=35,721). MEASUREMENTS: Mortality and rehospitalization rates within 90 days of readmission to the NH from the hospital. RESULTS: Almost one-third (31.8%) of the residents were identified as having delirium according to the RAP; 1.4% had full delirium, 13.2% had Subsyndromal II delirium, and 17.2% had Subsyndromal I delirium. More-severe NH-CAM scores were associated with greater risks of mortality and rehospitalization. NH-CAM levels were strong independent risk factors for survival and rehospitalization in a Cox model (hazard ratios ranging from 1.5 to 1.9 for mortality and 1.1 to 1.3 for rehospitalization) adjusting for cognitive and physical function, diagnoses, inpatient care parameters, care preferences, and sociodemographic factors. CONCLUSION: The NH-CAM successfully stratified NH residents' risk of mortality and rehospitalization. If validated clinically, the NH-CAM may be useful in care planning and in further research on the determinants and consequences of delirium in the NH. [source]

    Nursing Home Characteristics and Potentially Preventable Hospitalizations of Long-Stay Residents

    Orna Intrator PhD
    Objectives: To examine the association between having a nurse practitioner/physician assistant (NP/PA) on staff, other nursing home (NH) characteristics, and the rate of potentially preventable/avoidable hospitalizations of long-stay residents, as defined using a list of ambulatory care,sensitive (ACS) diagnoses. Design: Cross-sectional prospective study using Minimum Data Set (MDS) assessments, Centers for Medicare and Medicaid Services inpatient claims and eligibility records, On-line Survey Certification Automated Records, (OSCAR) and Area Resource File (ARP). Setting: Freestanding urban NHs in Maine, Kansas, New York, and South Dakota. Participants: Residents of 663 facilities with a quarterly or annual MDS assessment in the 2nd quarter of 1997, who had a prior MDS assessment at least 160 days before, and who were not health maintenance organization members throughout 1997 (N=54,631). Measurements: A 180-day multinomial outcome was defined as having any hospitalization with primary ACS diagnosis, otherwise having been hospitalized, otherwise died, and otherwise remained in the facility. Results: Multilevel models show that facilities with NP/PAs were associated with lower hospitalization rates for ACS conditions (adjusted odds ratio (AOR)=0.83), but not with other hospitalizations. Facilities with more physicians were associated with higher ACS hospitalizations (ACS, AOR=1.14, and non-ACS, AOR=1.10). Facilities providing intravenous therapy, and those that operate a nurses' aide training program were associated with fewer hospitalizations of both types. Conclusion: Employment of NP/PAs in NHs, the provision of intravenous therapy, and the operation of certified nurse assistant training programs appear to reduce ACS hospitalizations, and may be feasible cost-saving policy interventions. [source]

    Persistent Nonmalignant Pain and Analgesic Prescribing Patterns in Elderly Nursing Home Residents

    (See editorial comments by Dr. Debra Weiner on pp 1020, 1022)
    Objectives: To determine the prevalence of analgesics used, their prescribing patterns, and associations with particular diagnoses and medications in patients with persistent pain. Design: Cross-sectional study. Setting: Nursing homes from 10 U.S. states. Participants: A total of 21,380 nursing home residents aged 65 and older with persistent pain. Measurements: Minimum Data Set (MDS) assessments on pain, analgesics, cognitive, functional, and emotional status were summarized. Logistic regression models identified diagnoses associated with different analgesic classes. Results: Persistent pain as determined using the MDS was identified in 49% of residents with an average age of 83; 83% were female. Persistent pain was prevalent in patients with a history of fractures (62.9%) or surgery (63.6%) in the past 6 months. One-quarter received no analgesics. The most common analgesics were acetaminophen (37.2%), propoxyphene (18.2%), hydrocodone (6.8%), and tramadol (5.4%). Only 46.9% of all analgesics were given as standing doses. Acetaminophen was usually prescribed as needed (65.6%), at doses less than 1,300 mg per day. Nonsteroidal antiinflammatory drugs (NSAIDs) were prescribed as a standing dose more than 70% of the time, and one-third of NSAIDs were prescribed at high doses. Conclusion: In nursing home residents, persistent pain is highly prevalent, there is suboptimal compliance with geriatric prescribing recommendations, and acute pain may be an important contributing source of persistent pain. More effective provider education and research is needed to determine whether treatment of acute pain could prevent persistent pain. [source]

    The Minimum Data Set Weight-Loss Quality Indicator: Does It Reflect Differences in Care Processes Related to Weight Loss?

    Sandra F. Simmons PhD
    Objectives: To determine whether nursing homes (NHs) that score differently on prevalence of weight loss, according to a Minimum Data Set (MDS) quality indicator, also provide different processes of care related to weight loss. Design: Cross-sectional. Setting: Sixteen skilled nursing facilities: 11 NHs in the lower (25th percentile,low prevalence) quartile and five NHs in the upper (75th percentile,high prevalence) quartile on the MDS weight-loss quality indicator. Participants: Four hundred long-term residents. Measurements: Sixteen care processes related to weight loss were defined and operationalized into clinical indicators. Trained research staff conducted measurement of NH staff implementation of each care process during assessments on three consecutive 12-hour days (7 a.m. to 7 p.m.), which included direct observations during meals, resident interviews, and medical record abstraction using standardized protocols. Results: The prevalence of weight loss was significantly higher in the participants in the upper quartile NHs than in participants in the lower quartile NHs based on MDS and monthly weight data documented in the medical record. NHs with a higher prevalence of weight loss had a sig-nificantly larger proportion of residents with risk factors for weight loss, namely low oral food and fluid intake. There were few significant differences on care process measures between low- and high-weight-loss NHs. Staff in low-weight-loss NHs consistently provided verbal prompting and social interaction during meals to a greater proportion of residents, including those most at risk for weight loss. Conclusion: The MDS weight-loss quality indicator reflects differences in the prevalence of weight loss between NHs. NHs with a lower prevalence of weight loss have fewer residents at risk for weight loss and staff who provide verbal prompting and social interaction to more residents during meals, but the adequacy and quality of feeding assistance care needs improvement in all NHs. [source]

    Effect of Nonsteroidal Anti-Inflammatory Drug Use on the Rate of Gastrointestinal Hospitalizations Among People Living in Long-Term Care

    Kate L. Lapane PhD
    OBJECTIVES: Gastrointestinal (GI) complications are the most-common serious adverse reactions associated with nonsteroidal anti-inflammatory drugs (NSAIDs). We quantified the effect of specific NSAIDs on the rate of GI hospitalizations among older people living in long-term care. DESIGN: Retrospective cohort study. SETTING: All Medicare/Medicaid certified nursing homes in four states (Maine, Minnesota, New York, and South Dakota). PARTICIPANTS: We identified 125,516 newly admitted residents from a database of all residents (1992,1996) of all Medicare/Medicaid certified nursing homes in four states. Using the federally mandated Minimum Data Set, which includes information on all drugs received (prescription and over-the-counter), we identified patients who received at least one prescription for aspirin (n = 19,101) or NSAIDs (n = 9,777). The control population consisted of all institutionalized persons who did not receive these drugs. MEASUREMENTS: From Health Care Financing Administration inpatient claims, we identified the first hospitalization for GI perforation, ulcer, or hemorrhage that occurred during the year of follow up (ICD9-CM discharge codes: 531,534, 578). Cox proportional hazards models provided adjusted estimates of rate ratios. RESULTS: NSAID exposure increased the GI-event-related hospitalization rate in both men (rate ratios (RR) = 2.64; 95% confidence interval (CI) = 1.17,5.99) and women (RR = 3.23; 95% CI = 1.85,5.65). The rate of GI hospitalizations for both men and women taking sulindac, naproxen, or indomethacin was higher than for nonusers. The risk of GI-event-related hospitalizations was greatest among women exposed to diflunisal (RR = 6.08; 95% CI = 2.27,16.26) or oxaprozin (RR = 6.03; 95% CI = 2.49,14.58). CONCLUSIONS: Despite the high background rate of GI events, most NSAIDs increased the risk of GI hospitalization. Careful attention to choice of agent and dosing is needed in prescribing NSAIDs in this frail, older population. [source]

    Assessment of registration quality of trials sponsored by China

    Xuemei Liu
    Abstract Objective To evaluate the quality of the registration information for trials sponsored by China registered in the WHO primary registries or other registries that meet the requirements of the International Committee of Medical Journal Editors (ICMJE). Methods We assessed the registration information for trials registered in the 9 WHO primary registries and one other registry that met the requirements of ICJME as of 15 October 2008. We analyzed the trial registration data set in each registry and assessed the registration quality against the WHO Trial Registration Data Set (TRDS). We also evaluated the quality of the information in the Source(s) of Monetary or Material Support section, using a specially prepared scale. Results The entries in four registries met the 20 items of the WHO TRDS. These were the Chinese Clinical Trial Registration Center (ChiCR), Australian New Zealand Clinical Trials Registry (NZCTR), Clinical Trials Registry , India (CTRI), and Sri Lanka Clinical Trials Registry (SLCTR). Registration quality varied among the different registries. For example, using the Scale of TRDS, the NZCTR scored a median of 19 points, ChiCTR (median = 18 points), (median = 17 points), and Clinical (median = 12 points). The data on monetary or material support for ChiCTR and were relatively complete and the score on our Scale for the Completeness of Funding Registration Quality ranged from ChiCTR (median = 7 points), (median = 6 points), NZCTR (median = 3 points) to (median = 2 points). Conclusion Further improvements are needed in both the quantity and quality of trial registration. This could be achieved by full completion of the 20 items of the WHO TRDS. Future research should assess ways to ensure the quality and scope of research registration and the role of mandatory registration of funded research. [source]

    High risk for venous thromboembolism in diabetics with hyperosmolar state: comparison with other acute medical illnesses

    C. R. KEENAN
    Summary.,Background:,Diabetes mellitus is generally not recognized as an important risk factor for venous thromboembolism (VTE). However, clinical observations and case reports have suggested that patients with diabetes and hyperosmolarity may be at increased risk for VTE. Objectives:,To determine the risk of VTE in patients hospitalized for diabetes with hyperosmolar state compared to patients with other acute medical illnesses. Patients/methods:,The California Patient Discharge Data Set was used to determine the incidence of first-time VTE in all patients admitted between 1995 and 2000 for diabetes with hyperosmolarity and 11 other acute medical conditions. Proportional hazard modeling was used to adjust for age, race, gender, and prior hospitalization within 3 months. Results:,Among 2859 patients with diabetes and hyperosmolarity, 34 (1.2%) developed VTE during the hospitalization and 14 (0.5%) developed VTE within 91 days after discharge. In an adjusted multivariate model comparing the risk of VTE to cases with depression, patients with hyperosmolarity had a significantly higher risk of VTE [hazard ratio (HR) = 16.3; 95% confidence interval (CI): 10,25] comparable to the risk associated with sepsis (HR = 19.3; 95% CI: 13,29) or acute connective tissue disease (HR = 21; 95% CI: 15,31). Compared to uncomplicated diabetes, patients with hyperosmolarity had a significantly higher risk of VTE (HR = 3.0; 95% CI: 2.1,4.5) whereas patients with ketoacidosis were not at higher risk (HR = 1.2; 95% CI: 0.8,1.7). Conclusions:,Patients hospitalized for diabetes with hyperosmolarity are at increased risk for developing VTE both during their inpatient stay and in the 3 months after discharge. Thromboprophylaxis in these patients appears warranted, and extended prophylaxis for after hospital discharge should be studied. [source]

    Effect of age on the incidence of venous thromboembolism after major surgery

    R. H. White
    Summary.,Background:,Most guidelines for administration of thromboprophylaxis after major surgery use age as a major predictor of postoperative venous thromboembolism (VTE). We sought to quantify the effect of age on the risk of symptomatic VTE after a spectrum of surgical procedures. Methods:,Using the California Patient Discharge Data Set and specific ICD-9-CM surgical procedure codes, we retrospectively determined the incidence of VTE diagnosed within 91 days after 40 different urgent or elective surgeries performed in the hospital between 1992 and 1996. Logistic regression was used to quantify the effect of age on the incidence of postoperative VTE and to adjust for other risk factors. Results:,1 464 452 cases underwent one of 40 different procedures (mean cases per procedure = 35 718, range 4500,145 500). There was a significant interaction between age and the type of surgery performed (P<0.0001). Qualitative analysis of the effect of age on the incidence of VTE stratified by the presence or absence of malignancy revealed three general patterns: a steady increase in the incidence of VTE with age, exemplified by appendectomy or cholecystectomy; an increase in VTE up to approximately age 65 with no increase thereafter, exemplified by total hip arthroplasty; and no effect of age on the incidence of VTE, exemplified by vascular surgery. Conclusions:,The relationship between age and the risk of VTE after surgery is complex and depends on the nature of the surgery and the underlying pathologic process. Advancing age was a significant predictor for VTE following surgeries performed for conditions not inherently associated with significant comorbidity. Conversely, advancing age was not associated with a higher incidence of VTE after surgeries performed for conditions strongly associated with serious underlying comorbidity, such as a malignancy or severe peripheral vascular disease. [source]

    Residual Autocorrelation Distribution in the Validation Data Set

    Alessandro Fasso
    Testing model performance on a data set other than the data set used for estimation is common practice in econometrics, technological stochastic modelling and environmetrics. In this paper, using an ARMAX model, the asymptotic distribution of the residual autocorrelations in the validation data set is given and a ,2 test for overall residual incorrelation is considered. [source]

    Urinary incontinence among institutionalized oldest old Chinese men in Taiwan,

    Yi-Ming Chen
    Abstract Aims To explore prevalence and related factors for urinary incontinence (UI) among the oldest old institutionalized Chinese men in Taiwan. Methods All residents living in Banciao Veterans Care Home were invited for study. UI was defined as urinary leakage at least once weekly. Additional data items from the Minimum Data Set (MDS Nursing Home Chinese Version 2.1) were used to explore impact associated with physical function, cognitive status and quality of life (social engagement, SocE). Depressive symptoms were screened by the Short Form Geriatric Depression Scale. Results Data from 594 male residents (mean age: 80.9,±,5.3 years) were analyzed. Among all study subjects, 92.8% were functionally independent, 20.4% had certain cognitive impairment and 8.2% had depressive symptoms. The prevalence of UI in the Banciao Veterans Care Home was 10.1%. Compared with residents without UI, subjects with UI had poorer physical function, cognitive status, and more depressive symptoms. The mean SocE score was 1.5,±,1.3, and was similar between UI (+) and UI (,) subjects (1.4,±,1.2 vs. 1.6,±,1.3, P,=,0.411). By multivariate logistic regression, poorer physical functional status, cognitive impairment and depressive symptoms were independent risk factors for UI (P,<,0.05). Conclusions Poorer physical function, poorer cognitive status and depressive symptoms were all statistically significant independent risk factors for UI. However, SocE score (proxy indicator of quality of life) did not differ between subjects with and without UI. Further investigations are needed to evaluate the impact of UI on quality of life among oldest old institutionalized Chinese men in Taiwan. Neurourol. Urodynam. 28:335,338, 2009. © 2008 Wiley-Liss, Inc. [source]

    Comparing the Psychometric Properties of the Checklist of Nonverbal Pain Behaviors (CNPI) and the Pain Assessment in Advanced Dementia (PAIN-AD) Instruments

    PAIN MEDICINE, Issue 3 2010
    FAAN, Mary Ersek PhD
    Abstract Objective., To examine and compare the psychometric properties of two common observational pain assessment tools used in persons with dementia. Design., In a cross-sectional descriptive study nursing home (NH) residents were videotaped at rest and during a structured movement procedure. Following one training session and one practice session, two trained graduate nursing research assistants independently scored the tapes using the two pain observation tools. Setting., Fourteen NHs in Western Washington State participating in a randomized controlled trial of an intervention to enhance pain assessment and management. Participants., Sixty participants with moderate to severe pain were identified by nursing staff or chosen based on the pain items from the most recent Minimum Data Set assessment. Measures., Checklist of Nonverbal Pain Indicators (CNPI) and the Pain Assessment in Advanced Dementia (PAINAD), demographic and pain-related data (Minimum Data Set), nursing assistant reports of participants' usual pain intensity, and Pittsburgh Agitation Scale. Results., Internal consistency for both tools was good except for the CNPI at rest for one rater. Inter-rater reliability for pain presence was fair (K = 0.25 for CNPI with movement; K = 0.31 for PAINAD at rest) to moderate (K = 0.43 for CNPI at rest; K = 0.54 for PAINAD with movement). There were significant differences in mean CNPI and PAINAD scores at rest and during movement, providing support for construct validity. However, both tools demonstrated marked floor effects, particularly when participants were at rest. Conclusions., Despite earlier studies supporting the reliability and validity of the CNPI and the PAINAD, findings from the current study indicate that these measures warrant further study with clinical users, should be used cautiously both in research and clinical settings and only as part of a comprehensive approach to pain assessment. [source]