18 The Use of A Multifactorial Intervention to Improve Bowel Chart Recording and Laxative Prescription in A Tertiary Geriatrics Department

Introduction Constipation has a high prevalence of 30-40% in those aged over 65. It can lead to complications including delirium, faecal impaction, stercoral ulceration, and bowel obstruction. Although stool charts are used in geriatric wards to monitor bowel movements to guide management of constipation, they are often inconsistently recorded. Similarly, regular laxatives are often not prescribed for constipated patients due to ward pressures or unawareness regarding their importance. Aims Our aims were to audit the rates of recording on stool charts and laxative prescription in a geriatrics department, and to assess whether a multifactorial intervention aimed at both doctors and nursing staff improved these rates. Methods Two independent assessors audited the recording of stool charts, and rates of constipating medications and laxative prescription in two geriatrics wards in a tertiary UK hospital. A multifactorial intervention was implemented, consisting of didactic sessions for doctors and nurses, healthcare assistant champions to promote the recording of stool charts, and consolidation of bowel movement recording onto a single paper stool chart by the bedside rather than multiple charts. After the intervention, the data was re-audited on the same wards. Descriptive statistics and frequency tabulation were used for data analysis. Results Data was collected from 33 patients. Pre-intervention, stool charts were recorded daily in 13 patients, 10 patients had no stool chart record, 20 patients were on at least one constipating medication, 12 patients were prescribed at least one laxative, and 5 out of 7 patients with opiates had laxatives co-prescribed. Post-intervention, stool charts were recorded daily in 21 patients, all patients had a stool chart record, 20 patients were on at least one constipating medication, 23 patients were prescribed at least one laxative, and 2 out of 4 patients with opiates had laxatives co-prescribed. Our intervention improved daily recording on stool charts by 24%, resulted in all patients having a current stool chart and improved prescription of regular laxatives by 34%. Conclusions A multifactorial intervention based on educational sessions, healthcare assistants acting as champions, and consolidation of recording of bowel movements into a single chart, improved stool chart recording and prescription of regular laxatives in a tertiary geriatrics department. Future auditing will extend the sample size and generalise the intervention to other hospital departments.

Estimation of Submergent Plant Bed Biovolume using Acoustic Range Information

Acoustic measurements of the distance between the water surface, top of the aquatic plants, and bottom of the water column were made using chart recording echosounders. The vertical cross sectional area (m2), height (m), biovolume (m3), of aquatic plant beds and variances were computed for three surveys of Devils Lake, Oregon, in May, July, and September, 1986 when coefficients of variation for the plant bed biovolume estimates were 0.18, 0.05, and 0.06, respectively (n = 14). Coefficients of variation for plant biomass estimates (g/m2) computed from SCUBA quadrat samples collected concurrently with the acoustic surveys, were 0.98 (n = 48), 0.81 (n = 90), and 1.05 (n = 90), respectively. The higher precision of the biovolume estimates allow for a 5- to 18-fold greater capability to detect a change in the mean. The lower costs of the biovolume estimates allow for a 10- to 33-fold greater precision-for-cost. The plant bed biovolume variable contains ecologically different information than the biomass variable in that it provides a direct estimate of the amount of aquatic habitat in a lake that is influenced by plants; it should prove useful for evaluating plant control practices and possibly for studying plant-fish interactions.

A Possible Proximity Effect on Human Grip Strength: An Attempted Replication

A double-blind experiment with 50 adults was conducted to replicate a finding that proximity to sugar reduces human grip strength. Grip strength of the dominant hand was measured by a chart-recording hand dynamometer for 12 trials. For half of the trials, the subject held an opaque, sealed bottle containing sugar; for half of the trials, the subject held a control bottle of equal weight containing sand. Statistical analysis indicated no significant effect of held substance upon grip strength.

Measurement of chloride in sweat by use of a selective electrode and strip-chart recorder.

We describe a method for direct potentiometric measurement of sweat chloride by use of a chloride-selective electrode, with strip-chart recording of the measurement to facilitate interpretation of the measurement. Comparison of this method and the Gibson and Cooke method [Pediatrics 23, 545 (1959)] gave a correlation coefficient of 0.86. Recording of the same test at various pressures showed that different pressures had little effect if they were kept constant.

Apparatus for Recording Avoidance Movements of Fish

An apparatus is described for continuous measurements of movements of fish exposed to chemical substances in a tank. A strip chart recording provides information on position and rate of movement of the test specimen during the experiment.

A Discussion on the measurement and interpretation of changes of strain in the Earth - Crustal tilt fields and propagation velocities associated with earthquakes

Three borehole installation of 15 s horizontal pendulums (of the Lamont lunar type) with capacitance displacement transducers were carried out in 1968-1969 in Central Alaska in Gilmore (GLM near Fairbanks), Patson (PAT) and McKinley (MCK) int he Alaska Range. Data are telemetered over phone lines and v.h.f. radio links and the sensitivity is better than 10~9 rad/m m of chart recording. Tilt steps similar to strain steps have been observed for earthquakes with magnitude from 2 to 8 and distances ranging from 10 to 9000 km. The tilt step propagation velocity from the hypocentre to the station increases from about 1.3 km/s near the epicentral area to 2.6 to 2.8 km/s at 60 to 80 km and to 3.1 km/s at teleseismic distances. Tilt directions, amplitudes and velocities observed at several stations simultaneously for the same earthquake are internally consistent. For local Fairbanks quakes the data from the Alaska long period array (ALPA) also have been used and span a full quadrant from the epicentre. There is an indication that tilt amplitudes depend on the tectonic environment of the station. Examples of tilts from local and regional earthquakes are presented and observations from teleseismisms include the 10 January 1971 ( M = 8.1) New Guinea, the 9 July 1971 ( M = 7.7) Chile and the 14 July 1971 ( M = 8.1) Solomon Island earthquakes.