BACKGROUND AND OBJECTIVES Sleep is an essential part of the recovery process, yet inpatient sleep quality is poor. Patients and families report that vital signs are the most bothersome overnight disruption. Obtaining vital signs every 4 hours (Q4H) is not evidence-based and is frequently ordered indiscriminately. We aimed to decrease the percentage of patient nights with vital sign checks between 12 am and 6 am in a low-risk population from 98% to 70% within 12 months to minimize overnight sleep disruptions and improve inpatient sleep. METHODS We conducted a quality improvement project on 3 pediatric hospital medicine teams at a large free-standing children’s hospital. Our multidisciplinary team defined low-risk patients as those admitted for hyperbilirubinemia and failure to thrive. Interventions were focused around education, electronic health record decision support, and patient safety. The outcome measure was the percentage of patient nights without a vital sign measurement between 12 am and 6 am and was analyzed by using statistical process control charts. Our process measure was the use of an appropriate vital sign order. Balancing measures included adverse patient events, specifically code blues outside the ICU and emergent transfers. RESULTS From March 2020 to April 2021, our pediatric hospital medicine (PHM) services admitted 449 low-risk patients for a total of 1550 inpatient nights. The percentage of patient nights with overnight vital signs decreased from 98% to 38%. There were no code blues or emergent transfers. CONCLUSION Our improvement interventions reduced the frequency of overnight vital sign monitoring in 2 low-risk groups without any adverse events.

Background:Little is known about patient factors associated with the provision of hypertension care as recommended by JNC 7.Methods: We conducted a retrospective chart review (n ‫؍‬ 150) to compare documented provision of items recommended by JNC 7 with various patient factors, using a 15-point scoring tool (0% to 100%).Results: The overall documentation of JNC guideline-recommended care was 78.3%. There was a significant effect of marital status; married patients received more guideline-recommended care than unmarried patients (80.4% vs 74.4%; P ‫؍‬ .02). Men received more guideline-recommended care than women (80.7% vs 76.4%; P ‫؍‬ .02). Multivariate analysis revealed that Medicaid patients had 7.1% lower rates of guideline-recommended care than patients with other insurance (P ‫؍‬ .05). There was no significant difference in guideline-recommended care based on race/ethnicity; however, racial/ethnic disparities were identified for certain individual standards.Conclusions

Previous research has shown that the stability of haptic simulation systems is largely affected by the type of signals sampled and the discretization method used for implementing the virtual environment. In this paper, we analytically derive and experimentally evaluate the uncoupled stability of haptic simulation systems, that is when these systems are not being held by any operator, for various conditions. These stability conditions are expected to be the most stringent ones, as operators' grasp tend to stabilize the coupled system. Our evaluation includes cases in which position, velocity or both signals are sampled, the backward difference or Tustin methods are used to implement a linear-time-invariant damper-spring environment. Our results show that sampling the velocity signal will significantly increase the range of environment dynamics that can be stably implemented, particularly when the backward difference method is applied as the discretization method.

Twenty-eight sex- and age-matched participants, half dextrals and half sinstrals, were instructed to move a pen-sized planometer three inches (7.6 cm) while blindfolded. Under separate trials, movements were made at four angles, towards and away from the body, and at two distances from the body (30 cm, 53 cm). Half were made with the right hand and half with the left hand. Line estimates increased in length across blocks of trials in a linear fashion and progressively overestimated the three-inch imagined criterion. Lines made moving towards the body were longer than those made moving away from the body, implying an egocentric frame of reference in making the estimates. Line estimates made at an oblique angle differed significantly from estimates made at other angles. No influences of sex, handedness, or the hand used in making the estimates were observed. The findings suggest that motoric estimates of line lengths made without visual cues-a unique measure of an implicit cognitive concept-are significantly altered by temporal and spatial factors, but not by sex or hemispheric laterality.