Using three spatial network measures of “space syntax”, this correlational study describes four interaction-related behaviors among three groups of users in relation to visibility and accessibility of spaces in four adult intensive care units (ICUs) of different size, geometry, and specialty. Systematic field observations of interaction-related behaviors show significant differences in spatial distribution of interaction-related behaviors in the ICUs. Despite differences in unit characteristics and interaction-related behaviors, the study finds that when nurses and physicians “interact while sitting” they prefer spaces that help maintain a high level of environmental awareness; that when nurses “walk” and “interact while walking” they avoid spaces with better global access and visibility; and that everyone in ICUs “walk” more in spaces with higher control over neighboring spaces. It is argued that such consistent behavioral patterns occur due to the structural similarities of spatial networks over and above the more general functional similarities of ICUs.

Objective: The objective of the study was to develop instruments for describing and assessing some aspects of design of the primary work areas of nurses and physicians in intensive care units (ICUs).Design: Separate questionnaires for ICU physicians and nurses were developed. Items related to individual-and unit-level design features of the primary work areas of nurses and physicians were organized using constructs found in the literature. Items related to staff satisfaction and staff use of time in relation to primary work area design were also included. All items and constructs were reviewed by experts for content validity and were modified as needed before use. Settings:The final questionnaires were administered to a convenience sample of four ICUs in two large urban hospitals.Participants: A total of 55 nurses and 29 physicians completed the survey.Measurements: Cronbach's Alpha was used to measure internal consistency, and factor analysis was used to provide construct-related validity. Convergent and discriminant validity were assessed through examining bivariate correlations between relevant scales/items. Analysis of variance was used to identify if the between-group member responses were significant among the four units.Main Results: Cronbach's Alpha values for all except three preliminary scales indicated acceptable reliability. Factor analysis indicated that some preliminary scales could be partitioned 3 into subscales for finer descriptions of the primary work areas. Correlational analysis provided strong evidence of convergent and discriminant validity of all the scales and subscales. The significance level of F-statistics showed that the units were significantly different from each other, providing evidence of more between-unit variance than within-unit variance. Conclusion:The questionnaires developed in the study offer a promising departure point for rigorous description and evaluation of the primary work areas in relation to staff satisfaction and use of time in ICUs at a time when the importance of such studies is growing.4

INTRODUCTION: Bird Fancier's Lung (BFL) is one of the most common forms of hypersensitivity pneumonitis; however, patients can be quite heterogeneous and have varying clinical presentations. We present a case of a 51-year-old man with exposure to multiple parakeets at his home with 12 years of recurrent symptoms.CASE PRESENTATION: Over a period of 12 years, the patient had experienced recurrent episodes of shortness of breath and cough productive of white sputum clumps and plastic-looking casts of his airways. He was diagnosed on several occasions with right middle and lower lobe pneumonia with radiologic findings of interstitial and nodular infiltrates that improve with steroids and antibiotics, but would eventually recur. Bronchoscopy at that time was nondiagnostic and he underwent VATS lung biopsy (at an outside institution) of a right lower lobe infiltrate a year after initial onset of symptoms. Pathology demonstrated mild bronchiolitis and chronic inflammation and minimal fibrosis without evidence of active infectious pneumonia. This is unusual since biopsy findings of BFL typically include loosely formed granulomas, giant cells, lymphoplasmacytic interstitial infiltrate in addition to some degree of fibrosis that may be present. It is unknown if he was on steroids at the time of his biopsy. His only persistent finding over the years was a significantly elevated IgE level around 1000 IU/ml (normal 0-180 IU/ml). Diagnosis was established 12 years after onset of symptoms following a bronchoscopy and bronchoalveolar lavage which showed 60% lymphocytes and a Bird Fancier Profile Panel which was positive for IgG antibodies to parakeets but negative for IgE. He had initial improvement of symptoms and radiographic infiltrates with prednisone but managed to maintain extended relief after eliminating exposure to all but one of his birds at home in addition to twice daily fluticasone/salmeterol inhaler. DISCUSSION: A high grade of suspision is required to diagnose BFL. Exposure history and symptom resolution with elimination of antigen exposure were critical in this case.CONCLUSIONS: This case illustrates the importance of exposure history to diagnose hypersensitivity pneumonitis despite the absence of definitive initial workup.