bluuebunny/crossref_metadata_2025 huggingface dataset:
Rooftop Hospital Gardens for Physical Therapy: A Post-Occupancy Evaluation
Authors: Davis Brad E.
Published: February 2015

Objective: The goal of this study was to understand successes and weaknesses of a rooftop hospital garden used primarily for physical therapy.

Background: Literature on the healing benefits of nature and designed outdoor spaces in healthcare contexts continues to become more focused on specific patient populations. This study contributes to the knowledge of rooftop hospital gardens and gardens for physical rehabilitation.

Methods: A post-occupancy evaluation was conducted using interviews with a lead therapist and landscape architect, behavior mapping, a staff survey, and a patient questionnaire.

Results: The designer and administrative staff perceived high accessibility while patients and staff reported low accessibility. Patients reported high satisfaction with the garden while staff reported little time for garden use. Poor maintenance decisions resulted in decreased functional and aesthetic value.

Conclusions: Garden elements take on added layers of meaning and value to users seeking to escape the indoor environment, placing increased importance on evidence-based site design. Multiple perspectives must be considered in facility and garden master planning. Finally, designers and horticultural therapists must be retained in garden management to preserve and enhance garden functionality.
A Comparison of Parent Satisfaction in an Open-Bay and Single-Family Room Neonatal Intensive Care Unit
Authors: Stevens Dennis C. , Helseth Carol C. , Khan M. Akram , Munson David P. , Reid E. J.
Published: February 2015

Objective:

The purpose of this research was to test the hypothesis that parental satisfaction with neonatal intensive care is greater in a single-family room facility as compared with a conventional open-bay neonatal intensive care unit (NICU).

Methods:

This investigation was a prospective cohort study comparing satisfaction survey results for parents who responded to a commercially available parent NICU satisfaction survey following the provision of NICU care in open-bay and single-family room facilities. A subset of 16 items indicative of family-centered care was also computed and compared for these two NICU facilities.

Results:

Parents whose babies received care in the single-family room facility expressed significantly improved survey responses in regard to the NICU environment, overall assessment of care, and total survey score than did parents of neonates in the open-bay facility. With the exception of the section on nursing in which scores in both facilities were high, nonsignificant improvement in median scores for the sections on delivery, physicians, discharge planning, and personal issues were noted. The total median item score for family-centered care was significantly greater in the single-family room than the open-bay facility.

Conclusions:

Parental satisfaction with care in the single-family room NICU was improved in comparison with the traditional open-bay NICU. The single-family room environment appears more conducive to the provision of family-centered care. Improved parental satisfaction with care and the potential for enhanced family-centered care need to be considered in decisions made regarding the configuration of NICU facilities in the future.
Color-Coding and Human Factors Engineering to Improve Patient Safety Characteristics of Paper-Based Emergency Department Clinical Documentation
Authors: Kobayashi Leo , Boss Robert M. , Gibbs Frantz J. , Goldlust Eric , Hennedy Michelle M. , Monti James E. , Siegel Nathan A.
Published: February 2015

Objective:

Investigators studied an emergency department (ED) physical chart system and identified inconsistent, small font labeling; a single-color scheme; and an absence of human factors engineering (HFE) cues. A case study and description of the methodology with which surrogate measures of chart-related patient safety were studied and subsequently used to reduce latent hazards are presented.

Background:

Medical records present a challenge to patient safety in EDs. Application of HFE can improve specific aspects of existing medical chart organization systems as they pertain to patient safety in acute care environments.

Methods:

During 10 random audits over 5 consecutive days (573 data points), 56 (9.8%) chart binders (range 0.0–23%) were found to be either misplaced or improperly positioned relative to other chart binders; 12 (21%) were in the critical care area. HFE principles were applied to develop an experimental chart binder system with alternating color-based chart groupings, simple and prominent identifiers, and embedded visual cues.

Results:

Post-intervention audits revealed significant reductions in chart binder location problems overall ( p < 0.01), for Urgent Care A and B pods (6.4% to 1.2%; p < 0.05), Fast Track C pod (19.3% to 0.0%; p < 0.05) and Behavioral/Substance Abuse D pod (15.7% to 0.0%; p < 0.05) areas of the ED. The critical care room area did not display an improvement (11.4% to 13.2%; p = 0.40)

Conclusions:

Application of HFE methods may aid the development, assessment, and modification of acute care clinical environments through evidence-based design methodologies and contribute to safe patient care delivery.
Hospitals on the Time Axis: Trends in the Real World and Implications for Architectural Education
Authors: Kendall Stephen
Published: February 2015

Hospitals are never finished, and in the best cases they retain value and coherence for decades while they adjust in response to the dynamics of the healthcare field. In the worst cases, the facility is demolished, incapable of accommodating cycles of change. These are well known but poorly documented realities. Today, it is not unusual for one architect to design a hospital and another to design the interior fit-out, either initially or years later. Some clients ask for “shell space” to be fitted out later by another firm. Architects educated to define function first and to maintain unified control find this unsettling, believing that only if one party controls everything can high-quality architecture result. This is not the case, as diverse buildings, cities, and neighborhoods show, but the belief dies hard. In fact, the educational paradigm in schools of architecture largely maintains the old myths.

This article describes this reality and poses questions about habit and method that are now at odds with reality. Finally, the paper suggests a way to handle new realities in the education of the next generation of architects.
Environmental Congruence and Work-Related Stress in Acute Care Hospital Medical/Surgical Units: A Descriptive, Correlational Study
Authors: Dendaas Nancy
Published: February 2015

Objective:

To describe the degree to which Environmental Congruence (EC) is present in sampled units and considered important/desirable by staff RNs; staff RNs' reported level of work-related stress (WRS); the perceived contribution of the physical environment to WRS; and the relationship between existing levels of EC and WRS.

Background:

Few studies have focused on how the physical environment might contribute to nurses' WRS and chronic nursing shortages. The construct of EC can be used, within a Person Environment (PE)-Fit framework, to assess the fit among nurses, nursing work, the physical work environment, and WRS.

Methods:

EC was measured using investigator-developed, literature/criterion-based survey instruments. Staff RNs reported WRS variables by using two single-item self-report measures. The final convenience sample consisted of 471 staff RNs from 39 medical/surgical units from 12 hospitals in the upper Midwest. Data were collected over a 7-month period.

Results:

The mean level of existing EC in the sample was roughly 70% percent of highest capacity and that of important/desired EC in the sample was 93%. Staff RNs' mean level of WRS was 6.7; the mean contribution of the physical environment to WRS was 5.8. Moderate negative correlations were found between EC and WRS ( r = −.41, p < .05), and between physical environment contribution to WRS and EC ( r = −.55, p <.001).

Conclusions:

Staff RNs in the sampled units wanted a significantly higher level of EC. They rated their WRS moderately high and the contribution of the physical environment to it as moderate. A moderately negative relationship was found between EC and WRS. EC may be a useful construct in research that attempts to improve hospital nursing work environments.
Acuity-Adaptable Nursing Care: Exploring Its Place in Designing the Future Patient Room
Authors: Kwan Melissa A.
Published: February 2015

Aim:

To substantiate the anticipated benefits of the original acuity-adaptable care delivery model as defined by innovator Ann Hendrich.

Background:

In today's conveyor belt approach to healthcare, upon admission and through discharge, patients are commonly transferred based on changing acuity needs. Wasted time and money and inefficiencies in hospital operations often result—in addition to jeopardizing patient safety. In the last decade, a handful of hospitals pioneered the implementation of the acuity-adaptable care delivery model. Built on the concept of eliminating patient transfers, the projected outcomes of acuity-adaptable units—decreased average lengths of stay, increased patient safety and satisfaction, and increased nurses' satisfaction from reduced walking distances—make a good case for a model patient room.

Conclusion:

Although some hospitals experienced the projected benefits of the acuity-adaptable care delivery model, sustaining the outcomes proved to be difficult; hence, the original definition of acuity-adaptable units has not fared well. Variations on the original concept demonstrate that eliminating patient transfers has not been completely abandoned in healthcare redesign and construction initiatives. Terms such as flex-up, flex-down, universal room, and single-stay unit have since emerged. These variations convolute the search for empirical evidence to support the anticipated benefits of the original concept. To determine the future of this concept and its variants, a significant amount of outcome data must be generated by piloting the concept in different hospital settings. As further refinements and adjustments to the concept emerge, the acuity-adaptable room may find a place in future hospitals.
Impact of Imaging Room Environment: Staff Job Stress and Satisfaction, Patient Satisfaction, and Willingness to Recommend
Authors: Quan Xiaobo , Joseph Anjali , Ensign Janet C.
Published: February 2015

Background:

The built environment significantly affects the healthcare experiences of patients and staff. Healthcare administrators and building designers face the opportunity and challenge of improving healthcare experience and satisfaction through better environmental design.

Objective:

The purpose of the study was to evaluate how a novel environmental intervention for imaging rooms, which integrated multiple elements of healing environments including positive distractions and personal control over environment, affects the perceptions and satisfactions of its primary users—patients and staff.

Methods:

Anonymous questionnaire surveys were conducted to compare patient and staff perceptions of the physical environment, satisfaction, and stress in two types of imaging rooms: imaging rooms with the intervention installed (intervention rooms) and traditionally designed rooms without the intervention (comparison rooms).

Results:

Imaging technologists and patients perceived the intervention rooms to be significantly more pleasant-looking. Patients in the intervention rooms reported significantly higher levels of environmental control and were significantly more willing to recommend the intervention rooms to others.

Conclusions:

The environmental intervention was effective in improving certain aspects of the imaging environment: pleasantness and environmental control. Further improvement of the imaging environment is needed to address problematic areas such as noise.
The Challenge of Innovation and the High-Performance Team
Authors: Tam David A. , Chessum Thomas , Leopold Jay
Published: February 2015

Purpose:

This paper describes the use of a high-performance team model in the leadership of a healthcare construction project with a vision of fostering innovation in the design and building process. This model facilitated the effective implementation of = Lean principles and a joint governance model combining stakeholders under a shared vision.

Background:

The healthcare facility discussed is a California healthcare district in San Diego. Because of state seismic safety legislation, the district elected to build a replacement hospital for its tertiary care trauma facility. The organization's leadership decided to pursue a course that demanded innovation in both the design and construction process. The owner, architects, construction manager, and trade contractors adopted a high-performance team model to meet this challenge.

Conclusions and Recommendations:

The governance and leadership of a construction project should reflect the design and ultimate intent of the facility. The vision of building the most innovative hospital under constrained resources required the implementation of an innovative approach to leading the construction process.
A Cottage Model for Eldercare
Authors: Thistleton William , Warmuth Jacqueline , Joseph Joanne M.
Published: February 2015

Objective:

An overview of medical, cognitive, and affective changes experienced by geriatric long-term care residents during a migration from traditional healthcare delivery to a cottage-based model.

Background:

New architectural models hold great promise for improving health and social outcomes for residents. New studies must explore the resident, family, and staff outcomes across transformations, as well as the business case for change.

Methods:

A longitudinal, quasi-experimental design was employed, with an emphasis on regularly acquired institutional data, including the Minimum Data Set, as well as commonly available survey instruments including the MOSES, the 2005 NSWHN, and Castle's Job Satisfaction Questionnaire. Descriptive statistics, McNemar's Exact Test, repeated measures ANOVA, and t-tests were used as well as narratives from families, staff, and management.

Results:

Staff perceived enhanced institutional respect ( t(72) = 2.38, p = 0.02) and work environment, and families perceived more staff cooperation and a better bond between staff and residents. No changes were discerned in a resident's prevalence of pain (odds ratio 0.43, p = .34, 95% CI [0.07, 1.88]), mobility (odds ratio 0.50, p =.19, 95% CI [0.17, 1.32]), range of motion(odds ratio 0.57, p = .55, 95% CI [0.12, 2.25]), or depression and anxiety (odds ratio 2.33, p =.11, 95% CI [0.84, 7.41]). A modest decline in residents' systolic ( t (101) = 3.74, p < .001) and diastolic ( t (101) = 2.870, p < .01) blood pressures was demonstrated. The rate at which a resident's Activities of Daily Living score declined was attenuated ( t (57) = 3.37, p <.001). Operational costs remained constant across the move.

Conclusions:

Cottage settings were aesthetically appealing to residents, family, and staff. Modest improvements in health outcomes were observed, and operational costs remained stable.
The Role of Flooring as a Design Element Affecting Patient and Healthcare Worker Safety
Authors: Harris Debra D. , Detke Laura A.
Published: February 2015

OBJECTIVE:

The objective of this study was to review, identify, and synthesize the literature on patient and healthcare worker safety related to flooring. The topic of flooring in the design of healthcare facilities is complex: healthcare associated infections, push/pull limitations, falls and fall injuries, and noise as a contributing factor to quality of care.

BACKGROUND:

Most hospitals have not been explicitly designed to enhance patient safety. Recommendations from the Agency for Healthcare Research and Quality (AHRQ) include preventing patient falls, reducing infections, and preventing medication errors as the areas of emphasis of evidence-based design to improve patient safety and quality of care.

METHODS:

A review of the literature was conducted through search engines using a predefined list of keywords to identify studies about flooring and the safety of patients and healthcare workers. Inclusion criteria included peer-reviewed theoretical and empirical studies published in English from 1982 to 2012. Final inclusion was obtained based on an analysis of research design.

RESULTS:

Of those 27 articles that met inclusion, 7 focused on healthcare associated infections; 9 focused on slips, trips and falls; 7 articles focused on noise; and 4 focused on fatigue. The studies are profiled in tables and organized by environmental variable.

CONCLUSIONS:

Though a limited number of studies met the criteria for this review, the evidence base is emerging to design for safety. Recommendations for future research and practical application of design are provided.
Clinic Exam Room Design: Present and Future
Authors: Freihoefer Kara , Nyberg Gary , Vickery Christine
Published: February 2015

OBJECTIVE:

This article aims to deconstruct various design qualities and strategies of clinic exam rooms, and discuss how they influence users' interaction and behavior in the space. Relevant literature supports the advantages and disadvantages of different design strategies. Annotated exam room prototypes illustrate the design qualities and strategies discussed.

BACKGROUND:

Advancements in technology and medicine, along with new legislative policies, are influencing the way care providers deliver care and ultimately clinic exam room designs. The patient-centered medical home model has encouraged primary care providers to make patients more active leaders of their health plan which will influence the overall functionality and configuration of clinic exam rooms. Specific design qualities discussed include overall size, location of doors and privacy curtains, positioning of exam tables, influence of technology in the consultation area, types of seating, and placement of sink and hand sanitizing dispensers. In addition, future trends of exam room prototypes are presented.

CONCLUSIONS:

There is a general lack of published evidence to support design professionals' design solutions for outpatient exam rooms. Future research should investigate such topics as the location of exam tables and privacy curtains as they relate to patient privacy; typical size and location of consultation table as it relates to patient connection and communication; and placement of sinks and sanitization dispensers as they relate to frequency and patterns of usage.
Color Perception in Pediatric Patient Room Design: American versus Korean Pediatric Patients
Authors: Park Jin Gyu “Phillip” , Park Changbae
Published: February 2015

OBJECTIVE:

This study simultaneously addresses the issues of the scarcity of information about pediatric patient color preferences, conflicting findings about the impact of culture on color preferences, and limitations of previous research instruments. Effects of culture and gender on color preferences were investigated using American and Korean pediatric patients.

BACKGROUND:

Much of the existing research in environmental design has focused on environments for healthy children and adults, but those findings cannot be confidently applied to environments for pediatric patients. In previous studies, the impact of culture on color preferences has been suggested, though the effects appear to vary. Moreover, the results of previous studies were typically based on perceptions of small color chips, which are different from seeing a color on wall surfaces. Previous studies also failed to control for confounding variables such as color attributes and light sources.

METHODS:

Instead of using color chips, this study used physical model simulation to investigate environmental color preferences in real contexts.

RESULTS:

Cultural difference was found in white. Other than white, no significant cultural difference was found. Gender differences were found across both of the groups.

CONCLUSIONS:

Korean pediatric patients showed significantly higher preference scores for white than Americans did. Other than white, both groups reported blue and green as their most preferred colors; white was the least preferred. Both groups reported similar gender effects. Overall, male patients reported significantly lower preference scores for red and purple than female patients did. These results can help healthcare providers and professionals better understand appropriate colors for pediatric populations.
Design for the Post-Antibiotic Era: Experiences from a New Building for Infectious Diseases in Malmö, Sweden
Authors: Holmdahl Torsten , Lanbeck Peter
Published: February 2015

OBJECTIVE:

To describe the experience of planning and designing a new facility for infectious diseases in Sweden and to discuss underlying theories relating to infection prevention and evidence-based design.

BACKGROUND:

Departments of Infectious Diseases are common in healthcare facililties in Sweden. In 2005, a decision was made to build a new facility. The program required spacious single rooms, with a high ventilation standard, and anterooms.

METHODS:

In this article we present an analysis of the future of infectious diseases. Underlying theories are discussed. We also describe how a program was outlined using literature studies, including evidence-based healthcare design, focus groups of staff, and study visits.

RESULTS:

Active involvement of users and infection control specialists was important in the building process. A full-scale patient room mock-up was built with ventilation, electrical, and other systems. The mock-up was cost effective because it avoided costly mistakes during the building process. The mock-up also was a place where staff could assess and begin adapting to their future work environment. Separate ventilation and separate entrances to patient rooms from the building exterior allowed placement of isolation units in the main hospital area.

CONCLUSIONS:

Antimicrobial resistance, emerging diseases, healthcare associated infections, and outbreaks highlight the need for infection control measures in all hospital design. Infection control should be integrated in all hospital planning and be part of contracts. In this study we describe a specialized unit where a high degree of standardization and flexibility has made it possible to have a unique standard of preparedness for the post-antibiotic era.
When the World Is Closing In: Effects of Perceived Room Brightness and Communicated Threat During Patient-Physician Interaction
Authors: Okken Vanessa , van Rompay Thomas , Pruyn Ad
Published: February 2015

OBJECTIVE:

The study proposes that room brightness creates impressions of a more spacious environment and that this perception positively impacts feelings and behaviors during high-threat conversations in particular.

BACKGROUND:

To a large extent healthcare providers depend on their patients' willingness to disclose information. In addition to characteristics related to the physician and topic of conversation, research indicates that environmental factors influence patients' affective experiences and self-disclosure.

METHODS:

A two-factor between-subjects experimental design was used in which participants ( n = 90) were presented with a scenario describing a patient–physician encounter varying in communicated threat. Subsequently, participants were exposed to a picture in which room brightness was manipulated. Next, patient comfort, experienced spaciousness, and self-disclosure intentions were measured.

RESULTS:

An effect of brightness was found on affective experiences and self-disclosure intentions. In addition, the predicted interaction was obtained between brightness and communicated threat on these measures. Analyses confirmed that perceived spaciousness mediates the relationship between room brightness and self-disclosure intentions.

CONCLUSIONS:

The study confirms that brightness impacts self-disclosure intentions. Additionally, this relationship is influenced by psychological circumstances, with a more pronounced need for spaciousness when in an anxious state of mind. The results suggest that the physical environment can be used as a tool to improve active participation. In addition, the results stress the importance of attending to the patient's state of mind in creating the right atmosphere.
Expert Opinions on the Role of Facility Design in the Acquisition and Prevention of Healthcare-Associated Infections
Authors: Lenfestey Nancy F. , Denham Megan E. , Hall Kendall K. , Kamerow Douglas B.
Published: February 2015

OBJECTIVE:

To assess expert knowledge, perceptions, and experience on the role of the built environment in the acquisition and transmission of healthcare-associated infections (HAIs), facility design decision-making considerations, and strategies for intervention through facility design and technologies.

BACKGROUND:

Healthcare-associated infections pose a serious and costly threat to public health in the United States. A growing evidence base suggests that the built environment can play a role in interrupting the chain of infection.

METHODS:

Semi-structured individual interviews and triads were conducted with 26 experts in hospital administration, architecture, interior design, infection control, and air and water quality. A grounded theory approach was used for interview coding and interpretation.

RESULTS:

Participants characterized the shift in thinking about the relationship between the built environment and HAI transmission as a “progression,” as accountability for infection prevention has expanded beyond clinicians. Organizational leaders aim to make informed design decisions, but this can be challenging due to the paucity of efficacy and return on investment data. Emerging interventions include copper impregnated materials, seamless flooring, and chilled beams.

CONCLUSIONS:

No single intervention is entirely effective in mitigating HAI risk; multiple interventions are needed. In addition to the built environment, human behavior must be considered, as noncompliance can render even the best designs ineffective. Increased multidisciplinary collaboration is needed to improve the application of evidence and experience in healthcare facility design. In the absence of conclusive evidence regarding interventions aimed at reducing HAI transmission, a combination of research data and practical experience should be used to inform design decisions.
The Role of the Hospital Environment in Preventing Healthcare-Associated Infections Caused by Pathogens Transmitted through the Air
Authors: Jacob Jesse T. , Kasali Altug , Steinberg James P. , Zimring Craig , Denham Megan E.
Published: February 2015

OBJECTIVE:

To assess and synthesize available evidence in the infection control and healthcare design literature on strategies using the built environment to reduce the transmission of pathogens in the air that cause healthcare-associated infections (HAIs).

BACKGROUND:

Air can serve as a route for transmission of important HAI pathogens, including Mycobacterium tuberculosis and influenza, and may play a role for others typically transmitted by contact, including Staphylococcus aureus and Clostridium difficile.

TOPICAL HEADINGS:

Four primary interventions can be used interrupt the transmission of pathogens in air: ventilation, filtration, decontamination, and isolation. Many studies demonstrate that unidirectional airflows, when combined with very clean air and frequent air changes, reduce bacterial counts in the air, though mostly focused on the operating room. A high-efficiency particulate air filter removes almost all particles from the air and is used in protective environments such as the operating room, but little evidence supports its broader application. Ultraviolet germicidal radiation can augment the performance of heating, ventilation, and air conditioning systems. Isolation with negative pressure ventilation prevents spread of airborne pathogens such as tuberculosis.

CONCLUSIONS:

Current evidence is limited by the complexity of the interactions between pathogens and potential hosts, and in the methods used to assess impact of these strategies. Because the factors that affect transmission of the pathogens are complex and transcend disciplines, a collaborative approach among the key stakeholders in healthcare facility design should be actively pursued from planning to completion of construction and in rigorous research to best determine how design can reduce HAIs.
Space Allocation in the Award-Winning Adult ICUs of the Last Two Decades (1993–2012): An Exploratory Study
Authors: Rashid Mahbub
Published: February 2015

OBJECTIVE:

This exploratory study describes space allocation among different generic categories of functions in adult intensive care units (ICUs) showing how the amount of space of any one functional category is related to that of another functional category, and how different strategic choices, such as size, construction type, specialty type, and layout type, affect space allocation in these ICUs.

BACKGROUND:

Even though critical care practice has already undergone significant changes in the last few decades, it is still an evolving domain of medical practice. As a result, ICU design is also evolving as new regulatory standards, new technologies, and new clinical models are being introduced. A good understanding of the above issues regarding space allocation may help us better guide the evolution of ICU design.

METHODS:

The study includes a set of 25 adult ICUs that were recognized between 1993 and 2012 by the Society of Critical Care Medicine (SCCM), the American Association of Critical Care Nurses (AACCN), and the American Institute of Architects Academy of Architecture for Health (AIA AAH) for their efforts to promote healing of the critically ill and injured patients through the design of the critical care unit environment.

RESULTS:

The study finds notable differences in space allocation among different generic categories of functions between the ICUs of the first decade (1993–2002) and the second decade (2003–2012). The study also finds notable differences in space allocation among different generic categories of functions in relation to size, construction type, specialty type, and layout type.

CONCLUSIONS:

Despite several limitations, the study should help design better adult ICUs based on an evidence-based understanding of the relationships between space allocation and strategic choices.
A Comparative Evaluation of Swedish Intensive Care Patient Rooms
Authors: Apple Michael
Published: February 2015

OBJECTIVE:

This study investigates how design strategies in three recent intensive care units in Sweden impact patients, families, and staff. The area of focus is the patient room “module,” usually consisting of a pair of patient rooms and a joint location for monitoring and documentation.

BACKGROUND:

Many countries are expanding their number of intensive care beds and are also in the process of incorporating evidence-based design strategies such as single-bed patient rooms and access to daylight and nature. This situation provides a significant opportunity to review and learn from facilities leading the way in these areas.

METHODS:

Three intensive care units completed since 2010 were evaluated in relation to a combination of criteria. Methods included plan drawing analysis, staff questionnaires ( n = 72), staff interviews ( n = 9), and systematic observation (6 hours).

RESULTS:

In some patient rooms, access to daylight and/or outdoor views was excellent, while in other rooms such access was hindered by frosted glass or adjacent bushes or buildings. Single-bed rooms gave family members improved privacy and greater ability to stay in the patient room. Some patient room modules provided efficient patient observation and staff collaboration, but more noise and reduced patient privacy. Other modules provided a calm patient room environment, but caused some staff to feel isolated and have difficulty in getting assistance.

CONCLUSIONS:

The evaluation of the three projects reveals variation in whether design strategies successfully achieve their desired outcomes. Varying designs of the patient room module affect users in unique ways and must balance privacy, visibility, quietness, and staff access to assistance.
Centralized vs. Decentralized Nursing Stations: An Evaluation of the Implications of Communication Technologies in Healthcare
Authors: Bayramzadeh Sara , Alkazemi Mariam F.
Published: February 2015

OBJECTIVE:

This study aims to explore the relationship between the nursing station design and use of communication technologies by comparing centralized and decentralized nursing stations.

BACKGROUND:

The rapid changes in communication technologies in healthcare are inevitable. Communication methods can change the way occupants use a space. In the meantime, decentralized nursing stations are emerging as a replacement for the traditional centralized nursing stations; however, not much research has been done on how the design of nursing stations can impact the use of communication technologies.

METHODS:

A cross sectional study was conducted using an Internet-based survey among registered nurses in a Southeastern hospital in the United States. Two units with centralized nursing stations and two units with decentralized nursing stations were compared in terms of the application of communication technologies. A total of 70 registered nurses completed the survey in a 2-week period.

RESULTS:

The results revealed no significant differences between centralized and decentralized nursing stations in terms of frequency of communication technologies used. However, a difference was found between perception of nurses toward communication technologies and perceptions of the use of communication technologies in decentralized nursing stations.

CONCLUSIONS:

Although the study was limited to one hospital, the results indicate that nurses hold positive attitudes toward communication technologies. The results also reveal the strengths and weaknesses of each nursing station design with regard to communication technologies.
Positive Distraction and the Rehabilitation Hospitals of João Filgueiras Lima
Authors: Campagnol Gabriela , Shepley Mardelle McCuskey
Published: February 2015

OBJECTIVE:

This article discusses the use of positive distraction, an evidence-based design approach, in rehabilitation hospitals in Brazil through the work of João Filgueiras Lima (“Lelé”).

BACKGROUND:

In many parts of the world architects may not formally incorporate theories of positive distraction and evidence-based design, but there are multiple international examples of health facility architects and designers that use nature, daylighting, art, and social interaction to enhance the healing experience. The work of the Brazilian architect João Filgueiras Lima is a particularly salient example. Lima has been a dominant figure in 20th and 21st century Brazilian architecture and the architect of several rehabilitation facilities.

METHODS:

First positive distraction is defined as it relates to nature and art, and in the context of rehabilitation hospitals. Second, rehabilitation facilities are defined. The discussion then focuses on awareness of evidence-based design in Latin America. Next, Brazilian healthcare architecture is discussed along with the history of the Brazilian Sarah rehabilitation hospitals designed by Lelé and Lelé's role in the history of Brazilian architecture. Last we look at Lelé's use of positive distraction.

RESULTS:

Despite Lelé's recognition in Brazil, his work has not gained much international exposure. Lelé played a critical role in the design of the Sarah facilities and served on the board of directors for the Technological Center of the Sarah Network (CTRS) in Brazil from 1992 to 2009. Based on our review of his work it was clear that Lelé used positive distraction as a tool for creating healing environments.

CONCLUSIONS:

In spite of the lack of formal integration of evidence-based design in healthcare architecture in Latin America, many of its basic tenets have been incorporated in Brazilian rehabilitation hospitals. Lelé's projects are a clear example of this phenomenon and demonstrate an alignment between research and practitioner objectives. The presence of nature, art, and natural light in his rehabilitation hospitals serves as a model for evidence-based design in facilities throughout the world and presents an opportunity to measure the benefits of positive distraction on rehabilitation patient outcomes.
Ten Trends Transforming Cancer Care and Their Effects on Space Planning for Academic Medical Centers
Authors: Bloom Mara , Markovitz Sarah , Silverman Susan , Yost Carl
Published: February 2015

Objective:

This article aims to define the major trends currently affecting space needs for academic medical center (AMC) cancer centers. It will distinguish between the trends that promote the concentration of services with those that promote decentralization as well as identify opportunities for achieving greater effectiveness in cancer care space planning.

Background:

Changes in cancer care—higher survival rates, increased clinical trials, new technology, and changing practice models—increasingly fill hospitals’ and clinicians’ schedules and strain clinical space resources. Conflicts among these trends are concentrating some services and dispersing others. As a result, AMCs must expand and renovate intelligently to continue providing state-of-the-art, compassionate care.

Conclusions:

Although the typical AMC cancer center can expect to utilize more space than it would have 10 years ago, a deeper understanding of the cancer center enterprise can lead to opportunities for more effectively using available facility resources. Each AMC must determine for itself the appropriate balance of patient volume, clinical activity, and services between its main hospital campus and satellite branches. As well, space allocation should be flexible, as care trends, medical technology, and the provider’s own priorities shift over time. The goal isn’t necessarily more space—it’s better space.
Fatal Suppression
Authors: Szepsenwol Ohad , Mizrahi Moran , Birnbaum Gurit E.
Published: February 2015

The attachment and sexual systems operate jointly across partners to affect relationship outcomes. In the present longitudinal investigation of newly dating couples, we tested a dual deactivation hypothesis of relationship dissatisfaction. According to this hypothesis, individuals whose sexual system is chronically deactivated are expected to experience low relationship satisfaction early in their relationships. Their satisfaction should increase with time, but only if their partners are low in attachment avoidance. Newly dating couples (2–4 months; N = 62) completed three waves of individual measures of attachment and sexual deactivation and relationship satisfaction in 4-month intervals. Dyadic growth curves showed that sexual deactivation was negatively associated with relationship satisfaction in the beginning of the relationship. This negative effect gradually disappeared among individuals whose partners were low in attachment avoidance, but persisted among individuals with avoidantly attached partners. These findings suggest that attachment processes can compensate for sexual difficulties.
Differentiating malignant hypertension-induced thrombotic microangiopathy from thrombotic thrombocytopenic purpura
Authors: Khanal Nabin , Dahal Sumit , Upadhyay Smrity , Bhatt Vijaya Raj , Bierman Philip J.
Published: February 2015

Objectives:

Malignant hypertension can cause thrombotic microangiopathy (TMA) and the overall presentation may mimic thrombotic thrombocytopenic purpura (TTP). This presents a dilemma of whether or not to initiate plasma exchange. The objective of the study was to determine the clinical and laboratory manifestations of malignant hypertension-induced TMA, and its outcomes.

Methods:

Using several search terms, we reviewed English language articles on malignant hypertension-induced TMA, indexed in MEDLINE by 31 December 2013. We also report a new case. All these cases were analyzed using descriptive statistics.

Results:

A total of 19 patients, with 10 males, had a median age of 38 years at diagnosis; 58% had a history of hypertension. Mean arterial pressure at presentation was 159 mmHg (range 123–190 mmHg). All had prominent renal dysfunction (mean creatinine of 5.2 mg/dl, range 1.7–13 mg/dl) but relatively modest thrombocytopenia (mean platelet count of 60 × 103/µl, range 12–131 × 103/µl). Reported cases ( n = 9) mostly had preserved ADAMTS-13 activity (mean 64%, range 18–96%). Following blood pressure control, the majority had improvement in presenting symptoms (100%) and platelet counts (84%); however, only 58% had significant improvement in creatinine. More than half (53%) needed hemodialysis. One patient died of cardiac arrest during pacemaker insertion.

Conclusion:

Prior history of hypertension, high mean arterial pressure, significant renal impairment but relatively modest thrombocytopenia and lack of severe ADAMTS-13 deficiency (activity <10%) at diagnosis are clues to diagnose malignant hypertension-induced TMA. Patients with malignant hypertension respond well to antihypertensive agents and have favorable nonrenal outcomes.
Does Testing Improve Learning for College Students With Attention-Deficit/Hyperactivity Disorder?
Authors: Knouse Laura E. , Rawson Katherine A. , Vaughn Kalif E. , Dunlosky John
Published: February 2015

Taking tests on to-be-learned material is one of the most powerful learning strategies available to students. We examined the magnitude and mechanisms of the testing effect in college students with ( n = 25) and without ( n = 75) attention-deficit/hyperactivity disorder by comparing the effect of practice testing versus a comparable amount of restudy on long-term recall. Participants learned two lists of 48 words representing eight categories—one via eight consecutive study trials and another via four alternating study and test trials—and took recall tests 2 days later. Both groups demonstrated a moderate testing effect ( ds = 0.50, 0.57), and testing improved memory by enhancing both relational and item-specific processing. Results support the use of test-enhanced learning to promote the academic achievement of college students with attention-deficit/hyperactivity disorder and the inclusion of self-testing strategies into skills-based interventions for this population.
Sonographic Evaluation of Mobile Echogenicities Within the Epididymis
Authors: Shiling Margarita
Published: February 2015

Current ultrasound systems have significantly improved spatial and temporal resolution secondary to increased transducer frequencies, increased bandwidth, and complex signal processing such as harmonics and compound scanning. The case presented describes the differential diagnoses of small, linear, mobile echogenic foci visualized by sonography in the left epididymal tail. Differentiation of moving parasites associated with filariasis versus mobile sperm may become more difficult as the resolution of ultrasound equipment continues to improve.
Small Bowel Obstruction Due to MALT Lymphoma
Authors: Terry Merryl , Northrup Mindy , Connors James P.
Published: February 2015

Extranodal marginal zone lymphomas comprise approximately 5% of all non-Hodgkin lymphomas. These tumors may arise in any epithelial tissue, including the bowel lining. A report is presented of a patient who presented to the emergency department with epigastric abdominal pain and vomiting. An abdominal sonogram showed a 3.1 cm dilated loop of small bowel near midline just above the umbilicus as well as an abrupt transition zone to normal bowel suggestive of small bowel obstruction, confirmed by subsequent computed tomography. Small bowel resection found an intraluminal tumor, and biopsy showed extranodal marginal zone lymphoma of the mucosa-associated lymphoid tissue (MALT lymphoma).
Oxidized LDL activates blood platelets through CD36/NOX2–mediated inhibition of the cGMP/protein kinase G signaling cascade
Authors: Magwenzi Simbarashe , Woodward Casey , Wraith Katie S. , Aburima Ahmed , Raslan Zaher , Jones Huw , McNeil Catriona , Wheatcroft Stephen , Yuldasheva Nadira , Febbriao Maria , Kearney Mark , Naseem Khalid M.
Published: February 2015

Key Points

oxLDL binds platelet CD36 to stimulate tyrosine kinase– and PKC-dependent activation of NOX2 and generation of ROS. oxLDL- and hyperlipidemia-induced ROS mediate platelet desensitization to inhibitory cGMP signaling to facilitate platelet activation and thrombus formation.
Decitabine priming enhances the antileukemic effects of exportin 1 (XPO1) selective inhibitor selinexor in acute myeloid leukemia
Authors: Ranganathan Parvathi , Yu Xueyan , Santhanam Ramasamy , Hofstetter Jessica , Walker Alison , Walsh Katherine , Bhatnagar Bhavana , Klisovic Rebecca , Vasu Sumithira , Phelps Mitch A. , Devine Steven , Shacham Sharon , Kauffman Michael , Marcucci Guido , Blum William , Garzon Ramiro
Published: February 2015

Key Points

Decitabine priming increases antileukemic effects of selinexor in AML in vitro and in vivo. Decitabine priming allows for decreasing the dose of selinexor in patients, thus increasing tolerability without affecting antileukemic activity.
Content delivery to newly forming Weibel-Palade bodies is facilitated by multiple connections with the Golgi apparatus
Authors: Mourik Marjon J. , Faas Frank G. A. , Zimmermann Hans , Voorberg Jan , Koster Abraham J. , Eikenboom Jeroen
Published: February 2015

Key Points

WPBs stay connected to the Golgi apparatus until vesicle formation is completed. During biogenesis at the Golgi, WPBs increase in size through the addition of nontubular VWF.
Incorporating within- and between-patch resource selection in identification of critical habitat for brood-rearing greater sage-grouse
Authors: Dzialak Matthew R , Olson Chad V , Webb Stephen L , Harju Seth M , Winstead Jeffrey B
Published: February 2015

Introduction

Incorporating information on animal behavior in resource-based predictive modeling (e.g., occurrence mapping) can elucidate the relationship between process and spatial pattern and depict habitat in terms of its structure as well as its function. In this paper, we assigned location data on brood-rearing greater sage-grouse (Centrocercus urophasianus) to either within-patch (encamped) or between-patch (traveling) behavioral modes by estimating a movement-based relative displacement index. Objectives were to estimate and validate spatially explicit models of within- versus between-patch resource selection for application in habitat management and compare these models to a non-behaviorally adjusted model.

Results

A single model, the vegetation and water resources model, was most plausible for both the encamped and traveling modes, including the non-behaviorally adjusted model. When encamped, sage-grouse selected for taller shrubs, avoided bare ground, and were closer to mesic areas. Traveling sage-grouse selected for greater litter cover and herbaceous vegetation. Preference for proximity to mesic areas was common to both encamped and traveling modes and to the non-behaviorally adjusted model. The non-behaviorally adjusted map was similar to the encamped model and validated well. However, we observed different selection patterns during traveling that could have been masked had behavioral state not been accounted for.

Conclusions

Characterizing habitat that structured between-patch movement broadens our understanding of the habitat needs of brood-rearing sage-grouse, and the combined raster surface offers a reliable habitat management tool that is readily amenable to application by GIS users in efforts to focus sustainable landscape management.
Are Physicians Choosing Wisely When Imaging for Distant Metastases in Women With Operable Breast Cancer?
Authors: Simos Demetrios , Hutton Brian , Clemons Mark
Published: February 2015

Despite local imaging guidelines, patients with early-stage breast cancer still undergo imaging for distant metastases. There was no reduction in imaging frequency after publication of the ASCO top-five recommendations.