Note: This page contains sample records for the topic wards zylna choroba from Science.gov.
While these samples are representative of the content of Science.gov,
they are not comprehensive nor are they the most current set.
We encourage you to perform a real-time search of Science.gov
to obtain the most current and comprehensive results.
Last update: August 15, 2014.
1

4. FIRE BREAK BETWEEN PSYCHIATRIC WARD AND NEXT WARD TO ...  

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

4. FIRE BREAK BETWEEN PSYCHIATRIC WARD AND NEXT WARD TO THE SOUTH - Fort Randall, Neuro-Psychiatric Ward, Northeast of intersection of California Boulevard & Nurse Drive, Cold Bay, Aleutian Islands, AK

2

The Master Ward Identity  

NASA Astrophysics Data System (ADS)

In the framework of perturbative quantum field theory (QFT) we propose a new, universal (re)normalization condition (called `master Ward identity') which expresses the symmetries of the underlying classical theory. It implies for example the field equations, energy-momentum, charge- and ghost-number conservation, renormalized equal-time commutation relations and BRST-symmetry. It seems that the master Ward identity can nearly always be satisfied, the only exceptions we know are the usual anomalies. We prove the compatibility of the master Ward identity with the other (re)normalization conditions of causal perturbation theory, and for pure massive theories we show that the `central solution' of Epstein and Glaser fulfills the master Ward identity, if the UV-scaling behavior of its individual terms is not relatively lowered. Application of the master Ward identity to the BRST-current of non-Abelian gauge theories generates an identity (called `master BRST-identity') which contains the information which is needed for a local construction of the algebra of observables, i.e. the elimination of the unphysical fields and the construction of physical states in the presence of an adiabatically switched off interaction.

Dütsch, M.; Boas, F.-M.

3

Progress of the Productive Ward.  

PubMed

The progress of the Productive Ward programme has been variable. This article outlines a study that investigated the experience of implementing the programme in different hospitals and the lessons that can be learnt. PMID:21409998

Robert, Glenn

4

The productive ward: encouraging teambuilding and innovation.  

PubMed

The aim of the NHS Institute for Innovation and Improvement's Productive Ward series is to remove wasteful activities from ward processes and reinvest the time saved in making care more interactive, stimulating, reliable and safe. This article describes how the introduction of Productive Ward on one unit in a mental health trust has delivered improvements in general ward organisation and a range of ward processes, and has motivated and empowered team members to make changes and innovate. The article also describes leadership and teamworking lessons that the ward matron and project facilitator have learnt. PMID:21667814

Armitage, Claire; Higham, Pauline

2011-04-01

5

Food hygiene on the wards  

PubMed Central

A problem that is often overlooked or simply not given enough attention: the food served to patients from the kitchen is not sterile. If food is allowed to stand at room temperature for a long time, both in the case of food cooked for lunch and of food intended for supper which has been previously chilled, there is the possibility of massive spore germination or of dangerous toxin formation. Therefore regulations on how to handle food and beverages (e.g. tea) must be set out in the infection control policy, and checks carried out to monitor compliance with the rules relating to temperature checks, duration and type of storage, need for reheating, etc. Making staff aware of the issues involved is of paramount importance. These include monitoring hygiene standards in the ward kitchen, formulation of a cleaning policy, periodic bacteriological checks (not only of workstations but also of the dishwasher results), whenever possible the use of disposable cloths for working surfaces and equipment, changing cleaning cloths at least once daily and hygienic hand disinfection before and after handing out food. Foodstuffs brought in by visitors represent a special hygienic and organizational problem because in many cases they already have a high baseline microbial count. Visitors must be made aware that, for example, slices of cake left in the patient’s room and often eaten only hours later can pose a risk of infection. In summary, the following principles of food hygiene must be observed on the wards: Maintenance of the cold-hot chain Not only reheat food, but ensure it is well heated throughout Avoid situations giving rise to spore germination in foodstuffs brought in by visitors Cleanliness and minimal contamination of kitchen worktops Cleanliness of crockery and kitchen towels Do not allow food to stand at room temperature for a long time, in particular desserts and confectionery A standard policy must be enforced to define the hygienic status and organization for food distribution for ward kitchens too.

Steuer, Walter

2007-01-01

6

Food hygiene on the wards.  

PubMed

A PROBLEM THAT IS OFTEN OVERLOOKED OR SIMPLY NOT GIVEN ENOUGH ATTENTION: the food served to patients from the kitchen is not sterile. If food is allowed to stand at room temperature for a long time, both in the case of food cooked for lunch and of food intended for supper which has been previously chilled, there is the possibility of massive spore germination or of dangerous toxin formation. Therefore regulations on how to handle food and beverages (e.g. tea) must be set out in the infection control policy, and checks carried out to monitor compliance with the rules relating to temperature checks, duration and type of storage, need for reheating, etc. Making staff aware of the issues involved is of paramount importance. These include monitoring hygiene standards in the ward kitchen, formulation of a cleaning policy, periodic bacteriological checks (not only of workstations but also of the dishwasher results), whenever possible the use of disposable cloths for working surfaces and equipment, changing cleaning cloths at least once daily and hygienic hand disinfection before and after handing out food. Foodstuffs brought in by visitors represent a special hygienic and organizational problem because in many cases they already have a high baseline microbial count. Visitors must be made aware that, for example, slices of cake left in the patient's room and often eaten only hours later can pose a risk of infection.In summary, the following principles of food hygiene must be observed on the wards:Maintenance of the cold-hot chainNot only reheat food, but ensure it is well heated throughout Avoid situations giving rise to spore germination in foodstuffs brought in by visitorsCleanliness and minimal contamination of kitchen worktopsCleanliness of crockery and kitchen towels Do not allow food to stand at room temperature for a long time, in particular desserts and confectionery A standard policy must be enforced to define the hygienic status and organization for food distribution for ward kitchens too. PMID:20200664

Steuer, Walter

2007-01-01

7

Hospital ward patient-lifting tasks  

Microsoft Academic Search

From a questionnaire survey of the nursing staff in charge of 362 wards in Scotland and 363 wards in England, covering every major medical speciality, information was collected on five major tasks which involve lifting patients. The reliability of six parameters, namely, the method used for lifting patients, the number of patients requiring lifting, the number of staff required per

F. BELL; M. E. DALGITY; M.-J. FENNELL; R. C. B. AITKEN

1979-01-01

8

How to turn ward managers into leaders.  

PubMed

Ward managers are the largest management group in the NHS, and have an important leadership role in creating and sustaining excellent performance. Two London foundation trusts developed a unique frontline leadership programme for these staff. PMID:23550485

Castillo, Cavette; James, Sarah

9

Medication communication during ward rounds on medical wards: Power relations and spatial practices.  

PubMed

Communication plays a crucial role in the management of medications. Ward rounds are sites where health professionals from different disciplines and patients come together to exchange medication information and make treatment decisions. This article examines power relations and spatial practices surrounding medication communication between patients and health professionals including doctors, nurses and pharmacists during ward rounds. Data were collected in two medical wards of a metropolitan teaching hospital in Melbourne, Australia. Data collection methods involved participant observations, field interviews, video-recordings, together with individual and group reflexive interviews. A critical discourse analysis was undertaken to identify the location sites where power relations were reproduced or challenged in ward rounds. Findings demonstrated that traditional medical hierarchies constructed the ways in which doctors communicated about medications during ward rounds. Nurses and pharmacists ventured into the ward round space by using the discourse of preparation and occupying a peripheral physical position. Doctors privileged the discourse of medication rationalization in their ward round discussions, competing with the discourse of inquiry taken up by patients and families. Ward rounds need to be restructured to provide opportunities for nurses and pharmacists to speak at dedicated times and in strategic locations. By critically reflecting upon the complex process of medication communication during ward rounds, greater opportunities exist for enhanced team communication among health professionals. PMID:22674748

Liu, Wei; Manias, Elizabeth; Gerdtz, Marie

2013-03-01

10

Assessment of the social atmospheres of psychiatric wards  

Microsoft Academic Search

Describes the development of a Ward Atmosphere Scale, which differentiates between the social atmospheres of psychiatric inpatient wards. An initial form of the scale was given to Ss and staff on 14 wards from Veterans Administration, state, community, private, and university hospitals. The 2nd form of the scale consists of items which significantly differentiate between wards for Ss and\\/or staff.

Rudolf H. Moos; Peter S. Houts

1968-01-01

11

Operation Ward's Island, A Guide to the Trees and Other Features of Ward's Island.  

ERIC Educational Resources Information Center

This guide for teachers, students, and adults illustrates how it is possible to use Ward's Island as an outdoor laboratory. It contains a guide to 30 kinds of trees on the island, along with clearly drawn maps and illustrations. The guide helps the user to locate these trees along two nature trails. A section called "Ward's Island Roundup" briefly…

New York City Board of Education, Brooklyn, NY. Bureau of Curriculum Development.

12

Power and collegial relations among nurses on wards adopting primary nursing and hierarchical ward management structures.  

PubMed

Power and collegial relations among nurses on a number of hospital wards were analysed using a mixed methodology. Half the wards had adopted primary nursing whilst the rest continued with hierarchical management structures. Nurses' interactions were recorded as they worked, as were those that occurred during the shift handover period. The nurses' own perceptions of their collegial relations were measured using a 'Likert scale' type of questionnaire. Qualitative analysis of the observational data suggested that genuine differences in the nature of the power relations existed between the laterally and hierarchically managed wards. Some of the nurses on the primary nursing wards were observed to identify and discuss solutions to their patients' nursing problems, whereas these were either not followed-up or referred to other health care workers on the traditionally managed wards. Statistical analysis of the questionnaires suggested that nurses on the primary nursing wards found their collegial communication to be significantly more collaborative than that of the nurses on the hierarchical wards. Comparison between specialties did not reveal a statistical difference. PMID:2312925

McMahon, R

1990-02-01

13

Limits of Freedom: The Ward Churchill Case  

ERIC Educational Resources Information Center

The University of Colorado's Ward Churchill is but the latest in a long line of professors whose volatile statements have created controversy for themselves and their universities. Specific personnel matters in the case have been meticulously addressed in Boulder, but several larger questions have been curiously neglected. One might well ask, for…

O'Nell, Robert M.

2006-01-01

14

Ward Evaluations: Should They Be Abandoned?  

Microsoft Academic Search

Even in the era of the objective structured clinical examination (OSCE), the predominant method of resident evaluation is the faculty ward evaluation (WE), despite many concerns about its reliability. The aim of this study was to determine the value of the WE as a measurement of clinical competence in terms of both reliability and validity. In a one-year period, surgery

Christopher J. Kwolek; Michael B. Donnelly; David A. Sloan; Steven N. Birrell; William E. Strodel; Richard W. Schwartz

1997-01-01

15

Ward Identity in Krein Space Quantization  

NASA Astrophysics Data System (ADS)

In the previous paper, Krein space quantization has been studied for QED (Forghan et al. in Ann. Phys. 327:2388, 2012). In this paper, the relation between the vertex function and the electron self energy has been studied, showing that the Ward identity is correct for Krein space quantization.

Forghan, B.

2013-09-01

16

3. PSYCHIATRIC WARD IN 24' X 60' QUONSET HUT, VIEW ...  

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

3. PSYCHIATRIC WARD IN 24' X 60' QUONSET HUT, VIEW OF SOUTH FACE - Fort Randall, Neuro-Psychiatric Ward, Northeast of intersection of California Boulevard & Nurse Drive, Cold Bay, Aleutian Islands, AK

17

Cholesterol-Lowering Statin Drugs May Ward Off Dementia  

MedlinePLUS

Cholesterol-Lowering Statin Drugs May Ward Off Dementia... Text Size: Email This Post Print This Post Cholesterol-Lowering Statin Drugs May Ward Off Dementia Statins, the widely prescribed drugs taken by ...

18

Psychogeriatric Ward for Mentally Disturbed Elderly Patients  

PubMed Central

The operation is described of a special psychogeriatric ward of 23 beds set up in 1967 to provide treatment for mentally disturbed elderly patients who could not be kept in a general ward or at home. The unit is in a predominantly geriatric hospital which serves a population of 340,000 and in the four and a half years reviewed 600 patients were admitted. Half of the admissions were emergencies. A consultant geriatrician was in charge and the nursing staff were general trained. The number of beds was found to be adequate for the demand. Few patients had to be transferred to a psychiatric hospital, but, since the mental disturbance was often associated with severe illness and the patients were old, the death rate was high. The nursing staff have found the work interesting and stimulating.

Prinsley, D. M.

1973-01-01

19

Barriers to nursing care in emergency wards  

PubMed Central

Background: Caring is the essence of nursing. Since care is influenced by cultural, economic, and social factors, various diverse barriers exist in the realization of care. The aim of the study was to clarify barriers to caring in emergency patients based on experiences of nurses and patients and their relatives. Materials and Methods: A qualitative design of content analysis was used to identify the barriers to caring in emergency patients. In-depth interviews were conducted with 18 Iranian nurses working in a university hospital emergency ward and with seven patients. Participants were selected purposefully. Data were analyzed according to qualitative content analysis. Results: After the classification analyses and integration of codes, seven categories were acquired. Finally, following three themes were extracted: Identified barriers to nursing care in emergency wards – the nature of critical ward, performance weakness of nurses, and deficiency in clinical management. Conclusions: According to the results of this study fundamental and management education for nurses, empowerment of nurses, principle and scientific triage, effective supervision, nurses’ support, wage increase, and motivation in nurses are important to achieve the research purpose.

Mahmoudi, Hosein; Mohmmadi, Eesa; Ebadi, Abbas

2013-01-01

20

The role of the ward manager in promoting patient safety.  

PubMed

In this article the role of the ward manager in promoting patient safety is explored. The background to the development of the patient safety agenda is briefly discussed and the relationship between quality and safety is illustrated. The pivotal importance of the role of the ward manager in delivering services to patients is underlined and literature on patient safety is examined to identify what a ward manager can do to make care safer. Possible actions of the ward manager to improve safety discussed in the literature are structured around the Leadership Framework. This framework identifies seven domains for the leadership of service delivery. Ward managers use their personal qualities, and network and work within teams, while managing performance and facilitating innovation, change and measurement for improvement. The challenge of promoting patient safety for ward managers is briefly explored and recommendations for further research are made. PMID:23123893

Pinnock, David

21

Aggression in psychiatry wards: a systematic review.  

PubMed

Although fairly frequent in psychiatric in-patient, episodes of aggression/violence are mainly limited to verbal aggression, but the level of general health is significantly lower in nurses who report 'frequent' exposure to violent incidents, and there is disagreement between patients and staff concerning predictors of these episodes. We searched the Pubmed, Embase and PsychInfo databases for English, Italian, French or German language papers published between 1 January 1990 and 31 March 2010 using the key words "aggress*" (aggression or aggressive) "violen*" (violence or violent) and "in-patient" or "psychiatric wards", and the inclusion criterion of an adult population (excluding all studies of selected samples such as a specific psychiatric diagnosis other than psychosis, adolescents or the elderly, men/women only, personality disorders and mental retardation). The variables that were most frequently associated with aggression or violence in the 66 identified studies of unselected psychiatric populations were the existence of previous episodes, the presence of impulsiveness/hostility, a longer period of hospitalisation, non-voluntary admission, and aggressor and victim of the same gender; weaker evidence indicated alcohol/drug misuse, a diagnosis of psychosis, a younger age and the risk of suicide. Alcohol/drug misuse, hostility, paranoid thoughts and acute psychosis were the factors most frequently involved in 12 studies of psychotic patients. Harmony among staff (a good working climate) seems to be more useful in preventing aggression than some of the other strategies used in psychiatric wards, such as the presence of male nurses. PMID:21236497

Cornaggia, Cesare Maria; Beghi, Massimiliano; Pavone, Fabrizio; Barale, Francesco

2011-08-30

22

Ward Identities and Chiral Anomaly in the Luttinger Liquid  

Microsoft Academic Search

Systems of interacting non-relativistic fermions in d =1, as well as spin chains or interacting two dimensional Ising models, verify an hidden approximate Gauge invariance which can be used to derive suitable Ward identities. Despite the presence of corrections and anomalies, such Ward identities can be implemented in a Renormalization Group approach and used to exploit nontrivial cancellations which allow

Giuseppe Benfatto; Vieri Mastropietro

2005-01-01

23

Making anarchism respectable? The social philosophy of Colin Ward  

Microsoft Academic Search

Anarchism suffers from a respectability deficit, a problem of achieving a threshold level of credibility in the eyes of non-anarchists. One anarchist thinker who has grappled persistently with this problem over 60 years of activism is the influential post-war British anarchist, Colin Ward. Responding directly to the respectability deficit, Ward helped to develop a ‘pragmatist’ anarchism characterized by direct engagement

STUART WHITE

2007-01-01

24

The Ventilation, Heating and Lighting of Hospital Wards.  

PubMed

History of ventilation in last 100 years, showing reversal of ideas and influence of sanatorium idea.Physiology of cool moving air. How it affects metabolism, heat-loss and heat-production. Relation to sunlight. Reactive capacity of the individual.Practice of these teachings, as illustrated by sanatorium treatment of tuberculosis and by open-air schools. Exposure to cooling air a powerful therapeutic agent. Infrequent occurrence in sanatoria of diseases or complications often ascribed to cold. Dilution of infection. Applicability to diseases other than tuberculosis. Shock and old age.Perflation and diffusion, their relative values. Uniformity or variability of effect desirable? Incompatibility of good ventilation and ordinary standards of heating. Former the more important. Conclusion that ward temperatures may be lowered without harm. Measures necessary to compensate, clothing, classification of patients, small wards. Changing standards of comfort. Psychological effects.Systems of ventilation in hospital wards. Mechanical by propulsion or extraction being displaced by natural system, usually by cross-window ventilation. Supplementary ventilators. Objection to heating of incoming air. Fallibility of human factor in management. Sash versus casement windows. Hoppers. Austral window. Orientation and exposure of wards. Ventilation of small wards. Proportion of window space to solid wall. Balconies. Floor space.Heating of wards. Heating of air or floor or walls. Open fires. Value of radiant heat. Steam or water under low or high pressure. Radiators or pipes.Lighting. Avoidance of glare from windows. Arrangement of beds in wards. Colour of walls. Blinds and curtains. Artificial lighting. PMID:19989481

Watt, J

1933-09-01

25

[Physicians' expectations towards pharmacy services on ward].  

PubMed

Clinical pharmacy practice reveals an effective strategy to reduce medication errors and related costs. The present study aimed at confronting hospital perscribers' expectations towards pharmacy services and their jugement on the usefulness of routine pharmacist interventions. A questionnaire was sent to 562 prescribers of the Grenoble Teaching Hospital. They were asked to rank 1. key-points of prescribing process and specify those that could be shared with the pharmacist, 2. usefulness of a series of pharmacist interventions extracted from daily routine, 3. opportunity to perpetuate pharmacy service on ward. Questionnaire response rate was 18%. Concerning the key-points of the prescription process, (compliance to indications and guidelines, drug choice, dosage), responses express the physician's monopoly. Pharmacist's input in terms of drug choice or monitoring seems reduced. Experience in working with a clinical pharmacist or "junior prescriber" status have a positive effect on precribers' perception towards clinical pharmacy. 25% of the respondents cite the pharmacist as an active player in managing different key-points of the prescription. After being confronted with clinical examples, 73% of the prescribers consider pharmacists' interventions as useful. PMID:18269141

Bourget, S; Allenet, B; Bedouch, P; Bosson, L J; Calop, J

2007-01-01

26

18. INTERIOR OF WARD ROOM WITH RUDDER QUADRANT AND SHAFT ...  

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

18. INTERIOR OF WARD ROOM WITH RUDDER QUADRANT AND SHAFT LOCATED ABOVE. NOTE WIRE ROPE ALONG CEILING WHICH RUNS DIRECT TO WHEEL MECHANISM. - Lightship 116, Pier 3, Inner Harbor, Baltimore, Independent City, MD

27

Environmentalism in American Pedagogy: The Legacy of Lester Ward.  

ERIC Educational Resources Information Center

A review is presented of the legacy of Lester Frank Ward, widely recognized as the architect of environmentalism in American pedagogy and the creator of some of the most fundamental ideas about American curriculum. (CB)

Tanner, Laurel N.; Tanner, Daniel

1987-01-01

28

Los Angeles County Poor Farm, Patient Wards 201, 202, 203, ...  

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

Los Angeles County Poor Farm, Patient Wards 201, 202, 203, 204, 205, 206, 207, 208 & 209 - Type A Plan, 7601 Imperial Highway; bounded by Esperanza Street, Hawthorn Avenue, Laurel Street, and Descanso Street, Downey, Los Angeles County, CA

29

Los Angeles County Poor Farm, Patient Ward Nos. 210 & ...  

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

Los Angeles County Poor Farm, Patient Ward Nos. 210 & 211 - Type B Plan, 7601 Imperial Highway; bounded by Esperanza Street, Laurel Street, Flores Street, and Descanso Street, Downey, Los Angeles County, CA

30

1. ON HILLSIDE ABOVE ADDITIONAL WARDS AND OFFICES, SHOWING WOOD ...  

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

1. ON HILLSIDE ABOVE ADDITIONAL WARDS AND OFFICES, SHOWING WOOD FRAME CORRIDORS TO REAR - Fort Randall, Latrine & Bath, Northeast of intersection of California Boulevard & Nurse Drive, Cold Bay, Aleutian Islands, AK

31

Ward Rounds Revisited--The Validity of the Data Base  

ERIC Educational Resources Information Center

A format for ward rounds in use on a large medical service is designed to correct deficiencies in history-taking, interviewing, and physical diagnosis techniques. It is designed to emphasize basic clinical skills, observation, and reasoning. (Author)

Wiener, Stanley L.

1974-01-01

32

Do ward housekeepers free up time for care?  

PubMed

Introducing a ward housekeeping service may give nursing staff more time to focus on essential care. This small-scale evaluation found the role freed up healthcare assistant time and improved staff morale. PMID:22479768

Tye, Laura; Urmson, Stephanie; Maloney, Lindsey

33

Elevation of north facades of #156158 (triple wards) National ...  

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

Elevation of north facades of #156-158 (triple wards) - National Home for Disabled Volunteer Soldiers, Pacific Branch, Mental Health Buildings, 11301 Wilshire Boulevard, West Los Angeles, Los Angeles County, CA

34

Pseudoscalar quark states mixing and axial Ward identities.  

National Technical Information Service (NTIS)

The (nu)-, (nu)'-meson system is investigated in a relativistic invariant approach of composite operation under assumption of completeness and quark nature of mesons. New advanced solutions of axial Ward identities have been obtained. The connection of th...

M. L. Nekrasov

1990-01-01

35

Nurse-doctor interactions during critical care ward rounds.  

PubMed

This paper describes the participation of critical care nurses in ward rounds, and explores the power relations associated with the ways in which nurses interact with doctors during this oral forum of communication. The study comprised a critical ethnographic study of six registered nurses working in a critical care unit. Data collection methods involved professional journalling, participant observation, and individual and focus group interviews with the six participating nurses. Findings demonstrated that doctors used nurses to supplement information and provide extra detail about patient assessment during ward rounds. Nurses experienced enormous barriers to participating in decision-making activities during ward round discussions. By challenging the different points of view that doctors and nurses might hold about the ward round process, the opportunity exists for enhanced participation by nurses. PMID:11822491

Manias, E; Street, A

2001-07-01

36

Passive therapeutic gardens. A study on an inpatient geriatric ward.  

PubMed

A brief history of the link between horticultural activities and care of patients, particularly psychiatric patients, is reviewed in this article. Past research on both passive and active garden activities is examined in terms of physical and psychological benefits to patients. A passive garden intervention on an inpatient geriatric ward is described. Participants in this study were patients on a geriatric inpatient ward in a mid-sized regional hospital in New Zealand. Behavioral observations of patient movement on the ward were used to demonstrate the effects on patient behavior in response to the presence of the conservatory garden. Results showed a positive reaction to the conservatory, which was maintained 6 months after the initial plants were installed. The benefits of such garden installations are discussed, and areas for further research are outlined. Procedures, ethical concerns, and practical considerations of setting up such a conservatory on an inpatient ward are discussed. PMID:12765006

Pachana, Nancy A; McWha, J Lindsay; Arathoon, Maureen

2003-05-01

37

Strongly Lacunary Ward Continuity in 2-Normed Spaces  

PubMed Central

A function f defined on a subset E of a 2-normed space X is strongly lacunary ward continuous if it preserves strongly lacunary quasi-Cauchy sequences of points in E; that is, (f(xk)) is a strongly lacunary quasi-Cauchy sequence whenever (xk) is strongly lacunary quasi-Cauchy. In this paper, not only strongly lacunary ward continuity, but also some other kinds of continuities are investigated in 2-normed spaces.

Cakalli, Huseyin; Ersan, Sibel

2014-01-01

38

Parvovirus B19 outbreak on an adult ward.  

PubMed Central

In November and December 1992, an outbreak of parvovirus B19 infection occurred among patients and staff on an adult mixed surgical ward at a large hospital in London. Three patients and 15 staff members were serologically confirmed as acute cases. The attack rate among susceptible members of staff was 47%. In those infected, arthralgia (80%) and rash (67%) were the most common symptoms. Of six susceptible in-patients on the ward, three became infected. One of the in-patients who had carcinoma of the mouth was viraemic for more than 10 days with marrow suppression resulting in the postponement of chemotherapy until intravenous immunoglobulin was given and he was no longer viraemic. Control measures taken included closure of the ward to new admissions, transfer of only immune staff to the ward, and restriction of the ward nursing staff to working only on that ward. Although no specific exposure was conclusively identified as a risk factor, there was a suggestion of an increased risk of acquiring parvovirus B19 infection among those staff who did not adopt strict hand washing procedures after each physical contact with a patient (RR = 2.33; P = 0.07). Knowledge of parvovirus B19 among interviewed health care workers was poor: only 42% reported knowing about parvovirus B19 and only 38% could name a patient category at risk of a severe outcome following infection. This is the first report of a nosocomial outbreak affecting an adult ward and of possible transmission of parvovirus B19 infection from staff to in-patients. Hospital control of infection teams should include parvovirus B19 in their outbreak containment plans.

Seng, C.; Watkins, P.; Morse, D.; Barrett, S. P.; Zambon, M.; Andrews, N.; Atkins, M.; Hall, S.; Lau, Y. K.; Cohen, B. J.

1994-01-01

39

Parvovirus B19 outbreak on an adult ward.  

PubMed

In November and December 1992, an outbreak of parvovirus B19 infection occurred among patients and staff on an adult mixed surgical ward at a large hospital in London. Three patients and 15 staff members were serologically confirmed as acute cases. The attack rate among susceptible members of staff was 47%. In those infected, arthralgia (80%) and rash (67%) were the most common symptoms. Of six susceptible in-patients on the ward, three became infected. One of the in-patients who had carcinoma of the mouth was viraemic for more than 10 days with marrow suppression resulting in the postponement of chemotherapy until intravenous immunoglobulin was given and he was no longer viraemic. Control measures taken included closure of the ward to new admissions, transfer of only immune staff to the ward, and restriction of the ward nursing staff to working only on that ward. Although no specific exposure was conclusively identified as a risk factor, there was a suggestion of an increased risk of acquiring parvovirus B19 infection among those staff who did not adopt strict hand washing procedures after each physical contact with a patient (RR = 2.33; P = 0.07). Knowledge of parvovirus B19 among interviewed health care workers was poor: only 42% reported knowing about parvovirus B19 and only 38% could name a patient category at risk of a severe outcome following infection. This is the first report of a nosocomial outbreak affecting an adult ward and of possible transmission of parvovirus B19 infection from staff to in-patients. Hospital control of infection teams should include parvovirus B19 in their outbreak containment plans. PMID:7925671

Seng, C; Watkins, P; Morse, D; Barrett, S P; Zambon, M; Andrews, N; Atkins, M; Hall, S; Lau, Y K; Cohen, B J

1994-10-01

40

The Ventilation, Heating and Lighting of Hospital Wards  

PubMed Central

History of ventilation in last 100 years, showing reversal of ideas and influence of sanatorium idea. Physiology of cool moving air. How it affects metabolism, heat-loss and heat-production. Relation to sunlight. Reactive capacity of the individual. Practice of these teachings, as illustrated by sanatorium treatment of tuberculosis and by open-air schools. Exposure to cooling air a powerful therapeutic agent. Infrequent occurrence in sanatoria of diseases or complications often ascribed to cold. Dilution of infection. Applicability to diseases other than tuberculosis. Shock and old age. Perflation and diffusion, their relative values. Uniformity or variability of effect desirable? Incompatibility of good ventilation and ordinary standards of heating. Former the more important. Conclusion that ward temperatures may be lowered without harm. Measures necessary to compensate, clothing, classification of patients, small wards. Changing standards of comfort. Psychological effects. Systems of ventilation in hospital wards. Mechanical by propulsion or extraction being displaced by natural system, usually by cross-window ventilation. Supplementary ventilators. Objection to heating of incoming air. Fallibility of human factor in management. Sash versus casement windows. Hoppers. Austral window. Orientation and exposure of wards. Ventilation of small wards. Proportion of window space to solid wall. Balconies. Floor space. Heating of wards. Heating of air or floor or walls. Open fires. Value of radiant heat. Steam or water under low or high pressure. Radiators or pipes. Lighting. Avoidance of glare from windows. Arrangement of beds in wards. Colour of walls. Blinds and curtains. Artificial lighting. ImagesFig. 1Fig. 2Fig. 3Fig. 4Fig. 5

Watt, James

1933-01-01

41

Hospital admission avoidance through the introduction of a virtual ward.  

PubMed

The ageing British population is placing increased demands on the delivery of care in mainstream health-care institutions. While people are living longer, a significant percentage is also living with one or more long-term conditions. These issues, alongside continuing financial austerity measures, require a radical improvement in the care of patients away from hospitals. The Wyre Forest Clinical Commissioning Group introduced a virtual ward model for two main purposes: to save on spiralling costs of hospital admissions, and, secondly, to ensure the preferred wishes of most patients to be cared for and even die at home were achieved. This commentary describes how the virtual ward model was implemented and the impact of preventing unplanned emergency admissions to hospitals. The setting up of enhanced care services and virtual wards in one county is discussed, aiming to highlight success points and potential pitfalls to avoid. The results from the implementation of the virtual ward model show a significant reduction in emergency and avoidable patient admissions to hospital. The success of virtual wards is dependent on integrated working between different health-care disciplines. PMID:25039341

Jones, Joanne; Carroll, Andrea

2014-07-01

42

Development of competent children's ward co-ordinators.  

PubMed

Taking charge of a clinical shift on a ward is daunting for newly qualified staff nurses. This article describes the co-ordinators competency pathway, written to guide and assess band 5 ward nurses, and a co-ordinators development day, which is a simulation-based training day developed by a team of senior nurses to prepare band 5 nurses to become competent children's ward co-ordinators. Each of two groups - of either experienced or less experienced band 5s - starts with the training day as a base for either 12 or 18 months of in-work training that follow. A new job description matching the trust's workforce reorganisation enabled this development of the band 5 nurse's role. A service evaluation has found staff are more competent and confident as a result of this initiative. PMID:25004046

Scaife, Clair; October, Margaret; Kellett, Valerie

2014-07-01

43

Caring for young adults on a paediatric ward.  

PubMed

The need for adolescents and young adults (AYA) to have suitable age-specific inpatient facilities has been recognised for many years, yet has received relatively little attention. This article reports the successful introduction of an inpatient facility for AYA, aged 17-24 years, on a general paediatric ward in a small district general hospital. From December 2010, a young person's unit (YPU) consisting of an 8-bed area was opened within a 24-bed children's ward. Nursing care was provided by the ward staff, all of whom had been trained in the care of young adults. Policies regarding admission criteria, safeguarding, patient choice, visiting and 'house rules' were drafted, implemented and modified as necessary. Discussions with the adult clinicians (for medical care) and site managers were held to ensure smooth running of the system, and to address any concerns or difficulties. Paediatric patients had priority of admission at times of bed crisis. During 2012, there were a total of 2351 inpatient admissions to the paediatric ward, of whom 379 (16%) were YPU patients aged from 17-24 years. Median length of stay was 2 days for patients aged 17-24 years as compared with 1 day for patients aged less than or equal to 16 years. Patients who chose admission to the paediatric ward tended to be younger, in transition from paediatric to adult services for chronic conditions, or with special needs. Patient surveys showed a high level of satisfaction with the facility. Young adults can be cared for safely and effectively on a paediatric ward with minimal additional costs. The essential ingredients for success include discussion with affected parties to address specific concerns, and the establishment of a clear, simple and unambiguous admission policy. PMID:24165407

Heaton, Paul A J; Routley, Christine; Paul, Siba Prosad

44

Non-perturbative renormalization constants using Ward identities  

NASA Astrophysics Data System (ADS)

We extend the application of axial Ward identities to calculate bA, bP and bT, coefficients that give the mass dependence of the renormalization constants of the corresponding bilinear operators in the quenched theory. The extension relies on using operators with non-degenerate quark masses. It allows a complete determination of the O(a) improvement coefficients for bilinears in the quenched approximation using Ward Identities alone. Only the scale dependent normalization constants ZP0 (or ZS0) and ZT are undetermined. We present results of a pilot numerical study using hadronic correlators.

Bhattacharya, Tanmoy; Chandrasekharan, Shailesh; Gupta, Rajan; Lee, Weonjong; Sharpe, Stephen

1999-08-01

45

Implementing an effective intervention for problem drinkers on medical wards  

Microsoft Academic Search

Many medical inpatients have alcohol related problems but evidence of the feasibility of instituting a brief intervention is incomplete. An alcohol counsellor trained nurses on five general medical wards to screen patients routinely for alcohol problems. She counselled appropriate patients using one or two counselling sessions. Efficacy of the counselling was assessed at interview six months following the admission. We

S Mcmanus; J Hipkins; P Haddad; Elspeth Guthrie; Francis Creed

2003-01-01

46

14. Photocopy of ca. 1891 rendering of Receiving Ward, built ...  

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

14. Photocopy of ca. 1891 rendering of Receiving Ward, built at west end 1892-94. Designed by George W. Hewitt and his brother, William D. Hewitt of Philadelphia. - Hospital of Protestant Episcopal Church in Philadelphia, Front Street & Lehigh Avenue, Philadelphia, Philadelphia County, PA

47

8. View of south side of East Ward Street midblock ...  

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

8. View of south side of East Ward Street midblock between South Coweta Avenue and Sibett Avenue, facing southwest. - Gaskin Avenue Neighborhood, Bounded by Dart Street to east, CSX Railroad to south, Pearl & Madison Avenues to west, & Wilson & Gordon Streets to north, Douglas, Coffee County, GA

48

11. View of north side of East Ward Street midblock ...  

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

11. View of north side of East Ward Street midblock between Dewey AVenue and North McDonald Avenue, facing northeast. - Gaskin Avenue Neighborhood, Bounded by Dart Street to east, CSX Railroad to south, Pearl & Madison Avenues to west, & Wilson & Gordon Streets to north, Douglas, Coffee County, GA

49

10. View of north side of East Ward Street midblock ...  

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

10. View of north side of East Ward Street midblock between Dewey Avenue and North McDonald Avenue, facing northeast. - Gaskin Avenue Neighborhood, Bounded by Dart Street to east, CSX Railroad to south, Pearl & Madison Avenues to west, & Wilson & Gordon Streets to north, Douglas, Coffee County, GA

50

15. View of north side of East Ward Street at ...  

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

15. View of north side of East Ward Street at the intersection with North McDonald Avenue, facing northeast. - Gaskin Avenue Neighborhood, Bounded by Dart Street to east, CSX Railroad to south, Pearl & Madison Avenues to west, & Wilson & Gordon Streets to north, Douglas, Coffee County, GA

51

12. View of south side of East Ward Street west ...  

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

12. View of south side of East Ward Street west of Sibett Avenue, facing southwest. - Gaskin Avenue Neighborhood, Bounded by Dart Street to east, CSX Railroad to south, Pearl & Madison Avenues to west, & Wilson & Gordon Streets to north, Douglas, Coffee County, GA

52

1. View of north side of East Ward Street west ...  

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

1. View of north side of East Ward Street west of North Coweta Avenue, facing northwest. - Gaskin Avenue Neighborhood, Bounded by Dart Street to east, CSX Railroad to south, Pearl & Madison Avenues to west, & Wilson & Gordon Streets to north, Douglas, Coffee County, GA

53

3. View of north side of East Ward Street midblock ...  

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

3. View of north side of East Ward Street midblock between North Coweta Avenue and Dewey Avenue. - Gaskin Avenue Neighborhood, Bounded by Dart Street to east, CSX Railroad to south, Pearl & Madison Avenues to west, & Wilson & Gordon Streets to north, Douglas, Coffee County, GA

54

17. View of north side of East Ward Street east ...  

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

17. View of north side of East Ward Street east of North McDonald Avenue, facing northwest. - Gaskin Avenue Neighborhood, Bounded by Dart Street to east, CSX Railroad to south, Pearl & Madison Avenues to west, & Wilson & Gordon Streets to north, Douglas, Coffee County, GA

55

16. View of northeast corner of East Ward Street and ...  

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

16. View of northeast corner of East Ward Street and North McDonald Avenue, facing northeast. - Gaskin Avenue Neighborhood, Bounded by Dart Street to east, CSX Railroad to south, Pearl & Madison Avenues to west, & Wilson & Gordon Streets to north, Douglas, Coffee County, GA

56

13. View of south side of East Ward Street east ...  

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

13. View of south side of East Ward Street east of Sibett Avenue, facing southwest. - Gaskin Avenue Neighborhood, Bounded by Dart Street to east, CSX Railroad to south, Pearl & Madison Avenues to west, & Wilson & Gordon Streets to north, Douglas, Coffee County, GA

57

21. View of south side of East Ward Street midblock ...  

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

21. View of south side of East Ward Street midblock between South McDonald Avenue and Fales Avenue, facing southeast. - Gaskin Avenue Neighborhood, Bounded by Dart Street to east, CSX Railroad to south, Pearl & Madison Avenues to west, & Wilson & Gordon Streets to north, Douglas, Coffee County, GA

58

2. View of north side of East Ward Street east ...  

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

2. View of north side of East Ward Street east of North Coweta Avenue, facing northeast. - Gaskin Avenue Neighborhood, Bounded by Dart Street to east, CSX Railroad to south, Pearl & Madison Avenues to west, & Wilson & Gordon Streets to north, Douglas, Coffee County, GA

59

19. View of southeast corner of East Ward Street and ...  

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

19. View of southeast corner of East Ward Street and South McDonald Avenue, facing southeast. - Gaskin Avenue Neighborhood, Bounded by Dart Street to east, CSX Railroad to south, Pearl & Madison Avenues to west, & Wilson & Gordon Streets to north, Douglas, Coffee County, GA

60

5. View of northwest corner of East Ward Street and ...  

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

5. View of northwest corner of East Ward Street and Dewey Avenue, facing northwest. - Gaskin Avenue Neighborhood, Bounded by Dart Street to east, CSX Railroad to south, Pearl & Madison Avenues to west, & Wilson & Gordon Streets to north, Douglas, Coffee County, GA

61

20. View of south side of East Ward Street east ...  

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

20. View of south side of East Ward Street east of South McDonald Avenue, facing southeast. - Gaskin Avenue Neighborhood, Bounded by Dart Street to east, CSX Railroad to south, Pearl & Madison Avenues to west, & Wilson & Gordon Streets to north, Douglas, Coffee County, GA

62

14. View of southwest corner of East Ward Street and ...  

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

14. View of southwest corner of East Ward Street and South McDonald Avenue, facing southwest. - Gaskin Avenue Neighborhood, Bounded by Dart Street to east, CSX Railroad to south, Pearl & Madison Avenues to west, & Wilson & Gordon Streets to north, Douglas, Coffee County, GA

63

18. View of north side of East Ward Street at ...  

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

18. View of north side of East Ward Street at the intersection with North Dart Street, facing northwest. - Gaskin Avenue Neighborhood, Bounded by Dart Street to east, CSX Railroad to south, Pearl & Madison Avenues to west, & Wilson & Gordon Streets to north, Douglas, Coffee County, GA

64

6. Views of southeast corner of East Ward Street and ...  

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

6. Views of southeast corner of East Ward Street and South Coweta Avenue, facing southeast. - Gaskin Avenue Neighborhood, Bounded by Dart Street to east, CSX Railroad to south, Pearl & Madison Avenues to west, & Wilson & Gordon Streets to north, Douglas, Coffee County, GA

65

4. View of north side of East Ward Street west ...  

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

4. View of north side of East Ward Street west of Dewey Avenue, facing northeast. - Gaskin Avenue Neighborhood, Bounded by Dart Street to east, CSX Railroad to south, Pearl & Madison Avenues to west, & Wilson & Gordon Streets to north, Douglas, Coffee County, GA

66

7. View of south side of East Ward Street east ...  

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

7. View of south side of East Ward Street east of South Coweta Avenue, facing southwest. - Gaskin Avenue Neighborhood, Bounded by Dart Street to east, CSX Railroad to south, Pearl & Madison Avenues to west, & Wilson & Gordon Streets to north, Douglas, Coffee County, GA

67

25 CFR 117.23 - Transactions between guardian and ward.  

Code of Federal Regulations, 2011 CFR

...guardian and ward. 117.23 Section 117.23 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR FINANCIAL ACTIVITIES DEPOSIT AND EXPENDITURE OF INDIVIDUAL FUNDS OF MEMBERS OF THE OSAGE TRIBE OF INDIANS WHO DO NOT HAVE CERTIFICATES OF...

2011-04-01

68

Managing patients with identical names in the same ward  

Microsoft Academic Search

Purpose – To review the experience of managing two patients with identical names in the same ward during a five-month period. Design\\/methodology\\/approach – The records of the patients were reviewed to look for incorrect entries, errors in specimens sampling, administration of blood products and chemotherapy, and misplacement of clinical notes. Doctors and nurses involved were also invited to complete a

Anselm C. W. Lee; Mona Leung; K. T. So

2005-01-01

69

The Acquisition of Clinical Ward Skills during Undergraduate Medical Training.  

ERIC Educational Resources Information Center

Questionnaires, returned by nurses and clinical year medical students at the University of Oregon Health Sciences Center and Portland Veterans Administration hospitals, were examined to clarify how well traditional teaching strategy is meeting medical students' need to acquire competency in clinical ward skills. A need for increased and systematic…

Lee, Wesley

1980-01-01

70

Ward identities, two photon decays and off-shell corrections  

SciTech Connect

Off-shell corrections are considered in the low energy theorems for ..pi../sup 0/, eta, eta' and iota ..-->.. 2..gamma.. decays to solve the anomalous Ward identities. The iota ..-->.. 2..gamma.. prove to be sensitive to both SU(3) breaking and off-shell corrections.

Bagchi, B.; Debnath, S.

1988-03-01

71

Benefits of automated surface decontamination of a radioiodine ward.  

PubMed

A floor-washing robot has been acquired to assist physicists with decontamination of radioiodine therapy ward rooms after discharge of the patient at Sir Charles Gairdner Hospital. The effectiveness of the robot in decontaminating the ward has been evaluated. A controlled experiment was performed by deliberately contaminating a polyvinyl chloride flooring offcut with 131I followed by automated decontamination with the robot. The extent of fixed and removable contamination was assessed before and after decontamination by two methods: (1) direct Geiger-Mueller counting and (2) beta-counting wipe tests. Surface contamination was also assessed in situ on the ward by Geiger-Mueller counting and wipe testing. Contamination maps confirmed that contamination was removed rather than spread around by the robot. Wipe testing revealed that the robot was successful in clearing approximately 60-80% of removable contamination. The robotic floor-washing device was considered suitable to provide effective automated decontamination of the radioiodine ward. In addition, the robot affords other benefits: the time spent by the physicists decontaminating the room is greatly reduced offering financial and occupational safety and health benefits. The robot has also found utility in other decontamination applications in the healthcare environment. PMID:22249471

Westcott, Eliza; Broadhurst, Alicia; Crossley, Steven; Lee, Lloyd; Phan, Xuyen; Scharli, Rainer; Xu, Yan

2012-02-01

72

19. First and Second Floors. Ward 'K', Letterman General Hospital, ...  

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

19. First and Second Floors. Ward 'K', Letterman General Hospital, Presidio of San Francisco, Cal. Sheet No. 1. May 1917. BUILDING 1049. - Presidio of San Francisco, Letterman General Hospital, Building No. 12, Letterman Hospital Complex, Edie Road, San Francisco, San Francisco County, CA

73

20. West Elevation and Section, Ward 'K', Letterman General Hospital, ...  

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

20. West Elevation and Section, Ward 'K', Letterman General Hospital, Presidio of San Francisco, Cal. Sheet No. 2. May 1917. BUILDING 1049. - Presidio of San Francisco, Letterman General Hospital, Building No. 12, Letterman Hospital Complex, Edie Road, San Francisco, San Francisco County, CA

74

42 CFR 70.7 - Responsibility with respect to minors, wards, and patients.  

Code of Federal Regulations, 2012 CFR

...INTERSTATE QUARANTINE § 70.7 Responsibility with respect to minors, wards, and patients. A parent, guardian, physician, nurse, or other such person shall not transport, or procure or furnish transportation for any minor child or ward, patient or...

2012-10-01

75

Summative Evaluation on the Hospital Wards. What Do Faculty Say to Learners?  

ERIC Educational Resources Information Center

No previous studies have described how faculty give summative evaluations to learners on the medical wards. The aim of this study was to describe summative evaluations on the medical wards. Participants were students, house staff and faculty at the University of Pittsburgh. Ward rotation evaluative sessions were tape recorded. Feedback was…

Hasley, Peggy B.; Arnold, Robert M.

2009-01-01

76

A cross-sectional prospective study of seclusion, restraint and involuntary medication in acute psychiatric wards: patient, staff and ward characteristics  

PubMed Central

Background Previous research on mental health care has shown considerable differences in use of seclusion, restraint and involuntary medication among different wards and geographical areas. This study investigates to what extent use of seclusion, restraint and involuntary medication for involuntary admitted patients in Norwegian acute psychiatric wards is associated with patient, staff and ward characteristics. The study includes data from 32 acute psychiatric wards. Methods Multilevel logistic regression using Stata was applied with data from 1016 involuntary admitted patients that were linked to data about wards. The sample comprised two hierarchical levels (patients and wards) and the dependent variables had two values (0 = no use and 1 = use). Coercive measures were defined as use of seclusion, restraint and involuntary depot medication during hospitalization. Results The total number of involuntary admitted patients was 1214 (35% of total sample). The percentage of patients who were exposed to coercive measures ranged from 0-88% across wards. Of the involuntary admitted patients, 424 (35%) had been secluded, 117 (10%) had been restrained and 113 (9%) had received involuntary depot medication at discharge. Data from 1016 patients could be linked in the multilevel analysis. There was a substantial between-ward variance in the use of coercive measures; however, this was influenced to some extent by compositional differences across wards, especially for the use of restraint. Conclusions The substantial between-ward variance, even when adjusting for patients' individual psychopathology, indicates that ward factors influence the use of seclusion, restraint and involuntary medication and that some wards have the potential for quality improvement. Hence, interventions to reduce the use of seclusion, restraint and involuntary medication should take into account organizational and environmental factors.

2010-01-01

77

Effects and impacts of Productive Ward from a nursing perspective.  

PubMed

The Productive Ward: releasing time to care (PW) initiative is predominantly a nurse-led quality improvement (QI) offering, designed to streamline ward work processes and clinical environments in an attempt to 'release time to care'. It has been implemented widely in the UK, recently attracting international interest. This paper systematically reviews the literature relating to the PW initiative, highlights and ranks the reported effects and impacts from a nursing perspective. Nine themes emerged from our content analysis. This paper examines the three most reported themes-empowerment, leadership and engagement-exploring how they may influence the opportunities for implementing and sustaining the initiative. This study brings some experience, learning and insight from the PW initiative to those currently involved in implementation. It also highlights some elements of change not being delivered by PW. The comprehensive list of reported impacts and effects, from a nursing perspective, adds value to senior nurses attempting to cultivate a culture of QI. PMID:24763297

White, Mark; Waldron, Michelle

78

Clonal Dissemination of Staphylococcus epidermidis in an Oncology Ward  

Microsoft Academic Search

Coagulase-negative staphylococci (CoNS) are the main cause of catheter-related infections, especially among immunosuppressed and neutropenic patients, as well as a source of bacterial contamination in blood cultures. Using biochemical identification and pulsed-field gel electrophoresis (PFGE), we sought to identify possible clonal isolates of bacteremia in patients with central lines in an oncology ward (OW), with comparison to isolates that were

Kenneth L. Muldrew; Yi-Wei Tang; Haijing Li; Charles W. Stratton

79

Ward Morgan Photography, Southwest Michigan 1939-1980  

NSDL National Science Digital Library

Ward Morgan spent decades documenting life in and around Kalamazoo, Michigan. He went into interiors of women's shoe stores, took photos of students in classrooms, and photographed folks gathering for a society meeting. Most of his work took place in the middle decades of the 20th century, and these everyday photos eventually found their way to Western Michigan University. Visitors can browse these 500 photos randomly or look through the list of available topics, which include Advertising, Religious, Education, and Business Scenes.

80

Medical academia clinical experiences of Ward Round Teaching curriculum  

PubMed Central

Background: Medical students spend most of their time in hospital wards and it is necessary to study clinical educational opportunities. This study was aimed to explore faculty members’ experience on Ward Round Teaching content. Methods and Materials: This qualitative study was conducted by purposive sampling with the maximum variation of major clinical departments faculty members in Isfahan University of Medical Sciences (n = 9). Data gathering was based on deep and semi-structured interviews. Data gathering continued till data saturation. Data was analyzed through the Collaizzi method and validated. Strategies to ensure trustworthiness of data (credibility, dependability, conformability, transferability) were employed (Guba and Lincoln). Results: Basic codes extracted from the analyzed data were categorized into two main themes and related subthemes, including (1) tangible teachings (analytic intelligence, technical intelligence, legal duties) and (2) implied teachings (professionalism, professional discipline, professional difficulties). Conclusion: Ward round teaching is a valuable opportunity for learners to learn not only patient care aspects but also ethical values. By appropriate planning, opportunities can be used to teach capabilities that are expected of general practitioners.

Haghani, Fariba; Arabshahi, Seyed Kamran Soltani; Bigdeli, Shoaleh; Alavi, Mousa; Omid, Athar

2014-01-01

81

Psychiatric staff on the wards does not share attitudes on aggression  

PubMed Central

Background The concept of ward culture has been proposed as a reason for the often reported differences in treatment decisions when managing inpatient aggression. We therefore studied whether staff on wards actually shares similar perceptions and attitudes about aggression and whether the specialty of the ward on which the staff members work influences these opinions. Methods The Attitudes Towards Aggression Scale was used to assess attitudes towards aggression in 31 closed psychiatric wards. Altogether 487 staff members working on the study wards were asked to fill in the scale. Respondent’s gender, age, educational level, working experience on the current ward, and specialty of this ward (acute, forensic, rehabilitation) served as background variables. Results Most of the variance found was due to differences between individuals. Belonging to the personnel of a particular ward did not explain much of the variance. Conclusions Psychiatric staff on the wards does not share attitudes on aggression. As each staff member has his/her own opinion about aggression, training for dealing with aggression or violent incidents should be done, at least partly, on an individual level. We also suggest caution in using the concept of ward culture as an explanation for the use of restrictive measures on psychiatric wards.

2014-01-01

82

Surgical ward rounds in England: a trainee-led multi-centre study of current practice  

PubMed Central

Background Recent guidance advocates daily consultant-led ward rounds, conducted in the morning with the presence of senior nursing staff and minimising patients on outlying wards. These recommendations aim to improve patient management through timely investigations, treatment and discharge. This study sought to evaluate the current surgical ward round practices in England. Methods Information regarding timing and staffing levels of surgical ward rounds was collected prospectively over a one-week period. The location of each patient was also documented. Two surgical trainee research collaboratives coordinated data collection from 19 hospitals and 13 surgical subspecialties. Results Data from 471 ward rounds involving 5622 patient encounters was obtained. 367 (77.9%) ward rounds commenced before 9am. Of 422 weekday rounds, 190 (45%) were consultant-led compared with 33 of the 49 (67%) weekend rounds. 2474 (44%) patients were seen with a nurse present. 1518 patients (27%) were classified as outliers, with 361 ward rounds (67%) reporting at least one outlying patient. Conclusion Recommendations for daily consultant-led multi disciplinary ward rounds are poorly implemented in surgical practice, and patients continue to be managed on outlying wards. Although strategies may be employed to improve nursing attendance on ward rounds, substantial changes to workforce planning would be required to deliver daily consultant-led care. An increasing political focus on patient outcomes at weekends may prompt changes in these areas.

2014-01-01

83

Correlation between levels of conflict and containment on acute psychiatric wards: the city-128 study.  

PubMed

OBJECTIVE Attainment of safe, calm inpatient psychiatric wards that are conducive to positive therapeutic care is crucial. On such wards, rates of coerced medication, seclusion, manual restraint and other types of containment are comparatively low, and, usually, rates of conflict-for example, aggression, substance use, and absconding-are also low. Sometimes, however, wards maintain low rates of containment even when conflict rates are high. This study investigated wards with the counterintuitive combination of low containment and high conflict or high containment and low conflict. METHODS The authors conducted a secondary analysis of cross-sectional data collected from 136 acute psychiatric wards across England in 2004-2005. The wards were categorized into four groups on the basis of median splits of containment and conflict rates: high conflict and high containment, high conflict and low containment, low conflict and low containment, and low conflict and high containment. Features significantly associated with these ward types were identified. RESULTS Among the variables significantly associated with the various typologies, some-for example, environmental quality-were changeable, and others-such as social deprivation of the area served-were fixed. High-conflict, low-containment wards had higher rates of male staff and lower-quality environments than other wards. Low-conflict, high-containment wards had higher numbers of beds. High-conflict, high-containment wards utilized more temporary staff as well as more unqualified staff. No overall differences were associated with low-conflict, low-containment wards. CONCLUSIONS Wards can make positive changes to achieve a low-containment, nonpunitive culture, even when rates of patient conflict are high. PMID:23370595

Bowers, Len; Stewart, Duncan; Papadopoulos, Chris; Iennaco, Joanne DeSanto

2013-05-01

84

Delirium in elderly patients hospitalized in internal medicine wards.  

PubMed

A prospective observational study was conducted to evaluate the impact of delirium on geriatric inpatients in internal medical wards and to identify predisposing factors for the development of delirium. The study included all patients aged 65 years and older, who were consecutively admitted to the internal medicine wards of two public hospitals in Florence, Italy. On admission, 29 baseline risk factors were examined, cognitive impairment was evaluated by Short Portable Mental Status Questionnaire, and prevalent delirium cases were diagnosed by Confusion Assessment Method (CAM). Enrolled patients were evaluated daily with CAM to detect incident delirium cases. Among the 560 included patients, 19 (3 %) had delirium on admission (prevalent) and 44 (8 %) developed delirium during hospitalization (incident). Prevalent delirium cases were excluded from the statistical analysis. Incident delirium was associated with increased length of hospital stay (p < 0.01) and institutionalization (p < 0.01, OR 3.026). Multivariate analysis found that cognitive impairment on admission (p < 0.0002), diabetes (p < 0.05, OR 1.936), chronic kidney failure (p < 0.05, OR 2.078) and male gender (p < 0.05, OR 2.178) was significantly associated with the development of delirium during hospitalization. Results show that delirium impact is relevant to older patients hospitalized in internal medicine wards. The present study confirms cognitive impairment as a risk factor for incident delirium. The cognitive evaluation proved to be an important instrument to improve identification of patients at high risk for delirium. In this context, our study may contribute to improve application of preventive strategies. PMID:23771269

Fortini, Alberto; Morettini, Alessandro; Tavernese, Giuseppe; Facchini, Sofia; Tofani, Lorenzo; Pazzi, Maddalena

2014-06-01

85

Ward identities and chiral anomalies for coupled fermionic chains  

SciTech Connect

Coupled fermionic chains are usually described by an effective model written in terms of bonding and anti-bonding fermionic fields with linear dispersion in the vicinities of the respective Fermi points. We derive for the first time exact Ward Identities (WI) for this model, proving the existence of chiral anomalies which verify the Adler-Bardeen non-renormalization property. Such WI are expected to play a crucial role in the understanding of the thermodynamic properties of the system. Our results are non-perturbative and are obtained analyzing Grassmann functional integrals by means of constructive quantum field theory methods.

Costa, L. C. [Centro de Cięncias Naturais e Humanas, Universidade Federal do ABC, 09210-170 Santo André (Brazil)] [Centro de Cięncias Naturais e Humanas, Universidade Federal do ABC, 09210-170 Santo André (Brazil); Ferraz, A. [Department of Theoretical and Experimental Physics, International Institute of Physics, Universidade Federal do Rio Grande do Norte, 59012-970 Natal (Brazil)] [Department of Theoretical and Experimental Physics, International Institute of Physics, Universidade Federal do Rio Grande do Norte, 59012-970 Natal (Brazil); Mastropietro, Vieri [Dipartimento di Matematica F. Enriques, Universitá di Milano, Via C. Saldini 50, 20133 Milano (Italy)] [Dipartimento di Matematica F. Enriques, Universitá di Milano, Via C. Saldini 50, 20133 Milano (Italy)

2013-12-15

86

The type, level, and distribution of microorganisms within the ward environment: a zonal analysis of an intensive care unit and a gastrointestinal surgical ward.  

PubMed

OBJECTIVE.?To investigate the distribution of hospital pathogens within general and critical care ward environments and to determine the most significant bacterial reservoirs within each ward type. DESIGN.?Prospective 4-month microbiological survey. SETTING.?The intensive care unit (ICU) and gastrointestinal (GI) surgical ward of a London teaching hospital. PATIENTS.?Sampling was conducted in and around the bed space of 166 different patients (99 in the ICU and 67 in the GI ward). METHODS.?Conventional agar contact methodology was used to sample 123 predetermined sites twice a week for 17 weeks. Sixty-one surfaces were located within the ICU, and 62 were located within the GI ward. Each surface was located within a theoretical zone of increasing distance from the patient. Aerobic colony counts were determined, and confirmatory testing was conducted on all presumptive pathogens. RESULTS.?Regardless of ward type, surfaces located closest to the patient, specifically those associated with the bed (side rails, bed control, and call button), were the most heavily contaminated. Elsewhere, the type of surfaces contaminated differed with ward type. In the ICU, bacteria were most likely to be on surfaces that were regularly touched by healthcare workers (e.g., telephones and computer keyboards). In the GI ward, where the patients were mobile, the highest numbers of bacteria (including potential nosocomial pathogens) were on surfaces that were mainly touched by patients, particularly their toilet and shower facilities. CONCLUSIONS.?In terms of cleaning, a hospital should not be considered a single entity. Different ward types should be treated as separate environments, and cleaning protocols should be adjusted accordingly. PMID:23571367

Moore, Ginny; Muzslay, Monika; Wilson, A Peter R

2013-05-01

87

An evaluation of antiseptics used for hand disinfection in wards.  

PubMed Central

The antibacterial effectiveness of hand antiseptics commonly used in wards was studied by laboratory and in-use tests and their acceptability assessed by means of a questionnaire passed to hospital staff. To determine the immediate and long-term antibacterial effects of the preparations the in-use tests were performed by groups of students. The greatest immediate reduction in bacterial counts on hands was obtained by products containing chlorhexidine. The long-term antibacterial effect was recorded with emulsions containing 3% hexachlorophane, 2% Irgasan CF3R or 4% chlorhexidine when used constantly on several consecutive days. Considerable discrepancies were recorded in the antibacterial effectiveness of some preparations when comparing laboratory and in-use test results. Therefore it is suggested that antiseptics should be tested by in-use tests which more closely resemble practical conditions before their use, or further trial, in hospital.

OjajA?rvi, J.

1976-01-01

88

Ward Morgan Photography, Southwest Michigan 1939-1980  

NSDL National Science Digital Library

Ward Morgan spent almost fifty years of his life chronicling the people, places, and activities he knew best around southwestern Michigan in the 20th century. He documented industry rise and fall, weddings galore, company Christmas parties, and the streetscapes of Kalamazoo. This digital collection of almost 1,000 images is culled from a 27,000 item negative collection given to the Western Michigan University Libraries. On the homepage, visitors can use a scrollbar to move through a nice sampling of the collection, including a night scene in Kalamazoo and several industrial machine shops. Visitors can look at the Recent Additions area as well, and if interested, they can sign up to receive the RSS feed offered here. Finally, the site also has some Suggested Topics for casual browsing including residential scenes and people working.

Morgan, Ward

89

4WARD: A European Perspective towards the Future Internet  

NASA Astrophysics Data System (ADS)

In this paper, we describe several approaches to address the challenges of the network of the future. Our main hypothesis is that the Future Internet must be designed for the environment of applications and transport media of the 21st century, vastly different from the initial Internet's life space. One major requirement is the inherent support for mobile and wireless usage. A Future Internet should allow for the fast creation of diverse network designs and paradigms and must also support their co-existence at run-time. We detail the technical and business scenarios that lead the development in the EU FP7 4WARD project towards a framework for the Future Internet.

Brunner, Marcus; Abramowicz, Henrik; Niebert, Norbert; Correia, Luis M.

90

An evaluation of antiseptics used for hand disinfection in wards.  

PubMed

The antibacterial effectiveness of hand antiseptics commonly used in wards was studied by laboratory and in-use tests and their acceptability assessed by means of a questionnaire passed to hospital staff. To determine the immediate and long-term antibacterial effects of the preparations the in-use tests were performed by groups of students. The greatest immediate reduction in bacterial counts on hands was obtained by products containing chlorhexidine. The long-term antibacterial effect was recorded with emulsions containing 3% hexachlorophane, 2% Irgasan CF3R or 4% chlorhexidine when used constantly on several consecutive days. Considerable discrepancies were recorded in the antibacterial effectiveness of some preparations when comparing laboratory and in-use test results. Therefore it is suggested that antiseptics should be tested by in-use tests which more closely resemble practical conditions before their use, or further trial, in hospital. PMID:812901

Ojajärvi, J

1976-02-01

91

The Critical Ising Model via Kac-Ward Matrices  

NASA Astrophysics Data System (ADS)

The Kac-Ward formula allows to compute the Ising partition function on any finite graph G from the determinant of 22 g matrices, where g is the genus of a surface in which G embeds. We show that in the case of isoradially embedded graphs with critical weights, these determinants have quite remarkable properties. First of all, they satisfy some generalized Kramers-Wannier duality: there is an explicit equality relating the determinants associated to a graph and to its dual graph. Also, they are proportional to the determinants of the discrete critical Laplacians on the graph G, exactly when the genus g is zero or one. Finally, they share several formal properties with the Ray-Singer {overline{partial}}-torsions of the Riemann surface in which G embeds.

Cimasoni, David

2012-11-01

92

Evaluation of the California Youth Authority Ward Grievance Procedure. Final Report.  

ERIC Educational Resources Information Center

This document presents the findings and recommendations of the evaluation of the California Department of the Youth Authority Ward Grievance Procedure (WGP), which is a four-tiered conflict resolution system for wards in California institutions and camps. The information contained in this report was obtained through site visits to five…

EMT Associates, Inc., Sacramento, CA.

93

UK ward design: Patient dependency, nursing workload, staffing and quality—An observational study  

Microsoft Academic Search

BackgroundThere are important relationships between ward design, patient welfare and staff activity in the literature but studies seem not to have tested all the variables. Whether ward designs influence nursing structures, processes and outcomes, therefore, has not been fully answered. While studies provide helpful guidance, nursing efficiency and effectiveness implications are speculative.

Keith Hurst

2008-01-01

94

The cleaning of ward floors and the bacteriological study of floor-cleaning machines  

PubMed Central

Current trends in ward flooring materials and cleaning methods are considered from the point of view of the hospital bacteriologist. Methods employed in an investigation into the bacteriological safety of a number of floor-cleaning machines are described, and some considerations governing the choice of vacuum cleaners for ward use are discussed. Images

Bate, J. G.

1961-01-01

95

The Mass Balance of the Ward Hunt Ice Rise and Ice Shelf: An 18 Year Record.  

National Technical Information Service (NTIS)

The result of 18 year's record (1958-1976) of accumulation and ablation from the Ward Hunt ice rise and of 10 years record (1965-1976) from the Ward Hunt Ice Shelf are presented. The net mass balances on the ice rise for the years 1962-1965 and on both th...

H. V. Serson

1979-01-01

96

The Master Ward Identity and Generalized Schwinger-Dyson Equation in Classical Field Theory  

Microsoft Academic Search

In the framework of perturbative quantum field theory a new, universal renormalization condition (called Master Ward Identity) was recently proposed by one of us (M.D.) in a joint paper with F.-M. Boas. The main aim of the present paper is to get a better understanding of the Master Ward Identity by analyzing its meaning in classical field theory. It turns

Michael Dütsch; Klaus Fredenhagen

2003-01-01

97

WARD: an exploratory study of an affective sociotechnical framework for addressing medical errors  

Microsoft Academic Search

Aiming to reduce medical errors by 50% by 2010, the Institute of Medicine (IOM) has identified information technology (IT) as an important tool. One potential application of IT would be communicating with clinicians using affective multimodal interfaces. In this paper, we propose an Augmented Cognition (AugCog) related framework, Wearable Avatar Risk Display (WARD), for addressing medical errors. WARD is a

William Lee; Woodrow W. Winchester III; Tonya L. Smith-jackson

2006-01-01

98

Authenticity in Learning--Nursing Students' Experiences at a Clinical Education Ward  

ERIC Educational Resources Information Center

Purpose: This study aims to explore and understand first year nursing students' experiences of learning at a clinical education ward. Design/methodology/approach: The setting is a clinical education ward for nursing students at a department of infectious diseases. A qualitative study was carried out exploring students' encounters with patients,…

Manninen, Katri; Henriksson, Elisabet Welin; Scheja, Max; Silen, Charlotte

2013-01-01

99

Including pharmacists on consultant-led ward rounds: a prospective non-randomised controlled trial.  

PubMed

This study aimed to compare interventions made by pharmacists attending consultant-led ward rounds in addition to providing a ward pharmacy service, with those made by pharmacists providing a word pharmacy service alone. A prospective non-randomised controlled study on five inpatient medical wards was carried out at two teaching hospitals. A mean of 1.73 physician-accepted interventions were made per patient for the study group, compared to 0.89 for the control (Mann Whitney U, p < 0.001) with no difference between groups in the nature or clinical importance of the interventions. One physician-accepted intervention was made every eight minutes during the consultant-led ward rounds, compared to one every 63 minutes during a ward pharmacist visit. Pharmacists attending consultant-led ward rounds in addition to undertaking a ward pharmacist visit make significantly more interventions per patient than those made by pharmacists undertaking a ward pharmacist visit alone, rectifying prescribing errors and optimising treatment. PMID:21853822

Miller, Gavin; Franklin, Bryony Dean; Jacklin, Ann

2011-08-01

100

Ward Atmosphere, Client Satisfaction, and Client Motivation in a Psychiatric Work Rehabilitation Unit  

Microsoft Academic Search

This study investigated the ward atmosphere of a psychiatric work rehabilitation unit and its relationships to clients' satisfaction with the unit and client motivation, operationalised as proneness to set personal goals for their rehabilitation. The Community-oriented Programs Environment Scale was used and 52 clients participated. Their report of the ward atmosphere was in accordance with recommended levels on 5 sub-scales

Mona Eklund; Lars Hansson

2001-01-01

101

Study of Medication Errors on a Community Hospital Oncology Ward  

PubMed Central

Purpose Medication errors (MEs) have been a significant problem resulting in excessive patient morbidity and cost, especially for cancer chemotherapeutic agents. Although some progress has been made, ME measurement methods and prevention strategies remain important areas of research. Methods During a 2-year period (2003-2004), we conducted a prospective study on the oncology ward of a large community hospital, with the goals of (1) complete nurse reporting of observed medication administration errors (MAEs), (2) classifying observed MAEs, and (3) formulating improvement strategies. We also conducted a retrospective review of a randomly chosen sample of 200 chemotherapy orders to assess the appropriateness of ordering, dispensing, and administration. Results Our nurses reported 141 MAEs during the study period, for a reported rate of 0.04% of medication administrations. Twenty-one percent of these were order writing and transcribing errors, 38% were nurse or pharmacy dispensing errors, and 41% were nurse administration errors. Only three MAEs resulted in adverse drug events. Nurses were less likely to report MAEs that they felt were innocuous, especially late-arriving medications from the pharmacy. A retrospective review of 200 chemotherapy administrations found only one clear MAE, a miscalculated dose that should have been intercepted. Conclusions Significant reported MAE rates on our ward (0.04% of drug administrations and 0.03 MAEs/patient admission) appear to be relatively low due to application of current safety guidelines. An emphasis on studying MAEs at individual institutions is likely to result in meaningful process changes, improved efficiency of MAE reporting, and other benefits.

Ford, Clyde D.; Killebrew, Julie; Fugitt, Penelope; Jacobsen, Janet; Prystas, Elizabeth M.

2006-01-01

102

Variability in Costs across Hospital Wards. A Study of Chinese Hospitals  

PubMed Central

Introduction Analysts estimating the costs or cost-effectiveness of health interventions requiring hospitalization often cut corners because they lack data and the costs of undertaking full step-down costing studies are high. They sometimes use the costs taken from a single hospital, sometimes use simple rules of thumb for allocating total hospital costs between general inpatient care and the outpatient department, and sometimes use the average cost of an inpatient bed-day instead of a ward-specific cost. Purpose In this paper we explore for the first time the extent and the causes of variation in ward-specific costs across hospitals, using data from China. We then use the resulting model to show how ward-specific costs for hospitals outside the data set could be estimated using information on the determinants identified in the paper. Methodology Ward-specific costs estimated using step-down costing methods from 41 hospitals in 12 provinces of China were used. We used seemingly unrelated regressions to identify the determinants of variability in the ratio of the costs of specific wards to that of the outpatient department, and explain how this can be used to generate ward-specific unit costs. Findings Ward-specific unit costs varied considerably across hospitals, ranging from 1 to 24 times the unit cost in the outpatient department — average unit costs are not a good proxy for costs at specialty wards in general. The most important sources of variability were the number of staff and the level of capacity utilization. Practice Implications More careful hospital costing studies are clearly needed. In the meantime, we have shown that in China it is possible to estimate ward-specific unit costs taking into account key determinants of variability in costs across wards. This might well be a better alternative than using simple rules of thumb or using estimates from a single study.

Adam, Taghreed; Evans, David B.; Ying, Bian; Murray, Christopher J. L.

2014-01-01

103

An innovative model for teaching complex clinical procedures: Integration of standardised patients into ward round training for final year students  

Microsoft Academic Search

Objectives: Ward rounds are an essential activity for doctors in hospital settings and represent complex tasks requiring not only medical knowledge but also communication skills, clinical technical skills, patient management skills and team-work skills. However, although the need for ward round training is emphasized in the published literature, there are currently no reports of ward round training in a simulated

C. Nikendei; B. Kraus; H. Lauber; M. Schrauth; P. Weyrich; S. Zipfel; J. Jünger; S. Briem

2007-01-01

104

The USA's nurse managers and UK's ward sisters: critical roles for empowerment.  

PubMed

The nurse manager/ward sister role is becoming endangered as many of these nurses are being asked to take fiscal and personnel responsibility for multiple units/programmes and supervise more non-registered nursing staff. Loss of this important nurse manager/ward sister role could severely decrease nursing's voice in the development and implementation of policies that affect nurses and the care they deliver. The authors review 20 years of literature from both the USA and the UK regarding supportive supervision and the role of the nurse manager/ward sister. Nurse managers/ward sisters were found to be key individuals within the entire health-care organization. Nurse managers/ward sisters can empower the nurses they supervise to initiate changes that will improve patient care. Nurse managers/ward sisters can also improve the working conditions and thus increase the job satisfaction and retention of those they supervise. Strategies for being more supportive of these overworked and endangered nurse managers/ward sisters are suggested. PMID:8055167

Cameron-Buccheri, R; Ogier, M E

1994-07-01

105

Patients' feelings about ward nursing regimes and involvement in rule construction.  

PubMed

This study compared two acute psychiatric ward nursing regimes, focusing on ward rules as a means of investigating the relationship between the flexibility/inflexibility of the regimes and patient outcomes. Previous studies identified an association between ward rules and patient aggression. A link between absconding and nurses' attitudes towards rule enforcement has also been explored. However, an in-depth exploration of ward rules from the perspective of nurses and patients had not been undertaken previously. The study aimed to discover the content of rules within acute psychiatric wards; to explore patients' responses to the rules; to evaluate the impact of rules and rule enforcement on nurse-patient relationships and on ward events; and to investigate the relationship between ward rules, ward atmosphere and ward design. The relevance of sociological theory emerged from the data analysis. During this process, the results were moved up to another conceptual level to represent the meaning of lived experience at the level of theory. For example, nurses' descriptions of their feelings in relation to rule enforcement were merged as role ambivalence. This concept was supported by examples from the transcripts. Other possible explanations for the data and the connections between them were checked by returning to each text unit in the cluster and ensuring that it fitted with the emergent theory. The design centred on a comparative interview study of 30 patients and 30 nurses within two acute psychiatric wards in different hospitals. Non-participant observations provided a context for the interview data. Measures of the Ward Atmosphere Scale, the Hospital-Hostel Practices Profile, ward incidents and levels of as required (PRN) medication were obtained. The analysis of the quantitative data was assisted by spss, and the qualitative analysis by QSR *NUDIST. Thematic and interpretative phenomenological methods were used in the analysis of the qualitative data. A series of 11 interrelated concepts emerged from an analysis of the data, and a synthesis of the main themes. This paper focuses on the results and recommendations that emerged from the quantitative and qualitative patient data. A further paper will focus on nurses' perceptions of the same topics. PMID:16965473

Alexander, J

2006-10-01

106

Food work and feeding assistance on hospital wards.  

PubMed

Approximately 60 per cent of UK patients aged 65 years or older are at risk of malnutrition or their situation worsening while in hospital. We report the results of a qualitative study embedded in research to prevent malnutrition in older people in hospital (the mappmal study). Our aim was to understand and describe processes that promote or inhibit nutrition in hospital. Throughout 2009 we examined meal services at four UK hospital sites across two regional locations, focusing on older patients admitted with dementia, for stroke or for fractured neck of femur. Data were collected through semi-structured interviews with National Health Service staff (n = 54), stakeholders (n = 6), and a focus group with former patients and carers (n = 5). We identified ward-based food work as a technical and interpersonal challenge in narratives around malnutrition. Food work constituted two overlapping spheres of activity: interpersonal engagement through feeding assistance and reassurance and the arrangement of resources that facilitate meals such as the preparation of food trolleys. Our analysis is framed by the literature on emotional labour, dirty work and the professionalisation of nursing. We demonstrate how food work is overlooked by being conceptualised as common sense and as one of the most mundane and elementary tasks in hospitals. PMID:23009613

Heaven, Ben; Bamford, Claire; May, Carl; Moynihan, Paula

2013-05-01

107

Observations of mealtimes in hospital aged care rehabilitation wards.  

PubMed

Malnutrition is common in long-stay elderly hospitalized patients and their dietary intakes are often poor, despite the provision of adequate quantities of food to meet patient needs. The aim of this study was to identify environmental factors that were associated with achieving adequate food consumption in a hospital context. This study observed the daily routines of 30 elderly patients over 2days in rehabilitation wards in three Australian hospitals. All activities associated with mealtimes were recorded, from the commencement of breakfast to the conclusion of supper at the end of the day. Four key themes emerged: the eating location; assistance given at meals; negative and positive interruptions. The time taken to eat meals averaged 22min, ranging from 3 to 55min. Food intakes appeared to be better when meals were consumed communally in a dining room. There were many occasions when patients needed more assistance to eat than was available. The most common factors negatively affecting meal consumption were medication rounds, inappropriate placement of trays, packaging being hard to open, and patient showering. The presence of visitors, dietitians and nutrition assistants appeared to improve dietary intakes. Trials of protected mealtimes in Australian hospitals are certainly important and timely. PMID:23523667

Walton, Karen; Williams, Peter; Tapsell, Linda; Hoyle, Matthew; Shen, Zhi Wei; Gladman, Lauren; Nurka, Martin

2013-08-01

108

Consultant supervision of trainees seeing inpatient ward referrals - a cause for concern?  

PubMed

The adequate supervision of trainee doctors seeing ward referrals is critical to the quality of patient care and medical training. This survey assessed the level and nature of supervision of trainees in neurology and comparable specialities. 123 neurology specialty registrars from nine deaneries across the UK and 81 dermatology, rheumatology and infectious disease specialty registrars from the London deanery completed the survey. Only 11% of first year neurology and 21% of first year non-neurology registrars reported that the most common method of supervision when seeing ward referrals was for consultants to see ward referrals with them. The remaining first year neurology and non-neurology registrars reported being primarily supervised by discussing cases with consultant (62% and 37% respectively) or being asked to contact a consultant if help was needed (35% and 42% respectively). The lack of adequate supervision of junior trainees seeing ward referrals has significant implications for both patient safety and training. PMID:24889571

Yogarajah, Mahinda; Mirfenderesky, Mariyam; Ahmed, Tazeen; Schon, Fred

2014-06-01

109

Clustering files of chemical structures using the Székely-Rizzo generalization of Ward's method.  

PubMed

Ward's method is extensively used for clustering chemical structures represented by 2D fingerprints. This paper compares Ward clusterings of 14 datasets (containing between 278 and 4332 molecules) with those obtained using the Székely-Rizzo clustering method, a generalization of Ward's method. The clusters resulting from these two methods were evaluated by the extent to which the various classifications were able to group active molecules together, using a novel criterion of clustering effectiveness. Analysis of a total of 1400 classifications (Ward and Székely-Rizzo clustering methods, 14 different datasets, 5 different fingerprints and 10 different distance coefficients) demonstrated the general superiority of the Székely-Rizzo method. The distance coefficient first described by Soergel performed extremely well in these experiments, and this was also the case when it was used in simulated virtual screening experiments. PMID:19640752

Varin, Thibault; Bureau, Ronan; Mueller, Christoph; Willett, Peter

2009-09-01

110

Survey of unlicensed and off label drug use in paediatric wards in European countries  

Microsoft Academic Search

AbstractObjective: To determine the extent of use of unlicensed and off label drugs in children in hospital in five European countries.Design: Prospective study of drugs administered to children in general paediatric medical wards over four weeks.Setting: Children's wards in five hospitals (one each in the United Kingdom, Sweden, Germany, Italy, and the Netherlands).Subjects: Children aged 4 days to 16 years

Sharon Conroy; Imti Choonara; Piero Impicciatore; Angelika Mohn; Henrik Arnell; Anders Rane; Carmen Knoeppel; Hannsjoerg Seyberth; Chiara Pandolfini; Maria Pia Raffaelli; Francesca Rocchi; Maurizio Bonati; Geertt Jong; Matthijs de Hoog; John van den Anker

2000-01-01

111

Does daily nurse staffing match ward workload variability? : Three hospitals' experiences  

Microsoft Academic Search

Purpose – Nurse shortage and rising healthcare resource burdens mean that appropriate workforce use is imperative. This paper aims to evaluate whether daily nursing staffing meets ward workload needs. Design\\/methodology\\/approach – Nurse attendance and daily nurses' workload capacity in three hospitals were evaluated. Statistical process control was used to evaluate intra-ward nurse workload capacity and day-to-day variations. Statistical process control

Uri Gabbay; Michael Bukchin

2009-01-01

112

Cancer in young people in the north of England, 1968-85: analysis by census wards.  

PubMed Central

OBJECTIVE--To determine whether the seeming excess of childhood leukaemia and lymphoma identified in Seascale, Cumbria, UK, remains unusual when put into a wider context. DESIGN--Analysis of cancer incidence by geographical area. SETTING--The north of England including the Northern and North Western Regional Health Authority regions and the Southport and South Sefton districts of the Mersey Regional Health Authority. SUBJECTS--Altogether 6686 cases of malignant disease in people under 25 years old. MEASUREMENTS AND MAIN RESULTS--Cases of cancer diagnosed before their 25th birthday between January 1968 and December 1985 identified from three regional cancer registries were allocated to a census ward on the basis of 'usual place of residence'. Population data were derived from the 1971 and 1981 censuses, and the cancer incidence was calculated for each ward. Of the 6686 cases, there were 1035 cases of acute lymphoblastic leukaemia and 361 of non-Hodgkins lymphoma. Wards were ranked by cancer incidence and Poisson probability, using different population bases. Seascale ward is the most highly ranked ward for acute lymphoblastic leukaemia for the time periods 1968-85 or 1968-76. It is not the most highly ranked for non-Hodgkins lymphoma. However, combining acute lymphoblastic leukaemia and non-Hodgkins lymphoma incidence gives an even more extreme position for Seascale. The most extreme Poisson probability for any of the analyses was that for brain tumours in the electoral ward of Ashton St Michael, Tameside (p = 0.000009). CONCLUSION--The incidence of acute lymphoblastic leukaemia and non-Hodgkins lymphoma in the Seascale ward remains high when put into a wider context. For other cancers there are wards with even more extreme Poisson probability values.

Craft, A W; Parker, L; Openshaw, S; Charlton, M; Newell, J; Birch, J M; Blair, V

1993-01-01

113

How the inner world is reflected in relation to perceived ward atmosphere among patients with psychosis  

Microsoft Academic Search

.   Background: This study focused on how cognitive ability, personality traits, self-rated psychiatric symptoms, and social functioning\\u000a were related to the way in which patients with psychosis perceived supportive aspects of the ward atmosphere. Methods: Patients at a psychiatric rehabilitation unit (PRU) in southern Sweden completed a ward atmosphere questionnaire (COPES),\\u000a rated their psychiatric symptoms (SCL-90), self-image (SASB), and were

Jan-Ĺke Jansson; Mona Eklund

2002-01-01

114

Incidence of nosocomial pneumonia in a medical intensive care unit and general medical ward patients in a public hospital in Bombay, India  

Microsoft Academic Search

We prospectively studied the incidence of hospital-acquired pneumonia in 1886 consecutive admissions to an 1800 bed hospital in Bombay; 991 of them to general medical wards and 895 to a 17-bed medical intensive care unit (ICU). The average bed occupancy in the general wards was 56 patients in a ward with 40 beds. Staffing in the general ward was two

M. Merchant; D. R. Karnad; A. A. Kanbur

1998-01-01

115

Benefits of an accident and emergency short stay ward in the staged hospital care of elderly patients.  

PubMed Central

OBJECTIVE: To study the potential of a short stay ward attached to an accident and emergency (A&E) department to improve care and reduce admissions to hospital by enabling elderly patients to be monitored closely for up to 24 h before being formally admitted to hospital or discharged home. Patients admitted to the short stay ward were those who appeared to need only a brief period of assessment or treatment. METHODS: The medical records of all patients aged 65 years and above admitted to the short stay ward over a nine month period (April to December 1993, inclusive) were reviewed. RESULTS: 13% of all the patients over 65 attending A&E were admitted to the A&E ward. Of patients over 65 who were admitted to hospital, 20% were first admitted to the A&E ward. There were 502 admissions to the short stay ward of patients aged 65 years and above, who constituted 38% of the total admissions to that ward. Admitting these selected patients to the short stay ward allowed 71% to be discharged home, usually within 24 h, rather than being formally admitted to hospital. CONCLUSIONS: The addition of a short stay ward can shorten the hospital stay for selected elderly patients and reduce the demand for inpatient hospital beds. This ward also improves the quality of care to elderly patients attending the A&E department.

Khan, S A; Millington, H; Miskelly, F G

1997-01-01

116

Does doctors' workload impact supervision and ward activities of final-year students? A prospective study  

PubMed Central

Background Hospital doctors face constantly increasing workloads. Besides caring for patients, their duties also comprise the education of future colleagues. The aim of this study was to objectively investigate whether the workload arising from increased patient care interferes with student supervision and is associated with more non-medical activities of final-year medical students. Methods A total of 54 final-year students were asked to keep a diary of their daily activities over a three-week period at the beginning of their internship in Internal Medicine. Students categorized their activities – both medical and non-medical - according to whether they had: (1) only watched, (2) assisted the ward resident, (3) performed the activity themselves under supervision of the ward resident, or (4) performed the activity without supervision. The activities reported on a particular day were matched with a ward specific workload-index derived from the hospital information system, including the number of patients treated on the corresponding ward on that day, a correction factor according to the patient comorbidity complexity level (PCCL), and the number of admissions and discharges. Both students and ward residents were blinded to the study question. Results A total of 32 diaries (59 %, 442 recorded working days) were handed back. Overall, the students reported 1.2?±?1.3 supervised, 1.8 ±1.6 medical and 3.6?±?1.7 non-medical activities per day. The more supervised activities were reported, the more the number of reported medical activities increased (p?ward specific workload and number of medical activities could be shown. Conclusions There was a significant association between ward doctors’ supervision of students and the number of medical activities performed by medical students. The workload had no significant effect on supervision or the number of medical or non-medical activities of final-year students.

2012-01-01

117

Exploring the potential impact of hospital ward-based pharmacy interns on drug safety.  

PubMed

Clinical pharmacists play an important role in improving drug safety on hospital wards. However, little is known about the impact of pharmacy interns. The objective of our study was, therefore, to investigate the impact of hospital ward-based pharmacy interns on drug safety. This study was conducted as part of the project "P-STAT 2: Pharmacy interns on the ward" on 14 surgical wards in seven hospitals in Germany and a total of 27 pharmacy interns participated. All patients admitted to the participating wards from 1st June 2008 until 31st October 2008 and from 1st December 2008 till 30th April 2009 were included. The pharmacy interns were involved in medication reconciliation, and identifying, resolving, and preventing drug-related problems (DRPs) using the classification system APS-Doc. A total of 6,551 patients were included. Patients received on average (+/- SD) 4.4 +/- 3.9 drugs. The pharmacy interns detected a total of 4,085 DRPs and on average 0.6 +/- 1.2 DRPs per patient. Most frequently detected DRPs were potential drug-drug interactions (n = 591, 14%), missing drug strength, when different strengths were available (n = 373, 9%), and incomplete medication record (n = 296, 7%). The pharmacy interns conducted an intervention for 98% (n = 4,011) of all DRPs. According to their documentation, 74% of the DRPs (n = 3,038) were solved. Drugs which were most often related with DRPs were simvastatin, diclofenac, and ibuprofen. This is the very first study exploring the potential impact of pharmacy interns on drug safety on surgical wards in Europe. Pharmacy interns can play an important role to improve drug safety on hospital wards. PMID:24791599

Schorr, S G; Eickhoff, C; Feldt, S; Hohmann, C; Schulz, M

2014-04-01

118

Leadership support for ward managers in acute mental health inpatient settings.  

PubMed

This article shares findings of work undertaken with a group of mental health ward managers to consider their roles through workshops using an action learning approach. The tensions between the need to balance the burden of administrative tasks and act as clinical role models, leaders and managers are considered in the context of providing recovery-focused services. The group reviewed their leadership styles, broke down the administrative elements of their roles using activity logs, reviewed their working environments and considered how recovery focused they believed their wards to be. Findings support the notion that the ward manager role in acute inpatient settings is at times unmanageable. Administration is one aspect of the role for which ward managers feel unprepared and the high number of administrative tasks take them away from front line clinical care, leading to frustration. Absence from clinical areas reduces opportunities for role modeling good clinical practice to other staff. Despite the frustrations of administrative tasks, overall the managers thought they were supportive to their staff and that their wards were recovery focused. PMID:24779763

Bonner, Gwen; McLaughlin, Sue

2014-05-01

119

Detection of Equator-ward Meridional Flows in the Deep Solar Interior  

NASA Astrophysics Data System (ADS)

The meridional flow observed on the solar surface is a slow plasma motion from the equator to the poles. Flux-transport dynamo models of the solar cycle assume that this flow transports magnetic field of decaying active regions and causes polar field reversals. At what depth the meridional flow turns to equator-ward and how fast is the return flow are important questions for a better understanding of the dynamo process, and are also long-time puzzles of helioseismology. A recent finding of a systematic center-to-limb variation in the time-distance helioseismology measurements allows us to develop an empirical correction procedure for acoustic travel times, and improve the accuracy of helioseismic inferences. Using the helioseismic data of two entire years of SDO/HMI continuous observations and removing the systematic effect, we have detected the equator-ward meridional flows. Inversion of the travel times shows that the near-surface pole-ward meridional flow starts turning equator-ward at approximately 0.92 R_sun at low latitudes, and that the depth of the flow turning point increases with latitude. The equator-ward flow has a speed of 10 m/s or so, and extends from the surface to about 0.82 R_sun. Our analysis also shows evidences for a second meridional circulation cell starting at about 0.82 R_sun and extending deep to near the tachocline area (0.7 R_sun).

Zhao, J.; Bogart, R. S.; Kosovichev, A. G.; Duvall, T. L.

2012-12-01

120

The Barthel index in clinical practice: use on a rehabilitation ward for elderly people.  

PubMed

Primary activities of daily living (ADL) were monitored weekly in 102 patients admitted to a rehabilitation ward for elderly people using the Barthel index. The three commonest diagnoses were 'stroke', 'fractured neck of femur' and 'dementia recovering from acute illness'. Multiple disabling diagnoses were common: 60% of patients had dementia and 23% had a live-in carer; mean (median) length of stay in the rehabilitation ward was 98 (62 days). Over 18 months, the weekly assessment of patients in the ward was omitted once. No extra resources were needed. There was a significant rise in Barthel scores between admission to the rehabilitation ward (median Barthel 6) and discharge (median 13) for the group as a whole (median change 6, 95% CI 5-7; p < 0.001) and for each of the three main diagnostic groups. Barthel scores on discharge were significantly lower than in patients discharged from an acute ward for elderly people. Barthel scores and mental test scores (MTS) at discharge were significantly related to destination on discharge, with a characteristic pattern for patients unable to return home and having to be placed in nursing homes (Barthel < 10, MTS < 7). Our experience confirms that routine clinical use of the Barthel in this setting is feasible and responds to clinically important change, at least in group evaluation. It suggests that the Barthel may be useful in outcome measurement, case-mix adjustment and audit of discharge practices. PMID:7807430

Stone, S P; Ali, B; Auberleek, I; Thompsell, A; Young, A

1994-01-01

121

Perceived noise in surgical wards and an intensive care area: an objective analysis.  

PubMed Central

An investigation of noise levels in a hospital ward, a cubicle off the ward, and an intensive therapy unit (ITU) showed that the noise levels in all three areas were higher than internationally recommended levels at all times of day. Loud noises above 70 dB(A) were common in all areas but especially the ITU. The noise pollution levels reached annoying values during the day in the ward and cubicle and during both the day and the night in the ITU. Equipment and conversations among the staff were the main causes of noise in the ITU. These noisy environments are unlikely to help patients recover. Although measures designed to eliminate noisy surfaces will help, making staff aware of the noise they create and the effects it has may be much more effective in reducing noise pollution.

Bentley, S; Murphy, F; Dudley, H

1977-01-01

122

Wireless technology in the evolution of patient monitoring on general hospital wards.  

PubMed

The evolution of patient monitoring on general hospital wards is discussed. Patients on general wards are monitored according to the severity of their conditions, which can be subjective at best. A report by the Commission for Healthcare Audit and Inspection in 2008 indicated dissatisfaction with patient monitoring. Commitment to providing quality health service by healthcare organizations encourages the implementation of other mechanisms for patient care. Remote patient monitoring (RPM), by supplementing the role of nurses, can improve efficiency and patient care on general wards. Developments in technology made it possible for wireless sensors to measure and transmit physiological data from patients to a control room for monitoring and recording. Two approaches in the application of wireless ZigBee sensor networks are discussed and their performances compared in a simulation environment. The role of RPM in early detection of deteriorating patients' conditions, reducing morbidity and mortality rates are also discussed. PMID:19929237

Sahandi, R; Noroozi, S; Roushan, G; Heaslip, V; Liu, Y

2010-01-01

123

Ward atmosphere, client satisfaction, and client motivation in a psychiatric work rehabilitation unit.  

PubMed

This study investigated the ward atmosphere of a psychiatric work rehabilitation unit and its relationships to clients' satisfaction with the unit and client motivation, operationalised as proneness to set personal goals for their rehabilitation. The Community-oriented Programs Environment Scale was used and 52 clients participated. Their report of the ward atmosphere was in accordance with recommended levels on 5 sub-scales out of 10. A regression analysis revealed that optimal levels of order-and-organization and support were of importance for satisfaction with the unit. An optimal level of support was associated with a high rating of personal goals. This study added two therapeutically interesting factors-satisfaction and motivation-to the flora of factors that have been related to perceptions of the ward atmosphere. PMID:11318244

Eklund, M; Hansson, L

2001-04-01

124

Medical and surgical ward rounds in teaching hospitals of Kuwait University: students' perceptions  

PubMed Central

Background Teaching sessions for medical students during ward rounds are an essential component of bedside teaching, providing students with the opportunity to regard patients as actual people, and to observe their physical conditions directly, allowing a better understanding of illnesses to be developed. We aim to explore medical students’ perceptions regarding medical and surgical ward rounds within the Faculty of Medicine at Kuwait University, and to evaluate whether this teaching activity is meeting the expectation of learners. Methods A pretested questionnaire was used to collect data from 141 medical students during the 2012–2013 academic year. They were asked to provide their current and expected ratings about competencies that were supposed to be gained during ward rounds, on a scale from 1 (lowest) to 5 (highest). Mean scores were calculated, and the Student t-test was used to compare results. P < 0.05 was the cut-off level for significance. Results Only 17 students (12.1%) declined to participate in the study. The students’ current competency scores (for competencies taught within both disciplines – medical and surgical) were significantly lower than the scores indicating students’ expectations (P < 0.001). The best-taught competency was bedside examination, in both medical (mean: 3.45) and surgical (mean: 3.05) ward rounds. However, medical ward rounds were better than surgical rounds in covering some competencies, especially the teaching of professional attitude and approach towards patients (P < 0.001). Conclusion Both medical and surgical ward rounds were deficient in meeting the students’ expectations. Medical educators should utilize the available literature to improve the bedside teaching experience for their students.

AlMutar, Sara; AlTourah, Lulwa; Sadeq, Hussain; Karim, Jumanah; Marwan, Yousef

2013-01-01

125

Comparative study of the prevalence of sepsis in patients admitted to dermatology and internal medicine wards*  

PubMed Central

BACKGROUND Sepsis is a common cause of morbidity and mortality among hospitalized patients. The prevalence of this condition has increased significantly in different parts of the world. Patients admitted to dermatology wards often have severe loss of skin barrier and use systemic corticosteroids, which favor the development of sepsis. OBJECTIVES To evaluate the prevalence of sepsis among patients admitted to a dermatology ward compared to that among patients admitted to an internal medicine ward. METHODS It is a cross-sectional, observational, comparative study that was conducted at Hospital Santa Casa de Belo Horizonte. Data were collected from all patients admitted to four hospital beds at the dermatology and internal medicine wards between July 2008 and July 2009. Medical records were analyzed for the occurrence of sepsis, dermatologic diagnoses, comorbidities, types of pathogens and most commonly used antibiotics. RESULTS We analyzed 185 medical records. The prevalence of sepsis was 7.6% among patients admitted to the dermatology ward and 2.2% (p = 0.10) among those admitted to the internal medicine ward. Patients with comorbidities, diabetes mellitus and cancer did not show a higher incidence of sepsis. The main agent found was Staphylococcus aureus, and the most commonly used antibiotics were ciprofloxacin and oxacillin. There was a significant association between sepsis and the use of systemic corticosteroids (p <0.001). CONCLUSION It becomes clear that epidemiological studies on sepsis should be performed more extensively and accurately in Brazil so that efforts to prevent and treat this serious disease can be made more effectively.

Almeida, Luiz Mauricio Costa; Diniz, Michelle dos Santos; Diniz, Lorena dos Santos; Machado-Pinto, Jackson; Silva, Francisco Chagas Lima

2013-01-01

126

'Safety by DEFAULT': introduction and impact of a paediatric ward round checklist  

PubMed Central

Introduction Poor communication is a source of risk. This can be particularly significant in areas of high clinical acuity such as intensive care. Ward rounds are points where large amounts of information must be communicated in a time-limited environment with many competing interests. This has the potential to reduce effective communication and risk patient safety. Checklists have been used in many industries to improve communication and mitigate risk. We describe the introduction of a ward round safety checklist ‘DEFAULT’ on a paediatric intensive care unit. Methods A non-blinded, pre- and post-intervention observational study was undertaken in a 12-bedded Level 3 tertiary PICU between July 2009 and December 2011. Results Ward round stakeholders subjectively liked the checklist and felt it improved communication. Introduction of the ward round checklist was associated with an increase in median days between accidental extubations from 14 (range 2 to 86) to 150 (56 to 365) (Mann–Whitney P <0.0001). The ward round checklist was also associated with an increase in the proportion of invasively ventilated patients with target tidal volumes of <8 ml/kg, which increased from 35 of 71 patients at 08.00 representing a proportion of 0.49 (95% CI 0.38 to 0.60) to 23 of 38 (0.61, 0.45 to 0.74). This represented a trend towards an increased proportion of cases in the target range (z = 1.68, P = 0.09). Conclusions The introduction of a ward round safety checklist was associated with improved communication and patient safety.

2013-01-01

127

The effect of pharmacy restriction of clindamycin on Clostridium difficile infection rates in an orthopedics ward.  

PubMed

A high consumption of clindamycin was noted in an orthopedics ward with high rates of Clostridium difficile infection (CDI). We restricted clindamycin for the entire ward. A reduction of 88% in CDI (1.07 to 0.12 × 1,000 patients-days, P = .056) and 84% for all-cause diarrhea (2.40 to 0.38 × 1,000 patients-days, P = .021) was achieved. Clindamycin was reduced 92.61% without an increase in other antibiotics. We identified high consumption of clindamycin as a risk factor for CDI. PMID:24837129

Cruz-Rodríguez, Nora Cecilia; Hernández-García, Raúl; Salinas-Caballero, Ana Gabriela; Pérez-Rodríguez, Edelmiro; Garza-González, Elvira; Camacho-Ortiz, Adrián

2014-06-01

128

Phase Transition Free Regions in the Ising Model via the Kac-Ward Operator  

NASA Astrophysics Data System (ADS)

We provide an upper bound on the spectral radius of the Kac-Ward transition matrix for a general planar graph. Combined with the Kac-Ward formula for the partition function of the planar Ising model, this allows us to identify regions in the complex plane where the free energy density limits are analytic functions of the inverse temperature. The bound turns out to be optimal in the case of isoradial graphs, i.e., it yields criticality of the self-dual Z-invariant coupling constants.

Lis, Marcin

2014-05-01

129

Ward Valley: An Examination of Seven Issues in Earth Sciences and Ecology (1995)  

NSDL National Science Digital Library

The full text of the 1995 book Ward Valley: An Examination of Seven Issues in Earth Sciences and Ecology can be viewed online at the National Academies Press Website. The book contains information on the geology, hydrogeology, and ecology of Ward Valley, a proposed low-level radioactive waste disposal site in the Mojave Desert. The format is Open Book, a "browsable, nonproprietary, fully and deeply searchable version of the publication." The National Academies Press notes that it is not intended to replace printed books.

130

THE POLITICAL ECONOMY OF POST -KATRINA RECOVERY : PUBLIC CHOICE STYLE CRITIQUES FROM THE NINTH WARD , NEW ORLEANS  

Microsoft Academic Search

This paper provides an account of the political economy critique residents and other stakeholders in New Orleans' Ninth Ward communities hold of the post-Katrina policy environment. Of particular interest are policies that restricted access and delayed delivery of municipal services to some Ninth Ward neighborhoods, the city-wide redevelopment planning process, and Louisiana's Road Home rebuilding assistance program. We argue that

EMILY CHAMLEE; VIRGIL HENRY STORR

131

The team builder: The role of nurses facilitating interprofessional student teams at a Swedish clinical training ward  

Microsoft Academic Search

Interprofessional education (IPE) is an educational strategy attracting increased interest as a method to train future health care professionals. One example of IPE is the clinical training ward, where students from different health care professions practice together. At these wards the students work in teams with the support of facilitators. The professional composition of the team of facilitators usually corresponds

Carlson Elisabeth; Pilhammar Ewa; Wann-Hansson Christine

2011-01-01

132

Psychiatric care behind locked doors. A study regarding the frequency of and the reasons for locked psychiatric wards in Sweden.  

PubMed

The general aim was to describe the frequency of and the reasons for locked doors at wards within Swedish psychiatric care. A questionnaire was answered by 193 ward managers. The findings demonstrated that 73% (n = 193) of the wards were locked on the day of investigation. Wards were sometimes locked in the absence of committed patients and sometimes open in the presence of committed patients. Wards were more often locked if at least one committed patient was present. Fewer wards for children and adolescents, than for adults and old people, were locked. More wards in the areas of Sweden's three largest cities, than in the rest of the country, were locked. Fourteen categories of reasons for locking wards were generated by a content analysis of answers to an open-ended question. Most answers were categorized as: prevent patients from escaping, legislation, provide patients and others with safety and security, prevent import and unwelcome visits, and staff's need of control. Staff working in psychiatric care ought to reflect upon and articulate reasons for, and decisions about, locking or opening entrance doors, with the limitation of patients' freedom in mind. PMID:17244005

Haglund, K; van der Meiden, E; von Knorring, L; von Essen, L

2007-02-01

133

Real-Time thermal Ward-Takahashi Identity for vectorial current in QED and QCD  

Microsoft Academic Search

It is shown that, by means of canonical operator approach, the Ward-Takahashi identity (WTI) at finite temperature $T$ and finite chemical potential $\\\\mu$ for complete vectorial vertex and complete fermion propagator can be simply proven, rigorously for Quantum Electrodynamics (QED) and approximately for Quantum Chromodynamics (QCD) where the ghost effect in the fermion sector is neglected. The WTI shown in

Zhou Bang-Rong

2005-01-01

134

Real-Time thermal Ward-Takahashi Identity for vectorial current in QED and QCD  

Microsoft Academic Search

It is shown that , by means of canonical operator approach, the Ward-Takahashi identity (WTI) at finite temperature T and finite chemical potential µ for complete vectorial vertex and complete fermion propagator can be simply proven, rigorously for Quantum Electrodynamics (QED) and ap- proximately for Quantum Chromodynamics (QCD) where the ghost effect in the fermion sector is neglected. The WTI

Bang-Rong Zhou

135

Evaluation of physiological work demands and low back neuromuscular fatigue on nurses working in geriatric wards  

Microsoft Academic Search

This study evaluated the physiological demands and low back neuromuscular fatigue patterns following a daytime work shift of 21 female nurses working in geriatric wards. Subjects’ heart rate (HR) at work was monitored for 8h and surface electromyogram (EMG) of their back muscle was recorded during a 1-minute horizontal trunk holding test before and after work. Results showed that the

Ling Hui; Gabriel Y. F. Ng; Simon S. M. Yeung; Christina W. Y. Hui-Chan

2001-01-01

136

As His Day in Court Arrives, Ward Churchill Is Depicted in Sharply Different Lights  

ERIC Educational Resources Information Center

The trial in Ward Churchill's lawsuit against the University of Colorado got under way here last week with lawyers for the opposing sides painting starkly different pictures of both the controversial ethnic-studies professor and the circumstances surrounding his dismissal by the university in 2007. In delivering their opening remarks in a crowded…

Schmidt, Peter

2009-01-01

137

Inpatient Performance of Primary Care Residents: Impact of Reduction in Time on the Ward.  

ERIC Educational Resources Information Center

The inpatient (ward/intensive care unit) performance of primary care medical residents was compared with that of their peers in the standard internal medicine residency program. Nearly identical performances of the two groups suggests that substantial time in the first two years of residency can be devoted successfully to ambulatory training.…

And Others; Goroll, Allan H.

1979-01-01

138

A web of coordinative artifacts: collaborative work at a hospital ward  

Microsoft Academic Search

This paper reports from a field study of a hospital ward and discusses how people achieve coordination through the use of a wide range of interrelated non-digital artifacts, like whiteboards, work schedules, examination sheets, care records, post-it notes etc. These artifacts have multiple roles and functions which in combination facilitate location awareness, continuous coordination, cooperative planning and status overview. We

Jakob E. Bardram; Claus Bossen

2005-01-01

139

Moving Home: The Experiences of Women with Severe Intellectual Disabilities in Transition from a Locked Ward  

ERIC Educational Resources Information Center

Previous research into deinstitutionalization has largely ignored the perspective of people with intellectual disabilities, especially those with severe intellectual disabilities. This research aimed first to understand how women with severe intellectual disabilities experienced transition from a locked ward of an old long-stay hospital into other…

Owen, Katherine; Hubert, Jane; Hollins, Sheila

2008-01-01

140

Improving medication management for patients: the effect of a pharmacist on post-admission ward rounds  

Microsoft Academic Search

Problem: Medication management in the NHS has been highlighted by the UK Department of Health as an area for improvement. Pharmacist participation on post-take (post-admission) ward rounds was shown to reduce medication errors and reduced prescribing costs in the USA and in UK teaching hospitals, which can contribute to improved medication management. We sought to demonstrate the problem in our

M Fertleman; N Barnett; T Patel

2005-01-01

141

Scalable Web server cluster design with workload-aware request distribution strategy WARD  

Microsoft Academic Search

We consider a Web cluster in which the content-aware distribution is performed by each of the nodes in a Web cluster. Each server in the cluster may forward a request to another node based on the requested content. We propose a new workload-aware request distribution strategy WARD, that assigns a small set of most frequent files, called core, to be

Ludmila Cherkasova; Magnus Karlsson

2001-01-01

142

Occupational Analysis: Nursing Unit Administration (Ward Administration). Interim Report. The UCLA Allied Health Professions Project.  

ERIC Educational Resources Information Center

A national survey was conducted as part of the UCLA Allied Health Professions Project to: (1) analyze the various levels of personnel performing non-clinical tasks within the hospital nursing unit (ward), (2) determine the components of a curriculum for training such personnel, and (3) determine the feasibility of developing a pattern of upward…

Gosman, Minna L.; And Others

143

Narcissism in patients admitted to psychiatric acute wards: its relation to violence, suicidality and other psychopathology  

Microsoft Academic Search

BACKGROUND: The objective was to examine various aspects of narcissism in patients admitted to acute psychiatric wards and to compare their level of narcissism to that of an age- and gender-matched sample from the general population (NORM). METHODS: This cross-sectional study interviewed 186 eligible acute psychiatric patients with the Brief Psychiatric Rating Scale (BPRS) and the Global Assessment of Functioning

Marit F Svindseth; Jim Aage Nřttestad; Juliska Wallin; John Olav Roaldset; Alv A Dahl

2008-01-01

144

Unlicensed and off label drug use in paediatric wards: prospective study  

Microsoft Academic Search

AbstractObjective: To determine the extent of use in children in hospital of drugs that are not specifically licensed for use in children (unlicensed) and of drugs that are used outside the terms of their product licence that apply to indication, age, dose, or route of administration (off label).Design: Prospective study of drugs administered on paediatric medical and surgical wards for

Sean Turner; Alexandra Longworth; Anthony J Nunn; Imti Choonara

1998-01-01

145

Suicide amongst psychiatric in-patients who abscond from the ward: a national clinical survey  

Microsoft Academic Search

BACKGROUND: Suicide prevention by mental health services requires an awareness of the antecedents of suicide amongst high risk groups such as psychiatric in-patients. The goal of this study was to describe the social and clinical characteristics of people who had absconded from an in-patient psychiatric ward prior to suicide, including aspects of the clinical care they received. METHODS: We carried

Isabelle M Hunt; Kirsten Windfuhr; Nicola Swinson; Jenny Shaw; Louis Appleby; Nav Kapur

2010-01-01

146

Astronaut Jack Lousma looks at map of Earth in ward room of Skylab cluster  

NASA Technical Reports Server (NTRS)

Astronaut Jack R. Lousma, Skylab 3 pilot, looks at a map of Earth at the food table in the ward room of the Orbital Workshop (OWS). In this photographic reproduction taken from a television transmission made by a color TV camera aboard the Skylab space station cluster in Earth orbit.

1973-01-01

147

"Living My Native Life Deadly": Red Lake, Ward Churchill, and the Discourses of Competing Genocides  

ERIC Educational Resources Information Center

In an attempt to understand how rival narratives of genocide compete even at the cost of disavowing other historical experiences, this article considers how the U.S. national media represented and framed Red Lake in the wake of Ward Churchill's emergence on the national radar. The first section of this article examines how nineteenth-century…

Byrd, Jodi A.

2007-01-01

148

Factors affecting staff morale on inpatient mental health wards in England: a qualitative investigation  

PubMed Central

Background Good morale among staff on inpatient psychiatric wards is an important requirement for the maintenance of strong therapeutic alliances and positive patient experiences, and for the successful implementation of initiatives to improve care. More understanding is needed of mechanisms underlying good and poor morale. Method We conducted individual and group interviews with staff of a full range of disciplines and levels of seniority on seven NHS in-patient wards of varying types in England. Results Inpatient staff feel sustained in their potentially stressful roles by mutual loyalty and trust within cohesive ward teams. Clear roles, supportive ward managers and well designed organisational procedures and structures maintain good morale. Perceived threats to good morale include staffing levels that are insufficient for staff to feel safe and able to spend time with patients, the high risk of violence, and lack of voice in the wider organisation. Conclusions Increasing employee voice, designing jobs so as to maximise autonomy within clear and well-structured operational protocols, promoting greater staff-patient contact and improving responses to violence may contribute more to inpatient staff morale than formal support mechanisms.

2011-01-01

149

Characterisation of Clostridium difficile Hospital Ward-Based Transmission Using Extensive Epidemiological Data and Molecular Typing  

PubMed Central

Background Clostridium difficile infection (CDI) is a leading cause of antibiotic-associated diarrhoea and is endemic in hospitals, hindering the identification of sources and routes of transmission based on shared time and space alone. This may compromise rational control despite costly prevention strategies. This study aimed to investigate ward-based transmission of C. difficile, by subdividing outbreaks into distinct lineages defined by multi-locus sequence typing (MLST). Methods and Findings All C. difficile toxin enzyme-immunoassay-positive and culture-positive samples over 2.5 y from a geographically defined population of ?600,000 persons underwent MLST. Sequence types (STs) were combined with admission and ward movement data from an integrated comprehensive healthcare system incorporating three hospitals (1,700 beds) providing all acute care for the defined geographical population. Networks of cases and potential transmission events were constructed for each ST. Potential infection sources for each case and transmission timescales were defined by prior ward-based contact with other cases sharing the same ST. From 1 September 2007 to 31 March 2010, there were means of 102 tests and 9.4 CDIs per 10,000 overnight stays in inpatients, and 238 tests and 15.7 CDIs per month in outpatients/primary care. In total, 1,276 C. difficile isolates of 69 STs were studied. From MLST, no more than 25% of cases could be linked to a potential ward-based inpatient source, ranging from 37% in renal/transplant, 29% in haematology/oncology, and 28% in acute/elderly medicine to 6% in specialist surgery. Most of the putative transmissions identified occurred shortly (?1 wk) after the onset of symptoms (141/218, 65%), with few >8 wk (21/218, 10%). Most incubation periods were ?4 wk (132/218, 61%), with few >12 wk (28/218, 13%). Allowing for persistent ward contamination following ward discharge of a CDI case did not increase the proportion of linked cases after allowing for random meeting of matched controls. Conclusions In an endemic setting with well-implemented infection control measures, ward-based contact with symptomatic enzyme-immunoassay-positive patients cannot account for most new CDI cases. Please see later in the article for the Editors' Summary

Wyllie, David H.; Dingle, Kate E.; Harding, Rosalind M.; O'Connor, Lily; Griffiths, David; Vaughan, Ali; Finney, John; Wilcox, Mark H.; Crook, Derrick W.; Peto, Tim E. A.

2012-01-01

150

The learners' perspective on internal medicine ward rounds: a cross-sectional study  

PubMed Central

Background Ward rounds form an integral part of Internal Medicine teaching. This study aimed to determine the trainees' opinions regarding various aspects of their ward rounds, including how well they cover their learning needs, how they would like the rounds to be conducted, and differences of opinion between medical students and postgraduates. Methods A cross-sectional study was conducted on a total of 134 trainees in Internal Medicine, comprising medical students, interns, residents and fellows, who were asked to fill in a structured, self-designed questionnaire. Most of the responses required a rating on a scale of 1-5 (1 being highly unsatisfactory and 5 being highly satisfactory). Results Teaching of clinical skills and bedside teaching received the lowest overall mean score (Mean ± SD 2.48 ± 1.02 and 2.49 ± 1.12 respectively). They were rated much lower by postgraduates as compared to students (p < 0.001). All respondents felt that management of patients was the aspect best covered by the current ward rounds (Mean ± SD 3.71 ± 0.72). For their desired ward rounds, management of patients received the highest score (Mean ± SD 4.64 ± 0.55), followed by bedside examinations (Mean ± SD 4.60 ± 0.61) and clinical skills teaching (Mean ± SD 4.50 ± 0.68). The postgraduates desired a lot more focus on communication skills, counselling and medical ethics as compared to students, whose primary focus was teaching of bedside examination and management. A majority of the respondents (87%) preferred bedside rounds over conference room rounds. Even though the duration of rounds was found to be adequate, a majority of the trainees (68%) felt there was a lack of individual attention during ward rounds. Conclusions This study highlights important areas where ward rounds need improvement in order to maximize their benefit to the learners. There is a need to modify the current state of ward rounds in order to address the needs and expectations of trainees.

2010-01-01

151

French national survey of inpatient adverse events prospectively assessed with ward staff  

PubMed Central

Objectives To estimate the incidence of adverse events in medical and surgical activity in public and private hospitals, and to assess the clinical situation of patients and the active errors. Design Prospective assessment of adverse events by external senior nursing and doctor investigators with ward staff. Setting Random three?stage stratified cluster sampling of stays or fractions of stay in a 7?day observation period for each ward. Participants 8754 patients observed in 292 wards in 71 hospitals, over 35?234 hospitalisation days. Main outcome measures Number of adverse events in relation to number of days of hospitalisation. Results The incidence density of adverse events was 6.6 per 1000?days of hospitalisation (95% CI 5.7 to 7.5), of which 35% were preventable. Invasive procedures were the source of half the adverse events, of which 20% were preventable. Adverse events related to the psychological sphere and pain were mostly considered as preventable. Ward staff found it difficult to assess the role of care management in the occurrence of adverse events: 41% of adverse events were expected because of the disease itself, and could have occurred in the absence of the related medical management. Conclusion At the national level in France, every year 120?000–190?000 adverse events during hospitalisation can be considered as preventable. Areas such as perioperative period and geriatric units should receive closer attention. As adverse events occurred more commonly in vulnerable patients, who are not specifically targeted by clinical guidance, practising evidence?based medicine is not likely to prevent all cases. Therefore clinical risk management should prioritise empowerment of local staff, provision of favourable conditions within the organisation, and staff training based on simple tools appropriate for ward?level identification and analysis of adverse events.

Michel, Philippe; Quenon, Jean Luc; Djihoud, Ahmed; Tricaud-Vialle, Sophie; de Sarasqueta, Anne Marie

2007-01-01

152

Duration of bed occupancy as calculated at a random chosen day in an acute care ward. Implications for the use of scarce resources in psychiatric care  

Microsoft Academic Search

BACKGROUND: Psychiatric acute wards are obliged to admit patients without delay according to the Act on Compulsive Psychiatric Care. Residential long term treatment facilities and rehabilitation facilities may use a waiting list. Patients, who may not be discharged from the acute ward or should not wait there, then occupy acute ward beds. MATERIALS AND METHODS: Bed occupancy in one acute

John E Berg; Asbjřrn Restan

2005-01-01

153

From Paper to PDA: Design and Evaluation of a Clinical Ward Instruction on a Mobile Device  

NASA Astrophysics Data System (ADS)

Mobile devices with small screens and minimal facilities for interaction are increasingly being used in complex human activities for accessing and processing information, while the user is moving. This paper presents a case study of the design and evaluation of a mobile system, which involved transformation of complex text and tables to digital format on a PDA. The application domain was an emergency medical ward, and the user group was junior registrars. We designed a PDA-based system for accessing information, focusing on the ward instruction, implemented a prototype and evaluated it for usability and utility. The evaluation results indicate significant problems in the interaction with the system as well as the extent to which the system is useful for junior registrars in their daily work.

Kanstrup, Anne Marie; Stage, Jan

154

The effects of physical environments in medical wards on medication communication processes affecting patient safety.  

PubMed

Physical environments of clinical settings play an important role in health communication processes. Effective medication management requires seamless communication among health professionals of different disciplines. This paper explores how physical environments affect communication processes for managing medications and patient safety in acute care hospital settings. Findings highlighted the impact of environmental interruptions on communication processes about medications. In response to frequent interruptions and limited space within working environments, nurses, doctors and pharmacists developed adaptive practices in the local clinical context. Communication difficulties were associated with the ward physical layout, the controlled drug key and the medication retrieving device. Health professionals should be provided with opportunities to discuss the effects of ward environments on medication communication processes and how this impacts medication safety. Hospital administrators and architects need to consider health professionals' views and experiences when designing hospital spaces. PMID:24486620

Liu, Wei; Manias, Elizabeth; Gerdtz, Marie

2014-03-01

155

Ward-Green-Takahashi identities and the axial-vector vertex  

NASA Astrophysics Data System (ADS)

The colour-singlet axial-vector vertex plays a pivotal role in understanding dynamical chiral symmetry breaking and numerous hadronic weak interactions, yet scant model-independent information is available. We therefore use longitudinal and transverse Ward-Green-Takahashi (WGT) identities, together with kinematic constraints, in order to ameliorate this situation and expose novel features of the axial vertex: amongst them, Ward-like identities for elements in the transverse piece of the vertex, which complement and shed new light on identities determined previously for components in its longitudinal part. Such algebraic results are verified via solutions of the Bethe-Salpeter equation for the axial vertex obtained using two materially different kernels for the relevant Dyson-Schwinger equations. The solutions also provide insights that suggest a practical Ansatz for the axial-vector vertex.

Qin, Si-Xue; Roberts, Craig D.; Schmidt, Sebastian M.

2014-06-01

156

Supersymmetric Ward-Takahashi identity in one-loop lattice perturbation theory: General procedure  

Microsoft Academic Search

The one-loop corrections to the lattice supersymmetric Ward-Takahashi identity (WTi) are investigated in the off-shell regime. In the Wilson formulation of the N=1 supersymmetric Yang-Mills theory, supersymmetry is broken by the lattice, by the Wilson term, and is softly broken by the presence of the gluino mass. However, the renormalization of the supercurrent can be realized in a scheme that

Alessandra Feo

2004-01-01

157

On the one-loop ward identity for the gluon self-energy  

Microsoft Academic Search

Summary  Peculiarities of analytic regularization such as gauge violation at first order in perturbation theory are made explicit by\\u000a evaluating the self-energy for the gauge boson. Although the associated Ward identity is not preserved in general, it is shown\\u000a that the method has the power to provide a convenient alternative to the usual dimensional regularization carried out by Feynman\\u000a parametrization. This

E. Elizalde; A. Romeo

1990-01-01

158

Role of clinical pharmacists’ interventions in detection and prevention of medication errors in a medical ward  

Microsoft Academic Search

Objective Frequency and type of medication errors and role of clinical pharmacists in detection and prevention of these errors were\\u000a evaluated in this study. Method During this interventional study, clinical pharmacists monitored 861 patients’ medical records and detected, reported, and\\u000a prevented medication errors in the infectious disease ward of a major referral teaching hospital in Tehran, Iran. Error was\\u000a defined

Hossein Khalili; Shadi Farsaei; Haleh Rezaee; Simin Dashti-Khavidaki

2011-01-01

159

A Comparative Study of the Use of Four Fall Risk Assessment Tools on Acute Medical Wards  

Microsoft Academic Search

OBJECTIVES: To compare the effectiveness of four falls risk assessment tools (STRATIFY, Downton, Tullamore, and Tinetti) by using them simultaneously in the same environment. DESIGN: Prospective, open, observational study. SETTING: Two acute medical wards admitting predomi- nantly older patients. PARTICIPANTS: One hundred thirty-five patients, 86 female, mean agestandard deviation 83.8 ? 8.01 (range 56-100). MEASUREMENTS: A single clinician prospectively com-

Michael Vassallo; Rachel Stockdale; Jagdish C. Sharma; Roger Briggs; Stephen Allen

160

Randomized prospective study on prophylactic antibiotics in clean orthopedic surgery in one ward for 1 year  

Microsoft Academic Search

Background  At present in Japan, there are neither reports on antibiotic prophylaxis regardless of underlying diseases nor precise guidelines\\u000a on prophylactic antibiotics in orthopedic surgery. Therefore, the preventive effect of antimicrobial agents on surgical site\\u000a infection (SSI) after clean orthopedic surgery was studied to control the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in our ward and to reduce SSI caused by

Daisuke Kato; Katsuhiko Maezawa; Ikuho Yonezawa; Yoshiyuki Iwase; Hiroshi Ikeda; Masahiko Nozawa; Hisashi Kurosawa

2006-01-01

161

Expenditure elasticities for rural households in the Embo ward, Umbumbulu, KwaZulu-Natal  

Microsoft Academic Search

Household consumption patterns were investigated to determine the impact of an income shock on household expenditure and to establish the potential for demand-led growth in a rural area of KwaZulu-Natal. Household consumption data were collected from sample households in the Embo ward of Umbumbulu, KwaZulu-Natal during October 2004 and March 2005. Budget shares and expenditure elasticities were estimated for household

M. Browne; Gerald F. Ortmann; Sheryl L. Hendriks

2007-01-01

162

Psychotropic medication use in the child and adolescent psychiatry wards of a French hospital  

Microsoft Academic Search

Objective The aim of this study was to investigate the use of psychotropic medication in children and adolescents hospitalised in a\\u000a psychiatric ward. Methods A prospective analysis of psychotropic drug prescriptions was conducted for all patients hospitalised in two acute psychiatric\\u000a hospitalisation units of a paediatric teaching hospital in Paris, France. The study group consisted of 187 patients and was

Ursula Winterfeld; Marie-France Le Heuzey; Eric Acquaviva; Marie-Christine Mouren; Françoise Brion; Olivier Bourdon

2008-01-01

163

Community-Based Wetland Restoration Workshop in the Lower Ninth Ward, New Orleans  

Microsoft Academic Search

Since 2007 a workshop class of University of Wisconsin-Madison students has participated in a community-based project in New Orleans to investigate the feasibility of restoring the Bayou Bienvenue Wetland Triangle (BBWT), which is adjacent to the Lower 9th Ward in New Orleans. This 440-acre region is currently open water but was a cypress forest until the 1970s. Restoration would provide

H. F. Wang; L. Craig; J. A. Ross; L. Zepeda; Q. Carpenter

2010-01-01

164

A Controlled Investigation of Optimal Internal Medicine Ward Team Structure at a Teaching Hospital  

PubMed Central

Background The optimal structure of an internal medicine ward team at a teaching hospital is unknown. We hypothesized that increasing the ratio of attendings to housestaff would result in an enhanced perceived educational experience for residents. Methods Harbor-UCLA Medical Center (HUMC) is a tertiary care, public hospital in Los Angeles County. Standard ward teams at HUMC, with a housestaff?attending ratio of 5?1, were split by adding one attending and then dividing the teams into two experimental teams containing ratios of 3?1 and 2?1. Web-based Likert satisfaction surveys were completed by housestaff and attending physicians on the experimental and control teams at the end of their rotations, and objective healthcare outcomes (e.g., length of stay, hospital readmission, mortality) were compared. Results Nine hundred and ninety patients were admitted to the standard control teams and 184 were admitted to the experimental teams (81 to the one-intern team and 103 to the two-intern team). Patients admitted to the experimental and control teams had similar age and disease severity. Residents and attending physicians consistently indicated that the quality of the educational experience, time spent teaching, time devoted to patient care, and quality of life were superior on the experimental teams. Objective healthcare outcomes did not differ between experimental and control teams. Conclusions Altering internal medicine ward team structure to reduce the ratio of housestaff to attending physicians improved the perceived educational experience without altering objective healthcare outcomes.

Spellberg, Brad; Lewis, Roger J.; Sue, Darryl; Chavoshan, Bahman; Vintch, Janine; Munekata, Mark; Kim, Caroline; Lanks, Charles; Witt, Mallory D.; Stringer, William; Harrington, Darrell

2012-01-01

165

Ramond-Ramond S-matrix elements from the T-dual Ward identity  

NASA Astrophysics Data System (ADS)

Recently it has been speculated that the Ward identities associated with the string dualities and the gauge symmetries can be used as guiding principles to find all components of the scattering amplitude of n supergravitons from a given component of the S matrix. In this paper, we apply the Ward identities associated with the T duality and the gauge symmetries on the disk-level S-matrix element of one Ramond-Ramond (RR) (p-3) form, one Neveu-Schwarz-Neveu-Schwarz (NSNS), and one Neveu-Schwarz (NS) state to find the corresponding S-matrix elements of the RR (p-1) form, (p+1) form, or the RR (p+3) form on the world volume of a Dp-brane. Moreover, we apply these Ward identities on the S-matrix element of one RR (p -3) form and two NSNS states to find the corresponding S-matrix elements of the RR (p-1) form, (p+1) form, (p+3) form, or the RR (p+5) form.

Babaei Velni, Komeil; Garousi, Mohammad R.

2014-05-01

166

Assessment of the capacity to consent to treatment in patients admitted to acute medical wards  

PubMed Central

Background Assessment of capacity to consent to treatment is an important legal and ethical issue in daily medical practice. In this study we carefully evaluated the capacity to consent to treatment in patients admitted to an acute medical ward using an assessment by members of the medical team, the specific Silberfeld's score, the MMSE and an assessment by a senior psychiatrist. Methods Over a 3 month period, 195 consecutive patients of an internal medicine ward in a university hospital were included and their capacity to consent was evaluated within 72 hours of admission. Results Among the 195 patients, 38 were incapable of consenting to treatment (unconscious patients or severe cognitive impairment) and 14 were considered as incapable of consenting by the psychiatrist (prevalence of incapacity to consent of 26.7%). Agreement between the psychiatrist's evaluation and the Silberfeld questionnaire was poor (sensitivity 35.7%, specificity 91.6%). Experienced clinicians showed a higher agreement (sensitivity 57.1%, specificity 96.5%). A decision shared by residents, chief residents and nurses was the best predictor for agreement with the psychiatric assessment (sensitivity 78.6%, specificity 94.3%). Conclusion Prevalence of incapacity to consent to treatment in patients admitted to an acute internal medicine ward is high. While the standardized Silberfeld questionnaire and the MMSE are not appropriate for the evaluation of the capacity to consent in this setting, an assessment by the multidisciplinary medical team concurs with the evaluation by a senior psychiatrist.

Fassassi, Sylfa; Bianchi, Yanik; Stiefel, Friedrich; Waeber, Gerard

2009-01-01

167

Nurse and patient activities and interaction on psychiatric inpatients wards: a literature review  

PubMed Central

Background Despite major developments in community mental health services, inpatient care remains an important yet costly part of the service system and patients who are admitted frequently spend a long period of time in hospital. It is, therefore, crucial to have a good understanding of activities that take place on inpatient wards. Objective To review studies that have measured nursing and patient activity and interaction on psychiatric inpatient wards. Data sources and review methods This literature review was performed by searching electronic databases and hand-checking reference lists. Results The review identified 13 relevant studies. Most used observational methods and found that at best 50% of staff time is spent in contact with patients, and very little time is spent delivering therapeutic activities. Studies also showed that patients spend substantial time apart from staff or other patients. Conclusion On inpatient psychiatric wards, evidence over 35 years has found little patient activity or patient social engagement. The reasons for this trend and recommendations for the future are discussed.

Sharac, Jessica; McCrone, Paul; Sabes-Figuera, Ramon; Csipke, Emese; Wood, Ann; Wykes, Til

2014-01-01

168

Neuroinfection survey at a neurological ward in a Brazilian tertiary teaching hospital  

PubMed Central

OBJECTIVES: This study was undertaken to characterize the neuroinfection profile in a tertiary neurological ward. INTRODUCTION: Neuroinfection is a worldwide concern and bacterial meningitis, tetanus and cerebral malaria have been reported as the commonest causes in developing countries. METHODS: From 1999 to 2007, all patients admitted to the Neurology Ward of Hospital das Clínicas, S?o Paulo University School of Medicine because of neuroinfection had their medical records reviewed. Age, gender, immunological status, neurological syndrome at presentation, infectious agent and clinical outcome were recorded. RESULTS: Three hundred and seventy four cases of neuroinfectious diseases accounted for 4.2% of ward admissions and the identification of infectious agent was successful in 81% of cases. Mean age was 40.5±13.4 years, 63.8% were male, 19.7% were immunocompromised patients and meningoencephalitis was the most common clinical presentation despite infectious agent. Viruses and bacteria were equally responsible for 29.4% of neuroinfectious diseases; parasitic, fungal and prion infections accounted for 28%, 9.6% and 3.5% respectively. Human immunodeficiency virus (HIV), herpes simplex virus 1 (HSV1), Mycobacterium tuberculosis, Treponema pallidum, Taenia solium, Schistosoma mansoni, Cryptococcus neoformans and Histoplasma capsulatum were the more common infectious pathogens in the patients. Infection mortality rate was 14.2%, of which 62.3% occurred in immunocompetent patients. CONCLUSION: Our institution appeared to share some results with developed and developing countries. Comparison with literature may be considered as quality control to health assistance.

Marchiori, Paulo E; Lino, Angelina M M; Machado, Luis R; Pedalini, Livia M; Boulos, Marcos; Scaff, Milberto

2011-01-01

169

Review of Some of the Effects of Reduced Dissolved Oxygen on the Fish and Invertebrate Resources of Ward Cove, Alaska.  

National Technical Information Service (NTIS)

Contents: List of Figures; Acknowledgments; Executive summary; Introduction; Literature Review; Discussion; Limitations of this review; Literature cited; Appendix A: Native fish species potentially occuring in or near Ward Cove, AK; Appendix B: Location a...

D. W. Karna

2003-01-01

170

NIOSH Health Hazard Evaluation Report: HETA No. 2003-0229-2923, Ward Brodt Music Mall, Madison, Wisconsin.  

National Technical Information Service (NTIS)

On October 18, 2002, the National Institute for Occupational Safety and Health (NIOSH) received a confidential employee request for a health hazard evaluation (HHE) at Ward Brodt Music Mall in Madison, Wisconsin. The request centered on workers exposures ...

M. Finley L. Tapp

2004-01-01

171

Implementation Issues for Mobile-Wireless Infrastructure and Mobile Health Care Computing Devices for a Hospital Ward Setting  

Microsoft Academic Search

mWard is a project whose purpose is to enhance existing clinical and administrative decision support and to consider mobile\\u000a computers, connected via wireless network, for bringing clinical information to the point of care. The mWard project allowed\\u000a a limited number of users to test and evaluate a selected range of mobile-wireless infrastructure and mobile health care computing\\u000a devices at the

Liza Heslop; Stephen Weeding; Linda Dawson; Julie Fisher; Andrew Howard

2010-01-01

172

The ward atmosphere important for the psychosocial work environment of nursing staff in psychiatric in-patient care  

Microsoft Academic Search

Background  The nursing staff working in psychiatric care have a demanding work situation, which may be reflected in how they view their\\u000a psychosocial work environment and the ward atmosphere. The aims of the present study were to investigate in what way different\\u000a aspects of the ward atmosphere were related to the psychosocial work environment, as perceived by nursing staff working in

Hanna Tuvesson; Christine Wann-Hansson; Mona Eklund

2011-01-01

173

The ward atmosphere important for the psychosocial work environment of nursing staff in psychiatric in-patient care  

PubMed Central

Background The nursing staff working in psychiatric care have a demanding work situation, which may be reflected in how they view their psychosocial work environment and the ward atmosphere. The aims of the present study were to investigate in what way different aspects of the ward atmosphere were related to the psychosocial work environment, as perceived by nursing staff working in psychiatric in-patient care, and possible differences between nurses and nurse assistants. Methods 93 nursing staff working at 12 general psychiatric in-patient wards in Sweden completed two questionnaires, the Ward Atmosphere Scale and the QPSNordic 34+. Data analyses included descriptive statistics, the Mann-Whitney U-test, Spearman rank correlations and forward stepwise conditional logistic regression analyses. Results The data revealed that there were no differences between nurses and nurse assistants concerning perceptions of the psychosocial work environment and the ward atmosphere. The ward atmosphere subscales Personal Problem Orientation and Program Clarity were associated with a psychosocial work environment characterized by Empowering Leadership. Program Clarity was related to the staff's perceived Role Clarity, and Practical Orientation and Order and Organization were positively related to staff perceptions of the Organizational Climate. Conclusions The results from the present study indicate that several ward atmosphere subscales were related to the nursing staff's perceptions of the psychosocial work environment in terms of Empowering Leadership, Role Clarity and Organizational Climate. Improvements in the ward atmosphere could be another way to accomplish improvements in the working conditions of the staff, and such improvements would affect nurses and nurse assistants in similar ways.

2011-01-01

174

Continuous positive airway pressure for bronchiolitis in a general paediatric ward; a feasibility study  

PubMed Central

Background Continuous positive airway pressure (CPAP) is commonly used to relieve respiratory distress in infants with bronchiolitis, but has mostly been studied in an intensive care setting. Our prime aim was to evaluate the feasibility of CPAP for infants with bronchiolitis in a general paediatric ward, and secondary to assess capillary PCO2 (cPCO2) levels before and during treatment. Methods From May 1st 2008 to April 30th 2012, infants with bronchiolitis at Stavanger University Hospital were treated with CPAP in a general paediatric ward, but could be referred to an intensive care unit (ICU) when needed, according to in-house guidelines. Levels of cPCO2 were prospectively registered before the start of CPAP and at approximately 4, 12, 24 and 48 hours of treatment as long as CPAP was given. We had a continuous updating program for the nurses and physicians caring for the infants with CPAP. The study was population based. Results 672 infants (3.4%) were hospitalized with bronchiolitis. CPAP was initiated in 53 infants (0.3%; 7.9% of infants with bronchiolitis), and was well tolerated in all but three infants. 46 infants were included in the study, the majority of these (n?=?33) were treated in the general ward only. These infants had lower cPCO2 before treatment (8.0; 7.7, 8.6)(median; quartiles) than those treated at the ICU (n?=?13) (9.3;8.5, 9.9) (p?ward) (p?ward, providing sufficient staffing and training, and the possibility of referral to an ICU when needed.

2014-01-01

175

A recovery-oriented approach for an acute psychiatric ward: is it feasible and how does it affect staff satisfaction?  

PubMed

To evaluate professionals' attitudes to recovery and coercion, as well their satisfaction with working conditions before and after the implementation of a recovery-oriented ward concept on an admission ward. Longitudinal study design with two measurement times of the study sample, with a control group assessed at study end. Evaluating the implementation of the recovery concept, attitudes towards recovery, coercion, perceptions of the ward and working satisfaction were assessed with questionnaires and computed using Chi square and ANOVA variance analyses. The members of the intervention ward (n = 17) did not differ from the control group (n = 21), except that control group members were younger. The recovery-orientation of the study ward (ROSE questionnaire) increased significantly (alpha level = 0.05) from study begin to study end (p = 0.003), and compared to the control group (p = 0.002). The attitudes towards coercion did not change significantly in the intervention group, but did so compared to the control group. The contentedness (GMI) and the satisfaction with working conditions (ABB) of the intervention group members compared to control group was significantly higher (GMI: p = 0.004, ABB subscale working conditions: p = 0.043, satisfaction: p = 0.023). The study indicates that recovery-oriented principles can be implemented even in an acute admission ward, increasing team satisfaction with work, while attitudes towards coercion did not change significantly within this single-unit project. PMID:24307177

Rabenschlag, Franziska; Konrad, Albrecht; Rueegg, Sebastian; Jaeger, Matthias

2014-06-01

176

Effectiveness of Hospital-Wide Methicillin-Resistant Staphylococcus aureus (MRSA) Infection Control Policies Differs by Ward Specialty  

PubMed Central

Methicillin-resistant Staphylococcus aureus (MRSA) is a major cause of preventable nosocomial infections and is endemic in hospitals worldwide. The effectiveness of infection control policies varies significantly across hospital settings. The impact of the hospital context towards the rate of nosocomial MRSA infections and the success of infection control is understudied. We conducted a modelling study to evaluate several infection control policies in surgical, intensive care, and medical ward specialties, each with distinct ward conditions and policies, of a tertiary public hospital in Sydney, Australia. We reconfirm hand hygiene as the most successful policy and find it to be necessary for the success of other policies. Active screening for MRSA, patient isolation in single-bed rooms, and additional staffing were found to be less effective. Across these ward specialties, MRSA transmission risk varied by 13% and reductions in the prevalence and nosocomial incidence rate of MRSA due to infection control policies varied by up to 45%. Different levels of infection control were required to reduce and control nosocomial MRSA infections for each ward specialty. Infection control policies and policy targets should be specific for the ward and context of the hospital. The model we developed is generic and can be calibrated to represent different ward settings and pathogens transmitted between patients indirectly through health care workers. This can aid the timely and cost effective design of synergistic and context specific infection control policies.

Sadsad, Rosemarie; Sintchenko, Vitali; McDonnell, Geoff D.; Gilbert, Gwendolyn L.

2013-01-01

177

Retrospective Analysis of Use and Distribution of Resources in Otolaryngology Wards in Romanian Hospitals Between 2003 and 2008 to Improve Provision and Financial Performance of Healthcare Services  

PubMed Central

Aim To analyze use and distribution of resources by otolaryngology (ENT) hospital wards in Romania between 2003 and 2008, in order to plan the improvement of patient access to health care services and health care services’ financial performance. Methods Clinical electronic records were searched for all patients discharged from all public hospitals funded on a per-case basis by the government between January 2003 and September 2008. Adult and pediatric ENT wards, as well as ENT wards from different counties, were compared. Results The number of ENT hospital beds and the number of specialists decreased from 2003 to 2004 and specialists were distributed unevenly among the hospitals and counties. The total number of ENT wards was over 100 for almost the entire study period, but there were only about 15 pediatric ENT wards in all 42 counties. ENT wards recorded more cases and hospitalization days than oral-maxillofacial surgery and neurosurgery wards, but fewer cases than general surgery or obstetrics wards. ENT wards had the lowest mortality rates. Until the second half of 2007, adult ENT wards had a lower surgical index, higher complexity of cases, and longer average length of stay than pediatric ENT wards (P?wards treated more complex cases (P?=?0.004, t -test) that were less surgical in nature; this result was due to the shift from the Health Care Finance Administration classification diagnostic-related group (DRG) system to the Australian Refined DGR system, as well as to improper use of codes. ENT wards in different counties differed in the number of cases, average length of stay, and case mix index. Conclusion Statistics and case mix clinical data may be a good starting point for informing hospital management to assess ENT service coverage, but they should be supplemented with data on hospitalization costs.

Stamate, Marian; Chiriac, Nona Delia

2010-01-01

178

Medication prescribing errors and associated factors at the pediatric wards of Dessie Referral Hospital, Northeast Ethiopia  

PubMed Central

Background Medication error is common and preventable cause of medical errors and occurs as a result of either human error or a system flaw. The consequences of such errors are more harmful and frequent among pediatric patients. Objective To assess medication prescribing errors and associated factors in the pediatric wards of Dessie Referral Hospital, Northeast Ethiopia. Methods A cross-sectional study was carried out in the pediatric wards of Dessie Referral Hospital from February 17 to March 17, 2012. Data on the prescribed drugs were collected from patient charts and prescription papers among all patients who were admitted during the study period. Descriptive statistics was used to determine frequency, prevalence, means, and standard deviations. The relationship between dependent and independent variables were computed using logistic regression (with significance declared at p-value of 0.05 and 95% confidence interval). Results Out of the 384 Medication order s identified during the study, a total of 223 prescribing errors were identified. This corresponds to an overall medication prescribing error rate of 58.07%. Incomplete prescriptions and dosing errors were the two most common types of prescribing errors. Antibiotics (54.26%) were the most common classes of drugs subjected to prescribing error. Day of the week and route of administration were factors significantly associated with increased prescribing error. Conclusions Medication prescribing errors are common in the pediatric wards of Dessie Referral Hospital. Improving quick access to up to date reference materials, providing regular refresher trainings and possibly including a clinical pharmacist in the healthcare team are recommended.

2014-01-01

179

Drug-related problems among medical ward patients in Jimma university specialized hospital, Southwest Ethiopia  

PubMed Central

Objective: The increasing number of available drugs and drug users, as well as more complex drug regimens led to more side effects and drug interactions and complicates follow-up. The objective of this study was to assess drug-related problems (DRPs) and associated factors in hospitalized patients. Methods: A hospital-based cross-sectional study design was employed. The study was conducted in Jimma University Specialized Hospital, Jimma, located in the south west of Addis Ababa. All patients who were admitted to the medical ward from February 2011 to March 2011 were included in the study. Data on sociodemographic variables, past medical history, drug history, current diagnosis, current medications, vital signs, and relevant laboratory data were collected using semi-structured questionnaire and data collection forms which were filling through patient interview and card review. Data were analyzed using SPSS version 16 for windows. Descriptive statistics, cross-tabs, Chi-square, and logistic regression were utilized. Findings: Out of 257 study participants, 189 (73.5%) had DRPs and a total of 316 DRPs were identified. From the six classes of DRPs studied, 103 (32.6%) cases related to untreated indication or need additional drug therapy, and 49 (15.5%) cases related to high medication dosage. Unnecessary drug therapy in 49 (15.5%) cases, low medication dosage in 44 (13.9%) cases, and ineffective drug therapy in 42 (13.3%) cases were the other classes of problems identified. Noncompliance in 31 (9.8%) cases was the least prevalent DRP. Independent factors which predicted the occurrence of DRPs in the study population were sex, age, polypharmacy, and clinically significant potential drug-drug interactions. The prevalence of DRPs was substantially high (73.5%). Conclusion: Drug-related problems are common among medical ward patients. Indication-related problems, untreated indication and unnecessary drug therapy were the most common types of DRPs among patients of our medical ward.

Tigabu, Bereket Molla; Daba, Daniel; Habte, Belete

2014-01-01

180

A review of food provision to a renal ward and the proposed appointment of feeding assistants.  

PubMed

Malnutrition among renal patients has been widely documented and is associated with increased morbidity and mortality. Advances in dialysis technology and transplantation have helped to increase patient long-term survival, and as more elderly patients commence dialysis programs, the problem of malnutrition is escalating. Hospitalized renal patients are at a greater risk, as dietary intakes may be reduced for a number of reasons. A multidisciplinary team decided to review the existing cook-chill plated meal system and all food provision to the renal ward. The aim of this review was to assess the nutritional intake of renal inpatients and to gauge patients' and relatives' attitudes towards hospital food provision. From these results, we hoped to go on and implement some changes to help improve the situation. Results showed that 34% of the patients ate half or less of the hospital food provided, and 80% of patients surveyed relied on food brought in by relatives and friends. Actual dietary intakes were compared to Dietary Reference Values (DRVs; Department of Health [DoH], UK, 1995). One hundred percent of the patients did not achieve the DRVs for energy, iron, potassium, zinc, folate, B6, and riboflavin. Sixty-six percent of the patients did not achieve the DRV for protein. These results were discussed by the multidisciplinary group, and it was decided to trial a cook-chill bulk trolley to replace the existing plated meal system. Unfortunately, to implement a bulk trolley system, the ward needs someone to serve the food. This could be the job of a "feeding assistant" or "ward hostess." A bid has been put forward to the hospital Trust Board to obtain funding for these "feeding assistants, " and the bulk trolley can be acquired from existing funds. It is hoped that the creation of these new posts will go some of the way towards improving the patients' dietary intake while in the hospital. PMID:10528052

Bradburn, Y; Booth, J; Gokal, R; Hutchison, A; Marson, H; McErlain, L; Smith, M

1999-10-01

181

Fibrinolytic Therapy in CCU Instead of Emergency Ward: How It Affects Door to Needle Time?  

PubMed Central

Background: The door-to-needle-time (DNT) is considered a standard time for scheduling thrombolysis for acute ST-segment elevation of myocardial infarction and this time can be reduced by minimizing the delay in starting thrombolytic treatment once the patient has reached to the hospital. This study was carried out on a sample of Iranian patients with acute myocardial infarction to determine the DNT in those after changing schedule of thrombolysis during 8 years from emergency to coronary care unit (CCU). Methods: A descriptive cross-sectional study was carried out on all consecutive patients with a confirmed diagnosis of acute myocardial infarction admitted to the emergency ward of Ekbatan Hospital in Hamadan, Iran, within 2011 and had an indication of fibrinolytic therapy, which 47 patients were finally indicated to receive streptokinase in the part of CCU. Results: The mean time interval between arrival at the hospital and electrocardiogram (ECG) assessment was 6.30 min, taking ECG and patient's admission was 21.6 min and transferring the patient from admission to CCU ward was 31.9. The time between transferring the patients to CCU ward and fibrinolytic administration order and the time between its ordering and infusion was 31.2 min and 14.0 min respectively. In sum, the DNT was estimated 84.48 ± 53.00 min ranged 30-325 min that was significantly more than standard DNT (P <0.01). Furthermore, DNT mean in this study is significantly more than a study conducted 8 years ago in the same hospital (P <0.01). Conclusions: The DNT is higher than the standard level and higher than the estimated level in the past. This shows that DNT was longer after transferring to CCU.

Zeraati, Fatemeh; Homayounfar, Shahram; Esna-Ashari, Farzaneh; Khalili, Marzieh

2014-01-01

182

Outcomes of early switching from intravenous to oral antibiotics on medical wards  

PubMed Central

Objectives To evaluate outcomes following implementation of a checklist with criteria for switching from intravenous (iv) to oral antibiotics on unselected patients on two general medical wards. Methods During a 12 month intervention study, a printed checklist of criteria for switching on the third day of iv treatment was placed in the medical charts. The decision to switch was left to the discretion of the attending physician. Outcome parameters of a 4 month control phase before intervention were compared with the equivalent 4 month period during the intervention phase to control for seasonal confounding (before–after study; April to July of 2006 and 2007, respectively): 250 episodes (215 patients) during the intervention period were compared with the control group of 176 episodes (162 patients). The main outcome measure was the duration of iv therapy. Additionally, safety, adherence to the checklist, reasons against switching patients and antibiotic cost were analysed during the whole year of the intervention (n = 698 episodes). Results In 38% (246/646) of episodes of continued iv antibiotic therapy, patients met all criteria for switching to oral antibiotics on the third day, and 151/246 (61.4%) were switched. The number of days of iv antibiotic treatment were reduced by 19% (95% confidence interval 9%–29%, P = 0.001; 6.0–5.0 days in median) with no increase in complications. The main reasons against switching were persisting fever (41%, n = 187) and absence of clinical improvement (41%, n = 185). Conclusions On general medical wards, a checklist with bedside criteria for switching to oral antibiotics can shorten the duration of iv therapy without any negative effect on treatment outcome. The criteria were successfully applied to all patients on the wards, independently of the indication (empirical or directed treatment), the type of (presumed) infection, the underlying disease or the group of antibiotics being used.

Mertz, Dominik; Koller, Michael; Haller, Patricia; Lampert, Markus L.; Plagge, Herbert; Hug, Balthasar; Koch, Gian; Battegay, Manuel; Fluckiger, Ursula; Bassetti, Stefano

2009-01-01

183

Factors affecting staff morale on inpatient mental health wards in England: a qualitative investigation  

Microsoft Academic Search

Background  Good morale among staff on inpatient psychiatric wards is an important requirement for the maintenance of strong therapeutic\\u000a alliances and positive patient experiences, and for the successful implementation of initiatives to improve care. More understanding\\u000a is needed of mechanisms underlying good and poor morale.\\u000a \\u000a \\u000a \\u000a \\u000a Method  We conducted individual and group interviews with staff of a full range of disciplines and levels

Jonathan Totman; Gillian Lewando Hundt; Elizabeth Wearn; Moli Paul; Sonia Johnson

2011-01-01

184

[Methicillin and vancomycin-resistant staphylococci and vancomycin-resistant enterococci in a hematology ward].  

PubMed

Microbiological sampling of surfaces and air was performed in a hematology department, to monitor the presence of methicillin and vancomycin-resistant staphylococci and of vancomycin-resistant enterococci. The hematology department was divided in two areas, one of which with controlled access.Staphylococci were detected equally in the two areas while vancomycin-resistant enterococci were isolated only occasionally. The results show that the implementation of strict protocols for accessing hospital wards is not justified if effective cleaning and disinfection practices are not adopted. PMID:23064089

Donato, Rosa; Santomauro, Francesca; Pini, Gabriella; Capei, Raffaella; Faggi, Elisabetta; Sacco, Cristiana

2012-01-01

185

Tramadol infusion for pain therapy following bladder exstrophy surgery on pediatric wards  

Microsoft Academic Search

Summary  \\u000a We investigated in 17 children (mean 7.1 years) the continuous administration of tramadol following augmentation cystoplasty\\u000a or exstrophy reconstruction. Mean duration of the tramadol administration on the pediatric ward was 3.8 ± 1.1 days (initial\\u000a dosage 0.25 mg\\/kg\\/per hour, dose adjustment by the nursing staff). Mean tramadol consumption was 0.21 mg\\/kg\\/h on day 1 and\\u000a was reduced to 0.08

N. Grießinger; W. Rösch; G. Schott; R. Sittl

1997-01-01

186

[Allergen-free wards in the treatment of pollinoses and bronchial asthma].  

PubMed

Two allergen-free wards (AFW) fitted out with Academician I. V. Petryanov's filters have been in operation in the Department of General Allergy of the Institute of Immunology, USSR Ministry of Health, since 1981. A high AFW efficacy was shown during treatment without drugs of pollinosis patients with grave manifestations in the pollination season and patients with atopic bronchial asthma outside the season of plant pollination. Since 1981 treatment in AFW has been provided to 232 patients, of them in 104 with a good effect in the season of plant pollination. PMID:3715757

Poroshina, Iu A; Basmanov, P M; Gubankova, S G; Ivanov, Iu N; Belostotskaia, O I

1986-01-01

187

Hepatic and renal effects of low concentrations of methoxyflurane in exposed delivery ward personnel  

SciTech Connect

During five alternating three-week periods either methoxyflurane-nitrous oxide or nitrous oxide alone was used for obstetrical analgesia. Delivery ward personnel were followed by venous blood samples once a week. Analyses of blood urea nitrogen, serum uric acid, SGOT and SGPT showed significantly elevated levels three days after exposure to methoxyflurane. This study demonstrates the importance of the scavenging of anesthetic gases to reduce the exposure of personnel to inhalational agents used in delivery suites. Since definite alterations in the indices of both hepatic and renal functions were recognized in obstetrical personnel following exposure, a re-evaluation of the use of methoxyflurane for obstetrical analgesia is suggested.

Dahlgren, B.E.

1980-12-01

188

Examination of particulate matter and heavy metals and their effects in at-risk wards in Washington, DC  

NASA Astrophysics Data System (ADS)

One of the major contributions to pollution in the Washington, DC urban environment is particulate matter (PM). Quite often, ambient airborne toxics are closely associated with fine PM (PM2.5). We have performed high-resolution aerosol measurements of PM2.5 in four wards (Ward 1, 4, 5, and 7) of Washington, DC during two intensive observational periods (IOP). The first IOP occurred during the summer of 2003 (June 23rd to August 8th). The second IOP transpired during the late fall season of 2003 (October 20th to December 4 th). The measurement platform consisted of a Laser Particle Counter (LPC) and a Quartz Crystal Microbalance Cascade Impactor (QCM) to obtain both in-situ number and mass density distributions across the measurement sites. The data shows spatial distributions of particulate matter characterized as a function of size and mass properties. The QCM analyses show significant levels (> 15 mug/m3) of ward-averaged PM2.5 in Wards 4, 1, and 7 respectively during the summer IOP. However, all wards were less than the EPA National Ambient Air Quality Standard (NAAQS) of 15 mug/m 3 during the fall IOP ward-averaged measurements. Yet, investigations of the site-averaged measurements during the fall revealed some specific locations in Ward 4 that exceeded the NAAQS. Results also show that the aerosol mass density peaked in the 0.3 mum mode during the summer IOP and in the 0.15 mum mode during the fall IOP. The number density peaked in the 0.3--0.5 mum size range. Accordingly, the distributions have also been analyzed as a function of meteorological factors, such as wind speed and direction via NOAA HYSPLIT trajectories. One important attribute to this study is the evaluation of risks amongst IBC subgroups (youth, adults, elderly, black, white, hispanic, male, and female) for bath pediatric asthma rates and the onset of lung cancer over a lifetime (70-year period) when exposed to these levels of particulates. It has been determined that there are individual excess risks associated with inhalation of PM2.5 and the selected heavy metals chromium, arsenic, and cadmium. Particularly, Ward 4 has generated higher risks than the other three investigated wards for both health effects.

Greene, Natasha Ann

189

Contamination of the Hospital Environment with Gastroenteric Viruses: Comparison of Two Pediatric Wards over a Winter Season?  

PubMed Central

The aims of this study were to examine the extent of gastroenteric virus contamination in a pediatric primary immunodeficiency (PPI) ward and a general pediatric ward over a winter season and to determine whether changes to hospital infection control interventions would have an impact on environmental contamination levels within pediatric units. Environmental swabs were collected weekly from 11 sites in both wards from 15 December 2005 to 3 March 2006 and examined for the presence of norovirus (NoV), astrovirus, and rotavirus (RV) by reverse transcriptase PCR. Viruses were detected in 17% and 19% of swabs from both wards. Virus contamination for NoV and RV decreased from 20% to 6% and 15% to 10% of swabs, respectively, in the PPI ward from the 2004 study by Gallimore et al. (C. I. Gallimore, C. Taylor, A. R. Gennery, A. J. Cant, A. Galloway, M. Iturriza-Gomara, and J. J. Gray, J. Clin. Microbiol. 44:395-399, 2006). Overall, changes to cleaning protocols were deemed to have reduced the level of environmental contamination with gastroenteric viruses, but contamination still occurred due to a breakdown in infection control procedures indicated by contamination in areas frequented by parents but used only occasionally by staff.

Gallimore, Chris I.; Taylor, Clive; Gennery, Andrew R.; Cant, Andrew J.; Galloway, Angela; Xerry, Jacqueline; Adigwe, Juliet; Gray, Jim J.

2008-01-01

190

Molecular typing and epidemiology of Clostridium difficile in respiratory care wards of central Taiwan.  

PubMed

BACKGROUND/PURPOSE: In industrialized countries, Clostridium difficile is the major cause of nosocomial diarrhea. This study involved a broad overview of baseline epidemiology for C. difficile in Taiwan. MATERIALS AND METHODS: Point prevalence was estimated from a prospective survey conducted in the respiratory care wards of six hospitals in central Taiwan. Polymerase chain reaction (PCR) ribotyping and multiple-locus variable-number tandem-repeat analysis (MLVA) were performed on all toxigenic C. difficile isolates, including asymptomatic and symptomatic strains. RESULTS: A total of 149 patients were screened for C. difficile; the point prevalence for C. difficile infection (CDI) and C. difficile colonization was 4% and 19%, respectively. CDI cases were significantly related to end-stage renal disease, and C. difficile colonization cases were significantly associated with previous admission to an acute-care facility. No hypervirulent PCR ribotype 027 strain was found. MLVA detected two clusters of CDI-related and three clusters of asymptomatic C. difficile strains circulating in wards. CONCLUSION: Our results demonstrate a high prevalence of toxigenic C. difficile colonization in hospitals. Infection control personnel should pay attention to the increasing numbers of CDI cases, and molecular typing for C. difficile should be performed when necessary. PMID:23726464

Wei, Hsiao-Lun; Wei, Sung-Hsi; Huang, Chien-Wen; Shih, Chih-Hung; Huang, Yi-Wen; Lu, Min-Chi; Hsu, Jin-Chyr; Liou, Yi-Sheng; Chiou, Chien-Shun

2013-05-28

191

A ward-based writing coach program to improve the quality of nursing documentation.  

PubMed

A ward-based writing coach program was piloted at a metropolitan hospital in Australia to produce a quality improvement in nursing documentation. This paper describes the education program, which consisted of two writing workshops, each of one-hour duration followed by one-to-one coaching of nurses. This program could be carried out in any clinical area as a part of the regular education program. Nurses are encouraged to view their documentation practices in a critical light to ensure that the documentation is meaningful to readers within or outside the profession. The importance of nursing documentation as a communication tool for all health care professionals is emphasised. Barriers to meaning, such as fragmentary language or the use of unofficial abbreviations, are discussed. Nurses are also encouraged to document the patient's condition, care and response to care using defined principles for nursing documentation. This program would be transferrable to any clinical setting looking for a ward-based education program for nursing documentation. PMID:21982050

Jefferies, Diana; Johnson, Maree; Nicholls, Daniel; Lad, Shushila

2012-08-01

192

Factors Associated with Readmission of Patients at a University Hospital Psychiatric Ward in Iran  

PubMed Central

Objectives. Readmission has a major role in the reduction of the quality of life and the increase in the years of lost life. The main objectives of this study were to answer to the following research questions. (a) What was the readmission rate? (b) What were the social, demographic, and clinical characteristics of patients admitted to the Psychiatric Emergency Service at Nour University Hospital, affiliated to Isfahan University of Medical Sciences, Isfahan, Iran? (c) What were the effective factors on readmission? Method. This cross-sectional study was conducted on a total number of 3935 patients who were admitted to Isfahan University Hospital Psychiatric Ward in Isfahan, Iran, from 2004 to 2010. Gender, age, marital status, education, self-report history of previous admission, type of psychiatric disorder, substance misuse, suicide, and the length of the current psychiatric disorder were collected from the registered medical files of patients. The data were analysed using the negative binomial regression model. Results. We found that factors such as psychiatric anxiety disorder, bipolar I, bipolar II, psychotic disorder, depression, and self report history of previous admission were statistically significant in the number of readmissions using the negative binomial model. Conclusion. Readmission to the psychiatric ward is mainly predictable by the type of diagnosis and psychosocial supports.

Barekatain, Majid; Maracy, Mohammad Reza; Hassannejad, Razeyeh; Hosseini, Reihane

2013-01-01

193

Caring for patients with cancer in non-specialist wards: the nurse experience.  

PubMed

This study aims to describe the experiences of nurses caring for cancer patients in non-specialist wards. The study was conducted in a large (420 beds) and small (32 beds) hospital in an area health service with urban and rural populations in the west of Sydney. A qualitative descriptive approach was utilized to collect data from the nurses. Data were collected using a survey and in-depth interviews of nurses working in non-specialist cancer wards. Transcribed data were managed with Nudist Vivo software and analysed for common themes using process of constant comparison and contrast. Twenty-five surveys were returned and five nurses volunteered to be interviewed. The six major themes that emerged from analysis of data were: emotional nature of care, lack of time, lack of knowledge of cancer treatment, family support, environment not conducive to proper care and dealing with patient's non-acceptance of cancer diagnosis. The nurses in this study wished to provide quality supportive care for cancer patients and their families but the inconducive environment and inadequate relevant training hindered the nurses' efforts. This then presents further need of relevant training for nurses in cancer care and time management, to meet up with these challenges. PMID:15952970

Mohan, S; Wilkes, L M; Ogunsiji, O; Walker, A

2005-07-01

194

Teaching teamwork: an evaluation of an interprofessional training ward placement for health care students  

PubMed Central

The establishment of interprofessional teamwork training in the preprofessional health care curriculum is a major challenge for teaching faculties. Interprofessional clinical placements offer an opportunity for teamwork education, as students in various professions can work and learn together. In this sequential, mixed-method study, focus group and survey techniques were used to evaluate students’ educational experiences after 2-week ward-based interprofessional clinical placements. Forty-five senior nursing, medicine, and other health care students cared for patients in hospital wards under professional supervision, with nursing-medicine student “teams” leading care. Thirty-six students attended nine exit focus groups. Five central themes that emerged about training were student autonomy and workload, understanding of other professional roles, communication and shared knowledge, interprofessional teamwork/collaboration, and the “inner circle”, or being part of the unit team. The learning environment was described as positive. In a postplacement satisfaction survey (n=38), students likewise rated the educational experience highly. In practicing teamwork and collaboration, students were able to rehearse their future professional role. We suggest that interprofessional clinical placements be regarded as an essential learning experience for senior preprofessional students. More work is needed to fully understand the effect of this interactive program on students’ clinical learning and preparation for practice.

Morphet, Julia; Hood, Kerry; Cant, Robyn; Baulch, Julie; Gilbee, Alana; Sandry, Kate

2014-01-01

195

Urban land use and ground water vulnerability in Washington, DC: Environmental equity by city ward  

SciTech Connect

The DC WRRC initiated a USGS-funded study on impacts of urban land use on the city's ground water. Its main objective is the development of pollution potential maps using available physical and land use data for the District of Columbia. A second goal is the design of a ground water protection strategy applicable to a heterogeneous urban setting. The multitude of data required for this project were compiled using a Geographic Information System (GIS). GIS maps show the four hydrogeologic settings, traditional land use categories, specific urban pollution sources, and management units. A coding matrix was developed to create a rating hierarchy of the pollution potential of various land use/pollution source combinations. Subsequent superposition with the ground water vulnerability map allowed the city-wide spatial assessment of land use impacts on ground water quality. Preliminary results can be displayed by voting ward and used to educate residents on environmental conditions. Field trips and technical notes coupled with exposure to new laws and historic maps can heighten public and political awareness of the ground water resource. A city-wide GIS based on voting wards can enhance understanding of the dynamic urban hydrologic cycle and thus aid in establishing environmental equity.

Schneider, J.; O'Conner, J.V.; Wade, C.; Chang, F.M. (Univ. of the District of Columbia, Washington, DC (United States))

1992-01-01

196

Effects of neuromuscular electrostimulation in patients with heart failure admitted to ward  

PubMed Central

Background Neuromuscular electrostimulation has become a promising issue in cardiovascular rehabilitation. However there are few articles published in the literature regarding neuromuscular electrostimulation in patients with heart failure during hospital stay. Methods This is a randomized controlled pilot trial that aimed to investigate the effect of neuromuscular electrostimulation in the walked distance by the six-minute walking test in 30 patients admitted to ward for heart failure treatment in a tertiary cardiology hospital. Patients in the intervention group performed a conventional rehabilitation and neuromuscular electrostimulation. Patients underwent 60 minutes of electrostimulation (wave frequency was 20 Hz, pulse duration of 20 us) two times a day for consecutive days until hospital discharge. Results The walked distance in the six-minute walking test improved 75% in the electrostimulation group (from 379.7 ± 43.5 to 372.9 ± 46.9 meters to controls and from 372.9 ± 62.4 to 500 ± 68 meters to electrostimulation, p<0.001). On the other hand, the walked distance in the control group did not change. Conclusion The neuromuscular electrostimulation group showed greater improvement in the walked distance in the six-minute walking test in patients admitted to ward for compensation of heart failure.

2012-01-01

197

Outbreak of multiresistant OXA-24- and OXA-51-producing Acinetobacter baumannii in an internal medicine ward.  

PubMed

Here we describe the clinical, microbiological, epidemiological, and molecular characterization of an outbreak of multidrug-resistant Acinetobacter baumannii (MRAB) involving 5 patients admitted to the internal medicine ward of our hospital. Over a 6-week period, 5 MRAB isolates were recovered from 5 patients, including 1 with fatal meningitis, 3 with skin and soft tissue infections, and 1 with respiratory colonization. One sample obtained during environmental monitoring in the ward was A. baumannii-positive. According to the pulsed-field gel electrophoresis typing results, the strains isolated from all patients and the environmental sample belonged to a single clone, identified as ST79 by multilocus sequence typing. The blaOXA-24 and blaOXA-51 carbapenemases were detected in all isolates. Four patients died, but only the death of the meningitis patient was probably related to the A. baumannii infection. The infection source was probably the hands of the healthcare workers because the outbreak strain was isolated from the surface of a serum container. The results of the present study revealed the importance of strict adherence to control measures by all healthcare workers because the consequences of noncompliance can be very serious. PMID:23883845

Tena, Daniel; Martínez, Nora Mariela; Oteo, Jesús; Sáez, David; Vindel, Ana; Azańedo, María Luisa; Sánchez, Lorenzo; Espinosa, Alfredo; Cobos, Juan; Sánchez, Rosario; Otero, Ignacio; Bisquert, Julia

2013-01-01

198

One site fits all? A student ward as a learning practice for interprofessional development.  

PubMed

Interprofessional training wards (IPTWs), aiming to enhance interprofessional collaboration, have been implemented in medical education and evaluated over the last decade. The Faculty of Health Sciences, Linköping University has, in collaboration with the local health provider, arranged such training wards since 1996, involving students from the medical, nursing, physiotherapy, and occupational therapy programs. Working together across professional boundaries is seen as a necessity in the future to achieve sustainable and safe healthcare. Therefore, educators need to arrange learning contexts which enhance students' interprofessional learning. This article shows aspects of how the arrangement of an IPTW can influence the students' collaboration and learning. Data from open-ended questions from a questionnaire survey, during autumn term 2010 and spring term 2011 at an IPTW, was analyzed qualitatively using a theoretical framework of practice theory. The theoretical lens gave a picture of how architectures of the IPTW create a clash between the "expected" professional responsibilities and the "unexpected" responsibilities of caring work. Also revealed was how the proximity between students opens up contexts for negotiations and boundary work. The value of using a theoretical framework of professional learning in practice within the frames of healthcare education is discussed. PMID:23805862

Falk, Annika Lindh; Hult, Hĺkan; Hammar, Mats; Hopwood, Nick; Dahlgren, Madeleine Abrandt

2013-11-01

199

Future: new strategies for hospitalists to overcome challenges in teaching on today's wards.  

PubMed

Changes in the clinical learning environment under resident duty hours restrictions have introduced a number of challenges on today's wards. Additionally, the current group of medical trainees is largely represented by the Millennial Generation, a generation characterized by an affinity for technology, interaction, and group-based learning. Special attention must be paid to take into account the learning needs of a generation that has only ever known life with duty hours. A mnemonic for strategies to augment teaching rounds for hospitalists was created using an approach that considers time limitations due to duty hours as well as the preferences of Millennial learners. These strategies to enhance learning during teaching rounds are Flipping the Wards, Using Documentation to Teach, Technology-Enabled Teaching, Using Guerilla Teaching Tactics, Rainy Day Teaching, and Embedding Teaching Moments into Rounds (FUTURE). Hospitalists serving as teaching attendings should consider these possible strategies as ways to enhance teaching in the post-duty hours era. These techniques appeal to the preferences of today's learners in an environment often limited by time constraints. Hospitalists are well positioned to champion innovative approaches to teaching in a dynamic and evolving clinical learning environment. PMID:23757149

Martin, Shannon K; Farnan, Jeanne M; Arora, Vineet M

2013-07-01

200

Nature and frequency of medication errors in a geriatric ward: an Indonesian experience  

PubMed Central

Purpose To determine the nature and frequency of medication errors during medication delivery processes in a public teaching hospital geriatric ward in Bali, Indonesia. Methods A 20-week prospective study on medication errors occurring during the medication delivery process was conducted in a geriatric ward in a public teaching hospital in Bali, Indonesia. Participants selected were inpatients aged more than 60 years. Patients were excluded if they had a malignancy, were undergoing surgery, or receiving chemotherapy treatment. The occurrence of medication errors in prescribing, transcribing, dispensing, and administration were detected by the investigator providing in-hospital clinical pharmacy services. Results Seven hundred and seventy drug orders and 7,662 drug doses were reviewed as part of the study. There were 1,563 medication errors detected among the 7,662 drug doses reviewed, representing an error rate of 20.4%. Administration errors were the most frequent medication errors identified (59%), followed by transcription errors (15%), dispensing errors (14%), and prescribing errors (7%). Errors in documentation were the most common form of administration errors. Of these errors, 2.4% were classified as potentially serious and 10.3% as potentially significant. Conclusion Medication errors occurred in every stage of the medication delivery process, with administration errors being the most frequent. The majority of errors identified in the administration stage were related to documentation. Provision of in-hospital clinical pharmacy services could potentially play a significant role in detecting and preventing medication errors.

Ernawati, Desak Ketut; Lee, Ya Ping; Hughes, Jeffery David

2014-01-01

201

The cost of a hospital ward in Europe: is there a methodology available to accurately measure the costs?  

PubMed

Costing health care services has become a major requirement due to an increase in demand for health care and technological advances. Several studies have been published describing the computation of the costs of hospital wards. The objective of this article is to examine the methodologies utilised to try to describe the basic components of a standardised method, which could be applied throughout Europe. Cost measurement however is a complex matter and a lack of clarity exists in the terminology and the cost concepts utilised. The methods discussed in this review make it evident that there is a lack of standardized methodologies for the determination of accurate costs of hospital wards. A standardized costing methodology would facilitate comparisons, encourage economic evaluation within the ward and hence assist in the decision-making process with regard to the efficient allocation of resources. PMID:15366283

Negrini, D; Kettle, A; Sheppard, L; Mills, G H; Edbrooke, D L

2004-01-01

202

Trends and inequalities in cardiovascular disease mortality across 7932 English electoral wards, 1982-2006: Bayesian spatial analysis  

PubMed Central

Background Cardiovascular disease (CVD) mortality has more than halved in England since the 1980s, but there are few data on small-area trends. We estimated CVD mortality by ward in 5-year intervals between 1982 and 2006, and examined trends in relation to starting mortality, region and community deprivation. Methods We analysed CVD death rates using a Bayesian spatial technique for all 7932 English electoral wards in consecutive 5-year intervals between 1982 and 2006, separately for men and women aged 30–64 years and ?65 years. Results Age-standardized CVD mortality declined in the majority of wards, but increased in 186 wards for women aged ?65 years. The decline was larger where starting mortality had been higher. When grouped by deprivation quintile, absolute inequality between most- and least-deprived wards narrowed over time in those aged 30–64 years, but increased in older adults; relative inequalities worsened in all four age–sex groups. Wards with high CVD mortality in 2002–06 fell into two groups: those in and around large metropolitan cities in northern England that started with high mortality in 1982–86 and could not ‘catch up’, despite impressive declines, and those that started with average or low mortality in the 1980s but ‘fell behind’ because of small mortality reductions. Conclusions Improving population health and reducing health inequalities should be treated as related policy and measurement goals. Ongoing analysis of mortality by small area is essential to monitor local effects on health and health inequalities of the public health and healthcare systems.

Asaria, Perviz; Fortunato, Lea; Fecht, Daniela; Tzoulaki, Ioanna; Abellan, Juan Jose; Hambly, Peter; de Hoogh, Kees; Ezzati, Majid; Elliott, Paul

2012-01-01

203

Nosocomial outbreak of Salmonella enterica serovar Typhimurium primarily affecting a pediatric ward in South Africa in 2012.  

PubMed

We describe a nosocomial outbreak of diarrheal disease caused by extended-spectrum ?-lactamase-producing multidrug-resistant Salmonella enterica serovar Typhimurium, focused on a pediatric ward in South Africa. The outbreak peaked between May 2012 and July 2012. Person-to-person transmission was the most likely mechanism of spread of the infection, expedited due to a breakdown in hand-washing and hygiene, suboptimal infection control practices, overcrowding of hospital wards, and an undesirable nurse-to-patient ratio. PMID:24478499

Smith, Anthony M; Mthanti, Mnikelwa A; Haumann, Carel; Tyalisi, Nomalungisa; Boon, Gerald P G; Sooka, Arvinda; Keddy, Karen H

2014-02-01

204

Hospital Acquired Infections Among Patients Admitted in the Medical and Surgical Wards of a Non-Teaching Secondary Care Hospital in Northern India  

PubMed Central

Objective: To investigate the incidence of Nosocomial Infection (NI) and type of bacteriological isolates among the patients admitted in the medical and surgical wards of a non-teaching secondary care hospital in north India. Materials and Methods: This was a cross-sectional hospital based study conducted in the Wards of General Medicine, General Surgery and Orthopaedic of the hospital. The patient were admitted in the department for various surgical procedures, without evidence of initial infection, were included in the study. Results: A total of 176 patients were included in the study of which 82 were from Medical and 94 from Surgical ward. Overall incidence of NI was found to be 26.1% (Medical ward=28%, Surgical ward=24.5%., p=0.58). The isolation rate of Acinetobacter baumanii was (p=0.15) higher among the patients of medical ward (95.7%) than surgical ward (82.6). Escherichia coli was isolated in 89.1% and no significant difference was observed between medical and surgical wards. Klebsiella pneumoniae was isolated in 50% patients and was almost similar (p=0.37) in medical surgical wards. The isolation rate of Pseudomonos aeruginosa, Enterococcus faecalis, Staphylococcus aureus and Coagulase negative staphylococci were 43.5%, 73.9%, 34.8% and 17.4% respectively. A significant difference was observed in the isolation rate of Enterococcus faecalis (p=0.007) and Coagulase negative staphylococci (p=0.002) between medical and surgical wards. Overall, among the patients who developed NI, 27.2% patient’s bacterial isolates were Gram positive (Surgical=64.1, Medical=80%). Conclusion: The incidence of NI is increasing in the hospitals, so extensive that more care has to be taken in cleaning the wards of the hospitals.

Ginawi, I.; Saleem, Mohd; Sigh, Mastan; Vaish, A.K.; Ahmad, I.; Srivastava, V.K.; Abdullah, A. Fahad M.

2014-01-01

205

Hospital acquired infections among patients admitted in the medical and surgical wards of a non-teaching secondary care hospital in northern India.  

PubMed

Objective: To investigate the incidence of Nosocomial Infection (NI) and type of bacteriological isolates among the patients admitted in the medical and surgical wards of a non-teaching secondary care hospital in north India. Materials and Methods: This was a cross-sectional hospital based study conducted in the Wards of General Medicine, General Surgery and Orthopaedic of the hospital. The patient were admitted in the department for various surgical procedures, without evidence of initial infection, were included in the study. Results: A total of 176 patients were included in the study of which 82 were from Medical and 94 from Surgical ward. Overall incidence of NI was found to be 26.1% (Medical ward=28%, Surgical ward=24.5%., p=0.58). The isolation rate of Acinetobacter baumanii was (p=0.15) higher among the patients of medical ward (95.7%) than surgical ward (82.6). Escherichia coli was isolated in 89.1% and no significant difference was observed between medical and surgical wards. Klebsiella pneumoniae was isolated in 50% patients and was almost similar (p=0.37) in medical surgical wards. The isolation rate of Pseudomonos aeruginosa, Enterococcus faecalis, Staphylococcus aureus and Coagulase negative staphylococci were 43.5%, 73.9%, 34.8% and 17.4% respectively. A significant difference was observed in the isolation rate of Enterococcus faecalis (p=0.007) and Coagulase negative staphylococci (p=0.002) between medical and surgical wards. Overall, among the patients who developed NI, 27.2% patient's bacterial isolates were Gram positive (Surgical=64.1, Medical=80%). Conclusion: The incidence of NI is increasing in the hospitals, so extensive that more care has to be taken in cleaning the wards of the hospitals. PMID:24701489

Ginawi, I; Saleem, Mohd; Sigh, Mastan; Vaish, A K; Ahmad, I; Srivastava, V K; Abdullah, A Fahad M

2014-02-01

206

Predictive factors of adrenal insufficiency in patients admitted to acute medical wards: a case control study  

PubMed Central

Background Adrenal insufficiency is a rare and potentially lethal disease if untreated. Several clinical signs and biological markers are associated with glucocorticoid failure but the importance of these factors for diagnosing adrenal insufficiency is not known. In this study, we aimed to assess the prevalence of and the factors associated with adrenal insufficiency among patients admitted to an acute internal medicine ward. Methods Retrospective, case-control study including all patients with high-dose (250 ?g) ACTH-stimulation tests for suspected adrenal insufficiency performed between 2008 and 2010 in an acute internal medicine ward (n?=?281). Cortisol values <550 nmol/l upon ACTH-stimulation test were considered diagnostic for adrenal insufficiency. Area under the ROC curve (AROC), sensitivity, specificity, negative and positive predictive values for adrenal insufficiency were assessed for thirteen symptoms, signs and biological variables. Results 32 patients (11.4%) presented adrenal insufficiency; the others served as controls. Among all clinical and biological parameters studied, history of glucocorticoid withdrawal was the only independent factor significantly associated with patients with adrenal insufficiency (Odds Ratio: 6.71, 95% CI: 3.08 –14.62). Using a logistic regression, a model with four significant and independent variable was obtained, regrouping history of glucocorticoid withdrawal (OR 7.38, 95% CI [3.18 ; 17.11], p-value <0.001), nausea (OR 3.37, 95% CI [1.03 ; 11.00], p-value 0.044), eosinophilia (OR 17.6, 95% CI [1.02; 302.3], p-value 0.048) and hyperkalemia (OR 2.41, 95% CI [0.87; 6.69], p-value 0.092). The AROC (95% CI) was 0.75 (0.70; 0.80) for this model, with 6.3 (0.8 – 20.8) for sensitivity and 99.2 (97.1 – 99.9) for specificity. Conclusions 11.4% of patients with suspected adrenal insufficient admitted to acute medical ward actually do present with adrenal insufficiency, defined by an abnormal response to high-dose (250 ?g) ACTH-stimulation test. A history of glucocorticoid withdrawal was the strongest factor predicting the potential adrenal failure. The combination of a history of glucocorticoid withdrawal, nausea, eosinophilia and hyperkaliemia might be of interest to suspect adrenal insufficiency.

2013-01-01

207

Supersymmetric Ward-Takahashi identity in one-loop lattice perturbation theory: General procedure  

NASA Astrophysics Data System (ADS)

The one-loop corrections to the lattice supersymmetric Ward-Takahashi identity (WTi) are investigated in the off-shell regime. In the Wilson formulation of the N=1 supersymmetric Yang-Mills theory, supersymmetry is broken by the lattice, by the Wilson term, and is softly broken by the presence of the gluino mass. However, the renormalization of the supercurrent can be realized in a scheme that restores the continuum supersymmetric WTi (once the on-shell condition is imposed). The general procedure used to calculate the renormalization constants and mixing coefficients for the local supercurrent is presented. The supercurrent not only mixes with the gauge invariant operator T?. An extra mixing with other operators coming from the WTi appears. This extra mixing survives in the continuum limit in the off-shell regime and cancels out when the on-shell condition is imposed and the renormalized gluino mass is set to zero. Comparison with numerical results is also presented.

Feo, Alessandra

2004-09-01

208

Patient- and family-centred care on an acute adult cardiac ward.  

PubMed

This paper outlines a service improvement project undertaken in one acute cardiac ward within a regional NHS trust in the east of England that explored the impact of advancing patient- and family-centred care within an acute adult setting. The project was implemented and evaluated over a 9-month period between March and December 2012 and data collected via a pre and post-intervention survey. The results demonstrated that the majority of family carers wanted to be involved in patient care. The provision of flexible family visiting,facilitated and supported family carer involvement in care provision and improved partnership working between family carers and the multidisciplinary team, had a positive impact on the patient and family carer experience. This project has demonstrated the value of involving family carers in acute adult inpatient care provision and the importance of flexible family visiting to enable this to be successful. PMID:24809150

Ewart, Linda; Moore, Jenny; Gibbs, Claire; Crozier, Kenda

209

Patient rights and law: tobacco smoking in psychiatric wards and the Israeli Prevention of Smoking Act.  

PubMed

In August 2001, the Israeli Ministry of Health issued its Limitation of Smoking in Public Places Order, categorically forbidding smoking in hospitals. This forced the mental health system to cope with the issue of smoking inside psychiatric hospitals. The main problem was smoking by compulsorily hospitalized psychiatric patients in closed wards. An attempt by a psychiatric hospital to implement the tobacco smoking restraint instruction by banning the sale of cigarettes inside the hospital led to the development of a black market and cases of patient exploitation in return for cigarettes. This article surveys the literature dealing with smoking among psychiatric patients, the role of smoking in patients and the moral dilemmas of taking steps to prevent smoking in psychiatric hospitals. It addresses the need for public discussion on professional caregivers' dilemmas between their commitment to uphold the law and their duty to act as advocates for their patients' rights and welfare. PMID:15362356

Kagan, Ilya; Kigli-Shemesh, Ronit; Tabak, Nili; Abramowitz, Moshe Z; Margolin, Jacob

2004-09-01

210

Cryptosporidiosis among children with acute gastroenteritis in the pediatric ward in the General Hospital, Penang.  

PubMed

Stool samples from 836 cases with diarrhea and acute gastroenteritis from the Pediatric ward, Penang General Hospital, were examined for Cryptosporidium oocysts. A dimethyl sulfoxide modified acid fast technique was used for the identification of the parasites. 36 samples or 4.3% were found to be positive for Cryptosporidium. The prevalence of infection was higher (2.39%) in children with diarrhea and vomiting than in children with acute gastroenteritis alone (0.8%). Stool examination and cultures from the Cryptosporidium positive samples revealed no other parasites, rotavirus or enteropathogenic bacteria. This suggests that Cryptosporidium may be an important agent in the causation of diarrhea in young children. A routine laboratory examination for the detection of Cryptosporidium in the search for causal agents of childhood diarrhea in our environment may, therefore, be significant. PMID:1948280

Ludin, C M; Afifi, S A; Hasenan, N; Maimunah, A; Anuar, A K

1991-06-01

211

Perceptions of the real and the ideal ward atmosphere among trainees and staff before and after the introduction of a new work rehabilitation model.  

PubMed

Changes in the ward atmosphere of a psychiatric work rehabilitation unit were investigated. Both trainees and staff filled in the Community-Oriented Programs Environment Scale (COPES) before and after a new rehabilitation model was implemented. It was hypothesised that the levels of autonomy and practical orientation would increase from both the trainees' and staff's perspective concerning the real ward atmosphere and that the staff's perceptions of an ideal ward atmosphere would change in the same way. The staff perceived an increased level of autonomy with respect to both the real ward atmosphere and to what constitutes an ideal ward atmosphere, which partly confirmed the hypotheses, but the level of practical orientation was stable. Concerning the staff's estimate of an ideal ward atmosphere, further changes were an increased level of involvement and a decrease in spontaneity, which was not hypothesised, but was not in conflict with the philosophy behind the new model. From the trainee's perspective there was no change of either autonomy or practical orientation. Instead, there was a decrease in personal problem orientation. Compared to an optimal profile, the ward atmosphere was beneficial, before as well as after implementation of the new programme. Differences were found between the staff and the trainees, but they were not large enough to separate the groups according to what is considered an optimal profile. The few changes found support earlier conclusions that the ward atmosphere is a stable phenomenon over time. PMID:11514133

Eklund, M; Hansson, L

2001-08-01

212

Perceptions of the real and the ideal ward atmosphere among trainees and staff before and after the introduction of a new work rehabilitation model  

Microsoft Academic Search

Changes in the ward atmosphere of a psychiatric work rehabilitation unit were investigated. Both trainees and staff filled in the Community-Oriented Programs Environment Scale (COPES) before and after a new rehabilitation model was implemented. It was hypothesised that the levels of autonomy and practical orientation would increase from both the trainees’ and staff’s perspective concerning the real ward atmosphere and

M Eklund; L Hansson

2001-01-01

213

Incidence of nutritional support complications in patient hospitalized in wards. multicentric study  

PubMed Central

Introduction: Nutritional support generates complications that must be detected and treated on time. Objective: To estimate the incidence of some complications of nutritional support in patients admitted to general hospital wards who received nutritional support in six high-complexity institutions. Methods: Prospective, descriptive and multicentric study in patients with nutritional support; the variables studied were medical diagnosis, nutritional condition, nutritional support duration, approach, kind of formula, and eight complications. Results: A total of 277 patients were evaluated; 83% received enteral nutrition and 17% received parenteral nutrition. Some 69.3% presented risk of malnourishment or severe malnourishment at admittance. About 35.4% of those receiving enteral nutrition and 39.6% of the ones who received parenteral nutrition had complications; no significant difference per support was found (p= 0.363). For the enteral nutrition, the most significant complication was the removal of the catheter (14%), followed by diarrhea (8.3%); an association between the duration of the enteral support with diarrhea, constipation and removal of the catheter was found (p < 0.05). For parenteral nutrition, hyperglycemia was the complication of highest incidence (22.9%), followed by hypophosphatemia (12.5%); all complications were associated with the duration of the support (p < 0.05). Nutritional support was suspended in 24.2% of the patients. Conclusions: Complications with nutritional support in hospital-ward patients were frequent, with the removal of the catheter and hyperglycemia showing the highest incidence. Duration of the support was the variable that revealed an association with complications. Strict application of protocols could decrease the risk for complications and boost nutritional support benefits.

Giraldo, Nubia Amparo; Aguilar, Nora Luz; Restrepo, Beatriz Elena; Vanegas, Marcela; Alzate, Sandra; Martinez, Monica; Gamboa, Sonia Patricia; Castano, Eliana; Barbosa, Janeth; Roman, Juliana; Serna, Angela Maria; Hoyos, Gloria Marcela

2012-01-01

214

Antibiotic utilization pattern in a general medical ward of a tertiary medical center in Saudi Arabia.  

PubMed

To assess the pattern of antibiotic utilization and outcome of patients with bacteremia in a General Medical Ward, all positive blood cultures (BC) over a 12-month period from January 1994 to December 1995 were retrospectively reviewed. Fifty-two positive BC were recorded in 43 patients (63% males, 37% females; mean age 65.9 ± 16.6). 72% of the patients received antibiotics before or soon after obtaining the BC, and ceftriaxone was the most frequently-prescribed antibiotic (41.93%), either alone or in combination with other antibiotics. The bacteremia was due to gram-positive cocci in 60.46% of cases, gram-negative rods in 30.23%, and gram-positive rods in 9.30%. Positive BC due to contamination were not included. The most common gram-positive cocci were Staphylococcus epidermidis, followed by S. aureus, while the most common gram-negative bacilli were Brucella species, Proteus mirabilis, and Klebsiella sp. The suspected sources of the bacteremia were respiratory (21.2%), urinary (19.2%), or skin (19.2%). A subsequent change in the antibiotics regimen was done in 69.76% cases after BC results became available with no apparent effect on the outcome. Adding vancomycin and clindamycin was the most frequent change done (19.4% for each equally). Complications developed in 69.76% of patients, with 88.66% of them suffering from sepsis/shock. 69.23% of the patients improved and 30.77% expired; death was related to infection in 87.5% of cases. In conclusion, most bacteremia in the medical ward of the hospital were due to gram-positive cocci, which should be considered in antibiotic selection prior to BC. Risk factors for acquiring Brucellosis should always be obtained. PMID:23210003

Al Shimemeri, A; Al Ghadeer, H; Memish, Z

2011-07-01

215

Evaluation of risk factor management of patients treated on an internal nephrology ward: a pilot study  

PubMed Central

Background The objectives of this pilot study were to evaluate treatment quality for the risk factors of hypertension, diabetes and hyperlipidemia as well as the overall treatment quality for patients on an internal nephrology ward. This evaluation included the collection of data concerning the quality of therapeutic drug monitoring, drug use and potential drug-drug interactions. Establishing such baseline information highlights areas that have a need for further therapeutic intervention and creates a foundation for improving patient care, a subject that could be addressed in future clinical pharmacy research projects. Methods Medical charts of patients treated on a single internal nephrology ward were retrospectively evaluated using a predefined data collection form. Assessment of further need for therapeutic intervention was performed. Results For 76.5% (n = 78) of the total study population (n = 102), there was either a possibility (39.2%, n = 40) or a need (37.3%, n = 38) for further intervention based on the overall assessment. For the risk factors of hypertension, diabetes and hyperlipidemia, the proportions of patients that require further intervention were 78.8% (n = 71), 90.6% (n = 58) and 87.9% (n = 58), respectively. Patients with diabetes or hyperlipidemia were less likely to have optimal risk factor control. The number of drugs prescribed and the number of potential drug-drug interactions were significantly higher after in-hospital treatment. Conclusion Risk factor treatment needs optimisation. Risk factor management, systematic medication reviews, and screening for and management of potential drug-drug interactions deserve great attention. Clinical pharmacy services could help in the achievement of treatment goals.

Stemer, Gunar; Zehetmayer, Sonja; Lemmens-Gruber, Rosa

2009-01-01

216

"Extraordinary Understandings" of Composition at the University of Chicago: Frederick Champion Ward, Kenneth Burke, and Henry W. Sams  

ERIC Educational Resources Information Center

While Richard Weaver, R. S. Crane, Richard McKeon, and Robert Streeter have been most identified with rhetoric at the University of Chicago and its institutional return in the 1950s, the archival record demonstrates that Frederick Champion Ward, dean of the undergraduate "College" from 1947 to 1954, and Henry W. Sams, director of English in the…

Beasley, James P.

2007-01-01

217

The Association of Drug Use and Post-Traumatic Stress Reactions Due to Hurricane Ike Among Fifth Ward Houstonian Youth  

Microsoft Academic Search

This study shows the important link between higher drug use and self-medication among youth with higher reported posttraumatic stress reactions after natural disasters. The study offers secondary analysis of cross-sectional data collected on 170 predominately African American males through the Fifth Ward Enrichment program (FWEP) in Houston, Texas, between November and December 2009. Men who stated that in the last

Ronald J. Peters Jr; Angela Meshack; Charles Amos; Kathy Scott-Gurnell; Charles Savage; Kentya Ford

2010-01-01

218

Active Student Participation May Enhance Patient Centeredness: Patients' Assessments of the Clinical Education Ward for Integrative Medicine  

PubMed Central

Objectives. To examine the impact of active student participation on quality of care in an integrative inpatient setting. Methods. Over a two-year period, we surveyed all patients treated on the Clinical Education Ward for Integrative Medicine (CEWIM), where final-year medical students are integrated into an internal medicine ward complementing conventional medicine with anthroposophic medicine. Patients treated on the regular wards of the same internal medicine department served as the control group (CG). General quality of care was studied with the Picker Inpatient Questionnaire, physician empathy with the Consultation and Relational Empathy measure, and patient enablement with the Patient Enablement Index. ANCOVA was used to control for covariates while examining significant differences between both patient groups. Results. Comparison of the CG wards and the CEWIM revealed no significant differences in medical treatment success. The CEWIM, however, achieved better results for physician-patient interaction, physician empathy, and patient enablement. Eighty Percent of the CEWIM patients rated student participation as positively impacting quality of care. Conclusion. Our results indicate that incorporating students in an integrative healthcare setting may result in greater patient centeredness. Further studies are needed to determine whether this is due to organizational advantages, students' empathic activity, the impact of teaching, or learner-teacher interaction.

Tauschel, Diethard; Neumann, Melanie; Lutz, Gabriele; Valk-Draad, Maria

2013-01-01

219

Public Health Assessment for Scorpio Recycling, Incorporated Candelaria Ward, Toa Baja Municipality, Puerto Rico, EPA Facility ID: PRD987376662.  

National Technical Information Service (NTIS)

The Scorpio Recycling, Inc. (SRI) site is an active scrap metal yard located on State Road No. 2, Candelaria Ward, Toa Baja, and Puerto Rico. Part of the property was previously used as a battery salvage area where batteries were dismantled for scrap. SRI...

2004-01-01

220

An Exploratory Evaluation of the Ward and Hudson Offending Pathways Model with Sex Offenders Who Have Intellectual Disability  

ERIC Educational Resources Information Center

Background: It was predicted that offenders with intellectual disability (ID) categorised according to Ward & Hudson's (1998b) self-regulation theory as having an "Approach" goal would have higher levels of distorted cognitions, less victim empathy, and a history of more prolific offending compared to those with an "Avoidant" goal. Offenders…

Langdon, Peter E.; Maxted, Helen; Murphy, Glynis H.

2007-01-01

221

Utilization of Norway's Emergency Wards: The Second 5 Years after the Introduction of the Patient List System  

PubMed Central

Utilization of services is an important indicator for estimating access to healthcare. In Norway, the General Practitioner Scheme, a patient list system, was established in 2001 to enable a stable doctor-patient relationship. Although satisfaction with the system is generally high, people often choose a more accessible but inferior solution for routine care: emergency wards. The aim of the article is to investigate contact patterns in primary health care situations for the total population in urban and remote areas of Norway and for major immigrant groups in Oslo. The primary regression model had a cross-sectional study design analyzing 2,609,107 consultations in representative municipalities across Norway, estimating the probability of choosing the emergency ward in substitution to a general practitioner. In a second regression model comprising 625,590 consultations in Oslo, we calculated this likelihood for immigrants from the 14 largest groups. We noted substantial differences in emergency ward utilization between ethnic Norwegians both in rural and remote areas and among the various immigrant groups residing in Oslo. Oslo utilization of emergency ward services for the whole population declined, and so did this use among all immigrant groups after 2009. Other municipalities, while overwhelmingly ethnically Norwegian, showed diverse patterns including an increase in some and a decrease in others, results which we were unable to explain.

Goth, Ursula S.; Hammer, Hugo L.; Claussen, Bj?rgulf

2014-01-01

222

Prevalence of methicillin-resistant Staphylococcus aureus carriage at the time of admission in two acute geriatric wards  

Microsoft Academic Search

Studies on methicillin-resistant Staphylococcus aureus (MRSA) in the elderly have been concerned with patients hospitalized in nursing homes or long-term care facilities. Our objective was to estimate the prevalence of MRSA at the time of admission in two acute geriatric wards with high endemic MRSA incidence in a French teaching hospital. A prospective screening of MRSA carriers was conducted by

M. Eveillard; C. Ernst; S. Cuviller; F.-X. Lescure; M. Malpaux; I. Defouilloy; M. Grésanleux; M. Duboisset; J. Liénard; F. Eb

2002-01-01

223

Ethnomedicine of the Kagera Region, north western Tanzania. Part 2: The medicinal plants used in Katoro Ward, Bukoba District  

Microsoft Academic Search

BACKGROUND: The Kagera region of north western Tanzania has a rich culture of traditional medicine use and practices. The dynamic inter-ethnic interactions of different people from the surrounding countries constitute a rich reservoir of herbal based healing practices. This study, the second on an ongoing series, reports on the medicinal plant species used in Katoro ward, Bukoba District, and tries

Mainen J Moshi; Donald F Otieno; Pamela K Mbabazi; Anke Weisheit

2010-01-01

224

Utilization of Norway's emergency wards: the second 5 years after the introduction of the patient list system.  

PubMed

Utilization of services is an important indicator for estimating access to healthcare. In Norway, the General Practitioner Scheme, a patient list system, was established in 2001 to enable a stable doctor-patient relationship. Although satisfaction with the system is generally high, people often choose a more accessible but inferior solution for routine care: emergency wards. The aim of the article is to investigate contact patterns in primary health care situations for the total population in urban and remote areas of Norway and for major immigrant groups in Oslo. The primary regression model had a cross-sectional study design analyzing 2,609,107 consultations in representative municipalities across Norway, estimating the probability of choosing the emergency ward in substitution to a general practitioner. In a second regression model comprising 625,590 consultations in Oslo, we calculated this likelihood for immigrants from the 14 largest groups. We noted substantial differences in emergency ward utilization between ethnic Norwegians both in rural and remote areas and among the various immigrant groups residing in Oslo. Oslo utilization of emergency ward services for the whole population declined, and so did this use among all immigrant groups after 2009. Other municipalities, while overwhelmingly ethnically Norwegian, showed diverse patterns including an increase in some and a decrease in others, results which we were unable to explain. PMID:24662997

Goth, Ursula S; Hammer, Hugo L; Claussen, Bjřrgulf

2014-03-01

225

Is closure of entire wards necessary to control norovirus outbreaks in hospital? Comparing the effectiveness of two infection control strategies.  

PubMed

The standard approach for norovirus control in hospitals in the UK, as outlined by the Health Protection Agency guidance and implemented previously by Lancashire Teaching Hospitals, involves the early closure of affected wards. However, this has a major impact on bed-days lost and cancelled admissions. In 2008, a new strategy was introduced in the study hospital, key elements of which included closure of affected ward bays (rather than wards), installation of bay doors, enhanced cleaning, a rapid in-house molecular test and an enlarged infection control team. The impact of these changes was assessed by comparing two norovirus seasons (2007-08 and 2009-10) before and after implementation of the new strategy, expressing the contrast between seasons as a ratio (r) of expected counts in the two seasons. There was a significant decrease in the ratio of confirmed hospital outbreaks to community outbreaks (r = 0.317, P = 0.025), the number of days of restricted admissions on hospital wards per outbreak (r = 0.742, P = 0.041), and the number of hospital bed-days lost per outbreak (r = 0.344, P <0.001). However, there was no significant change in the number of patients affected per hospital outbreak (r = 1.080, P = 0.517), or the number of hospital staff affected per outbreak (r = 0.651, P = 0.105). Closure of entire wards during norovirus outbreaks is not always necessary. The changes implemented at the study hospital resulted in a significant reduction in the number of bed-days lost per outbreak, and this, together with a reduction in outbreak frequency, resulted in considerable cost savings. PMID:21684038

Illingworth, E; Taborn, E; Fielding, D; Cheesbrough, J; Diggle, P J; Orr, D

2011-09-01

226

Epidemiology and Clinical Features of Bloodstream Infections in Hematology Wards: One Year Experience at the Catholic Blood and Marrow Transplantation Center  

PubMed Central

Background The aim of this study was to investigate the clinical features and epidemiology of bloodstream infections (BSIs) in 2 distinctive hematological wards of the Catholic Blood and Marrow Transplantation (BMT) center. Materials and Methods We retrospectively reviewed the medical data of patients who developed BSIs from June 2009 to May 2010 in 2 hematologic wards at the Catholic BMT center. Ward A is a 44-bed unit mainly conducting conventional high dose chemotherapy and ward B is a 23-bed unit exclusively conducting BMT. Results Overall, 222 BSI episodes were developed from 159 patients. Acute myeloid leukemia in ward A and multiple myeloma in ward B were more frequent than in ward B and A, respectively. Sex, age, presence of neutropenia, shock, Pitt bacteremia score, type of central catheter, level of C-reactive protein, duration of admission days, type of BSI, overall mortality and distribution of organisms were not different between the 2 wards. There were 202 monomicrobial and 20 polymicrobial BSI episodes, including 2 fungemia episodes. The incidence rate of overall BSIs per 1,000 patient-days was higher in ward A than in ward B (incidence rate ratio 2.88, 95% confidence interval 1.97-4.22, P<0.001). Among 243 organisms isolated, the number of gram positives, gram negatives and fungi were 122, 119 and 2, respectively. Escherichia coli was the most common organism in both ward A and B (27.6% and 42.4%), followed by viridians streptococci (18.6% and 15.2%) and Klebsiella pneumoniae (13.3% and 9.0%). Extended spectrum beta-lactamase (ESBL) producers accounted for 31.9% (23/72) of E. coli and 71.0% (22/31) of K. pneumoniae. Out of 19 Enterococcus faecium, 7 isolates (36.8%) were resistant to vancomycin. The crude mortality rates at 7 and 30 days after each BSI episode were 4.5% (10/222) and 13.1% (29/222), and were significantly higher in the patients with shock compared with those without shock (20.5% vs. 1.1%, P<0.001 and 38.5% vs. 7.7%, P<0.001, respectively). Conclusions The incidence rate of BSIs was higher in patients receiving chemotherapy than those receiving BMT, but the distribution of organisms was not different between the 2 wards. E. coli was the most common causative BSI organism in hematologic wards followed by viridians streptococci and K. pneumoniae.

Kwon, Jae-Cheol; Kim, Si-Hyun; Choi, Jae-Ki; Cho, Sung-Yeon; Park, Yeon-Joon; Park, Sun Hee; Choi, Su-Mi; Choi, Jung-Hyun; Yoo, Jin-Hong

2013-01-01

227

Community-Based Wetland Restoration Workshop in the Lower Ninth Ward, New Orleans  

NASA Astrophysics Data System (ADS)

Since 2007 a workshop class of University of Wisconsin-Madison students has participated in a community-based project in New Orleans to investigate the feasibility of restoring the Bayou Bienvenue Wetland Triangle (BBWT), which is adjacent to the Lower 9th Ward in New Orleans. This 440-acre region is currently open water but was a cypress forest until the 1970s. Restoration would provide protection from storm surges, restored ecological services, and recreational use. The workshop introduced students to the multidisciplinary skills needed to work effectively with the complex and interconnected issues within a project involving many stakeholders. The stakeholders included the Center for Sustainable Engagement and Development (CSED), Lower 9th Ward residents, non-profits (e.g., Sierra Club, Environmental Defense, Lake Pontchartrain Basin Foundation, National Wildlife Federation), government agencies (e.g., New Orleans Sewerage and Water Board, Army Corps of Engineers), neighborhood groups (e.g., Holy Cross Neighborhood Association, The Village), and universities (Tulane, U. of New Orleans, LSU, U. Colorado-Denver, Southeastern Louisiana). The course ran initially as a Water Resources Management practicum in the first two summers and then as a broader multidisciplinary project with student expertise in hydrology, social science, law, planning, policy analysis, community development, GIS, public health, environmental education and ecological restoration. The project divided into three main components: wetland science, social science, and land tenure and planning. Principal activities in wetland science were to monitor water levels and water quality, inventory flora and fauna, and plant grasses on small “floating islands.” The principal social science activity was to conduct a neighborhood survey about knowledge of the wetland and interest in its restoration. The land tenure and planning activity was to investigate ownership and transfer of property within the wetland because it had been platted with large areas privately owned. A self-published workshop report was produced each of the first three years. Bayou Bienvenue Wetland Triangle with downtown New Orleans in the background. Photo by Travis Scott, U. of Wisconsin-Madison, 2007.

Wang, H. F.; Craig, L.; Ross, J. A.; Zepeda, L.; Carpenter, Q.

2010-12-01

228

Patients' approaches to students' learning at a clinical education ward-an ethnographic study  

PubMed Central

Background It is well known that patients’ involvement in health care students’ learning is essential and gives students opportunities to experience clinical reasoning and practice clinical skills when interacting with patients. Students encounter patients in different contexts throughout their education. However, looking across the research providing evidence about learning related to patient-student encounters reveals a lack of knowledge about the actual learning process that occurs in encounters between patients and students. The aim of this study was to explore patient-student encounters in relation to students’ learning in a patient-centered health-care setting. Methods An ethnographic approach was used to study the encounters between patients and students. The setting was a clinical education ward for nursing students at a university hospital with eight beds. The study included 10 observations with 11 students and 10 patients. The observer followed one or two students taking care of one patient. During the fieldwork observational and reflective notes were taken. After each observation follow-up interviews were conducted with each patient and student separately. Data were analyzed using an ethnographic approach. Results The most striking results showed that patients took different approaches in the encounters with students. When the students managed to create a good atmosphere and a mutual relationship, the patients were active participants in the students’ learning. If the students did not manage to create a good atmosphere, the relationship became one-way and the patients were passive participants, letting the students practice on their bodies but without engaging in a dialogue with the students. Conclusions Patient-student encounters, at a clinical education ward with a patient-centred pedagogical framework, can develop into either a learning relationship or an attending relationship. A learning relationship is based on a mutual relationship between patients and students resulting in patients actively participating in students’ learning and they both experience it as a joint action. An attending relationship is based on a one-way relationship between patients and students resulting in patients passively participating by letting students to practice on their bodies but without engaging in a learning dialogue with the students.

2014-01-01

229

Feasibility of Progressive Strength Training Implemented in the Acute Ward after Hip Fracture Surgery  

PubMed Central

Importance Patients with a hip fracture lose more than 50% knee-extension strength in the fractured limb within one week of surgery. Hence, immediate progressive strength training following hip fracture surgery may be rational, but the feasibility unknown. Objective To examine the feasibility of in-hospital progressive strength training implemented in the acute ward following hip fracture surgery, based on pre-specified criteria for feasibility. Design, Setting and Patients A prospective cohort study conducted in an acute orthopedic hip fracture unit at a university hospital. A consecutive sample of 36 patients, 18 with a cervical and 18 with a trochanteric hip fracture (27 women and 9 men, mean (SD) age of 79.4 (8.3) years) were included between June and December 2012. Intervention A daily (on weekdays) program of progressive knee-extension strength training for the fractured limb, using ankle weight cuffs in 3 sets of 10 repetition maximum loadings. Main outcomes and Measures The primary outcome was the change in training load (kg) during the knee-extension strength training. The secondary outcomes were changes in hip fracture-related pain and maximal isometric knee-extension strength. Results The strength training was commenced at a mean of 2.4 (0.7) days after surgery. The training loads (kilograms lifted) increased from 1.6 (0.8) to 4.3 (1.7) kg over 4.3 (2.2) training sessions (P<.001). The maximal isometric knee-extension strength of the fractured limb increased from 0.37 (0.2) to 0.61 (0.3) Nm/kg (P<.001), while the average strength deficit in the fractured limb decreased from 50% to 32% (% non-fractured, P<.001). Only 3 of 212 sessions were not performed because of severe hip fracture-related pain. Conclusion and Relevance Progressive knee-extension strength training of the fractured limb commenced in the acute ward seems feasible, and may reduce strength asymmetry between limbs without hip pain interfering. The clinical efficacy needs confirmation in a randomized controlled design. Trial Registration ClinicalTrials.gov ID: NCT01616030

Kronborg, Lise; Bandholm, Thomas; Palm, Henrik; Kehlet, Henrik; Kristensen, Morten Tange

2014-01-01

230

Introduction and evaluation of a newly established holiday work system in the pharmacy ward at Municipal Ikeda Hospital.  

PubMed

At the Municipal Ikeda Hospital, a system in which pharmacists stationed in one ward pharmacy dispense drugs to be administered by injection and injectable preparations delivered to patients' bedsides was introduced in April 2000. This system was aimed at minimizing risks related to injections. Initially, however, on holidays, nurses played the roles of pharmacists in terms of the injections, and there were concerns over a possible rise in the incidence of errors (adverse events/near-misses) related to injections on these days compared with weekdays. Later, when planning to introduce a new holiday work system in the ward pharmacy, we took into account such factors as the number of pharmacists needed on holidays, their duties on holidays and the influence on weekday pharmacy activity of compensatory days-off taken by such pharmacists. In May 2004, the new holiday work system was introduced in the ward pharmacy. Under the new system, 5 pharmacists work at the ward pharmacy on holidays. After this system was put into operation, the number of injections dispensed at the ward pharmacy averaged 230 per day, and 177 per holiday. To evaluate the validity of this system, we recently conducted a questionnaire survey of nurses at our hospital. The survey involved 139 nurses. Of these nurses, 69.1% responded that the number of incidents (adverse events/near-misses) related to dispensing injections on holidays had decreased. Furthermore, 65.4% of the nurses reported a decrease in incidents related to the delivery and administration of injectable preparations. More than half of the nurses answered that the new system had made it easier for them to collect information on medicines and helped them provide better nursing services. When the nurses were asked to make a general assessment of the new system, 90% rated the system as "good." The results of this survey indicate that keeping the ward pharmacy open on holidays contributes to the promotion of the proper use of medicines, reduction of risks related to injections and improvement in the quality of medical care. PMID:17016030

Myotoku, Michiaki; Iwamoto, Chiaki; Tomida, Yumi; Murayama, Yoko; Irishio, Keiko; Nakanishi, Akiko; Shimomura, Kazunori; Ihara, Yuki; Shioishi, Tomoko; Inui, Toshiko; Yohiro, Chika; Miyamoto, Emi; Suemura, Natsuko; Kawaguchi, Syunichi

2006-10-01

231

The so-called "inappropriate" psychiatric consultation request on a medical or surgical ward.  

PubMed

Seven cases of psychiatric consultations on medical and surgical wards are reviewed to show how intrapsychic conflicts in the staff may make the consultation request appear inappropriate. On deeper examination, such requests may signify staff dysfunction caused by arousal of conflictual feelings about the behavior of illness of the patient. Mutilated, mute patients appear to arouse fear of agression in their caregivers, who in turn reject such patients, see them as alien and violent, and become illogical in their management. Patients who publicly display sexual behaviors appear to arouse shame over exhibitionism, voyeurism, and masturbation; their caregivers become too passive to effect common-sense measures appropriate to the situation. Very sick and dying patients and ungrateful, demanding patients can arouse anger and despair. Their caregivers may become depressed about failure, feeling helpless and out of control; using projection, they can see such patients as evil or suicidal, and may eventually turn against themselves. The psychiatric consultant, recognizing the conflicts that make the requests seem inappropriate, seeks to substitute higher-level cognitive operations and coping behaviors in the staff (distancing, rationalization, intellectualization, undoing, and altruism) for distortion projection, over-identification, reaction formation, and turning against the self. PMID:1052121

Kucharski, A; Groves, J E

232

Supersymmetric Ward-Takahashi identity in one-loop lattice perturbation theory: General procedure  

SciTech Connect

The one-loop corrections to the lattice supersymmetric Ward-Takahashi identity (WTi) are investigated in the off-shell regime. In the Wilson formulation of the N=1 supersymmetric Yang-Mills theory, supersymmetry is broken by the lattice, by the Wilson term, and is softly broken by the presence of the gluino mass. However, the renormalization of the supercurrent can be realized in a scheme that restores the continuum supersymmetric WTi (once the on-shell condition is imposed). The general procedure used to calculate the renormalization constants and mixing coefficients for the local supercurrent is presented. The supercurrent not only mixes with the gauge invariant operator T{sub {mu}}. An extra mixing with other operators coming from the WTi appears. This extra mixing survives in the continuum limit in the off-shell regime and cancels out when the on-shell condition is imposed and the renormalized gluino mass is set to zero. Comparison with numerical results is also presented.

Feo, Alessandra [School of Mathematics, Trinity College, Dublin 2 (Ireland); Dipartimento di Fisica, Universita di Parma and INFN Gruppo, Collegato di Parma, Parco Area delle Scienze, 7/A, 43100 Parma (Italy)

2004-09-01

233

Mechanical and pharmacological restraints in acute psychiatric wards--why and how are they used?  

PubMed

Restraint use has been reported to be common in acute psychiatry, but empirical research is scarce concerning why and how restraints are used. This study analysed data from patients' first episodes of restraint in three acute psychiatric wards during a 2-year study period. Logistic regression analyses were used to identify predictors for type and duration of restraint. The distribution of restraint categories for the 371 restrained patients was as follows: mechanical restraint, 47.2%; mechanical and pharmacological restraint together, 35.3%; and pharmacological restraint, 17.5%. The most commonly reported reason for restraint was assault (occurred or imminent). It increased the likelihood of resulting in concomitant pharmacological restraint. Female patients had shorter duration of mechanical restraint than men. Age above 49 and female gender increased the likelihood of pharmacological versus mechanical restraint, whereas being restrained due to assault weakened this association. Episodes with mechanical restraint and coinciding pharmacological restraint lasted longer than mechanical restraint used separately, and were less common among patients with a personality disorder. Diagnoses, age and reason for restraint independently increased the likelihood for being subjected to specific types of restraint. Female gender predicted type of restraint and duration of episodes. PMID:23219102

Knutzen, Maria; Bjřrkly, Stĺl; Eidhammer, Gunnar; Lorentzen, Steinar; Helen Mjřsund, Nina; Opjordsmoen, Stein; Sandvik, Leiv; Friis, Svein

2013-08-30

234

Struggle with a gap between intensive care units and general wards  

PubMed Central

Nursing critically ill patients includes planning and performing safe discharges from Intensive Care Units (ICU) to the general wards. The aim of this study was to obtain a deeper understanding of the main concern in the ICU transitional process—the care before, during, and after the transfer of ICU patients. Interviews were conducted with 35 Swedish nurses and analysed according to grounded theory. The main concern was the nurses' “struggling with a gap.” The “gap” was caused by differences in the altered level of care and contributed to difficulties for nurses encountering an overlap during the transitional care. The categories: sheltering, seeking organizational intertwining and striving for control are related to the core category and were used to generate a theory. The nurses sought improved collaboration, and employed patient-centred routines. They wanted access to necessary tools; they relayed or questioned their own competence and sought assurance of the patients' ability to be transferred. If the nurses felt a loss of control, lack of intertwining and lack of collaboration, they sheltered their patients and themselves. Intertwining was more difficult to perform, but actually even more important to do. With knowledge about ICU transitional care, collaboration, routines, and with an organization that provides an educational environment, the process could be improved.

Haggstrom, Marie; Asplund, Kenneth; Kristiansen, Lisbeth

2009-01-01

235

Telephone support: a descriptive study in an Italian oncological Day-Hospital ward.  

PubMed

The past decade has been seen widespread use of telephone and computer technologies to provide a broad array of health behaviours intervention and health services. The purpose of this study is to explore the frequency and the reasons about telephone using in an Italian Day Hospital oncological ward. The study was conducted in 2008 throughout a questionnaire filled by nurses that receive patients telephone calls. We analyzed 100 hours of nurses' work corresponding to about 13 days. The mean of daily calls was 30.5 (SD=6.4). 72.2% were calls effectuated on the morning, the others in the afternoon. Nurses spent 13% of their shiftwork time on telephone: 6.97 hours for calls regards directly patients and 5.8 hours for service calls. General information and information on tests results were the more frequent motivations of patients' calls. The study stress major workload for nurses in telephone answers. A significant patient demand emerged that should be addressed also identifying specific hours during the day. PMID:21135903

Quattrin, R; Zanini, A; Di Vora, S; Piller Roner, S; Palese, A; Brusaferro, S

2010-01-01

236

Documenting the NICU design dilemma: parent and staff perceptions of open ward versus single family room units  

Microsoft Academic Search

Objective:With neonatal intensive care units (NICUs) evolving from multipatient wards toward family-friendly, single-family room units, the study objective was to compare satisfaction levels of families and health-care staff across these differing NICU facility designs.Study Design:This prospective study documented, by means of institutional review board-approved questionnaire survey protocols, the perceptions of parents and staff from two contrasting NICU environments.Result:Findings showed that

Renee Domanico; Diana K. Davis; F. Coleman; B O Davis

2010-01-01

237

On the density of the Ward ansätze in the space of anti-self-dual Yang Mills solutions  

Microsoft Academic Search

A general patching matrixP for the twistor construction of antiself-dual Yang-Mills fields is approximated by a terminating Laurent series. The approximate patching matrixP(m) is triangularized (so that it becomes one of the Ward ansätze) and the associated Riemann-Hilbert problem is solved, thereby generating an anti-self-dual solution of the Yang-Mills equations. The approximate patching matrices and the associated (exact) anti-self-dual Yang-Mills

J. S. Ivancovich; L. J. Mason; E. T. Newman

1990-01-01

238

On the density of the Ward ansätze in the space of anti-self-dual Yang Mills solutions  

Microsoft Academic Search

A general patching matrix P for the twistor construction of antiself-dual Yang-Mills fields is approximated by a terminating Laurent series. The approximate patching matrix P(m) is triangularized (so that it becomes one of the Ward ansätze) and the associated Riemann-Hilbert problem is solved, thereby generating an anti-self-dual solution of the Yang-Mills equations. The approximate patching matrices and the associated (exact)

J. S. Ivancovich; L. J. Mason; E. T. Newman

1990-01-01

239

[Appropriateness of admission and hospital stay in pediatric wards: the case of a teaching hospital in Rome].  

PubMed

The objective of our study was to evaluate the appropriateness of admission and hospital stay in pediatric wards of a Teaching Hospital in Rome using the Italian version of pediatric Appropriateness Evaluation Protocol (AEP). We reviewed 263 medical records of patients admitted in hospital during 2004. For each hospitalisation a judge on appropriateness/inappropriateness of admission and hospital stay was elaborated. We retrieved also data on type of ward, date, time and type of admission, date of discharge and data related to each patient. We carried out an univariate and a multivariate logistic regression analysis. Our results showed that the risk of an inappropriate admission is associated to residence out of Rome (OR = 2.45; CI 95%: 1.35-4.47) while the urgent admission is protective against inappropriateness (OR = 0.14; CI 95%: 0.07-0.25). The inappropriate hospital stay is associated to inappropriate admission (OR = 5.82; CI 95%: 3.17-10.70) and hospitalisation in a medical ward (OR = 3.26; CI 95%: 1.81-5.90). Stay in hospital in spring or summer periods is protective against hospitalisation inappropriateness (OR = 0.52; CI 95%: 0.30-0.91). The percentage of inappropriate admission and hospital stay is, respectively, 42.1%, and 50.2%, thus pointing out that there is the need of organisational interventions to reduce inappropriate hospitalisations. PMID:18478673

Chiaradia, G; de Waure, C; La Torre, G; Paparatti, M; Ricciardi, W

2008-01-01

240

Prevalence of potential drug-drug interactions among internal medicine ward in University of Gondar Teaching Hospital, Ethiopia  

PubMed Central

Objective To determine the prevalence, clinical significance and the associated risk factors of potential drug-drug interactions (DDIs) at internal medicine ward of University of Gondar (UOG) hospital. Method A prospective cross-sectional study was conducted on patients treated in internal medicine ward of UOG hospital from April 29, 2013 to June 2, 2013. Data was collected from medical records and by interviewing the patients face to face. Descriptive analysis was conducted for back ground characteristics and logistic regression was used to determine the associated risk factors. Result In our study, we have identified a total number of 413 potential DDIs and 184 types of interacting combinations with 4.13 potential DDIs per patient. Among 413 potential DDIs most were of moderate interactions 61.2% (n=253) followed by 26% (n=107) of minor interactions and 12.8% (n=53) of major interactions. There was significant association of occurrence of potential DDIs only with taking three or more medications. Conclusion We have recorded a high rate of prevalence of potential DDI in the internal medicine ward of UOG hospital and a high number of clinically significant DDIs which the most prevalent DDI were of moderate severity. Careful selection of drugs and active pharmaceutical care is encouraged in order to avoid negative consequences of these interactions.

Bhagavathula, Akshaya Srikanth; Berhanie, Alemayehu; Tigistu, Habtamu; Abraham, Yishak; Getachew, Yosheph; Khan, Tahir Mehmood; Unakal, Chandrashekhar

2014-01-01

241

Do 'virtual wards' reduce rates of unplanned hospital admissions, and at what cost? A research protocol using propensity matched controls  

PubMed Central

Background This retrospective study will assess the extent to which multidisciplinary case management in the form of virtual wards (VWs) leads to changes in the use of health care and social care by patients at high risk of future unplanned hospital admission. VWs use the staffing, systems and daily routines of a hospital ward to deliver coordinated care to patients in their own homes. Admission to a VW is offered to patients identified by a predictive risk model as being at high risk of unplanned hospital admission in the coming 12 months. Study design and data collection methods We will compare the health care and social care use of VW patients to that of matched controls. Controls will be drawn from (a) national, and (b) local, individual-level pseudonymous routine data. The costs of setting up and running a VW will be determined from the perspectives of both health and social care organizations using a combination of administrative data, interviews and diaries. Methods of analysis Using propensity score matching and prognostic matching, we will create matched comparator groups to estimate the effect size of virtual wards in reducing unplanned hospital admissions. Conclusions This study will allow us to determine relative to matched comparator groups: whether VWs reduce the use of emergency hospital care; the impact, if any, of VWs on the uptake of primary care, community health services and council-funded social care; and the potential costs and savings of VWs from the perspectives of the national health service (NHS) and local authorities.

Lewis, Geraint; Bardsley, Martin; Vaithianathan, Rhema; Steventon, Adam; Georghiou, Theo; Billings, John; Dixon, Jennifer

2011-01-01

242

The team builder: the role of nurses facilitating interprofessional student teams at a Swedish clinical training ward.  

PubMed

Interprofessional education (IPE) is an educational strategy attracting increased interest as a method to train future health care professionals. One example of IPE is the clinical training ward, where students from different health care professions practice together. At these wards the students work in teams with the support of facilitators. The professional composition of the team of facilitators usually corresponds to that of the students. However, previous studies have revealed that nurse facilitators are often in the majority, responsible for student nurses' profession specific facilitation as well as interprofessional team orientated facilitation. The objective of this study was to describe how nurses act when facilitating interprofessional student teams at a clinical training ward. The research design was ethnography and data were collected through participant observations and interviews. The analysis revealed the four strategies used when facilitating teams of interprofessional students to enhance collaborative work and professional understanding. The nurse facilitator as a team builder is a new and exciting role for nurses taking on the responsibility of facilitating interprofessional student teams. Future research needs to explore how facilitating nurses balance profession specific and team oriented facilitating within the environment of an interprofessional learning context. PMID:21342789

Elisabeth, Carlson; Ewa, Pilhammar; Christine, Wann-Hansson

2011-09-01

243

Monitoring Vital Signs: Development of a Modified Early Warning Scoring (Mews) System for General Wards in a Developing Country  

PubMed Central

Objective The aim of the study was to develop and validate, by consensus, the construct and content of an observations chart for nurses incorporating a modified early warning scoring (MEWS) system for physiological parameters to be used for bedside monitoring on general wards in a public hospital in South Africa. Methods Delphi and modified face-to-face nominal group consensus methods were used to develop and validate a prototype observations chart that incorporated an existing UK MEWS. This informed the development of the Cape Town ward MEWS chart. Participants One specialist anaesthesiologist, one emergency medicine specialist, two critical care nurses and eight senior ward nurses with expertise in bedside monitoring (N?=?12) were purposively sampled for consensus development of the MEWS. One general surgeon declined and one neurosurgeon replaced the emergency medicine specialist in the final round. Results Five consensus rounds achieved ?70% agreement for cut points in five of seven physiological parameters respiratory and heart rates, systolic BP, temperature and urine output. For conscious level and oxygen saturation a relaxed rule of <70% agreement was applied. A reporting algorithm was established and incorporated in the MEWS chart representing decision rules determining the degree of urgency. Parameters and cut points differed from those in MEWS used in developed countries. Conclusions A MEWS for developing countries should record at least seven parameters. Experts from developing countries are best placed to stipulate cut points in physiological parameters. Further research is needed to explore the ability of the MEWS chart to identify physiological and clinical deterioration.

Kyriacos, Una; Jelsma, Jennifer; James, Michael; Jordan, Sue

2014-01-01

244

Narcissism in patients admitted to psychiatric acute wards: its relation to violence, suicidality and other psychopathology  

PubMed Central

Background The objective was to examine various aspects of narcissism in patients admitted to acute psychiatric wards and to compare their level of narcissism to that of an age- and gender-matched sample from the general population (NORM). Methods This cross-sectional study interviewed 186 eligible acute psychiatric patients with the Brief Psychiatric Rating Scale (BPRS) and the Global Assessment of Functioning (GAF). The patients filled in the Narcissistic Personality Inventory-21 item version (NPI-21), The Hospital Anxiety and Depression Scale (HADS) and the Rosenberg Self-Esteem Scale. High and low narcissism was defined by the median of the total NPI-21 score. An age- and gender-matched control sample from the general population also scored the NPI-21 (NORM). Results Being male, involuntary admitted, having diagnosis of schizophrenia, higher self-esteem, and severe violence were significantly associated with high narcissism, and so were also low levels of suicidality, depression, anxiety and GAF scores. Severe violence and high self-esteem were significantly associated with high narcissism in multivariable analyses. The NPI-21 and its subscales showed test-retest correlations ?0.83, while the BPRS and the HADS showed lower correlations, confirming the trait character of the NPI-21. Depression and suicidality were negatively associated with the NPI-21 total score and all its subscales, while positive association was observed with grandiosity. No significant differences were observed between patients and NORM on the NPI-21 total score or any of the NPI subscales. Conclusion Narcissism in the psychiatric patients was significantly associated with violence, suicidality and other symptoms relevant for management and treatment planning. Due to its trait character, use of the NPI-21 in acute psychiatric patients can give important clinical information. The similar level of narcissism found in patients and NORM is in need of further examination.

Svindseth, Marit F; N?ttestad, Jim Aage; Wallin, Juliska; Roaldset, John Olav; Dahl, Alv A

2008-01-01

245

Characterization of Colonizing Staphylococcus aureus Isolated from Surgical Wards' Patients in a Nigerian University Hospital  

PubMed Central

In contrast to developed countries, only limited data on the prevalence, resistance and clonal structure of Staphylococcus aureus are available for African countries. Since S. aureus carriage is a risk factor for postoperative wound infection, patients who had been hospitalized in surgical wards in a Nigerian University Teaching Hospital were screened for S. aureus carriage. All S. aureus isolates were genotyped (spa, agr) and assigned to multilocus sequence types (MLST). Species affiliation, methicillin-resistance, and the possession of pyrogenic toxin superantigens (PTSAg), exfoliative toxins (ETs) and Panton-Valentine Leukocidin (PVL) were analyzed. Of 192 patients screened, the S. aureus carrier rate was 31.8 % (n?=?61). Of these isolates, 7 (11.5%) were methicillin-resistant (MRSA). The isolates comprised 24 spa types. The most frequent spa types were t064, t084, t311, and t1931, while the most prevalent MLST clonal complexes were CC5 and CC15. The most frequent PTSAg genes detected were seg/sei (41.0%) followed by seb (29.5%), sea (19.7%), seh (14.7%) and sec (11.5). The difference between the possession of classical and newly described PTSAg genes was not significant (63.9% versus 59.0% respectively; P?=?0.602). PVL encoding genes were found in 39.3% isolates. All MRSA isolates were PVL negative, SCCmec types I and VI in MLST CC 5 and CC 30, respectively. Typing of the accessory gene regulator (agr) showed the following distribution: agr group 1 (n?=?20), group II (n?=?17), group III (n?=?14) and group IV (n?=?10). Compared to European data, enterotoxin gene seb and PVL-encoding genes were more prevalent in Nigerian methicillin-susceptible S. aureus isolates, which may therefore act as potential reservoir for PVL and PTSAg genes.

Kolawole, Deboye O.; Adeyanju, Adeniran; Schaumburg, Frieder; Akinyoola, Akinyele L.; Lawal, Oladejo O.; Amusa, Yemisi B.; Kock, Robin; Becker, Karsten

2013-01-01

246

Characterization of colonizing Staphylococcus aureus isolated from surgical wards' patients in a Nigerian university hospital.  

PubMed

In contrast to developed countries, only limited data on the prevalence, resistance and clonal structure of Staphylococcus aureus are available for African countries. Since S. aureus carriage is a risk factor for postoperative wound infection, patients who had been hospitalized in surgical wards in a Nigerian University Teaching Hospital were screened for S. aureus carriage. All S. aureus isolates were genotyped (spa, agr) and assigned to multilocus sequence types (MLST). Species affiliation, methicillin-resistance, and the possession of pyrogenic toxin superantigens (PTSAg), exfoliative toxins (ETs) and Panton-Valentine Leukocidin (PVL) were analyzed. Of 192 patients screened, the S. aureus carrier rate was 31.8 % (n?=?61). Of these isolates, 7 (11.5%) were methicillin-resistant (MRSA). The isolates comprised 24 spa types. The most frequent spa types were t064, t084, t311, and t1931, while the most prevalent MLST clonal complexes were CC5 and CC15. The most frequent PTSAg genes detected were seg/sei (41.0%) followed by seb (29.5%), sea (19.7%), seh (14.7%) and sec (11.5). The difference between the possession of classical and newly described PTSAg genes was not significant (63.9% versus 59.0% respectively; P?=?0.602). PVL encoding genes were found in 39.3% isolates. All MRSA isolates were PVL negative, SCCmec types I and VI in MLST CC 5 and CC 30, respectively. Typing of the accessory gene regulator (agr) showed the following distribution: agr group 1 (n?=?20), group II (n?=?17), group III (n?=?14) and group IV (n?=?10). Compared to European data, enterotoxin gene seb and PVL-encoding genes were more prevalent in Nigerian methicillin-susceptible S. aureus isolates, which may therefore act as potential reservoir for PVL and PTSAg genes. PMID:23935883

Kolawole, Deboye O; Adeyanju, Adeniran; Schaumburg, Frieder; Akinyoola, Akinyele L; Lawal, Oladejo O; Amusa, Yemisi B; Köck, Robin; Becker, Karsten

2013-01-01

247

Utilization Effect of Integrating a Chest Radiography Room into a Thoracic Surgery Ward  

PubMed Central

PURPOSE Bedside chest radiography (bCXR) represents a substantial fraction of the volume of medical imaging for inpatient healthcare facilities. However, its image quality is limited compared to posterior-anterior/lateral (PA/LAT) acquisitions taken radiographic rooms. We evaluated utilization of bCXR and other chest imaging modalities before and after placing a radiography room within our thoracic surgical inpatient ward. METHODS Institutional review board approval was obtained for this HIPAA-compliant. We retrospectively identified all patient admissions (3,852) to the thoracic surgical units between April 1, 2007 and December 31, 2010. All chest imaging tests performed for these patients including computed tomography (CT) scans, magnetic resonance imaging (MRI), ultrasound (US), bedside and PA/LAT radiographs were counted. Our primary outcome measure was chest imaging utilization, defined as the number of chest examinations per admission, pre- and post-establishment of the digital radiography room on January, 10th 2010. Statistical analysis was performed using an independent-samples t-test to evaluate changes in chest imaging utilization. RESULTS We observed a 2.61 fold increase in the number of PA/LAT CXR per admission (p<0.01) and a 1.96 fold decrease in the number of bCXR per admission (p<0.01) post radiography room implementation. The number of chest CT, MRI and US per admission did not change significantly. CONCLUSION Establishing a radiography room physically within thoracic surgery units or in close proximity can significantly shift CXR utilization from bedside to PA/LAT acquisitions, which may enable opportunities for improvement in efficiency, quality, and safety in patient care.

Maehara, Cleo; Jacobson, Francine; Andriole, Katherine P.; Khorasani, Ramin

2012-01-01

248

Microbial habitat dynamics and ablation control on the Ward Hunt Ice Shelf  

NASA Astrophysics Data System (ADS)

The Ward Hunt Ice Shelf (83°02N, 74°00W) is an 40 m thick ice feature that occupies a large embayment along Canada's northernmost coast. Sediments cover 10% of its surface and provide a habitat for diverse microbial communities. These assemblages form an organo-sedimentary matrix (microbial mat) composed of cold-tolerant cyanobacteria and several other types of organisms. We investigated the environmental properties (temperature, irradiance, conductivity and nutrient concentration) of the microbial mat habitat and the effect of the microbial mats on the surface topography of the ice shelf. The low albedo of microbial mats relative to the surrounding snow and ice encouraged meltwater production, thereby extending the growth season to 61 days despite only 52 days with mean temperatures above 0 °C. We found large excursions in salinity near the microbial mat during freeze-up and melt, and 54% of all ponds sampled had conductivity profiles indicating stratification. Nutrient concentrations within the microbial mats were up to two orders of magnitude higher than those found in the water column, which underscores the differences between the microbial mat microenvironment and the overall bulk properties of the cryo-ecosystem. The average ice surface ablation in the microbial mat-rich study site was 1.22 m year-1, two times higher than values measured in areas of the ice shelf where mats were less prevalent. We demonstrate with topographic surveys that the microbial mats promote differential ablation and conclude that the cohesive microbial aggregates trap and stabilize sediment, reduce albedo, and thereby influence the surface morphology of the ice shelf.

Mueller, Derek R.; Vincent, Warwick F.

2006-03-01

249

Acquired CNS Demyelinating Syndrome in Children Referred to ShirazPediatric Neurology Ward  

PubMed Central

Objective Incidence of CNS acquired demyelinating syndrome (ADS), especially multiple sclerosis (MS) in children, appears to be on the rise worldwide. The objective of this study was to determine prevalence, clinical presentation, neuroimaging features, and prognosis of different types of ADS in Iranian children. Materials & Methods During the period 2002-2012, all the patients (aged 1-18 years) with ADS, such as MS, acute disseminated encephalomyelitis (ADEM), optic neurotic (ON), Devic disease, and transverse myelitis (TM), referred to the pediatric neurology ward, Nemazee Hospital, Shiraz University of Medical Sciences, were included in this study. Demographic data, clinical signs and symptoms, past and family history, preclinical findings, clinical course, and outcome were obtained. Results We identified 88 patients with ADS in our center. The most prevalent disease was MS with 36.5% (n=32), followed by AEDM 26.1% (n=31), ON 17% (n=13), TM 15.9% (n=14), and Devic disease 4.5% (n=4). MS, ON, TM were more common among females while ADEM was more common in males. Children with ADEM were significantly younger than those with other types of ADS. Family history was positive in 10% of patients with MS. Previous history of recent infection was considerably seen in cases with ADEM. Clinical presentation and prognosis in this study was in accordance with those in previous studies on children. Conclusion In this study, the most common type of ADS was MS, which was more common in female and older age cases. ADEM was more common in male and younger children. ADEM and ON had the best and Devic disease had the worst prognosis.

INALOO, Soroor; HAGHBIN, Saeedeh; MORADI, Mehrpoor; DASHTI, Hassan; SAFARI, Nazila

2014-01-01

250

Treatment in a ward for elderly patients with dementia in Japan  

PubMed Central

Background Japan has become the world’s most aged country. The percentage of elderly people in Japan is estimated to reach 25.2% in 2013, and the number of patients with dementia is estimated to reach 2.5 million in 2015. In addition to its deterioration of physical function and activities of daily living (ADL), behavioral and psychological symptoms of dementia (BPSD) often become major clinical problems, greatly annoying patients and their caregivers. In Japan, we utilize wards for elderly patients with dementia (WEDs) for BPSD treatment. However, there are few studies investigating the effectiveness of treatment in a WED. In such treatment, physical complications are a challenge physicians must overcome while treating BPSD and safely returning patients home or to the institutions in which they live. Therefore, we investigated the effectiveness of treatment in a WED, focusing on physical complications. Methods The subjects were 88 patients who were admitted to and discharged from a WED. Severity of dementia, basic ADL, and BPSD were investigated using the Clinical Dementia Rating, Physical Self-Maintenance Scale (PSMS), and Neuropsychiatric Inventory. Differences in characteristics between patients discharged from the WED because of physical complications and all other patients were also examined. Results: We found significant improvements in the PSMS score and decreases in delusions and sleep disturbances in all patients. Patients discharged from the WED because of physical complications had significantly greater severity of dementia at discharge compared to all other patients. Conclusion: Treatment in a WED seems to be effective for BPSD and ADL, but care should be taken regarding physical complications, especially in patients with advanced dementia.

Taniguchi, Shogo; Narumoto, Jin; Shibata, Keisuke; Ayani, Nobutaka; Matsuoka, Teruyuki; Okamura, Aiko; Nakamura, Kaeko; Shimizu, Hiroshi; Fukui, Kenji

2013-01-01

251

A case-control study of purple urine bag syndrome in geriatric wards.  

PubMed

The clinical background of purple urine bag syndrome (PUBS) has not yet been well characterized. In previous reports, clinical, biochemical, or bacteriological analyses were carried out using urine or bacteria from a limited number of patients. Other than one report, we are not aware of any case-control studies that compared the clinical, biochemical, or bacteriological background between patients with and without PUBS. To examine the risk of PUBS, we carried out a case-control study. Twenty-six patients, in three long-term care wards, who had been catheterized for more than 3 months with the same types of balloon catheters and who had the same type of disposable plastic urine bags were enrolled as the PUBS-positive case group (14 patients; 2 men and 12 women), and as the PUBS-negative control group (12 patients; 4 men and 8 women) were enrolled. The data for urine tests (pH, sugar, protein, leukocyte counts, and bacterial yields and species) were compared for the two groups. A relatively higher prevalence of PUBS was observed in female and alkaline-urine-producing patients. Bacteriological studies, using fresh urine collected through the catheter, showed that the bacterial counts were significantly higher, by 1 to 2 logs, in most samples from the case group than those from the control group (P = 0.012). Although a total of 66 bacterial strains, belonging to 12 separate species, were isolated from the urine accumulated in bags, no causative relationship between bacterial species and PUBS was observed. These data suggest that a higher bacterial yield in urine acts as the most important factor in PUBS, in combination with other facilitating factors, such as female-specific ones and the alkaline condition of urine. PMID:12673408

Mantani, Naoki; Ochiai, Hiroshi; Imanishi, Nobuko; Kogure, Toshiaki; Terasawa, Katsutoshi; Tamura, Jun'ichi

2003-03-01

252

Care transitions for frail, older people from acute hospital wards within an integrated healthcare system in England: a qualitative case study  

PubMed Central

Introduction Frail older people experience frequent care transitions and an integrated healthcare system could reduce barriers to transitions between different settings. The study aimed to investigate care transitions of frail older people from acute hospital wards to community healthcare or community hospital wards, within a system that had vertically integrated acute hospital and community healthcare services. Theory and methods The research design was a multimethod, qualitative case study of one healthcare system in England; four acute hospital wards and two community hospital wards were studied in depth. The data were collected through: interviews with key staff (n = 17); focus groups (n = 9) with ward staff (n = 36); interviews with frail older people (n = 4). The data were analysed using the framework approach. Findings Three themes are presented: Care transitions within a vertically integrated healthcare system, Interprofessional communication and relationships; Patient and family involvement in care transitions. Discussion and conclusions A vertically integrated healthcare system supported care transitions from acute hospital wards through removal of organisational boundaries. However, boundaries between staff in different settings remained a barrier to transitions, as did capacity issues in community healthcare and social care. Staff in acute and community settings need opportunities to gain better understanding of each other's roles and build relationships and trust.

Baillie, Lesley; Gallini, Andrew; Corser, Rachael; Elworthy, Gina; Scotcher, Ann; Barrand, Annabelle

2014-01-01

253

An observational study in psychiatric acute patients admitted to General Hospital Psychiatric Wards in Italy  

PubMed Central

Objectives this Italian observational study was aimed at collecting data of psychiatric patients with acute episodes entering General Hospital Psychiatric Wards (GHPWs). Information was focused on diagnosis (DSM-IV), reasons of hospitalisation, prescribed treatment, outcome of aggressive episodes, evolution of the acute episode. Methods assessments were performed at admission and discharge. Used psychometric scales were the Brief Psychiatric Rating Scale (BPRS), the Modified Overt Aggression Scale (MOAS) and the Nurses' Observation Scale for Inpatient Evaluation (NOSIE-30). Results 864 adult patients were enrolled in 15 GHPWs: 728 (320 M; mean age 43.6 yrs) completed both admission and discharge visits. A severe psychotic episode with (19.1%) or without (47.7%) aggressive behaviour was the main reason of admission. Schizophrenia (42.8% at admission and 40.1% at discharge) and depression (12.9% at admission and 14.7% at discharge) were the predominant diagnoses. The mean hospital stay was 12 days. The mean (± SD) total score of MOAS at admission, day 7 and discharge was, respectively, 2.53 ± 5.1, 0.38 ± 2.2, and 0.21 ± 1.5. Forty-four (6.0%) patients had episodes of aggressiveness at admission and 8 (1.7%) at day 7. A progressive improvement in each domain/item vs. admission was observed for MOAS and BPRS, while NOSIE-30 did not change from day 4 onwards. The number of patients with al least one psychotic drug taken at admission, in the first 7 days of hospitalisation, and prescribed at discharge, was, respectively: 472 (64.8%), 686 (94.2%) and 676 (92.9%). The respective most frequently psychotic drugs were: BDZs (60.6%, 85.7%, 69.5%), typical anti-psychotics (48.3%, 57.0%, 49.6%), atypical anti-psychotics (35.6%, 41.8%, 39.8%) and antidepressants (40.9%, 48.8%, 43.2%). Rates of patients with one, two or > 2 psychotic drugs taken at admission and day 7, and prescribed at discharge, were, respectively: 24.8%, 8.2% and 13.5% in mono-therapy; 22.0%, 20.6% and 26.6% with two drugs, and 53.2%, 57.8% and 59.0% with > two drugs. Benzodiazepines were the most common drugs both at admission (60.0%) and during hospitalisation (85.7%), and 69.5% were prescribed at discharge. Conclusion patients with psychiatric diseases in acute phase experienced a satisfactory outcome following intensified therapeutic interventions during hospitalisation.

Ballerini, Andrea; Boccalon, Roberto; Boncompagni, Giancarlo; Casacchia, Massimo; Margari, Francesco; Minervini, Lina; Righi, Roberto; Russo, Federico; Salteri, Andrea

2007-01-01

254

"Driving the devil away": qualitative insights into miraculous cures for AIDS in a rural Tanzanian ward  

PubMed Central

Background The role of religious beliefs in the prevention of HIV and attitudes towards the infected has received considerable attention. However, little research has been conducted on Faith Leaders' (FLs) perceptions of antiretroviral therapy (ART) in the developing world. This study investigated FLs' attitudes towards different HIV treatment options (traditional, medical and spiritual) available in a rural Tanzanian ward. Methods Qualitative interviews were conducted with 25 FLs purposively selected to account for all the denominations present in the area. Data was organised into themes using the software package NVIVO-7. The field work guidelines were tailored as new topics emerged and additional codes progressively added to the coding frame. Results Traditional healers (THs) and FLs were often reported as antagonists but duality prevailed and many FLs simultaneously believed in traditional healing. Inter-denomination mobility was high and guided by pragmatism. Praying for the sick was a common practice and over one third of respondents said that prayer could cure HIV. Being HIV-positive was often seen as "a punishment from God" and a consequence of sin. As sinning could result from "the work of Satan", forgiveness was possible, and a "reconciliation with God" deemed as essential for a favourable remission of the disease. Several FLs believed that "evil spirits" inflicted through witchcraft could cause the disease and claimed that they could cast "demons" away. While prayers could potentially cure HIV "completely", ART use was generally not discouraged because God had "only a part to play". The perceived potential superiority of spiritual options could however lead some users to interrupt treatment. Conclusions The roll-out of ART is taking place in a context in which the new drugs are competing with a diversity of existing options. As long as the complementarities of prayers and ART are not clearly and explicitly stated by FLs, spiritual options may be interpreted as a superior alternative and contribute to hampering adherence to ART. In contexts where ambivalent attitudes towards the new drugs prevail, enhancing FLs understanding of ART's strengths and pitfalls is an essential step to engage them as active partners in ART scale-up programs.

2010-01-01

255

The Relationship between Therapeutic Alliance and Service User Satisfaction in Mental Health Inpatient Wards and Crisis House Alternatives: A Cross-Sectional Study  

PubMed Central

Background Poor service user experiences are often reported on mental health inpatient wards. Crisis houses are an alternative, but evidence is limited. This paper investigates therapeutic alliances in acute wards and crisis houses, exploring how far stronger therapeutic alliance may underlie greater client satisfaction in crisis houses. Methods and Findings Mixed methods were used. In the quantitative component, 108 crisis house and 247 acute ward service users responded to measures of satisfaction, therapeutic relationships, informal peer support, recovery and negative events experienced during the admission. Linear regressions were conducted to estimate the association between service setting and measures, and to model the factors associated with satisfaction. Qualitative interviews exploring therapeutic alliances were conducted with service users and staff in each setting and analysed thematically. Results We found that therapeutic alliances, service user satisfaction and informal peer support were greater in crisis houses than on acute wards, whilst self-rated recovery and numbers of negative events were lower. Adjusted multivariable analyses suggest that therapeutic relationships, informal peer support and negative experiences related to staff may be important factors in accounting for greater satisfaction in crisis houses. Qualitative results suggest factors that influence therapeutic alliances include service user perceptions of basic human qualities such as kindness and empathy in staff and, at service level, the extent of loss of liberty and autonomy. Conclusions and Implications We found that service users experience better therapeutic relationships and higher satisfaction in crisis houses compared to acute wards, although we cannot exclude the possibility that differences in service user characteristics contribute to this. This finding provides some support for the expansion of crisis house provision. Further research is needed to investigate why acute ward service users experience a lack of compassion and humanity from ward staff and how this could be changed.

Sweeney, Angela; Fahmy, Sarah; Nolan, Fiona; Morant, Nicola; Fox, Zoe; Lloyd-Evans, Brynmor; Osborn, David; Burgess, Emma; Gilburt, Helen; McCabe, Rosemarie; Slade, Mike; Johnson, Sonia

2014-01-01

256

Population mixing, socioeconomic status and incidence of childhood acute lymphoblastic leukaemia in England and Wales: analysis by census ward.  

PubMed

In this population-based study of acute lymphoblastic leukaemia (ALL) diagnosed among children aged under 15 years in England and Wales during 1986-1995, we analysed incidence at census ward level in relation to a range of variables from the 1991 census, which could be relevant to theories of infectious aetiology. 'Population-mixing' measures, used as surrogates for quantity and diversity of infections entering the community, were calculated from census data on the origins and destinations of migrants in the year before the census. Incidence at ages 1-4 years tended independently to be higher in rural wards, to increase with the diversity of origin wards from which in-migrants had moved during the year before the census, and to be lower in the most deprived areas as categorised by the Carstairs index. This last association was much weaker when urban/rural status and in-migrants' diversity were allowed for. There was no evidence of association with population mixing or deprivation for ALL diagnosed at ages 0 or 5-14 years. The apparent specificity to the young childhood age group suggests that these associations are particularly marked for precursor B-cell ALL, with the disease more likely to occur when delayed exposure to infection leads to increased immunological stress, as predicted by Greaves. The association with diversity of incomers, especially in rural areas, is also consistent with the higher incidence of leukaemia predicted by Kinlen, where population mixing results in below average herd immunity to an infectious agent. PMID:18253115

Stiller, C A; Kroll, M E; Boyle, P J; Feng, Z

2008-03-11

257

Main clinical features in patients at their first psychiatric admission to Italian acute hospital psychiatric wards. The PERSEO study  

PubMed Central

Background Few data are available on subjects presenting to acute wards for the first time with psychotic symptoms. The aims of this paper are (i) to describe the epidemiological and clinical characteristics of patients at their first psychiatric admission (FPA), including socio-demographic features, risk factors, life habits, modalities of onset, psychiatric diagnoses and treatments before admission; (ii) to assess the aggressive behavior and the clinical management of FPA patients in Italian acute hospital psychiatric wards, called SPDCs (Servizio Psichiatrico Diagnosi e Cura = psychiatric service for diagnosis and management). Method Cross-sectional observational multi-center study involving 62 Italian SPDCs (PERSEO – Psychiatric EmeRgency Study and EpidemiOlogy). Results 253 FPA aged <= 40 were identified among 2521 patients admitted to Italian SPDCs over the 5-month study period. About half of FPA patients showed an aggressive behavior as defined by a Modified Overt Aggression Scale (MOAS) score greater than 0 Vs 46% of non-FPA patients (p = 0.3651). The most common was verbal aggression, while about 20% of FPA patients actually engaged in physical aggression against other people. 74% of FPA patients had no diagnosis at admission, while 40% had received a previous psychopharmacological treatment, mainly benzodiazepines and antidepressants. During SPDC stay, diagnosis was established in 96% of FPA patients and a pharmacological therapy was prescribed to 95% of them, mainly benzodiazepines, antipsychotics and mood stabilizers. Conclusion Subjects presenting at their first psychiatric ward admission have often not undergone previous adequate psychiatric assessment and diagnostic procedures. The first hospital admission allows diagnosis and psychopharmacological treatment to be established. In our population, aggressive behaviors were rather frequent, although most commonly verbal. Psychiatric symptoms, as evaluated by psychiatrists and patients, improved significantly from admission to discharge both for FPA and non-FPA patients.

Ballerini, Andrea; Boccalon, Roberto M; Boncompagni, Giancarlo; Casacchia, Massimo; Margari, Francesco; Minervini, Lina; Righi, Roberto; Russo, Federico; Salteri, Andrea; Frediani, Sonia; Rossi, Andrea; Scatigna, Marco

2007-01-01

258

IR system to provide effective IR countermeasure (IRCM) capability to ward off threats posed by shoulder-fired missiles (SFMs)  

NASA Astrophysics Data System (ADS)

This paper present an unique IR sensor technology capable of providing effective deception and noise jamming IReM capability to ward off threats posed by SFMs or STINGER missiles operated by various terrorist groups and Islamic radicals. More than 60,000 such missiles are currently in the hands of Islamic radicals and terrorist groups. Even one such missile can bring down a commercial jet transport carrying more than 350 passengers. The proposed IReM system deploys innovative jamming technique to confuse the missile seeker receiver by introducing sharp FM-modulated noise spikes in the receiver bandwidth, thereby preventing the detection and tracking of aircraft.

Jha, A. R.

2007-11-01

259

Regularisation: many recipes, but a unique principle: Ward identities and normalisation conditions. The case of CPT violation in QED  

NASA Astrophysics Data System (ADS)

We analyse the recent controversy on a possible Chern-Simons like term generated through radiative corrections in QED with a CPT violating term: we prove that, if the theory is correctly defined through Ward identities and normalisation conditions, no Chern-Simons term appears, without any ambiguity. This is related to the fact that such a term is a kind of minor modification of the gauge fixing term, and then no renormalised. The past year literature on that subject is discussed, and we insist on the fact that any absence of an a priori divergence should be explained by some symmetry or some non-renormalisation theorem.

Bonneau, Guy

2001-01-01

260

Exilic effects of illness and pain in Solzhenitsyn's Cancer Ward: how sharpening the moral imagination can facilitate repatriation.  

PubMed

This essay uses Solzhenitsyn's Cancer Ward to explore the exilic effects of illness and pain. The novel is uniquely suited for such an analysis given the theme of exile that predominates both in the narrative and in the composition of multiple characters within that narrative. I argue that illness, and in particular pain, is a liminal state, an existential hinterlands. The ethical approach to literature and medicine may suggest, as a response to these exilic effects, the need to cultivate connection and empathy by sharpening the moral imagination. If pain and illness exile the sufferer, the imperative to reach out takes on ethical content. PMID:18946635

Goldberg, Daniel S

2009-03-01

261

Cost-effectiveness of ward-based pharmacy care in surgical patients: protocol of the SUREPILL (Surgery & Pharmacy In Liaison) study  

PubMed Central

Background Preventable adverse drug events (pADEs) are widely known to be a health care issue for hospitalized patients. Surgical patients are especially at risk, but prevention of pADEs in this population is not demonstrated before. Ward-based pharmacy interventions seem effective in reducing pADEs in medical patients. The cost-effectiveness of these preventive efforts still needs to be assessed in a comparative study of high methodological standard and also in the surgical population. For these aims the SUREPILL (Surgery & Pharmacy in Liaison) study is initiated. Methods/Design A multi-centre controlled trial, with randomisation at ward-level and preceding baseline assessments is designed. Patients admitted to the surgical study wards for elective surgery with an expected length of stay of more than 48 hours will be included. Patients admitted to the intervention ward, will receive ward-based pharmacy care from the clinical pharmacy team, i.e. pharmacy practitioners and hospital pharmacists. This ward-based pharmacy intervention includes medication reconciliation in consultation with the patient at admission, daily medication review with face-to-face contact with the ward doctor, and patient counselling at discharge. Patients admitted in the control ward, will receive standard pharmaceutical care. The primary clinical outcome measure is the number of pADEs per 100 elective admissions. These pADEs will be measured by systematic patient record evaluation using a trigger tool. Patient records positive for a trigger will be evaluated on causality, severity and preventability by an independent expert panel. In addition, an economic evaluation will be performed from a societal perspective with the costs per preventable ADE as the primary economic outcome. Other outcomes of this study are: severity of pADEs, number of patients with pADEs per total number of admissions, direct (non-)medical costs and indirect non-medical costs, extra costs per prevented ADE, number and type of pharmacy interventions, length of hospital stay, complications registered in a national complication registration system for surgery, number of readmissions within three months after initial admission (follow-up), quality of life and number of non-institutionalized days during follow-up. Discussion This study will assess the cost-effectiveness of ward-based pharmacy care on preventable adverse drug events in surgical patients from a societal perspective, using a comparative study design. Trial registration Netherlands Trial Register (NTR): NTR2258

2011-01-01

262

[Patient record based ward rounds as an example of coordination between doctors and nurses "courses of action"].  

PubMed

Working in the hospital field is characterized by collective work that requires collaboration and coordination. Characterizing the way, in which individual activities contribute to the construction of a collective activity, is an important issue to better understand teamwork. A phenomenological research approach was applied to analyze the situated activity of nurses and physicians during patient record based ward rounds, according to the theoretical and methodological frame of "course of action" Our findings revealed ward rounds comprising not only an information exchange but a privileged space and moment of construction of knowledge and coordination. Two processes were derived from the actors' commitments and concerns, and from their articulation: "seeking to contribute to a shared interpretation of the situation" and "seeking to develop a precise working knowledge of the situation". These processes contribute to characterize the coordination between the professionals involved in hospital care. Future educational activities for health care professionals should consider the importance of the perception of and meanings for the involved professionals and consider training actions to foster reflecting on and during action. PMID:23923739

Nadot Ghanem, Nicole

2013-06-01

263

Evaluation of the antioxidant and hepatoprotective effect of Majoon-e-Dabeed-ul-ward against carbon tetrachloride induced liver injury.  

PubMed

The present study was designed to demonstrate the antioxidant and hepatoprotective effect of Majoon-e-Dabeed-ul-ward, a Unani herbal formulation. The Majoon-e-Dabeed-ul-ward (MD) at the doses of 250, 500 and 1000 mg/kg, p.o. was administered after carbon-tetrachloride (CCl(4); 1.5 ml/kg, i.p. once only) intoxication. Treatment with MD at three doses brought the levels of aspartate transaminase, alanine transaminase, albumin and urea in dose dependent manner. Signification reduction was found in TBARS content and restored the level of reduced glutathione, adenosine triphosphatase, and glucose-6-phosphatase in liver. Therapy of MD showed its protective effect on biochemical and histopathological observation at all the three doses in a dose dependent manner. The study conducted showed that MD possesses strong hepatoprotective activity as decrease the hexobarbitone sleep time and improvement in physiological parameter, excretory capacity (BSP retention time) was seen. DPPH and H(2)O(2) scavenging effects indicated its potent antioxidant activities. The results revealed that MD could afford significant dose-dependent protection against CCl(4) induced hepatocellular injury. PMID:21371873

Shakya, Arvind Kumar; Sharma, Neetu; Saxena, Monika; Shrivastava, Sadhana; Shukla, Sangeeta

2012-11-01

264

Preliminary study of the fungal ecology at the haematology and medical-oncology ward in bamako, mali.  

PubMed

Data on fungal epidemiology in sub-Saharan African countries are scarce. This exploratory study aimed to characterize the fungal flora at the Onco-Haematology ward of the National Teaching Hospital of Point G in Bamako, Mali. A cross-sectional survey was conducted in the dry and in the rainy seasons. Nasal swab and sputum samples were collected from the hospitalized patients while airborne fungal spores were collected using electrostatic dust-fall collectors. Fungi were identified by their morphological characteristics and MALDI-TOF mass spectrometry. Candida albicans was the most frequent yeast species colonizing patients; Aspergillus species were isolated in 86 % of the patients and were the main airborne environmental contaminants. Overall, airborne fungal contamination rates increased from 33.8 % in the dry to 66.2 % in the rainy season (p < 0.001). The most frequent Aspergillus species were Aspergillus niger (36.6 %) and Aspergillus flavus (32.92 %). In contrast, Aspergillus fumigatus (5.43 %) was relatively rare. This high level of fungal exposure raises concern regarding the management of at-risk patients in this Onco-Haematology ward and stresses the need for strengthening the mycological diagnostic capacities to accompany the implementation of adapted fungal infection prevention and management policies. PMID:24889723

Niaré-Doumbo, Safiatou; Normand, Anne Cécile; Diallo, Yacouba Lazarre; Dembelé, Abdoul Karim; Thera, Mahamadou A; Diallo, Dapa; Piarroux, Renaud; Doumbo, Ogobara; Ranque, Stéphane

2014-08-01

265

The Good Pain Management (GPM) Ward Program in China and its impact on Chinese cancer patients: the SYSUCC experience  

PubMed Central

To improve cancer pain management, the Medical Oncology Department of Sun Yat-sen University Cancer Center (SYSUCC) launched the Good Pain Management (GPM) Ward Program, which has been recognized by the Chinese Ministry of Health and promoted throughout the nation. This retrospective case-control study was designed to evaluate the effectiveness of the program. Patients diagnosed with malignant solid tumors with bone metastasis were eligible. Patients who were admitted 6 months before the initiation of the GPM program were used as the control group, and patients admitted 6 months after the initiation of the program were used as the GPM group. The pain-reporting rate and pain management index (PMI) were calculated. The pain levels before and after pain management were compared. A total of 475 patients (244 in the control group and 231 in the GPM group) were analyzed. The pain-reporting rate of the GPM group was significantly higher than that of the control group (62.8% vs. 37.7%, P < 0.001). The PMI of the GPM group was significantly higher than that of the control group (0.083 vs. -0.261, P < 0.001). Therefore, the GPM Ward Program improved the pain management of cancer patients and provided experience for improving cancer pain management in the future.

Yang, Yun-Peng; Ma, Yu-Xiang; Huang, Yan; Zhao, Yuan-Yuan; Xu, Fei; Tian, Ying; Zou, Ben-Yan; Gao, Rui-Zhen; Zhang, Li

2014-01-01

266

Retrospective review of trends in assaults and seclusion at an acute psychiatric ward over a 5-year period.  

PubMed

In developing countries such as South Africa, not much is known about the prevalence of assaults and seclusion occurring in mental health wards over time. Here, we describe a 5-year trend in assaults and seclusions, stratified by gender, at Stikland Hospital, South Africa. A retrospective review of clinical records of patients admitted to the acute psychiatric admission wards at Stikland and involved in assault and secluded was undertaken between 1 January 2005 and 31 December 2010. Data on the number of patient and staff assaults as well as seclusions, gender, age, marital status, level of education, level of income, duration of hospital admission and primary psychiatric diagnosis were collected. Significantly (P < 0.01) more men than women engaged in patient assaults, while significantly (P < 0.01) more men were secluded than women. On a monthly basis, the number of gender-stratified patient assaults and seclusions significantly increased (P < 0.01) throughout the study period. In conclusion, we show here that gender had a significant effect on both patient assault and seclusion numbers, which increased towards the end of the study period. Monitoring of these events is therefore important to continuously improve quality of care. PMID:22988983

Luckhoff, M; Jordaan, E; Swart, Y; Cloete, K J; Koen, L; Niehaus, D J H

2013-10-01

267

Genetic diversity in sugarcane varieties in Brazil based on the Ward-Modified Location Model clustering strategy.  

PubMed

We evaluated the genetic diversity of 77 clones of sugarcane used in crosses made by the Brazilian interuniversity network for the development of the sugar/energy sector (RIDESA) breeding program. Characterization of the genotypes was carried out at the ratoon stage, based on eight morphological traits and seven agronomic traits. Diversity analysis was carried out beginning with the Ward-Modified Location Model. The ideal number of groups was three. Groups 1, 2, and 3 were composed of 37, 21, and 19 accessions, respectively. Group 1 was formed entirely of commercial varieties (hybrids of advanced generations) and elite clones, with the exception of the old varieties 'Caiana Fita' and 'Cana Blanca' (hybrids of Saccharum officinarum). In general, group 2 had more divergent accessions regarding origin, including L60-14, NG57-6, TUC77-42, IN84-105 (hybrid of S. officinarum), and 28NG289 (species of S. robustum). Group 3 was formed entirely of commercial varieties and elite clones from the RIDESA program, with the exception of genotypes Co285 (India), Q124 (Australia) and VAT90-212 (unknown origin). The analysis based on the Ward-Modified Location Model procedure resulted in an adequate and clearly discriminating grouping of sugarcane accessions, allowing the use of all the available information about the genotypes, in a mix of continuous and categorical variables. PMID:24535897

Brasileiro, B P; Marinho, C D; Costa, P M A; Moreira, E F A; Peternelli, L A; Barbosa, M H P

2014-01-01

268

How does the environment impact on the quality of life of advanced cancer patients? A qualitative study with implications for ward design.  

PubMed

It is well recognized that the ward environment has an effect on patients' quality of life and may, therefore, impact on the quality of end of life care. The body of evidence that informs ward design policy recommends single-bedded rooms on grounds of reduced infection risk, noise and versatility. Considering the majority of anticipated patient deaths occurring in hospitals, the quality of life aspects of ward design should also be considered. The aim of this study is to explore the views of patients with advanced cancer on the effect the ward environment has on their overall well-being. Semi-structured interviews exploring the experiences of 12 inpatients at a regional cancer centre were recorded and transcribed verbatim. Transcripts were analysed for emerging themes until theoretical saturation. Four major themes emerged: staff behaviours, the immediate environment, single vs. multi-bedded rooms and contact with the outside environment. The attitude, competence and helpfulness of the staff creates the atmosphere of the ward regardless of layout, furnishings, equipment and décor. The majority of the patients in this study expressed a strong preference for a multi-bedded room when they were well enough to interact and a single cubicle when they were very ill or dying, which opposes the current advice for building new hospitals with all single rooms. Although the current policy recommends the use of single-bedded rooms, this study suggests the need for a mix of multi-bedded wards and single rooms with respect to the impact of the environment on patient quality of life. PMID:18715977

Rowlands, J; Noble, S

2008-09-01

269

Conflicting priorities: evaluation of an intervention to improve nurse-parent relationships on a Tanzanian paediatric ward  

PubMed Central

Background Patient, or parent/guardian, satisfaction with health care provision is important to health outcomes. Poor relationships with health workers, particularly with nursing staff, have been reported to reduce satisfaction with care in Africa. Participatory research approaches such as the Health Workers for Change initiative have been successful in improving provider-client relationships in various developing country settings, but have not yet been reported in the complex environment of hospital wards. We evaluated the HWC approach for improving the relationship between nurses and parents on a paediatric ward in a busy regional hospital in Tanzania. Methods The intervention consisted of six workshops, attended by 29 of 31 trained nurses and nurse attendants working on the paediatric ward. Parental satisfaction with nursing care was measured with 288 parents before and six weeks after the workshops, by means of an adapted Picker questionnaire. Two focus-group discussions were held with the workshop participants six months after the intervention. Results During the workshops, nurses demonstrated awareness of poor relationships between themselves and mothers. To tackle this, they proposed measures including weekly meetings to solve problems, maintain respect and increase cooperation, and representation to administrative forces to request better working conditions such as equipment, salaries and staff numbers. The results of the parent satisfaction questionnaire showed some improvement in responsiveness of nurses to client needs, but overall the mean percentage of parents reporting each of 20 problems was not statistically significantly different after the intervention, compared to before it (38.9% versus 41.2%). Post-workshop focus-group discussions with nursing staff suggested that nurses felt more empathic towards mothers and perceived an improvement in the relationship, but that this was hindered by persisting problems in their working environment, including poor relationships with other staff and a lack of response from hospital administration to their needs. Conclusion The intended outcome of the intervention was not met. The priorities of the intervention – to improve nurse-parent relationships – did not match the priorities of the nursing staff. Development of awareness and empathy was not enough to provide care that was satisfactory to clients in the context of working conditions that were unsatisfactory to nurses.

Manongi, Rachel N; Nasuwa, Fortunata R; Mwangi, Rose; Reyburn, Hugh; Poulsen, Anja; Chandler, Clare IR

2009-01-01

270

The Ward and Hudson pathways model of the sexual offense process applied to offenders with intellectual disability.  

PubMed

The offense pathways model of Ward and Hudson has had a significant impact on work with sex offenders. Researchers have hypothesised that offenders with intellectual disability (ID) will show a predominantly avoidant and passive pathway. The present study classifies 62 sex offenders with ID according to the four self-regulation pathways. Allocation to pathways is highly reliable and, against prediction, most participants are allocated to approach pathways. Explicit/active offenders have a higher rate of contact offenses and a lower rate of reoffending. Automatic/passive offenders have a lower average IQ. There are no significant differences between groups on victim choice, previous offenses, or assessment of cognitive distortions. The results suggest that treatment may improve understanding of society's laws, promote self-regulation, and reduce recidivism for explicit/active offenders. PMID:18941166

Lindsay, William R; Steptoe, Lesley; Beech, Anthony T

2008-12-01

271

[Dealing with parents facing imminent death of their neonate: introducing palliative care in maternity wards and neonatal intensive care units].  

PubMed

Following antenatal diagnosis of a lethal disorder, some parents are so overwhelmed by grief that therapeutic abortion is seen as the least traumatic option. However, the impending death and anticipated mourning create a particularly complex emotional situation. When faced with such dramatic circumstances, some parents seek to restore meaning to their parenthood by accompanying their baby through to the end of its life. Methods derived from hospice care may be appropriate in such situations, considering the unborn child as "a living being among the living ", pregnancy as the first chapter of every life, and death as a natural process. This approach, which may be adopted in maternity wards and neonatal intensive care units, requires the medical team to provide consistent information to the parents and to ensure their close involvement. These new parental demands must be clearly understood if they are to be met as effectively as possible. PMID:21513125

Storme, Laurent; de Mézerac, Isabelle

2010-06-01

272

Byron Emerson Wall - John Venn, James Ward, and the Chair of Mental Philosophy and Logic at the University of Cambridge - Journal of the History of Ideas 68:1  

Microsoft Academic Search

In 1897, Cambridge University created a professorship in Mental Philosophy and Logic; despite the double name it was filled by a “mental philosopher,” James Ward, who did no work in logic. The chief logician candidate, John Venn, then turned his attention elsewhere, leaving Cambridge without senior leadership in logic. Ward himself turned to other philosophical issues, doing little further original

Byron E. Wall

2007-01-01

273

Examination of Heavy Metals and Particulate Matter Exposures and Effects in Susceptible Wards in the Washington, D.C. Region  

NASA Astrophysics Data System (ADS)

The District of Columbia has one of the greatest health disparities of cancer in the nation and ranks seventh highest as one of the unhealthiest places to live due to poor air quality (EPA Report, 1999). Also, a 1999 report from the Centers for Disease Control stated that the District had the highest overall rate of cancer incidence in the nation. Particulate matter is one of the major contributors to pollution in the environment. Quite often particulate matter is composed of toxic materials including heavy metals, pesticides, and spores. In some cases, the heavy metal particulates are considered carcinogenic. They are typically characterized as particles with diameters smaller than 1 m and are easily deposited into the alveolar regions of the human lungs, which can impose threatening health risks. In this study, I will design and execute an environmental exposure assessment for PM2.5, PM10, and heavy metals like chromium, as well as lead, cadmium and arsenic, in four observed wards of Washington, DC. Most interestingly, spatial distributions of both aerosols and heavy metals will be characterized as a function of size and mass properties. This will formulate a limited climatology of both types of particulate matter and selected heavy metals for specific regions within the District of Columbia. This dataset will further be related to epidemiological data and health outcomes for the observed areas of study. The essence of this study lies in its notoriety as the first to generate a dataset that focuses on toxic air pollutants in particular wards and may be utilized in various aspects of public health.

Greene, N. A.; Morris, D. R.

2004-05-01

274

Close Encounters in a Pediatric Ward: Measuring Face-to-Face Proximity and Mixing Patterns with Wearable Sensors  

PubMed Central

Background Nosocomial infections place a substantial burden on health care systems and represent one of the major issues in current public health, requiring notable efforts for its prevention. Understanding the dynamics of infection transmission in a hospital setting is essential for tailoring interventions and predicting the spread among individuals. Mathematical models need to be informed with accurate data on contacts among individuals. Methods and Findings We used wearable active Radio-Frequency Identification Devices (RFID) to detect face-to-face contacts among individuals with a spatial resolution of about 1.5 meters, and a time resolution of 20 seconds. The study was conducted in a general pediatrics hospital ward, during a one-week period, and included 119 participants, with 51 health care workers, 37 patients, and 31 caregivers. Nearly 16,000 contacts were recorded during the study period, with a median of approximately 20 contacts per participants per day. Overall, 25% of the contacts involved a ward assistant, 23% a nurse, 22% a patient, 22% a caregiver, and 8% a physician. The majority of contacts were of brief duration, but long and frequent contacts especially between patients and caregivers were also found. In the setting under study, caregivers do not represent a significant potential for infection spread to a large number of individuals, as their interactions mainly involve the corresponding patient. Nurses would deserve priority in prevention strategies due to their central role in the potential propagation paths of infections. Conclusions Our study shows the feasibility of accurate and reproducible measures of the pattern of contacts in a hospital setting. The obtained results are particularly useful for the study of the spread of respiratory infections, for monitoring critical patterns, and for setting up tailored prevention strategies. Proximity-sensing technology should be considered as a valuable tool for measuring such patterns and evaluating nosocomial prevention strategies in specific settings.

Isella, Lorenzo; Romano, Mariateresa; Barrat, Alain; Cattuto, Ciro; Colizza, Vittoria; Van den Broeck, Wouter; Gesualdo, Francesco; Pandolfi, Elisabetta; Rava, Lucilla; Rizzo, Caterina; Tozzi, Alberto Eugenio

2011-01-01

275

The Association between Pain and Depression, Anxiety, and Cognitive Function among Advanced Cancer Patients in the Hospice Ward  

PubMed Central

Background Pain is the most common but severe physical symptom among cancer patients. This study aimed to identify correlation between pain and psychological symptoms for terminal cancer patients. Methods The total sample consisted of 69 subjects who were recruited through two hospice wards, limited to patients who were mentally alert and had no psychiatric diseases. The subjects were divided into two groups according to the numerical rating scale: the pain-free group, 0 to 3 points; and the pain group, 4 to 10 points. We used the Beck depression inventory (BDI), Beck anxiety inventory (BAI), mini-mental status examination-Korea (MMSE-K), and short form 36 health survey (SF-36). Logistic regression analysis was performed to verify the correlation between pain and other psychosocial disorders. Results The mean scores of BDI in the pain-free and pain groups were 25.7 and 31.5; mean BAI scores were 23.4 and 34.7; mean MMSE-K scores were 25.7 and 21.8, respectively. There were no significant differences between the two groups in SF-36 score except scores of body pain. The results of logistic regression analysis adjusted for age, sex, marital status, types of cancer, history of chemotherapy, or radiotherapy showed significant correlation between pain and depression (BDI ? 24; odds ratio [OR], 4.199; 95% confidence interval [CI], 1.171 to 15.060), and pain and cognitive impairment (MMSE < 24; OR, 5.495; 95% CI, 1.449 to 20.843); but not between pain and anxiety (BAI ? 22; OR, 3.011; 95% CI, 0.907 to 9.997). Conclusion Pain significantly affects depression and cognitive impairment among advanced cancer patients in the hospice ward. Accordingly, more aggressive treatment of pain is required to reduce not only physical suffering but also physiological distress.

Ko, Hae Jin; Seo, Se Jung; Kim, Hyo Min; Chung, Seung Eun

2013-01-01

276

Effect of end-of-life care education on the attitudes of nurses in infants' and children's wards  

PubMed Central

BACKGROUND: Infants palliative care becomes an important aspect of nursing when providing welfare and promoting children's life quality are the objectives of care. The number of children with life threatening diseases has increased alongside the developments in technology and medical treatment in medicine. It is a pure fact that our attitudes are related to our behaviors and performances. This research was conducted with the aim of assessing the effect of intensive course of children's palliative care on the attitudes of children and infants’ nurses in Isfahan University of Medical Sciences. METHODS: This was a quasi-experimental, two-group and two-stage study in which 56 nurses working at Infants’ and children's wards who met inclusion criteria were divided into experiment and control groups. The participants of experiment group attended in the infants’ palliative care training course which lasted for 3 weeks. A reliable and already validated questionnaire of Infants and Children Wards Nurses’ Attitudes Regarding the Dying Children was used before and after training. RESULTS: There was no significant difference between the two groups regarding demographic characteristics, except for marital status which was found the study findings were not confounded by it. There was a significant difference between mean test and re-test scores in the experiment group and also between the mean scores of control and experiment groups after training. There was no significant difference between mean scores before and after training in the control group. CONCLUSIONS: End-of-life children care is one of the issues in modern medicine which has not gained a definite status in Iran. It is hoped that nurses would be the forerunners of this modern science in Iran.

Zargham-Boroujeni, Ali; Bagheri, Sayed Hamid Sayed; Kalantari, Mehrdad; Talakoob, Sadigheh; Samooai, Farangis

2011-01-01

277

The Study of the Continuum Limit of the Supersymmetric Ward-Takahashi Identity for N = 1 Super Yang-Mills Theory  

NASA Astrophysics Data System (ADS)

The one-loop corrections to the supersymmetric Ward-Takahashi identity (WTi) are investigated in the off-shell regime in the Wilson formulation of the discretized N = 1 Super Yang-Mills (SYM) theory. The study of the continuum limit as well as the renormalization procedure for the supercurrent are presented.

Feo, A.

2004-04-01

278

Professional practices and recommendations What is the interest of rehabilitation in physical medicine and functional rehabilitation ward after total knee arthroplasty? Elaboration of French clinical practice guidelines  

Microsoft Academic Search

Objectives. - To develop clinical practice guidelines concerning the interest of post-operative rehabilitation in physical medicine and func- tional rehabilitation (PMR) ward after total knee arthroplasty (TKA). Method. - The SOFMER (French Physical Medicine and Rehabilitation Society) methodology, associating a systematic literature review, collection of everyday clinical practice, and external review by a multidisciplinary expert panel, was used. Main outcomes

B. Barrois; P. Ribinika; M. Revelc Rannou

279

Incidence and outcome of critical illness amongst hospitalised patients with haematological malignancy: a prospective observational study of ward and intensive care unit based care  

Microsoft Academic Search

Summary To determine the incidence and outcome of critical illness amongst the total population of hospital patients with haematological malignancy (including patients treated on the ward as well as those admitted to the intensive care unit), consecutive patients with haematological malign- ancy were prospectively studied. One hundred and one of the 1437 haemato-oncology admis- sions (7%) in 2001 were complicated

A. C. Gordon; H. E. Oakervee; B. Kaya; J. M. Thomas; M. J. Barnett; A. Z. S. Rohatiner; T. A. Lister; J. D. Cavenagh; C. J. Hinds

2005-01-01

280

Ventilation grilles as a potential source of methicillin-resistant Staphylococcus aureus causing an outbreak in an orthopaedic ward at a district general hospital  

Microsoft Academic Search

The spread of methicillin-resistant Staphylococcus aureus (MRSA) in a hospital is thought to be mainly by direct contact. Environmental sources such as exhaust ducting systems have been increasingly recognized as a source for MRSA outbreaks in intensive therapy units. We describe an outbreak of MRSA related to ventilation grilles in an orthopaedic ward. Six patients and one nurse were involved

D. N. P. Kumari; T. C. Haji; V. Keer; P. M. Hawkey; V. Duncanson; E. Flower

1998-01-01

281

Job Analysis Techniques for Restructuring Health Manpower Education and Training in the Navy Medical Department. Attachment 2. General Ward Corpsman QPCB Task Sort for Patient Care.  

ERIC Educational Resources Information Center

This publication is Attachment 2 of a set of 16 computer listed QPCB task sorts, by career level, for the entire Hospital Corps and Dental Technician fields. Statistical data are presented in tabular form for a detailed listing of job duties for a general ward corpsman. (BT)

Technomics, Inc., McLean, VA.

282

Temporal monitoring and rapid disappearance of perennial ice-cover on Canada's northernmost lake: Ward Hunt Lake, Nunavut  

NASA Astrophysics Data System (ADS)

Recent environmental changes in the High Arctic have had a striking impact on surface cryospheric features such as lake ice, glaciers and pack ice. Recent reports of changes on Ellesmere Island's north coast have included the breakup of Ward Hunt Ice Shelf, the loss of epishelf lakes and the thinning of land fast ice. On arctic lakes, perennial ice cover has become less common and lake phenology is shifting as a consequence of warmer waters and decreased albedo. A GEOEYE satellite image acquired in late August 2011 revealed a complete absence of ice-cover on Ward Hunt Lake (WHL), Canada's northernmost lake, while lake ice thickness was reported to be around four meters July 1958 and August 2003. Using synthetic aperture radar (SAR) imagery and oblique photographs of the lake, we conducted a yearly ice-cover monitoring of WHL since 1995 and confirmed the presence of perennial ice-cover throughout this period, with cover ranging from 63% to 85% (mean= 76%) of the lake's surface between 1995 and 2008. Climatic data was obtained from previous studies and from the SILA weather station network on Ward Hunt Island and nearby Lake A on Ellesmere Island. In 2008, a very warm summer melted 52% of the lake ice-cover, and a complete loss of ice-cover was observed in 2011. Early and/or late summer ice thickness measurements over the last ten years and reported measurements from the literature have indicated a rapid decline from around 4 m in the 1950's, early and late 1990's and early 2000's down to 3m in 2008 and 1.6m in 2010. During a field survey in late June and early July 2011, less than half the lake (48%) was covered by perennial ice, which was split in two rafts no thicker than two meters. A field visit in 2012 revealed a seasonal candle ice cover thickness of 1.76m on July 1st, which is similar to the 2011 status (1.9m). Overall, climate data showed a general warming trend in the last 50 years, with declining freezing degree days and increasing melting degree days. This warming resulted in a lack of recovery of perennial ice cover after warmer summers and a positive feedback effect clearly shown by an increase in the water column temperature profiles collected since 2010. Overall, possible effects of the warming temperature are the lowering of the lake and the ice-cover albedo by ponding and moating and by changing ice-type from multi-year to candle ice. This in turn delays ice formation during freeze-back and reduces perennial lake ice thickness in a positive feedback effect. Candle ice is also more fragile and more sensitive to mechanical fractures than perennial ice and these disturbances can accelerate lake ice cover destruction in summer. The implications of a reduced ice cover include an accelerating effect on lake phenology with water column mixing occurring earlier in the melt season in 2011 and 2012 than in 2010.

Paquette, M.; Fortier, D.; Mueller, D.; Sarrazin, D.; Vincent, W. F.

2012-12-01

283

Mobile and Fixed Computer Use by Doctors and Nurses on Hospital Wards: Multi-method Study on the Relationships Between Clinician Role, Clinical Task, and Device Choice  

PubMed Central

Background Selecting the right mix of stationary and mobile computing devices is a significant challenge for system planners and implementers. There is very limited research evidence upon which to base such decisions. Objective We aimed to investigate the relationships between clinician role, clinical task, and selection of a computer hardware device in hospital wards. Methods Twenty-seven nurses and eight doctors were observed for a total of 80 hours as they used a range of computing devices to access a computerized provider order entry system on two wards at a major Sydney teaching hospital. Observers used a checklist to record the clinical tasks completed, devices used, and location of the activities. Field notes were also documented during observations. Semi-structured interviews were conducted after observation sessions. Assessment of the physical attributes of three devices—stationary PCs, computers on wheels (COWs) and tablet PCs—was made. Two types of COWs were available on the wards: generic COWs (laptops mounted on trolleys) and ergonomic COWs (an integrated computer and cart device). Heuristic evaluation of the user interfaces was also carried out. Results The majority (93.1%) of observed nursing tasks were conducted using generic COWs. Most nursing tasks were performed in patients’ rooms (57%) or in the corridors (36%), with a small percentage at a patient’s bedside (5%). Most nursing tasks related to the preparation and administration of drugs. Doctors on ward rounds conducted 57.3% of observed clinical tasks on generic COWs and 35.9% on tablet PCs. On rounds, 56% of doctors’ tasks were performed in the corridors, 29% in patients’ rooms, and 3% at the bedside. Doctors not on a ward round conducted 93.6% of tasks using stationary PCs, most often within the doctors’ office. Nurses and doctors were observed performing workarounds, such as transcribing medication orders from the computer to paper. Conclusions The choice of device was related to clinical role, nature of the clinical task, degree of mobility required, including where task completion occurs, and device design. Nurses’ work, and clinical tasks performed by doctors during ward rounds, require highly mobile computer devices. Nurses and doctors on ward rounds showed a strong preference for generic COWs over all other devices. Tablet PCs were selected by doctors for only a small proportion of clinical tasks. Even when using mobile devices clinicians completed a very low proportion of observed tasks at the bedside. The design of the devices and ward space configurations place limitations on how and where devices are used and on the mobility of clinical work. In such circumstances, clinicians will initiate workarounds to compensate. In selecting hardware devices, consideration should be given to who will be using the devices, the nature of their work, and the physical layout of the ward.

Andersen, Pia; Lindgaard, Anne-Mette; Prgomet, Mirela; Creswick, Nerida

2009-01-01

284

Ethnomedicine of the Kagera Region, north western Tanzania. Part 2: The medicinal plants used in Katoro Ward, Bukoba District  

PubMed Central

Background The Kagera region of north western Tanzania has a rich culture of traditional medicine use and practices. The dynamic inter-ethnic interactions of different people from the surrounding countries constitute a rich reservoir of herbal based healing practices. This study, the second on an ongoing series, reports on the medicinal plant species used in Katoro ward, Bukoba District, and tries to use the literature to establish proof of the therapeutic claims. Methodology Ethnomedical information was collected using Semi-structured interviews in Kyamlaile and Kashaba villages of Katoro, and in roadside bushes on the way from Katoro to Bukoba through Kyaka. Data collected included the common/local names of the plants, parts used, the diseases treated, methods of preparation, dosage, frequency and duration of treatments. Information on toxicity and antidote were also collected. Literature was consulted to get corroborative information on similar ethnomedical claims and proven biological activities of the plants. Results Thirty three (33) plant species for treatement of 13 different disease categories were documented. The most frequently treated diseases were those categorized as specific diseases/conditions (23.8% of all remedies) while eye diseases were the least treated using medicinal plants (1.5% of all remedies). Literature reports support 47% of the claims including proven anti-malarial, anti-microbial and anti-inflammatory activity or similar ethnomedical uses. Leaves were the most frequently used plant part (20 species) followed by roots (13 species) while making of decoctions, pounding, squeezing, making infusions, burning and grinding to powder were the most common methods used to prepare a majority of the therapies. Conclusion Therapeutic claims made on plants used in traditional medicine in Katoro ward of Bukoba district are well supported by literature, with 47% of the claims having already been reported. This study further enhances the validity of plants used in traditional medicine in this region as resources that can be relied on to provide effective, accessible and affordable basic healthcare to the local communities. The plants documented also have the potential of being used in drug development and on farm domestication initiatives.

2010-01-01

285

Drug-resistant coagulase-negative skin staphylococci. Evaluation of four marker systems and epidemiology in an orthopaedic ward.  

PubMed Central

Drug-resistant coagulase-negative staphylococci (DRCNS) in orthopaedic patients and ward staff were studied. A significant increase in the DRCNS carriage rate was observed among the 16 patients studied after 14 days of hospitalization with levels approaching that of the staff. Patients receiving dicloxacillin prophylaxis (n = 9) were more likely to be colonized with methicillin-resistant CNS, while patients receiving no antibiotics (n = 7) became to a larger extent colonized with multiple DRCNS. The combined data from species determination, biochemical, plasmid, and antibiogram typing revealed a considerable diversity among DRCNS; 64 types were distinguished among 112 DRCNS isolates selected for study after exclusion of apparently duplicate isolates. Plasmid plus antibiogram typing yielded almost as many types (61); whereas species determination plus antibiogram distinguished only 33 types. Although a novel computerized 96-reaction biotyping method alone enabled differentiation of 17 biotypes, most DRCNS isolates belonged to one of three major biotypes limiting the usefulness of this method. Ten of the 64 (16%) DRCNS types identified comprised 50 of the 112 (45%) isolates. These were isolated from staff and from patients on day 14, suggesting a nosocomial origin.

Thore, M.; Kuhn, I.; Lofdahl, S.; Burman, L. G.

1990-01-01

286

The association of drug use and post-traumatic stress reactions due to Hurricane Ike among Fifth Ward Houstonian youth.  

PubMed

This study shows the important link between higher drug use and self-medication among youth with higher reported posttraumatic stress reactions after natural disasters. The study offers secondary analysis of cross-sectional data collected on 170 predominately African American males through the Fifth Ward Enrichment program (FWEP) in Houston, Texas, between November and December 2009. Men who stated that in the last week they tried to keep from thinking or talking about the hurricane or things that remind them of what happen were significantly more likely to use alcohol (p < .05), marijuana (p < .01), codeine cough syrup (p < .00), anti-energy drinks (p < .00), crystal methamphetamines (p < .00), and Viagra (p < .00). Unadjusted logistic regression showed that they also experienced over twice the odds of reporting past 30 day use of alcohol (OR = 2.57, 95% CI = .98, 6.8), marijuana (OR = 4.31, 95% CI = 1.2, 15.3), codeine cough syrup (OR = 5.22, 95% CI = 1.4, 19.5), and anti-energy drinks (OR = 3.27, 95% CI = 1.0, 1.4). Adjusted logistic regression revealed that male youth post-traumatic stress reaction is a significant predictor of marijuana use (OR = 4.1, 95% CI = 1.0, 16.5). This study shows the important link of higher drug use and self-medication among youth with higher reported posttraumatic stress reactions after natural disasters. PMID:20509087

Peters, Ronald J; Meshack, Angela; Amos, Charles; Scott-Gurnell, Kathy; Savage, Charles; Ford, Kentya

2010-01-01

287

Characteristics of patients frequently subjected to pharmacological and mechanical restraint--a register study in three Norwegian acute psychiatric wards.  

PubMed

This retrospective study from three catchment-area-based acute psychiatric wards showed that of all the pharmacologically and mechanically restrained patients (n=373) 34 (9.1%) had been frequently restrained (6 or more times). These patients accounted for 39.2% of all restraint episodes during the two-year study period. Adjusted binary logistic regression analyses showed that the odds for being frequently restrained were 91% lower among patients above 50 years compared to those aged 18-29 years; a threefold increase (OR=3.1) for those admitted 3 times or more compared to patients with only one stay; and, finally, a threefold increase (OR=3.1) if the length of stay was 16 days or more compared to those admitted for 0-4 days. Among frequently restrained patients, males (n=15) had significantly longer stays than women (n=19), and 8 of the females had a diagnosis of personality disorder, compared to none among males. Our study showed that being frequently restrained was associated with long inpatient stay, many admissions and young age. Teasing out patient characteristics associated with the risk of being frequently restraint may contribute to reduce use of restraint by developing alternative interventions for these patients. PMID:24230996

Knutzen, Maria; Bjřrkly, Stĺl; Eidhammer, Gunnar; Lorentzen, Steinar; Mjřsund, Nina Helen; Opjordsmoen, Stein; Sandvik, Leiv; Friis, Svein

2014-01-30

288

Measuring the evidence: Reviewing the literature of the measurement of therapeutic engagement in acute mental health inpatient wards.  

PubMed

Quality nursing plays a central role in the delivery of contemporary health and social care, with a positive correlation being demonstrated between patient satisfaction and the quality of nursing care received. One way to ensure such quality is to develop metrics that measure the effectiveness of various aspects of care across a variety of settings. Effective mental health nursing is predicated on understanding the lived experiences of service users in order to provide sensitively-attuned nursing care. To achieve this, mental health nurses need to establish the all-important therapeutic relationship, showing compassion and creating a dialogue whereby service users feel comfortable to share their experiences that help contextualize their distress. Indeed, service users value positive attitudes, being listened to, and being able to trust those who provide care, while mental health nurses value their ability to relate through talking, listening, and expressing empathy. However, the literature suggests that within mental health practice, a disproportionate amount of time is taken up by other activities, with little time being spent listening and talking to service users. The present study discusses the evidence relating to the therapeutic relationship in acute mental health wards and explores why, after five decades, it is not recognized as a fundamental metric of mental health nursing. PMID:24103061

McAndrew, Sue; Chambers, Mary; Nolan, Fiona; Thomas, Ben; Watts, Paul

2014-06-01

289

Management of minor head injuries in the accident and emergency department: the effect of an observation ward.  

PubMed Central

The management of 483 patients presenting with minor head injury to the accident and emergency (A&E) departments of two Scottish hospitals was studied prospectively. Such patients comprised 5.7 and 3.9% of the total attendances to each department. Of the 277 patients assessed in the former department, 83 (30%) fulfilled at least one of the currently accepted criteria for recommending admission to hospital and 49 (17.7%) patients were actually admitted. Patients in whom head injury was not the principal reason for admission were excluded from the study. In the same time period the second department dealt with 206 patients with minor head injury, 49 (24%) of whom had criteria for admission. However, significantly fewer, 10 (4.9%) patients, were actually admitted. The major relevant factor when comparing the two departments was the existence in the former of an observation ward. These results support the view that easy access to hospital beds is a major determinant of management in patients presenting with minor head injury to the A&E department and may be more influential than clinical findings.

Brown, S R; Raine, C; Robertson, C E; Swann, I J

1994-01-01

290

Predicting inpatient violence in acute psychiatric wards using the Brřset-Violence-Checklist: a multicentre prospective cohort study.  

PubMed

The Norwegian Brřset-Violence-Checklist (BVC) is one of the few instruments that is suitable for short-term prediction of violence of psychiatric inpatients by nursing staff in routine care. The instrument assesses the presence or absence of six behaviours or states frequently observed before a violent incident. We conducted a study to elucidate whether the predictive properties of the BVC are retained in other psychiatric settings than the original north-Norwegian validation dataset. During their admission period, 219 consecutive patients admitted to six acute psychiatric wards were assessed as to the risk for attack using a German version of the BVC (BVC-G). Data on preventive measures were concurrently collected. Aggressive incidents were registered using an instrument equivalent to the Staff Observation of Aggression Scale (SOAS-R). Fourteen attacks towards staff were observed with incident severity ranging from 5 to 18 of a possible 22 points. BVC-G sensitivity was 64.3%, the specificity 93.9%, the positive predictive value 11.1%, and the area under the receiver operating characteristic curve 0.88. In some false positive cases intense preventive measures had been implemented. The predictive accuracy of the BVC-G proved consistent with the Norwegian original. PMID:15255916

Abderhalden, C; Needham, I; Miserez, B; Almvik, R; Dassen, T; Haug, H-J; Fischer, J E

2004-08-01

291

The periodicities in and biometeorological relationships with bed occupancy of an acute psychiatric ward in Antwerp, Belgium  

NASA Astrophysics Data System (ADS)

Recently, some investigators have established a seasonal pattern in normal human psychology, physiology and behaviour, and in the incidence of psychiatric psychopathology. In an attempt to elucidate the chronopsy and meteotropism in the latter, we have examined the chronograms of, and the biometeorological relationships to bed occupancy of the psychiatric ward of the Antwerp University Hospital during three consecutive calendar years (1987 1989). Weather data for the vicinity were provided by a local meteorological station and comprise mean atmospheric pressure, air temperature, relative humidity, wind speed and minutes of sunlight and precipitation/day. The number of psychiatric beds occupied during the study period exhibited a significant seasonal variation. Peaks in bed occupancy were observed in March and November, with lows in August. An important part of the variability in the number of beds occupied could be explained by the composite effects of weather variables of the preceding weeks. Our results suggest that short-term fluctuations in atmospheric activity may dictate some of the periodicities in psychiatric psychopathology.

Maes, M.; de Meyer, F.; Peeters, D.; Meltzer, H.; Schotte, C.; Scharpe, S.; Cosyns, P.

1993-06-01

292

Is a mandatory intensive care unit stay needed after liver transplantation? Feasibility of fast-tracking to the surgical ward after liver transplantation.  

PubMed

The continuation of hemodynamic, respiratory, and metabolic support for a variable period after liver transplantation (LT) in the intensive care unit (ICU) is considered routine by many transplant programs. However, some LT recipients may be liberated from mechanical ventilation shortly after the discontinuation of anesthesia. These patients might be appropriately discharged from the postanesthesia care unit (PACU) to the surgical ward and bypass the ICU entirely. In 2002, our program started a fast-tracking program: select LT recipients are transferred from the operating room to the PACU for recovery and tracheal extubation with a subsequent transfer to the ward, and the ICU stay is completely eliminated. Between January 1, 2003 and December 31, 2007, 1045 patients underwent LT at our transplant program; 175 patients were excluded from the study. Five hundred twenty-three of the remaining 870 patients (60.10%) were fast-tracked to the surgical ward, and 347 (39.90%) were admitted to the ICU after LT. The failure rate after fast-tracking to the surgical ward was 1.90%. The groups were significantly different with respect to the recipient age, the raw Model for End-Stage Liver Disease (MELD) score at the time of LT, the recipient body mass index (BMI), the retransplantation status, the operative time, the warm ischemia time, and the intraoperative transfusion requirements. A multivariate logistic regression analysis revealed that the raw MELD score at the time of LT, the operative time, the intraoperative transfusion requirements, the recipient age, the recipient BMI, and the absence of hepatocellular cancer/cholangiocarcinoma were significant predictors of ICU admission. In conclusion, we are reporting the largest single-center experience demonstrating the feasibility of bypassing an ICU stay after LT. PMID:22140001

Taner, C Burcin; Willingham, Darrin L; Bulatao, Ilynn G; Shine, Timothy S; Peiris, Prith; Torp, Klaus D; Canabal, Juan; Nguyen, Justin H; Kramer, David J

2012-03-01

293

Treatable factors associated with severe anaemia in adults admitted to medical wards in Blantyre, Malawi, an area of high HIV seroprevalence  

Microsoft Academic Search

Severe anaemia is a common presentation in non-pregnant adults admitted to hospital in southern Africa. Standard syndromic treatment based on data from the pre-HIV era is for iron deficiency, worms and malaria. We prospectively investigated 105 adults admitted consecutively to medical wards with haemoglobin < 7 g\\/dl. Those with acute blood loss were excluded. Patients were investigated for possible parasitic,

David K. Lewis; Christopher J. M. Whitty; Amanda L. Walsh; Henry Epino; Nynke R. van den Broek; Elizabeth A. Letsky; Clyton Munthali; Joshua M. Mukiibi; Martin J. Boeree

2005-01-01

294

Feasibility, acceptability, and effectiveness of an electronic sensor bed/chair alarm in reducing falls in patients with cognitive impairment in a subacute ward.  

PubMed

Falls from bed are common in subacute hospital settings, particularly for patients with cognitive impairment. This repeated measures, single cohort study in 1 subacute ward evaluated effectiveness of an electronic sensor alarm in reducing falls in patients (n = 34) with cognitive impairment. Nursing staff feedback (focus group, survey) was used to determine electronic sensor alarm feasibility. The electronic alarm system was found to be a feasible, effective, and acceptable fall prevention strategy for patients with cognitive impairment. PMID:24487696

Wong Shee, Anna; Phillips, Bev; Hill, Keith; Dodd, Karen

2014-01-01

295

The utility of intensified environmental surveillance for pathogenic moulds in a stem cell transplantation ward during construction work to monitor the efficacy of HEPA filtration  

Microsoft Academic Search

A 12-week environmental study was performed to ensure that the patient rooms of an SCT ward with high-efficiency particulate air (HEPA) filtration remained uncontaminated by moulds during close-by construction work. The sampling included measuring the ventilation channel pressure, particle count measurements, air sampling, settled dust analysis and fungal cultures from the oral and nasal cavities of the patients. No changes

A Nihtinen; V-J Anttila; M Richardson; T Meri; L Volin; T Ruutu

2007-01-01

296

Influence of structural evolution on reservoir development and distribution in the Silurian Fusselman: Vermejo-Moore Hopper field, Loving and Ward Counties, Texas  

Microsoft Academic Search

The Vermejo-Moore Hooper field lies in the deep Delaware basin adjacent to the Pecos River in Loving and Ward counties, Texas. Discovered in 1973, the field produces dry gas from the Fusselman and Ellenburger formations. The Fusselman reservoir has produced over 400 bcf of gas from depths between 18,500 and 19,200 ft. The field primarily is a structural trap, but

W. M. Colleary; J. R. Hulme; J. W. Crafton

1992-01-01

297

Patients Hospitalized in General Wards via the Emergency Department: Early Identification of Predisposing Factors for Death or Unexpected Intensive Care Unit Admission-A Historical Prospective.  

PubMed

Background. To identify, upon emergency department (ED) admission, predictors of unexpected death or unplanned intensive care/high dependency units (ICU/HDU) admission during the first 15 days of hospitalization on regular wards. Methods. Prospective cohort study in a medical-surgical adult ED in a teaching hospital, including consecutive patients hospitalized on regular wards after ED visit, and identification of predictors by logistic regression and Cox proportional hazards model. Results. Among 4,619 included patients, 77 (1.67%) target events were observed: 32 unexpected deaths and 45 unplanned transfers to an ICU/HDU. We identified 9 predictors of the target event including the oxygen administration on the ED, unknown current medications, and use of psychoactive drug(s). All predictors put the patients at risk during the first 15 days of hospitalization. A logistic model for hospital mortality prediction (death of all causes) still comprised oxygen administration on the ED, unknown current medications, and the use of psychoactive drug(s) as risk factors. Conclusion. The "use of oxygen therapy on the ED," the "current use of psychoactive drug(s)", and the "lack of knowledge of current medications taken by the patients" were important predisposing factors to severe adverse events during the 15 days of hospitalization on regular wards following the ED visit. PMID:24624300

Boulain, Thierry; Runge, Isabelle; Delorme, Nathalie; Bouju, Angčle; Valéry, Antoine

2014-01-01

298

[Clinical psychopathological research on late-onset schizophrenia--mainly patients with schizophrenia from a hospital psychiatric ward].  

PubMed

In the field of clinical psychiatry, cases of late-onset schizophrenia are often observed in the population of 40 years or older. Female patients seem to significantly predominate those diagnosed with late-onset schizophrenia. Generally, paranoid delusions of reference with family members, neighbors, and friends are observed as clinical features of such late-onset schizophrenia conditions. Medical treatment for such a condition is often effective and considered to improve the prognosis. The authors conducted clinical research at Jichi Medical University Hospital psychiatric ward involving 38 late-onset schizophrenia patients (7 males; 31 females) diagnosed over the age of 40 using DSM-IV-TR diagnostic criteria. Subjects were selected from 316 schizophrenia patients (164 males; 152 females) admitted to the hospital for schizophrenia treatment at some time during the 13 years from April 1, 1993 to March 31, 2006. Also, another 14 late-onset schizophrenia patients diagnosed over the age of 40 (1 male; 13 females), with additional investigation, were selected from 130 cases (50 males; 80 females) treated in related facilities at some time during the 2 years from April 1, 2004 to March 31, 2006. The investigation revealed the following results: (1) Cases showing an onset after the age of 40 comprised 12% of the total population. Female cases comprised 20.4%, being significantly higher than that of male cases (4.3%). Within the psychiatric ward, cases showing an onset after 40 made up 10.8% of the total population. Female cases comprised 16.3%, being significantly higher than that of male cases (2.0%). (2) The paranoid type comprised 55.3% of the total population of late-onset cases, being significantly higher than in early-onset cases younger than 40 years old. A total of 55.3% of late-onset cases also showed depressive symptoms, being significantly higher than in early-onset cases. (3) For late-onset, 55.3% of patients showed an introverted premorbid character, while 15.8% of patients exhibited an extroverted premorbid character. Regarding late-onset cases, the number of introverted premorbid character cases significantly lower than in early-onset cases diagnosed at 40 years or younger; however, no significant difference was observed for the extroverted premorbid character. (4) A total of 65.8% of the population of late-onset cases were diagnosed as having psychosocial stresses as their cause. In addition, 36 % of subjects with psychosocial stress recognition had experienced a sense of loss. Of these, 66.6% of the loss experience involved separation from their family members. (5) Cases showing a successful recovery from schizophrenia comprised 55.3 % of the total population. On the other hand, cases with an unsuccessful outcome were observed in 34.2% of the total population, accounting for a relatively large portion. A total of 30.8% of subjects with an unsuccessful outcome were unmarried at the time of onset, and made up 57.1% of the late-onset population. According to the results of this investigation, late-onset schizophrenia represents about 10% of the total cases, and female cases are significantly more common than male cases. For late-onset patients, subjects' self-functions were more developed compared to those of early-onset patients, so they did not seem to clearly show early-onset symptoms during a younger period. The late-onset type has a tendency to show a better rate of successful recovery; however, there are situations where the condition reverts toward the "disorganized type", moving closer toward Kraepelin's early-onset disorganized schizophrenia. PMID:19425390

Yasuda, Manabu; Kato, Satoshi

2009-01-01

299

Functional Changes during Hospital Stay in Older Patients Admitted to an Acute Care Ward: A Multicenter Observational Study  

PubMed Central

Objectives Changes in physical performance during hospital stay have rarely been evaluated. In this study, we examined functional changes during hospital stay by assessing both physical performance and activities of daily living. Additionally, we investigated characteristics of older patients associated with meaningful in-hospital improvement in physical performance. Methods The CRiteria to assess appropriate Medication use among Elderly complex patients project recruited 1123 patients aged ?65 years, consecutively admitted to geriatric or internal medicine acute care wards of seven Italian hospitals. We analyzed data from 639 participating participants with a Mini Mental State Examination score ?18/30. Physical performance was assessed by walking speed and grip strength, and functional status by activities of daily living at hospital admission and at discharge. Meaningful improvement was defined as a measured change of at least 1 standard deviation. Multivariable logistic regression models predicting meaningful improvement, included age, gender, type of admission (through emergency room or elective), and physical performance at admission. Results Mean age of the study participants was 79 years (range 65–98), 52% were female. Overall, mean walking speed and grip strength performance improved during hospital stay (walking speed improvement: 0.04±0.20 m/s, p<0.001; grip strength improvement: 0.43±5.66 kg, p?=?0.001), no significant change was observed in activities of daily living. Patients with poor physical performance at admission had higher odds for in-hospital improvement. Conclusion Overall, physical performance measurements show an improvement during hospital stay. The margin for meaningful functional improvement is larger in patients with poor physical function at admission. Nevertheless, most of these patients continue to have poor performance at discharge.

De Buyser, Stefanie L.; Petrovic, Mirko; Taes, Youri E.; Vetrano, Davide L.; Corsonello, Andrea; Volpato, Stefano; Onder, Graziano

2014-01-01

300

Prevalence of Antimicrobial-Resistant Pathogens in Canadian Hospitals: Results of the Canadian Ward Surveillance Study (CANWARD 2008) ?  

PubMed Central

A total of 5,282 bacterial isolates obtained between 1 January and 31 December 31 2008, inclusive, from patients in 10 hospitals across Canada as part of the Canadian Ward Surveillance Study (CANWARD 2008) underwent susceptibility testing. The 10 most common organisms, representing 78.8% of all clinical specimens, were as follows: Escherichia coli (21.4%), methicillin-susceptible Staphylococcus aureus (MSSA; 13.9%), Streptococcus pneumoniae (10.3%), Pseudomonas aeruginosa (7.1%), Klebsiella pneumoniae (6.0%), coagulase-negative staphylococci/Staphylococcus epidermidis (5.4%), methicillin-resistant S. aureus (MRSA; 5.1%), Haemophilus influenzae (4.1%), Enterococcus spp. (3.3%), Enterobacter cloacae (2.2%). MRSA comprised 27.0% (272/1,007) of all S. aureus isolates (genotypically, 68.8% of MRSA were health care associated [HA-MRSA] and 27.6% were community associated [CA-MRSA]). Extended-spectrum ?-lactamase (ESBL)-producing E. coli occurred in 4.9% of E. coli isolates. The CTX-M type was the predominant ESBL, with CTX-M-15 the most prevalent genotype. MRSA demonstrated no resistance to ceftobiprole, daptomycin, linezolid, telavancin, tigecycline, or vancomycin (0.4% intermediate intermediate resistance). E. coli demonstrated no resistance to ertapenem, meropenem, or tigecycline. Resistance rates with P. aeruginosa were as follows: colistin (polymyxin E), 0.8%; amikacin, 3.5%; cefepime, 7.2%; gentamicin, 12.3%; fluoroquinolones, 19.0 to 24.1%; meropenem, 5.6%; piperacillin-tazobactam, 8.0%. A multidrug-resistant (MDR) phenotype occurred frequently in P. aeruginosa (5.9%) but uncommonly in E. coli (1.2%) and K. pneumoniae (0.9%). In conclusion, E. coli, S. aureus (MSSA and MRSA), P. aeruginosa, S. pneumoniae, K. pneumoniae, H. influenzae, and Enterococcus spp. are the most common isolates recovered from clinical specimens in Canadian hospitals. The prevalence of MRSA was 27.0% (of which genotypically 27.6% were CA-MRSA), while ESBL-producing E. coli occurred in 4.9% of isolates. An MDR phenotype was common in P. aeruginosa.

Zhanel, George G.; DeCorby, Melanie; Adam, Heather; Mulvey, Michael R.; McCracken, Melissa; Lagace-Wiens, Philippe; Nichol, Kimberly A.; Wierzbowski, Aleksandra; Baudry, Patricia J.; Tailor, Franil; Karlowsky, James A.; Walkty, Andrew; Schweizer, Frank; Johnson, Jack; Hoban, Daryl J.

2010-01-01

301

Efficacy of a Low-Cost Bubble CPAP System in Treatment of Respiratory Distress in a Neonatal Ward in Malawi  

PubMed Central

Background Respiratory failure is a leading cause of neonatal mortality in the developing world. Bubble continuous positive airway pressure (bCPAP) is a safe, effective intervention for infants with respiratory distress and is widely used in developed countries. Because of its high cost, bCPAP is not widely utilized in low-resource settings. We evaluated the performance of a new bCPAP system to treat severe respiratory distress in a low resource setting, comparing it to nasal oxygen therapy, the current standard of care. Methods We conducted a non-randomized convenience sample study to test the efficacy of a low-cost bCPAP system treating newborns with severe respiratory distress in the neonatal ward of Queen Elizabeth Central Hospital, in Blantyre, Malawi. Neonates weighing >1,000 g and presenting with severe respiratory distress who fulfilled inclusion criteria received nasal bCPAP if a device was available; if not, they received standard care. Clinical assessments were made during treatment and outcomes compared for the two groups. Findings 87 neonates (62 bCPAP, 25 controls) were recruited. Survival rate for neonates receiving bCPAP was 71.0% (44/62) compared with 44.0% (11/25) for controls. 65.5% (19/29) of very low birth weight neonates receiving bCPAP survived to discharge compared to 15.4% (1/13) of controls. 64.6% (31/48) of neonates with respiratory distress syndrome (RDS) receiving bCPAP survived to discharge, compared to 23.5% (4/17) of controls. 61.5% (16/26) of neonates with sepsis receiving bCPAP survived to discharge, while none of the seven neonates with sepsis in the control group survived. Interpretation Use of a low-cost bCPAP system to treat neonatal respiratory distress resulted in 27% absolute improvement in survival. The beneficial effect was greater for neonates with very low birth weight, RDS, or sepsis. Implementing appropriate bCPAP devices could reduce neonatal mortality in developing countries.

Kawaza, Kondwani; Machen, Heather E.; Brown, Jocelyn; Mwanza, Zondiwe; Iniguez, Suzanne; Gest, Al; Smith, E. O'Brian; Oden, Maria; Richards-Kortum, Rebecca R.; Molyneux, Elizabeth

2014-01-01

302

Antibiotic Stewardship Ward Rounds and a Dedicated Prescription Chart Reduce Antibiotic Consumption and Pharmacy Costs without Affecting Inpatient Mortality or Re-Admission Rates  

PubMed Central

Background Antibiotic consumption is a major driver of bacterial resistance. To address the increasing burden of multi-drug resistant bacterial infections, antibiotic stewardship programmes are promoted worldwide to rationalize antibiotic prescribing and conserve remaining antibiotics. Few studies have been reported from developing countries and none from Africa that report on an intervention based approach with outcomes that include morbidity and mortality. Methods An antibiotic prescription chart and weekly antibiotic stewardship ward round was introduced into two medical wards of an academic teaching hospital in South Africa between January-December 2012. Electronic pharmacy records were used to collect the volume and cost of antibiotics used, the patient database was analysed to determine inpatient mortality and 30-day re-admission rates, and laboratory records to determine use of infection-related tests. Outcomes were compared to a control period, January-December 2011. Results During the intervention period, 475.8 defined daily doses were prescribed per 1000 inpatient days compared to 592.0 defined daily doses/1000 inpatient days during the control period. This represents a 19.6% decrease in volume with a cost reduction of 35% of the pharmacy’s antibiotic budget. There was a concomitant increase in laboratory tests driven by requests for procalcitonin. There was no difference in inpatient mortality or 30-day readmission rate during the control and intervention periods. Conclusions Introduction of antibiotic stewardship ward rounds and a dedicated prescription chart in a developing country setting can achieve reduction in antibiotic consumption without harm to patients. Increased laboratory costs should be anticipated when introducing an antibiotic stewardship program.

Boyles, Tom H.; Whitelaw, Andrew; Bamford, Colleen; Moodley, Mischka; Bonorchis, Kim; Morris, Vida; Rawoot, Naazneen; Naicker, Vanishree; Lusakiewicz, Irena; Black, John; Stead, David; Lesosky, Maia; Raubenheimer, Peter; Dlamini, Sipho; Mendelson, Marc

2013-01-01

303

Medically unexplained illness and the diagnosis of hysterical conversion reaction (HCR) in women's medicine wards of Bangladeshi hospitals: a record review and qualitative study  

PubMed Central

Background Frequent reporting of cases of hysterical conversion reaction (HCR) among hospitalized female medical patients in Bangladesh’s public hospital system led us to explore the prevalence of “HCR” diagnoses within hospitals and the manner in which physicians identify, manage, and perceive patients whom they diagnose with HCR. Methods We reviewed admission records from women’s general medicine wards in two public hospitals to determine how often and at what point during hospitalization patients received diagnoses of HCR. We also interviewed 13 physicians about their practices and perceptions related to HCR. Results Of 2520 women admitted to the selected wards in 2008, 6% received diagnoses of HCR. HCR patients had wide-ranging symptoms including respiratory distress, headaches, chest pain, convulsions, and abdominal complaints. Most doctors diagnosed HCR in patients who had any medically-unexplained physical symptom. According to physician reports, women admitted to medical wards for HCR received brief diagnostic evaluations and initial treatment with short-acting tranquilizers or placebo agents. Some were referred to outpatient psychiatric treatment. Physicians reported that repeated admissions for HCR were common. Physicians noted various social factors associated with HCR, and they described failures of the current system to meet psychosocial needs of HCR patients. Conclusions In these hospital settings, physicians assign HCR diagnoses frequently and based on vague criteria. We recommend providing education to increase general physicians’ awareness, skill, and comfort level when encountering somatization and other common psychiatric issues. Given limited diagnostic capacity for all patients, we raise concern that when HCR is used as a "wastebasket" diagnosis for unexplained symptoms, patients with treatable medical conditions may go unrecognized. We also advocate introducing non-physician hospital personnel to address psychosocial needs of HCR patients, assist with triage in a system where both medical inpatient beds and psychiatric services are scarce commodities, and help ensure appropriate follow up.

2012-01-01

304

The effect of Computerized Physician Order Entry and decision support system on medication errors in the neonatal ward: experiences from an Iranian teaching hospital.  

PubMed

Medication dosing errors are frequent in neonatal wards. In an Iranian neonatal ward, a 7.5 months study was designed in three periods to compare the effect of Computerized Physician Order Entry (CPOE) without and with decision support functionalities in reducing non-intercepted medication dosing errors in antibiotics and anticonvulsants. Before intervention (Period 1), error rate was 53%, which did not significantly change after the implementation of CPOE without decision support (Period 2). However, errors were significantly reduced to 34% after that the decision support was added to the CPOE (Period 3; P?

Kazemi, Alireza; Ellenius, Johan; Pourasghar, Faramarz; Tofighi, Shahram; Salehi, Aref; Amanati, Ali; Fors, Uno G H

2011-02-01

305

'It makes me want to run away to Saudi Arabia': management and implementation challenges for public financing reforms from a maternity ward perspective.  

PubMed

Poor practice by health care workers has been identified as contributing to high levels of maternal mortality in South Africa. The country is undergoing substantial structural and financial reforms, yet the impact of these on health care workers performance and practice has not been studied. This study, which consisted of an ethnography of two labour wards (one rural and one urban), aimed to look at the factors that shaped everyday practice of midwives working in district hospitals in South Africa during the implementation of a public sector reform to improve financial management. The study found that the Public Financing Management Act, that aimed to improve the efficiency and accountability of public finance management, had the unintended consequence of causing the quality of maternal health services to deteriorate in the hospital wards studied. The article supports the need for increased dialogue between those working in the sexual and reproductive health and health systems policy arenas, and the importance of giving a voice to front-line health workers who implement systems changes. However, it cautions that there are no simple answers to how health systems should be organized in order to better provide sexual and reproductive health services, and suggests instead that more attention in the debate needs to be paid to the challenges of policy implementation and the socio-political context and process issues which affect the success or failure of the implementation. PMID:15452017

Penn-Kekana, Loveday; Blaauw, Duane; Schneider, Helen

2004-10-01

306

Clinical Documentation and Data Transfer from Ebola and Marburg Virus Disease Wards in Outbreak Settings: Health Care Workers' Experiences and Preferences  

PubMed Central

Understanding human filovirus hemorrhagic fever (FHF) clinical manifestations and evaluating treatment strategies require the collection of clinical data in outbreak settings, where clinical documentation has been limited. Currently, no consensus among filovirus outbreak-response organisations guides best practice for clinical documentation and data transfer. Semi-structured interviews were conducted with health care workers (HCWs) involved in FHF outbreaks in sub-Saharan Africa, and with HCWs experienced in documenting and transferring data from high-risk areas (isolation wards or biosafety level 4 laboratories). Methods for data documentation and transfer were identified, described in detail and categorised by requirement for electricity and ranked by interviewee preference. Some methods involve removing paperwork and other objects from the filovirus disease ward without disinfection. We believe that if done properly, these methods are reasonably safe for certain settings. However, alternative methods avoiding the removal of objects, or involving the removal of paperwork or objects after non-damaging disinfection, are available. These methods are not only safer, they are also perceived as safer and likely more acceptable to health workers and members of the community. The use of standardised clinical forms is overdue. Experiments with by sunlight disinfection should continue, and non-damaging disinfection of impregnated paper, suitable tablet computers and underwater cameras should be evaluated under field conditions.

Buhler, Silja; Roddy, Paul; Nolte, Ellen; Borchert, Matthias

2014-01-01

307

[The development of a bedside cart for the management of acute respiratory failure with non-invasive ventilation in Internal Medicine wards].  

PubMed

In order to improve the organization of a General Medical ward without a real critical care area and to optimize treatment of patients with acute respiratory failure, we developed a cart for non-invasive ventilation to be used at the patient bedside. In the rear panel, we set two i.v. drip poles used for i.v. therapy and to hold two Venturi-like flow generators for continuous positive airway pressure. On the top, two ventilators are present, a smaller one (domiciliary) and a bigger one (intensive care unit ventilator). In the front panel, there are 4 drawers called "blood - drugs", "oxygenation", "CPAP", "ventilation", in which all the devices for ventilation, oxygenation, aerosol and medical therapy are easily and quickly available. The management of acute respiratory failure is simpler, easier and safer with this cart: each necessary device is immediately available, and this avoids wasting time. This bedside non-invasive ventilation cart, as far as the cardiac emergency cart, can be useful in general medical wards lacking a critical care area in order to improve interventions in patients with acute respiratory failure. PMID:23548951

Lari, Federico; Bortolotti, Roberta; Scandellari, Novella; Zecchi, Virna; Bragagni, Gianpaolo; Giostra, Fabrizio; Di Battista, Nicola

2013-03-01

308

Unexplained Falls Are Frequent in Patients with Fall-Related Injury Admitted to Orthopaedic Wards: The UFO Study (Unexplained Falls in Older Patients)  

PubMed Central

To evaluate the incidence of unexplained falls in elderly patients affected by fall-related fractures admitted to orthopaedic wards, we recruited 246 consecutive patients older than 65 (mean age 82 ± 7 years, range 65–101). Falls were defined “accidental” (fall explained by a definite accidental cause), “medical” (fall caused directly by a specific medical disease), “dementia-related” (fall in patients affected by moderate-severe dementia), and “unexplained” (nonaccidental falls, not related to a clear medical or drug-induced cause or with no apparent cause). According to the anamnestic features of the event, older patients had a lower tendency to remember the fall. Patients with accidental fall remember more often the event. Unexplained falls were frequent in both groups of age. Accidental falls were more frequent in younger patients, while dementia-related falls were more common in the older ones. Patients with unexplained falls showed a higher number of depressive symptoms. In a multivariate analysis a higher GDS and syncopal spells were independent predictors of unexplained falls. In conclusion, more than one third of all falls in patients hospitalized in orthopaedic wards were unexplained, particularly in patients with depressive symptoms and syncopal spells. The identification of fall causes must be evaluated in older patients with a fall-related injury.

Chiara, Mussi; Gianluigi, Galizia; Pasquale, Abete; Alessandro, Morrione; Alice, Maraviglia; Gabriele, Noro; Paolo, Cavagnaro; Loredana, Ghirelli; Giovanni, Tava; Franco, Rengo; Giulio, Masotti; Gianfranco, Salvioli; Niccolo, Marchionni; Andrea, Ungar

2013-01-01

309

Unexplained Falls Are Frequent in Patients with Fall-Related Injury Admitted to Orthopaedic Wards: The UFO Study (Unexplained Falls in Older Patients).  

PubMed

To evaluate the incidence of unexplained falls in elderly patients affected by fall-related fractures admitted to orthopaedic wards, we recruited 246 consecutive patients older than 65 (mean age 82 ± 7 years, range 65-101). Falls were defined "accidental" (fall explained by a definite accidental cause), "medical" (fall caused directly by a specific medical disease), "dementia-related" (fall in patients affected by moderate-severe dementia), and "unexplained" (nonaccidental falls, not related to a clear medical or drug-induced cause or with no apparent cause). According to the anamnestic features of the event, older patients had a lower tendency to remember the fall. Patients with accidental fall remember more often the event. Unexplained falls were frequent in both groups of age. Accidental falls were more frequent in younger patients, while dementia-related falls were more common in the older ones. Patients with unexplained falls showed a higher number of depressive symptoms. In a multivariate analysis a higher GDS and syncopal spells were independent predictors of unexplained falls. In conclusion, more than one third of all falls in patients hospitalized in orthopaedic wards were unexplained, particularly in patients with depressive symptoms and syncopal spells. The identification of fall causes must be evaluated in older patients with a fall-related injury. PMID:23533394

Chiara, Mussi; Gianluigi, Galizia; Pasquale, Abete; Alessandro, Morrione; Alice, Maraviglia; Gabriele, Noro; Paolo, Cavagnaro; Loredana, Ghirelli; Giovanni, Tava; Franco, Rengo; Giulio, Masotti; Gianfranco, Salvioli; Niccolň, Marchionni; Andrea, Ungar

2013-01-01

310

Clinical documentation and data transfer from Ebola and Marburg virus disease wards in outbreak settings: health care workers' experiences and preferences.  

PubMed

Understanding human filovirus hemorrhagic fever (FHF) clinical manifestations and evaluating treatment strategies require the collection of clinical data in outbreak settings, where clinical documentation has been limited. Currently, no consensus among filovirus outbreak-response organisations guides best practice for clinical documentation and data transfer. Semi-structured interviews were conducted with health care workers (HCWs) involved in FHF outbreaks in sub-Saharan Africa, and with HCWs experienced in documenting and transferring data from high-risk areas (isolation wards or biosafety level 4 laboratories). Methods for data documentation and transfer were identified, described in detail and categorised by requirement for electricity and ranked by interviewee preference. Some methods involve removing paperwork and other objects from the filovirus disease ward without disinfection. We believe that if done properly, these methods are reasonably safe for certain settings. However, alternative methods avoiding the removal of objects, or involving the removal of paperwork or objects after non-damaging disinfection, are available. These methods are not only safer, they are also perceived as safer and likely more acceptable to health workers and members of the community. The use of standardised clinical forms is overdue. Experiments with by sunlight disinfection should continue, and non-damaging disinfection of impregnated paper, suitable tablet computers and underwater cameras should be evaluated under field conditions. PMID:24556792

Bühler, Silja; Roddy, Paul; Nolte, Ellen; Borchert, Matthias

2014-02-01

311

On-ward participation of a hospital pharmacist in a Dutch intensive care unit reduces prescribing errors and related patient harm: an intervention study  

PubMed Central

Introduction Patients admitted to an intensive care unit (ICU) are at high risk for prescribing errors and related adverse drug events (ADEs). An effective intervention to decrease this risk, based on studies conducted mainly in North America, is on-ward participation of a clinical pharmacist in an ICU team. As the Dutch Healthcare System is organized differently and the on-ward role of hospital pharmacists in Dutch ICU teams is not well established, we conducted an intervention study to investigate whether participation of a hospital pharmacist can also be an effective approach in reducing prescribing errors and related patient harm (preventable ADEs) in this specific setting. Methods A prospective study compared a baseline period with an intervention period. During the intervention period, an ICU hospital pharmacist reviewed medication orders for patients admitted to the ICU, noted issues related to prescribing, formulated recommendations and discussed those during patient review meetings with the attending ICU physicians. Prescribing issues were scored as prescribing errors when consensus was reached between the ICU hospital pharmacist and ICU physicians. Results During the 8.5-month study period, medication orders for 1,173 patients were reviewed. The ICU hospital pharmacist made a total of 659 recommendations. During the intervention period, the rate of consensus between the ICU hospital pharmacist and ICU physicians was 74%. The incidence of prescribing errors during the intervention period was significantly lower than during the baseline period: 62.5 per 1,000 monitored patient-days versus 190.5 per 1,000 monitored patient-days, respectively (P < 0.001). Preventable ADEs (patient harm, National Coordinating Council for Medication Error Reporting and Prevention severity categories E and F) were reduced from 4.0 per 1,000 monitored patient-days during the baseline period to 1.0 per 1,000 monitored patient-days during the intervention period (P = 0.25). Per monitored patient-day, the intervention itself cost €3, but might have saved €26 to €40 by preventing ADEs. Conclusions On-ward participation of a hospital pharmacist in a Dutch ICU was associated with significant reductions in prescribing errors and related patient harm (preventable ADEs) at acceptable costs per monitored patient-day. Trial registration number ISRCTN92487665

2010-01-01

312

Performance of a clinical decision support system and of clinical pharmacists in preventing drug-drug interactions on a geriatric ward.  

PubMed

Background Drug-drug interactions (DDIs) can lead to adverse drug events and compromise patient safety. Two common approaches to reduce these interactions in hospital practice are the use of clinical decision support systems and interventions by clinical pharmacists. Objective To compare the performance of both approaches with the main objective of learning from one approach to improve the other. Setting Acute geriatric ward in a university hospital. Methods Prospective single-centre, cohort study of patients admitted to the geriatric ward. An independent pharmacist compared the clinical decision support alerts with the DDIs identified by clinical pharmacists and evaluated their interventions. Contextual factors used by the clinical pharmacists for evaluation of the clinical relevance were analysed. Adverse drug events related to DDIs were investigated and the causality was evaluated by a clinical pharmacologist based on validated criteria. Main outcome measure Number of alerts, interventions and the acceptance rates. Results Fifty patients followed by the clinical pharmacists, were included. The clinical pharmacists identified 240 DDIs (median of 3.5 per patient) and advised a therapy change for 16 of which 13 (81.2 %) were accepted and three (18.8 %) were not. The decision support system generated only six alerts of which none were accepted by the physicians. Thirty-seven adverse drug events were identified for 29 patients that could be related to 55 DDIs. For two interactions the causality was evaluated as certain, for 31 as likely, for ten as possible and for 12 as unlikely. Mainly intermediate level interactions were related to adverse drug events. Contextual factors taken into account by the clinical pharmacists for evaluation of the interactions were blood pressure, international normalised ratio, heart rate, potassium level and glycemia. Additionally, the clinical pharmacists looked at individual administration intervals and drug sequence to determine the clinical relevance of the interactions. Conclusion Clinical pharmacists performed better than the decision support system mainly because the system screened only for high level DDIs and because of the low specificity of the alerts. This specificity can be increased by including contextual factors into the logic and by defining appropriate screening intervals that take into account the sequence in which the drugs are given. PMID:24566821

Cornu, Pieter; Steurbaut, Stephane; Soštari?, Sabina; Mrhar, Aleš; Dupont, Alain G

2014-06-01

313

Emergence of high ampicillin-resistant Enterococcus faecium isolates in a kidney transplant ward: role of antibiotic pressure and cross transmission.  

PubMed

The epidemiology of patients associated with ampicillin-resistant Enterococcus faecium (ARE) was investigated by combining both clinical approach and molecular analysis in a kidney transplant patient's ward. A case-control study was performed to identify risk factors for ARE by matching each patient with ARE with two control patients without any isolated E. faecium strain. ARE isolates were characterized by pulsed-field gel electrophoresis. From June 2004 to May 2006, 18 cases with clinical ARE samples were detected and compared with 35 control patients. By univariate analysis, recurrent urinary tract infections (UTIs) (odds ratio [OR], 4.9; 95% confidence interval [CI], 1.0-25.6), mean number of hospitalization days in the last year (p < 0.003), pyelonephritis or UTI (OR, 9.6; 95% CI, 2.2-46.1), oral third-generation cephalosporin use (OR, 12.42; 95% CI, 2.04-109.1), and fluoroquinolone use (OR, 4.4; 95% CI, 1.1-18.2) were significantly associated with ARE urinary tract colonization. By conditional logistic regression, hospitalization >21 days within 1 year (adjusted OR [aOR], 6.9; 95% CI, 1.0-46.5), recent medical history of pyelonephritis or UTI (aOR, 8.6; 95% CI, 1.5-49.1), and prior oral third-generation cephalosporin use (aOR, 13.1; 95% CI, 1.2-142.6) were identified as independent factors associated with ARE urinary tract colonization. Genotyping revealed a heterogeneous epidemiological situation with two major clones in patients hospitalized in successive rooms and 10 different single pulsotypes. Emergence of highly resistant enterococcal strains is a collateral damage from antibiotic prescription and represents a potential source of patient-to-patient transmission. Combining epidemiological approach and molecular analysis is a powerful tool to delineate mechanisms of emerging resistance. Improving our knowledge on ARE emergence in high antibiotic pressure hospital wards is a key factor to better control these colonizations/infections and to prevent the emergence of vancomycin-resistant E. faecium. PMID:20370509

Maillard, Olivier; Corvec, Stéphane; Dantal, Jacques; Reynaud, Alain; Lucet, Jean-Christophe; Bémer, Pascale; Lepelletier, Didier

2010-06-01

314

Reiki and related therapies in the dialysis ward: an evidence-based and ethical discussion to debate if these complementary and alternative medicines are welcomed or banned  

PubMed Central

Background Complementary and Alternative Medicines (CAMs) are increasingly practiced in the general population; it is estimated that over 30% of patients with chronic diseases use CAMs on a regular basis. CAMs are also used in hospital settings, suggesting a growing interest in individualized therapies. One potential field of interest is pain, frequently reported by dialysis patients, and seldom sufficiently relieved by mainstream therapies. Gentle-touch therapies and Reiki (an energy based touch therapy) are widely used in the western population as pain relievers. By integrating evidence based approaches and providing ethical discussion, this debate discusses the pros and cons of CAMs in the dialysis ward, and whether such approaches should be welcomed or banned. Discussion In spite of the wide use of CAMs in the general population, few studies deal with the pros and cons of an integration of mainstream medicine and CAMs in dialysis patients; one paper only regarded the use of Reiki and related practices. Widening the search to chronic pain, Reiki and related practices, 419 articles were found on Medline and 6 were selected (1 Cochrane review and 5 RCTs updating the Cochrane review). According to the EBM approach, Reiki allows a statistically significant but very low-grade pain reduction without specific side effects. Gentle-touch therapy and Reiki are thus good examples of approaches in which controversial efficacy has to be balanced against no known side effect, frequent free availability (volunteer non-profit associations) and easy integration with any other pharmacological or non pharmacological therapy. While a classical evidence-based approach, showing low-grade efficacy, is likely to lead to a negative attitude towards the use of Reiki in the dialysis ward, the ethical discussion, analyzing beneficium (efficacy) together with non maleficium (side effects), justice (cost, availability and integration with mainstream therapies) and autonomy (patients’ choice) is likely to lead to a permissive-positive attitude. Summary This paper debates the current evidence on Reiki and related techniques as pain-relievers in an ethical framework, and suggests that physicians may wish to consider efficacy but also side effects, contextualization (availability and costs) and patient’s requests, according also to the suggestions of the Society for Integrative Oncology (tolerate, control efficacy and side effects).

2013-01-01

315

Nurse Managers' Perceptions Related to Their Leadership Styles, Knowledge, and Skills in These Areas--A Viewpoint: Case of Health Centre Wards in Finland  

PubMed Central

The purpose of this study was to explore nurse managers' perceptions related to their leadership styles, knowledge, and their skills in these areas in health centre wards in Finland. The data were collected from nurse managers (n = 252) in health centre hospitals in Finland using a structured questionnaire (response rate 63%). Six leadership styles—visionary, coaching, affiliate, democratic, commanding, and isolating—were reflected on. Almost all respondents in every age group considered four leadership styles—visionary, coaching, affiliate, and democratic—to be very important or important. Nurse managers estimated their knowledge and skills in leadership styles to be essentially fairly sufficient or sufficient. Nurse managers' abilities to reflect, understand, and, if necessary, change their leadership style influence the work unit's success and employees' job satisfaction. Nurse managers, especially new nurse managers, need more theoretic, evidence-based education to cope with these expectations and to develop their professional abilities. Together with universities, health care organizations should start planning nurse manager education programmes that focus on strategic issues, leadership, job satisfaction, challenging situations in leadership, change management, work unit management (e.g., economy, efficiency, and resources), and how the nurse managers consider their own wellbeing.

Suhonen, Marjo; Isola, Arja; Paasivaara, Leena; Laukkala, Helena

2013-01-01

316

Nurse managers' perceptions related to their leadership styles, knowledge, and skills in these areas-a viewpoint: case of health centre wards in Finland.  

PubMed

The purpose of this study was to explore nurse managers' perceptions related to their leadership styles, knowledge, and their skills in these areas in health centre wards in Finland. The data were collected from nurse managers (n = 252) in health centre hospitals in Finland using a structured questionnaire (response rate 63%). Six leadership styles-visionary, coaching, affiliate, democratic, commanding, and isolating-were reflected on. Almost all respondents in every age group considered four leadership styles-visionary, coaching, affiliate, and democratic-to be very important or important. Nurse managers estimated their knowledge and skills in leadership styles to be essentially fairly sufficient or sufficient. Nurse managers' abilities to reflect, understand, and, if necessary, change their leadership style influence the work unit's success and employees' job satisfaction. Nurse managers, especially new nurse managers, need more theoretic, evidence-based education to cope with these expectations and to develop their professional abilities. Together with universities, health care organizations should start planning nurse manager education programmes that focus on strategic issues, leadership, job satisfaction, challenging situations in leadership, change management, work unit management (e.g., economy, efficiency, and resources), and how the nurse managers consider their own wellbeing. PMID:23691356

Vesterinen, Soili; Suhonen, Marjo; Isola, Arja; Paasivaara, Leena; Laukkala, Helena

2013-01-01

317

Can't we just let them eat? Defining and addressing under-use of the oral route in a post-surgical ward.  

PubMed

Early postoperative nutrition improves outcomes. However, postoperative fasting is a tradition that persists in some areas of surgical practice. This retrospective audit was performed to benchmark current nutrition support practices on a mixed specialty surgical ward in a large tertiary-referral teaching hospital. Thirty-eight consecutive patients, who were undergoing gynaecological or urological surgical procedures between November 2010 and May 2011, had data collected including demographics, nutritional status, details of surgery performed, postoperative complications, modes of nutrition support and time taken to progress to solid oral diet. Energy and protein provision and adequacy was estimated for the first week postoperatively. Sixteen patients commenced parenteral nutrition postoperatively without any trial of oral or enteral nutrition. Reasons for using parenteral nutrition included observed or expected gut dysmotility and lack of enteral access for feeding. These patients did demonstrate longer length of stay and higher rates of postoperative complications. Given the proportion of patients initiated immediately on parenteral nutrition and maintained on it alone, it can be argued that these patients are not able to demonstrate tolerance and receive the benefits of early enteral feeding predicted by studies within these patient groups. None of the patients met their energy and protein requirements in the first week postoperatively. Despite support in the literature, it can be challenging to implement early postoperative nutrition support after pelvic surgery. It may be necessary to employ a variety of strategies to change this aspect of practice and promote earlier introduction of an oral diet or the use of enteral nutrition. PMID:23635362

Conchin, Simone; Muirhead, Ros; Ferrie, Suzie; Carey, Sharon

2013-01-01

318

The Luttinger-Ward functional approach in the Eliashberg framework: a systematic derivation of scaling for thermodynamics near the quantum critical point.  

PubMed

Scaling expressions for the free energy are derived, using the Luttinger-Ward (LW) functional approach in the Eliashberg framework, for two different models of the quantum critical point (QCP). First, we consider the spin-density-wave model for which the effective theory is the Hertz-Moriya-Millis theory, describing the interaction between itinerant electrons and collective spin fluctuations. The dynamics of the latter are described using a dynamical exponent z depending on the nature of the transition. Second, we consider the Kondo breakdown model for QCPs, one possible scenario for heavy-fermion quantum transitions, for which the effective theory is given by a gauge theory in terms of conduction electrons, spinons for localized spins, holons for hybridization fluctuations, and gauge bosons for collective spin excitations. For both models, we construct the thermodynamic potential, in the whole phase diagram, including all kinds of self-energy corrections in a self-consistent way, at the one-loop level. We show how the Eliashberg framework emerges at this level and use the resulting Eliashberg equations to simplify the LW expression for the free energy. It is found that collective boson excitations play a central role. The scaling expression for the singular part of the free energy near the Kondo breakdown QCP is characterized by two length scales: one is the correlation length for hybridization fluctuations, and the other is that for gauge fluctuations, analogous to the penetration depth for superconductors. PMID:21427476

Benlagra, A; Kim, K-S; Pépin, C

2011-04-13

319

Well completion and hydraulic-fracture-treatment design and analysis of the Canyon Sands (Lower and Middle Intervals). Phillips Petroleum Company, Ward C Well No. 11, Sonora (Canyon Sands) field, Sutton County, Texas. Topical report, July 1991  

SciTech Connect

The report represents a comprehensive analysis of the testing and design of the completion and hydraulic fracturing treatment on the Lower and Middle Intervals of the Canyon Sands in the Phillips Petroleum Company Ward C No. 11 Well. Presented is a reservoir description; in-situ stress measurements; and the design, execution and evaluation of the mini-frac and propped fracturing treatments. As part of the West Texas Canyon Sands GRI cooperative well program, some of the data and results obtained on another Canyon Sands co-op well are included with the results from the Ward C-11. In-situ stress measurements are coupled with the results from the LSDS log stress to obtain a calibrated stress profile. These data, along with mini-frac data are used to analyze hydraulic fracturing in the reservoir.

Wooten, C.T.

1991-07-11

320

Diagnostic Performance of a Multiple Real-Time PCR Assay in Patients with Suspected Sepsis Hospitalized in an Internal Medicine Ward  

PubMed Central

Early identification of causative pathogen in sepsis patients is pivotal to improve clinical outcome. SeptiFast (SF), a commercially available system for molecular diagnosis of sepsis based on PCR, has been mostly used in patients hospitalized in hematology and intensive care units. We evaluated the diagnostic accuracy and clinical usefulness of SF, compared to blood culture (BC), in 391 patients with suspected sepsis, hospitalized in a department of internal medicine. A causative pathogen was identified in 85 patients (22%). Sixty pathogens were detected by SF and 57 by BC. No significant differences were found between the two methods in the rates of pathogen detection (P = 0.74), even after excluding 9 pathogens which were isolated by BC and were not included in the SF master list (P = 0.096). The combination of SF and BC significantly improved the diagnostic yield in comparison to BC alone (P < 0.001). Compared to BC, SF showed a significantly lower contamination rate (0 versus 19 cases; P < 0.001) with a higher specificity for pathogen identification (1.00, 95% confidence interval [CI] of 0.99 to 1.00, versus 0.94, 95% CI of 0.90 to 0.96; P = 0.005) and a higher positive predictive value (1.00, 95% CI of 1.00 to 0.92%, versus 0.75, 95% CI of 0.63 to 0.83; P = 0.005). In the subgroup of patients (n = 191) who had been receiving antibiotic treatment for ?24 h, SF identified more pathogens (16 versus 6; P = 0.049) compared to BC. These results suggest that, in patients with suspected sepsis, hospitalized in an internal medicine ward, SF could be a highly valuable adjunct to conventional BC, particularly in patients under antibiotic treatment.

Pasqualini, Leonella; Leli, Christian; Montagna, Paolo; Cardaccia, Angela; Cenci, Elio; Montecarlo, Ines; Pirro, Matteo; di Filippo, Francesco; Cistaro, Emma; Schillaci, Giuseppe; Bistoni, Francesco; Mannarino, Elmo

2012-01-01

321

Dissemination of IncFII(K)-type plasmids in multiresistant CTX-M-15-producing Enterobacteriaceae isolates from children in hospital paediatric oncology wards.  

PubMed

In this study, extended-spectrum ?-lactamase (ESBL)-producing Enterobacteriaceae isolates in children with malignancies hospitalised at a paediatric oncology department in the Czech Republic were investigated. From June 2009 to January 2010, a total of 50 ESBL-producing faecal isolates of Enterobacteriaceae were obtained from 28 patients. These isolates were characterised with regard to ESBL enzymes, plasmid-mediated quinolone resistance genes, multilocus sequence typing (MLST) and plasmids conferring resistance to cephalosporins and fluoroquinolones. ESBL-producing isolates included Klebsiella pneumoniae (n=36), Escherichia coli (n=7), Klebsiella oxytoca (n=3), Enterobacter cloacae (n=2) and Citrobacter freundii (n=2). Klebsiella pneumoniae isolates belonged to 7 MLST types, including sequence types ST280, ST321, ST323 and ST416 as well as the novel types ST626, ST627 and ST628. The multiresistant epidemic clone E. coli B2-O25b-ST131 was detected in one patient. The gene bla(CTX-M-15) was found on large conjugative IncFII(K) plasmids along with bla(TEM-1), bla(OXA-1), qnrB1, aac(6')-Ib-cr, strA, sul2, aac(3')-II and tet(A) genes in most isolates. Dissemination of IncFII(K) plasmids among various Enterobacteriaceae isolates was considered an important aspect of nosocomial colonisation in the wards by Enterobacteriaceae species producing ESBLs. This is the first study documenting multiple antibiotic resistance elements, including qnr genes, in IncFII(K) plasmids in various bacterial species isolated in a single hospital department. The results highlight the evolution of IncFII(K) plasmids into new variants containing novel antibiotic resistance elements and their important role in spreading ESBL-producing bacteria among hospitalised patients. PMID:23043911

Dolejska, Monika; Brhelova, Eva; Dobiasova, Hana; Krivdova, Jana; Jurankova, Jana; Sevcikova, Alena; Dubska, Lenka; Literak, Ivan; Cizek, Alois; Vavrina, Martin; Kutnikova, Lucia; Sterba, Jaroslav

2012-12-01

322

Prescribing patterns of antibiotics and sensitivity patterns of common microorganisms in the Internal Medicine ward of a teaching hospital in Western Nepal: a prospective study  

PubMed Central

Background Information about antibiotic use and resistance patterns of common microorganisms are lacking in hospitals in Western Nepal. Excessive and inappropriate use of antibiotics contributes to the development of bacterial resistance. The parameter: Defined daily dose/100 bed-days, provides an estimate of consumption of drugs among hospital in-patients. This study was carried out to collect relevant demographic information, antibiotic prescribing patterns and the common organisms isolated including their antibiotic sensitivity patterns. Methods The study was carried out over a 3-month period (01.04.2002 to 30.06.2002) at the Manipal Teaching Hospital, Western Nepal. The median number of days of hospitalization and mean ± SD cost of antibiotics prescribed during hospital stay were calculated. The use of antibiotics was classified for prophylaxis, bacteriologically proven infection or non-bacteriologically proven infection. Sensitivity patterns of the common organisms were determined. Defined daily dose/100 bed-days of the ten most commonly prescribed antibiotics were calculated. Results 203 patients were prescribed antibiotics; 112 were male. Median duration of hospitalization was 5 days. 347 antibiotics were prescribed. The most common were ampicillin, amoxicillin, metronidazole, ciprofloxacin and benzylpenicillin. Mean ± SD cost of antibiotics was 16.5 ± 13.4 US$. Culture and sensitivity testing was carried out in 141 patients. The common organisms isolated were H. influenzae, E. coli, K. pneumoniae and S. aureus. Conclusions Antibiotic resistance is becoming a problem in the Internal Medicine ward. Formulation of a policy for hospital antibiotic use and an educational programme especially for junior doctors is required.

Shankar, Ravi Pathiyil; Partha, Praveen; Shenoy, Nagesh Kumar; Easow, Joshy Maducolil; Brahmadathan, Kottallur Narayanan

2003-01-01

323

The Cancer Ward: Scapegoating Revisited.  

ERIC Educational Resources Information Center

Describes scapegoating encountered during the author's third-year experience as psychological consultant to the oncology unit of a large medical center. Therapeutic strategies for managing the crisis within the structure of an ongoing staff support group are discussed. A conceptual framework for understanding the scapegoating process is…

Yeargan, Linda D.; Nehemkis, Alexis M.

1983-01-01

324

N-Point Vertex Functions, Ward-Takahashi Identities and Dyson-Schwinger Equations in Thermal QCD/QED in the Real Time Hard-Thermal-Loop Approximation  

NASA Astrophysics Data System (ADS)

In this paper we calculate the n-point hard-thermal-loop (HTL) vertex functions in QCD/QED for n= 2, 3 and 4 in the physical representation using the real time formalism (RTF). The result reveals that the n-point HTL vertex functions can be classified into two groups, a) those with odd numbers of external retarded indices, and b) those with even numbers of external retarded indices. The n-point HTL vertex functions with one retarded index, which obviously belong to group a), are identical to the HTL vertex functions that appear in the imaginary time formalism (ITF). All the HTL vertex functions belonging to group a) are O(g2T2) and satisfy among them the simple QED-type Ward-Takahashi identities, as in the ITF. Those vertex functions belonging to group b) never appear in the ITF, their existence being characteristic of the RTF, and their HTLs exhibit high temperature behavior that is O(g2T3), one power of T higher than usual. Despite this difference, we were able to verify that those HTL vertex functions belonging to group b) also satisfy among themselves the QED-type Ward-Takahashi identities, thus guaranteeing the gauge invariance of the HTLs in the real time thermal QCD/QED. As an application, we explicitly derive the HTL resummed Dyson-Schwinger equations for the physical fermion mass function and for the gauge boson polarization tensor in thermal QCD/QED.

Fueki, Y.; Nakkagawa, H.; Yokota, H.; Yoshida, K.

2002-04-01

325

Outbreak of Salmonella enterica serotype Infantis producing ArmA 16S RNA methylase and CTX-M-15 extended-spectrum ?-lactamase in a neonatology ward in Constantine, Algeria.  

PubMed

Plasmid-mediated 16S rRNA methylases such as ArmA, which confer high levels of resistance to aminoglycosides, are increasingly reported in Enterobacteriaceae. This study investigated the molecular mechanism of ?-lactam and aminoglycoside resistance in extended-spectrum ?-lactamase (ESBL)-producing Salmonella enterica serotype Infantis isolated at the 53-bed neonatology ward of University Hospital Benabib in Constantine, Algeria. From September 2008 to January 2009, 200 S. enterica isolates were obtained from 138 patients (age range 8-80 months) hospitalised in the neonatology ward. Most isolates were from stool cultures, but also from two blood cultures and one gastric fluid. The isolates were multidrug-resistant and produced TEM-1 and CTX-M-15 enzymes as well as the 16S RNA methylase ArmA. The armA, bla(CTX-M-15) and bla(TEM-1) genes were located on the same 140-kb self-transferable plasmid belonging to the IncL/M incompatibility group. All of the S. Infantis isolates belonged to a single clone. Increased infection control measures and thorough biodecontamination of the rooms led to control of the outbreak but did not eradicate the epidemic strain. This study further illustrates the global emergence of ArmA methylase and its frequent association with bla(CTX-M) genes. Spread of 16S RNA methylase determinants at the same level as bla(CTX-M) genes in Enterobacteriaceae may seriously compromise the efficacy of aminoglycosides for treating Gram-negative infections. PMID:21658916

Naas, Thierry; Bentchouala, Chafia; Cuzon, Gaelle; Yaou, Sanŕa; Lezzar, Abdesselam; Smati, Farida; Nordmann, Patrice

2011-08-01

326

Genetics Home Reference: Romano-Ward syndrome  

MedlinePLUS

... into and out of cells. In cardiac muscle, ion channels play critical roles in maintaining the heart's normal ... gene does not provide instructions for making an ion channel. The ANK2 protein, ankyrin-2, ensures that certain ...

327

Using Exercise to Ward Off Depression.  

ERIC Educational Resources Information Center

Exercise can be as effective as psychotherapy and antidepressant therapy in treating mild-to-moderate depression, and even more effective when used in conjunction with them. Exercise can also be preventive therapy for those not clinically depressed. The paper explains how best to work exercise into a depressed patient's therapy. (Author/SM)

Nicoloff, George; Schwenk, Thomas L.

1995-01-01

328

Cruelty in Maternity Wards: Fifty Years Later  

PubMed Central

Fifty years have passed since a scandal broke over inhumane treatment of laboring women in U.S. hospitals, yet first-person and eyewitness reports document that medical care providers continue to subject childbearing women to verbal and physical abuse and even to what would constitute sexual assault in any other context. Women frequently are denied their right to make informed decisions about care and may be punished for attempting to assert their right to refusal. Mistreatment is not uncommon and persists because of factors inherent to hospital social culture. Concerted action on the part of all stakeholders will be required to bring about systemic reform.

Goer, Henci

2010-01-01

329

Subcutaneous Injection of Mercury: "Warding Off Evil"  

PubMed Central

Deliberate injection of mercury, especially subcutaneous injection, is rare but is seen in psychiatric patients, individuals who attempt suicide, those who are accidentally injected, and boxers who wish to build muscle bulk. Metallic mercury plays a major role in ethnic folk medicine. Neurologic and renal complications can result from high systemic levels of mercury, and subcutaneous injection usually results in sterile abscesses. Urgent surgical evacuation and close monitoring for neurologic and renal functions as well as chelation (if toxicity is indicated) are key aspects of treatment. Education of the adverse effects and dangers of mercury is important, especially in pregnant women and children. As increased immigration changes demographic patterns, proper disposal of mercury and preventing its sale and use should become urgent societal priorities. Psychiatric consultation should be obtained whenever appropriate.

Prasad, Venkat L.

2004-01-01

330

Use of the Xpert(R) MTB/RIF assay for diagnosing pulmonary tuberculosis comorbidity and multidrug-resistant TB in obstetrics and gynaecology inpatient wards at the University Teaching Hospital, Lusaka, Zambia  

PubMed Central

OBJECTIVES In high-tuberculosis (TB)-endemic countries, comorbidity of pulmonary TB in hospitalised patients with non-communicable diseases is well documented. In this study, we evaluated the use of the Xpert® MTB/RIF assay for the detection of concomitant pulmonary TB in patients admitted to the University Teaching Hospital, Lusaka, Zambia, with a primary obstetric or gynaecological condition. METHODS The Study population were inpatients admitted with a primary obstetric or gynaecological problem who had a concomitant cough and were able to expectorate a sputum sample. Sputum samples from 94 patients were analysed for the presence of Mycobacterium tuberculosis (M.tb) by standard smear microscopy, MGIT culture, MGIT drug-susceptibility testing (DST) and the Xpert® MTB/RIF assay. The sensitivity and specificity of the Xpert® MTB/RIF assay were evaluated against the culture gold standard. RESULTS Twenty-six of 94 (27.7%) patients had culture-confirmed pulmonary TB. The Xpert® MTB/RIF assay had a sensitivity of 80.8% [95% CI: 60.0–92.7%]) compared against MGIT culture. The Xpert® MTB/RIF assay was more sensitive than sputum smear microscopy (21/26 (80.8%) vs. 13/26 (50.0%), P = 0.02) and detected an additional eight culture-confirmed cases. Culture DST analysis identified two monoresistant M.tb strains: one resistant to rifampicin (rifampicin sensitive by the Xpert® MTB/RIF assay) and one to ethambutol. HIV infection was linked with a 3-fold increase in risk of TB, accounting for 87.5% (21/24) of TB cases. 50% of cases presented as comorbidities with other communicable diseases (CDs) and non-communicable diseases (NCDs). CONCLUSIONS As an alternative to sputum microscopy, the Xpert® MTB/RIF assay provides a sensitive, specific and rapid method for the diagnosis of pulmonary TB in obstetric or gynaecological inpatients. Pulmonary TB is an important cause of concomitant comorbidity to the obstetric or gynaecological condition necessitating admission. TB and HIV comorbidities with other communicable and non-communicable diseases were also common. More proactive screening for TB comorbidity is required in obstetric and gynaecological wards.

Bates, Matthew; Ahmed, Yusuf; Chilukutu, Lophina; Tembo, John; Cheelo, Busiku; Sinyangwe, Sylvester; Kapata, Nathan; Maeurer, Markus; O'Grady, Justin; Mwaba, Peter; Zumla, Alimuddin

2013-01-01

331

Duplex ultrasound, clinical score, thrombotic risk, and D-dimer testing for evidence based diagnosis and management of deep vein thrombosis and alternative diagnoses in the primary care setting and outpatient ward.  

PubMed

Deep vein thrombosis (DVT) has an annual incidence of 0.2% in the urban population. First episodes of calf vein thrombosis (CVT) and proximal DVT are frequently elicited by risk factors, including varicose veins, cancer, pregnancy/postpartum, oral contraceptives below the age of 50 years, immobility or surgery. Leg pain and tenderness in the calf and popliteal fossa on physical examination may result from other conditions than DVT labeled as alternative diagnosis (AD) Congenital venous thrombophilia is present in every third first DVT, increased FVIII in every fourth first DVT, and FV Leiden/FII mutation in 40% of women on oral anticonceptive pill before reaching the menopause. Routine thrombophilia testing for FV Leiden/prothrombin mutation and FVIII as main risk factor for venous thrombosis is recommended. Primary superficial venous thrombosis (SVT) and DVT patients with a autosomal dominant family history of DVT are candidates for thrombophilia testing for congenital AT, PC and PS deficiency. The requirement for a safe diagnostic strategy of CVT and DVT should be based on an objective post-test incidence of venous thromboembolism (VTE) of less than 0.1% with a negative predictive value for exclusion of DVT of 99.9% during 3 months follow-up. Modification of the Wells score by elimination of the "minus 2 points" for AD is mandatory and will improve the diagnostic accuracy of CVT/DVT suspicion in the primary care setting and outpatient ward. The sequential use of complete DUS, ELISA D-dimer testing and modified clinical Wells' score assessment is safe and effective for the exclusion and diagnosis of CVT, DVT and AD. About 10% to 20% of patients with DVT develop overt post-thrombotic syndrome (PTS) at one year post-DVT, and both PTS and DVT recurrences further increase to about 30% during long-term follow-up. Objective risk stratification of PTS complications using DUS for recanalization and reflux and D-dimer testing will become an integral part in routine clinical practice to assess the optimal duration of wearing medical elastic stockings and anticoagulation for the prevention DVT recurrence as the best option to reduce the incidence and costs of suffering from irreversible PTS. PMID:24452081

Michiels, J J; Moosdorff, W; Maasland, H; Michiels, J M; Lao, M U; Neumann, H A; Dulicek, P; Stvrtinova, V; Barth, J; Palareti, G

2014-02-01

332

Blunt abdominal trauma treated in an intensive care ward  

PubMed Central

Seventy-two cases of major abdominal trauma with an overall mortality of 29% are reviewed. Only cases of sufficient severity to require nursing in an intensive care unit are included. The incidence of injury to the various viscera is shown. Methods of diagnosis and treatment are discussed. The causes of death in this series are analysed and ways of lowering the mortality figures outlined.

Arthur, G. W.; Lane, B. E.

1969-01-01

333

From Back Wards to Back Alleys: Deinstitutionalization and the Homeless.  

ERIC Educational Resources Information Center

The current non-system for dealing with the mentally disabled is expensive and inefficient and is the primary cause of a substantial proportion of all homelessness. A comprehensive national policy and the delegation of greater administrative responsibilities to private agencies would help to address the problem of the homeless mentally ill. (GC)

Hope, Marjorie; Young, James

1984-01-01

334

Cancer Ward Staff Group: An Intervention Designed to Prevent Disaster.  

ERIC Educational Resources Information Center

Describes a case study illustrating organizational and system contingencies for introducing and maintaining a support group for oncology nursing staff in a large general hospital culture. Criteria for long-run survivability of innovation in a work system are applied to a group structured like that described by Balint for training physicians in…

Barber, William H.

1985-01-01

335

Walter Russell Mead: Power, Terror, Peace, and Ward: Study Guide  

Microsoft Academic Search

Walter Russell Mead places this volume (which builds on Special Providence) into the context of the ideological and theological debates that have shaped American history. Like Michael Oakeshott and various conservatives, Mead depicts the contemporary world as the outworking of a “modern temper” or an “Enlightenment project,” two phases of which he focuses on: Fordism (resembling Lewis Mumford’s modern megamachine)

Steven Alan Samson

2008-01-01

336

Senile anorexia in acute-ward and rehabilitation settings  

Microsoft Academic Search

The most common pathological change in eating behaviour among older persons is anorexia, which accounts for a large percent\\u000a of undernutrition in older adults. The main research aims are to determine, in a sample of acute and rehabilitation elderly\\u000a subjects, the prevalence of anorexia of aging and the causes most impacting on senile anorexia.Methods: four different Units cooperated to this

L. M. Donini; C. Savina; M. Piredda; D. Cucinotta; A. Fiorito; E. M. Inelmen; G. Sergi; L. J. Dominguez; M. Barbagallo; C. Cannella

2008-01-01

337

Closure of a Long-Stay Ward: Five Years Onwards  

Microsoft Academic Search

Closure of psychiatric hospitals has engendered much debate. There is a growing body of literature resulting from such closures. Lamb [1] in a lecture has pointed out the need for deinstitutionalisation to be clinically driven rather than by pre-conceived ideology. Bachrach [2] discussed the need to espouse a bio-psycho-social and humanistic approach coupled with the provision of adequate resources. In

Mahendra H. Perera; John Parkinson; Dhara Perera

1999-01-01

338

Integrated vulnerability mapping for wards in Mid-Norway  

Microsoft Academic Search

The future climate of Norway is expected to become “warmer, wetter, and wilder”, and it is anticipated that this will cause more extreme weather events. Local authorities therefore need to increase their ability to assess weather-related hazards such as flooding and landslide, as well as peoples’ capacities to cope with such events. Any evaluation of future vulnerability towards natural hazards

Jan Ketil Rřd; Ivar Berthling; Haakon Lein; Päivi Lujala; Geir Vatne; Linda Marie Bye

2012-01-01

339

[Profile of psychiatric emergencies in general hospital wards].  

PubMed

Statistical study, using objective variables, was carried out to draw the profile of psycho-social cases at the emergency unit of Publics hospitals. The study analyses the attitude of the nursing and medical staff. This paper looks the problem throw three parameters: the symptoms, the diagnosis and the final destination. The most important conclusion is: staff seems to see his work with emergencies cases like a shunting problem and not like a beginning of therapeutical work. PMID:6524416

Corten, P; Pelc, I

1984-01-01

340

Residential mobility among patients admitted to acute psychiatric wards.  

PubMed

Residential mobility among those with mental disorders is consistently associated with hospital admission. We studied 4485 psychiatric admissions in South London, aiming to describe the prevalence, timing and associations of residential moves occurring in association with admission. Moves tended to cluster around discharge; 15% of inpatients moved during admission or up to 28 days after discharge. The strongest associations were with younger age (especially 16-25 years) and homelessness. Unadjusted effects of gender, marital status and previous service use were mediated by homelessness. Possible mechanisms for the associations with homelessness and younger age are discussed. PMID:21612971

Tulloch, Alex D; Fearon, Paul; David, Anthony S

2011-07-01

341

A Logical levothyroxine dose Individualization: Optimization Approach at discharge from Radioiodine therapy ward and during follow-up in patients of Differentiated Thyroid Carcinoma: Balancing the Risk based strategy and the practical issues and challenges: Experience and Views of a large volume referral centre in India  

PubMed Central

In this communication, the authors discuss the issue of individualization of thyrotropin suppressive therapy in differentiated thyroid carcinoma (DTC) patients and share their views with respect to optimizing the dose of levothyroxine (LT) prescription both during discharge from radioiodine therapy ward and during follow-up. The changing management paradigm at our Institute during post-thyroidectomy period and during the preparation for radioiodine scan is also briefly highlighted. Five factors can be identified as important determinants for the dose individualization approach: (1) Persistence or absence of metastatic disease, (2) the risk characteristics of the patient and the tumor (3) patient's clinical profile, symptomatology, and contraindications (4) the feasibility to ensure a proper thyroid stimulating hormone TSH suppression level (depends on patient's socio-economic and educational background, the connectivity with the local physician and his expertise) (5) time period elapsed since initial diagnosis. While discussing each individual case scenario, the authors, based upon their experience in one of the busiest thyroid cancer referral centers in the country, discuss certain unaddressed points in the current guideline recommendations, deviations made and some challenges toward employing them into practice, which could be situation and center specific. In addition to these, the value of clinical examination, patient profile and detailed enquiry about clinical symptomatology by the attending physician in each follow-up visit cannot be overemphasized. According to the authors, this aspect, quite important for dose determination in an individual, is relatively underrepresented in the present guidelines. It would also be worthwhile to follow a conservative approach (till clear data emerges) in patients who have characteristics of “high-risk” disease, but are clinically and biochemically disease free, if no medical contraindications exist and patient tolerates the suppressive therapy well. This would be particularly applicable in the presence of aggressive histopathological variants, where, in the event of recurrence/metastasis, the disease demonstrates adverse prognosis and higher incidence of radioiodine refractoriness. At the end, certain important and noteworthy concepts pertaining to LT prescription that has definitive practical implications for the suppressive therapy in DTC patients are described.

Basu, Sandip; Abhyankar, Amit; Asopa, Ramesh; Chaukar, Devendra; DCruz, Anil K

2013-01-01

342

77 FR 10960 - Security Zone, East River and Bronx Kill; Randalls and Wards Islands, NY  

Federal Register 2010, 2011, 2012, 2013

...Marine security, Navigation (water), Reporting and recordkeeping...temporary security zone: All waters of the East River between the Hell Gate Rail Road Bridge (mile...Port Morris Stacks), and all waters of the Bronx Kill...

2012-02-24

343

Smoke-free policies in the psychiatric population on the ward and beyond: A discussion paper  

Microsoft Academic Search

Healthcare facilities from a number of countries have or are in the process of implementing smoke-free policies as part of their public health agenda and tobacco control strategy. Their main intent is to prevent the harmful effects of environmental tobacco smoke on employees and patients. However, these protection policies are often implemented before taking into account the specific needs of

Margaret A. Green; Pamela G. Hawranik

2008-01-01

344

Study: Daily Low-Dose Aspirin May Help Ward Off Pancreatic Cancer  

MedlinePLUS

... oncologist at North Shore-LIJ Cancer Institute in Lake Success, N.Y., said, "Pancreatic cancer is not ... M.D., oncologist, North Shore-LIJ Cancer Institute, Lake Success, N.Y.; Eric Jacobs, Ph.D., strategic ...

345

Ward features affecting stigma experiences in contemporary psychiatric hospitals: a multilevel study  

Microsoft Academic Search

Background  Various studies have revealed the existence and negative consequences of stigmatization of persons receiving professional\\u000a mental health care. Less attention is generally paid to factors affecting these stigma experiences. The influence of the immediate\\u000a treatment context, especially, is largely neglected.\\u000a \\u000a \\u000a \\u000a Objective  In this article, a multilevel design is used to explore the link between characteristics of the treatment context and stigma

Mieke Verhaeghe; Piet Bracke

2008-01-01

346

Birthing the Lesbian Teacher Within: To wards an Understanding of Identity and Self-Actualization  

Microsoft Academic Search

t is mid-semester and I have arranged individual conferences with all of my first- year composition students to gauge how they are doing in the course and to address any of their concerns about it. It's 12:00 and my next appointment, Monica, should be here any minute. Monica generally sits in the farthest comer of the room, arms crossed, rarely

Catherine Fox

347

Would artificial neural networks implemented in clinical wards help nephrologists in predicting epoetin responsiveness?  

Microsoft Academic Search

BACKGROUND: Due to its strong intra- and inter-individual variability, predicting the ideal erythropoietin dose is a difficult task. The aim of this study was to re-evaluate the impact of the main parameters known to influence the responsiveness to epoetin beta and to test the performance of artificial neural networks (ANNs) in predicting the dose required to reach the haemoglobin target

Luca Gabutti; Nathalie Lötscher; Josephine Bianda; Claudio Marone; Giorgio Mombelli; Michel Burnier

2006-01-01

348

A case-control study of purple urine bag syndrome in geriatric wards  

Microsoft Academic Search

The clinical background of purple urine bag syndrome (PUBS) has not yet been well characterized. In previous reports, clinical,\\u000a biochemical, or bacteriological analyses were carried out using urine or bacteria from a limited number of patients. Other\\u000a than one report, we are not aware of any case-control studies that compared the clinical, biochemical, or bacteriological\\u000a background between patients with and

Naoki Mantani; Hiroshi Ochiai; Nobuko Imanishi; Toshiaki Kogure; Katsutoshi Terasawa; Jun'ichi Tamura

2003-01-01

349

Introducing an osteopathic approach into neonatology ward: the NE-O model  

PubMed Central

Background Several studies showed the effect of osteopathic manipulative treatment on neonatal care in reducing length of stay in hospital, gastrointestinal problems, clubfoot complications and improving cranial asymmetry of infants affected by plagiocephaly. Despite several results obtained, there is still a lack of standardized osteopathic evaluation and treatment procedures for newborns recovered in neonatal intensive care unit (NICU). The aim of this paper is to suggest a protocol on osteopathic approach (NE-O model) in treating hospitalized newborns. Methods The NE-O model is composed by specific evaluation tests and treatments to tailor osteopathic method according to preterm and term infants’ needs, NICU environment, medical and paramedical assistance. This model was developed to maximize the effectiveness and the clinical use of osteopathy into NICU. Results The NE-O model was adopted in 2006 to evaluate the efficacy of OMT in neonatology. Results from research showed the effectiveness of this osteopathic model in reducing preterms’ length of stay and hospital costs. Additionally the present model was demonstrated to be safe. Conclusion The present paper defines the key steps for a rigorous and effective osteopathic approach into NICU setting, providing a scientific and methodological example of integrated medicine and complex intervention.

2014-01-01

350

Reducing Ward-Clinic Conflicts by Rotational Scheduling of House Staff.  

ERIC Educational Resources Information Center

Internal medicine residency programs that put increasing emphasis on outpatient experience and continuity of care place demands on residents that conflict with inpatient responsibilities. The development and implementation at the University of Virginia Hospital of a rotational scheduling system aimed at alleviating the conflict is described.…

And Others; Hodge, Robert H.

1979-01-01

351

Everyday practices at the medical ward: a 16-month ethnographic field study  

PubMed Central

Background Modern hospital care should ostensibly be multi-professional and person-centred, yet it still seems to be driven primarily by a hegemonic, positivistic, biomedical agenda. This study aimed to describe the everyday practices of professionals and patients in a coronary care unit, and analyse how the routines, structures and physical design of the care environment influenced their actions and relationships. Methods Ethnographic fieldwork was conducted over a 16-month period (between 2009 and 2011) by two researchers working in parallel in a Swedish coronary care unit. Observations, informal talks and formal interviews took place with registered nurses, assistant nurses, physicians and patients in the coronary care unit. The formal interviews were conducted with six registered nurses (five female, one male) including the chief nurse manager, three assistant nurses (all female), two cardiologists and three patients (one female, two male). Results We identified the structures that either promoted or counteracted the various actions and relationships of patients and healthcare professionals. The care environment, with its minimalistic design, strong focus on routines and modest capacity for dialogue, restricted the choices available to both patients and healthcare professionals. This resulted in feelings of guilt, predominantly on the part of the registered nurses. Conclusions The care environment restricted the choices available to both patients and healthcare professionals. This may result in increased moral stress among those in multi-professional teams who work in the grey area between biomedical and person-centred care.

2012-01-01

352

An Audit of Ward Experience as a Tool for Teaching Diagnosis in Pulmonary Medicine  

ERIC Educational Resources Information Center

Analyzes and compares diagnoses made over a five-year period to determine whether differences between diagnoses of students and those of specialists justified further verification by specialized staff, and whether the proportion of such differences had changed with time because of more effective teaching. (WM)

Kale, Madhav K.; and others

1969-01-01

353

Liver biopsy in chronic hepatitis C: the experience of 15 Italian wards of infectious diseases.  

PubMed

To evaluate the impact of liver histology on the management of HCV-related chronic hepatitis, 281 patients with chronic HCV infection who consecutively underwent percutaneous liver biopsy (LB) at one of the 15 participating Italian Units of Infectious Diseases were investigated in 2005. Demographic, aetiological, laboratory and clinical data and information on methods applied to perform ultrasonography (US) and LB were recorded. Males predominated (61.6%), mean age was 47.5 years and the mean BMI 22.3. In each case LB was US-guided or US-assisted. An 18-gauge Menghini-type needle was used in 203 (72.2%) cases. The length of the specimen ranged between 1.5 and 5 cm in 279 (99.3%) cases, it was smaller in two cases, but the diagnosis was still possible. Haemoperitoneum was the only (0.4%) major unpredictable complication; minor complications were also infrequent (4%). Using both clinical and laboratory data and US examination the physician misdiagnosed liver histology in 25% of cases. After LB the physicians changed their opinion on whether to treat with PEG-INF plus ribavirin in 43 (15.5%) cases. Liver histology allows more accurate diagnosis and enables physicians to make the most appropriate choic. PMID:22475658

Sagnelli, Evangelista; Sagnelli, Caterina; Pisaturo, Maria Antonietta; Coppola, Nicola; Pasquale, Giuseppe; Piccinino, Felice

2012-03-01

354

Infrastructuring and Ordering Devices in Health Care: Medication Plans and Practices on a Hospital Ward  

Microsoft Academic Search

In this paper, we analyse physicians’ and nurses’ practices of prescribing and administering medication through the use of\\u000a paper-based, and digitalized medication plans. Our point of departure is an ethnographic study of the implications of upgrading\\u000a an electronic medication module (EMM) that is part of an electronic health record (EHR), carried out at an endocrinology department.\\u000a The upgrade led to

Claus Bossen; Randi Markussen

2010-01-01

355

Enterobacter sakazakii in dried infant formulas and milk kitchens of maternity wards in Săo Paulo, Brazil.  

PubMed

This study was the first conducted in Brazil to evaluate the presence of Enterobacter sakazakii in milk-based powdered infant formula manufactured for infants 0 to 6 months of age and to examine the conditions of formula preparation and service in three hospitals in Săo Paulo State, Brazil. Samples of dried and rehydrated infant formula, environments of milk kitchens, water, bottles and nipples, utensils, and hands of personnel were analyzed, and E. sakazakii and Enterobacteriaceae populations were determined. All samples of powdered infant formula purchased at retail contained E. sakazakii at <0.3 [corrected] most probable number (MPN)/100 g. In hospital samples, E. sakazakii was found in one unopened formula can (0.3 MPN/100 g) and in the residue from one nursing bottle from hospital A. All other cans of formula from the same lot bought at a retail store contained E. sakazakii at <0.3 [corrected] MPN/100 g. The pathogen also was found in one cleaning sponge from hospital B. Enterobacteriaceae populations ranged from 10(1) to 10(5) CFU/g in cleaning aids and <5 CFU/g in all formula types (dry or rehydrated), except for the sample that contained E. sakazakii, which also was contaminated with Enterobacteriaceae at 5 CFU/g. E. sakazakii isolates were not genetically related. In an experiment in which rehydrated formula was used as the growth medium, the temperature was that of the neonatal intensive care unit (25 degrees C), and the incubation time was the average time that formula is left at room temperature while feeding the babies (up to 4 h), a 2-log increase in levels of E. sakazakii was found in the formula. Visual inspection of the facilities revealed that the hygienic conditions in the milk kitchens needed improvement. The length of time that formula is left at room temperature in the different hospitals while the babies in the neonatal intensive care unit are being fed (up to 4 h) may allow for the multiplication of E. sakazakii and thus may lead to an increased health risk for infants. PMID:19205461

Palcich, Gabriela; Gillio, Cintia de Moraes; Aragon-Alegro, Lina Casale; Pagotto, Franco J; Farber, Jeffrey M; Landgraf, Mariza; Destro, Maria Teresa

2009-01-01

356

Assessment of quality of care in postpartum wards of Shaheed Beheshti Medical Science University hospitals, 2004  

Microsoft Academic Search

Purpose – Despite 77 per cent antenatal care coverage and 90 per cent skilled attendant at delivery, adjusted maternal mortality in Iran is 76 per 100,000 births. Low quality of maternal health services is one cause of maternal morbidity and mortality. However, few and limited studies have been devoted to the quality of postpartum care in Iran. This study aims

M. Simbar; Z. Alizadeh Dibazari; J. Abed Saeidi; H. Alavi Majd

2005-01-01

357

Treatment of schizophrenia with antipsychotics in Norwegian emergency wards, a cross-sectional national study  

Microsoft Academic Search

BACKGROUND: Surveys on prescription patterns for antipsychotics in the Scandinavian public health system are scarce despite the prevalent use of these drugs. The clinical differences between antipsychotic drugs are mainly in the areas of safety and tolerability, and international guidelines for the treatment of schizophrenia offer rational strategies to minimize the burden of side effects related to antipsychotic treatment. The

Rune A Kroken; Erik Johnsen; Torleif Ruud; Tore Wentzel-Larsen; Hugo A Jřrgensen

2009-01-01

358

Facilitating the transition from physiology to hospital wards through an interdisciplinary case study of septic shock  

PubMed Central

Background In order to develop clinical reasoning, medical students must be able to integrate knowledge across traditional subject boundaries and multiple disciplines. At least two dimensions of integration have been identified: horizontal integration, bringing together different disciplines in considering a topic; and vertical integration, bridging basic science and clinical practice. Much attention has been focused on curriculum overhauls, but our approach is to facilitate horizontal and vertical integration on a smaller scale through an interdisciplinary case study discussion and then to assess its utility. Methods An interdisciplinary case study discussion about a critically ill patient was implemented at the end of an organ system-based, basic sciences module at New York University School of Medicine. Three clinical specialists—a cardiologist, a pulmonologist, and a nephrologist—jointly led a discussion about a complex patient in the intensive care unit with multiple medical problems secondary to septic shock. The discussion emphasized the physiologic underpinnings behind the patient’s presentation and the physiologic considerations across the various systems in determining proper treatment. The discussion also highlighted the interdependence between the cardiovascular, respiratory, and renal systems, which were initially presented in separate units. After the session students were given a brief, anonymous three-question free-response questionnaire in which they were asked to evaluate and freely comment on the exercise. Results Students not only took away physiological principles but also gained an appreciation for various thematic lessons for bringing basic science to the bedside, especially horizontal and vertical integration. The response of the participants was overwhelmingly positive with many indicating that the exercise integrated the material across organ systems, and strengthened their appreciation of the role of physiology in understanding disease presentations and guiding appropriate therapy. Conclusions Horizontal and vertical integration can be presented effectively through a single-session case study, with complex patient cases involving multiple organ systems providing students opportunities to integrate their knowledge across organ systems while emphasizing the importance of physiology in clinical reasoning. Furthermore, having several clinicians from different specialties discuss the case together can reinforce the matter of integration across multiple organ systems and disciplines in students’ minds.

2014-01-01

359

The Ward identity and nonadiabatic corrections to the quasiparticle self-energy  

Microsoft Academic Search

In some newly discovered materials the ratio of phonon to electron enrgies is no longer small. We have investigated the basis of the recently proposed gauge-invariant self-consistent method and found conditions of its applicability.

O. V. Danylenko; O. V. Dolgov; V. V. Losyakov

1997-01-01

360

First Ward Urban Renewal Area, N.C. R-79, Charlotte, North Carolina.  

National Technical Information Service (NTIS)

The project is a conventional urban renewal program proposing to clear and redevelop 141.7 acres of blighted predominantly residential land, close to and southeast of the Central Downtown Business District of Charlotte, North Carolina. The project area wi...

1973-01-01

361

First Ward Urban Renewal Area, N.C. R-79, Charlotte, North Carolina.  

National Technical Information Service (NTIS)

The project is a conventional urban renwal program proposing to clear and redevelop 141.7 acres of blighted predominantly residential land, near the central business district of Charlotte, North Carolina. Approximately 37 acres of this land has been clear...

1973-01-01

362

From Classroom to Boardroom and Ward: Developing Generic Intercultural Skills in Diverse Disciplines  

ERIC Educational Resources Information Center

A strategic approach to internationalize learning in higher education institutions is to use the curriculum and classroom cultural diversity to create opportunities to broaden students' intercultural perspectives, appreciate sociocultural variability in professional practice, and improve their intercultural interaction skills. There is no…

Barker, Michelle C.; Mak, Anita S.

2013-01-01

363

Palestinian Children in the Hemato-Oncology Ward of an Israeli Hospital  

PubMed Central

Purpose An encounter between Palestinian parents of children with cancer and Israeli medical staff is a very special situation where “potential enemies” interact in a caring, trusting and intimate relationship for long periods of time. Our aim was to study the psychological and cultural encounter in order to understand the dynamics involved. Method The study is a qualitative one. Data was collected by way of structured in-depth interviews. Participants were physicians and nurses employed in the department, and Palestinian parents accompanying their children who were hospitalized during the research period. Results Six main themes emerged from the analysis of the interviews: (1) The decision to come to Israel for treatment. (2) The “meeting points” of the two peoples: the Israeli check points and the Palestinian Authority permits. (3) Encounter with the Israeli hospital. (4) Relationship between medical staff and parents. (5) Language and cultural barriers. (6) Emotions, thoughts and behaviors during high security tension. Conclusion The interviews depict a poignant picture of the unique encounter between Israeli Doctors and nurses and Palestinian parents. The psychological mechanism used by parents and doctors is “splitting”-having a dichotomized, simple emotional-perceptual picture of a situation with no conflicts. Nurses use another psychological mechanism in addition which enables them to contain the paradox and the conflict.

Nehari, Miri; Bielorai, Bella; Toren, Amos

2008-01-01

364

Intravascular catheter related infections in children admitted on the paediatric wards of Mulago hospital, Uganda  

Microsoft Academic Search

Introduction: Worldwide use of intravascular catheters (IVC) has been associated with both local and systemic infections. No studies have been done in the sub-Saharan region on IVC related infections. Objective: To determine the prevalence, causative organisms and their antimicrobial susceptibility pattern and the factors associated with infections related to short term peripheral venous catheters in children admitted to the general

Patricia Nahirya; Justus Byarugaba; Sarah Kiguli; Deogratias Kaddu-Mulindwa

365

Laptops on trolleys: lessons from a mobile-wireless hospital ward.  

PubMed

Most hospital-based staff can be considered to be mobile but many hospital information systems (HIS) are based on fixed desk top computers. Wireless networks allow HIS to be brought to the point of care using mobile devices such as laptops on trolleys thus providing data which can aid in clinical decision-making. The research objective of this project focusses on the collaborative design of a laptop solution for providing data at the point of care. The research approach was based on a combination of action research and design science. Action research techniques including participant observation and informal one-to-one discussions were used to obtain information that was used to evolve the trolley design as a design artefact while addressing usability limitations. This paper presents three versions of the trolley design and how they evolved based on the feedback provided to the researchers from clinical use. Also these results show that using iterative action research techniques (planning, action, evaluation and reflection) in collaborative research can provide productive outcomes addressing a specific design objective within an acute care setting. PMID:22760941

Weeding, Stephen; Dawson, Linda

2012-12-01

366

Implementing a Mobile Wireless Environment in a Hospital Ward: Encouraging Adoption by Nursing  

Microsoft Academic Search

Sophisticated technology is commonplace in most hospitals and increasingly mobile devices are being used in hospitals by clinical staff. Although the growth in mobile device usage in hospitals has the potential to contribute to better health and medical services delivery, nurses and doctors are still very reliant on paper-based information. Much of the research reported to date has focused on

Julie Fisher; Linda Dawson; Stephen Weeding; Liza Heslop

367

Interprofessional interaction, negotiation and non-negotiation on general internal medicine wards.  

PubMed

Research suggests that health care can be improved and patient harm reduced when health professionals successfully collaborate across professional boundaries. Consequently, there is growing support for interprofessional collaboration in health and social care, both nationally and internationally. Factors including professional hierarchies, discipline-specific patterns of socialization, and insufficient time for teambuilding can undermine efforts to improve collaboration. This paper reports findings from an ethnographic study that explored the nature of interprofessional interactions within two general and internal medicine (GIM) settings in Canada. 155 hours of observations and 47 interviews were gathered with a range of health professionals. Data were thematically analyzed and triangulated. Study findings indicated that both formal and informal interprofessional interactions between physicians and other health professionals were terse, consisting of unidirectional comments from physicians to other health professionals. In contrast, interactions involving nurses, therapists and other professionals as well as intraprofessional exchanges were different. These exchanges were richer and lengthier, and consisted of negotiations which related to both clinical as well as social content. The paper draws on Strauss' (1978) negotiated order theory to provide a theoretical lens to help illuminate the nature of interaction and negotiation in GIM. PMID:19842957

Reeves, Scott; Rice, Kathleen; Conn, Lesley Gotlib; Miller, Karen-Lee; Kenaszchuk, Chris; Zwarenstein, Merrick

2009-11-01

368

Timing, prevalence, determinants and outcomes of homelessness among patients admitted to acute psychiatric wards  

Microsoft Academic Search

Purpose  To document the prevalence, timing, associations and short-term housing outcomes of homelessness among acute psychiatric inpatients.\\u000a \\u000a \\u000a \\u000a Methods  Cross-sectional study of 4,386 acute psychiatric admissions discharged from a single NHS Trust in 2008–2009.\\u000a \\u000a \\u000a \\u000a Results  Homelessness occurred in 16%. Most homelessness (70%) was either recorded as present at admission or started within 1 week.\\u000a It was associated with younger age; male gender; ethnicity other than

Alex D. TullochPaul; Paul Fearon; Anthony S. David

369

Model Determination of Delayed Causes of Analgesics Prescription in the Emergency Ward in Arak, Iran  

PubMed Central

Background According to the reports of the World Health Organization 20% of world population suffer from pain and 33% of them suffer to some extent that they cannot live independently. Methods This is a cross-sectional study which was conducted in the emergency department (ED) of Valiasr Hospital of Arak, Iran, in order to determine the causes of delay in prescription of analgesics and to construct a model for prediction of circumstances that aggravate oligoanalgesia. Data were collected during a period of 7 days. Results Totally, 952 patients participated in this study. In order to reduce their pain intensity, 392 patients (42%) were treated. Physicians and nurses recorded the intensity of pain for 66.3% and 41.37% of patients, respectively. The mean (SD) of pain intensity according to visual analogue scale (VAS) was 8.7 (1.5) which reached to 4.4 (2.3) thirty minutes after analgesics prescription. Median and mean (SD) of delay time in injection of analgesics after the physician's order were 60.0 and 45.6 (63.35) minutes, respectively. The linear regression model suggested that when the attending physician was male or intern and patient was from rural areas the delay was longer. Conclusions We propose further studies about analgesics administration based on medical guidelines in the shortest possible time and also to train physicians and nurses about pain assessment methods and analgesic prescription.

Cyrus, Ali; Moghimi, Mehrdad; Jokar, Abolfazle; Rafeie, Mohammad; Moradi, Ali; Ghasemi, Parisa; Shahamat, Hanieh

2014-01-01

370

New Orleans and Hurricane Katrina. II: The Central Region and the Lower Ninth Ward  

Microsoft Academic Search

The failure of the New Orleans regional flood protection systems, and the resultant catastrophic flooding of much of New Orleans during Hurricane Katrina, represents the most costly failure of an engineered system in U.S. history. This paper presents an overview of the principal events that unfolded in the central portion of the New Orleans metropolitan region during this hurricane, and

R. B. Seed; R. G. Bea; A. Athanasopoulos-Zekkos; G. P. Boutwell; J. D. Bray; C. Cheung; D. Cobos-Roa; L. Ehrensing; L. F. Harder Jr.; J. M. Pestana; M. F. Riemer; J. D. Rogers

2008-01-01

371

Anticipatory grief among close relatives of patients in hospice and palliative wards.  

PubMed

A Swedish widowhood study revealed that four out of ten widows regarded the pre-loss period more stressful than the post-loss. The present investigation of close relatives to patients dying from cancer (using interviews and the Anticipatory Grief Scale) found that preparatory grief involves much emotional stress, as intense preoccupation with the dying, longing for his/her former personality, loneliness, tearfulness, cognitive dysfunction, irritability, anger and social withdrawal, and a need to talk. Psychological status was bad one by every fifth. However, the relatives mostly stated adjustment and ability to mobilize strength to cope with the situation. The results suggest development of support and guiding programs also for the anticipatory period. PMID:21596732

Johansson, Asa K; Grimby, Agneta

2012-03-01

372

Preventing homelessness after discharge from psychiatric wards: perspectives of consumers and staff.  

PubMed

After spending time in the hospital, psychiatric clients are often discharged to homeless shelters or the streets, which can place a burden on health care systems. This study examined the effects of an intervention in which psychiatric clients from acute (n = 219) and tertiary (n = 32) sites were provided with predischarge assistance in securing housing. A program evaluation design was used to examine the effectiveness of the intervention. Qualitative data were available through interviews, focus groups, and monthly meetings. The results highlight several benefits of the intervention and show that homelessness can be reduced by connecting housing support, income support, and psychiatric care. PMID:23394964

Forchuk, Cheryl; Godin, Mike; Hoch, Jeffrey S; Kingston-Macclure, Shani; Jeng, Momodou S; Puddy, Liz; Vann, Rebecca; Jensen, Elsabeth

2013-03-01

373

Omega-3s in Diet May Help Ward Off Lou Gehrig's Disease  

MedlinePLUS

... 15, 2014 Related MedlinePlus Pages Amyotrophic Lateral Sclerosis Dietary Fats TUESDAY, July 15, 2014 (HealthDay News) -- A diet ... 3 polyunsaturated fatty acids -- an essential type of dietary fat found in vegetable oils and fish -- had a ...

374

Malondialdehyde-Deoxyguanosine Adduct Formation in Workers of Pathology Wards. The Role of Air Formaldehyde Exposure  

PubMed Central

Background Formaldehyde is a ubiquitous pollutant to which humans are exposed. Pathologists can experience high formaldehyde exposure levels. Formaldehyde – among other properties – induce oxidative stress and free radicals, which react with DNA and lipids, leading to oxidative damage and lipid peroxidation, respectively. We measured the levels of air-formaldehyde exposure in a group of Italian pathologists and controls. We analyzed the effect of formaldehyde exposure on leukocyte malondialdehyde-deoxyguanosine adducts (M1-dG), a biomarker of oxidative stress and lipid peroxidation. We studied the relationship between air-formaldehyde and M1-dG adducts. Methods Air-formaldehyde levels were measured by personal air samplers. M1-dG adducts were analyzed by 32P-postlabelling assay. Results Reduction rooms pathologists were significantly exposed to air-formaldehyde in respect to controls and to the pathologists working in other laboratory areas (p<0.001). A significant difference for M1-dG adducts between exposed pathologists and controls was found (p=0.045). The effect becomes stronger when the evaluation of air-formaldehyde exposure was based on personal samplers (p=0.018). Increased M1dG adduct levels were only found in individuals exposed to air-formaldehyde concentrations higher than 66 ?g/m3. When the exposed workers and controls were subgrouped according to smoking, M1-dG tended to increase in all the subjects but a significant association between M1-dG and air-formaldehyde was only found in not smokers (p= 0.009). Air formaldehyde played a role positive but not significant (r = 0.355, p = 0.075, Pearson correlation) in the formation of M1-dG, only in not smokers. Conclusions Working in the reduction rooms and to be exposed to air-formaldehyde concentrations higher than 66 ?g/m3 is associated with increased levels of M1-dG adducts.

Romanazzi, Valeria; Munnia, Armelle; Piro, Sara; Allione, Alessandra; Ricceri, Fulvio; Guarrera, Simonetta; Pignata, Cristina; Matullo, Giuseppe; Wang, Poguang; Giese, Roger W.; Peluso, Marco

2010-01-01

375

Supporting information access in a hospital ward by a context-aware mobile electronic patient record  

Microsoft Academic Search

Context-awareness holds promise for improving the utility of software products. Context-aware mobile systems encompass the\\u000a ability to automatically discover and react to changes in an environment. Most contemporary context-aware mobile systems aim\\u000a to support users in private situations, for example, as tourist guides. Thus, we still lack an understanding of the impact\\u000a of context-awareness in professional work situations. In this

Mikael B. Skov; Rune Thaarup Hřegh

2006-01-01

376

Attitudes of mothers admitted to a maternity ward in Port Harcourt, to breast-feeding.  

PubMed

146 recently delivered mothers at the University Teaching Hospital, Port Harcourt, were questioned within 24 hours of delivery, about how they intended to feed their new babies. Of those questioned, 65 (45%) intended to exclusively breastfeed their babies, 81 (55%) hoped to use a combination of formula and breastfeeding, and none wanted her newborn baby wholly bottlefed. The main reasons given for intending to breastfeed exclusively were that the breastmilk was better for baby's health and that it was the natural thing to do. Mothers who chose to supplement breastfeeding with bottles were mainly working mothers and those who thought that breastmilk alone was not sufficient for their babies. The choice of feeding method was not significantly influenced by maternal age, parity, educational status, maternal occupation, marital status, and mode of delivery of the new baby, but was very influenced by the method chosen to feed a previous baby (P 0.001). PMID:12281229

Oruamabo, R S; Mbuagbaw, L T

1985-01-01

377

[Five cases of purple urine bag syndrome in a geriatric ward].  

PubMed

We report five cases of purple urine bag syndrome (PUBS). All the patients were women and they had been bed-ridden for a long period due to cerebrovascular diseases. They tended to be constipated as a result of habitual use of laxatives. Indicanuria was proven in the all urinary samples from the patients. The four assessable urinary cultures showed Proteus mirabilis contamination. Total days without evacuation per month in patients with PUBS and control subjects (5 catheterized subjects without PUBS) were 16.5 +/- 3.7 and 6.8 +/- 4.8, respectively (mean +/- SD), showing a significant difference (p < 0.05). In each case, this syndrome was not considered to have affected their clinical course. We concluded that it is unnecessary to treat patients with PUBS aggressively. Control of evacuation and urological sanitation are important in these patients. PMID:10655742

Ishida, T; Ogura, S; Kawakami, Y

1999-11-01

378

Words and wards: a model of reflective writing and its uses in medical education.  

PubMed

Personal, creative writing as a process for reflection on patient care and socialization into medicine ("reflective writing") has important potential uses in educating medical students and residents. Based on the authors' experiences with a range of writing activities in academic medical settings, this article sets forth a conceptual model for considering the processes and effects of such writing. The first phase (writing) is individual and solitary, consisting of personal reflection and creation. Here, introspection and imagination guide learners from loss of certainty to reclaiming a personal voice; identifying the patient's voice; acknowledging simultaneously valid yet often conflicting perspectives; and recognizing and responding to the range of emotions triggered in patient care. The next phase (small-group reading and discussion) is public and communal, where sharing one's writing results in acknowledging vulnerability, risk-taking, and self-disclosure. Listening to others' writing becomes an exercise in mindfulness and presence, including witnessing suffering and confusion experienced by others. Specific pedagogical goals in three arenas-professional development, patient care and practitioner well-being - are linked to the writing/reading/listening process. The intent of presenting this model is to help frame future intellectual inquiry and investigation into this innovative pedagogical modality. PMID:17001529

Shapiro, Johanna; Kasman, Deborah; Shafer, Audrey

2006-01-01

379

Using SOM-Ward Clustering and Predictive Analytics for Conducting Customer Segmentation  

Microsoft Academic Search

Continuously increasing amounts of data in data warehouses are providing companies with ample opportunity to conduct analytical customer relationship management (CRM). However, how to utilize the information retrieved from the analysis of these data to retain the most valuable customers, identify customers with additional revenue potential, and achieve cost-effective customer relationship management, continue to pose challenges for companies. This study

Zhiyuan Yao; Tomas Eklund; Barbro Back

2010-01-01

380

76 FR 37002 - Safety Zone; Central Astoria Independence Celebration Fireworks Event, Wards Island, NY  

Federal Register 2010, 2011, 2012, 2013

...with the fireworks display. Due to the dangers posed by the pyrotechnics used in this fireworks display, the safety zone is necessary...vessels, and other property to the hazards associated with pyrotechnics used in the fireworks display. Basis and Purpose The...

2011-06-24

381

The effect of Creating Opportunities for Parent Empowerment program on maternal stress, anxiety, and participation in NICU wards in Iran  

PubMed Central

Background: The purpose of this study was to perform the Creating Opportunities for Parent Empowerment (COPE) program for Iranian mothers and evaluate its effectiveness on stress, anxiety, and participation of mothers who have premature infants hospitalized in neonatal intensive care units (NICUs). Materials and Methods: A randomized clinical trial was conducted with 90 mothers of premature infants hospitalized in the educational neonatal NICUs of state hospitals affiliated to Isfahan University of Medical Sciences. For measuring the variables, State-Trait Anxiety Inventory, the Parental Stressor Scale: Neonatal Intensive Care, and The Index of Parental Participation/Hospitalized Infant were used. Intervention group received two phases of COPE program. This program consisted of information and behavioral activities about the characteristics of premature infants. Sessions’ interval was from 2 to 4 days. Stress and anxiety were measured three times (before each phase and 2-4 days after the second phase). Mothers’ participation was evaluated 2-4 days after the second phase. The t-test, ?2, Mann-Whitney U test, and repeated measurement test were used for data analysis. Results: Mothers in the intervention group reported significantly less anxiety and less stress in the NICU after performing each phase of the COPE program (P < 0.001), whereas at this time, the level of stress in the comparison group increased. Also, COPE mothers participated in their infants’ care rather than the mothers in the comparison group (P < 0.001). Conclusion: COPE program was effective for Iranian mothers. This study shows that irrespective of any culture, giving early and comprehensible educational-behavioral information may have positive effect on maternal psychological condition and maternal–infant interaction.

Mianaei, Soheila Jafari; Karahroudy, Fatemeh Alaee; Rassouli, Maryam; Tafreshi, Mansoureh Zagheri

2014-01-01

382

Implementation of Ward-Based Clinical Pharmacy Services in Belgium—Description of the Impact on a Geriatric Unit  

Microsoft Academic Search

RESULTS: A total of 1066 interventions were made over the 7 month period. The most frequent drug-related problems underlying interventions were: underuse (15.9%), wrong dose (11.9%), inappropriate duration of therapy (9.7%), and inappropriate choice of medicine (9.6%). The most prevalent consequences were to discontinue a drug (24.5%), add a drug (18.6%), and change dosage (13.7%). Acceptance rate by physicians was

Anne Spinewine; Soraya Dhillon; Louise Mallet; Paul M Tulkens; Léon Wilmotte; Christian Swine

383

Modelling the Patient Care Process of an Acute Care Ward in a Public Hospital: A Methodological Perspective  

Microsoft Academic Search

The paper introduces a mixed-method approach, based on the combination of an analytic technique of business process modelling and ethnographic research typically used in interpretive studies. Ontological and epistemological foundations are derived from the \\

Elena Gospodarevskaya; Leonid Churilov; Lyn Wallace

2005-01-01

384

Dynamic Route Decision Model-based Multi-agent Evacuation Simulation - Case Study of Nagata Ward, Kobe  

Microsoft Academic Search

In this research, involving local people's concerns in the decision on the evacuation route, a dynamic route deci- sion model is proposed by explicitly considering group evacuation, landmarks & evacuation signs, and familiarity with the local environment. A spatial relationship-dependent approach is used to measure the difference in resi- dents regarding local knowledge. To understand the people's decision-making process for

Yuling Liu; Norio Okada; Yukiko Takeuchi

2008-01-01

385

Assessment of quality of midwifery care in labour and delivery wards of selected Kordestan Medical Science University hospitals  

Microsoft Academic Search

Purpose – Quality improvement of reproductive health care has been announced as one of five global strategies to accelerate progress toward reproductive health goals. The World Health Organization emphasises the evaluation of structure, procedure and outcome of health services to improve quality of care. This study aims to assess the quality of provided care in labour and delivery units in

Masoumeh Simbar; Farideh Ghafari; Shahnaz Tork Zahrani; Hamid Alavi Majd

2009-01-01

386

Child deaths from injury in the special wards of Tokyo, Japan (2006-2010): a descriptive study.  

PubMed

Background: There has been increasing interest in the formal review of child deaths in Japan. In this study we examined the causes and scene information regarding child deaths from injury in Tokyo, the capital of Japan, as preparation for implementation of a full-scale review of child deaths.Methods: Documents on deaths from injury (excluding homicides) investigated by the Tokyo Medical Examiner's Office during the period from 2006 through 2010 were reviewed. Deaths of children younger than 18 years (N = 217) were selected as the study sample. We examined the cause of and information on the death and were particularly interested in whether a case had preventable factors.Results: Overall, 67% of the cases were deaths from unintentional injury. The main cause of death among children younger than 1 year was asphyxia, and the proportions of deaths from traffic accidents were higher in older age groups. Thirty percent of deaths from injury were due to suicide, and all cases of suicide were among children older than 10 years. Although analysis of preventable factors was difficult in some cases, owing to limited information on the death scene, 87% of deaths from unintentional injury, excluding those involving traffic accidents, had preventable factors.Conclusions: Most unintentional child deaths from injury appear to be preventable. Development of a system to collect detailed information on the scene at the time of death will help decrease child deaths in Japan. PMID:24705644

Suzuki, Hideto; Hikiji, Wakako; Tanifuji, Takanobu; Abe, Nobuyuki; Fukunaga, Tatsushige

2014-05-01

387

Child Deaths From Injury in the Special Wards of Tokyo, Japan (2006-2010): A Descriptive Study  

PubMed Central

Background There has been increasing interest in the formal review of child deaths in Japan. In this study we examined the causes and scene information regarding child deaths from injury in Tokyo, the capital of Japan, as preparation for implementation of a full-scale review of child deaths. Methods Documents on deaths from injury (excluding homicides) investigated by the Tokyo Medical Examiner’s Office during the period from 2006 through 2010 were reviewed. Deaths of children younger than 18 years (N = 217) were selected as the study sample. We examined the cause of and information on the death and were particularly interested in whether a case had preventable factors. Results Overall, 67% of the cases were deaths from unintentional injury. The main cause of death among children younger than 1 year was asphyxia, and the proportions of deaths from traffic accidents were higher in older age groups. Thirty percent of deaths from injury were due to suicide, and all cases of suicide were among children older than 10 years. Although analysis of preventable factors was difficult in some cases, owing to limited information on the death scene, 87% of deaths from unintentional injury, excluding those involving traffic accidents, had preventable factors. Conclusions Most unintentional child deaths from injury appear to be preventable. Development of a system to collect detailed information on the scene at the time of death will help decrease child deaths in Japan.

Suzuki, Hideto; Hikiji, Wakako; Tanifuji, Takanobu; Abe, Nobuyuki; Fukunaga, Tatsushige

2014-01-01

388

Management of acute bronchiolitis in emergency wards in Spain: variability and appropriateness analysis (aBREVIADo Project).  

PubMed

Most patients with acute bronchiolitis have a mild course and only require outpatient care. However, some of them have to go to emergency departments, because they have respiratory distress or feeding problems. There, they frequently receive diagnostic and therapeutic procedures. We want to know the variability and appropriateness of these procedures. A cross-sectional study (October 2007 to March 2008) was carried out on 2,430 diagnosed cases of bronchiolitis in hospital emergency departments, which required no hospitalization. An analysis of the appropriateness of the treatments was made in 2,032 cases gathered in ten departments with at least 100 cases, using as criterion the recommendations of a consensus conference. We estimated the adjusted percentages of each department. Most of the bronchiolitis were mild, in spite that they underwent multiple diagnostic and therapeutic procedures. In the acute phase, different treatments were used: inhaled beta 2 agonists (61.4%), antipyretics (17.1%), oral steroids (11.3%), and nebulized adrenaline (9.3%). In the maintenance phase, the most common treatments were: inhaled beta 2 agonists (50.5%), oral steroids (17%), oral beta 2 agonists (14.9%), and antibiotics (6.1%). The 64% of the treatments used in the acute phase and the 55.9% in the maintenance phase were considered inappropriate in the appropriateness analysis; a great heterogeneity among centers was found. Conclusions: There are discrepancies between clinical practice and evidence-based management of bronchiolitis in Spanish emergency departments. Inappropriate treatments were used in more than half of patients. The wide variation between centers shows the influence of local prescribing habits and reveals the scope for improvement. PMID:22350372

Ochoa Sangrador, Carlos; González de Dios, Javier

2012-07-01

389

A qualitative assessment of implementing a cross-cultural survey on cancer wards in Denmark - a description of barriers  

Microsoft Academic Search

BACKGROUND: Research into migration and health is often confronted with methodological challenges related to the identification of migrants in various settings. Furthermore, it is often difficult to reach an acceptable level of participation among migrant groups in quantitative research. The aim of this study is to conduct a qualitative assessment of the barriers encountered during the implementation of a cross-cultural

Maria Kristiansen; Amani Hassani; Allan Krasnik

2010-01-01

390

Evaluation of organizational maturity based on people capacity maturity model in medical record wards of Iranian hospitals  

PubMed Central

Context: People capacity maturity model (PCMM) is one of the models which focus on improving organizational human capabilities. Aims: The aim of this model's application is to increase people ability to attract, develop, motivate, organize and retain the talents needed to organizational continuous improvement. Settings and Design: In this study, we used the PCMM for investigation of organizational maturity level in medical record departments of governmental hospitals and determination strengths and weaknesses of their staff capabilities. Materials and Methods: This is an applied research and cross sectional study in which data were collected by questionnaires to investigation of PCMM model needs in medical record staff of governmental hospitals at Isfahan, Iran. We used the questionnaire which has been extracted from PCMM model and approved its reliability with Cronbach's Alpha 0.96. Statistical Analysis Used: Data collected by the questionnaire was analyzed based on the research objectives using SPSS software and in accordance with research questions descriptive statistics were used. Results: Our findings showed that the mean score of medical record practitioners, skill and capability in governmental hospitals was 35 (62.5%) from maximum 56 (100%). There is no significant relevance between organizational maturity and medical record practitioners, attributes. Conclusions: Applying PCMM model is caused increasing staff and manager attention in identifying the weaknesses in the current activities and practices, so it will result in improvement and developing processes.

Yarmohammadian, Mohammad H.; Tavakoli, Nahid; Shams, Assadollah; Hatampour, Farzaneh

2014-01-01

391

Differences in learning objectives during the labour ward clinical attachment between medical students and their midwifery preceptors  

Microsoft Academic Search

Objectives: Midwives have been actively involved in the clinical teaching of medical students for many years. However, this role has received little attention and limited research has been conducted into either its efficacy or the development of strategies to maximise the potential of such teaching opportunities. We examined medical student and midwifery preceptor attitudes towards students’ learning objectives during the

Julie A Quinlivan; Kirsten I Black; Rodney W Petersen; Louise H Kornman

2003-01-01

392

[Conjugative transfer frequency of resistance genes from ESBL-producing Enterobacteriaceae strains isolated from patients hospitalized in pediatric wards].  

PubMed

The aim of this study was to evaluate the transfer frequency of plasmids encoding extended-spectrum beta-lactamases (ESBLs) from clinical isolates of Enterobacteriaceae to E. coli K12 C600 recipient strain. Additionally, resistance patterns to antimicrobial drugs of the isolates as well as transconjugants were analyzed. Fifty-four clinical strains belonging to the Enterobacteriaceae family were isolated from children hospitalized in Medical University Hospital in Wroc?aw. All the strains studied were identified in automatic ATB system using ID32E tests. Besides, they were ESBL-positive as was confirmed by the double-disc synergy test (DDST). The minimal inhibitory concentration (MIC) was determined for twelve selected antibiotics and chemotherapeutics. The majority of the strains (87%) were able to transfer plasmid-mediated ESBL to E. coli K12 C600 recipient strain with a frequencies ranged from 10(-5) to 10(-1) per donor cell. All the isolates studied as well as their transconjugants were susceptible to imipenem, meropenem and norfloxacin (MIC <1mg/L). On the other hand, these strains displayed high level of resistance (MIC 512 - >1024 mg/L) to cefotaxime, ceftriaxone, gentamycin, amikacin and cotrimoxazole. Genetic markers conferring resistance to aminoglycosides and cotrimoxazole were often co-transferred to recipient strain in conjugation process. PMID:16871972

Franiczek, Roman; Dolna, Izabela; Krzyzanowska, Barbara; Szufnarowski, Krzysztof; Kowalska-Krochmal, Beata; Zieli?ska, Marzena

2006-01-01

393

Hepatitis C disease burden and strategies to manage the burden (Guest Editors Mark Thursz, Gregory Dore and John Ward).  

PubMed

Chronic hepatitis C virus (HCV) infection leads to liver fibrosis, cirrhosis and hepatocellular carcinoma (HCC). The recent Global Burden of Disease project estimated that in 2010 among 170 million people living with chronic HCV, an estimated 483 100 people died from HCV-related liver failure or HCC. The last two decades has seen progressive improvements in treatment of HCV infection with the most recent therapies offering simple, tolerable, short-duration therapy with extremely high efficacy. The development of public health strategies addressing emerging epidemics requires sound epidemiological data. This study covers epidemiological data collection, detailed expert opinion input and country-specific mathematical modelling of the HCV epidemic and potential impact of improved HCV treatment strategies in 16 countries. The analysis demonstrates that the HCV epidemics vary considerably in terms of age distribution of the infected population across countries. In addition, the burden of advanced liver disease varies widely. This burden is dependent upon factors including chronic HCV prevalence, age distribution (and duration of infection) of those infected, prevalence of cofactors for disease progression (particularly heavy alcohol intake) and uptake and success of therapeutic intervention. Introduction of new therapies with assumed sustained virological response (SVR) rate of >90% will have a modest impact on projected advanced liver disease burden. A combination of enhanced treatment efficacy and improved treatment uptake will have a greater impact on population-level disease burden. However public health advocacy and both public and private sector investment in the HCV response are required to demonstrate significant reduction in HCV disease burden. PMID:24713003

Dore, G J; Ward, J; Thursz, M

2014-05-01

394

Echocardiographic, chest X-ray and electrocardiogram findings in children presenting with heart failure to a Ugandan paediatric ward.  

PubMed

The aim of this study was to describe the aetiology of congestive cardiac failure (CCF) in children with suspected structural abnormalities presenting to a regional hospital in southwestern Uganda. The method used was a prospective descriptive study of successive admissions of children with persistent cardiac signs after routine treatment of CCF. Children with severe anaemia (haemoglobin [Hb]<7 g/dL), pneumonia, sepsis or severe malnutrition were excluded. Chest X-ray, electrocardiogram and echocardiography data were validated by a paediatric cardiologist and radiologist at the Bristol Royal Hospital for Children, UK. A cohort of 58 patients was identified. The aetiology of heart failure in this cohort (n = 58) was due to congenital heart disease (35%), renal hypertensive disease (26%), rheumatic heart disease (17%), cardiomyopathies (12%), endomyocardial fibrosis (7%) and tamponade (3%). In conclusion, this study confirmed the ongoing prevalence of congenital heart disease, rheumatic heart disease and endomyocardial fibrosis in this area. The cardiac effect of renal hypertension was a new and significant finding. PMID:17716499

Ellis, John; Martin, Rob; Wilde, Peter; Tometzki, Andy; Senkungu, Jude; Nansera, Denis

2007-07-01

395

Flow situations during everyday practice in a medical hospital ward. Results from a study based on experience sampling method  

Microsoft Academic Search

BACKGROUND: Nursing is a constant balance between strain and stimulation and work and health research with a positive reference point has been recommended. A health-promoting circumstance for subjective experience is flow, which is a psychological state, when individuals concurrently experience happiness, motivation and cognitive efficiency. Flow situations can be identified through individuals' estimates of perceived challenge and skills. There is,

Ĺsa Bringsén; Göran Ejlertsson; Ingemar H Andersson

2011-01-01

396

Comparison of the antibacterial efficacy of 4% chlorhexidine gluconate and 1% triclosan handwash products in an acute clinical ward  

Microsoft Academic Search

The antibacterial efficacy of 4% chlorhexidine gluconate (CHG) and 1% triclosan as handwash antiseptics is well established. Few published studies have identified hand bacteria found in glove juice samples, and most studies have used nonclinical study subjects. We report a longitudinal comparative study to determine the effect of 4% CHG and 1% triclosan on the composition of the hand bacterial

Joan L. Faoagali; Narelle George; Jonathan Fong; Jenny Davy; Muriel Dowser

1999-01-01

397

Unlicensed and off-label drug use in a paediatric ward of a general hospital in the Netherlands  

Microsoft Academic Search

Objectives. Many drugs used in paediatric care are not licensed for that use or are prescribed outside the terms of the product license (off-label). Studies in the UK and Europe showed a large number of unlicensed and off-label drug prescription in specialised paediatric health care centres. We determined the extent and nature of use of unlicensed drugs and off-label prescriptions

G.'t Jong; P. van der Linden; E. Bakker; N. van der Lely; I. Eland; B. Stricker; J. van den Anker

2002-01-01

398

From the ICU to the ward: cross-checking of the physician’s transfer report by intensive care nurses  

Microsoft Academic Search

Objective  To assess whether cross-checking of the physician ICU transfer report by ICU nurses may reduce transfer report errors.\\u000a \\u000a \\u000a \\u000a Design  Prospective, observational study with random selection (according to patient registration code) of ICU transfer reports.\\u000a \\u000a \\u000a \\u000a Setting  Eight-bed multidisciplinary intensive care unit of a teaching hospital.\\u000a \\u000a \\u000a \\u000a Patients and participants  ICU transfer reports of 123 patients were randomly selected at discharge from the ICU between November

Andreas Perren; Patrik Conte; Nunzio De Bitonti; Costanzo Limoni; Paolo Merlani

2008-01-01

399

Small-scale, homelike facilities versus regular psychogeriatric nursing home wards: a cross-sectional study into residents' characteristics  

Microsoft Academic Search

BACKGROUND: Nursing home care for people with dementia is increasingly organized in small-scale and homelike care settings, in which normal daily life is emphasized. Despite this increase, relatively little is known about residents' characteristics and whether these differ from residents in traditional nursing homes. This study explored and compared characteristics of residents with dementia living in small-scale, homelike facilities and

Hilde Verbeek; Sandra MG Zwakhalen; Erik van Rossum; Ton Ambergen; Gertrudis IJM Kempen; Jan PH Hamers

2010-01-01

400

Timoloqinash: Incorporating Chumash Cultural Self-History into the History of California By Michael K. Ward, MA  

Microsoft Academic Search

interpretive dialogue in American1 and California history that has for several decades attempted to incorporate multiple cultural voices.2 The importance of beginning an account of Native Americans at times prior to the time of European contact and colonization has been noted,3 but the inclusion of Indian self-history presents a few problems that are not often recognized. Of particular relevance in

Douglas Monroy

401

Monitoring Ambulation of Patients in Geriatric Rehabilitation Wards: The Accuracy of Clinicians' Prediction of Patients' Walking Time  

ERIC Educational Resources Information Center

The aim of this study is to determine whether clinicians' estimates of patients' walking time agree with those determined by accelerometer devices. The walking time was measured using a waist-mounted accelerometer device everyday during the patients' waking hours. At each weekly meeting, clinicians estimated the patients' average daily walking…

Cheung, Vivian H. Y.; Salih, Salih A.; Crouch, Alisa; Karunanithi, Mohanraj K.; Gray, Len

2012-01-01

402

Mathematical models for assessing the role of airflow on the risk of airborne infection in hospital wards  

PubMed Central

Understanding the risk of airborne transmission can provide important information for designing safe healthcare environments with an appropriate level of environmental control for mitigating risks. The most common approach for assessing risk is to use the Wells–Riley equation to relate infectious cases to human and environmental parameters. While it is a simple model that can yield valuable information, the model used as in its original presentation has a number of limitations. This paper reviews recent developments addressing some of the limitations including coupling with epidemic models to evaluate the wider impact of control measures on disease progression, linking with zonal ventilation or computational fluid dynamics simulations to deal with imperfect mixing in real environments and recent work on dose–response modelling to simulate the interaction between pathogens and the host. A stochastic version of the Wells–Riley model is presented that allows consideration of the effects of small populations relevant in healthcare settings and it is demonstrated how this can be linked to a simple zonal ventilation model to simulate the influence of proximity to an infector. The results show how neglecting the stochastic effects present in a real situation could underestimate the risk by 15 per cent or more and that the number and rate of new infections between connected spaces is strongly dependent on the airflow. Results also indicate the potential danger of using fully mixed models for future risk assessments, with quanta values derived from such cases less than half the actual source value.

Noakes, Catherine J.; Sleigh, P. Andrew

2009-01-01

403

Does empirical therapy with a fluoroquinolone or the combination of a ?-lactam plus a macrolide result in better outcomes for patients admitted to the general ward?  

PubMed

Community-acquired pneumonia (CAP) is a frequent cause of morbidity and mortality in the United States and worldwide, in particular among older patients and those with significant comorbid conditions. Current guidelines recommend therapy with a fluoroquinolone or a ?-lactam plus a macrolide for the treatment of hospitalized adults with CAP who do not require admission to an intensive care unit. This article provides a brief summary and overview of the existing literature on this topic categorized by the main results; the potential implications for future clinical practice and research are discussed. PMID:23398869

Ruhe, Jörg; Mildvan, Donna

2013-03-01

404

Study to Identify Functions Which Inhibit or Facilitate the Health Care Delivery Process on Ward 51 at Walter Reed Army Medical Center, Washington, D.C.  

National Technical Information Service (NTIS)

In recent years, national concern for the increasing costs of providing health care has forced hospital administrators to focus on methods which will improve efficiency of operations, decrease resource consumption, and reduce operation costs. This study i...

E. L. Fletcher

1980-01-01

405

Prospective monitoring study: isolating Legionella pneumophila in a hospital water system located in the obstetrics and gynecology ward after eradication of Legionella anisa and reconstruction of shower units.  

PubMed

We previously reported on the sporadic contamination by Legionella anisa of shower units and sink taps at Ryukyu University Hospital. Starting in July 2003, the neonatal area underwent an 8-month reconstruction, and in March 2005, the boiler system was replaced. We therefore examined shower water and tap water for the presence of Legionella just after replacement of the boiler system. In 3 of the 8 water samples collected from the remodeled area, we isolated Legionella pneumophila serogroup 1 and L. anisa. Moreover, L. pneumophila serogroup 1 was isolated in 4 of the 5 water samples gathered from the unreconstructed area of the same floor. Random amplified polymorphic DNA analysis suggested that a single clone of L. pneumophila might exist throughout the floors of the water distribution system. We replaced the shower units at the Legionella-positive site, and began flushing the sink-faucets with water heated to 55N for at least 1 h every morning. As a result, Legionella was not subsequently isolated in water samples. In this prospective study, we identified a central contamination by L. pneumophila serogroup 1 and showed that flushing with hot tap water was effective to counter this situation. PMID:17314417

Koide, Michio; Owan, Tomoko; Nakasone, Chikara; Yamamoto, Natsuo; Haranaga, Shusaku; Higa, Futoshi; Tateyama, Masao; Yamane, Nobuhisa; Fujita, Jiro

2007-02-01

406

Frequency of Vital Signs Monitoring and its Association with Mortality among Adults with Severe Sepsis Admitted to a General Medical Ward in Uganda  

PubMed Central

Introduction Optimal vital signs monitoring of patients with severe sepsis in resource-limited settings may improve outcomes. The objective of this study was to determine the frequency of vital signs monitoring of patients with severe sepsis and its association with mortality in a regional referral hospital in Uganda. Methods We reviewed medical records of patients admitted to Mbarara Regional Referral Hospital in Southwestern Uganda with severe sepsis defined by the presence of infection plus ?2 of the systemic inflammatory response syndrome criteria, and ?1 organ dysfunction (altered mental state, hypotension, jaundice, or thrombocytopenia). We recorded frequency of vital signs monitoring in addition to socio-demographic, clinical, and outcome data. We analyzed the data using logistic regression. Results We identified 202 patients with severe sepsis. The median age was 35 years (IQR, 25–47) and 98 (48%) were female. HIV infection and anemia was present in 115 (57%) and 83 (41%) patients respectively. There were 67 (33%) in-hospital deaths. The median monitoring frequency per day was 1.1 (IQR 0.9–1.5) for blood pressure, 1.0 (IQR, 0.8–1.3) for temperature and pulse, and 0.5 (IQR, 0.3–1.0) for respiratory rate. The frequency of vital signs monitoring decreased during the course of hospitalization. Patients who died had a higher frequency of vital signs monitoring (p<0.05). The admission respiratory rate was associated with both frequency of monitoring (coefficient of linear regression 0.6, 95% CI 0.5–0.8, p<0.001) and mortality (AOR 2.5, 95% CI 1.3–5.3, p?=?0.01). Other predictors of mortality included severity of illness, HIV infection, and anemia (p<0.05). Conclusions More research is needed to determine the optimal frequency of vital signs monitoring for severely septic patients in resource-limited settings such as Uganda.

Asiimwe, Stephen B.; Okello, Samson; Moore, Christopher C.

2014-01-01

407

Discharged from a mental health admission ward: is it safe to go home? A review on the negative outcomes of psychiatric hospitalization  

PubMed Central

Before psychiatry emerged as a medical discipline, hospitalizing individuals with mental disorders was more of a social stigmatizing act than a therapeutic act. After the birth of the mental health disciplines, psychiatric hospitalization was legitimized and has proven to be indispensable, preventing suicides and helping individuals in need. However, despite more than a century passing since this legitimization occurred, psychiatric hospitalization remains a controversial issue. There is the question of possible negative outcomes after a psychiatric admission ceases to take its protective effect, and even of whether the psychiatric admission itself is related to a negative setback after discharge. This review aims to summarize some of the most important negative outcomes after discharge from a psychiatric institution. These experiences were organized into two groups: those after a brief psychiatric hospitalization, and those after a long-stay admission. The author further suggests possible ways to minimize these adversities, emphasizing the need of awareness related to this important issue.

Loch, Alexandre Andrade

2014-01-01

408

Clinical Risk Factors of Death From Pneumonia in Children with Severe Acute Malnutrition in an Urban Critical Care Ward of Bangladesh  

PubMed Central

Background Risks of death are high when children with pneumonia also have severe acute malnutrition (SAM) as a co-morbidity. However, there is limited published information on risk factors of death from pneumonia in SAM children. We evaluated clinically identifiable factors associated with death in under-five children who were hospitalized for the management of pneumonia and SAM. Methods For this unmatched case-control design, SAM children of either sex, aged 0–59 months, admitted to the Dhaka Hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) during April 2011 to July 2012 with radiological pneumonia were studied. The SAM children with pneumonia who had fatal outcome constituted the cases (n?=?35), and randomly selected SAM children with pneumonia who survived constituted controls (n?=?105). Results The median (inter-quartile range) age (months) was comparable among the cases and the controls [8.0 (4.9, 11.0) vs. 9.7 (5.0, 18.0); p?=?0.210)]. In logistic regression analysis, after adjusting for potential confounders, such as vomiting, abnormal mental status, and systolic hypotension (<70 mm of Hg) in absence of dehydration, fatal cases of severely malnourished under-five children with pneumonia were more often hypoxemic (OR?=?23.15, 95% CI?=?4.38–122.42), had clinical dehydration (some/severe) (OR?=?9.48, 95% CI?=?2.42–37.19), abdominal distension at admission (OR?=?4.41, 95% CI?=?1.12–16.52), and received blood transfusion (OR?=?5.50, 95% CI?=?1.21–24.99) for the management of crystalloid resistant systolic hypotension. Conclusion and Significance We identified hypoxemia, clinical dehydration, and abdominal distension as the independent predictors of death in SAM children with pneumonia. SAM children with pneumonia who required blood transfusion for the management of crystalloid resistant systolic hypotension were also at risk for death. Thus, early identification and prompt management of these simple clinically recognizable predictors of death and discourage the use of blood transfusion for the management of crystalloid resistant systolic hypotension may help reduce deaths in such population.

Chisti, Mohammod Jobayer; Salam, Mohammed Abdus; Ashraf, Hasan; Faruque, Abu S. G.; Bardhan, Pradip Kumar; Hossain, Md Iqbal; Shahid, Abu S. M. S. B.; Shahunja, K. M.; Das, Sumon Kumar; Imran, Gazi; Ahmed, Tahmeed

2013-01-01

409

Randomized double-blind placebo-controlled trial of 40 mg/day of atorvastatin in reducing the severity of sepsis in ward patients (ASEPSIS Trial)  

PubMed Central

Introduction Several observational studies suggest that statins modulate the pathophysiology of sepsis and may prevent its progression. The aim of this study was to determine if the acute administration of atorvastatin reduces sepsis progression in statin naďve patients hospitalized with sepsis. Methods A single centre phase II randomized double-blind placebo-controlled trial. Patients with sepsis were randomized to atorvastatin 40 mg daily or placebo for the duration of their hospital stay up to a maximum of 28-days. The primary end-point was the rate of sepsis progressing to severe sepsis during hospitalization. Results 100 patients were randomized, 49 to the treatment with atorvastatin and 51 to placebo. Patients in the atorvastatin group had a significantly lower conversion rate to severe sepsis compared to placebo (4% vs. 24% p = 0.007.), with a number needed to treat of 5. No significant difference in length of hospital stay, critical care unit admissions, 28-day and 12-month readmissions or mortality was observed. Plasma cholesterol and albumin creatinine ratios were significantly lower at day 4 in the atorvastatin group (p < 0.0001 and p = 0.049 respectively). No difference in adverse events between the two groups was observed (p = 0.238). Conclusions Acute administration of atorvastatin in patients with sepsis may prevent sepsis progression. Further multi-centre trials are required to verify these findings. Trial Registration International Standard Randomized Control Trial Registry ISRCTN64637517.

2012-01-01

410

"Junior Doctor Decision Making: Isn't that an Oxymoron?" A Qualitative Analysis of Junior Doctors' Ward-Based Decision-Making  

ERIC Educational Resources Information Center

Unacceptable levels of adverse healthcare events, combined with changes to training, have put the spotlight on junior doctor decision-making. This study aimed to describe the decisions made by junior doctors and the contextual factors influencing how decisions were made and justified. Stimulated recall interviews with 20 junior doctors across five…

Bull, Stephanie; Mattick, Karen; Postlethwaite, Keith

2013-01-01

411

Health Hazard Evaluation Report: HETA-2011-0047-3143, October 2011. Multiple Sclerosis Cluster Evaluation in an Inpatient Oncology Ward - Wisconsin.  

National Technical Information Service (NTIS)

In January 2011 NIOSH received an employee HHE request concerning a potential cluster of MS cases among nurses employed in the inpatient oncology unit of a university hospital in Wisconsin. The request detailed concern about acrolein as a potential exposu...

E. Page J. Couch

2011-01-01

412

The completeness of medication histories in hospital medical records of patients admitted to general internal medicine wards: Completeness of medication in hospital medical records  

Microsoft Academic Search

Aims Accurate recording of medication histories in hospital medical records (HMR) is important when patients are admitted to the hospital. Lack of registration of drugs can lead to unintended discontinuation of drugs and failure to detect drug related problems. We investigated the comprehensiveness of medication histories in HMR with regard to prescription drugs by comparing the registration of drugs in

Hong Sang Lau; Christa Florax; Arijan J. Porsius; Anthonius De Boer

2001-01-01

413

[Information on osteoporosis among ward nurses. Deficient knowledge and need for information regarding osteoporosis in women from 45 to 54 years].  

PubMed

This article describes the results of a cross-sectional study in which an inventory is made of the level of knowledge of and the need for information about osteoporosis among women in Breda aged 44-54 years. Subsequently the relation between self care agency and the level of knowledge is explored. Orem's self care theory was used as theoretical framework for this study. PMID:8044401

Peynenburg, J M; Frederiks, C M

1994-05-01

414

Increasing the frequency of hand washing by healthcare workers does not lead to commensurate reductions in staphylococcal infection in a hospital ward  

Microsoft Academic Search

BACKGROUND: Hand hygiene is generally considered to be the most important measure that can be applied to prevent the spread of healthcare-associated infection (HAI). Continuous emphasis on this intervention has lead to the widespread opinion that HAI rates can be greatly reduced by increased hand hygiene compliance alone. However, this assumes that the effectiveness of hand hygiene is not constrained

Clive B Beggs; Simon J Shepherd; Kevin G Kerr

2008-01-01

415

Four important features in the Ward Hunt Ice Shelf revealed from the high-temporal- and high-spatial-resolution images taken by Formosat-2 in Summer 2008  

Microsoft Academic Search

Massive ice shelf collapsing in Polar Regions is indisputably a clear warning of global warming. To investigate such a rapid change of a breaking up event at a remote site requires an innovative approach that is able to make both high-temporal- and high-spatial-resolution observations. Deploying a high-spatial-resolution sensor in a daily revisit orbit, Formosat-2 successfully captured the details of Wilkins

C. Liu; Y. Chang; S. Yan; A. Wu

2008-01-01

416

Using a Model of Clinical Events to Determine Supply Requirements for Marine Corps Shock Surgical Team/Triage (SST) and Acute Care Ward Units.  

National Technical Information Service (NTIS)

Moving toward a concept of medical organization that achieves the objectives of Marine Corps guidance such as Operational Maneuver from the Sea brings particular challenges when examining forward medical treatment facilities. These units must be small eno...

M. R. Galarneau G. Pang P. J. Konoske E. D. Gauker

1998-01-01

417

Investigating differences in electoral turnout: the influence of ward-level context on participation in local and parliamentary elections in Britain  

Microsoft Academic Search

Electoral turnout is an important measure of the health of a liberal democracy. Although research identifies factors that affect electoral participation, we still know little about how electors in a specific location respond to opportunities to vote for different kinds of local, national, and supranational institutions. This paper addresses this issue by analysing the relative rates of turnout at local,

Scott Orford; Colin Rallings; Michael Thrasher; Galina Borisyuk

2008-01-01

418

An Aetiological Survey of Burns in Abusers of Various Kinds of Drugs Admitted to the Tabriz Sina Hospital Burns Ward in Iran  

PubMed Central

Summary A five-year prospective study (March 2003-March 2008) of burn victims hospitalized in a major burns centre in Iran was conducted in order to survey the aetiology and outcome of burns in patients who were drug addicts. Three hundred and thirty patients addicted to drugs were identified and stratified by age, sex, burn size, presence or absence of inhalation injury, kinds of abuse agents, and cause of burn. The mean patient age was 27.9 yr, and the male:female ratio was 7.6:1. There were 60 deaths overall (18.18%), the majority (47) among patients with flame burns. The mortality rate was significantly higher in multi-drug abusers than in single-drug abusers. Except for burn incidence, there were no significant differences between males and females. The mean burn size, 30.9%, was significantly larger in non-survivors than in survivors (57.8% versus 27.8%; p < 0.001). Inhalation injuries were strongly associated with large burns, and were present in all flame-burn fatalities. Flame burns were the most common type of burns in drug-addicted patients: incorrect use of a lighter and match and falling onto a brazier were the most common causes of flames. There were 11 deaths related to electrical injuries. Large burn size was the strongest predictor of mortality followed by the presence of inhalation injury. The most common agent of abuse was opium, followed by heroin and hashish; there was no difference between males and females in relation to the type of agent of which abuse was made

Maghsoudi, H.; Raghifar, R.

2010-01-01

419

A comparison of symptoms and drug use between patients with methamphetamine associated psychoses and patients diagnosed with schizophrenia in two acute psychiatric wards.  

PubMed

Psychosis induced by the use of amphetamine or methamphetamine leads to dramatic symptoms and frequent readmissions and poses diagnostic challenges. Earlier studies have often relied on history taking and/or urine samples to reveal drug use. The aim of this study was to compare the psychotic symptoms of two groups: (1) acutely admitted patients who tested positive for methamphetamines and were diagnosed with drug-induced or methamphetamine-induced psychoses and (2) acutely admitted patients who tested negative for methamphetamines and were diagnosed with schizophrenia. Blood and urine samples were used. In addition, we investigated whether the severity of symptoms, in those who tested positive, was related to the blood concentration of methamphetamine. Of 285 patients who volunteered blood and/or urine samples within 48h of admission, 37 (13%) had recently taken methamphetamine. Positive psychotic symptoms between the two groups were compared by PANSS using the positive subscale. The results showed no differences in positive psychotic symptoms between the two groups. The severity of positive psychotic symptoms in patients with three different levels of urine/blood methamphetamine concentrations, were compared. We found no clinically or statistically significant relationship between blood methamphetamine levels and severity of psychotic symptoms. PMID:23036490

Medhus, Sigrid; Mordal, Jon; Holm, Bjřrn; Mřrland, Jřrg; Bramness, Jřrgen G

2013-03-30

420

Intra-hospital dissemination of quinupristin\\/dalfopristin- and vancomycin-resistant Enterococcus faecium in a paediatric ward of a German hospital  

Microsoft Academic Search

Results: A single E. faecium isolate per patient was investigated. All exhibited resistances to quinupristin\\/ dalfopristin, vancomycin\\/teicoplanin, streptomycin (high-level), penicillin\\/ampicillin, erythromycin, oxy- tetracycline, chloramphenicol, rifampicin and fusidic acid. The isolates were susceptible to linezolid only and intermediately resistant to fluoroquinolones including moxifloxacin. PFGE revealed identical patterns for all three isolates. PCRs for virulence determinants hyaluronidase and enterococcal surface protein, esp,

Guido Werner; Ingo Klare; Friedrich-Bernhard Spencker; Wolfgang Witte

2003-01-01

421

‘Balanced Scorecard’ as an operation-level strategic planning tool for service innovation  

Microsoft Academic Search

This study proposes a model for implementing the balanced scorecard (BSC) as an operation-level strategic planning tool in a medical service department for service innovation. The study involved four major units in a district hospital: the internal medicine ward, surgery ward, gynecology ward, and pediatrics ward. The results indicated that the nursing department not only had its own unique goals

Chih-Ming Arthur Luo; Hung-Fan Chang; Chi-Hung Su

2012-01-01

422

BSC as an operation-level strategic planning tool for service innovation  

Microsoft Academic Search

This study proposes a model for implementing the balanced scorecard (BSC) as an operation-level strategic planning tool in a medical service department for service innovation. The study involved four major units in a district hospital: the internal medicine ward, surgery ward, gynecology ward, and pediatrics ward. The results indicated that the nursing department not only had its own unique goals

Chih-Ming Arthur Luo; Hung-Fan Chang; Chi-Hung Su

2011-01-01

423

Public health assessment for V and M/Albaladejo Norte Ward (a/k/a V and M/Albaladejo Farms site), Vega Baja, Vega Baja County, Puerto Rico, Region 2: CERCLIS Number PRD987366101. Final report  

SciTech Connect

The Agency for Toxic Substances and Disease Registry (ATSDR) published a Site Review and Update for the V and M/Albaladejo Farms site on May 7, 1997. The site includes the V and M property and the Albaladejo farm. Total acreage is unknown. Several small plots within the site were formerly used for dumping plastic-coated electrical cables, electrical equipment, car batteries, and transformers. To total quantity of waste brought onto the site and the date when activities began are not known. Some wastes were burned, presumably to recover copper, aluminum, and lead. ATSDR prepared public health consultations in 1995 that concluded that site soils posed a potential health concern and concurred with EPA`s proposed cleanup levels. EPA also will investigate groundwater quality to determine whether remedial activities are needed to protect the aquifer that supplies off-site public wells that serve large numbers of residents in Vega Baja. ATSDR concluded that the site poses no apparent public health hazard. The proposed soil removal and proposed groundwater investigation and any required followup groundwa