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  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. Wards from hell.

    PubMed

    Bates, Jane

    2016-03-16

    'You're kidding,' I thought, having just realised the special care baby unit where I intended to work was next to the ward where they performed terminations of pregnancy. To make matters worse, women who had miscarried were on the same ward. PMID:26982847

  3. [Interface ward round].

    PubMed

    Fischer, Martin Rudolf; Wölfel, Teresa; Schmidmaier, Ralf

    2016-01-01

    Ward rounds are the pivot point of the daily routine on internal medicine wards. They are crucial to the interprofessional team to inform the patient and his relatives, to gather new information as well as to plan further diagnostics, evaluation of prognosis and therapy. Furthermore, medical rounds provide an important setting for situational learning and reflection of alternatives of action in terms of evidence based medicine. The war round is a vital component of the patient-doctor communication and contributes strongly to patient safety. PMID:26710200

  4. Doctor Ward's Accidental Terrarium.

    ERIC Educational Resources Information Center

    Hershey, David R.

    1996-01-01

    Presents the story of the accidental invention of the Wardian case, or terrarium, by Nathaniel Bagshaw Ward. Advocates the use of this story in teaching precollege biology as an illustration of how a chance event can lead to a major scientific advancement and as an example of the common occurrence of multiple discovery in botany. Contains 34…

  5. 15. New York Connecting Railroad: Wards Island Viaduct. Wards Island, ...

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

    15. New York Connecting Railroad: Wards Island Viaduct. Wards Island, New York Co., NY. Sec. 4207, MP 7.65. - Northeast Railroad Corridor, Amtrak Route between New Jersey/New York & New York/Connecticut State Lines, New York, New York County, NY

  6. Teaching a 'good' ward round.

    PubMed

    Powell, Natalie; Bruce, Christopher G; Redfern, Oliver

    2015-04-01

    Ward rounds are a vital part of hospital medicine and junior doctors play a key role in their delivery. Despite the importance of ward rounds to patient care and experience, we believe that junior doctors may lack the training and skills to carry them out most effectively. We designed a simulation-based training session focusing on ward round skills themed to key patient safety issues and have delivered the training to over 100 learners (medical students and foundation year one doctors). Few learners had any prior training in ward rounds. The session was highly valued by all participants and surveys completed both before and after the session showed statistically significant improvements in confidence in leading and documenting ward rounds. In addition, 94% of final year medical students and 93% of doctors felt such training should be included in the undergraduate curriculum. We believe there is a current gap in training around ward round skills and would strongly encourage simulation-based ward round training to be developed for undergraduates. Further sessions following qualification may then consolidate and develop ward round skills adapted to the level of the doctor. PMID:25824064

  7. [Comment on “Ward Off?”] More on Ward Valley

    NASA Astrophysics Data System (ADS)

    Powers, Dennis W.

    The May 23rd Eos “In Brief” could have been considerably more informative about Ward Valley and the work of the NAS panel in reviewing issues raised about the proposed site. The article should have included more comprehensive discussion by the scientific participants who reviewed the technical issues involved. In addition, the article raised two very different subjects—safety issues at Ward Valley and alleged bias of NAS panels—but did not separate the subjects well. Readers may not have distinguished between the Ward Valley panel and the NAS Board on Radioactive Waste Management in the question of bias. In addition, the nature of the reported-on attacks on scientific and personal integrity of the scientists may well discourage qualified but thinner-skinned geoscientists from public service on panels.

  8. The productive ward: encouraging teambuilding and innovation.

    PubMed

    Armitage, Claire; Higham, Pauline

    2011-04-01

    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

  9. Safer Wards: reducing violence on older people's mental health wards.

    PubMed

    Brown, Juliette; Fawzi, Waleed; McCarthy, Cathy; Stevenson, Carmel; Kwesi, Solomon; Joyce, Maggie; Dusoye, Jenny; Mohamudbucus, Yasin; Shah, Amar

    2015-01-01

    Through the Safer Wards project we aimed to reduce the number of incidents of physical violence on older people's mental health wards. This was done using quality improvement methods and supported by the Trust's extensive programme of quality improvement, including training provided by the Institute for Healthcare Improvement. Violence can be an indicator of unmet needs in this patient population, with a negative effect on patient care and staff morale. Reducing harm to patients and staff is a strategic aim of our Trust. We established a multi-disciplinary group who led on the project on each ward and used a Pareto diagram to establish the focus of our work. We established a dashboard of measures based on our incident reporting system Datix, including number of incidents of violence, days between incidents, days of staff sickness, days between staff injury, use of restraint, and use of rapid tranquilisation (the last two being balancing measures in the reduction of violence). Each team identified factors driving physical violence on the wards, under headings of unmet patient needs, staff needs and staff awareness, which included lack of activity and a safe and therapeutic environment. Using driver diagrams, we identified change ideas that included hourly rounding (proactive checks on patient well-being), the addition of sensory rooms, flexible leave for patients, and a structured activity programme. We also introduced exercise to music, therapeutic groups led by patients, and focused on discharge planning and pet therapy, each of which starting sequentially over the course of a one year period from late 2013 and subject to a cycle of iterative learning using PDSA methods. The specific aim was a 20% decrease in violent incidents on three wards in City and Hackney, and Newham. Following our interventions, days between violent incidents increased from an average of three to an average of six. Days between staff injury due to physical violence rose from an average of eight (one violent incident resulting in staff injury every eight days) to 22 (one incident every 22 days). Incidents of physical violence reduced from 63 in 2013 to 39 in 2014. We were also able to quantify reduced costs associated with reduction in violence. The success of this project in our view lay in the involvement of ward staff in understanding the problems and generating local solutions which were also broadly evidenced based. Patients were also closely involved in generating ideas. We are currently incorporating much of this work into routine practice in order to sustain improvement, as well as continuing to generate new ideas for further improvement while using the skills learnt in this process to address other problems. PMID:26734353

  10. Safer Wards: reducing violence on older people's mental health wards

    PubMed Central

    Brown, Juliette; Fawzi, Waleed; McCarthy, Cathy; Stevenson, Carmel; Kwesi, Solomon; Joyce, Maggie; Dusoye, Jenny; Mohamudbucus, Yasin; Shah, Amar

    2015-01-01

    Through the Safer Wards project we aimed to reduce the number of incidents of physical violence on older people's mental health wards. This was done using quality improvement methods and supported by the Trust's extensive programme of quality improvement, including training provided by the Institute for Healthcare Improvement. Violence can be an indicator of unmet needs in this patient population, with a negative effect on patient care and staff morale. Reducing harm to patients and staff is a strategic aim of our Trust. We established a multi-disciplinary group who led on the project on each ward and used a Pareto diagram to establish the focus of our work. We established a dashboard of measures based on our incident reporting system Datix, including number of incidents of violence, days between incidents, days of staff sickness, days between staff injury, use of restraint, and use of rapid tranquilisation (the last two being balancing measures in the reduction of violence). Each team identified factors driving physical violence on the wards, under headings of unmet patient needs, staff needs and staff awareness, which included lack of activity and a safe and therapeutic environment. Using driver diagrams, we identified change ideas that included hourly rounding (proactive checks on patient well-being), the addition of sensory rooms, flexible leave for patients, and a structured activity programme. We also introduced exercise to music, therapeutic groups led by patients, and focused on discharge planning and pet therapy, each of which starting sequentially over the course of a one year period from late 2013 and subject to a cycle of iterative learning using PDSA methods. The specific aim was a 20% decrease in violent incidents on three wards in City and Hackney, and Newham. Following our interventions, days between violent incidents increased from an average of three to an average of six. Days between staff injury due to physical violence rose from an average of eight (one violent incident resulting in staff injury every eight days) to 22 (one incident every 22 days). Incidents of physical violence reduced from 63 in 2013 to 39 in 2014. We were also able to quantify reduced costs associated with reduction in violence. The success of this project in our view lay in the involvement of ward staff in understanding the problems and generating local solutions which were also broadly evidenced based. Patients were also closely involved in generating ideas. We are currently incorporating much of this work into routine practice in order to sustain improvement, as well as continuing to generate new ideas for further improvement while using the skills learnt in this process to address other problems. PMID:26734353

  11. 45 CFR 46.409 - Wards.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... Protections for Children Involved as Subjects in Research § 46.409 Wards. (a) Children who are wards of the state or any other agency, institution, or entity can be included in research approved under § 46.406 or § 46.407 only if such research is: (1) Related to their status as wards; or (2) Conducted in...

  12. How to turn ward managers into leaders.

    PubMed

    Castillo, Cavette; James, Sarah

    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

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

    PubMed

    Liu, Wei; Manias, Elizabeth; Gerdtz, Marie

    2013-03-01

    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

  14. Developing a general ward nursing dashboard.

    PubMed

    Russell, Margot; Hogg, Maggie; Leach, Stuart; Penman, Mags; Friel, Susan

    2014-12-15

    The seventh and final article in the series on Leading Better Care explores some of the challenges in clinical practice relating to the use of data and making information meaningful to senior charge nurses and ward sisters. It describes the collaborative approach taken by NHS Lanarkshire, which involved nursing staff, programme leads and the eHealth team in the development of a general ward nursing dashboard as a means of ensuring safe, effective person-centred care. The article also illustrates how this web-based data-reporting programme is used to support clinical practice. PMID:25492791

  15. The ward atmosphere of single-sex wards in a maximum-security forensic psychiatric hospital in Sweden.

    PubMed

    Brunt, David

    2008-03-01

    This exploratory study investigated the ward atmosphere of single-sex wards in a forensic psychiatric context in the light of Moos' conceptualization of the treatment setting. The wards for female patients bore similarities to Relationship-Oriented and Insight-Oriented programmes and had a generally positive ward atmosphere. On the other hand the wards for male patients did not resemble any treatment programme and had a more mixed diagnosis profile than those for female patients. Comparisons of the two types of wards are made and implications of the findings in terms of the overriding principle of normalization are discussed. PMID:18340610

  16. [Quality of medication storage on hospital wards].

    PubMed

    Burnat, Pascal; Dupont, Hélène; Koch, Isabelle; Le Garlantezec, Patrick; Oulieu, Sylvie; Dussart, Claude

    2015-03-01

    In order to meet regulations and limit the risks for patients, the quality of medication storage on hospital wards requires practical actions. They concern mainly the management of the emergency medication cabinets, conditions regarding supply and cold storage under controlled temperatures. Failures in the system may result in nurses carrying out risky procedures. PMID:26145140

  17. Henry Ward Beecher: A Nation's Tribune.

    ERIC Educational Resources Information Center

    Chandler, Daniel Ross

    Henry Ward Beecher was America's most prominent 19th century liberal preacher and a major spokesperson for New England Transcendentalism. His philosophy integrated four fundamental themes: the creation of a moral code based on the internalization of values and peer group pressures, the establishment of the reform ideal of the impartial nonpartisan…

  18. "Ward v. Wilbanks": Counselor Educators Respond

    ERIC Educational Resources Information Center

    Burkholder, David; Hall, Stephanie F.; Burkholder, Jessica

    2014-01-01

    This article investigated 71 counselor educators' perspectives and pedagogical practices related to "Ward v. Wilbanks" (2009) and the American Counseling Association (ACA) response to the case. The authors used qualitative content analysis to identify 6 themes from survey data: (a) views on gatekeeping and student training; (b)


  19. Dealing with Scabies in a Hospital Ward.

    PubMed

    Clavagnier, Isabelle

    2015-01-01

    A case of scabies has been diagnosed in the Medical Ward where Sophie works, and the hospital is having to take appropriate measures. Scabies mites can spread quickly, and staff who are in contact with the infected patient risk catching the parasites and contaminating their own family in turn. One of the night nurses is probably infected. PMID:26365648

  20. Limits of Freedom: The Ward Churchill Case

    ERIC Educational Resources Information Center

    O'Nell, Robert M.

    2006-01-01

    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…

  1. 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

  2. Control of infection in hospital wards

    PubMed Central

    Blowers, Robert

    1961-01-01

    Some of the problems of ward management are reviewed. Methods suggested for dealing with them are probably not the ideals that should ultimately be attained but minimum standards to serve as immediate objectives. They concern indications for and methods of isolation, control of infection from staff, environmental contamination, and a few technical procedures. A new type of dressing towel for wounds is described. Images PMID:16810967

  3. Service audit of a forensic rehabilitation ward.

    PubMed

    Young, Susan; Gudjonsson, Gisli H; Needham-Bennett, Humphrey; Chick, Kay

    2009-10-01

    An open forensic rehabilitation ward provides an important link bridging the gap between secure and community provisions. This paper provides an audit of such a service by examining the records of an open forensic rehabilitation ward over a five-year period from 1 June 2000 until 31 May 2005. During the audit period there were 51 admissions, involving 45 different patients, and 50 discharges. The majority of the patients came from secure unit facilities, acute psychiatric wards or home. Thirty-nine patients were discharged either into hostels (66%) or their home (12%). The majority of patients (80%) had on admission a primary diagnosis of either schizophrenia or schizoaffective disorder. Most had an extensive forensic history. The focus of their admission was to assess and treat their mental illness/disorder and offending behaviour and this was successful as the majority of patients were transferred to a community placement after a mean of 15 months. It is essential that there is a well-integrated care pathway for forensic patients, involving constructive liaison with generic services and a well-structured treatment programme which integrates the key principles of the 'recovery model' approach to care. PMID:20025105

  4. The transition from staff nurse to ward leader.

    PubMed

    Spencer, Caroline; Al-Sadoon, Tara; Hemmings, Laura; Jackson, Karen; Mulligan, Paul

    Moving from the staff nurse to ward sister role involves acquiring a range of skills to lead and motivate a team and ensure standards of care are high. Recognising new ward sisters' need for support, a trust developed a training programme to enable them to develop the necessary skills and provide mutual support. This article discusses the development of the programme and offers the reflections of three ward sisters who participated in it. PMID:26012049

  5. Monitoring environmental cleanliness on two surgical wards.

    PubMed

    Dancer, Stephanie J; White, Liza; Robertson, Chris

    2008-10-01

    Ten hand-touch sites were screened weekly on two surgical wards over two consecutive six-month periods. The results were analysed using hygiene standards, which specify (i) an aerobic colony count (ACC) > 2.5 cfu/cm(2), and (ii) presence of coagulase-positive staphylococci, as hygiene failures. Sites most often failing the standards were beds and hoist (64%: 33 of 52 weeks), bedside lockers (62%: 32 of 52) and overbed tables (44%: 23 of 52). Methicillin-susceptible/resistant Staphylococcus aureus (MSSA/MRSA) were more often recovered from lockers, overbed tables and beds. Recovery of MSSA/MRSA at any site was significantly associated with an ACC > 2.5 cfu/cm(2) from that site (p = 0.001; OR: 3.35 [95% CI 1.79, 6.28]). In addition, total ACC's > 2.5 cfu/cm(2) each week were significantly associated with weekly bed occupancies > 95% (p = 0.0004; OR: 2.94 [95% CI 1.44, 6.02]). Higher microbial growth levels from hand-touch sites reflect weekly bed occupancies and indicate a risk for both resistant and susceptible S. aureus. These organisms are more likely to be recovered from near-patient sites on the ward. PMID:18821374

  6. Solution to the Ward identities for superamplitudes

    NASA Astrophysics Data System (ADS)

    Elvang, Henriette; Freedman, Daniel Z.; Kiermaier, Michael

    2010-10-01

    Supersymmetry and R-symmetry Ward identities relate on-shell amplitudes in a supersymmetric field theory. We solve these Ward identities for N K MHV amplitudes of the maximally supersymmetric mathcal{N} = 4 and mathcal{N} = 8 theories. The resulting superamplitude is written in a new, manifestly supersymmetric and R-invariant form: it is expressed as a sum of very simple SUSY and {text{SU}}{left( mathcal{N} right)_R} -invariant Grassmann polynomials, each multiplied by a “basis amplitude”. For N K MHV n-point superamplitudes the number of basis amplitudes is equal to the dimension of the irreducible representation of SU( n - 4) corresponding to the rectangular Young diagram with mathcal{N} columns and K rows. The linearly independent amplitudes in this algebraic basis may still be functionally related by permutation of momenta. We show how cyclic and reflection symmetries can be used to obtain a smaller functional basis of color-ordered single-trace amplitudes in mathcal{N} = 4 gauge theory. We also analyze the more significant reduction that occurs in mathcal{N} = 8 supergravity because gravity amplitudes are not ordered. All results are valid at both tree and loop level.

  7. Establishment of an intermediate care ward for babies and mothers.

    PubMed Central

    Dear, P R; McLain, B I

    1987-01-01

    This paper describes one year's experience with the running of a special postnatal ward area, established so that babies who needed more treatment and monitoring than is generally undertaken on postnatal wards but who did not need the facilities of the neonatal unit could be kept by their mother's bedside. This 'intermediate care ward' admitted 297 babies with their mothers during its first year of operation. We estimate that the opening of the ward led to a 20% reduction in admissions to the neonatal unit, without disadvantage to any baby. The indications for admission are outlined and the reactions of patients and staff to the innovation discussed. PMID:3619477

  8. Experiences of ward rounds among in-patients on an acute mental health ward: a qualitative exploration†

    PubMed Central

    Cappleman, Reed; Bamford, Zandra; Dixon, Clare; Thomas, Hayley

    2015-01-01

    Aims and method To address the gap in qualitative research examining patients' experiences of ward rounds. In-depth interviews were conducted with five in-patients on an acute mental health ward. Data were analysed using thematic analysis. Results Data were organised into three first-order themes, positioned within an overarching theme relating to patients' perceptions of the use of power and control within ward rounds. Clinical implications Systemic factors may make it difficult to facilitate ward rounds in a manner which leaves patients feeling fully empowered or in control, but there are practical measures to address these issues, drawn from participants' accounts. PMID:26755967

  9. Zipf's law organizes a psychiatric ward.

    PubMed

    Piqueira, J R; Monteiro, L H; de Magalhăes, T M; Ramos, R T; Sassi, R B; Cruz, E G

    1999-06-01

    We developed a simple mathematical model based on power law fitting for describing the interactions among patients from a psychiatric ward. First we defined a protocol in order to evaluate in a quantative way the state of the patient, measuring sociability/restlessness through a daily analysis of the behavior and attributing a grade for both parameters, per patient. The grades were checked by two different specialists and a table of incidence was constructed. This table generated power laws for the grades and their variations. We concluded that power laws, like Zipf's law, may be good to explain the data, showing a self-organizing process that indicates a strong interaction component determining the whole behavior. We would like to see more data being collected, in other centers and among normal populations, trying to quantify complex collective behavioral phenomena using self-organizing criticality laws. PMID:10366495

  10. 18. View looking NE up corridor showing Wards Island Viaduct ...

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

    18. View looking NE up corridor showing Wards Island Viaduct in foreground and Randalls Island Viaduct in background. Wards Island, New York Co., NY. Sec. 4207, MP 8.02. - Northeast Railroad Corridor, Amtrak Route between New Jersey/New York & New York/Connecticut State Lines, New York, New York County, NY

  11. Improving fluid balance monitoring on the wards

    PubMed Central

    Jeyapala, Sobanakumari; Gerth, Alice; Patel, Aarti; Syed, Nazia

    2015-01-01

    Clinical experience and nursing metrics have consistently identified poor documentation of fluid balance monitoring at Milton Keynes University Hospital, compromising patient safety and quality of care. This project aimed to increase the percentage of fluid balance charts correctly completed on the wards. Three areas for improvement were identified: understanding the importance of good fluid balance monitoring, correct identification of patients requiring monitoring, and ease of completion of fluid balance charts. Three interventions were deployed on two acute medical awards in consecutive cycles; 1) small group education for staff, 2) creation of board magnets to aid the multidisciplinary team to identify patients requiring monitoring, 3) modification of the current fluid balance chart. Questionnaires were utilised to highlight improvements with current charts and measured staff awareness pre and post education. Each intervention was implemented for one week followed by daily surveys for four days to monitor compliance. Initial results showed a range of 6-12 charts used daily per ward. Of these 0-45% of them were correctly filled. Post education there was a reduced number of inappropriate charts. Introduction of board magnets improved correlation between doctors and nurses in identification of patients (52% before, 77% after magnets). Following modification there was a subjective improvement in the quality of chart completion. This study highlighted that understanding and use of fluid balance monitoring can be improved for nurses, health care assistants (HCAs), and doctors. These improvements allow better documentation and safer patient care. As a result, Milton Keynes University Hospital is investing in magnets and modified charts for a Trust-wide pilot. PMID:26734450

  12. Subjective odour levels in an air - conditioned hospital ward.

    PubMed

    Rae, A; Smith, R M

    1976-03-01

    Tests were carried out in an experimental air-conditioned hospital ward to determine what effect the mechanical ventilation and recirculation rates had on subjective odour levels in the ward. Odour conditions in the ward were not found to deteriorate with decreasing mechanical ventilation rate or increasing recirculation rate, but to fall into two distinct categories, which have been termed 'Acute' and 'Intermittent Background' conditions. 'Acute' conditions, where a particularly foul malodour prevailed in one or more rooms of the ward, were a rarity in the experimental general surgical ward; they occurred only twice during the testing period of approximately two years, and the mechanical ventilation rates tested were incapable of dealing with them. 'Intermittent Background' conditions, which are not attributable to a general prevailing odour level but rather to specific low level odour producing events, were satisfactory even under the most extreme test condition of three mechanical air changes per hour and 80% recirculation. PMID:15677196

  13. Developing a ward round checklist to improve patient safety

    PubMed Central

    Hale, Gordon; McNab, Duncan

    2015-01-01

    Checklists have been shown to improve care and reduce morbidity and mortality in the healthcare setting.[1] Their application in safety-critical industries outside of medicine continues to offer a strong argument for their application to medicine.[2] The daily in-patient medical ward round is a complex process and includes multiple potential risks to patient safety. This project aims to evaluate the effectiveness of a ward round review checklist on one general medical ward in a district general hospital in the UK. A baseline audit was performed, examining case-notes for a set of pre-defined outcome measures relevant to patient safety. Compliance with documentation of each outcome measure was assessed prior to the introduction of a ward round checklist. This was followed by a quality improvement project through the use of PDSA cycles, with the aim of introducing and developing a ward round checklist over a nine month period. Following the introduction of a checklist, overall compliance with documentation of each outcome measure improved from 45% to 89%. In conclusion, a quality improvement project involving the introduction of a ward round checklist for daily use has resulted in improved documentation of outcome measures that are relevant to patient safety. Teamwork and leadership skills from clinicians committed to improving patient safety is essential to sustaining improvements in traditional ward round practice.

  14. Exploring positive hospital ward soundscape interventions.

    PubMed

    Mackrill, J; Jennings, P; Cain, R

    2014-11-01

    Sound is often considered as a negative aspect of an environment that needs mitigating, particularly in hospitals. It is worthwhile however, to consider how subjective responses to hospital sounds can be made more positive. The authors identified natural sound, steady state sound and written sound source information as having the potential to do this. Listening evaluations were conducted with 24 participants who rated their emotional (Relaxation) and cognitive (Interest and Understanding) response to a variety of hospital ward soundscape clips across these three interventions. A repeated measures ANOVA revealed that the 'Relaxation' response was significantly affected (n(2) = 0.05, p = 0.001) by the interventions with natural sound producing a 10.1% more positive response. Most interestingly, written sound source information produced a 4.7% positive change in response. The authors conclude that exploring different ways to improve the sounds of a hospital offers subjective benefits that move beyond sound level reduction. This is an area for future work to focus upon in an effort to achieve more positively experienced hospital soundscapes and environments. PMID:24768090

  15. Environmentalism in American Pedagogy: The Legacy of Lester Ward.

    ERIC Educational Resources Information Center

    Tanner, Laurel N.; Tanner, Daniel

    1987-01-01

    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)

  16. Ward nurses' resuscitation of critical patients: current training and barriers.

    PubMed

    Roh, Young Sook; Issenberg, S Barry; Chung, Hyun Soo

    2014-09-01

    Little is known about the current training and barriers in resuscitation skills among practicing ward nurses. A convenience sample of 459 ward nurses, recruited from 11 academic teaching hospitals in Korea, were surveyed to assess current training and barriers to optimal resuscitation performance on the wards. The Perceived Barriers scale was developed, refined, and its psychometric properties were assessed. Approximately 36% of nurses had received simulation-based resuscitation skills training. Exploratory factor analysis identified four barriers accounting for 58.4% of the variance: insufficient training (37.7%), lack of competence (9.8%), lack of self-confidence (5.9%), and workload and tension (5.1%). Strategic planning and resuscitation skills training should be incorporated into staff development programs to reduce barriers to optimal resuscitation performance and cope with work demands for ward nurses. PMID:23162061

  17. Ward Field and grandstand (Facility S 1009), looking toward Recreation ...

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

    Ward Field and grandstand (Facility S 1009), looking toward Recreation Center portion of Facility 161 (visible below tree canopy). - U.S. Naval Base, Pearl Harbor, Recreational Facilities, Various locations throughout base, Pearl City, Honolulu County, HI

  18. 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

  19. 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

  20. 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

  1. 16. BUILDING 1049, SECOND FLOOR WARD WITH CUBICLE ADDITIONS. ...

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

    16. BUILDING 1049, SECOND FLOOR WARD WITH CUBICLE ADDITIONS. - Presidio of San Francisco, Letterman General Hospital, Building No. 12, Letterman Hospital Complex, Edie Road, San Francisco, San Francisco County, CA

  2. 15. BUILDING 1049, SECOND FLOOR HALLWAY LOOK SOUTH FROM WARD. ...

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

    15. BUILDING 1049, SECOND FLOOR HALLWAY LOOK SOUTH FROM WARD. - Presidio of San Francisco, Letterman General Hospital, Building No. 12, Letterman Hospital Complex, Edie Road, San Francisco, San Francisco County, CA

  3. 14. BUILDING 1049, SECOND FLOOR HALLWAY LOOKING NORTH INTO WARD. ...

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

    14. BUILDING 1049, SECOND FLOOR HALLWAY LOOKING NORTH INTO WARD. - Presidio of San Francisco, Letterman General Hospital, Building No. 12, Letterman Hospital Complex, Edie Road, San Francisco, San Francisco County, CA

  4. 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

  5. Developing skills in clinical leadership for ward sisters.

    PubMed

    Fenton, Katherine; Phillips, Natasha

    The Francis report has called for a strengthening of the ward sister's role. It recommends that sisters should operate in a supervisory capacity and should not be office bound. Effective ward leadership has been recognised as being vital to high-quality patient care and experience, resource management and interprofessional working. However, there is evidence that ward sisters are ill equipped to lead effectively and lack confidence in their ability to do so. University College London Hospitals Foundation Trust has recognised that the job has become almost impossible in increasingly large and complex organisations. Ward sisters spend less than 40% of their time on clinical leadership and the trust is undertaking a number of initiatives to support them in this role. PMID:23550483

  6. Ward rounds are an essential component of good basic care.

    PubMed

    Smith, Joan

    2015-01-27

    In my day, we called intentional rounding 'ward rounds' or 'the back round'. It puzzles me that the prime minister is championing a Ł450,000 study to see if they lead to better care (News December 17). PMID:25605106

  7. B Vitamin May Help Ward Off Some Skin Cancers

    MedlinePLUS

    ... nih.gov/medlineplus/news/fullstory_155264.html B Vitamin May Help Ward Off Some Skin Cancers Study ... 2015 (HealthDay News) -- A cheap and readily available vitamin supplement appears to reduce a person's risk of ...

  8. [Nursing Education Utilizing Experiences in a Virtual Hospital Ward].

    PubMed

    Tsuji, Keiko; Matsumoto, Maki; Takai, Kiyako; Kodama, Hiromi; Hagiwara, Tomoko; Iwata, Naomi

    2015-06-01

    Environmental design should be required at medical facilities for conducting medical practice safely and for making hospitalization comfortable. Many medical nursing students cannot imagine medical facilities, especially hospital wards, when they study medical environments in a basic nursing lecture. As a result, they cannot connect well with patient assistance. We employed a computer assisted designing software, "3D My Home Designer" (Mega Soft Company) that runs on Windows 8, and considered the usefulness of it for lectures on environmental design showing how to design a hospital ward for patients' optimal hospital stay. We drew a medical facility in 2-D first, transformed it into 3D images, and then created movies of a virtual hospital ward in which a patient walked around. These movies consisted of 3 kinds: a) hospital room with changeable wall color, b) different allocations of hospital room and nurse station, and c) a blurred ward which corresponded to how a patient with poor eyesight (cataract) would see a ward. We prepared as controls: a') still images of a hospital room, b') still images of ward, and c') a documentation on how a ward is seen by a patient with a cataract. We gave a questionnaire to students and nurses about these movies and still images (controls). In a) and b), there were no differences between the movies and still images in both students and nurses. In c), both students and nurses had a viewpoint from the patient with poor eyesight. From these results, we consider that the students, who have fewer experiences in a hospital, may understand the environments well by movies and the application of a virtual movie ward to nursing education may be useful in a lecture, depending on the readiness of the students. PMID:26073505

  9. Pharmacognostic standardization of Turnera aphrodisiaca Ward.

    PubMed

    Kumar, Suresh; Taneja, Ruchi; Sharma, Anupam

    2006-01-01

    Turnera aphrodisiaca Ward (Turneraceae) has been used traditionally as an aphrodisiac, stimulant, nerve tonic, and laxative and in kidney, menstrual, and pregnancy disorders. Despite a long tradition of use in the treatment of various ailments, no systematic phytochemical and pharmacological work has ever been carried out on T. aphrodisiaca. The authors suggest that the major stumbling block in systematic exploration of the plant is non-availability of authentic plant material. In the present investigation, various pharmacognostic standards for the plant have been generated so that authentic T. aphrodisiaca could be explored for its traditional claims. Microscopically, T. aphrodisiaca leaf showed the presence of abundant unicellular, warty, non-glandular trichomes, anomocytic stomata, and a large number of calcium oxalate crystals along the veins. Powdered stem of the plant showed lignified spiral and pitted tracheidal vessels, and pericyclic fibers were observed in powder microscopy of stem. Total ash of the aerial parts of T. aphrodisiaca was approximately eight and four times more than acid-insoluble and water-soluble ash, respectively. The water-soluble extractive value of the plant was slightly higher than its ethanol-soluble extractive value. Volatile oil content of T. aphrodisiaca was found to be 0.44% (wt/vol), the thin-layer chromatography of which exhibited seven spots using toluene:ethyl acetate (93:7 vol/vol) as mobile phase. Thin-layer chromatography of the petroleum ether extract showed nine spots using hexane:dichloromethane (1:1 vol/vol), while the chloroform extract showed 11 spots using toluene:ethyl acetate:glacial acetic acid (35:4:1 by volume). Phytochemically, the plant was found to contain alkaloids, cyanogenic glycosides, steroids, saponins, flavonoids, tannins, carbohydrates, and proteins. PMID:16822212

  10. Correction to Ward et al. (2015).

    PubMed

    Ward, Ryan D; Winiger, Vanessa; Higa, Kerin K; Kahn, Julia B; Kandel, Eric R; Balsam, Peter D; Simpson, Eleanor H

    2015-08-01

    Reports an error in "The impact of motivation on cognitive performance in an animal model of the negative and cognitive symptoms of schizophrenia" by Ryan D. Ward, Vanessa Winiger, Kerin K. Higa, Julia B. Kahn, Eric R. Kandel, Peter D. Balsam and Eleanor H. Simpson (Behavioral Neuroscience, 2015[Jun], Vol 129[3], 292-299). There is a text error in the 4th paragraph of the Discussion section. The explanation for the abbreviation OFC was incorrectly listed as occipitofrontal circumference. It should have been orbitofrontal cortex. (The following abstract of the original article appeared in record 2015-18639-001.) Interactions between motivation and cognition are implicated in producing functional impairments and poor quality of life in psychiatric patients. This interaction, however, is not well understood at either the behavioral or neural level. We developed a procedure for mice in which a cognitive measure, sustained attention, is modulated by a motivationally relevant signal that predicts reward probability on a trial-by-trial basis. Using this paradigm, we tested the interaction between motivation and cognition in mice that model the increased striatal D2 receptor activity observed in schizophrenia patients (D2R-OE mice). In control mice, attention was modulated by signaled-reward probability. In D2R-OE mice, however, attention was not modulated by reward-related cues. This impairment was not due to any global deficits in attention or maintenance of the trial-specific information in working memory. Turning off the transgene in D2R-OE mice rescued the motivational modulation of attention. These results indicate that deficits in motivation impair the ability to use reward-related cues to recruit attention and that improving motivation improves functional cognitive performance. These results further suggest that addressing motivational impairments in patients is critical to achieving substantive cognitive and functional gains. PMID:26214211

  11. Stress Among Iranian Nurses in Critical Wards

    PubMed Central

    Hashemian, Seyed Mohammad Reza; Farzanegan, Behrooz; Fathi, Mohammad; Ardehali, Seyed Hossein; Vahedian-Azimi, Amir; Asghari-Jafarabadi, Mohammad; Hajiesmaeili, Mohammadreza

    2015-01-01

    Background: Stress has been recognized as a significant psychosocial and physiologic component in educational and practical processes. Objectives: The purpose of present study was to survey stress among Iranian nurses in critical wards. Patients and Methods: In this cross-sectional study, 3643 anonymous questionnaires were disseminated among nurses in different hospitals in Tehran, Iran, by utilizing multistage random sampling. The questionnaire consisted of two sections: demographic characteristics and a 22-item list on a five-point Likert scale. The association of variables with stress was evaluated using hierarchical logistic regression. Results: A total of 3043 completed questionnaires were completed and returned (response rate, 83.53%). Age (> 33 years, 1571 (51.63%); < 33 years old, 1472 (48.37%)), marital status (single, 188 (6.18%); married, 2685 (88.24%); and widow, 170 (5.59%)), working shift (morning, 605 (19.88%); evening, 631 (20.74%); night, 603 (19.82%); and rotation, 1204 (39.57%)), and the years of experience of nurses (1 - 5 years, 413 (13.57%); 6 - 10 years, 589 (19.36%); 11 - 15 years, 832 (27.34%); 16 - 20 years, 758 (24.91%); and 21-25 years, 451 (14.82%)) had significant association with the level of stress (P < 0.05 for all parameters). However, sex (male, 937 (30.79%); and female, 2106 (69.21%)), education (associate, 444 (14.59%); baccalaureate, 2250 (73.94%); and master, 349 (11.47%)), and body mass index (> 24.6 kg/m2, 2514 (49.75%); and < 24.6 kg/m2, 1529 (50.25%)) showed no significant association with the level of stress (P > 0.05 for all parameters). Conclusions: Considering the personal and background characteristics of personnel and understanding their association with stress and stressful situations encompasses the ability to persevere and adapt to contextual stressors. PMID:26380798

  12. Why patients need leaders: introducing a ward safety checklist

    PubMed Central

    Amin, Yogen; Grewcock, Dave; Andrews, Steve; Halligan, Aidan

    2012-01-01

    The safety and consistency of the care given to hospital inpatients has recently become a particular political and public concern. The traditional ‘ward round’ presents an obvious opportunity for systematically and collectively ensuring that proper standards of care are being achieved for individual patients. This paper describes the design and implementation of a ‘ward safety checklist’ that defines a set of potential risk factors that should be checked on a daily basis, and offers multidisciplinary teams a number of prompts for sharing and clarifying information between themselves, and with the patient, during a round. The concept of the checklist and the desire to improve ward rounds were well received in many teams, but the barriers to adoption were informative about the current culture on many inpatient wards. Although the ‘multidisciplinary ward round’ is widely accepted as good practice, the medical and nursing staff in many teams are failing to coordinate their workloads well enough to make multidisciplinary rounds a working reality. ‘Nursing’ and ‘medical’ care on the ward have become ‘de-coupled’ and the potential consequences for patient safety and good communication are largely self-evident. This problem is further complicated by a medical culture which values the primacy of clinical autonomy and as a result can be resistant to perceived attempts to ‘systematize’ medical care through instruments such as checklists. PMID:22977047

  13. Why patients need leaders: introducing a ward safety checklist.

    PubMed

    Amin, Yogen; Grewcock, Dave; Andrews, Steve; Halligan, Aidan

    2012-09-01

    The safety and consistency of the care given to hospital inpatients has recently become a particular political and public concern. The traditional 'ward round' presents an obvious opportunity for systematically and collectively ensuring that proper standards of care are being achieved for individual patients. This paper describes the design and implementation of a 'ward safety checklist' that defines a set of potential risk factors that should be checked on a daily basis, and offers multidisciplinary teams a number of prompts for sharing and clarifying information between themselves, and with the patient, during a round. The concept of the checklist and the desire to improve ward rounds were well received in many teams, but the barriers to adoption were informative about the current culture on many inpatient wards. Although the 'multidisciplinary ward round' is widely accepted as good practice, the medical and nursing staff in many teams are failing to coordinate their workloads well enough to make multidisciplinary rounds a working reality. 'Nursing' and 'medical' care on the ward have become 'de-coupled' and the potential consequences for patient safety and good communication are largely self-evident. This problem is further complicated by a medical culture which values the primacy of clinical autonomy and as a result can be resistant to perceived attempts to 'systematize' medical care through instruments such as checklists. PMID:22977047

  14. Sexual dysfunctions in the patients hospitalized in psychiatric wards compared to other specialized wards in Isfahan, Iran, in 2012

    PubMed Central

    Ahmadzadeh, Gholamhossain; Shahin, Ali

    2015-01-01

    Background: Having pleasurable sexual intercourses plays a major role in marital life satisfaction. Many of the medical and psychiatric disorders may affect the sexual function of the patients. The present study aims to investigate the relative frequency of sexual dysfunctions in the patients hospitalized in psychiatric wards and that of the patients in other specialized wards. Materials and Methods: This study is a descriptive-analytical, cross-sectional one, carried out on 900 patients hospitalized in psychiatric, cardiac, orthopedic, ophthalmology, and dermatology and plastic surgery wards of 5 hospitals in Isfahan. Data collection tools included demographic questionnaire and Arizona Sexual Experiences Scale (ASEX). Results: Sexual dysfunction in the patients hospitalized in psychiatric wards (38%) was significantly higher than in the patients in other wards (27%), (P = 0.00). Among the patients hospitalized in psychiatric wards, those with bipolar disorder (37.3%) had the highest prevalence rate of sexual dysfunction. The patients with schizophrenia, major depression, substance abuse, and anxiety disorders had the following rates respectively. Among the patients in non-psychiatric wards, those in cardiac wards (37.1%) had the highest prevalence rate of sexual dysfunction. There was a significant relationship between the drug uses, mostly psychiatric drugs especially anti-psychotics, and the occurrence of sexual dysfunction. Conclusion: Considering the significant relative frequency of sexual dysfunction in psychiatric patients and undesired effects of simultaneous occurrence of both of these disorders in the patients, more emphasis is recommended to be placed on the prevention and proper treatment of these disorders in the patients. PMID:26623400

  15. Hospital admission avoidance through the introduction of a virtual ward.

    PubMed

    Jones, Joanne; Carroll, Andrea

    2014-07-01

    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

  16. Ward Valley status report: Science versus politics. Which will win?

    SciTech Connect

    Pasternak, A.D.

    1996-10-01

    The State of California has issued a license to US Ecology, Inc. to construct and operate a disposal facility for low-level radioactive waste (LLRW) at the remote, arid Ward Valley site in the Mojave Desert. The license and certification of the associated environmental documentation have been upheld by the California courts. The Ward Valley license is the first and, so far, only license to be issued for a new LLRW disposal facility pursuant to the Low-Level Radioactive Waste Policy Act enacted in 1980 and amended in 1985. However, the dates of construction and operation of the disposal facility are uncertain because the federal government has refused to sell land in Ward Valley to the State of California for the site of the Southwestern Compact`s regional disposal facility. The Clinton Administration`s repeated excuses for delaying the land transfer, and the circumstances of these delays, indicate that prospects for success of the Ward Valley project, and perhaps the Policy Act itself, depend on the outcome of a battle between science and politics. In view of these delays by the administration, Congressional action to Transfer the Ward Valley lands to California will serve both state and federal goals for safe disposal of LLRW.

  17. Occurrence of hypoxia in the wards of a teaching hospital

    PubMed Central

    Singh, Virendra; Aziz, Adil; Wakil, Qutbuddin; Sharma, Bharat Bhushan

    2012-01-01

    Objective: Appearance of hypoxia in a patient may be an indicator of a serious medical condition that can have grave consequences. Clinical evaluation fails to detect majority of the patients of hypoxia, and therefore, it may remain unnoticed in the wards. We planned to assess the magnitude of hypoxia in different wards of our tertiary care hospital. Materials and Methods: We studied all the patients admitted in various medical and surgical wards during 1 week of study. Oxygen saturation (SpO2) was measured with the help of a pulse oximeter in all the patients who remained admitted for at least 24 h. Hypoxia was diagnosed in a patient when he had SpO2 less than 90%. Results: During the study period, 1167 patients were admitted in various wards of the hospital. Hypoxia was detected in 121 patients (10.36%). Among them, 7 (0.59%) patients were already having a diagnosis of respiratory failure, but were not on oxygen therapy while 5 (0.42%) patients were having SpO2 less than 90% despite of oxygen therapy. In 109 (9.34%) patients, hypoxia was detected incidentally. Conclusion: Unnoticed hypoxia was detected in a significant number of the patients admitted in the wards of the hospital. Therefore, it is concluded that oxygen saturation measurements should be included with other vital parameters like pulse, temperature, and blood pressure, in the monitoring chart of all the admitted patients. PMID:23243345

  18. Seizures: awareness and observation in the ward environment.

    PubMed

    Spray, Jennifer

    The preconceived 'foaming' and 'violent' seizure stereotypes are misrepresentations, particularly by non-specialist health professionals. Thus the vast semiology (signs and symptoms) of seizures and their subtle signs too easily go unrecognised by the untrained eye. Nevertheless, a significant proportion of adult patients admitted to the ward for treatment of their current illness will have a pre-existing seizure disorder (epilepsy). Furthermore, such hospitalised patients are more likely to suffer a seizure within the ward environment as triggering factors are unavoidably present. Thus, it is essential that nurses are prepared to encounter seizures, irrespective of the reason for admission. This article discusses the clinical semiology of the various seizure types in association with the underpinning neuropathophysiology, as well as the potential seizure triggers. It thereby enhances nurses' awareness and observations of seizure activity in patients in the ward environment. PMID:26500124

  19. Development of competent children's ward co-ordinators.

    PubMed

    Scaife, Clair; October, Margaret; Kellett, Valerie

    2014-07-01

    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

  20. Intestinal failure and the ward nurses: causes, assessment and management.

    PubMed

    Smith, Lisa

    In order to manage intestinal failure (IF), a complex regimen of care is required to manage fluid intake and electrolyte balance. In the majority of cases ward nurses will bare the responsibility of managing patients with these specific needs, with the support of the nutritional multidisciplinary team. Therefore, nurses need to ensure they have expert knowledge of each area of IF management. This article defines IF and outlines how it can be managed surgically and medically. The author discusses the role of the ward nurse in monitoring and managing therapy, and states the importance of providing emotional and psychological care. PMID:22624194

  1. 2. Ramp No. 3 connection between two Standard Wards: Building ...

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

    2. Ramp No. 3 connection between two Standard Wards: Building Nos. 9935-A (left) and 9934-A (right). Note asymetrical wooden door, and brick arch above doorway. - Madigan Hospital, Corridors & Ramps, Bounded by Wilson & McKinley Avenues & Garfield & Lincoln Streets, Tacoma, Pierce County, WA

  2. 34 CFR 303.37 - Ward of the State.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 34 Education 2 2012-07-01 2012-07-01 false Ward of the State. 303.37 Section 303.37 Education Regulations of the Offices of the Department of Education (Continued) OFFICE OF SPECIAL EDUCATION AND REHABILITATIVE SERVICES, DEPARTMENT OF EDUCATION EARLY INTERVENTION PROGRAM FOR INFANTS AND TODDLERS...

  3. 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

  4. 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

  5. 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

  6. 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

  7. 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

  8. 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

  9. 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

  10. 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

  11. 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

  12. 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

  13. 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

  14. 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

  15. 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

  16. 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

  17. 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

  18. 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

  19. 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

  20. 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

  1. 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

  2. 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

  3. 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

  4. 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

  5. The Problems and Needs of Juvenile Court Wards in Oregon.

    ERIC Educational Resources Information Center

    Heuser, James Paul

    This document is an assessment of the service needs of one state's juvenile court wards written by a group of representatives of private and governmental agencies involved in working with children in the juvenile justice system. The group's goals were to generate accurate program and fiscal information about the juvenile justice and juvenile…

  6. 34 CFR 303.37 - Ward of the State.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 34 Education 2 2013-07-01 2013-07-01 false Ward of the State. 303.37 Section 303.37 Education Regulations of the Offices of the Department of Education (Continued) OFFICE OF SPECIAL EDUCATION AND REHABILITATIVE SERVICES, DEPARTMENT OF EDUCATION EARLY INTERVENTION PROGRAM FOR INFANTS AND TODDLERS...

  7. 34 CFR 303.37 - Ward of the State.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 34 Education 2 2014-07-01 2013-07-01 true Ward of the State. 303.37 Section 303.37 Education Regulations of the Offices of the Department of Education (Continued) OFFICE OF SPECIAL EDUCATION AND REHABILITATIVE SERVICES, DEPARTMENT OF EDUCATION EARLY INTERVENTION PROGRAM FOR INFANTS AND TODDLERS...

  8. The Acquisition of Clinical Ward Skills during Undergraduate Medical Training.

    ERIC Educational Resources Information Center

    Lee, Wesley

    1980-01-01

    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…

  9. 17. New York Connecting Railroad: Little Hell Gate Bridge. Wards ...

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

    17. New York Connecting Railroad: Little Hell Gate Bridge. Wards Island, New York Co., NY. Sec. 4207, MP 8.02. - Northeast Railroad Corridor, Amtrak Route between New Jersey/New York & New York/Connecticut State Lines, New York, New York County, NY

  10. 78 FR 14543 - Ward Transformer Superfund Site; Raleigh, Wake County, NC; Notice of Settlement

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-03-06

    ... AGENCY Ward Transformer Superfund Site; Raleigh, Wake County, NC; Notice of Settlement AGENCY... Agency has entered into a settlement at the Ward Transformer Superfund Site located in Raleigh, Wake... EPA Region 4 contact Ms. Paula V. Painter. Submit your comments by Site name Ward...

  11. 75 FR 81269 - Ward Transformer Superfund Site Raleigh, Wake County, NC; Notice of Settlements

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-12-27

    ... AGENCY Ward Transformer Superfund Site Raleigh, Wake County, NC; Notice of Settlements AGENCY... Ward Transformer Superfund Site located in Raleigh, Wake County, North Carolina for publication. DATES... your comments, identified by Docket ID No. EPA-RO4- SFUND-2010-1053 or Site name Ward...

  12. Youth Health Coordinating Council Ward 8 Secret Health Clinic Shopper Report

    ERIC Educational Resources Information Center

    Behrens, Donna

    2010-01-01

    There are over 70,000 residents in Ward 8, the poorest area of Washington, DC and along with Ward 7, it's most geographically remote. Approximately 36% of the Ward 8 population consists of children and youth, 18 years or younger. Children in the District of Columbia are at greater risk for poorer health and life outcomes than children in other…

  13. 42 CFR 70.7 - Responsibility with respect to minors, wards, and patients.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 1 2011-10-01 2011-10-01 false Responsibility with respect to minors, wards, and... QUARANTINE, INSPECTION, LICENSING INTERSTATE QUARANTINE § 70.7 Responsibility with respect to minors, wards... procure or furnish transportation for any minor child or ward, patient or other such person who is in...

  14. 42 CFR 70.7 - Responsibility with respect to minors, wards, and patients.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 1 2013-10-01 2013-10-01 false Responsibility with respect to minors, wards, and... QUARANTINE, INSPECTION, LICENSING INTERSTATE QUARANTINE § 70.7 Responsibility with respect to minors, wards... procure or furnish transportation for any minor child or ward, patient or other such person who is in...

  15. 42 CFR 70.7 - Responsibility with respect to minors, wards, and patients.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 1 2010-10-01 2010-10-01 false Responsibility with respect to minors, wards, and... QUARANTINE, INSPECTION, LICENSING INTERSTATE QUARANTINE § 70.7 Responsibility with respect to minors, wards... procure or furnish transportation for any minor child or ward, patient or other such person who is in...

  16. 42 CFR 70.7 - Responsibility with respect to minors, wards, and patients.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 1 2012-10-01 2012-10-01 false Responsibility with respect to minors, wards, and... QUARANTINE, INSPECTION, LICENSING INTERSTATE QUARANTINE § 70.7 Responsibility with respect to minors, wards... procure or furnish transportation for any minor child or ward, patient or other such person who is in...

  17. 42 CFR 70.7 - Responsibility with respect to minors, wards, and patients.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 1 2014-10-01 2014-10-01 false Responsibility with respect to minors, wards, and... QUARANTINE, INSPECTION, LICENSING INTERSTATE QUARANTINE § 70.7 Responsibility with respect to minors, wards... procure or furnish transportation for any minor child or ward, patient or other such person who is in...

  18. Noether's second theorem and Ward identities for gauge symmetries

    NASA Astrophysics Data System (ADS)

    Avery, Steven G.; Schwab, Burkhard U. W.

    2016-02-01

    Recently, a number of new Ward identities for large gauge transformations and large diffeomorphisms have been discovered. Some of the identities are reinterpretations of previously known statements, while some appear to be genuinely new. We use Noether's second theorem with the path integral as a powerful way of generating these kinds of Ward identities. We reintroduce Noether's second theorem and discuss how to work with the physical remnant of gauge symmetry in gauge fixed systems. We illustrate our mechanism in Maxwell theory, Yang-Mills theory, p-form field theory, and Einstein-Hilbert gravity. We comment on multiple connections between Noether's second theorem and known results in the recent literature. Our approach suggests a novel point of view with important physical consequences.

  19. Ward identities and relations between conductivities and viscosities in holography

    NASA Astrophysics Data System (ADS)

    Hoyos, Carlos; Fernández, David Rodríguez

    2016-01-01

    We derive relations between viscosities and momentum conductivity in 2 + 1 dimensions by finding a generalization of holographic Ward identities for the energy-momentum tensor. The generalization is novel in the sense that it goes beyond the usual identities obtained from holographic renormalization. Our results are consistent with previous field theory analysis. The main tools we use are a constant `probability current' in the gravity dual, that we are able to define for any system of linear ODEs, and parity symmetry.

  20. Midwifery students first encounter with the maternity ward.

    PubMed

    Thunes, Sissel; Sekse, Ragnhild Johanne Tveit

    2015-05-01

    Considerable research has been made in order to find what promotes students' learning in general, but few studies have included midwifery students and their learning in clinical practice. The purpose of this study was to get a better understanding of the midwifery students' first encounter with the maternity ward and of what was essential to them in the learning environment. A qualitative study, based on in-depth interviews with six students during their first clinical practice at a maternity ward, was conducted. The findings show that the students needed to feel their presence desired and to be included in the activities in the ward. Learning needed to be based on the students' expectations, understanding and previous experiences. The most important factor influencing the students' well-being and learning was their relationships with their mentor. In conclusion, learning in a clinical setting required more than just motivated students. Engaged mentors, who linked the students' previous experiences and expectations to the clinical practice, were crucial to learning outcomes. Mutual engagement, shared understanding and common goals were imperative for the students' experiences of a good learning environment. PMID:25701290

  1. Ventilation assessment of an infectious disease ward housing TB patients

    SciTech Connect

    Crandall, M.S.; Hughes, R.T.

    1996-05-01

    The National Institute for Occupational Safety and Health (NIOSH) assisted the National Center for Infectious Diseases and the National Center for Prevention Services, Centers for Disease Control (CDC), in their investigation of nosocomial transmission of tuberculosis (TB) at a Veterans Administration Medical Center. NIOSH was asked to determine whether ventilation requirements expected of TB patient isolation facilities were being met. In the Infectious Disease ward (513), 24 staff were given a tuberculin skin test (TST) in the summer of 1991. Eleven (46%) were positive then, and 13 were negative. Ten of the 13 testing negative in 1991 were retested within a year, and 5 (50%) converted to a positive TST. NIOSH investigators made ventilation measurements on Ward 5B, an infectious diseases ward housing patients with acquired immune deficiency syndrome (AIDS), two of them with infectious TB, to determine the status of the systems serving the area. Airflow measurements showed that in all the single-patient rooms, exhaust airflow was essentially zero. The average supply airflow varied above and below the designed value. These rooms were all positively pressurized, which would be recommended for the isolation of infectious patients. Based on the measurements made during this evaluation, it was recommended that a separate isolation facility be constructed in the hospital to house infectious patients. Interim corrective measures for the systems in place were also recommended.

  2. The Changing Pattern of Hospital Admission to Medical Wards

    PubMed Central

    Noor, Sufian K.; Elmadhoun, Wadie M.; Bushara, Sarra O.; Ahmed, Mohamed H.

    2015-01-01

    Objectives: This study aimed to determine the pattern of hospital admissions and patient outcomes in medical wards at Atbara Teaching Hospital in River Nile State, Sudan. Methods: This retrospective cross-sectional study was conducted from August 2013 to July 2014 and included all patients admitted to medical wards at the Atbara Teaching Hospital during the study period. Morbidity and mortality data was obtained from medical records. Diseases were categorised using the World Health Organization’s International Classification of Diseases (ICD) coding system. Results: A total of 2,614 patient records were analysed. The age group with the highest admissions was the 56–65-year-old age group (19.4%) and the majority of patients were admitted for one week or less (86.4%). Non-communicable diseases constituted 71.8% of all cases. According to ICD classifications, patients were admitted most frequently due to infectious or parasitic diseases (19.7%), followed by diseases of the circulatory (16.4%), digestive (16.4%) and genito-urinary (13.8%) systems. The most common diseases were cardiovascular disease (16.4%), malaria (11.3%), gastritis/peptic ulcer disease (9.8%), urinary tract infections (7.2%) and diabetes mellitus (6.9%). The mortality rate was 4.7%. Conclusion: The burden of non-communicable diseases was found to exceed that of communicable diseases among patients admitted to medical wards at the Atbara Teaching Hospital. PMID:26629380

  3. Medical academia clinical experiences of Ward Round Teaching curriculum

    PubMed Central

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

    2014-01-01

    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. PMID:24627858

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

    PubMed Central

    2014-01-01

    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. PMID:24581228

  5. Ward identities and chiral anomalies for coupled fermionic chains

    NASA Astrophysics Data System (ADS)

    Costa, L. C.; Ferraz, A.; Mastropietro, Vieri

    2013-12-01

    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.

  6. Ward identities and chiral anomalies for coupled fermionic chains

    SciTech Connect

    Costa, L. C.; Ferraz, A.; Mastropietro, Vieri

    2013-12-15

    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.

  7. The educational value of ward rounds for junior trainees.

    PubMed

    Laskaratos, Faidon-Marios; Wallace, Deirdre; Gkotsi, Despoina; Burns, Aine; Epstein, Owen

    2015-01-01

    The ward round (WR) is a complex task and medical teachers are often faced with the challenge of finding a balance between service provision and clinical development of learners. The educational value of WRs is an under-researched area. This short communication aims to evaluate the educational role of WRs for junior trainees and provides insight into current practices. It also identifies obstacles to effective teaching/training in this setting and provides suggestions for improving the quality of WR teaching. PMID:25907002

  8. The educational value of ward rounds for junior trainees

    PubMed Central

    Laskaratos, Faidon-Marios; Wallace, Deirdre; Gkotsi, Despoina; Burns, Aine; Epstein, Owen

    2015-01-01

    The ward round (WR) is a complex task and medical teachers are often faced with the challenge of finding a balance between service provision and clinical development of learners. The educational value of WRs is an under-researched area. This short communication aims to evaluate the educational role of WRs for junior trainees and provides insight into current practices. It also identifies obstacles to effective teaching/training in this setting and provides suggestions for improving the quality of WR teaching. PMID:25907002

  9. Measuring the impact of modern matrons in the ward setting.

    PubMed

    Shanley, Oliver

    With the The NHS Plan (Department of Health, 2000) the government made it clear there was a need to reintroduce the role of matron to establish a clear responsibility for standards in the ward setting. The role of modern matron is now considered to be a fundamental part of clinical governance, ensuring the quality of the care provided is of the highest standard. Staff at South Essex Partnership NHS Trust instituted an audit to provide an accurate picture of the impact of modern matrons. PMID:15552487

  10. Ward identities, B ? V transition form factors and applications

    NASA Astrophysics Data System (ADS)

    Paracha, M. Ali; El-Bennich, Bruno; Aslam, M. Jamil; Ahmed, Ishtiaq

    2015-07-01

    Long distance effects are studied in the rare exclusive semileptonic B(d,s) ? V?+?- decays, where V denotes a K* or ? meson. The form factors, which describe the meson transition amplitudes in the effective Hamiltonian approach, are calculated by means of Ward identities, experimental constraints and extrapolated within a general vector meson dominance framework. These form factors are then compared to the ones obtained in Lattice QCD simulations, with Light Cone Sum Rules and a Dyson-Schwinger equation approach. Additionally, the Bd ? K*?+?- and Bs ? ??+?- branching ratios are computed and the differential branching fractions are given as a function of the squared-momentum transfer.

  11. 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

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

    2013-05-01

    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

  12. Mothers’ Satisfaction Rate from Hospital Cares in Hematology- Oncology Ward

    PubMed Central

    Boroumand, H; Moshki, M; Khajavi, A; Hashemizadeh, H

    2015-01-01

    Background Satisfaction evaluation is a good way to assess hospital conditions. In Health Care System, parentscan be also as children's main supporters, thus they may act as patient's viewpoints' representatives.This study aimed to evaluate mother’s satisfaction of hospital care in hematology – oncology ward in Dr Sheikh hospital. Materials and Methods A Cross-sectional descriptive analytic study was conducted using Pediatric Family Satisfaction (PFS) questionnaire and interviewing with 164 mothers duringMarchto February2013. The obtained data were analyzed using SPSS -16 software and descriptive statistics. Results The mean age of mothers and children was31.2±5.8, and 7.95 4/66 years.The children were 64 % male and 36 % femael. A large number of mothers (%56 (describedtheir satisfaction about medical care as moderate,(%70.7) reported their satisfaction about nursing care at very high level and(36.5 %) reported satisfaction about welfare services at high level(59%)and describe overall satisfaction at very high level . The totals mean of mothers’ satisfaction ratewas 121.8 ± 10.8. The mean of medical care, nursing care, welfare services was 2.9±34.1,4.6±50 and4.8± 32.9 respectively. Conclusion Overall satisfaction with medical, nursing and welfare staff was acceptable. For more satisfaction, it is widely recommended to improve veinipuncture by nurses, Physicians should inform parents about the tests results, and finally disturbance in ward with noise should be controled.

  13. Multi-Criteria Knapsack Problem for Disease Selection in an Observation Ward

    NASA Astrophysics Data System (ADS)

    Lurkittikul, N.; Kittithreerapronchai, O.

    2014-06-01

    The aging population and the introduction of Thailand universal healthcare have increased inpatients and outpatients to public hospitals, particularly to a hospital that provides special and comprehensive health services. Many inpatient wards have experienced large influx of inpatients as the hospitals have to admit all patients regardless their conditions. These overcrowding wards cause stress to medical staffs, block access between medical departments, hospital-acquired infections, and ineffective uses of resources. One way to manage such inundated inpatient is to select some patients whose conditions require less clinical attention or whose lengths of stay are predictable and short and, then, place them at an observation ward. This intermediate ward increases turnover of beds and reduces unnecessary paperwork as patients are considered to be outpatients. In this article, we studied inpatient data of a tertiary care hospital in which an observation ward was considered to alleviate the overcrowding problem at Internal Medicine Department. The analysis of data showed that the hospital can balance inpatient flow by managing a group of patients who is admitted because of treatments ordered by its special clinics. Having explored several alternatives, we suggested patient selection criteria and proposed a layout at an observation ward. The hospital should increase medical beds in a new building ward because the current observation ward can handle 27.3% of total short stay patients, while the observation ward is projected to handle 80% of total short stay patients.

  14. [Expected Duties of Pharmacists and Potential Needs of Physicians and Nurses on a Kaifukuki Rehabilitation Ward].

    PubMed

    Fujihara, Hisato; Koinuma, Masayoshi; Yumoto, Tetsuro; Maeda, Takuya; Kamite, Mariko; Kawahara, Eiko; Soeda, Shinji; Takimoto, Atsushi; Tamura, Kazuyoshi; Nakamura, Masatoshi; Kaneta, Mitsumasa; Takao, Yoshihiro; Saito, Masahisa; Kagaya, Hajime; Murayama, Jun-ichiro

    2015-01-01

    This study investigated the required duties of pharmacists in a kaifukuki rehabilitation ward from the viewpoint of the ward physicians and nurses. A questionnaire survey was distributed to 27 facilities with kaifukuki rehabilitation wards. The questionnaire examined which duties the physicians and nurses expected from pharmacists while on the ward (4 areas, 10 items), as well as the time required for pharmacists to carry out those duties. Multivariate analysis was used to investigate which types of work took the most time for pharmacists on kaifukuki rehabilitation wards. Responses were received from 43 physicians and 184 nurses who worked on the kaifukuki rehabilitation wards of 19 facilities. The results revealed that the essential duties performed by pharmacists were the management of medical supplies, instruction on the use of self-medicating drugs at the time of introduction, and monitoring drug side effects. Furthermore, some duties, such as the distribution of medicines and changing or suggesting new drugs, required pharmacists to spend extended time on the ward. The responses indicated that physicians and nurses recognized the necessity for pharmacists to perform ward duties along with their routine work. This study shows that physicians and nurses working in kaifukuki rehabilitation wards demand proactive participation from pharmacists in appropriate medical therapy, such as instruction in the administration of medications and assessment at the time of prescription changes. PMID:26234355

  15. Job enrichment, work motivation, and job satisfaction in hospital wards: testing the job characteristics model.

    PubMed

    Kivimäki, M; Voutilainen, P; Koskinen, P

    1995-03-01

    This study investigated work motivation and job satisfaction at hospital wards with high and low levels of job enrichment. Primary nursing was assumed to represent a highly enriched job, whereas functional nursing represented a job with a low level of enrichment. Five surgical wards were divided into these two categories based on the structured interviews with head nurses. Work motivation and job satisfaction among ward personnel were assessed by a questionnaire. The ward personnel occupying highly enriched jobs reported significantly higher work motivation and satisfaction with the management than the personnel occupying jobs with a low level of enrichment. PMID:7735655

  16. Using league tables to reduce missed dose medication errors on mental healthcare of older people wards

    PubMed Central

    Cottney, Alan

    2015-01-01

    The unintentional omission of medication is one of the most commonly-reported administration errors on hospital wards throughout the world. The omission of a dose of medication can severely harm the patient affected, but to date there is limited evidence about cost-effective means for reducing the incidence of such errors. The current report describes a quality improvement project, conducted on the mental healthcare of older people (MHCOP) wards in East London NHS Foundation Trust, which led to a greater than 90% reduction in the rate of unintentionally omitted doses of medication. The project involved the publication of a fortnightly league table which ranked each of the wards by how many doses they had missed, with the ward missing the fewest doses receiving a prize. PDSA cycles were used to refine the concept, with the final incarnation of the fortnightly league table also incorporating the publication of a poster for each ward which showed how many weeks it had been since the ward missed a dose, and the ward's overall trend in missed doses. The project has resulted in the average missed dose rate on the MCHOP wards decreasing from 1.07% to 0.07%. In real terms, this represents a reduction from an estimated 2878 to 188 missed doses per year on the six MHCOP wards. By greatly reducing the risk of patients experiencing adverse drug events as a result of missed doses, this project has given rise to a potential cost-saving of around Ł34,000 per year across the wards studied. The use of league tables represents a simple, cost-effective means of tackling the problem of doses of medication being unintentionally omitted on hospital wards. PMID:26734424

  17. Psychiatric team's experience of working in psychiatric wards

    PubMed Central

    Fard, Victoria Omrani; Mehrabi, Tayebeh; Fanian, Nasrin

    2011-01-01

    BACKGROUND: Psychiatric team plays an important role in treating and taking care of psychiatric patients. Using this team's experience seems necessary for enhancing care services. The aim of this study was to assess psychiatric team's experience of working in different psychiatric groups. METHODS: This is a qualitative study with phenomenological approach. Samples were chosen using purposive sampling method. Samples included 10 personnel from psychiatric wards of 4 hospitals in Isfahan city in 2007. Data was gathered using deep interviews which were recorded on tapes. Data was analyzed using Colaizzi's seven steps method. RESULTS: Results from participants’ experiences were summarized in 3 main concepts: “communication”, “ability” and “conflict”; and 5 sub concepts: “cooperation”, “self acknowledgement”, “hope”, “qualification” and “multiple roles”. CONCLUSIONS: Results of this study could be used in future programming to enhance care services for psychiatric patients in hospitals. PMID:22039375

  18. Training in General Surgery Ward Call: A Resident-Student Buddy System

    PubMed Central

    Maurice, Andrew; Hann, Angus

    2015-01-01

    There is a paucity of literature regarding medical student experiences of after hours hospital ward call. It was observed at our institution that medical students had minimal experience in ward call, yet were required to undertake such shifts as interns after graduation. We implemented a buddy system in which a medical student shadowed a general surgery resident for a ward call shift. Final year medical students were recruited from the local university at a tertiary teaching hospital after institutional approval. Each student attended a 4 hour evening shift on a general surgery ward with a supervising resident. A survey detailing attitudes and expectations of ward call was completed before and after the experience. Nine students enrolled in the project. Familiarity of expectations of what is required of an intern on a ward call shift improved significantly after the experience (3.1/5 to 4.1/5, p = 0.002). After hours work experience was reported as useful both before and after the study (4.5/5 to 4.7/5, p = 0.47). Students and doctors involved unanimously felt the experience was worthwhile. After hours ward call experience is useful for a final year medical student. More studies are required to further define the role of after hours ward call experiences during medical training. PMID:26732229

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

    ERIC Educational Resources Information Center

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

    2013-01-01

    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,…

  20. Creating Readers: Vonda Ward--Broward County Library, Fort Lauderdale, FL

    ERIC Educational Resources Information Center

    Library Journal, 2004

    2004-01-01

    This article details the work of Vonda Ward--a middle-school teacher turned librarian. When Vonda Ward was a middle-school teacher, she could not get her students to share her excitement about history because they could not read its stories. That is when she realized how much subject mastery depended on the basics. Broward County Library's leaders…

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

    ERIC Educational Resources Information Center

    EMT Associates, Inc., Sacramento, CA.

    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


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

    ERIC Educational Resources Information Center

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

    2013-01-01

    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,


  3. Education for Ward Nurses Influences the Quality of Inpatient's Bowel Preparation for Colonoscopy.

    PubMed

    Lee, Yoo Jin; Kim, Eun Soo; Park, Kyung Sik; Cho, Kwang Bum; Jang, Byoung Kuk; Chung, Woo Jin; Hwang, Jae Seok

    2015-08-01

    Although adequate bowel preparation is a prerequisite for colonoscopy, preparation among inpatients is often suboptimal. This study aimed to evaluate the impact of ward nurse education on the quality of bowel preparation of inpatients.A prospective, double-blinded, non-randomized, controlled study was performed. Expert endoscopists provided enhanced education to nurses who belonged to an "educated ward" followed by training that was repeated every week for 1 month. The primary outcome was the quality of the bowel preparation, which was based on the Ottawa Bowel Preparation Scale (OBPS). Patient compliance and their subjective feelings and the factors affecting inadequate bowel preparation were also analyzed.One hundred three inpatients in the educated ward and 102 patients in the control ward were enrolled. Baseline data were comparable between the 2 wards. The mean values of the total OBPS scores were 4.42?±?2.23 and 6.15?±?2.38 in the educated and control wards, respectively (P?ward was significantly lower than that in the control ward (31.1% vs 58.8%, P?ward was superior to that in the control ward (P<0.001). Control patients were more likely to be anxious before colonoscopy (P?ward showed higher level of satisfaction (P?=?0.001) and better sleep quality (P?ward nurse education (OR 2.365, P?=?0.025), constipation (OR 6.517, P?Ward nurse education effectively improved the quality of bowel preparation, and relevant colonoscopic outcomes among inpatients. Additional efforts are needed to control constipation and to encourage additional water ingestion in inpatients for better bowel preparation. PMID:26313794

  4. The acoustic environment of intensive care wards based on long period nocturnal measurements.

    PubMed

    Xie, Hui; Kang, Jian

    2012-01-01

    The patients in the Intensive Care Units are often exposed to excessive levels of noise and activities. They can suffer from sleep disturbance, especially at night, but they are often too ill to cope with the poor environment. This article investigates the acoustic environment of typical intensive care wards in the UK, based on long period nocturnal measurements, and examines the differences between singlebed and multibed wards, using statistical analysis. It has been shown that the acoustic environment differs significantly every night. There are also significant differences between the noise levels in the singlebed and multibed wards, where acoustic ceilings are present. Despite the similar background noises in both ward types, more intrusive noises tend to originate from the multibed wards, while more extreme sounds are likely to occur in the single wards. The sound levels in the measured wards for each night are in excess of the World Health Organization's (WHO) guide levels by at least 20 dBA, dominantly at the middle frequencies. Although the sound level at night varies less than that in the daytime, the nocturnal acoustic environment is not dependant on any specific time, thus neither the noisiest nor quietest period can be determined. It is expected that the statistical analysis of the collected data will provide essential information for the development of relevant guidelines and noise reduction strategies. PMID:23117538

  5. Holomorphic Vector Bundles Corresponding to some Soliton Solutions of the Ward Equation

    NASA Astrophysics Data System (ADS)

    Zhu, Xiujuan

    2015-12-01

    Holomorphic vector bundles corresponding to the static soliton solution of the Ward equation were explicitly presented by Ward in terms of a meromorphic framing. Bundles (for simplicity, "bundle" is to be taken throughout to mean "holomorphic vector bundle") corresponding to all Ward k-soliton solutions whose extended solutions have only simple poles, and some Ward 2-soliton solutions whose extended solutions have only a second-order pole, were explicitly described by us in a previous paper. In this paper, we go on to present some bundles corresponding to soliton-antisoliton solutions of the Ward equation, and Ward 3-soliton solutions whose extended solutions have a simple pole and a double pole. To give some more interpretation of the bundles, we study the second Chern number of the corresponded bundles and find that it can be obtained directly from the patching matrices. We also point out some information about bundles corresponding to Ward soliton solutions whose extended solutions have general pole data at the end of the paper.

  6. Ward tension and staff leadership in a therapeutic community for hospitalized adolescents.

    PubMed

    Levinson, D F; Crabtree, L H

    1979-08-01

    Mental health workers on inpatient units spend a great deal of time trying to cope with interpersonal tensions that disrupt ward life. We have focused our attention on two aspects of this problem. The first is clarifying the nature of the social processes that underlie periods of increased tension and conflict on wards. The second is clarifying the kinds of staff leadership required to manage these tensions. We are sure that those who have worked on interactive treatment wards will recognize this situation: for a period of weeks or more there is an uneasy tension; patient cliques form and disruption occurs between cliques and with the staff. Often there is a climax of disruptive behavior, such as a day or weekend when a large number of patients break ward rules. Trouble seems to be contagious. Throughout the period staff members disagree about how to manage the patients and the disruption, and usually this disagreement is tinged with old philosophical or personal differences. No one feels very confident about taking leadership initiatives, and the formal leaders are blamed for various failures and lacks. Eventually, often after a climactic disturbance is resolved, ward life returns to "normal" and people feel much better about living and working on the ward. In this paper we review previous work on this kind of ward process and discuss some of the problems involved in conceptualizing it. We report on two period of ward observation that illustrate the sequence from low to high tension and back to relative calm. We then discuss our ideas about the kinds of staff leadership needed to manage different phases of this sequence and the problems of developing and integrating multiple ward leadership roles. PMID:461595

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

    PubMed Central

    2010-01-01

    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 out a national clinical survey based on a 10-year (1997-2006) sample of people in England and Wales who had died by suicide. Detailed data were collected on those who had been in contact with mental health services in the year before death. Results There were 1,851 cases of suicide by current psychiatric in-patients, 14% of all patient suicides. 1,292 (70%) occurred off the ward. Four hundred and sixty-nine of these patients died after absconding from the ward, representing 25% of all in-patient suicides and 38% of those that occurred off the ward. Absconding suicides were characterised by being young, unemployed and homeless compared to those who were off the ward with staff agreement. Schizophrenia was the most common diagnosis, and rates of previous violence and substance misuse were high. Absconders were proportionally more likely than in-patients on agreed leave to have been legally detained for treatment, non-compliant with medication, and to have died in the first week of admission. Whilst absconding patients were significantly more likely to have been under a high level of observation, clinicians reported more problems in observation due to either the ward design or other patients on the ward. Conclusion Measures that may prevent absconding and subsequent suicide amongst in-patients might include tighter control of ward exits, and more intensive observation of patients, particularly in the early days of admission. Improving the ward environment to provide a supportive and less intimidating experience may contribute to reduced risk. PMID:20128891

  8. Productive Ward initiative promotes better communication between mental health teams and ensures timely discharge for patients.

    PubMed

    Lennard, C

    2014-02-01

    The Productive Ward is an initiative whereby nursing staff are empowered to bring about changes in the workplace to streamline systems and release time to care for patients. It is an evidence-based approach, which brings about improved clinical and safety outcomes. This paper discusses how three of the Productive Ward Modules - Ward Round, Admissions and Planned Discharge, and Patient Status At a Glance - have meshed to promote better communication and working between inpatient nursing and medical teams, Home Treatment Team and Community Mental Health Team, and to endeavour to ensure timely discharge for patients. PMID:23157208

  9. Education for Ward Nurses Influences the Quality of Inpatient's Bowel Preparation for Colonoscopy

    PubMed Central

    Lee, Yoo Jin; Kim, Eun Soo; Park, Kyung Sik; Cho, Kwang Bum; Jang, Byoung Kuk; Chung, Woo Jin; Hwang, Jae Seok

    2015-01-01

    Abstract Although adequate bowel preparation is a prerequisite for colonoscopy, preparation among inpatients is often suboptimal. This study aimed to evaluate the impact of ward nurse education on the quality of bowel preparation of inpatients. A prospective, double-blinded, non-randomized, controlled study was performed. Expert endoscopists provided enhanced education to nurses who belonged to an “educated ward” followed by training that was repeated every week for 1 month. The primary outcome was the quality of the bowel preparation, which was based on the Ottawa Bowel Preparation Scale (OBPS). Patient compliance and their subjective feelings and the factors affecting inadequate bowel preparation were also analyzed. One hundred three inpatients in the educated ward and 102 patients in the control ward were enrolled. Baseline data were comparable between the 2 wards. The mean values of the total OBPS scores were 4.42 ± 2.23 and 6.15 ± 2.38 in the educated and control wards, respectively (P < 0.001). The rate of poor preparation (OBPS ≄ 6) in the educated ward was significantly lower than that in the control ward (31.1% vs 58.8%, P < 0.001). Compliance with preparation and diet instructions in the educated ward was superior to that in the control ward (P<0.001). Control patients were more likely to be anxious before colonoscopy (P < 0.001), whereas patients in the educated ward showed higher level of satisfaction (P = 0.001) and better sleep quality (P < 0.001). A lack of ward nurse education (OR 2.365, P = 0.025), constipation (OR 6.517, P < 0.001), and insufficient water ingestion (OR 2.044, P = 0.042) were independently associated with inadequate bowel preparation among inpatients. Ward nurse education effectively improved the quality of bowel preparation, and relevant colonoscopic outcomes among inpatients. Additional efforts are needed to control constipation and to encourage additional water ingestion in inpatients for better bowel preparation. PMID:26313794

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

    PubMed

    Alexander, J

    2006-10-01

    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

  11. Ward identities and gauge independence in general chiral gauge theories

    NASA Astrophysics Data System (ADS)

    Anselmi, Damiano

    2015-07-01

    Using the Batalin-Vilkovisky formalism, we study the Ward identities and the equations of gauge dependence in potentially anomalous general gauge theories, renormalizable or not. A crucial new term, absent in manifestly nonanomalous theories, is responsible for interesting effects. We prove that gauge invariance always implies gauge independence, which in turn ensures perturbative unitarity. Precisely, we consider potentially anomalous theories that are actually free of gauge anomalies thanks to the Adler-Bardeen theorem. We show that when we make a canonical transformation on the tree-level action, it is always possible to re-renormalize the divergences and re-fine-tune the finite local counterterms, so that the renormalized Γ functional of the transformed theory is also free of gauge anomalies, and is related to the renormalized Γ functional of the starting theory by a canonical transformation. An unexpected consequence of our results is that the beta functions of the couplings may depend on the gauge-fixing parameters, although the physical quantities remain gauge independent. We discuss nontrivial checks of high-order calculations based on gauge independence and determine how powerful they are.

  12. Sexual assault on wards: Staff actions and reactions.

    PubMed

    Cole, Mary; Baldwin, David; Thomas, Peter

    2003-01-01

    INTRODUCTION The aim of the study was to look at staff practices when patients had been sexually assaulted, and to look at their emotions around an event that normally causes outrage amongst those who deal with it. METHODS A 16-item, five-point questionnaire was supplied to all medical and nursing staff working on five wards of a psychiatric inpatient unit. Demographic details of respondents and their work experience of sexual assault (defined as all forms of sexual touching without consent, including rape) were also noted. There were four additional questions inviting a free text response. Two questions were posed about inpatient sexuality in general, and two about sexual assault. RESULTS Staff generally agreed about what action should be taken in cases of sexual assault and, except for anger, experienced low levels of negative emotions when dealing with cases amongst patients. However, weariness was a key emotion, correlating with post held, levels of anger, depression, and likelihood of helping the patients inform the police. Consultants were the most weary professional group. Free text written responses revealed widespread concern amongst staff that women inpatients forming sexual relationships are vulnerable to exploitation and abuse, and that staff will be blamed in the event of sexual assault. CONCLUSION Policy documents should specifically address issues around staff intervention in inpatients' sexual lives. PMID:24930410

  13. Should we use automated external defibrillators in hospital wards?

    PubMed

    De Regge, M; Monsieurs, K G; Vandewoude, K; Calle, P A

    2012-01-01

    Automated external defibrillators (AEDs) have shown to improve survival after cardiopulmonary arrest (CPA) in many, but not all clinical settings. A recent study reported that the use of AEDs in-hospital did not improve survival. The current retrospective study reports the results of an in-hospital AED programme in a university hospital, and focuses on the quality of AED use. At Ghent University Hospital 30 AEDs were placed in non-monitored hospital wards and outpatient clinics treating patients with non-cardiac problems. Nurses were trained to use these devices. From November 2006 until March 2011, the AEDs were used in 23 of 39 CPA cases, in only one patient the presenting heart rhythm was ventricular fibrillation and this patient survived. Pulseless electrical activity was present in 14 patients (four survived) and asystole in eight patients (one survived). AEDs were attached to eight patients without CPA, and in 16 patients with CPA AED was not used. The quality of AED use was often suboptimal as illustrated by external artifacts during the first rhythm analysis by the AED in 30% (7/23) and more than 20 seconds delay before restart of chest compressions after the AED rhythm analysis in 50% (9/18). The literature data, supported by our results, indicate that in-hospital AED programmes are unlikely to improve survival after CPA. Moreover, their use is often suboptimal. Therefore, if AEDs are introduced in a hospital, initial training, frequent retraining and close follow-up are essential. PMID:23019797

  14. Profiling psychotropic discharge medication from a children's psychiatric ward.

    PubMed

    Akram, Gazala

    2015-10-01

    Background Community prescribing of medication to treat psychiatric illness in children is increasing. However, details about medication prescribed at discharge from psychiatric inpatient services for children are scarce. Objectives Characterise the nature of psychotropic medication prescribed on discharge from a children's psychiatric ward over a 15-year period. Method Retrospective analysis of discharge summary letters of all discharges occurring between Jan 1997 to Dec 2012. Results 234 children (152 males and 82 females) were discharged with 117 (50%) prescribed psychotropic medication at discharge. 133 medicines were prescribed (stimulants n = 49, antipsychotics n = 31, antidepressants n = 22, mood stabilisers n = 1, other ADHD medication n = 11, melatonin n = 10, benzodiazepines n = 7, other n = 2). Risperidone was the most popular antipsychotic at a mean daily dose of 1 mg (range 0.25-4 mg). Fifty per cent were given an unlicensed medicine or a licensed drug was used in an unlicensed manner, of which risperidone was the most common (n = 14). Sleep disturbance and tics were most often treated using unlicensed/off label medication (n = 10). Conclusion Psychotropic medication is routinely used in inpatient children's services, with the majority of use confined to stimulants and atypical antipsychotics. Much of the antipsychotic use is for unlicensed indications or at unlicensed doses. PMID:25893488

  15. Suicide ideation among oncologic patients in a Spanish ward.

    PubMed

    Diaz-Frutos, D; Baca-Garcia, E; Mahillo-Fernandez, I; Garcia-Foncillas, J; Lopez-Castroman, J

    2016-04-01

    Oncologic patients are exposed to a higher risk of suicidal behaviors than the general population. In this study, we aim to examine the severity of suicidal ideation in a sample of oncologic patients considering different psychological and clinical features. We interviewed 202 inpatients receiving curative or palliative treatment in a medical oncology ward of a Spanish hospital during the period 2012-2014. A complete assessment of psychosocial factors, cancer diagnoses (lung, colon rectum, and genitourinary system), and suicidal behaviors were made during admission, including validated questionnaires about depression, anxiety, personality, quality of life, body image, life threatening events, hopelessness, and suicidal ideation. The characteristics of inpatients with high and low suicidal ideation were retrospectively compared. A logistic regression model was constructed to examine the relationship between the significant factors retained after the univariate analyses. One of every four patients (n = 51; 25.24%) presented high scores of suicidal ideation. Logistic regression analyses retained depression (OR = 3.55; 95% CI = 1.25-11.68; p = .016), hopelessness (OR = 8.78; 95% CI = 3.44-25.88; p ? .001), personality (OR = .44; 95% CI = .2-.96; p = .038), and advanced age (OR = 2.60; 95% CI = 1.18-5.98; p = .016) as the main risk factors for high suicidal ideation. Suicidal ideation was frequent among oncologic patients. These patients should receive closer monitoring, especially, when old, retired, or severely depressed. PMID:26109239

  16. Observations of mealtimes in hospital aged care rehabilitation wards.

    PubMed

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

    2013-08-01

    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

  17. Antimicrobial stewardship: Improving antibiotic prescribing practice in a respiratory ward.

    PubMed

    Yeo, Jing Ming

    2016-01-01

    International efforts have mandated guidelines on antibiotic use and prescribing, therefore the focus is now on encouraging positive behavioral changes in antibiotic prescribing practice. Documentation of indication and intended duration of antibiotic use in drug charts is an evidence-based method of reducing inappropriate antibiotic prescribing. It is also a standard detailed in our local antimicrobial guidelines. We collected baseline data on compliance with documentation of indication and duration in drug charts in a respiratory ward which revealed compliance rates of 24% and 39% respectively. We introduced interventions to improve accessibility to the guideline and to increase awareness by distributing antibiotic guardian pocket cards with a three-point checklist and strategically-placed mini-posters. We also aim to increase team motivation by obtaining their feedback in multidisciplinary team meetings and by introducing certificates for their involvement in the quality improvement process. The results of the second cycle post-intervention showed an increase in compliance rates for documentation of indication and duration of 97% and 69% respectively. After a further awareness and discussion session at the multidisciplinary team meeting with the local antimicrobial management team audit nurses, a third cycle showed compliance rates of 94% and 71% for indication and duration respectively. This project has highlighted the importance of improving accessibility and of encouraging interventions that would bring about a change in personal value and subsequently in behavior and individual practice. PMID:26893898

  18. Food work and feeding assistance on hospital wards.

    PubMed

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

    2013-05-01

    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

  19. Antimicrobial stewardship: Improving antibiotic prescribing practice in a respiratory ward

    PubMed Central

    Yeo, Jing Ming

    2016-01-01

    International efforts have mandated guidelines on antibiotic use and prescribing, therefore the focus is now on encouraging positive behavioral changes in antibiotic prescribing practice. Documentation of indication and intended duration of antibiotic use in drug charts is an evidence-based method of reducing inappropriate antibiotic prescribing. It is also a standard detailed in our local antimicrobial guidelines. We collected baseline data on compliance with documentation of indication and duration in drug charts in a respiratory ward which revealed compliance rates of 24% and 39% respectively. We introduced interventions to improve accessibility to the guideline and to increase awareness by distributing antibiotic guardian pocket cards with a three-point checklist and strategically-placed mini-posters. We also aim to increase team motivation by obtaining their feedback in multidisciplinary team meetings and by introducing certificates for their involvement in the quality improvement process. The results of the second cycle post-intervention showed an increase in compliance rates for documentation of indication and duration of 97% and 69% respectively. After a further awareness and discussion session at the multidisciplinary team meeting with the local antimicrobial management team audit nurses, a third cycle showed compliance rates of 94% and 71% for indication and duration respectively. This project has highlighted the importance of improving accessibility and of encouraging interventions that would bring about a change in personal value and subsequently in behavior and individual practice. PMID:26893898

  20. View of compartment C110, senior officers ward room from port ...

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

    View of compartment C-110, senior officers ward room from port to starboard, showing wooden furnishings, deck stanchions and the olympia's piano. (084) - USS Olympia, Penn's Landing, 211 South Columbus Boulevard, Philadelphia, Philadelphia County, PA

  1. The evaluation of a hostel ward. A controlled study using modified cost-benefit analysis.

    PubMed

    Hyde, C; Bridges, K; Goldberg, D; Lowson, K; Sterling, C; Faragher, B

    1987-12-01

    A controlled modified cost-benefit evaluation of a hostel ward caring for new long-stay patients is described and results are presented for the first two years. In some respects the residents of the hostel ward had fewer psychotic impairments than those remaining on the wards of the district general hospital, mainly because the latter seem to continue to acquire such defects, while the former have remained relatively unchanged. The hostel ward residents also develop superior domestic skills, use more facilities in the community, and are more likely to be engaged in constructive activities than controls. These advantages were not purchased at a price, since the cost of providing this form of care for these patients has cost less than care provided by the district general hospital. PMID:3139122

  2. The Mind-Body Connection - How to Fight Stress and Ward Off Illness

    MedlinePLUS

    ... Past Issues The Mind-Body Connection How to Fight Stress and Ward Off Illness Past Issues / Winter ... sick. Hormones weaken the immune system's ability to fight disease." Dangers of Chronic Stress Unhealthy levels of ...

  3. Anomalies of BRS and anti-BRS ward-identities in N=1 supersymmetric theory

    SciTech Connect

    Lhallabi, T. )

    1988-01-01

    The requirement of BRS and anti-BRS symmetries in N = 1 supersymmetric theory leads to Ward-identities independent of the gauge parameter. The cohomology conditions are immediately satisfied. This yields a supersymmetric formula of the chiral anomaly.

  4. [METHOTREXATE - GENOTOXIC AND TERATOGENIC FOR MEDICAL STAFF OF ONCOLOGY WARDS?].

    PubMed

    Kupczewska-Dobecka, Ma?gorzata

    2015-01-01

    Methotrexate (MTX) is one of the most widely used cytostatic drugs belonging to the folic acid antagonists. It is a substance non-classified as a carcinogen in the European Union and by the International Agency for Research on Cancer (IARC) as there is no evidence of its carcinogenicity to humans and animals. Nevertheless, MTX has been placed on the list of dangerous drugs used in chemotherapy, mainly due to geniotoxic and teratogenic effects, causing developmental toxicity and reproductive toxicity. Methotrexate was determined in the hospital ward air during the preparation of a medicament at a level of 0.3 mg/m3, as well as on protective gloves and preparatory room surfaces. In most research projects MTX was identified in the urine of health care workers, pharmacists and nursing staff. The highest cumulative concentration of MTX in 112 urine samples was 1416 mg in workers preparing infusions for patients. Studies carried out in pharmacies revealed the presence of MTX in 60% of tests, and the maximum concentration of 15 ng/cm2 surface of the tray to count tablets. Legal exposure limit values for MTX in the work environment have not yet been established. Occupational exposure limits have been established by some manufacturers at the level of 0.0003-0.0025 mg/m3. There is an urgent need to establish normative values. It should also be emphasized that MTX is absorbed through the skin, which may significantly-increase the exposure and measuring its concentration in the work environment may not be sufficient to estimate the actual exposure. PMID:26294316

  5. Post-acute surgical ward round proforma improves documentation

    PubMed Central

    Al-Mahrouqi, Haitham; Oumer, Ramadan; Tapper, Richard; Roberts, Ross

    2013-01-01

    In health care, record keeping of doctor-patient encounters is vital for quality patient care and medico-legal reasons. We audited the documentation of post-acute consultant ward round (PACWR) in our department before and six months after an introduction of a proforma (standard form). The clinical notes of all patients admitted acutely under General Surgery over a period of one week before and one week after the introduction of a proforma were reviewed to note whether time and date, signature, impression and dietary plan were documented after PACWR. The nurses were also surveyed on the day of the PACWR for their certainty regarding the dietary plan of their patients and whether they had to contact the surgical team for clarification. There were 108 and 103 patients eligible for the first and second study periods respectively. After the introduction of the proforma, there was a statistically significant improvement in the documentation of time and date (37% vs. 72%, p-value < 0.01) and impression (40% vs. 61%, p-value < 0.01). Improvement in the documentation of the dietary plan reached statistical significant only when the analysis was restricted to the cases where a proforma was filled out (78 out of 103 patients). Introduction of the proforma had no statistically significant impact on the nurses’ certainty regarding their patients’ dietary plan and the number of times they had to contact the surgical teams. In conclusion, PACWR proforma improves overall documentation. This will help in avoiding adverse effects on patient care and medico-legal ramifications.

  6. Ophthalmology hospital wards contamination to pathogenic free living Amoebae in Iran.

    PubMed

    Lasjerdi, Zohreh; Niyyati, Maryam; Lorenzo-Morales, Jacob; Haghighi, Ali; Taghipour, Niloofar

    2015-09-01

    The present study was conducted to determine the occurrence of potentially pathogenic free-living amoeba in ophthalmology wards in reference hospitals in Iran. Since an increasing number of Acanthamoeba Keratitis cases after eye surgery and eye trauma have been recently observed in this country, it could be possible that the disinfection procedures undertaken in the clinical setting may not have a good hygiene and disinfection procedures, hence the aim of this study. Therefore, 42 dust and biofilm samples were collected from different areas of ophthalmology wards and checked for the presence of FLA using morphological criteria, PCR based analysis and DNA sequencing. Of the 42 samples from dust and biofilm sources, 18(42.86%) isolates were found to contain FLA and 12(92.3%) isolates belonged to Acanthamoeba T4 genotype. Isolation of the pathogenic genotype T4 from medical instruments, including slit lamp in corneal wards, may be a threat for patients undergoing eye surgery in these wards. Other FLA isolated in this study included Acanthamoeba genotype T5, Vahlkampfia sp, Naegleria australiensis, Vermamoeba vermiformis and Echinamoeba exudans. To our knowledge, this is the first report of the presence of potentially pathogenic FLA in ophthalmology wards in Iran. Improved disinfection methods and monitoring of hospitals ward are thus necessary in this area in order to minimize the risk of infection in patients. PMID:26204177

  7. Electronic patient record use during ward rounds: a qualitative study of interaction between medical staff

    PubMed Central

    Morrison, Cecily; Jones, Matthew; Blackwell, Alan; Vuylsteke, Alain

    2008-01-01

    Introduction Electronic patient records are becoming more common in critical care. As their design and implementation are optimized for single users rather than for groups, we aimed to understand the differences in interaction between members of a multidisciplinary team during ward rounds using an electronic, as opposed to paper, patient medical record. Methods A qualitative study of morning ward rounds of an intensive care unit that triangulates data from video-based interaction analysis, observation, and interviews. Results Our analysis demonstrates several difficulties the ward round team faced when interacting with each other using the electronic record compared with the paper one. The physical setup of the technology may impede the consultant's ability to lead the ward round and may prevent other clinical staff from contributing to discussions. Conclusions We discuss technical and social solutions for minimizing the impact of introducing an electronic patient record, emphasizing the need to balance both. We note that awareness of the effects of technology can enable ward-round teams to adapt their formations and information sources to facilitate multidisciplinary communication during the ward round. PMID:19025662

  8. [Airborne Fungal Aerosol Concentration and Distribution Characteristics in Air- Conditioned Wards].

    PubMed

    Zhang, Hua-ling; Feng, He-hua; Fang, Zi-liang; Wang, Ben-dong; Li, Dan

    2015-04-01

    The effects of airborne fungus on human health in the hospital environment are related to not only their genera and concentrations, but also their particle sizes and distribution characteristics. Moreover, the mechanisms of aerosols with different particle sizes on human health are different. Fungal samples were obtained in medicine wards of Chongqing using a six-stage sampler. The airborne fungal concentrations, genera and size distributions of all the sampling wards were investigated and identified in detail. Results showed that airborne fungal concentrations were not correlated to the diseases or personnel density, but were related to seasons, temperature, and relative humidity. The size distribution rule had roughly the same for testing wards in winter and summer. The size distributions were not related with diseases and seasons, the percentage of airborne fungal concentrations increased gradually from stage I to stage III, and then decreased dramatically from stage V to stage VI, in general, the size of airborne fungi was a normal distribution. There was no markedly difference for median diameter of airborne fungi which was less 3.19 ÎŒm in these wards. There were similar dominant genera in all wards. They were Aspergillus spp, Penicillium spp and Alternaria spp. Therefore, attention should be paid to improve the filtration efficiency of particle size of 1.1-4.7 ÎŒm for air conditioning system of wards. It also should be targeted to choose appropriate antibacterial methods and equipment for daily hygiene and air conditioning system operation management. PMID:26164895

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

    PubMed

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

    2014-04-01

    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

  10. The survival time of chocolates on hospital wards: covert observational study

    PubMed Central

    2013-01-01

    Objective To quantify the consumption of chocolates in a hospital ward environment. Design Multicentre, prospective, covert observational study. Setting Four wards at three hospitals (where the authors worked) within the United Kingdom. Participants Boxes of Quality Street (Nestlé) and Roses (Cadbury) on the ward and anyone eating these chocolates. Intervention Observers covertly placed two 350 g boxes of Quality Street and Roses chocolates on each ward (eight boxes were used in the study containing a total of 258 individual chocolates). These boxes were kept under continuous covert surveillance, with the time recorded when each chocolate was eaten. Main outcome measure Median survival time of a chocolate. Results 191 out of 258 (74%) chocolates were observed being eaten. The mean total observation period was 254 minutes (95% confidence interval 179 to 329). The median survival time of a chocolate was 51 minutes (39 to 63). The model of chocolate consumption was non-linear, with an initial rapid rate of consumption that slowed with time. An exponential decay model best fitted these findings (model R2=0.844, P<0.001), with a survival half life (time taken for 50% of the chocolates to be eaten) of 99 minutes. The mean time taken to open a box of chocolates from first appearance on the ward was 12 minutes (95% confidence interval 0 to 24). Quality Street chocolates survived longer than Roses chocolates (hazard ratio for survival of Roses v Quality Street 0.70, 95% confidence interval 0.53 to 0.93, P=0.014). The highest percentages of chocolates were consumed by healthcare assistants (28%) and nurses (28%), followed by doctors (15%). Conclusions From our observational study, chocolate survival in a hospital ward was relatively short, and was modelled well by an exponential decay model. Roses chocolates were preferentially consumed to Quality Street chocolates in a ward setting. Chocolates were consumed primarily by healthcare assistants and nurses, followed by doctors. Further practical studies are needed. PMID:24333986

  11. Learning from positively deviant wards to improve patient safety: an observational study protocol

    PubMed Central

    Baxter, Ruth; Taylor, Natalie; Kellar, Ian; Lawton, Rebecca

    2015-01-01

    Introduction Positive deviance is an asset-based approach to improvement which has recently been adopted to improve quality and safety within healthcare. The approach assumes that solutions to problems already exist within communities. Certain groups or individuals identify these solutions and succeed despite having the same resources as others. Within healthcare, positive deviance has previously been applied at individual or organisational levels to improve specific clinical outcomes or processes of care. This study explores whether the positive deviance approach can be applied to multidisciplinary ward teams to address the broad issue of patient safety among elderly patients. Methods and analysis Preliminary work analysed National Health Service (NHS) Safety Thermometer data from 34 elderly medical wards to identify 5 ‘positively deviant’ and 5 matched ‘comparison’ wards. Researchers are blinded to ward status. This protocol describes a multimethod, observational study which will (1) assess the concurrent validity of identifying positively deviant elderly medical wards using NHS Safety Thermometer data and (2) generate hypotheses about how positively deviant wards succeed. Patient and staff perceptions of safety will be assessed on each ward using validated surveys. Correlation and ranking analyses will explore whether this survey data aligns with the routinely collected NHS Safety Thermometer data. Staff focus groups and researcher fieldwork diaries will be completed and qualitative thematic content analysis will be used to generate hypotheses about the strategies, behaviours, team cultures and dynamics that facilitate the delivery of safe patient care. The acceptability and sustainability of strategies identified will also be explored. Ethics and dissemination The South East Scotland Research Ethics Committee 01 approved this study (reference: 14/SS/1085) and NHS Permissions were granted from all trusts. Findings will be published in peer-reviewed, scientific journals, and presented at academic conferences. Trial registration number This study is registered on the UK Clinical Research Network Study Portfolio (reference number—18050). PMID:26656985

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

    PubMed

    Bonner, Gwen; McLaughlin, Sue

    2014-05-01

    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

  13. A problem of hospital hygiene: the presence of aspergilli in hospital wards with different air-conditioning features.

    PubMed

    Perdelli, Fernanda; Sartini, Marina; Spagnolo, Anna Maria; Dallera, Maurizio; Lombardi, Roberto; Cristina, Maria Luisa

    2006-06-01

    A total of 1,030 microbiological samples were taken in 3 hospital wards with different air-conditioning features: no conditioning system (ward A), a conditioning system equipped with minimum efficiency reporting value (MERV) filters (ward B), and a conditioning system thoroughly maintained and equipped with high-efficiency particulate air (HEPA) filters (absolute) (ward C). The air in each ward was sampled, and the bacterial and fungal concentrations were determined by active and passive methods. The concentration of fungi on surfaces was also determined. Active sampling showed positive samples in wards A and B only, with average values of 0.50 colony-forming units (CFU)/m(3) (95% CI, 0.30 to 0.70) in A and 0.16 CFU/m(3) (95% CI, 0.13 to 0.20) in B. Passive sampling was positive only in ward A (mean, 0.14 CFU/cm(2)/h; 95% CI, 0.13 to 0.15). Aspergillus was found in 27% and 22% of sampled surfaces in wards A and B, respectively, but in no samples from ward C. The most commonly found species was A. fumigatus (76% of cases in A and 34% of cases in B). The results show that the use of air-conditioning systems markedly reduces the concentration of aspergilli in the environment. Proper maintenance of these systems is clearly fundamental if their efficacy is to be ensured. PMID:16765203

  14. Implementation and Evaluation of a Ward-Based eLearning Program for Trauma Patient Management.

    PubMed

    Curtis, Kate; Wiseman, Taneal; Kennedy, Belinda; Kourouche, Sarah; Goldsmith, Helen

    2016-01-01

    The majority of trauma nursing education is focused on the emergency phases of care. We describe the development and evaluation of a trauma eLearning module for the ward environment. The module was developed using adult learning principles and implemented in 2 surgical wards. There were 3 phases of evaluation: (1) self-efficacy of nurses; (2) relevance and usability of the module and; (3) application of knowledge learnt. The majority indicated they had applied new knowledge, particularly when performing a physical assessment (85.7%), communicating (91.4%), and identifying risk of serious illness (90.4%). Self-efficacy relating to confidence in caring for patients, communication, and escalating clinical deterioration improved (p = .023). An eLearning trauma patient assessment module for ward nursing staff improves nursing knowledge and self-efficacy. PMID:26745537

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

    PubMed

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

    2010-01-01

    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

  16. The ethics of space, design and color in an oncology ward.

    PubMed

    Andritsch, Elisabeth; Stöger, Herbert; Bauernhofer, Thomas; Andritsch, Hans; Kasparek, Anne-Katrin; Schaberl-Moser, Renate; Ploner, Ferdinand; Samonigg, Hellmut

    2013-06-01

    Change affects all areas of healthcare organizations and none more so than each aspect of the oncology ward, beginning with the patient's room. It is there that the issues faced by the major players in healing environments - administrator, caregiver, family member, and, most importantly, the patient - come sharply into focus. Hospitals are building new facilities or renovating old ones in order to adapt to new environmental demands of patient care and security. Driven by ethical and professional responsibility, the oncological team headed by Professor Hellmut Samonigg of Graz Medical University Graz pursued a vision of designing a model oncology ward unique in Europe. Friedensreich Hundertwasser, the world-famous artist, was the creative force behind the design. The oncology ward became a place of healing, permeated with a colorful sense of life and harmonious holistic care. The successful outcome was confirmed by the extraordinarily positive feedback by patients, families, and healthcare staff. PMID:22883931

  17. First-class health: amenity wards, health insurance, and normalizing health care inequalities in Tanzania.

    PubMed

    Ellison, James

    2014-06-01

    In 2008, a government hospital in southwest Tanzania added a "first-class ward," which, unlike existing inpatient wards defined by sex, age, and ailment, would treat patients according to their wealth. A generation ago, Tanzanians viewed health care as a right of citizenship. In the 1980s and 1990s, structural adjustment programs and user fees reduced people's access to biomedical attention. Tanzania currently promotes "amenity" wards and health insurance to increase health care availability, generate revenue from patients and potential patients, and better integrate for-profit care. In this article, I examine people's discussions of these changes, drawing on ethnographic fieldwork in the 2000s and 1990s. I argue that Tanzanians criticize unequal access to care and health insurance, although the systemic structuring of inequalities is becoming normalized. People transform the language of socialism to frame individualized market-based care as mutual interdependence and moral necessity, articulating a new biomedical citizenship. PMID:24753314

  18. Poverty and violence, frustration and inventiveness: hospital ward life in Bangladesh.

    PubMed

    Zaman, Shahaduz

    2004-11-01

    An ethnographic exploration was done in an orthopaedic ward of a government teaching hospital in Bangladesh to understand the nature of hospital culture in the context of Bangladeshi society at large. Life and work in the ward result in a culture that is simultaneously created by its inhabitants and the conditions in which they are situated. The study shows that biomedicine is a product of particular social conditions and that the hospital reflects features of its society. Behind the injuries and broken limbs in the ward are stories of violence, crime, and intolerance occurring in a society where masses of people fight over limited resources. In the ward people interact in an extremely hierarchical manner. The patients, who are mainly from poor economic backgrounds, remain at the bottom of the hierarchy. Doctors and other staff members are often professionally frustrated. Strikes related to hospital staff's various professional demands hamper the regular flow of work in the ward. Family members are engaged in nursing and provide various kinds of support to their hospitalized relatives. Patients give small bribes to ward boys and cleaners to obtain their day-to-day necessities. Patients joke with each other and mock senior doctors. Thus, they neutralize their powerlessness and drive away the monotony of their stay. Doctors develop 'indigenous' solutions to orthopaedic problems. Instead of using high-tech devices, they employ instruments made of bamboo, bricks, and razor blades. This study shows how medical practice takes shape in an understaffed, under-resourced and poorly financed hospital operating in a low-income country. PMID:15351470

  19. Experience based co-design reduces formal complaints on an acute mental health ward

    PubMed Central

    Springham, Neil; Robert, Glenn

    2015-01-01

    An acute mental health triage ward at Oxleas NHS Foundation Trust was attracting high levels of formal service user and family complaints. The Trust used experience based co-design to examine the issues and redesign procedures. This resulted in an immediate eradication of formal complaints for a period of 23 months. This paper describes two outcomes: firstly, the successful adaptations made to the experience based co-design methodology from its origins in physical care, in order to ensure it was safe and effective in an acute mental health setting; and, secondly, the changes made to the ward as a result of this quality improvement intervention. PMID:26734433

  20. The Romano-Ward syndrome--1964-2014: 50 years of progress.

    PubMed

    Hodkinson, E C; Hill, A P; Vandenberg, J I

    2014-04-01

    This year marks the 50th anniversary of publication in the then Journal of the Irish Medical Association of the seminal work by Irish paediatrician Professor Conor Ward entitled 'A new familial Cardiac Syndrome in Children'. The condition soon became known by the eponym Romano-Ward Syndrome and is now recognised as the congenital Long QT Syndrome. Here we review the major developments in the field over the past fifty years, with special mention of the important contributions made by Irish researches. PMID:24834591

  1. [The leadership style exercised by nurses in surgical wards focuses on situational leadership].

    PubMed

    GalvĂŁo, C M; Trevizan, M A; Sawada, N O; FĂĄvero, N

    1997-04-01

    The present study was oriented to the leadership theme focussing nurses inside surgical ward unities. As a theoretical reference, the authors used the Situational Leadership Model proposed by Hersey and Blanchard. This study aimed at analysing the correspondence between the opinions of nurses and auxiliary personnel about the leadership style exerted by nurses in the surgical ward unit regarding the six categories of the assistance activity that were studied. Authors noticed that nurses, from the two studied hospitals, adopted the directive leadership styles (E2/selling or E1/telling) with the auxiliary personnel. PMID:9370755

  2. Assessment of knowledge among patients of surgical wards regarding clinical symptoms and diagnostics of the most common malignant tumors

    PubMed Central

    Koz?owska, El?bieta

    2013-01-01

    Aim of the study The aim of this work was to evaluate the knowledge of symptoms and prophylaxis among hospitalized patients. Material and methods The research was carried in the Provincial Hospital in Bydgoszcz (i.e. general surgery, gynecology and obstetrics, urology, breast surgery and thoracic surgery). 250 hospitalized patients took part in the tests, as well as 50 healthy people. The scientific method used was a specially designed questionnaire. The Bioethics Committee of Collegium Medicum of Miko?aj Kopernik University in Bydgoszcz approved these tests. Results Patients from the Breast Diseases Ward had better knowledge about cancers than the control group. Symptoms of lung cancer were known to both groups to the same extent. Patients from the Clinical Ward of Thoracic Surgery were very knowledgeable about lung cancer, but they did not know anything about other malignant types of cancer. Patients from Gynecology and Obstetrics wards are better than the control group only at knowledge about symptoms and screening of cervix cancer. Patients from the Urology Ward have the best knowledge about screening of prostate cancer and colon cancer. Those hospitalized at the Surgery Ward do not know symptoms of colon cancer, but they have knowledge about its screening. Conclusions Patients from the Clinical Ward of Thoracic and Cancer Surgery and the Clinical Surgery Ward had the least knowledge about malignant tumors.Patients from Urology, Gynecology and Obstetrics wards have better knowledge about malignant tumors treated there. PMID:23788944

  3. Affirmative Action and Equal Employment Opportunity after Richmond and Wards Cove.

    ERIC Educational Resources Information Center

    Connerty, Paul L.

    1990-01-01

    Analyzes two personnel-related decisions--"City of Richmond v. J. A. Croson Co." and "Wards Cove Packing Co. v. Atonio"--rendered during the 1988 term of the Supreme Court. Examines the impact they are expected to have on two key personnel-centered equity programs, affirmative action and equal employment opportunity. (AF)

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

    ERIC Educational Resources Information Center

    Gosman, Minna L.; And Others

    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…

  5. Constructing and Evaluating a Validity Argument for the Final-Year Ward Simulation Exercise

    ERIC Educational Resources Information Center

    Till, Hettie; Ker, Jean; Myford, Carol; Stirling, Kevin; Mires, Gary

    2015-01-01

    The authors report final-year ward simulation data from the University of Dundee Medical School. Faculty who designed this assessment intend for the final score to represent an individual senior medical student's level of clinical performance. The results are included in each student's portfolio as one source of evidence of the student's…

  6. Is Clinical Competence Perceived Differently for Student Daily Performance on the Wards versus Clerkship Grading?

    ERIC Educational Resources Information Center

    Wimmers, Paul F.; Kanter, Steven L.; Splinter, Ted A. W.; Schmidt, Henk G.

    2008-01-01

    Clinical rotations play an important role in the medical curriculum and are considered crucial for student learning. However, competencies that should be learned can differ from those that are assessed. In order to explore which competencies are considered important for daily performance of student on the wards and to what extent clinical teachers…

  7. Constructing and Evaluating a Validity Argument for the Final-Year Ward Simulation Exercise

    ERIC Educational Resources Information Center

    Till, Hettie; Ker, Jean; Myford, Carol; Stirling, Kevin; Mires, Gary

    2015-01-01

    The authors report final-year ward simulation data from the University of Dundee Medical School. Faculty who designed this assessment intend for the final score to represent an individual senior medical student's level of clinical performance. The results are included in each student's portfolio as one source of evidence of the student's


  8. Light-front Ward-Takahashi identity for two-fermion systems

    SciTech Connect

    Marinho, J. A. O.; Frederico, T.; Pace, E.; Salme, G.; Sauer, P. U.

    2008-06-01

    We propose a three-dimensional electromagnetic current operator within light-front dynamics that satisfies a light-front Ward-Takahashi identity for two-fermion systems. The light-front current operator is obtained by a quasipotential reduction of the four-dimensional current operator and acts on the light-front valence component of bound or scattering states. A relation between the light-front valence wave function and the four-dimensional Bethe-Salpeter amplitude both for bound or scattering states is also derived, such that the matrix elements of the four-dimensional current operator can be fully recovered from the corresponding light-front ones. The light-front current operator can be perturbatively calculated through a quasipotential expansion, and the divergence of the proposed current satisfies a Ward-Takahashi identity at any given order of the expansion. In the quasipotential expansion the instantaneous terms of the fermion propagator are accounted for by the effective interaction and two-body currents. We exemplify our theoretical construction in the Yukawa model in the ladder approximation, investigating in detail the current operator at the lowest nontrivial order of the quasipotential expansion of the Bethe-Salpeter equation. The explicit realization of the light-front form of the Ward-Takahashi identity is verified. We also show the relevance of instantaneous terms and of the pair contribution to the two-body current and the Ward-Takahashi identity.

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

    ERIC Educational Resources Information Center

    Byrd, Jodi A.

    2007-01-01

    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


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

    PubMed Central

    2011-01-01

    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. PMID:21510852

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

    ERIC Educational Resources Information Center

    Byrd, Jodi A.

    2007-01-01

    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…

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

    PubMed Central

    Fertleman, M; Barnett, N; Patel, T

    2005-01-01

    ??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 hospital by collecting data on prescribing practice from three consecutive general medical post-take ward rounds. Setting: Northwick Park Hospital, a district general hospital in north-west London, which provides acute medical services to a population of 300 000. Strategy for change: A pharmacist was invited to become a member of the post-take ward round team that reviewed medical patients admitted within the preceding 24 hours. Patients also continued to receive care from a ward based pharmacist. Patient notes were analysed for cost of drugs on admission and discharge, discrepancies between admission drug history and pharmacist history, number of admission drugs stopped before discharge, and pharmacist recommendations. Pharmacist recommendations and actions were classified using a National Patient Safety Agency risk matrix. Effects of change: Discrepancies between the admission and the pharmacist derived drug history were noted in 26 of 50 in the pre-intervention group and 52 of 53 in the intervention group. The annual drug cost per patient following discharge increased by Ł181 in the pre-intervention group and by Ł122 in the intervention group. Five pre-admission drugs were stopped in three pre-intervention patients saving Ł276 per annum, while the 42 drugs stopped in 19 intervention patients saved Ł4699 per annum. No ward based pharmacist recommendations were recorded in the pre-intervention group. Recommendations regarding drug choice, dose, and need for drug treatment were most common; 58 minor, 48 moderate and four major risks to patients were potentially avoided. Lessons learnt: The presence of a pharmacist on a post-take ward round improved the accuracy of drug history documentation, reduced prescribing costs, and decreased the potential risk to patients in our hospital. As a result of this work a full time pharmacist has now been funded to attend daily post-take ward rounds on a permanent basis. PMID:15933319

  13. Characterisation of Clostridium difficile Hospital Ward–Based Transmission Using Extensive Epidemiological Data and Molecular Typing

    PubMed Central

    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

    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 PMID:22346738

  14. Improving the inpatient oncology experience through a new consultant ward round

    PubMed Central

    Navani, Vishal

    2014-01-01

    Regular consultant ward rounds have been shown to reduce the length of stay and improve the discharge planning for patients (1). To balance the competing demands of outpatient activity and inpatient oncology, it has been difficult to provide specialist care in our hospital. Previously, inpatients were managed primarily by the oncology specialist trainees, who are qualified in internal medicine, with an ad-hoc review by their named consultant. A regular consultant ward round was introduced for the first time on the 7/1/13. Each consultant was timetabled to give a twice weekly morning ward round on a rolling rota. To evaluate this intervention, a retrospective case note analysis was undertaken. This included all patients admitted under oncology for the two months preceding and succeeding the new ward round. For each patient the admission date, time to first consultant review, number of consultant reviews, time to discharge after consultant review, and discharge date was identified. A staff survey also took place. Statistical analysis was performed using Mann-Whitney U or Chi-Squared tests. 85 patient episodes met the inclusion criteria. Case notes were available for 63 episodes (74%). The average length of stay significantly decreased from 11 days to three and half days (p<0.05). The time to discharge after first consultant review also significantly decreased from six days to two days (p<0.05). The number of consultant reviews and time to first consultant review remained unchanged (p>0.05). The percentage of patients receiving a consultant review increased, from 54.3% to 71.4%, though this was not statistically significant. However it is likely such a large increase is clinically significant. Medical and nursing staff satisfaction also improved. This study suggests that a regular consultant ward round improves length of stay for patients. This is possibly because an increase in patients received a consultant review and that the treatment and discharge decisions were expedited after such a review.

  15. Safewards: a new model of conflict and containment on psychiatric wards

    PubMed Central

    Bowers, L

    2014-01-01

    Accessible summary Rates of violence, self-harm, absconding and other incidents threatening patients and staff safety vary a great deal by hospital ward. Some wards have high rates, other low. The same goes for the actions of staff to prevent and contain such incidents, such as manual restraint, coerced medication, etc. The Safewards Model provides a simple and yet powerful explanation as to why these differences in rates occur. Six features of the inpatient psychiatric system have the capacity to give rise to flashpoints from which adverse incidents may follow. The Safewards Model makes it easy to generate ideas for changes that will make psychiatric wards safer for patients and staff. Abstract Conflict (aggression, self-harm, suicide, absconding, substance/alcohol use and medication refusal) and containment (as required medication, coerced intramuscular medication, seclusion, manual restraint, special observation, etc.) place patients and staff at risk of serious harm. The frequency of these events varies between wards, but there are few explanations as to why this is so, and a coherent model is lacking. This paper proposes a comprehensive explanatory model of these differences, and sketches the implications on methods for reducing risk and coercion in inpatient wards. This Safewards Model depicts six domains of originating factors: the staff team, the physical environment, outside hospital, the patient community, patient characteristics and the regulatory framework. These domains give risk to flashpoints, which have the capacity to trigger conflict and/or containment. Staff interventions can modify these processes by reducing the conflict-originating factors, preventing flashpoints from arising, cutting the link between flashpoint and conflict, choosing not to use containment, and ensuring that containment use does not lead to further conflict. We describe this model systematically and in detail, and show how this can be used to devise strategies for promoting the safety of patients and staff. PMID:24548312

  16. Is locating acute wards in the general hospital an essential element in psychiatric reform? The U.K. experience.

    PubMed

    Totman, Jonathan; Mann, Farhana; Johnson, Sonia

    2010-01-01

    Locating psychiatric wards in general hospitals has long been seen in many countries as a key element in the reform of services to promote community integration of the mentally ill. In the U.K., however, this is no longer a policy priority, and the recent trend has been towards small freestanding inpatient units, located either within the communities they serve, or on general hospital sites, but separate from the main building. Whether locating the psychiatric wards in the general hospital is essential to psychiatric reform has been little discussed, and we can find no relevant evidence. Perceived strengths of general hospital psychiatric wards are in normalisation of mental health problems, accessibility to local communities, better availability of physical health care resources, and integration of psychiatry with the rest of the medical profession, which may faclilitate recruitment. However, difficulties seem to have been encountered in establishing well-designed psychiatric wards with access to open space in general hospitals. Also, physical proximity may not be enough to achieve the desired reduction in stigma, and complaints from the general hospital may sometimes result in undue restrictions on psychiatric ward patients. There are strong arguments both for and against locating psychiatric wards in general hospitals: an empirical evidence base would be helpful to inform important decisions about the best setting for wards. PMID:21322499

  17. Prospective cohort study protocol to describe the transfer of patients from intensive care units to hospital wards

    PubMed Central

    Buchner, Denise L; Bagshaw, Sean M; Dodek, Peter; Forster, Alan J; Fowler, Robert A; Lamontagne, François; Turgeon, Alexis F; Potestio, Melissa; Stelfox, Henry T

    2015-01-01

    Introduction The transfer of patient care between the intensive care unit (ICU) and the hospital ward is associated with increased risk of medical error and adverse events. This study will describe patient transfer from ICU to hospital ward by documenting (1) patient, family and provider experiences related to ICU transfer, (2) communication between stakeholders involved in ICU transfer, (3) adverse events that follow ICU transfer and (4) opportunities to improve ICU to hospital ward transfer. Methods This is a mixed methods prospective observational study of ICU to hospital ward transfer practices in 10 ICUs across Canada. We will recruit 50 patients at each site (n=500) who are transferred from ICU to hospital ward, and distribute surveys to enrolled patients, family members, and healthcare providers (ICU and ward physicians and nurses) after patient transfer. A random sample of 6 consenting study participants (patients, family members, healthcare providers) from each study site (n=60) will be offered an opportunity to participate in interviews to further describe stakeholders’ experience with ICU to hospital ward transfer. We will abstract information from patient health records to identify clinical data and use of transfer tools, and identify adverse events that are related to the transfer. Ethics and Dissemination Research ethics board approval has been obtained at the coordinating study centre (UofC REB13-0021) and 5 study sites (UofA Pro00050646; UBC-PHC H14-01667; Sunnybrook 336-2014; QCH 14-07; Sherbrooke 14-172). Dissemination of the findings will provide a comprehensive description of transfer from ICU to hospital ward in Canada including the uptake of validated or local transfer tools, a conceptual framework of the experiences and needs of stakeholders in the ICU transfer process, a summary of adverse events experienced by patients after transfer from ICU to hospital ward, and opportunities to guide quality improvement efforts. PMID:26155820

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

    PubMed

    Liu, Wei; Manias, Elizabeth; Gerdtz, Marie

    2014-03-01

    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

  19. Investigation of Seclusion in one of the Psychiatric Wards in Razi Teaching Hospital of Tabriz

    PubMed Central

    Vahidi, Maryam; Hosseinzadeh, Mina

    2014-01-01

    Seclusion is one of the methods in controlling violent behavior of inpatients in psychiatric wards. In current descriptive analytic study, data collection instrument included the seclusion list of inpatients by considering individual, social and clinical characteristics in one of the psychiatry wards In the Razi teaching hospital of Tabriz in the first six months of 2012. Among 264 admitted patients, 24 patients (9.1%) had been secluded and a total of 29 isolated incidents were recorded. Most of secluded incidents occurred on weekdays (75.9%), first week of inpatient (87.7%), and during the evening shifts (48.3%). The results obtained in this study demonstrate that in 55.2% cases, the duration of isolation was two hours and the most common cause of seclusion was aggressive behaviors. Most of secluded patients (66.7%) were diagnosed with mood disorders. PMID:25717458

  20. [Risks in postoperative pain therapy using a peridural catheter in a normal general ward].

    PubMed

    Maier, C; Wawersik, J; Wulf, H

    1986-04-01

    In general surgical wards postoperative epidural analgesia was performed in 286 patients consecutively. Epidural catheters were kept in place 8.3 days in the average with a minimum of 24 h and a maximum of 45 d. Bupivacain was applied as a 0.25% solution with an average daily dose of 75-250 mg and single doses of 12.5-50.0 mg. An uncomplicated course was noticed in 250 cases, 19 cases showed haemodynamic, 7 cases neurologic and 10 cases technical complications. Severe decrease of systolic blood pressure more than 30% of the control value was due to postoperative haemorrhage, to anaemia with Hgb-concentration lower than 11 g/dl or to untreated chronical hypertension. On the basis of these observations a list of conditions has been drawn up which should be adhered to when epidural catheters are used for postoperative pain relief in normal wards. PMID:3728890

  1. Multicenter Development and Validation of a Risk Stratification Tool for Ward Patients

    PubMed Central

    Yuen, Trevor C.; Winslow, Christopher; Robicsek, Ari A.; Meltzer, David O.; Gibbons, Robert D.; Edelson, Dana P.

    2014-01-01

    Rationale: Most ward risk scores were created using subjective opinion in individual hospitals and only use vital signs. Objectives: To develop and validate a risk score using commonly collected electronic health record data. Methods: All patients hospitalized on the wards in five hospitals were included in this observational cohort study. Discrete-time survival analysis was used to predict the combined outcome of cardiac arrest (CA), intensive care unit (ICU) transfer, or death on the wards. Laboratory results, vital signs, and demographics were used as predictor variables. The model was developed in the first 60% of the data at each hospital and then validated in the remaining 40%. The final model was compared with the Modified Early Warning Score (MEWS) using the area under the receiver operating characteristic curve and the net reclassification index (NRI). Measurements and Main Results: A total of 269,999 patient admissions were included, with 424 CAs, 13,188 ICU transfers, and 2,840 deaths occurring during the study period. The derived model was more accurate than the MEWS in the validation dataset for all outcomes (area under the receiver operating characteristic curve, 0.83 vs. 0.71 for CA; 0.75 vs. 0.68 for ICU transfer; 0.93 vs. 0.88 for death; and 0.77 vs. 0.70 for the combined outcome; P value < 0.01 for all comparisons). This accuracy improvement was seen across all hospitals. The NRI for the electronic Cardiac Arrest Risk Triage compared with the MEWS was 0.28 (0.18–0.38), with a positive NRI of 0.19 (0.09–0.29) and a negative NRI of 0.09 (0.09–0.09). Conclusions: We developed an accurate ward risk stratification tool using commonly collected electronic health record variables in a large multicenter dataset. Further study is needed to determine whether implementation in real-time would improve patient outcomes. PMID:25089847

  2. Point prevalence of general ward patients fulfilling criteria for systemic inflammatory response syndrome.

    PubMed

    Douglas, L; Casamento, A; Jones, D

    2016-02-01

    The systemic inflammatory response syndrome (SIRS) is defined by abnormal temperature, heart rate, minute ventilation or white cell count and can be due to infectious or non-infectious causes. In a single day, 23% of hospital ward patients fulfilled SIRS criteria. Patients with SIRS were more likely to be under medical than surgical units. One-third of the patients had evidence of infection. There was no association between SIRS criteria and increased mortality or hospital length of stay. PMID:26899889

  3. [open quotes]Victory[close quotes] a matter of perception in Ward Valley dispute

    SciTech Connect

    Newman, P.

    1994-02-17

    This article concerns the legal battle over the siting of Ward Valley, a proposed low-level nuclear waste site in California's Mojave Desert. The discussion centers around a judge's decision to deny a pretrial request for adjudicatory hearings to determine the site's suitability as a repository. The site is within an area designated as territory for the desert tortoise by the U.S. Fish and Wildlife Service.

  4. Risk Assessment Tool for Pressure Ulcer Development in Indian Surgical Wards.

    PubMed

    Kumari, Sushma; Sharma, Deborshi; Rana, Anshika; Pathak, Reetesh; Lal, Romesh; Kumar, Ajay; Biswal, U C

    2015-06-01

    The aims of this paper were to compare the predictive validity of three pressure ulcer (PU) risk scales-the Norton scale, the Braden scale, and the Waterlow scale-and to choose the most appropriate calculator for predicting PU risk in surgical wards of India. This is an observational prospective cohort study in a tertiary educational hospital in New Delhi among 100 surgical ward patients from April to July 2011. The main outcomes measured included sensitivity, specificity, positive predictive value (PVP) and negative predictive value (PVN), and the area under the curve of the receiver operating characteristic (ROC) curve of the three PU risk assessment scales. Based on the cutoff points found most appropriate in this study, the sensitivity, specificity, PVP, and PVN were as follows: the Norton scale (cutoff, 16) had the values of 95.6, 93.5, 44.8, and 98.6, respectively; the Braden scale (cutoff, 17) had values of 100, 89.6, 42.5, and 100, respectively; and the Waterlow scale (cutoff, 11) had 91.3, 84.4, 38.8, and 97, respectively. According to the ROC curve, the Norton scale is the most appropriate tool. Factors such as physical condition, activity, mobility, body mass index (BMI), nutrition, friction, and shear are extremely significant in determining risk of PU development (p?wards. BMI, mobility, activity, nutrition, friction, and shear are the most significant factors in Indian surgical ward settings with necessity for future comparison with established scales. PMID:26246703

  5. Custom active RFId solution for children tracking and identifying in a resuscitation ward.

    PubMed

    Iadanza, Ernesto; Dori, Fabrizio

    2009-01-01

    In this work is discussed an active RFId system to track and identify patients in a children's critical care ward. The technical solutions may be very different according to the patients type, age and cognitive conditions and according to the hospital shapes. The proposed system to track and identify patients has been developed taking into account all the constraints induced by the particular environment. The system is composed of five different hardware devices and a tracking software, purposely designed and realized. PMID:19964116

  6. The outbreak of Serratia marcescens bacteremia in a pediatric ward, Siriraj Hospital 1997.

    PubMed

    Chokephaibulkit, Kulkanya; Danchaivijitr, Somwang; Boonpragaigaew, Gorapin; Dhiraputra, Chertsak; Vanprapa, Nirun; Visitsunthorn, Nuananong; Trakulsomboon, Suwanna

    2002-08-01

    Between October 20 and November 11, 1997, Serratia marcescens bacteremia was identified in 8 patients in a pediatric ward at Siriraj Hospital. The organism was isolated from 17 blood and 3 bone marrow specimens. The only common associated factor in these patients was that they all had received an intravenous fluid infusion. In the attempt to investigate the source of S. marcescens implicated in the outbreak, 108 specimens of intravenous fluid, 3 intravenous fluid bottle caps, 4 specimens from intravenous fluid tubing sets, 21 specimens of antiseptics used on the ward, 28 specimens of rectal swabs from patients on the ward, 1 sample of blood culture media prepared by the hospital for routine use, and 62 environmental specimens including hand swabs of the medical personnel, refrigerator, air conditioning, milk samples, room air, water sink, wooden splint and adhesive tape used to immobilize the intravenous access. Of 227 specimens sent for culture, S. marcescens was isolated from only one specimen collected from the in-use intravenous fluid given to a patient with Serratia bacteremia. S. marcescens was not found in any other surveillance culture. The 8 patients were placed under quarantine in the same room with an exclusive nursing team. With the investigation and intervention including monitoring for meticulous hand washing of the ward staff, the outbreak was stopped within 7 days. Although the investigation failed to discover the environmental reservoir of S. marcescens in this outbreak, the data suggested that intravenous fluid was probably the route of transmission and the medical personnel played an important role in spreading the infection. PMID:12403246

  7. Rationale and staff evaluation of using a "therapeutic milieu" for substance users within a tuberculosis ward.

    PubMed

    Chemtob, Daniel; Levy, Avi

    2009-01-01

    Approximately 30% of tuberculosis (TB) patients in Israel were treated, in part, in two dedicated hospital wards during the years 2003-2005. A portion of them manifested severe psychosocial conditions. An intervention based on the "Therapeutic Milieu" (TM) model was implemented in the larger ward and included a staff evaluation of this intervention. The concept of TM, based on psychosocial paradigms and behavioral medicine, is aimed at providing a supportive environment for patients. Weekly group patients' meetings and monthly group staff supervisions were performed during 15 months (2003-2005). Forty of the 196 (20%) TB patients, mainly "complex," and 13 of 20 staff members (65%) attended regularly and discussed how to deal with substance abuse, personality disorders, and immigration-related crises. Out of 40 TB cases, 30 (75%) were also substance users. Ten staff members self-analyzed the impact of this intervention in terms of (1) having given adequate tools for the staff, (2) reducing physical violence, (3) increasing adherence to TB treatment, and (4) more efficient treatment for their substance use. No direct evaluation was done among the TB patients. According to staff members, this intervention had a positive overall impact. However, using Therapeutic Milieu in TB ward hospitalization, as a "window of opportunity," remains the first step in a longer journey for rehabilitation. The study's limitations are noted. PMID:19266356

  8. Patients' perceptions of patient education on psychiatric inpatient wards: a qualitative study.

    PubMed

    Hätönen, H; Suhonen, R; Warro, H; Pitkänen, A; Välimäki, M

    2010-05-01

    This study describes patients' perceptions of different types of patient education interventions and areas where patient education should be improved on psychiatric wards. Thematic interviews were conducted with 16 patients who had completed the information technology (IT)-based patient education, conventional patient education with leaflets or patient education according to ward standards during their hospital stay. Data were analysed using inductive content analysis. Patients' perceptions of patient education varied depending on which patient education group they had participated in. Patients participating in IT-based or conventional patient education perceived education as a systematic and planned process. However, especially patients in the patient education group applying ward standard education perceived patient education as occasional information dissemination situations. To improve patient education, patients suggested that it should be based on their individual needs and offered with different methods systematically to all patients. The results indicate that patients find structured and systematic patient education programmes useful. Different educational methods should be used, not forgetting interaction between patient and nurse, which was reportedly as an essential element of patient education. PMID:20529184

  9. Prevalence of ESBLs-producing Pseudomonas aeruginosa isolates from different wards in a Chinese teaching hospital

    PubMed Central

    Chen, Zhilong; Niu, Hui; Chen, Guangyu; Li, Mingcheng; Li, Ming; Zhou, Yuqing

    2015-01-01

    This study was to explore the molecular dissemination of P. aeruginosa producing extended spectrum ?-lactamase (ESBLs) recovered from the different wards in a teaching hospital, Jilin. Among 240 isolates, 91 strains were isolated from burn wards and 149 strains from surgical wards. A total of 210 strains (87.5%) produced ESBLs, 30 strains (12.5%) didn’t produce ESBLs. All ESBLs isolates showed identical antimicrobial susceptibility profiles. The genotypic prevalence of ESBLs for bla SHV-12, bla TEM-24, bla CTX-M-1, bla CTX-M-2, bla CTX-M-3, bla PER and bla VEB genes was 17.6%, 20.5%, 14.3%, 9.6%, 12.9%, 13.8% and 11.4% respectively. All P. aeruginosa strains producing ESBLs had three to six plasmids and contained class 1 integrons, which transferred resistance to E. coli C 600 by conjuation. The data indicated a high prevalence of ESBL among P. aeruginosa isolates in this region and their enzyme types were diverse. PMID:26770582

  10. Drinking Water Quality Surveillance in a Vulnerable Urban Ward of Ahmedabad

    PubMed Central

    Iyer, Veena; Choudhury, Nandini; Azhar, Gulrez Shah; Somvanshi, Bhushan

    2014-01-01

    The World Bank estimates that 21% of all communicable diseases in India are related to unsafe water with diarrhoea alone causing more than 0.1 million deaths annually. The WHO drinking water surveillance parameters of quality, quantity, accessibility, affordability and continuity were assessed in one vulnerable ward of Ahmedabad—a fast growing city in Western India. Interviews with key informants of the ward office, health centre and water supply department, secondary analysis and mapping of field test reports and a questionnaire-based survey of different household types were conducted. We found that Ahmedabad Municipal Corporation (AMC) supplies water to the ward intermittently for two hours during the day. Housing society clusters supplement their AMC water supply with untested bore-well water. The water quality surveillance system is designed for a twenty-four-hour piped distribution of treated surface water. However, in order to maintain surveillance over an intermittent supply that includes ground water, the sampling process should include periodic surveys of water actually consumed by the citizens. The laboratory capacity of the Central Water Testing Laboratory should expand to include more refined tests for microbial and chemical contamination. PMID:25254083

  11. Improving Intensive Care Unit and Ward Utilization by Adapting Master Surgery Schedules.

    PubMed

    FĂŒgener, Andreas; Edenharter, Guenther Michael; Kiefer, Paskal; Mayr, Ulrike; Schiele, Julian; Steiner, Fabian; Kolisch, Rainer; Blobner, Manfred

    2016-03-15

    With increasing organizational and financial pressure on hospitals, each individual surgical treatment has to be reviewed and planned thoroughly. Apart from the expensive operating room facilities, proper staffing and planning of downstream units, like the wards or the intensive care units (ICUs), should be considered as well. In this article, we outline the relationship between a master surgery schedule (MSS), i.e., the assignment of surgical blocks to medical specialties, and the bed demand in the downstream units using an analytical model. By using historical data retrieved from the clinical information system and a patient flow model, we applied a recently developed algorithm for predicting bed demand based on the MSSs for patients of 3 surgical subspecialties of a hospital. Simulations with 3 different MSSs were performed. The impact on the required amount of beds in the downstream units was analyzed. We show the potential improvements of the current MSS considering 2 main goals: leveling workload among days and reduction of weekend utilization. We discuss 2 different MSSs, one decreasing the weekend ICU utilization by 20% and the other one reducing maximum ward bed demand by 7%. A test with 12 months of real-life data validates the results. The application of the algorithm provides detailed insights for the hospital into the impact of MSS designs on the bed demand in downstream units. It allowed creating MSSs that avoid peaks in bed demand and high weekend occupancy levels in the ICU and the ward. PMID:26517232

  12. Reducing conflict and containment rates on acute psychiatric wards: The Safewards cluster randomised controlled trial

    PubMed Central

    Bowers, Len; James, Karen; Quirk, Alan; Simpson, Alan; Stewart, Duncan; Hodsoll, John

    2015-01-01

    Background Acute psychiatric wards manage patients whose actions may threaten safety (conflict). Staff act to avert or minimise harm (containment). The Safewards model enabled the identification of ten interventions to reduce the frequency of both. Objective To test the efficacy of these interventions. Design A pragmatic cluster randomised controlled trial with psychiatric hospitals and wards as the units of randomisation. The main outcomes were rates of conflict and containment. Participants Staff and patients in 31 randomly chosen wards at 15 randomly chosen hospitals. Results For shifts with conflict or containment incidents, the experimental condition reduced the rate of conflict events by 15% (95% CI 5.6–23.7%) relative to the control intervention. The rate of containment events for the experimental intervention was reduced by 26.4% (95% CI 9.9–34.3%). Conclusions Simple interventions aiming to improve staff relationships with patients can reduce the frequency of conflict and containment. Trial registration IRSCTN38001825. PMID:26166187

  13. Effects of family-centered care on the satisfaction of parents of children hospitalized in pediatric wards in a pediatric ward in Chaloos in 2012

    PubMed Central

    Rostami, Forouzan; Hassan, Syed Tajuddin Syed; Yaghmai, Farideh; Ismaeil, Suriani Binti; Suandi, Turiman Bin

    2015-01-01

    Background: Family-centered care (FCC) involves holistic care and requires cooperation with the family in planning, intervention, and the evolution of the care that is being provided. Many previous studies have provided results that indicate the importance of the family’s involvement in pediatric care, but there is still resistance in doing so within the organizational culture of the hospitals in Iran. The aim of this study was to determine the effects of FCC on the satisfaction of parents of children hospitalized in 2012 in the pediatric ward at Razi Hospital in Chaloos, Iran. Methods: This Quasi-experimental study was conducted in 2012 in the pediatric ward at Razi Hospital in Chaloos, Iran. Seventy hospitalized children between the ages of 1 and 3 who suffered from diarrhea, vomiting, or pneumonia were selected through convenience sampling. They were divided randomly into two equal groups, a control group (routine care) and an experimental group (family-centered care). SPSS Statistics 14 software was used to analyze the data, and p<0.05 was considered to be significant. Results: In the FCC group, the mean score of satisfaction among the parents of the children was 20 out of 90 before the intervention, but, after the FCC method was used, it increased to 83.2 out of 90. In addition, a significant difference was found between the scores of satisfaction for the control and experimental groups (p<0.001), and all parents of children in the experimental group expressed high satisfaction. Conclusion: Our findings showed that the practice of FCC in caring for the sick children can increase the satisfaction of their parents significantly. The role of the family’s involvement is critical in every component of the intervention efforts, as shown by the constructs of participatory support, educational support, and psychological support. Thus, a notable implication here is that FCC may lead to increased quality of care and should be included in the educational programs of the nursing staff in pediatric ward PMID:26120418

  14. Antibiotic resistance patterns of microorganisms isolated from nephrology and kidney transplant wards of a referral academic hospital

    PubMed Central

    Samanipour, Atieh; Dashti-Khavidaki, Simin; Abbasi, Mohammad-Reza; Abdollahi, Alireza

    2016-01-01

    Objective: Antibiotic use pattern and emergence of resistant bacteria are major concerns in clinical settings. This study aimed to detect common bacteria and their antibiotic sensitivity patterns in nephrology and kidney transplant wards. Methods: This 1-year, observational study was performed in the nephrology and kidney transplant wards of Imam Khomeini Hospital Complex, Tehran, Iran. All patients treated with antimicrobial agents for confirmed or suspected infections were included. Their demographic, clinical, and laboratory data (including biological media used for microbial culture, growth organisms, and antibiograms) were collected. Adherence of antimicrobial regimen to standard guidelines was also assessed. Findings: About half of the patients received antibiotic. The most common infecting bacteria were Escherichia coli followed by Enterococcus sp. and Staphylococcus aureus. E. coli showed high rate of sensitivity to carbapenems and nitrofurantoin and high rate of resistance to co-trimoxazole and ciprofloxacin. Enterococcus sp. in both wards had high rate of resistance to ampicillin and were all sensitive to linezolid. Unlike to the nephrology ward, more than 50% of Enterococcus sp. from kidney transplant ward was resistant to vancomycin. The most common type of S. aureus in this nephrology ward was methicillin-resistant S. aureus (MRSA). Most commonly-prescribed antibiotics were carbapenems followed by vancomycin, ciprofloxacin, and ceftriaxone. Antibiotic regimens were 75% and 83%, 85% and 91%, and 80% and 87% compatible with international guidelines in antibiotic types, dosages, and treatment durations, respectively, in nephrology and kidney transplant wards, respectively. Conclusion: MRSA, fluoroquinolone-resistant E. coli, and vancomycin resistant Enterococcus species are major threats in nephrology and kidney transplant wards. Most commonly-prescribed antibiotics were carbapenems that necessitate providing internal guidelines by the teamwork of clinical pharmacist, infectious disease specialists, and nephrologists to avoid the widespread use of broad-spectrum antibiotics. PMID:26985435

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

    PubMed Central

    2014-01-01

    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. PMID:24886569

  16. Making the ward a more efficient place: a qualitative evaluation of the impact of the Vista 90 trolley

    PubMed Central

    Ahluwalia, Nikhil

    2013-01-01

    A significant amount of professional time is wasted during a medical ward round retrieving patient notes from the ward trolley. If the efficiency of this non-clinical, non-functional interaction could be improved it would save time, maintain continuity and have financial implications. One identified constraint was the structure of the traditional ward trolley; a stationary filing tray with vertical sleeves. During ward round, time is spent returning and retrieving each patients notes from outside the patient bay and additional time may be wasted if the notes are misplaced or in use elsewhere. To resolve this, the ‘Vista 90’ trolley with horizontal, transparent trays, is portable and has an ergonomic writing surface was selected as a potential second generation replacement. An assessment of the impact of the Vista 90 trolley over the traditional trolley in the clinical setting was carried out on Erringham (medical) Ward, Worthing Hospital, West Sussex Hospital Trust, UK. This was by way of qualitative analysis performed by semi-structured interview of 12 doctors and other healthcare professionals who regularly interacted with the Vista 90 and traditional trolley in December 2012. The audit found that those interviewed preferred using the Vista 90 trolley over its predecessor as it improved the efficiency of the ward round and subsequent clinical work. It's mobility allowed it to be easily transported with the ward round, reducing disruption during a consultation and between consecutives ones. The ergonomic writing surface was noted to improve legibility of documentation due to greater comfort and if placed appropriately, did not interfere with the doctor-patient interaction. The financial savings of this greater efficiency was found to be of significance and justify the cost of the Vista 90 within two weeks.

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

    PubMed Central

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

    2014-01-01

    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. PMID:24829715

  18. The permeable institution: an ethnographic study of three acute psychiatric wards in London.

    PubMed

    Quirk, Alan; Lelliott, Paul; Seale, Clive

    2006-10-01

    In Asylums, Goffman [1961. Asylums. London: Penguin] identified some permeable features of the old mental hospitals but presented them as exceptions to the rule and focused on their impermeable aspects. We argue that this emphasis is no longer valid and offer an alternative ideal type that better represents the reality of everyday life in contemporary 'bricks and mortar' psychiatric institutions. We call this the "permeable institution". The research involved participant observation of between 3 and 4 months and interviews with patients, patient advocates and staff on 3 psychiatric wards. Evidence for permeability includes that ward membership is temporary and changes rapidly (patients tend to have very short stays and staff turnover is high); patients maintain contact with the outside world during their stay; and institutional identities are blurred to the point where visitors or new patients can easily mistake staff and patients for one another. Permeability has both positive consequences (e.g., reduced risk of institutionalism), and negative consequences (e.g., unwanted people coming into hospital to cause trouble, and illicit drug use among patients). Staff employ various methods to regulate their ward's permeability, within certain parameters. The metaphor of the total/closed institution remains valuable, but it fails to capture the highly permeable nature of the psychiatric institutions we studied. Analysts may therefore find the permeable institution a more helpful reference point or ideal type against which to examine and compare empirical cases. Perhaps most helpful is to conceptualise a continuum of institutional permeability with total and permeable institutions at each extreme. PMID:16806622

  19. Feasibility and acceptability of rapid HIV screening in a labour ward in Togo

    PubMed Central

    Ekouevi, Didier K; Kariyiare, Benjamin G; Coffie, Patrick A; Jutand, Marthe-Aline; Akpadza, Koffi; Lawson-Evi, Annette; Tatagan, Albert; Dabis, François; Sibe, Mathieu; Pitche, Vincent P; Becquet, Renaud; David, Mireille

    2012-01-01

    Background HIV screening in a labour ward is the last opportunity to initiate an antiretroviral prophylaxis among pregnant women living with HIV to prevent mother-to-child HIV transmission. Little is known about the feasibility and acceptability of HIV screening during labour in West Africa. Findings A cross-sectional survey was conducted in the labour ward at the Tokoin Teaching Hospital in Lomé (Togo) between May and August 2010. Pregnant women admitted for labour were randomly selected to enter the study and were interviewed on the knowledge of their HIV status. Clinical and biological data were collected from the individual maternal health chart. HIV testing or re-testing was systematically proposed to all pregnant women. Among 1530 pregnant women admitted for labour, 508 (32.2%) were included in the study. Information on HIV screening was available in the charts of 359 women (71%). Overall, 467 women accepted HIV testing in the labour ward (92%). The HIV prevalence was 8.8% (95% confidence interval: 6.4 to 11.7%). Among the 41 women diagnosed as living with HIV during labour, 34% had not been tested for HIV during pregnancy and were missed opportunities. Antiretroviral prophylaxis had been initiated antenatally for 24 women living with HIV and 17 in the labour room. Conclusions This study is the first to show in West Africa that HIV testing in a labour room is feasible and well accepted by pregnant women. HIV screening in labour rooms needs to be routinely implemented to reduce missed opportunities for intervention aimed at HIV care and prevention, especially PMTCT. PMID:22905362

  20. Protocol for an exploration of knowledge sharing for improved discharge from a mental health ward

    PubMed Central

    Rowley, Emma; Wright, Nicola; Waring, Justin; Gregoriou, Kyri; Chopra, Arun

    2014-01-01

    Introduction Strategies to reduce hospital admissions for mental health service users have received vast amounts of attention, yet the transfer of care from hospital to the community has been ignored. The discharge process is complex, messy, disjointed and inefficient, relying on cross-agency and organisational working. Focusing on one acute mental health admission ward, we will investigate whether the discharge process for people with severe mental health problems can be enhanced through the creation, implementation and utilisation of a knowledge sharing proforma that is used on their admission to the ward. Methods and analysis The project uses qualitative interviews to understand the complex processes associated with being admitted and discharged from inpatient mental health wards. Practitioners will be asked to identify and map the relevant stakeholders involved in admission and discharge, and discuss any problems with the process. The study team will work with clinicians to develop a knowledge collection proforma, which will be piloted for 2?months. Qualitative interviews will be carried out to collect reflections on the experiences of using the tool, with data used for further refinement of the intervention. Baseline and repeat quantitative measures will be taken to illustrate any changes to length of stay and readmission rates achieved as a result of the study. Ethics and dissemination A key issue is that participants are able to comment frankly on something that is a core part of their work, without fear or reprise. It is equally important that all participants are offered the opportunity to develop and coproduce the knowledge collection proforma, in order that the intervention produced is fit for purpose and usable in the real world, away from a research environment. The study has received ethical approval from Nottingham University Business School ethics committee, and has all appropriate National Health Service research governance clearances. PMID:25273812

  1. Implementation of a ward round pro-forma to improve adherence to best practice guidelines.

    PubMed

    Boland, Xavier

    2015-01-01

    Our aim was firstly to assess adherence to best practice guidelines for the prevention of healthcare associated causes of inpatient mortality and morbidity by junior doctors. Secondly, we wanted to measure the impact of a ward round checklist on rates of adherence. The rates of correct prescribing of antibiotics, venous thrombo-embolism prophylaxis, and oxygen (pro re nata) as well as correctly completed paperwork for peripheral venous cannulas were measured in a spot audit of all medical notes of patients on a medical assessment unit. This was repeated two weeks and two months after the introduction of a specifically designed ward round checklist for junior doctors. Initial audit of 40 patient notes confirmed generally poor compliance with best practice guidelines in the prescription of antibiotics (58% correctly prescribed) and oxygen (42%), and in the use cannula care plans (39%). Venous thrombo-embolism prophylaxis prescribing on the other hand was widespread (82%). The introduction and extensive use of the ward round checklist did not have a significant impact on these figures as shown in the two following stop audits (30 and 36 notes respectively). Checklists are helpful in providing a structured and systematic approach to complex tasks and have been shown to have a measurable impact in improving patient care. Their effectiveness is however limited by their uptake and regular correct use. Obstructing issues include poor understanding of the need for change in practice, lack of individual accountability and variable involvement of clinical leaders. These issues must be addressed together in order to effect a successful change in clinical practice. PMID:26734332

  2. The utilisation of the MUST nutritional screening tool on vascular surgical wards

    PubMed Central

    Tewari, Nilanjana; Rodrigues, Jeremy; Bothamley, Lydia; Altaf, Nishath; Awad, Sherif

    2013-01-01

    Whilst malnutrition is prevalent in approximately 40% of general surgical patients, the prevalence of malnutrition and nutritional screening practices amongst vascular patients remain unknown. The Malnutrition Universal Screening Tool (MUST) is recommended for risk screening and provides 3 scores for risk classification: 0=low risk, 1=intermediate risk, 2=high risk. The aim of this preliminary study was to evaluate the use of MUST on vascular wards. This prospective study was undertaken in a tertiary referral vascular unit in the UK. Patient demographics, utilisation of MUST by nursing staff (N-MUST) and referral to nutritional support teams (NST) were studied. When MUST was not completed by nursing staff, the study team (S-MUST) performed it. Fifty-three patients, median (interquartile range, IQR) age 67 (59-75) years were initially studied. For N-MUST: Overall MUST score was recorded in 18/25 (72%) patients, of whom 1 (4%) scored 2, whilst the remainder scored 0. For S-MUST: Overall MUST scores were recorded in 28 patients, MUST=0 in 75% and ?2 in 21%. An educational session on use of MUST was delivered to nursing staff, as well as a Trust-wide educational initiative to improve assessment of nutritional status and, after a 2-month period, the study was repeated. The second cohort comprised forty-two patients, median (IQR) age 72 (64–79) years. For N-MUST: Overall MUST score was recorded in 37/40 (93%) patients, of whom 3 (8%) scored ?2. For S-MUST: Overall MUST scores were recorded in 2 patients, MUST = 0 in 67% and ?2 in 33%. Despite the ease of use of MUST, it was under-utilised on vascular wards. However, following provision of a dedicated educational programme to ward nursing staff, utilisation of MUST for risk scoring patients on admission increased to over 90%.

  3. Improving VTE risk assessment at point of admission to a tertiary centre cardiology ward

    PubMed Central

    Wilson, Rachel

    2015-01-01

    Cardiology wards are generally high turnover units, which may receive primary PCI, high-risk NSTEMI patients, and other general cardiac admissions from a large geographical area. Many centres also provide national specialist services for rarer cardiac conditions for which admissions may be lengthy. Cardiac patients have significant risk factors for venous thromboembolism (VTE) as immobility may be due to systolic dysfunction, attachment to continuous monitoring and predisposition to chest pain, or cardiac syncope. It is recommended by NICE that an initial VTE risk assessment is undertaken at the time of patient admission, with reassessment within 24 hours. For this purpose a risk assessment tool is featured on the front of many Trust drug charts. It is noted that this risk assessment is electronic in other trusts. We undertook an audit into the drug chart documentation of VTE risk assessment on the cardiology ward and the Coronary Care Unit (CCU) at The Royal Free Hospital. It was evident that documentation of VTE risk assessment was poor. The audit interventions were; a teaching presentation to the cardiology department, an educational poster, several update emails to the department and the identification of a ‘VTE risk assessment champion’ to audit ongoing compliance. Following these measures the second audit round demonstrated that documentation of initial risk assessment was slightly improved, but significant improvement was seen in documentation of risk assessment at 24 hours post admission. Results from a third audit cycle indicated that the improvement in initial VTE risk assessment was sustained, and that there was a significant sustained improvement in risk assessment at 24 hours (p <0.05). Recommendations for sustained improvement included: redesigning the drug chart so that the VTE risk assessment tool was linked to the VTE prophylaxis prescription box, and designating the responsibility of the initial VTE risk assessment to the on call junior doctor who receives admissions on to the ward.

  4. Implementation of a ward round pro-forma to improve adherence to best practice guidelines

    PubMed Central

    Boland, Xavier

    2015-01-01

    Our aim was firstly to assess adherence to best practice guidelines for the prevention of healthcare associated causes of inpatient mortality and morbidity by junior doctors. Secondly, we wanted to measure the impact of a ward round checklist on rates of adherence. The rates of correct prescribing of antibiotics, venous thrombo-embolism prophylaxis, and oxygen (pro re nata) as well as correctly completed paperwork for peripheral venous cannulas were measured in a spot audit of all medical notes of patients on a medical assessment unit. This was repeated two weeks and two months after the introduction of a specifically designed ward round checklist for junior doctors. Initial audit of 40 patient notes confirmed generally poor compliance with best practice guidelines in the prescription of antibiotics (58% correctly prescribed) and oxygen (42%), and in the use cannula care plans (39%). Venous thrombo-embolism prophylaxis prescribing on the other hand was widespread (82%). The introduction and extensive use of the ward round checklist did not have a significant impact on these figures as shown in the two following stop audits (30 and 36 notes respectively). Checklists are helpful in providing a structured and systematic approach to complex tasks and have been shown to have a measurable impact in improving patient care. Their effectiveness is however limited by their uptake and regular correct use. Obstructing issues include poor understanding of the need for change in practice, lack of individual accountability and variable involvement of clinical leaders. These issues must be addressed together in order to effect a successful change in clinical practice.

  5. It is time to introduce ST analysis for fetal monitoring in the labor ward?

    PubMed

    Visser, Gerard H A; Kessler, Jűrg

    2014-06-01

    Five randomized controlled trials have been published on intrapartum fetal heart rate monitoring with ST analysis of the fetal electrocardiogram, but the debate on its usefulness has not yet been ended. We consider ST analysis a useful and cost-effective addition to conventional fetal heart rate monitoring. We will provide support for this opinion by discussing the pathophysiology of ST changes in relation to fetal asphyxia, the results of the randomized controlled trials and numerous meta-analyses of these randomized controlled trials and trends in fetal outcome in hospitals in different countries following the introduction of the ST technology in the labor ward. PMID:24766548

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

    PubMed

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

    2012-01-01

    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

  7. Development of a self-assessment tool for measuring competences of obstetric nurses in rooming-in wards in China

    PubMed Central

    Zhang, Ju; Ye, Wenqin; Fan, Fan

    2015-01-01

    Introduction: To provide high-quality nursing care, a reliable and feasible competency assessment tool is critical. Although several questionnaire-based competency assessment tools have been reported, a tool specific for obstetric nurses in rooming-in wards is lacking. Therefore, the purpose of this research is to develop a competency assessment tool for obstetric rooming-in ward nurses. Methods: A literature review was conducted to create an individual intensive interview with 14 nurse managers, educators, and primary nurses in rooming-in wards. Expert reviews (n = 15) were conducted to identify emergent themes in a Delphi fashion. A competency assessment questionnaire was then developed and tested with 246 rooming-in ward nurses in local hospitals. Results: We constructed a three-factor linear model for obstetric rooming-in nurse competency assessment. Further refinement resulted in a self-assessment questionnaire containing three first-tier, 12 second-tier, and 43 third-tier items for easy implementation. The questionnaire was reliable, contained satisfactory content, and had construct validity. Discussion: Our competency assessment tool provides a systematic, easy, and operational subjective evaluation model for nursing managers and administrators to evaluate obstetric rooming-in ward primary nurses. The application of this tool will facilitate various human resources functions, such as nurse training/education effect evaluation, and will eventually promote high-quality nursing care delivery. PMID:26770468

  8. Challenges of the ward round teaching based on the experiences of medical clinical teachers

    PubMed Central

    Arabshahi, Kamran Soltani; Haghani, Fariba; Bigdeli, Shoaleh; Omid, Athar; Adibi, Peyman

    2015-01-01

    Background: Holding educational sessions in a clinical environment is a major concern for faculty members because of its special difficulties and restrictions. This study attempts to recognize the challenges of the ward round teaching through investigating the experiences of clinical teachers in 2011. Materials and Methods: This qualitative research is carried out through purposive sampling with maximum variation from among the clinical teachers of major departments in Isfahan University of Medical Sciences (9 persons). The sampling continued until data saturation. Data were collected through semi-structured interview and analyzed through Collaizzi method. Data reliability and validity was confirmed through the four aspects of Lincoln and Guba method (credibility, conformability, transferability, and dependability). Results: Three major themes and their related sub-themes (minor themes) were found out including the factors related to the triad of clinical teaching (patient, learner, and clinical teacher) (concern about patient's welfare, poor preparation, lack of motivation, ethical problems), factors related to the educational environment (stressful environment, humiliating environment and poor communication) and the factors related to the educational system of the clinical environment (poor organizing and arrangement of resources, poor system's monitoring, bad planning and inadequate resource). Conclusion: Ward round teaching has many concerns for teachers, and this should be recognized and resolved by authorities and teachers. If these problems are not resolved, it would affect the quality of clinical teaching. PMID:26109975

  9. Evaluation of the biological efficacy of hydrogen peroxide vapour decontamination in wards of an Australian hospital.

    PubMed

    Chan, H-T; White, P; Sheorey, H; Cocks, J; Waters, M-J

    2011-10-01

    This study assessed the efficacy of a 'dry' hydrogen peroxide vapour decontamination in an Australian hospital via a two-armed study. The in vivo arm examined the baseline bacterial counts in high-touch zones within wards and evaluated the efficacy of cleaning with a neutral detergent followed by either hydrogen peroxide vapour decontamination, or a manual terminal clean with bleach or Det-Sol 500. The in vitro arm examined the efficacy of hydrogen peroxide vapour decontamination on a variety of different surfaces commonly found in the wards of an Australian hospital, deliberately seeded with a known concentration of vancomycin-resistant enterococci (VRE). All bacterial counts were evaluated by a protocol of contact plate method. In the in vivo arm, 33.3% of the high-touch areas assessed had aerobic bacterial count below the detection limit (i.e. no bacteria recoverable) post hydrogen peroxide decontamination, and in all circumstances the highest microbial density was ?3 cfu/cm(2), while in the in vitro arm there was at least a reduction in bacterial load by a factor of 10 at all surfaces investigated. These results showed that dry hydrogen peroxide vapour room decontamination is highly effective on a range of surfaces, although the cleanliness data obtained by these methods cannot be easily compared among the different surfaces as recovery of organisms is affected by the nature of the surface. PMID:21824681

  10. Between-ward disparities in colorectal cancer incidence and screening in Washington DC.

    PubMed

    Chatterjee, Sharmila; Chattopadhyay, Amit; Levine, Paul H

    2015-12-01

    This study aims to investigate the incidence and determinants of colorectal cancer (CRC) and its screening in District of Columbia (DC), and identify modifiable risk factors. Data (2000-2009) from the DC Cancer Registry, Behavioral Risk Factor Surveillance System (BRFSS-DC) and Surveillance Epidemiology and End Results (SEER) were used to estimate CRC incidence in eight DC Wards. Risk factors and CRC screening were analyzed using uni-, bi-, and multivariable statistical methods with survey procedures in SAS (version 9.2) including binary, unconditional multivariable logistic regression analysis. Factors measured included stage of diagnosis, age, gender, race/ethnicity, smoking, alcohol, exercise, body weight, health insurance, education, employment, and income. Over the study time, CRC screening increased from 48.4% to 68.6%. Mean age at diagnosis was 67years. CRC incidence is high in DC. Furthermore, CRC incidence rates in DC below 50years age were higher than the SEER18 average. Disparities exist between CRC incidence and screening among DC Wards. Identified risk factors for CRC are smoking, obesity, and low physical activity; screening was less prevalent among the uninsured and low socio-economic group. Local variations in CRC occurrence exist and may vary from average national experiences. Identification of local regions which vary from national trends in disease occurrence is important for comprehensive understanding of the disease in the community. PMID:26344423

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

    PubMed Central

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

    2014-01-01

    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. PMID:25028569

  12. Medication communication through documentation in medical wards: knowledge and power relations.

    PubMed

    Liu, Wei; Manias, Elizabeth; Gerdtz, Marie

    2014-09-01

    Health professionals communicate with each other about medication information using different forms of documentation. This article explores knowledge and power relations surrounding medication information exchanged through documentation among nurses, doctors and pharmacists. Ethnographic fieldwork was conducted in 2010 in two medical wards of a metropolitan hospital in Australia. Data collection methods included participant observations, field interviews, video-recordings, document retrieval and video reflexive focus groups. A critical discourse analytic framework was used to guide data analysis. The written medication chart was the main means of communicating medication decisions from doctors to nurses as compared to verbal communication. Nurses positioned themselves as auditors of the medication chart and scrutinised medical prescribing to maintain the discourse of patient safety. Pharmacists utilised the discourse of scientific judgement to guide their decision-making on the necessity of verbal communication with nurses and doctors. Targeted interdisciplinary meetings involving nurses, doctors and pharmacists should be organised in ward settings to discuss the importance of having documented medication information conveyed verbally across different disciplines. Health professionals should be encouraged to proactively seek out each other to relay changes in medication regimens and treatment goals. PMID:23822212

  13. Safewards: a new model of conflict and containment on psychiatric wards.

    PubMed

    Bowers, L

    2014-08-01

    Conflict (aggression, self-harm, suicide, absconding, substance/alcohol use and medication refusal) and containment (as required medication, coerced intramuscular medication, seclusion, manual restraint, special observation, etc.) place patients and staff at risk of serious harm. The frequency of these events varies between wards, but there are few explanations as to why this is so, and a coherent model is lacking. This paper proposes a comprehensive explanatory model of these differences, and sketches the implications on methods for reducing risk and coercion in inpatient wards. This Safewards Model depicts six domains of originating factors: the staff team, the physical environment, outside hospital, the patient community, patient characteristics and the regulatory framework. These domains give risk to flashpoints, which have the capacity to trigger conflict and/or containment. Staff interventions can modify these processes by reducing the conflict-originating factors, preventing flashpoints from arising, cutting the link between flashpoint and conflict, choosing not to use containment, and ensuring that containment use does not lead to further conflict. We describe this model systematically and in detail, and show how this can be used to devise strategies for promoting the safety of patients and staff. PMID:24548312

  14. Constructing and evaluating a validity argument for the final-year ward simulation exercise.

    PubMed

    Till, Hettie; Ker, Jean; Myford, Carol; Stirling, Kevin; Mires, Gary

    2015-12-01

    The authors report final-year ward simulation data from the University of Dundee Medical School. Faculty who designed this assessment intend for the final score to represent an individual senior medical student's level of clinical performance. The results are included in each student's portfolio as one source of evidence of the student's capability as a practitioner, professional, and scholar. Our purpose in conducting this study was to illustrate how assessment designers who are creating assessments to evaluate clinical performance might develop propositions and then collect and examine various sources of evidence to construct and evaluate a validity argument. The data were from all 154 medical students who were in their final year of study at the University of Dundee Medical School in the 2010-2011 academic year. To the best of our knowledge, this is the first report on an analysis of senior medical students' clinical performance while they were taking responsibility for the management of a simulated ward. Using multi-facet Rasch measurement and a generalizability theory approach, we examined various sources of validity evidence that the medical school faculty have gathered for a set of six propositions needed to support their use of scores as measures of students' clinical ability. Based on our analysis of the evidence, we would conclude that, by and large, the propositions appear to be sound, and the evidence seems to support their proposed score interpretation. Given the body of evidence collected thus far, their intended interpretation seems defensible. PMID:25808311

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

    SciTech Connect

    Schneider, J.; O'Conner, J.V.; Wade, C.; Chang, F.M. )

    1992-01-01

    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.

  16. An evaluation of a formative assessment process used on post take ward rounds.

    PubMed

    Caldwell, G

    2013-01-01

    The purpose of clinical training is to develop doctors capable of delivering professional, personal, effective, high quality, safe clinical care with Intelligent Kindness. The processes supporting training must promote development towards excellence. In 2004 a formative assessment process for use on medical post take ward rounds was introduced based on a model of a Driving Instructor and Learner Driver. This process has been evaluated in comparison with the Case based Discussion (CbD) and mini-Cex by 140 of 369 trainees, using online surveys. Ten trainees were interviewed in depth. The majority of trainees reported that this process had helped them more in their development as doctors than the CbD or mini-CEX. Trainees were able to describe positive effects in areas such as diagnosis, prescribing and confidence in their work. In the NHS the assessments are meant to be "trainee driven", however all but one of the trainees stated that they preferred the routine provision of an assessment to having to ask for an assessment. This evaluation of a truly formative assessment process shows that the trainees benefit in their progression towards clinical excellence. Effective formative feedback can be provided on an Acute Medical Unit even within the constraints of busy post take ward rounds. Within a team of Consultants one should be allowed time to develop an extended Clinical Supervisor role. PMID:24364051

  17. Evaluation of parenteral nutritional support in the surgical and medical wards of a referral teaching hospital

    PubMed Central

    2012-01-01

    Background and purpose Malnutrition is a common problem in patients who are hospitalized in surgical and medical wards. Surgical patients, geriatric populations and individuals with severe illness are more vulnerable to malnutrition during their hospitalization course. The purpose of this study was evaluation of parenteral nutrition services in a referral teaching hospital, Tehran, Iran. Method Medical records of 72 patients who received parenteral nutrition during one year period in different surgical and medical wards of Imam Khomeini hospital were reviewed retrospectively by clinical pharmacists. Criteria for initiation of parenteral nutrition, selection of appropriate formulation and monitoring parameters were assessed based on the American Society of Parenteral and Enteral Nutrition recommendations. Results Based on the patients' anthropometric parameters and serum albumin levels, 4.2%, 75% and 20.8% of the patients were well-nourished, moderately malnourished and severely malnourished respectively at the hospital admission and before nutritional support. Adequate calorie, protein, carbohydrate and lipid supports were achieved in 21.1%, 32.4%, 23.7% and 10.5% of the patients respectively. About 91% of the patients experienced at least one complication of the nutritional support. Conclusion In this evaluation, several errors in assessment, establishing goals, and monitoring of parenteral nutrition regimens have been detected. Approximately all of the patients did not receive to the trace elements supports goals. PMID:23351175

  18. Bottom-up regulation of a pole-ward migratory predator population

    PubMed Central

    van den Hoff, John; McMahon, Clive R.; Simpkins, Graham R.; Hindell, Mark A.; Alderman, Rachael; Burton, Harry R.

    2014-01-01

    As the effects of regional climate change are most pronounced at polar latitudes, we might expect polar-ward migratory populations to respond as habitat suitability changes. The southern elephant seal (Mirounga leonina L.) is a pole-ward migratory species whose populations have mostly stabilized or increased in the past decade, the one exception being the Macquarie Island population which has decreased continuously over the past 50 years. To explore probable causes of this anomalous trend, we counted breeding female seals annually between 1988 and 2011 in order to relate annual rates of population change (r) to foraging habitat changes that have known connections with atmospheric variability. We found r (i) varied annually from −0.016 to 0.021 over the study period, (ii) was most effected by anomalous atmospheric variability after a 3 year time lag was introduced (R = 0.51) and (iii) was associated with sea-ice duration (SID) within the seals’ foraging range at the same temporal lag. Negative r years may be extrapolated to explain, at least partially, the overall trend in seal abundance at Macquarie Island; specifically, increasing SID within the seals foraging range has a negative influence on their abundance at the island. Evidence is accruing that suggests southern elephant seal populations may respond positively to a reduced sea-ice field. PMID:24619437

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

    PubMed Central

    2012-01-01

    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. PMID:23153062

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

    PubMed

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

    2005-07-01

    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

  1. Four Simple Ward Based Initiatives to Reduce Unnecessary In-Hospital Patient Stay: A Quality Improvement Project.

    PubMed

    Shabbir, Asad; Wali, Gorav; Steuer, Alan

    2015-01-01

    Prolonged hospital stay not only increases financial stress on the National Health Service but also exposes patients to an unnecessarily high risk of adverse ward events. Each day accumulates approximately Ł225 in bed costs with additional risks of venousthromboembolism, hospital acquired infections, prescription errors, and falls. Despite being medically fit for discharge (MFFD), patients awaiting care packages with prolonged length of stay (LoS) have poorer outcomes and experience increased rates of mortality as a result. A six cycle prospective audit was carried out to investigate if four simple ward based initiatives could optimise patient flow through a medical ward and reduce LoS of inpatients awaiting social packages and placement. The four daily initiatives were: A morning board round between nurses and doctors to prioritise new or sick patients for early review.A post ward round meeting between the multidisciplinary team to expedite rehabilitation and plan discharges early.An evening board round to highlight which patients needed discharge paperwork for the next day to alleviate the wait for pharmacy.A 'computer on wheels' on ward rounds so investigations could be ordered and reviewed at the bedside allowing more time to address patient concerns. A control month in August 2013 and five intervention cycles were completed between September 2013 and January 2014. Prior to intervention, mean time taken for patients to be discharged with a package of care, once declared MFFD, was 25 days. With intervention this value dropped to 1 day. The total LoS fell from 46 days to 16 days. It was also found that the time taken from admission to MFFD status was reduced from 21 days to 15 days. In conclusion this data shows that with four simple modifications to ward behaviour unnecessary inpatient stay can be significantly reduced. PMID:26734432

  2. Nosocomial Outbreak of Salmonella enterica Serovar Typhimurium Primarily Affecting a Pediatric Ward in South Africa in 2012

    PubMed Central

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

    2014-01-01

    We describe a nosocomial outbreak of diarrheal disease caused by extended-spectrum ÎČ-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

  3. Differences in distribution and drug sensitivity of pathogens in lower respiratory tract infections between general wards and RICU

    PubMed Central

    He, Ruoxi; Luo, Bailing; Hu, Chengping; Li, Ying

    2014-01-01

    Background Lower respiratory tract infections (LRTIs) are common among patients in hospitals worldwide, especially in patients over the age of 60. This study investigates the differences in distribution and drug sensitivity of pathogens in LRTIs. Methods The clinical and laboratory data of 4,762 LRTI patients in the general ward and respiratory intensive care unit (RICU) of Xiangya Hospital (Changsha) were retrospectively analyzed. Results The infection rate of Gram-negative bacteria was significantly higher than that of Gram-positive bacteria in both the general ward and RICU (P<0.05). The incidence of Gram-negative bacteria infection was significantly higher in the RICU than in the general ward (P<0.05), whereas the incidence of Gram-positive bacteria infection is less in the RICU than in the general ward (P<0.05). In the general ward, the incidence of Gram-negative bacteria infection significantly increased (P<0.05) over time, whereas the incidence of Gram-positive bacteria infection significantly decreased from 1996 to 2011 (P<0.05). In the RICU, the incidence of Gram-positive bacteria infection decreased, while Gram-negative bacteria infections increased without statistical significance (P>0.05). Staphylococcus pneumoniae and Staphylococcus aureus were found to be the predominant Gram-positive strains in the general ward (34.70-41.18%) and RICU (41.66-54.87%), respectively (P>0.05). Pseudomonas aeruginosa and Acinetobacter baumannii were the predominant gram negative strains in the general ward (19.17-21.09%) and RICU (29.60-33.88%), respectively (P>0.05). Streptococcus pneumoniae is sensitive to most antibiotics with a sensitivity of more than 70%. Staphylococcus aureus is highly sensitive to vancomycin (100%), linezolid (100%), chloramphenicol (74.36-82.19%), doxycycline (69.57-77.33%), and sulfamethoprim (67.83-72.46%); however, its sensitivity to other antibiotics is low and decreased each year. Sensitivity of Pseudomonas aeruginosa to most ?-lactam, aminoglycoside, and quinolone group antibiotics decreased each year. Conclusions The distribution and drug sensitivity of LRTI pathogens exhibit a high divergence between the general ward and RICU. Streptococcus pneumoniae may not be the predominant pathogen in LRTIs in some areas of China. PMID:25364517

  4. Nursing and midwife staffing needs in maternity wards in Burkina Faso referral hospitals

    PubMed Central

    2014-01-01

    Background In 2006, Burkina Faso set up a policy to subsidize the cost of obstetric and neonatal emergency care. This policy has undoubtedly increased attendance at all levels of the health pyramid. The aim of this study was to measure the capacity of referral hospitals’ maternity services to cope with the demand for health services after the implementation of this policy. Methods This study was conducted in three referral health centres (CMAs, CHRs, and CHUs). The CHU Yalgado Ouédraogo (tertiary level) and the CMA in Sector 30 (primary level) were selected as health facilities in the capital, along with the Kaya CHR (secondary level). At each health facility, the study included official maternity ward staff only. We combined the two occupational categories (nurses and midwives) because they perform the same activities in these health facilities. We used the WISN method recommended by WHO to assess the availability of nurses and midwives. Results Nurses and midwives represented 38% of staff at the University Hospital, 65% in the CHR and 80% in the CMA. The number of nurses and midwives needed for carrying out the activities in the maternity ward in the University Hospital and the CMA is greater than the current workforce, with WISN ratio of 0.68 and 0.79 respectively. In the CHR, the current workforce is greater than the number required (WISN ratio = 2). This medical centre is known for performing a high number curative and preventive activities compared to the Kaya CHR. Like the CHU, the delivery room is a very busy unit. This activity requires more time and more staff compared to other activities. Conclusion This study showed a shortage of nurses and midwives in two health facilities in Ouagadougou, which confirms that there is considerable demand. At the Kaya CHR, there is currently enough staff to handle the workload in the maternity ward, which may indicate a need to expand the analysis to other health facilities to determine whether a redistribution of health human resources is warranted. PMID:25860077

  5. Prediction of mortality in patients in acute medical wards using basic laboratory and anthropometric data.

    PubMed Central

    Woo, J.; Mak, Y. T.; Lau, J.; Swaminathan, R.

    1992-01-01

    The value of anthropometric and biochemical indices in predicting short-term mortality among patients in general medical wards was assessed in 294 patients admitted consecutively to a district hospital over a one month period. Using a stepwise logistic regression model and supported by the linear discriminant analysis method, mortality within 3 months could be predicted with sensitivity of 83% and specificity of 84% using the following variables: sex, functional ability, urea, total protein, alkaline phosphatase and albumin-adjusted calcium. Addition of anthropometric values and biochemical nutritional indices did little to improve the accuracy of the prediction, contrary to previous findings among surgical patients and elderly residents of long-term care institutions. PMID:1494524

  6. An analysis of population and social change in London wards in the 1980s.

    PubMed

    Congdon, P

    1989-01-01

    "This paper discusses the estimation and projection of small area populations in London, [England] and considers trends in intercensal social and demographic indices which can be calculated using these estimates. Information available annually on vital statistics and electorates is combined with detailed data from the Census Small Area Statistics to derive demographic component based population estimates for London's electoral wards over five year periods. The availability of age disaggregated population estimates permits derivation of small area social indicators for intercensal years, for example, of unemployment and mortality. Trends in spatial inequality of such indicators during the 1980s are analysed and point to continuing wide differentials. A typology of population and social indicators gives an indication of the small area distribution of the recent population turnaround in inner London, and of its association with other social processes such as gentrification and ethnic concentration." PMID:12282380

  7. W-infinity ward identities and correlation functions in the c = 1 matrix model

    SciTech Connect

    Das, S.R.; Dhar, A.; Mandal, G.; Wadia, S.R. )

    1992-04-10

    In this paper, the authors explore consequences of W-infinity symmetry in the fermionic field theory of the c = 1 matrix model. The authors derive exact Ward identities relating correlation functions of the bilocal operator. These identities can be expressed as equations satisfied by the effective action of a three-dimensional theory and contain non-perturbative information about the model. The authors use thee identities to calculate the two-point function of the bilocal operator in the double scaling limit. The authors extract the operator whose two-point correlator has a single pole at an (imaginary) integer value of the energy. The authors then rewrite the W-infinity charges in terms of operators in the matrix model and use this to derive constraints satisfied by the partition function of the matrix model with a general time dependent potential.

  8. [Hygiene and motivation factors of nursing work in a cardiology ward].

    PubMed

    Somense, Carolina Bueno; Duran, Erika Christiane Marocco

    2014-09-01

    The present study aimed to identify hygienic and motivational factors in the nursing work according to the Two-Factor Theory, as well as their relation with professional satisfaction/dissatisfaction. This exploratory-descriptive study involved nine nurses from the cardiology ward of a hospital in the interior of the State of Săo Paulo, between August and September 2013. A self-applied questionnaire was used, including open and closed questions. The data were categorized as hygienic and motivational. Results show the nurses' satisfaction with autonomy, work itself and teamwork, duties, content and responsibilities of the job. Dissatisfaction is related to career growth possibilities; work, political and administrative conditions at the institution, supervision and lack of institutional support. Satisfaction and dissatisfaction factors include relationships, acknowledgements and remuneration. Nurses' satisfaction is determined by multiple and often controversial factors. PMID:25508624

  9. [Hygiene and motivation factors of nursing work in a cardiology ward].

    PubMed

    Somense, Carolina Bueno; Duran, Erika Christiane Marocco

    2014-09-01

    The present study aimed to identify hygienic and motivational factors in the nursing work according to the Two-Factor Theory, as well as their relation with professional satisfaction/dissatisfaction. This exploratory-descriptive study involved nine nurses from the cardiology ward of a hospital in the interior of the State of Săo Paulo, between August and September 2013. A self-applied questionnaire was used, including open and closed questions. The data were categorized as hygienic and motivational. Results show the nurses' satisfaction with autonomy, work itself and teamwork, duties, content and responsibilities of the job. Dissatisfaction is related to career growth possibilities; work, political and administrative conditions at the institution, supervision and lack of institutional support. Satisfaction and dissatisfaction factors include relationships, acknowledgements and remuneration. Nurses' satisfaction is determined by multiple and often controversial factors. PMID:25474845

  10. Anti-anxiety activity studies of various extracts of Turnera aphrodisiaca Ward.

    PubMed

    Kumar, Suresh; Sharma, Anupama

    2005-01-01

    Turnera aphrodisiaca Ward (Turneraceae) has been used traditionally for treatment of anxiety neurosis and as an aphrodisiac. Yet, the plant has never been subjected to systematic biological investigation. In the present investigation, petroleum ether (60-80 degrees C), chloroform, methanol, and water extracts of T. aphrodisiaca aerial parts were evaluated for anti-anxiety activity in mice using elevated plus-maze apparatus. Among all the extracts, only methanol exhibited significant anti-anxiety activity at a dose of 25 mg/kg with respect to control as well as standard (diazepam, 2 mg/kg). The bioactive methanol extract was shaken with petroleum ether, chloroform, and n-butyl alcohol, and all the shakings as well as the remaining methanol extract (RME) were further evaluated for anxiolytic activity. Butanol fraction and RME were found to exhibit anxiolytic activity in mice at the dose of 10 mg/kg and 75 mg/kg, respectively. PMID:16635964

  11. Comparison of automatic oscillometric arterial pressure measurement with conventional auscultatory measurement in the labour ward.

    PubMed

    Hasan, M A; Thomas, T A; Prys-Roberts, C

    1993-02-01

    We have compared two non-invasive methods of arterial pressure (AP) measurement used in labour wards: an automatic oscillometric measurement obtained by Dinamap 1846, and a conventional auscultatory measurement obtained by midwives. A total of 369 AP measurements were recorded, involving 28 normotensive and hypertensive pregnant women during labour, with or without extradural analgesia. Compared with the midwife group, the Dinamap group had a greater systolic AP, by 2.7 mm Hg (P < 0.01) and smaller diastolic AP, by 9.8 mm Hg (P < 0.01). The correlations between the two methods were highly significant, but the limits of agreement were relatively wide for both systolic and diastolic AP measurements. We conclude that a clinically important difference exists in diastolic AP measurements. Dinamap diastolic AP must be corrected using a regression equation, or simply by adding 10 mm Hg, before being compared with the available normal and hypertensive AP values. PMID:8435255

  12. Warding off the evil eye: when the fear of being envied increases prosocial behavior.

    PubMed

    van de Ven, Niels; Zeelenberg, Marcel; Pieters, Rik

    2010-11-01

    The fear of being envied makes people act prosocially, in an attempt to ward off the potentially destructive effects of envy. In three experiments, people who were in a superior position and could be envied were more likely than control participants to give time-consuming advice to a potentially envious person or to help a potentially envious person pick up erasers she had accidentally scattered. However, helping behavior increased only if envy was likely to be malicious rather than benign. People who were better off did not increase their helping behavior toward people in general, but increased their helping only toward the potentially envious. This finding is consistent with the idea that the better off act more prosocially as an appeasement strategy. The fear of being envied serves useful group functions, because it triggers prosocial behavior that is likely to dampen the potentially destructive effects of envy and simultaneously helps to improve the situation of people who are worse off. PMID:20889930

  13. Improved aseptic technique can reduce variable contamination rates of ward-prepared parenteral doses.

    PubMed

    Austin, P; Elia, M

    2013-02-01

    Aseptic techniques are required to manipulate central venous lines and prepare intravenous doses. This study aimed to examine whether different aseptic techniques affect the contamination rates of intravenous doses prepared on hospital wards. Syringes of tryptic soy broth test media prepared by one pharmacy operator and five nurses were assessed for contamination. The pharmacy operator achieved lower contamination than the nurses (0.0% vs 6.9%; Fisher's exact test, P < 0.001). Contamination differed significantly between nurses (?2-17% of syringes; binary logistic regression, P = 0.018). In conclusion, appropriate training and experience in aseptic techniques should be embedded into routine clinical practice to reduce contamination rates. PMID:23313030

  14. [When should a patient with abdominal pain be referred to the emergency ward?].

    PubMed

    de Saussure, Wassila Oulhaci; Andereggen, Elisabeth; Sarasin, François

    2010-08-25

    When should a patient with abdominal pain be referred to the emergency ward? The following goals must be achieved upon managing patients with acute abdominal pain: 1) identify vital emergency situations; 2) detect surgical conditions that require emergency referral without further diagnostic procedures; 3) in "non surgical acute abdomen patients" perform appropriate diagnostic procedures, or in selected cases delay tests and reevaluate the patient after an observation period, after which a referral decision is made. Clues from the history and physical examination are critical to perform this evaluation. A good knowledge of the most frequent acute abdominal conditions, and identifying potential severity criteria allow an appropriate management and decision about emergency referral. PMID:20873434

  15. Quality of bedside teaching in internal wards of Qaem and Imam Reza hospitals in Mashhad

    PubMed Central

    Jamaazghandi, Alireza; Emadzadeh, Ali; Vakili, Vida; Bazaz, Seyed Mojtaba Mousavi

    2015-01-01

    Background: Bedside teaching is a patient-based teaching method in medical education. The present study has been conducted with the aim of investigating the quality of bedside teaching in the internal wards of Qaem and Imam Reza Educational Hospitals. Methods: This study follows a mixed qualitative-quantitative approach using checklists on educational clinical rounds in Imam Reza and Qaem Hospitals in Mashhad. In the first stage consisting of qualitative study, the parts related to the quality of bedside teaching were recognized and a checklist was designed in three domains of patient comfort (8 questions), targeted teaching (14 questions) and group dynamics (8 questions), and its reliability and validity were verified. In the next step, data were collected and then analyzed using SPSS 16 software through statistical techniques of independent t-test, one-way ANOVA and variance analysis. Results: In total, 113 educational rounds were investigated in this study. Among them, 59 (52.2%) and 54 (47.8%) educational rounds have been investigated in Imam Reza and Qaem Hospitals, respectively. The average total score of bedside teaching was 180.8 out of 300 in the internal wards of both Imam Reza and Qaem Hospitals. Conclusion: The results of this study showed that generally the quality of bedside teaching in Imam Reza and Qaem Hospitals of Mashhad is low according to the qualitative standards considered in this study. Holding educational workshops along with more familiarity of the professors with effective bedside teaching strategies could be effective in improving the quality of educational rounds. PMID:26396735

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

    PubMed Central

    Giraldo, Nubia Amparo; Aguilar, Nora Luz; Restrepo, Beatriz Elena; Vanegas, Marcela; Alzate, Sandra; Martínez, Mónica; Gamboa, Sonia Patricia; Castańo, Eliana; Barbosa, Janeth; Román, Juliana; Serna, Ángela María; Hoyos, Gloria Marcela

    2012-01-01

    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. PMID:24893056

  17. Non-Invasive Continuous Respiratory Monitoring on General Hospital Wards: A Systematic Review

    PubMed Central

    van Loon, Kim; van Zaane, Bas; Bosch, Els J.; Kalkman, Cor J.; Peelen, Linda M.

    2015-01-01

    Background Failure to recognize acute deterioration in hospitalized patients may contribute to cardiopulmonary arrest, unscheduled intensive care unit admission and increased mortality. Purpose In this systematic review we aimed to determine whether continuous non-invasive respiratory monitoring improves early diagnosis of patient deterioration and reduces critical incidents on hospital wards. Data Sources Studies were retrieved from Medline, Embase, CINAHL, and the Cochrane library, searched from 1970 till October 25, 2014. Study Selection Electronic databases were searched using keywords and corresponding synonyms ‘ward’, ‘continuous’, ‘monitoring’ and ‘respiration’. Pediatric, fetal and animal studies were excluded. Data Extraction Since no validated tool is currently available for diagnostic or intervention studies with continuous monitoring, methodological quality was assessed with a modified tool based on modified STARD, CONSORT, and TREND statements. Data Synthesis Six intervention and five diagnostic studies were included, evaluating the use of eight different devices for continuous respiratory monitoring. Quantitative data synthesis was not possible because intervention, study design and outcomes differed considerably between studies. Outcomes estimates for the intervention studies ranged from RR 0.14 (0.03, 0.64) for cardiopulmonary resuscitation to RR 1.00 (0.41, 2.35) for unplanned ICU admission after introduction of continuous respiratory monitoring, Limitations The methodological quality of most studies was moderate, e.g. ‘before-after’ designs, incomplete reporting of primary outcomes, and incomplete clinical implementation of the monitoring system. Conclusions Based on the findings of this systematic review, implementation of routine continuous non-invasive respiratory monitoring on general hospital wards cannot yet be advocated as results are inconclusive, and methodological quality of the studies needs improvement. Future research in this area should focus on technology explicitly suitable for low care settings and tailored alarm and treatment algorithms. PMID:26658343

  18. Physician experience and outcomes among patients admitted to general internal medicine teaching wards

    PubMed Central

    McAlister, Finlay A.; Youngson, Erik; Bakal, Jeffrey A.; Holroyd-Leduc, Jayna; Kassam, Narmin

    2015-01-01

    Background: Physician scores on examinations decline with time after graduation. However, whether this translates into declining quality of care is unknown. Our objective was to determine how physician experience is associated with negative outcomes for patients admitted to hospital. Methods: We conducted a retrospective cohort study involving all patients admitted to general internal medicine wards over a 2-year period at all 7 teaching hospitals in Alberta, Canada. We used files from the Alberta College of Physicians and Surgeons to determine the number of years since medical school graduation for each patient’s most responsible physician. Our primary outcome was the composite of in-hospital death, or readmission or death within 30 days postdischarge. Results: We identified 10 046 patients who were cared for by 149 physicians. Patient characteristics were similar across physician experience strata, as were primary outcome rates (17.4% for patients whose care was managed by physicians in the highest quartile of experience, compared with 18.8% in those receiving care from the least experienced physicians; adjusted odds ratio [OR] 0.88, 95% confidence interval [CI] 0.72–1.06). Outcomes were similar between experience quartiles when further stratified by physician volume, most responsible diagnosis or complexity of the patient’s condition. Although we found substantial variability in length of stay between individual physicians, there were no significant differences between physician experience quartiles (mean adjusted for patient covariates and accounting for intraphysician clustering: 7.90 [95% CI 7.39–8.42] d for most experienced quartile; 7.63 [95% CI 7.13–8.14] d for least experienced quartile). Interpretation: For patients admitted to general internal medicine teaching wards, we saw no negative association between physician experience and outcomes commonly used as proxies for quality of inpatient care. PMID:26283716

  19. Drug-related problems in medical wards of Tikur Anbessa specialized hospital, Ethiopia

    PubMed Central

    Ayalew, Mohammed Biset; Megersa, Teshome Nedi; Mengistu, Yewondwossen Taddese

    2015-01-01

    Objective: This study was aimed to determine the prevalence of drug-related problems (DRPs), identify the most common drugs, and drug classes involved in DRPs as well as associated factors with the occurrence of DRPs. Methods: A prospective cross-sectional study was conducted on 225 patients admitted to medical wards of Tikur Anbessa Specialized Hospital, Addis Ababa from March to June 2014. Data regarding patient characteristics, medications, diagnosis, length of hospitalization, investigation, and laboratory results were collected using data abstraction forms through review of patients’ medical card and medication charts. Identified DRPs were recorded and classified using DRP registration forms. The possible intervention measures for the identified DRPs were proposed and communicated to either the physician or the patient. Data were entered into Epi Info 7 and analyzed using SPSS version 21 (IBM Corp. Released 2012, Armonk, NY: IBM Corp). Findings: DRPs were found in 52% of study subjects. A drug-drug interaction (48% of all DRPs) was the most common DRP followed by adverse drug reaction (23%). Anti-infectives and gastrointestinal medicines were commonly involved in DRPs. Drugs with the highest drug risk ratio were gentamycin, warfarin, nifedipine, and cimetidine. The number of drugs taken by the patient per day is an important risk factor for DRPs. Conclusion: DRPs are common among medical ward patients. Polypharmacy has a significant association with the occurrence of DRP. Drugs such as gentamycin, warfarin, nifedipine, and cimetidine have the highest probability of causing DRP. So, patients who are taking either of these drugs or polypharmacy should be closely assessed for identification and timely correction of DRPs. PMID:26645029

  20. Evaluation of Potential Drug - Drug Interactions in General Medicine Ward of Teaching Hospital in Southern India

    PubMed Central

    Ahmad, Akram; Khan, Muhammad Umair; Ivan, Rahul; Dasari, Ram; Revanker, Megha; Pravina, A.; Kuriakose, Sheetal

    2015-01-01

    Background: Polypharmacy is considered as one of the major risk factors in precipitation of drug-drug interactions (DDIs). Patient population at high risk include the elderly and patients with co morbidities as they are usually prescribed with more number of drugs. Critical evaluation of such prescriptions by pharmacist could result in identification and reduction of such problems. Objective: The study aims to assess the prevalence, severity and significance of potential DDI (pDDI) in general medicine wards of South Indian tertiary care teaching hospital. Materials and Method: A prospective observational study was conducted in a general medicine ward for a period of six months (September 2012 to February 2013). The socio-demographic, clinical characteristics and medication prescribed was documented in a specially designed form. Analysis was carried out to assess the prevalence, severity and significance of identified pDDIs using Micromedex. Descriptive and Univariate analysis were used to report the findings. Results: A total of 404 case records reviewed, 78 (19.3%) patients had pDDIs. A total of 139 (34.4%) pDDIs were reported during the study period. Majority (53.95%, n=75) of the interactions were moderate in intensity and significant in nature (53.23%, n=74). Positive association between number of pDDIs and age was observed. Conclusion: The prevalence of pDDIs was 19.3% which is lesser then previously reported studies from India. Patient with more co-morbidities and elders were observed with more pDDIs. The study highlighted the need to effectively monitor and patients prevent pDDIs to improve patient safety. PMID:25859467

  1. Evaluation of Nosocomial Infection in Patients at hematology-oncology ward of Dr. Sheikh children’s hospital

    PubMed Central

    Ghassemi, A; Farhangi, H; Badiee, Z; Banihashem, A; Mosaddegh, MR

    2015-01-01

    Background Infections in critical care unit are high, and they are serious hospital problems. Infections acquired during the hospital stay are generally called nosocomial infections, initially known as infections arising after 48 h of hospital admission. The mostfrequent nosocomial infections (urinary, respiratory, gastroenteritis and blood stream infection) were common in patients at hospital.The aim was to study, the current status of nosocomial infection, rate of infection among hospitalized children at hematology-oncology ward of Dr. Sheikh children’s hospital, Mashhad, Iran. Materials and Methods Data were collected from 200 patient's records presented with symptoms of nosocomial infection at hematology-oncology ward of Dr. Sheikh children’s hospital from March 2014 to September 2014. Descriptive statistics using percentage was calculated. Results Incidence of nosocomial infections inpatients athematology-oncology ward was 31% (62/200). Of which 69.35% (43/62) blood stream infection being the most frequent; followed by 30.64% (19/62) was urinary tract infection (UTI), and the most common blood culture isolate was been Staphylococcus epidermidis 18 (41.86%), andour study showed that large numbers ofnosocomial UTIs causing by Gram‑negative bacteria. Conclusion This study showed blood stream infection and UTI are the common nosocomial infections among patients athematology-oncology ward. Early recognition of infections and short term use of invasive devices along with proper infection control procedures can significantly decrease the incidence of nosocomial infections in patients. PMID:26985350

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

    ERIC Educational Resources Information Center

    Beasley, James P.

    2007-01-01

    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…

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

    PubMed

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

    2014-03-01

    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

  4. Pathways to Sexual Offense Recidivism Following Treatment: An Examination of the Ward and Hudson Self-Regulation Model of Relapse

    ERIC Educational Resources Information Center

    Webster, Stephen D.

    2005-01-01

    Ward and Hudson (1998, 2000) proposed a self-regulation model of relapse in sexual offenders, which classifies offenders into one of four pathways. This study examined the validity of the model, whether sexual recidivists are characterized by one predominant pathway and offense type, and whether participants would change pathway pre- to…

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

    ERIC Educational Resources Information Center

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

    2007-01-01

    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…

  6. Technical Report on Development of USES Specific Aptitude Test Battery for Ward Clerk (medical ser.) 219.388.

    ERIC Educational Resources Information Center

    Manpower Administration (DOL), Washington, DC.

    Research which resulted in the development of the Specific Aptitude Test Battery for use in selecting inexperienced or untrained individuals for training as ward clerks is described. Occupational norms in terms of minimum qualifying scores for the aptitude measures which predict job performance were established. The General Aptitude Test Battery…

  7. Pattern and Trend of Morbidity in the Infectious Disease Ward of North Bengal Medical College and Hospital

    PubMed Central

    Basak, Moumita; Chaudhuri, Sudip Banik; Ishore, Kaushik; Das, Dilip Kumar

    2015-01-01

    Background In spite of experiencing a large decline in the spread and burden of infectious diseases, the Global Burden of Disease Project suggests that about 30% of the disease burden in India is attributable to infections. The hospital data constitute a basic and primary source of information for continuous follow up of this changing pattern of morbidity and mortality. Aim To identify the pattern and trend of different infectious diseases among admissions in the Infectious Disease ward of North Bengal Medical College and Hospital. Materials and Methods Retrospective analysis of inpatient hospital database over 5 years period (January 2008 – December 2012) of Infectious Disease ward of North Bengal Medical College & Hospital. Results Among 3277 admissions in the Infectious Disease ward during 2008-12, diarrhoeal diseases (84.3%) were most common. The highest mortality was recorded for rabies cases (83.9%), followed by tetanus (32.6%) and diphtheria (27.3%). The majority cases of diphtheria (78.9%) and measles (53.1%) belonged to below 9 years age. Except the year 2010, there was a gradual rise in admissions from 2008 to 2012. Conclusion Review of hospital records provided information regarding the pattern of diseases but no definite trend among admissions in the infectious diseases ward. PMID:26674374

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

    PubMed Central

    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

    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. PMID:24265950

  9. [IMPORTANCE OF HEALTH CARE FOR THE ERADICATION OF TUBERCULOSIS--Efforts Implemented in Nishinari Ward, Osaka City].

    PubMed

    Matsumoto, Kenji

    2015-01-01

    1) Changes in the incidence rate of tuberculosis in Osaka City and Nishinari Ward. The incidence rate of tuberculosis among people living in Osaka City (per 100,000 people) was 41.5 (number of patients: 1,109) in 2011--an approximately 50% decrease from 82.6 in 2001. However, the figure is 2.3 times higher than the national incidence rate of tuberculosis (17.7), and the highest of all ordinance-designated cities and prefectures. Osaka City consists of 24 wards, and the incidence rate of tuberculosis varies from ward to ward. Although the incidence rate of tuberculosis in Nishinari Ward in 2011 was 199.6 (number of patients: 242) and the highest by far in the city, the figure is approximately 50% of the incidence rate in 2001 (405.9). There were two other wards with the incidence rate of 50.0 or higher, and the lowest incidence rate was 22.4. The incidence rate of tuberculosis in the Airin area of Nishinari Ward is particularly high. Although the number of newly registered patients decreased from 336 to 128 over the past ten years, and the incidence rate significantly decreased from 1,120.0 to 426.7 (when the population of the area was estimated to be 30,000), it is still 24.1 times higher than the national incidence rate. 2) Basic guidelines for tuberculosis strategy developed by Osaka City. Osaka City has developed basic guidelines for tuberculosis strategy to address patients with tuberculosis and eradicate the disease. The first and second periods of the basic guidelines for tuberculosis strategy were ten years from 2001 and 2011, respectively. The overall objective of these basic guidelines was to significantly reduce the incidence rate of tuberculosis, and numerical targets related to basic policies and specific activities were set to accomplish the goal. The basic guidelines allow Osaka City, including its public health centers, to implement measures against tuberculosis as a municipal project. 3) Assessment of the City's efforts. The measures were assessed on a regular basis at the committee on the assessment of measures for tuberculosis and analysis assessment review meetings, and, as the results, problems were identified and activities were further promoted and reviewed based on scientific evidence. 4) Important measures for patients with tuberculosis living in Nishinari Ward, Osaka City. In addition to the measures implemented by Osaka City, Nishinari Ward plans to improve the measures for the prevention of tuberculosis. 1. Although tuberculosis screening tests conducted in the Airin area have been effective for its early detection to some extent, the rate of identification of patients from 2007 to 2011 was still high (163/18,378). It is necessary to further promote tuberculosis screening. 2. Although the outcomes in general were improved by emphasizing drug administration guidance, there are still many homeless people with tuberculosis and patients who may stop taking drugs. The outcomes of these patients are poor, and, therefore, it is necessary to provide them with improved support. PMID:26979043

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

    NASA Astrophysics Data System (ADS)

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

    2010-12-01

    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.

  11. Workplace Learning: An analysis of students' expectations of learning on the ward in the Department of Internal Medicine

    PubMed Central

    Köhl-Hackert, Nadja; Krautter, Markus; Andreesen, Sven; Hoffmann, Katja; Herzog, Wolfgang; JĂŒnger, Jana; Nikendei, Christoph

    2014-01-01

    Background: Learning on the ward as a practice-oriented preparation for the future workplace plays a crucial role in the medical education of future physicians. However, students’ ward internship is partially problematic due to condensed workflows on the ward and the high workload of supervising physicians. For the first time in a German-speaking setting, students’ expectations and concerns about their internship on the ward are examined in a qualitative analysis regarding their internal medicine rotation within clinical medical education. Methods: Of a total of 168 medical students in their 6th semester at the Medical Faculty of Heidelberg, 28 students (m=8, f=20, Ø 23.6 years) took part in focus group interviews 3 to 5 days prior to their internship on the internal medicine ward within their clinical internal medicine rotation. Students were divided into four different focus groups. The protocols were transcribed and a content analysis was conducted based on grounded theory. Results: We gathered a total of 489 relevant individual statements. The students hope for a successful integration within the ward team, reliable and supportive supervisors and supervision in small groups. They expect to face the most common diseases, to train the most important medical skills, to assume full responsibility for their own patients and to acquire their own medical identity. The students fear an insufficient time frame to achieve their aims. They are also concerned they will have too little contact with patients and inadequate supervision. Conclusion: For the development and standardization of effective student internships, the greatest relevance should be attributed to guidance and supervision by professionally trained and well-prepared medical teachers, entailing a significant increase in staff and costs. A structural framework is required in order to transfer the responsibility for the treatment of patients to the students at an early stage in medical education and in a longitudinal manner. The data suggest that the development and establishment of guidelines for medical teachers associated with clearly defined learning objectives for the students’ internships are urgently needed. Based on our findings, we provide first recommendations and suggest possible solutions. PMID:25489343

  12. Factors Influencing Communication Between the Patients with Cancer and their Nurses in Oncology Wards

    PubMed Central

    Zamanzadeh, Vahid; Rassouli, Maryam; Abbaszadeh, Abbas; Nikanfar, Alireza; Alavi-Majd, Hamid; Ghahramanian, Akram

    2014-01-01

    Aims: The purpose of this study was to demonstrate the factors influencing nurse-patient communication in cancer care in Iran. Materials and Methods: This study was conducted with a qualitative conventional content analysis approach in oncology wards of hospitals in Tabriz. Data was collected through purposive sampling by semi-structured deep interviews with nine patients, three family members and five nurses and analyzed simultaneously. Robustness of data analysis was evaluated by the participants and external control. Results: The main theme of the research emerged as “three-factor effects” that demonstrates all the factors related to the patient, nurse, and the organization and includes three categories of “Patient as the center of communication”, “Nurse as a human factor”, and “Organizational structures”. The first category consists of two sub-categories of “Imposed changes by the disease” and the “patient's particular characteristics”. The second category includes sub-categories of “sense of vulnerability” and “perception of professional self: Pre-requisite of patient-centered communication”. The third category consists of the sub-categories of “workload and time imbalance”, “lack of supervision”, and “impose duties in context of neglecting nurse and patient needs”. Characteristics of the patients, nurses, and care environment seemed to be the influential factors on the communication. Conclusions: In order to communicate with cancer patients effectively, changes in philosophy and culture of the care environment are essential. Nurses must receive proper trainings which meet their needs and which focus on holistic and patient-centered approach. PMID:24600177

  13. [Patients with drug dependence can be treated in a ward for alcohol dependence on certain conditions].

    PubMed

    Naruse, Nobuya

    2009-04-01

    The treatment for drug dependence in Japan only focuses on detoxification and psychotic disorders, treatment facilities for this study are limited. My proposal for this problem is to improve this situation by having the alcohol treatment ward accept the drug dependency patients. However, drug dependency in-patient treatment has the following concerns, 1. Most patients have tendencies of violence. 2. Motivation and continuation of treatment by the patient is difficult. 3. Breaking rules and deviational conduct. 4. Disintegration of conduct. 5. Disorder of uniformity of group treatment. 6. Lack of specialized resources. In a response to these problems, I am presenting some techniques now on practice at Saitama Prefecture Psychiatric Hospital. Some of these important points are, 1. Building a treatment relationship before admission. 2. Establishing motivation before admission. 3. Stabilization of mental condition before admission. 4. Establishing an explanation and consensus about admission treatment. 5. Knowledge of the craving phase stage and its effects. 6. Devise the program to focus on recovery.7. Create an atmosphere to encourage participation in alcohol and drug dependency groups. 8. Preserve the balance of the program which respects the originality of both groups. I sincerely hope that the above devises will allow the opportunity for the alcohol treatment facilities to open up to the drug dependent patients in the future. PMID:19489443

  14. Ward assessment of SmartIdeas Project: bringing source isolation to the patient.

    PubMed

    Moore, G; Ali, S; FitzGerald, G; Muzslay, M; Atkinson, S; Smith, S; Cryer, P; Gush, C; Wilson, A P R

    2010-10-01

    Most UK hospitals lack enough single rooms to provide source isolation for all infected patients. The aim of this study was to test prototype isolation systems on general wards together with specifically designed portable sink units and toilets. Questionnaires were offered to staff, patients and visitors covering ease of use and acceptability. A total of 53 patients were isolated, with concurrent collection of environmental samples and staff hand hygiene audit. Blocking of beds next to infected patients was avoided but patients and staff were concerned about limited space and communication. Hand hygiene compliance on entry or exit to/from an isolated bed space significantly improved [43/76 (56.6%) to 107/147 (72.8%), P<0.05]. Although popular, the toilets were mechanically unreliable. Low levels of microbial contamination (<1-3.4cfu/cm(2)) were present within all isolated bed spaces. The highest colony counts were obtained from high contact sites (e.g. remote controls). Meticillin-resistant Staphylococcus aureus (MRSA) was present at similar levels inside all systems. Although one system was designed to provide airborne as well as contact isolation, MRSA was isolated from air inside and outside the system suggesting poor efficiency of the air door. The finding was confirmed by aerobiology tests at the Health Protection Agency Laboratory, Porton Down, UK. A trial of redesigned units is required to establish efficacy (Trial Identifier: ISRCTN02681602). PMID:20561713

  15. Prevalence of and Reasons for Patients Leaving Against Medical Advice from Paediatric Wards in Oman

    PubMed Central

    Al-Ghafri, Mohamed; Al-Bulushi, Abdullah; Al-Qasmi, Ahmed

    2016-01-01

    The objective of this study was to determine the prevalence of and reasons for patients leaving against medical advice (LAMA) in a paediatric setting in Oman. This retrospective study was carried out between January 2007 and December 2009 and assessed patients who left the paediatric wards at the Royal Hospital, Muscat, Oman, against medical advice. Of 11,482 regular discharges, there were 183 cases of LAMA (prevalence: 1.6%). Dissatisfaction with treatment and a desire to seek a second opinion were collectively the most cited reasons for LAMA according to data from the hospital’s electronic system (27.9%) and telephone conversations with patients’ parents (55.0%). No reasons for LAMA were documented in the hospital’s electronic system for 109 patients (59.6%). The low observed prevalence of LAMA suggests good medical practice at the Royal Hospital. This study indicates the need for thorough documentation of all LAMA cases to ensure the availability of high-quality data for healthcare workers involved in preventing LAMA. PMID:26909217

  16. Modeling clinical context: rediscovering the social history and evaluating language from the clinic to the wards.

    PubMed

    Walsh, Colin; Elhadad, Noémie

    2014-01-01

    Social, behavioral, and cultural factors are clearly linked to health and disease outcomes. The medical social history is a critical evaluation of these factors performed by healthcare providers with patients in both inpatient and outpatient care settings. Physicians learn the topics covered in the social history through education and practice, but the topics discussed and documented in real-world clinical narrative have not been described at scale. This study applies large-scale automated topic modeling techniques to discover common topics discussed in social histories, to compare those topics to the medical textbook representation of those histories, and to compare topics between clinical settings to illustrate differences of clinical context on narrative content. Language modeling techniques are used to consider the extent to which inpatient and outpatient social histories share in their language use. Our findings highlight the fact that clinical context and setting are distinguishing factors for social history documentation, as the language of the hospital wards is not the same as that of the ambulatory clinic. Moreover, providers receive little feedback on the quality of their documentation beyond that needed for billing processes. The findings in this study demonstrate a number of topics described in textbooks - schooling, religion, alternative health practices, stressors, for example - do not appear in social histories in either clinical setting. PMID:25717417

  17. Anti-anxiety Activity Studies on Homoeopathic Formulations of Turnera aphrodisiaca Ward

    PubMed Central

    2005-01-01

    Turnera aphrodisiaca Ward (Turneraceae) has been traditionally used for the treatment of anxiety neurosis, and as an aphrodisiac. Mother tinctures (85% ethanol extracts) of T. aphrodisiaca have also been used for the treatment of central nervous system disorders. In the present investigation, T. aphrodisiaca mother tinctures formulated by three reputed manufacturers of homoeopathic medicines (NLK, DWSG and SBL) were evaluated for their anxiolytic activity. Dried mother tinctures of T. aphrodisiaca were subjected to anxiolytic activity evaluation at various doses, i.e. 50, 75, 100, 125 or 150 mg/kg p.o. in mice using elevated plus maze apparatus. Dried mother tinctures exhibited significant anxiolytic activity at 50 mg/kg (NLK), 75 mg/kg (DWSG) and 125 mg/kg (SBL), respectively, with reference to control as well as standard (diazepam, 2 mg/kg p.o.). Mother tinctures of T. aphrodisiaca available in the market, have significant anxiolytic activity. Amongst the three mother tinctures of T. aphrodisiaca analyzed, the dry residue of NLK possesses the highest amount of anxiolytic constituent(s). To ensure uniformity and consistency of biological effects in herbal formulations, these should be standardized on the basis of bioactive markers. The authors are actively involved in isolating the bioactive constituent(s) from T. aphrodisiaca so that the plant can be standardized on the basis of biologically active constituent(s). PMID:15864356

  18. Dietary lipids and blood cholesterol: quantitative meta-analysis of metabolic ward studies.

    PubMed Central

    Clarke, R.; Frost, C.; Collins, R.; Appleby, P.; Peto, R.

    1997-01-01

    OBJECTIVE: To determine the quantitative importance of dietary fatty acids and dietary cholesterol to blood concentrations of total, low density lipoprotein, and high density lipoprotein cholesterol. DESIGN: Meta-analysis of metabolic ward studies of solid food diets in healthy volunteers. SUBJECTS: 395 dietary experiments (median duration 1 month) among 129 groups of individuals. RESULTS: Isocaloric replacement of saturated fats by complex carbohydrates for 10% of dietary calories resulted in blood total cholesterol falling by 0.52 (SE 0.03) mmol/l and low density lipoprotein cholesterol falling by 0.36 (0.05) mmol/l. Isocaloric replacement of complex carbohydrates by polyunsaturated fats for 5% of dietary calories resulted in total cholesterol falling by a further 0.13 (0.02) mmol/l and low density lipoprotein cholesterol falling by 0.11 (0.02) mmol/l. Similar replacement of carbohydrates by monounsaturated fats produced no significant effect on total or low density lipoprotein cholesterol. Avoiding 200 mg/day dietary cholesterol further decreased blood total cholesterol by 0.13 (0.02) mmol/l and low density lipoprotein cholesterol by 0.10 (0.02) mmol/l. CONCLUSIONS: In typical British diets replacing 60% of saturated fats by other fats and avoiding 60% of dietary cholesterol would reduce blood total cholesterol by about 0.8 mmol/l (that is, by 10-15%), with four fifths of this reduction being in low density lipoprotein cholesterol. PMID:9006469

  19. Improving multidisciplinary communication at ward board rounds using video enhanced reflective practice

    PubMed Central

    Hellier, Cyril; Tully, Vicki; Forrest, Sandra; Jaggard, Pamela; MacRae, Morag; Habicht, Dirk; Greene, Alexandra; Collins, Karen

    2015-01-01

    The priority to ensure patient safety and use resources effectively, demands attention and innovation. Video enhanced reflective practice (VERP) provides training based upon analysis of film clips of one's professional practice to develop practical insight into the processes of communication, so that effective changes can be made to ongoing behaviour and practice. In this case the focus was on multi-disciplinary communication within daily board rounds on an acute medicine and care of the elderly ward. Baseline assessment and post intervention testing of perceptions of change by both full and core team were undertaken to establish the impact of VERP training. In addition pre and post focus group discussion and film analysis supplemented evaluation. The findings support the view that after VERP training of a core team, board rounds were seen as consistently easier to participate in, providing improved focus, were more efficient in goal setting and resulting in better care for patients as well as improved pathways to discharge. This suggests benefits to the communication “culture” of a multidisciplinary team resulting in increased benefits for the wider team. It is concluded that the use of tailored VERP training for personal, professional and team development is relevant, feasible, and worthy of further testing and investigation. PMID:26734342

  20. Improving Peripherally Inserted Central Catheter (PICC) care on a Trauma and Orthopaedics ward

    PubMed Central

    Piorkowska, Marta; Al-Raweshidy, Zahra; Yeong, Keefai

    2013-01-01

    Peripherally Inserted Central Catheter (PICC) blockage rate was audited over a two month period on the Trauma & Orthopaedics ward at our District General Hospital. A 70% (five out of seven) PICC blockage rate was observed. High blockage rates lead to potential treatment complications, delays in delivery of treatment, increase in costs, and reduction in patient satisfaction. The factors contributing to the significant blockage rate include, long and contradictory PICC care guidelines, no information sheets in the patient notes, lack of training and awareness about care of, and flushing of, PICC lines, and lack of accountability for PICC flushing. Our project aimed to achieve a greater rate of PICC patency. We produced one succinct and comprehensive PICC care guideline, carried out staff training sessions, introduced a sticker reminding staff to flush the PICC line after use, and introduced a prescription of weekly heparin saline and PRN saline flushes (for monitoring and accountability). We used questionnaires to assess competency of hospital staff pre-teaching (doctors 6%, nurses 0%), and post-teaching (doctors 70%, nurses 38%). Blockage rate data post-intervention is pending. Education improved awareness of guidelines amongst staff and we anticipate that the proposed interventions will translate into reduced blockage rates, improving patient outcomes and reducing costs.

  1. Does gender matter? Differences between students at an interprofessional training ward.

    PubMed

    Lindh Falk, Annika; Hammar, Mats; Nyström, Sofia

    2015-11-01

    Studies on graduates' transitions from education into clinical work highlight inequalities concerning how women and men experience their professional learning and development. This study explores how female and male students from different programs within the health care education system (i.e. medicine, nursing, occupational therapy, and physiotherapy programmes) experience an interprofessional training ward (IPTW) as a part of their professional identity formation. Students from the medicine, nursing, physiotherapy, and occupational therapy programmes collaborate in teams during two weeks at one of three IPTWs at the medical school, Linköping University. They together take the responsibility for diagnosis, treatment, and rehabilitation of the patients, albeit with professional supervisors as support. During 2010 to 2011, 454 (93%) of the 488 students who practiced at the IPTWs answered a questionnaire on their experiences of the IPTW. The students stated that the IPTW had positively influenced their professional development. The female and male medical students were significantly less positive than other female and male students, respectively, concerning the value of IPTW. The male students from all programmes were slightly, but significantly, less positive than all the female students. These findings show that students "do gender" as an integral part of the educational practice. It is important to scrutinise the IPTW as an educational practice, influencing students' preparation for future work. Gender should be discussed not only during the IPTW rotation but also in general during the curriculum for all healthcare programmes. PMID:26652634

  2. Labor ward workload waxes and wanes with the lunar cycle, myth or reality?

    PubMed

    Joshi; Bharadwaj; Gallousis; Matthews

    1998-07-01

    Objective: To test the validity of the statement "We are busy because it is getting close to the full moon" often heard on labor ward, by analysis of birth statistics in relation to lunar cycles.Method: Data for births from spontaneous onset labors for 12 lunar cycles from January 1 to December 31, 1994 was analyzed. Births resulting from induced labors were excluded. Birthrate for each day of the lunar cycle from new moon to full moon (ascending lunar phase) and from full moon to new moon (descending lunar phase) were analyzed using Pearson correlation coefficient. Birthrate at full moon was compared to that at new moon and that at mid ascending lunar phase was compared with that at mid descending lunar phase using t test.Results: There were 3706 spontaneous births during the study period. The average daily birthrate was 10.58 with standard deviation (SD) of 1.27. There was no statistically significant difference in the daily birthrate between the ascending and the descending lunar phases, r = -0.21. Statistical analysis showed no significant difference in the number of births at full moon as compared to that at new moon, P =.44. No difference was found on comparison of number of births during the mid ascending phase to that at the mid descending lunar phase, P =.84.Conclusion: Scientific analysis of data does not support the belief that the number of births increases as the full moon approaches, therefore it is a myth not reality. PMID:10838345

  3. [The Health Station of the First Inner Ward, Peiping: Its history and legacy].

    PubMed

    Liao, Susu

    2015-09-01

    The Health Station of the First Inner Ward, Peiping, was open in 1925 as a community health care institution of Peiping Health Bureau, sponsored and operated by Peking Union Medical College (PUMC) established in 1921. It was a unique demonstration project to provide the community with medical and prevention service, to implement an extraordinary educational internship of preventive medicine for PUMC students and other doctors and nurses all over the country; and to conduct applied research on the community residents'disease prevention and health promotion. Guided by the prevention thought advocated by John B. Grant, the first Chairperson of the Department of Public Health, PUMC, the station created a variety of innovative programs such as prevention-oriented public health nursing for the residents and school students, maternal and child health programs, and family health records and residents' vital surveillance statistics. The station operated for 26 years and made a significant influence on the contemporary public health in China through its unparalleled prevention education and training program and its innovative community health care demonstration. As one of the examples, it inspired the thought of primary health care raised by WHO several decades later. It provides us definitely beneficial learning as nowadays we reform health system in China. PMID:26813093

  4. Anti-anxiety Activity Studies on Homoeopathic Formulations of Turnera aphrodisiaca Ward.

    PubMed

    Kumar, Suresh; Sharma, Anupam

    2005-03-01

    Turnera aphrodisiaca Ward (Turneraceae) has been traditionally used for the treatment of anxiety neurosis, and as an aphrodisiac. Mother tinctures (85% ethanol extracts) of T. aphrodisiaca have also been used for the treatment of central nervous system disorders. In the present investigation, T. aphrodisiaca mother tinctures formulated by three reputed manufacturers of homoeopathic medicines (NLK, DWSG and SBL) were evaluated for their anxiolytic activity. Dried mother tinctures of T. aphrodisiaca were subjected to anxiolytic activity evaluation at various doses, i.e. 50, 75, 100, 125 or 150 mg/kg p.o. in mice using elevated plus maze apparatus. Dried mother tinctures exhibited significant anxiolytic activity at 50 mg/kg (NLK), 75 mg/kg (DWSG) and 125 mg/kg (SBL), respectively, with reference to control as well as standard (diazepam, 2 mg/kg p.o.). Mother tinctures of T. aphrodisiaca available in the market, have significant anxiolytic activity. Amongst the three mother tinctures of T. aphrodisiaca analyzed, the dry residue of NLK possesses the highest amount of anxiolytic constituent(s). To ensure uniformity and consistency of biological effects in herbal formulations, these should be standardized on the basis of bioactive markers. The authors are actively involved in isolating the bioactive constituent(s) from T. aphrodisiaca so that the plant can be standardized on the basis of biologically active constituent(s). PMID:15864356

  5. Positive behavioral intervention in children who were wards of the court attending a mainstream school.

    PubMed

    Navarro, Jose I; Aguilar, Manuel; Aguilar, Concepcion; Alcalde, Concepcion; Marchena, Esperanza

    2007-12-01

    This report looked at the effects of treatment using contingency contracts and token economy procedures in three children, two 14 yr. and one 8 yr., who were wards of the court and attending a mainstream school. Students presented problems of adaptation to school, such as making constant noises with the mouth, hands, or pencil on the desk; frequently emitted raucous cries in the classroom; destruction of school resource materials; verbal aggression to classmates and teachers; verbal rejection of all academic work, refusing to do it, making negative comments prior to starting any school activity, in addition to lack of motivation for undertaking school activities. A 4-mo. individual treatment using contingency contracts and token economy behavioral procedures was implemented, with several follow-up sessions. The results indicated an adaptation of behavior to the school environment, confirmed by teachers, significantly reducing the incidence of insults, the destruction of school materials, and indolence during class sessions. These students are at high risk for social exclusion. Interventions have potential social importance in possible prevention of adult criminality, increasing academic achievement, and decreasing social exclusion. PMID:18361121

  6. Decreasing assault occurrence on a psychogeriatric ward: an agitation management model.

    PubMed

    Savage, Troy; Crawford, Ian; Nashed, Yousery

    2004-05-01

    An agitation management model providing staff education, quantitative assessment of agitation, and emphasized psychosocial interventions was introduced on a geriatric psychiatry ward for male patients. A within-subjects comparison was made of Cohen-Mansfield Agitation Inventory (CMAI) scores and frequency of committing assault under pre- and post-intervention conditions. Among participants (N = 8) who finished the 72-week study, CMAI scores did not differ significantly under either of the study conditions (p > .05, two-tailed t test). Twenty-nine assaults occurred during the pre-intervention time period and six assaults occurred during the post-intervention time period. According to analysis with the Wilcoxon signed ranks test, the distribution of assaults differed significantly between the two time periods (p < .05, two-tailed). Among individuals who were excluded from the intervention because of lack of consent, assaults increased over the same two time periods. Psychosocial interventions intended to reduce agitation among elderly men with dementia may not necessarily serve to decrease agitation, but may serve to decrease assault occurrence. PMID:15152742

  7. An infinite set of Ward identities for adiabatic modes in cosmology

    SciTech Connect

    Hinterbichler, Kurt; Hui, Lam; Khoury, Justin E-mail: lh399@columbia.edu

    2014-01-01

    We show that the correlation functions of any single-field cosmological model with constant growing-modes are constrained by an infinite number of novel consistency relations, which relate N+1-point correlation functions with a soft-momentum scalar or tensor mode to a symmetry transformation on N-point correlation functions of hard-momentum modes. We derive these consistency relations from Ward identities for an infinite tower of non-linearly realized global symmetries governing scalar and tensor perturbations. These symmetries can be labeled by an integer n. At each order n, the consistency relations constrain — completely for n = 0,1, and partially for n ≄ 2 — the q{sup n} behavior of the soft limits. The identities at n = 0 recover Maldacena's original consistency relations for a soft scalar and tensor mode, n = 1 gives the recently-discovered conformal consistency relations, and the identities for n ≄ 2 are new. As a check, we verify directly that the n = 2 identity is satisfied by known correlation functions in slow-roll inflation.

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

    PubMed

    Kucharski, A; Groves, J E

    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

  9. Use of copper alloy for preventing transmission of methicillin-resistant Staphylococcus aureus contamination in the dermatology ward.

    PubMed

    Niiyama, Nanako; Sasahara, Takeshi; Mase, Hiroshi; Abe, Michiko; Saito, Haruo; Katsuoka, Kensei

    2013-05-01

    Metallic copper has been shown significantly to reduce methicillin-resistant Staphylococcus aureus (MRSA) contamination of the ambient surroundings of the beds of MRSA-carrying patients in dermatology wards. The aim of this study was to determine whether a bed sheet made of copper-coated film will reduce the spread of MRSA contamination in the environment of a heavily-colonized patient. The bacterial count was highest on the bed sheet. MRSA cell counts on the surface of the non-film-coated control sheet were high (6,600-11,000 colony forming units (cfu)), but those on the copper film were considerably lower (20-130 cfu). Use of metallic copper on the bed sheets of patients who are likely to be a source of MRSA contamination may help to prevent the spread of MRSA contamination in hospital wards. PMID:23038099

  10. Analysis of the interface and data transfer from ICU to normal wards in a German University Hospital.

    PubMed

    Vollmer, Anne-Maria; Skonetzki-Cheng, Stefan; Prokosch, Hans-Ulrich

    2013-01-01

    Typically general wards and intensive care units (ICU) have very different labor organizations, structures and IT-systems in Germany. There is a need for coordination, because of the different working arrangements. Our team investigated the interface between ICU and general ward and especially the respective information transfer in the University hospital in Erlangen (Bavaria, Germany). The research team used a combination of interviews, observations and the analysis of transfer records and forms as part of a methodical triangulation. We identified 41 topics, which are discussed or presented in writing during the handover. In a second step, we investigate the requirements of data transmission in expert interviews. A data transfer concept from the perspective of the nurses and physicians was developed and we formulated recommendations for improvements of process and communication for this interface. Finally the data transfer concept was evaluated by the respondents. PMID:23920878

  11. Evaluation of pharmaceutical care in a diabetes ward from China: a pre-and post-intervention study.

    PubMed

    Xin, Chuanwei; Ge, Xing; Zheng, Liujuan; Huang, Ping

    2016-02-01

    Objective To describe the development and implementation of pharmaceutical care services in a diabetes ward, and to examine the effectiveness of pharmacist interventions. Setting Tongde hospital of Zhejiang province, a 1,200-bed South China teaching hospital, serving the local community. Method A single-center, 2-phase (pre-/post-intervention phase) designs was performed in the diabetes ward of a general hospital. Patients in post-intervention phase (October 2012 to December 2012) received pharmaceutical care from a clinical pharmacist, while patients in the pre-intervention phase (January 2012 to March 2012) received routine medical care. The pre- and post-intervention phases were then compared to evaluate the outcomes of pharmacist interventions. Main outcome measure type and number of interventions, and medication errors assessed at the baseline and at the end of pharmaceutical care were the main outcome measures. Results During the 3-month study period, the clinical pharmacist made 240 interventions for 473 admitted patients; of these, 207 (86.3 %) were accepted by physicians or nurses, and dosage adjustment [n = 83, (34.6 %)] was the type of intervention implemented most often. In the group that received the participation of pharmacists, medication errors per patient decreased from 1.68 to 0.46 (p < 0.001); medication errors, of incorrect dose or dosing interval, were markedly improved (decreased from 0.87 to 0.14; p < 0.001), the drug cost per patient day decreased from $347.15 to $309.74 (p = 0.095), and the length of diabetes ward stay did not change significantly (16.14 vs. 15.93 days; p = 0.15). Conclusion The presence of the pharmacist in the diabetes ward resulted in significant reduction in medication errors and had potential drug-cost-saving effects. PMID:24132736

  12. Successful reduction of hospital-acquired methicillin-resistant Staphylococcus aureus in a urology ward: a 10-year study

    PubMed Central

    2013-01-01

    Background To eradicate hospital-acquired methicillin-resistant Staphylococcus aureus (MRSA) using a stepwise infection control strategy that includes an avoidance of antimicrobial prophylaxis (AMP) based on surgical wound classification and an improvement in operative procedures in gasless single-port urologic surgery. Methods The study was conducted at an 801-bed university hospital. Since 2001, in the urology ward, we have introduced the stepwise infection control strategy. In 2007, surveillance cultures for MRSA in all urological patients were commenced. The annual incidence of MRSA was calculated as a total number of newly identified MRSA cases per 1,000 patient days. Trend analysis was performed using a Poisson regression. Results Over the study period, 139,866 patients, including 10,201 urology patients, were admitted to our hospital. Of these patients, 3,719 patients, including 134 ones in the urology ward, were diagnosed with MRSA throughout the entire hospital. Although the incidence of MRSA increased throughout the entire hospital (p = 0.002), it decreased significantly in the urology ward (p < 0.0001). Of the 134 cases, 45 (33.6%) were classified as “imported,” and 89 (66.4%) as “acquired.” In the urology ward, the incidence of acquired MRSA decreased significantly over time (p < 0.0001), whereas the incidence of imported MRSA did not change over time (p = 0.66). A significant decrease (p < 0.0001) in the incidence of clinically significant MRSA infection over time was found. Conclusions Stepwise infection control strategy that includes a reduction or avoidance of antimicrobial prophylaxis in minimally invasive surgery can contribute to a reduction in hospital-acquired MRSA. Trial registration Current study has approved by the institutional ethical review board (No.1141). PMID:23866941

  13. Does antimicrobial use density at the ward level influence monthly central line-associated bloodstream infection rates?

    PubMed Central

    Yoshida, Junichi; Harada, Yukiko; Kikuchi, Tetsuya; Asano, Ikuyo; Ueno, Takako; Matsubara, Nobuo

    2014-01-01

    The aim of this study was to elucidate risk factors, including ward antimicrobial use density (AUD), for central line-associated bloodstream infection (CLABSI) as defined by the Centers for Disease Control and Prevention in a 430-bed community hospital using central venous lines with closed-hub systems. We calculated AUD as (total dose)/(defined daily dose Ś patient days) Ś1,000 for a total of 20 drugs, nine wards, and 24 months. Into each line day data, we inputed AUD and device utilization ratios, number of central line days, and CLABSI. The ratio of susceptible strains in isolates were subjected to correlation analysis with AUD. Of a total of 9,997 line days over 24 months, CLABSI was present in 33 cases (3.3 ‰), 14 (42.4%) of which were on surgical wards out of nine wards. Of a total of 43 strains isolated, eight (18.6%) were methicillin-resistant Staphylococcus aureus (MRSA); none of the MRSA-positive patients had received cefotiam before the onset of infection. Receiver-operating characteristic analysis showed that central line day 7 had the highest accuracy. Logistic regression analysis showed the central line day showed an odds ratio of 5.511 with a 95% confidence interval of 1.936–15.690 as did AUD of cefotiam showing an odds ratio of 0.220 with 95% confidence interval of 0.00527–0.922 (P=0.038). Susceptible strains ratio and AUD showed a negative correlation (R2=0.1897). Thus, CLABSI could be prevented by making the number of central line days as short as possible. The preventative role of AUD remains to be investigated. PMID:25525373

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

    PubMed

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

    2011-09-01

    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

  15. An Australian hospital-based student training ward delivering safe, client-centred care while developing students' interprofessional practice capabilities.

    PubMed

    Brewer, Margo L; Stewart-Wynne, Edward G

    2013-11-01

    Royal Perth Hospital, in partnership with Curtin University, established the first interprofessional student training ward in Australia, based on best practice from Europe. Evaluation of the student and client experience was undertaken. Feedback from all stakeholders was obtained regularly as a key element of the quality improvement process. An interprofessional practice program was established with six beds within a general medical ward. This provided the setting for 2- to 3-week clinical placements for students from medicine, nursing, physiotherapy, occupational therapy, social work, pharmacy, dietetics and medical imaging. Following an initial trial, the training ward began with 79 students completing a placement. An interprofessional capability framework focused on the delivery of high quality client care and effective teamwork underpins this learning experience. Quantitative outcome data showed not only an improvement in students' attitudes towards interprofessional collaboration but also acquisition of a high level of interprofessional practice capabilities. Qualitative outcome data from students and clients was overwhelmingly positive. Suggestions for improvement were identified. This innovative learning environment facilitated the development of the students' knowledge, skills and attitudes required for interprofessional, client centred collaborative practice. Staff reported a high level of compliance with clinical safety and quality. PMID:24299579

  16. Antibiotic resistance and OXA-type carbapenemases-encoding genes in airborne Acinetobacter baumannii isolated from burn wards.

    PubMed

    Gao, Jing; Zhao, Xiaonan; Bao, Ying; Ma, Ruihua; Zhou, Yufa; Li, Xinxian; Chai, Tongjie; Cai, Yumei

    2014-03-01

    The study was conducted to investigate drug resistance, OXA-type carbapenemases-encoding genes and genetic diversity in airborne Acinetobacter baumannii (A. baumannii) in burn wards. Airborne A. baumannii were collected in burn wards and their corridors using Andersen 6-stage air sampler from January to June 2011. The isolates susceptibility to 13 commonly used antibiotics was examined according to the CLSI guidelines; OXA-type carbapenemases-encoding genes and molecular diversity of isolates were analyzed, respectively. A total of 16 non-repetitive A. baumannii were isolated, with 10 strains having a resistance rate of greater than 50% against the 13 antibiotics. The resistance rate against ceftriaxone, cyclophosvnamide, ciprofloxacin, and imipenem was 93.75% (15/16), but no isolate observed to be resistant to cefoperazone/sulbactam. Resistance gene analyses showed that all 16 isolates carried OXA-51, and 15 isolates carried OXA-23 except No.15; but OXA-24 and OXA-58 resistance genes not detected. The isolates were classified into 13 genotypes (A-M) according to repetitive extragenic palindromic sequence PCR (REP-PCR) results and only six isolates had a homology ?90%. In conclusion, airborne A. baumannii in the burn wards had multidrug resistance and complex molecular diversity, and OXA-23 and OXA-51 were dominant mechanisms for resisting carbapenems. PMID:23886986

  17. Clinical Evaluation of Pharmacist Interventions in Patients Treated with Anti-methicillin-Resistant Staphylococcus aureus Agents in a Hematological Ward.

    PubMed

    Okada, Naoto; Fushitani, Shuji; Azuma, Momoyo; Nakamura, Shingen; Nakamura, Toshimi; Teraoka, Kazuhiko; Watanabe, Hiroyoshi; Abe, Masahiro; Kawazoe, Kazuyoshi; Ishizawa, Keisuke

    2016-01-01

    The therapeutic effects of anti-methicillin-resistant Staphylococcus aureus (MRSA) agents, vancomycin (VCM), teicoplanin (TEIC), and arbekacin (ABK), depend on their concentrations in blood. Therefore, therapeutic drug monitoring (TDM) is important when these antibiotics are used. In the hematological ward at Tokushima University Hospital, pharmacists have ordered the measurement of blood VCM, TEIC, and ABK concentrations to promote the use of TDM in accordance with an agreed protocol since 2013. Moreover, the infection control team includes several medical disciplines and has advised on the optimal treatment using VCM, TEIC, and ABK since 2013. This study aimed to investigate the clinical effectiveness of these pharmacist interventions. We retrospectively studied 145 cases in which patients were treated with VCM, TEIC, or ABK between January 2012 and December 2013 in the hematological ward at Tokushima University Hospital. The patients were divided into a control group (71 cases) and an intervention group (74 cases), and their clinical outcomes were compared. The rate of achievement of effective drug concentrations significantly increased in the intervention group (74%), compared to the rate in the control group (55%). Moreover, univariate and multivariate Cox proportional hazard regression revealed that pharmacist intervention and appropriate concentrations of anti-MRSA agents were independent factors associated with reduced hospitalization periods in patients with lymphoma. Our study revealed that proactive pharmacist intervention may improve the therapeutic effect of anti-MRSA agents in hematology ward patients. PMID:26830489

  18. [Uterine rupture in the maternity ward of the Bangui Community Hospital (Central Africa)].

    PubMed

    Sepou, A; Yanza, M C; Nguembi, E; Ngbale, R; Kouriah, G; Kouabosso, A; Nali, M N

    2002-01-01

    Although now uncommon in developed countries, uterine rupture is among the major obstetrical emergencies dealt on a daily bases in the maternity ward of the Bangui Community Hospital in Central African Republic, which is the national reference facility. Uterine rupture is life-threatening for both the fetus and mother. In view of the relatively high rate of rupture observed in our department in previous years, this cross-sectional study was undertaken in order to determine incidence, identify predisposing factors, evaluate prognosis for the mother and newborn, and propose solutions. From January 1997 to December 1997, all deliveries by the vaginal route or cesarean section including cases involving uterine rupture were recorded. The length of time elapsed between the decision to perform cesarean section and actual performance of the procedure was determined. Risk factors associated with uterine rupture in our department were noted. The outcome of uterine rupture was evaluated in both the mother and fetus. Of a total of 5763 deliveries during the study period, 299 required cesarean section (5.9%). Uterine rupture occurred in 35 cases of the 299 women (11.7%). In 10 cases of uterine rupture, the time lapse for performance of cesarean section was at least 2 hours. The main cause of delay was the lack of funding for cesarean section. Six women died due to irreversible shock (0.1% of deliveries, 2% of cesarean sections and 17.1% of uterine ruptures). The perinatal mortality rate was 80%. In our department, uterine rupture is a common emergency causing high mortality in mothers and newborns. Most of these patients could have been saved. PMID:12616945

  19. Epidemiology of Methicillin-Susceptible Staphylococcus aureus in a Neonatology Ward.

    PubMed

    Achermann, Yvonne; Seidl, Kati; Kuster, Stefan P; Leimer, Nadja; Durisch, Nina; Ajdler-Schäffler, Evelyne; Karrer, Stephan; Senn, Gabriela; Holzmann-Bürgel, Anne; Wolfensberger, Aline; Leone, Antonio; Arlettaz, Romaine; Zinkernagel, Annelies S; Sax, Hugo

    2015-11-01

    OBJECTIVE In-hospital transmission of methicillin-susceptible Staphylococcus aureus (MSSA) among neonates remains enigmatic. We describe the epidemiology of MSSA colonization and infection in a 30-bed neonatal ward. DESIGN Multimodal outbreak investigation SETTING A public 800-bed tertiary care university hospital in Switzerland METHODS Investigations in 2012-2013, triggered by a MSSA infection cluster, included prospective MSSA infection surveillance, microbiologic screening of neonates and environment, onsite observations, and a prospective cohort study. MSSA isolates were characterized by pulsed-field gel electrophoresis (PFGE) and selected isolates were examined for multilocus sequence type (MLST) and virulence factors. RESULTS Among 726 in 2012, 30 (4.1%) patients suffered from MSSA infections including 8 (1.1%) with bacteremia. Among 655 admissions in 2013, 13 (2.0%) suffered from MSSA infections including 2 (0.3%) with bacteremia. Among 177 neonates screened for S. aureus carriage, overall 77 (44%) tested positive. A predominant PFGE-1-ST30 strain was identified in 6 of 30 infected neonates (20%) and 30 of 77 colonized neonates (39%). This persistent clone was pvl-negative, tst-positive and belonged to agr group III. We found no environmental point source. MSSA carriage was associated with central vascular catheter use but not with a particular midwife, nurse, physician, or isolette. Observed healthcare worker behavior may have propagated transmission via hands and fomites. Despite multimodal interventions, clonal transmission and colonization continued and another clone, PFGE-6-ST5, became predominant. CONCLUSIONS Hospital-acquired MSSA clones represent a high proportion of MSSA colonization but not MSSA infections in neonate inpatients. In contrast to persisting MSSA, transmission infection rates decreased concurrently with interventions. It remains to be established whether eradication of hospital-acquired MSSA strains would reduce infection rates further. Infect. Control Hosp. Epidemiol. 2015;36(11):1305-1312. PMID:26290400

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

    NASA Astrophysics Data System (ADS)

    Mueller, Derek R.; Vincent, Warwick F.

    2006-03-01

    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.

  1. [Acute lumbago due to the manual lifting of patients in wards: prevalence and incidence data].

    PubMed

    Colombini, D; Cianci, E; Panciera, D; Martinelli, M; Venturi, E; Giammartini, P; Ricci, M G; Menoni, O; Battevi, N

    1999-01-01

    The aim of the study was to measure the occurrence (prevalence and incidence) of episodes of acute low back pain (definite effect) in a wide sample of health workers assisting disabled patients. A questionnaire was used for the study both of true acute low back pain and of episodes of ingravescent low back pain controlled pharmacologically at the onset. The questionnaire identified overall acute and pharmacologically controlled episodes occurring in the previous 12 months, both in the course of work and over the whole life of the subject. Appropriately trained operators administered the questionnaire to 551 subjects; 481 valid answer cards were obtained from 372 females and 109 males working in medical, orthopaedic and geriatric departments. 75.4% of the sample had high exposure index levels for patient lifting. The prevalence of true acute low back pain was 9% in males and 11% in females referred to the previous 12 months. Taking acute true and pharmacologically controlled low back pain together the prevalences rose to 13.8% for males and 26.9% in females. Data from the reference populations showed that acute low back pain did not exceed 3% on average in the previous year. Since work seniority in the hospital wards was known, the incidences were calculated, giving 7.9% in females and 5.29% in males for acute low back pain, and 19% in females and 3.49% in males for pharmacologically controlled low back pain. Considering the number of episodes in 100 workers/year, acute low back pain alone reached prevalences of 13-14%. This therefore appears to confirm the positive ratio between episodes of low back pain and duties involving assistance to disabled patients. PMID:10371816

  2. The Effect on Mortality of Fluconazole or Echinocandins Treatment in Candidemia in Internal Medicine Wards

    PubMed Central

    Filippini, Claudia; Raviolo, Stefania; Fossati, Lucina; Montrucchio, Chiara; Aldieri, Chiara; Petrolo, Alessia; Cavallo, Rossana; Di Perri, Giovanni

    2015-01-01

    The incidence of candidemia has increased over the past two decades, with an increased number of cases in Internal Medicine and a prevalence ranging from 24% to 57%. This single-center retrospective study was performed to evaluate the epidemiology and the risk factors associated with mortality of candidemia in patients admitted to Internal Medicine wards (IMWs) of the City of Health and Sciences, Molinette Hospital, Turin, from January 2004 to December 2012. For each patient, demographic, clinical and microbiological data were collected. A case of candidemia was defined as a patient with at least one blood culture positive for Candida spp. Amongst 670 episodes of candidemia, 274 (41%) episodes occurred in IMWs. The mortality was 39% and was associated at multivariate analysis with sepsis, cirrhosis and neurologic diseases, whilst removal of central venous catheter ?48h was significantly associated with survival. In the 77 patients treated with early antifungal therapy the mortality was 29% and was not significantly different with caspofungin or fluconazole, whilst in patients with definitive therapy the mortality was significantly lower with echinocandins compared to fluconazole (11.7% Vs. 39%; p=0.0289), a finding confirmed by multivariate analysis. The mortality was significantly associated with sepsis, cirrhosis and neurologic diseases, whilst CVC removal ?48h was associated with survival. In patients with early therapy, fluconazole or caspofungin were equally effective. However, echinocandins were significantly more effective as definitive treatment, a finding not explained by differences in treatment delays. Further studies are needed to understand the full potential of these different therapeutic strategies in IMWs. PMID:25938486

  3. Outcome Risk Factors during Respiratory Infections in a Paediatric Ward in Antananarivo, Madagascar 2010–2012

    PubMed Central

    Rajatonirina, Soatiana; Razanajatovo, Norosoa Harline; Ratsima, Elisoa Hariniana; Orelle, Arnaud; Ratovoson, Rila; Andrianirina, Zo Zafitsara; Andriatahina, Todisoa; Ramparany, Lovasoa; Herindrainy, Perlinot; Randrianirina, Frédérique; Heraud, Jean-Michel; Richard, Vincent

    2013-01-01

    Background Acute respiratory infections are a leading cause of infectious disease-related morbidity, hospitalisation and mortality among children worldwide, and particularly in developing countries. In these low-income countries, most patients with acute respiratory infection (ARI), whether it is mild or severe, are still treated empirically. The aim of the study was to evaluate the risk factors associated with the evolution and outcome of respiratory illnesses in patients aged under 5 years old. Materials and Methods We conducted a prospective study in a paediatric ward in Antananarivo from November 2010 to July 2012 including patients under 5 years old suffering from respiratory infections. We collected demographic, socio-economic, clinical and epidemiological data, and samples for laboratory analysis. Deaths, rapid progression to respiratory distress during hospitalisation, and hospitalisation for more than 10 days were considered as severe outcomes. We used multivariate analysis to study the effects of co-infections. Results From November 2010 to July 2012, a total of 290 patients were enrolled. Co-infection was found in 192 patients (70%). Co-infections were more frequent in children under 36 months, with a significant difference for the 19–24 month-old group (OR: 8.0). Sixty-nine percent (230/290) of the patients recovered fully and without any severe outcome during hospitalisation; the outcome was scored as severe for 60 children and nine patients (3%) died. Risk factors significantly associated with worsening evolution during hospitalisation (severe outcome) were admission at age under 6 months (OR?=?5.3), comorbidity (OR?=?4.6) and low household income (OR?=?4.1). Conclusion Co-mordidity, low-income and age under 6 months increase the risk of severe outcome for children infected by numerous respiratory pathogens. These results highlight the need for implementation of targeted public health policy to reduce the contribution of respiratory diseases to childhood morbidity and mortality in low income countries. PMID:24069161

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

    PubMed Central

    2010-01-01

    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. PMID:20646300

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

    PubMed Central

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

    2007-01-01

    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. PMID:17257438

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

    PubMed Central

    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

    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. PMID:25010773

  7. 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

    PubMed Central

    Berg, John E; Restan, Asbjűrn

    2005-01-01

    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 ward at a random day in 2002 was registered (n = 23). Successively, the length of stay of all patients was registered, together with information on waiting time after a decision was made on further treatment needs. Eleven patients waited for further resident treatment. The running cost of stay was calculated for the acute ward and in the different resident follow-up facilities. Twenty-three patients consumed a total of 776 resident days. 425 (54.8%) of these were waiting days. Patients waited up to 86 days. Results Total cost of treatment was 0.69 million Euro (0.90 mill. $), waiting costs were 54.8% of this, 0.38 million Euro (0.50 million $). The difference between acute care costs and the costs in the relevant secondary resident facility was defined as the imputed loss. Net loss by waiting was 0.20 million Euro (0.26 million $) or 28.8% of total cost. Discussion This point estimate study indicates that treating patients too sick to be released to anything less than some other intramural facility locks a sizable amount of the resources of a psychiatric acute ward. The method used minimized the chance of financially biased treatment decisions. Costs of frustration to staff and family members, and delayed effect of treatment was set to zero. Direct extrapolation to costs per year is not warranted, but it is suggested that our findings would be comparable to other acute wards as well. The study shows how participant observation and cost effectiveness analysis may be combined. PMID:15921516

  8. Multidrug-resistant organisms in a routine ward environment: differential propensity for environmental dissemination and implications for infection control.

    PubMed

    Tan, Thean Yen; Tan, Jasmine Shi Min; Tay, Huiyi; Chua, Gek Hong; Ng, Lily Siew Yong; Syahidah, Nur

    2013-05-01

    Multidrug-resistant organisms (MDROs) pose significant infection-control challenges in settings with high prevalence and limited isolation facilities. This observational study in an 800-bed hospital determined the prevalence, bacterial density and genetic relatedness of MDROs isolated from ward surfaces, medical devices and the hands of healthcare professionals. The targeted MDROs were meticillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), Escherichia coli and Klebsiella pneumoniae resistant to extended-spectrum cephalosporins, and carbapenem-resistant (CR) Acinetobacter baumannii. During a 2-month period, microbiological sampling and molecular typing were performed on environment isolates, clinical isolates and isolates recovered from the hands of healthcare professionals. The target MDROs were recovered from 79% of sampled surfaces, predominantly MRSA (74% of all tested surfaces) and CR A. baumannii (29%) but also VRE (2%) and K. pneumoniae (1%). MRSA was recovered from most tested surfaces throughout the ward, whilst CR A. baumannii was significantly more likely to be recovered from near-patient surfaces. Hand sampling demonstrated infrequent recovery of MRSA (5%), CR A. baumannii (1%) and VRE (1%). Molecular typing of the study isolates identified seven MRSA and five Acinetobacter clonal clusters, respectively, and typing identified similar strains from the environment, patients and hands. Thus, in a healthcare setting with endemic circulation of MDROs, MRSA and CR A. baumannii were the predominant organisms recovered from ward surfaces, with MRSA in particular demonstrating widespread environmental dissemination. Molecular typing demonstrated the presence of related strains in patients, in the environment and on the hands of healthcare workers. PMID:23393110

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

    PubMed Central

    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

    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. PMID:17239235

  10. Psychological distress in mothers of children admitted to a nutritional rehabilitation unit in Malawi - a comparison with other paediatric wards.

    PubMed

    Colman, Sarah; Stewart, Robert C; MacArthur, Christine; Kennedy, Neil; Tomenson, Barbara; Creed, Francis

    2015-10-01

    In a previous study we found a very high prevalence of psychological distress in mothers of children admitted to a nutritional rehabilitation unit (NRU) in Malawi, Africa. The objective of this study was to compare the prevalence and severity of maternal distress within the NRU with that in other paediatric wards. Given the known association between poor maternal psychological well-being and child undernutrition in low- and middle-income countries, we hypothesised that distress would be higher among NRU mothers. Mothers of consecutive paediatric inpatients in a NRU, a high-dependency (and research) unit and an oncology ward were assessed for psychological distress using the Self-Reporting Questionnaire (SRQ). Two hundred sixty-eight mothers were interviewed (90.3% of eligible). The prevalence of SRQ score ≄8 was 35/150 {23.3% [95% confidence interval (CI) 16.8- 30.9%]} on the NRU, 13/84 [15.5% (95% CI 8.5-25.0%)] on the high-dependency unit and 7/34 [20.6% (95% CI 8.7-37.9%)] on the oncology ward (χ(2)  = 2.04, P = 0.36). In linear regression analysis, the correlates of higher SRQ score were child diarrhoea on admission, child diagnosed with tuberculosis, and maternal experience of abuse by partner; child height-for-age z-score fell only just outside significance (P = 0.05). In summary, we found no evidence of greater maternal distress among the mothers of severely malnourished children within the NRU compared with mothers of paediatric inpatients with other severe illnesses. However, in support of previous research findings, we found some evidence that poor maternal psychological well-being is associated with child stunting and diarrhoea. PMID:24224802

  11. Convergence Aspects for q-Appell Functions and q-Lauricella Functions with Applications to the Ward q-Addition

    NASA Astrophysics Data System (ADS)

    Ernst, Thomas

    2010-09-01

    We first outline the foundations of the q-umbral calculus, which consists of an infinite alphabet A of letters or umbrae, with two dual q-additions, the Nalli-Ward-Alsalam (NWA) q-addition and the Jackson-Hahn-Cigler (JHC) q-addition. By using a certain q-Stirling approximation, we show that the NWA decides the convergence region for 50% of the q-Appell- and q-Lauricella functions. This assumption is verified by numerical examples. In the process we investigate numerical aspects, including a local maximum, of the NWA q-addition of two and three letters.

  12. Occurrence and Duration of Interruptions During Nurses' Work in Surgical Wards: Findings From a Multicenter Observational Study.

    PubMed

    Dante, Angelo; Andrigo, Isabella; Barone, Francesca; Bonamico, Rossella; De Chiara, Antonio; Nait, Michela; Toci, Ergyseda; Palese, Alvisa

    2016-01-01

    This was an observational multicenter study of 50 registered nurses, randomly selected, on 5 surgical wards in 5 Italian hospitals. There were on average 5.6 interruptions per hour. Interruptions occurred more frequently during the afternoon shift (n = 1061; 52.8%), were caused mainly by the staff members (n = 978; 48.7%) during medication administration (n = 1075; 53.5%), and were managed directly by the nurses (n = 1639; 81.6%). The average duration of an interruption was 32.7 seconds (95% confidence interval, 30.7-34.7). PMID:26447344

  13. Comparison of short-term clinical postoperative outcomes in patients who underwent carotid endarterectomy: intensive care unit versus the ward high-dependency unit.

    PubMed

    Angel, Donna; Sieunarine, Kishore; Finn, Judith; McKenzie, Eileen; Taylor, Bernie; Kidd, Heather; Mwipatayi, B P

    2004-09-01

    The objective of this research was to examine the routine postoperative management of patients who have undergone carotid endarterectomy and compare the intensive care unit (ICU) with the ward high-dependency unit (HDU) in terms of the number, type, severity, or management of postoperative clinical events within a 48-hour time frame. Two of the vascular surgeons routinely admitted patients to the ICU, and 1 vascular surgeon routinely admitted patients to the ward HDU. This research determines whether there was a difference in outcomes between the 2 groups with the intention of changing the practice of the 2 vascular surgeons who routinely admitted their patients to the ICU. This was a nonexperimental, descriptive, prospective study of all patients who underwent carotid endarterectomy during an 18-month period between August 1999 and January 2000. A total of 104 patients were recruited to the study. There were 84 patients in the ICU cohort; 59 were male and 25 were female, with a mean age of 72 years. There were 20 patients in the ward HDU cohort; 12 were male and 8 were female, with a mean age of 66 years. Major complications occurred in 3 patients. One patient from the ICU group was returned to the operating room for evacuation of a hematoma, and 2 patients from the ward HDU group were transferred to the ICU for an inotropic infusion. During the first 24 hours, hypertension developed in 37 patients in the ICU cohort, 12 of whom did not require intervention. Hypertension requiring intervention developed in 3 patients in the ward group. Chi-square cross-tabulation revealed a chi 2 value of 1.4 and a P value of.01, which is a significant difference in the number of hypertensive events in the ICU versus the ward HDU. Hypotension occurred in 41 patients in the ICU group and in 9 patients in the ward cohort. The same chi 2 test was used to reveal a chi 2 value of 0.026 and a P value of.87, which are nonsignificant results. There was no difference in the number of hypotensive events in the ICU versus the ward HDU. There were no reported incidents of tachycardia. Bradycardia was reported in 64 patients in the ICU group and in 12 patients in the HDU group. There was no significant difference in the number of patients with bradycardia in either group of patients. Chi-square analysis revealed a chi 2 value of 1.4 and a P value of.23 during the first 24 hours postoperatively. We believe that careful selection of patients to the ward HDU is safe and cost-effective. PMID:15371974

  14. Water budget and water quality of Ward Lake, flow and water-quality characteristics of the Braden River estuary, and the effects of Ward Lake on the hydrologic system, west-central Florida

    USGS Publications Warehouse

    Trommer, J.T.; DelCharco, M.J.; Lewelling, B.R.

    1999-01-01

    The Braden River is the largest tributary to the Manatee River. The river was dammed in 1936 to provide the city of Bradenton a source of freshwater supply. The resulting impoundment was called Ward Lake and had a storage capacity of about 585 million gallons. Reconstruction in 1985 increased the size of the reservoir to about 1,400 million gallons. The lake has been renamed the Bill Evers Reservoir and drains about 59 square miles. The Braden River watershed can be subdivided into three hydrologic reaches. The upper reach consists of a naturally incised free-flowing channel. The middle reach consists of a meandering channel affected by backwater as a result of the dam. The lower reach is a tidal estuary. Water budgets were calculated for the 1993 through 1997 water years. Mean surface-water inflow to Ward Lake for the 5-year period was 1,645 inches per year (equivalent depth over the surface of the lake), or about 81.8 percent of total inflow. Mean ground-water inflow was 311 inches per year, or about 15.5 percent. A mean of 55 inches of rain fell directly on the lake and accounted for only 2.7 percent. Mean surface-water outflow was 1,736 inches, or about 86.4 percent of total water leaving the lake. There was no net ground-water outflow from the lake. Mean surface-water withdrawal for public supply was 229 inches per year, or about 11.4 percent. Mean evaporation was 45 inches and accounted for only 2.2 percent of the mean outflow. Change in lake storage on the budget was negligible. Most chemical constituents contained in water flowing to Ward Lake meet the standards specified by the Florida Department of Environmental Protection and the U.S. Environmental Protection Agency. Phosphorus is the exception, exceeding the U.S. Environmental Protection Agency limits of 0.10 milligram per liter in most samples. However, the source of the phosphorus is naturally occurring phosphate deposits underlying the watershed. Organic nitrogen and orthophosphate are the dominant species of nutrients in the streams and the lake. A major source of water to the streams is the surficial aquifer system. Mineralized water pumped from the intermediate aquifer system and the Upper Floridan aquifer for irrigation of agricultural areas or golf courses has influenced the chemical composition of the surficial aquifer and surface-water systems. The Braden River estuary receives freshwater inflow from Ward Lake and from three major streams discharging downstream from the dam. Salinity levels in the estuary are affected by freshwater flow from these sources and by antecedent conditions in the estuary prior to flow events. The lowest salinity levels are often measured at the confluence with Williams and Gap Creeks rather than at the outfall from the lake. The chemical composition of water flowing from the tributaries to the estuary is similar to the chemical composition of water in the tributaries flowing to Ward Lake and does not appear to be affected by brackish water from high tides. Nitrogen concentrations in water from Glen Creek were greater than in water from all other tributaries in the watershed. Fertilizer from orange groves and stormwater runoff from urban and industrial areas affect the water quality in Glen Creek. The effects of the reservoir on the hydrology of the watershed were to change the middle reach of the river from a brackish water estuary ecosystem to a freshwater lake ecosystem, raise water levels in the surficial aquifer system adjacent to the river, change water quality, and reduce freshwater flow to the estuary during periods of low flow. The lake acts as a sink for total organic carbon, dissolved solids, calcium, chloride, and sulfate, thereby decreasing loads of these constituents to the estuary.

  15. Differences in mortality from acute myocardial infarction between coronary care unit and medical ward: treatment or bias?

    PubMed Central

    Reznik, R; Ring, I; Fletcher, P; Siskind, V

    1987-01-01

    To analyse the effectiveness of coronary care units in reducing mortality from myocardial infarction 18 hospitals ranging from large urban teaching hospitals to small country hospitals were stratified into four levels of care. Previous analysis had failed to show significant differences in the overall mortality in hospital among levels. There were significant differences in mortality, however, between those patients allocated to be cared for in the coronary care unit and those in the medical wards in the more advanced hospitals. The differences were largest in the hospitals with the most elaborate facilities (level 1) and non-existent in those with the least (level 4). Several analytical approaches to these observed differences indicated that they were: (a) reduced by adjustment for age and severity of infarction; (b) paralleled by differences in coexisting disease recorded on death certificates; (c) no longer significant at level 1 after allowing for differences in coexisting disease; and (d) not significant at any level after exclusion of patients first diagnosed at necropsy. These findings suggest that the observed differences in mortality between coronary care units and medical wards are largely due to bias in selection and diagnosis. PMID:3121054

  16. Prevalence of body dysmorphic disorder on a psychiatric inpatient ward and the value of a screening question.

    PubMed

    Veale, David; Akyüz, Elvan U; Hodsoll, John

    2015-12-15

    The aim of this study was to estimate the prevalence of body dysmorphic disorder (BDD) on an inpatient ward in the UK with a larger sample than previously studied and to investigate the value of a simple screening question during an assessment interview. Four hundred and thirty two consecutive admissions were screened for BDD on an adult psychiatric ward over a period of 13 months. Those who screened positive had a structured diagnostic interview for BDD. The prevalence of BDD was estimated to be 5.8% (C.I. 3.6-8.1%). Our screening question had a slightly low specificity (76.6%) for detecting BDD. The strength of this study was a larger sample size and narrower confidence interval than previous studies. The study adds to previous observations that BDD is poorly identified in psychiatric inpatients. BDD was identified predominantly in those presenting with depression, substance misuse or an anxiety disorder. The screening question could be improved by excluding those with weight or shape concerns. Missing the diagnosis is likely to lead to inappropriate treatment. PMID:26404769

  17. Efficacy of environmental measures to decrease the risk of hospital-acquired aspergillosis in patients hospitalised in haematology wards.

    PubMed

    Berthelot, P; Loulergue, P; Raberin, H; Turco, M; Mounier, C; Tran Manh Sung, R; Lucht, F; Pozzetto, B; Guyotat, D

    2006-08-01

    This study evaluated a multidisciplinary strategy to decrease the rate of invasive pulmonary aspergillosis (IPA) among adult patients hospitalised in two haematology wards in a single 560-bed building at the University Hospital of Saint-Etienne. Upgrading of the air filtration system and construction of an air-lock chamber at the entrance to the unit were completed during 1994. In 1995, specific hygienic measures were introduced during hospital building work, including the use of plastic barriers, watering during demolition work, reduction of pedestrian traffic in construction areas, and the wearing of high-efficiency filtration masks by immunosuppressed patients when outside the protected unit. This strategy was evaluated by a prospective survey of IPA cases between 1993 and 2001, coupled with environmental surveillance. The number and risk-level of hospital renovation projects increased between 1995 and 2001 (p < 0.01). In parallel, the rate of IPA decreased globally in the haematology unit from 0.85% (1.19/1,000 patients) in 1993 to 0.28% (0.21/1,000 patients) in 2001. The incidence of IPA decreased significantly between 1993-1996 and 1997-2001 (p 0.02, Mann-Whitney test). These results show that a multidisciplinary approach involving engineers, infection control practitioners, mycologists and clinicians enables IPA rates among patients hospitalised in haematology wards to be significantly decreased. PMID:16842568

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

    PubMed

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

    2014-01-01

    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

  19. Effect of Education on Stress of Exposure to Sharps Among Nurses in Emergency and Trauma Care Wards

    PubMed Central

    Moayed, Malihe Sadat; Mahmoudi, Hosein; Ebadi, Abbas; Salary, Mohammad Mehdi; Danial, Zahra

    2015-01-01

    Background: Health care services can cause injuries to medical staff. One of these injuries is exposure to needle-sticks. This can result in the transmission of blood-borne diseases, such as HIV and hepatitis B; the staff undergo continuous stress. Thus, it is necessary to use some method to reduce this stress. Objectives: The purpose of this study was to examine the effect of education based on the stabilization model on stress induced exposure to needle sticks among nurses working in emergency and trauma wards. Patients and Methods: This Quast- Experiental Study was performed on 35 nurses working in emergency and trauma wards of our hospital in October-December 2013. Data were collected using a two-part questionnaire; Reliability and validity of the questionnaire were confirmed (? = 0. 92 and ICC = 0.94).Data were analyzed using SPSS version 20. The one-sample Kolmogorov-Smirnov test, independent t-test and paired sample t-test were also used. Results: The mean and standard deviation of stress experienced by nurses before and after the intervention were 64.94 ± 15.67 and 43.91 ± 10.73, respectively. Findings indicated that education decrease needle stick stress in nurses significantly (P < 0.001). Conclusions: According to the results of this study, the stress level induced due to needle-stick exposure and its complications is high and interventions for reduction are essential. PMID:26290853

  20. Preliminary study of the fungal ecology at the haematology and medical-oncology ward in Bamako, Mali.

    PubMed

    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

    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

  1. Bacterial Epidemiology and Antimicrobial Resistance in the Surgery Wards of a Large Teaching Hospital in Southern Italy

    PubMed Central

    Esposito, Silvano; Gioia, Renato; De Simone, Giuseppe; Noviello, Silvana; Lombardi, Domenico; Di Crescenzo, Vincenzo Giuseppe; Filippelli, Amelia; Rega, Maria Rosaria; Massari, Angelo; Elberti, Maria Giovanna; Grisi, Lucilla; Boccia, Giovanni; De Caro, Francesco; Leone, Sebastiano

    2015-01-01

    Objectives Surgical infections represent an increasingly important problem for the National Health System. In this study we retrospectively evaluated the bacterial epidemiology and antimicrobial susceptibility of the microorganisms concerned as well as the utilization of antibiotics in the General and Emergency Surgery wards of a large teaching hospital in southern Italy in the period 2011–2013. Methods Data concerning non-duplicate bacterial isolates and antimicrobial susceptibility were retrieved from the Vitek 2 database. The pharmacy provided data about the consumption of antibiotics in the above reported wards. Chi-square or Fisher’s exact test were used. Results In all, 94 Gram-negative were isolated in 2011, 77 in 2012, and 125 in 2013, Escherichia coli, Acinetobacter baumannii and Pseudomonas aeruginosa always being the most frequently isolated microorganisms. A. baumannii showed high rates of resistance to carbapenems (with values of 100% in 2011 and 2012) and low rates of resistance to tigecycline, colistin and amikacin. In the same years, there were respectively 105, 93, and 165 Gram-positive isolated. The rate of MRSA isolates ranged from 66% to 75% during the study period. Conclusions Our results show no significant increase in antimicrobial resistance over the period in question, and a higher rate of both MRSA isolates and resistance to carbapenems in A. baumannii compared with other European data. PMID:26075047

  2. Infection-free surgery: how to improve hand-hygiene compliance and eradicate methicillin-resistant Staphylococcus aureus from surgical wards

    PubMed Central

    Davis, CR

    2010-01-01

    INTRODUCTION Healthcare-associated infections cost the UK National Health Service Ł1 billion per annum. Poor hand hygiene is the main route of transmission for methicillin-resistant Staphylococcus aureus (MRSA), leading to increased mortality and morbidity for infected patients. This study aims to quantify MRSA infection rates and compliance of alcohol gel application at the entrance to a surgical ward and assess how a simple intervention affects compliance. SUBJECTS AND METHODS Compliance was assessed via a discretely positioned close-surveillance camera at the ward entrance, ootage was reviewed to monitor compliance of all persons entering the ward over a 12-month period. RESULTS For the initial 6 months, mean alcohol gel compliance was 24% for all persons entering the ward. After this period, a conspicuous strip of bright red tape was positioned along the corridor approaching the ward entrance. The red line continued up the wall to an arrow head pointing to the two alcohol gel dispensers on the wall. Mean compliance over the subsequent 6 months significantly improved to 62% (P< 0.0001). Compliance improved for all persons entering the ward as follows (before – after, significance): doctors (0% – 54%, P< 0.01); nurses (24% – 75%, P< 0.05); porters (21% – 67%, P< 0.05); visitors (35% – 68%, P< 0.01); patients (23% – 44%, P > 0.05). There were two cases of MRSA bacteraemia in the initial 6 months and no cases in the following 6 months with the red line in situ. CONCLUSIONS This study demonstrates how a simple intervention significantly improves hand-hygiene compliance with associated eradication of MRSA. PMID:20514722

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

    PubMed

    Rowlands, J; Noble, S

    2008-09-01

    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

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

    PubMed Central

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

    2009-01-01

    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. PMID:19549319

  5. Disengaged: a qualitative study of communication and collaboration between physicians and other professions on general internal medicine wards

    PubMed Central

    2013-01-01

    Background Poor interprofessional communication in hospital is deemed to cause significant patient harm. Although recognition of this issue is growing, protocols are being implemented to solve this problem without empirical research on the interprofessional communication interactions that directly underpin patient care. We report here the first large qualitative study of directly-observed talk amongst professions in general internal medicine wards, describing the content and usual conversation partners, with the aim of understanding the mechanisms by which current patterns of interprofessional communications may impact on patient care. Methods Qualitative study with 155 hours of data-collection, including observation and one-on-one shadowing, ethnographic and semi-structured interviews with physicians, nurses, and allied health professionals in the General Internal Medicine (GIM) wards of two urban teaching hospitals in Canada. Data were coded and analysed thematically with a focus on collaborative interactions between health professionals in both interprofessional and intraprofesional contexts. Results Physicians in GIM wards communicated with other professions mainly in structured rounds. Physicians’ communications were terse, consisting of reports, requests for information, or patient-related orders. Non-physician observations were often overlooked and interprofessional discussion was rare. Intraprofessional interactions among allied health professions, and between nursing, as well as interprofessional interactions between nursing and allied health were frequent and deliberative in character, but very few such discussions involved physicians, whose deliberative interactions were almost entirely with other physicians. Conclusion Without interprofessional problem identification and discussion, physician decisions take place in isolation. While this might be suited to protocol-driven care for patients whose conditions were simple and courses predictable, it may fail complex patients in GIM who often need tailored, interprofessional decisions on their care. Interpersonal communication training to increase interprofessional deliberation may improve efficiency, patient-centredness and outcomes of care in hospitals. Also, electronic communications tools which reduce cognitive burden and facilitate the sharing of clinical observations and orders could help physicians to engage more in non-medical deliberation. Such interventions should take into account real-world power differentials between physicians and other health professions. PMID:24274052

  6. The development and implementation of an inter-professional simulation based pediatric acute care curriculum for ward health care providers.

    PubMed

    Kotsakis, Afrothite; Mercer, Karen; Mohseni-Bod, Hadi; Gaiteiro, Rose; Agbeko, Rachel

    2015-01-01

    An interprofessional, simulation based, acute care course for ward health care providers was developed and implemented with the objectives of teaching identification of deteriorating patients, practicing crisis resource management and basic life support skills, and using the SBAR (Situation Background Assessment Recommendation) communication tool. Thirty-eight physicians and 51 nurses attended the four separate courses. Nine questions on a 5-point Likert scale and two open-ended questions revealed that over 95% of respondents strongly agreed/agreed that facilitators encouraged active participation, lectures were presented in an interesting manner, and that simulations were useful for practical skills and for practicing communication. Open-ended questions revealed that participants felt more confident, understood the importance of communication, roles, teamwork and valued the day. Based on this evaluation, the program was regarded as feasible and acceptable to all health care providers. PMID:25421455

  7. The effect of music on body-rocking manifested by severely mentally deficient patients in ward environments.

    PubMed

    Tierney, I R; McGuire, R J; Walton, H J

    1978-12-01

    By controlling whether or not music was played in the wards, the effect of music on stereotyped body-rocking was assessed for twelve severely mentally deficient adults who engaged in this behaviour. There were significant differences between male and female patients. While music did not appear to affect rates, but increased the amounts, of body-rocking in both groups, the distribution of this increase was different. These results suggested that the effect of music was to increase the duration of body-rocking sequences. Once the music had been removed there was, for females, a persistence of the increased amount of body-rocking. It was hypothesised that there may be sexual dimorphism in the brain-hemisphere structures which organise rhythmic stimuli. PMID:745225

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

    PubMed

    Storme, Laurent; de Mézerac, Isabelle

    2010-06-01

    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

  9. Documenting the NICU design dilemma: comparative patient progress in open-ward and single family room units

    PubMed Central

    Domanico, R; Davis, D K; Coleman, F; Davis, B O

    2011-01-01

    Objective: To test the efficacy of single family room (SFR) neonatal intensive care unit (NICU) designs, questions regarding patient medical progress and relative patient safety were explored. Addressing these questions would be of value to hospital staff, administrators and designers alike. Study Design: This prospective study documented, by means of Institution Review Board-approved protocols, the progress of patients in two contrasting NICU designs. Noise levels, illumination and air quality measurements were included to define the two NICU physical environments. Result: Infants in the SFR unit had fewer apneic events, reduced nosocomial sepsis and mortality, as well as earlier transitions to enteral nutrition. More mothers sustained stage III lactation, and more infants were discharged breastfeeding in the SFR. Conclusion: This study showed the SFR to be more conducive to family-centered care, and to enhance infant medical progress and breastfeeding success over that of an open ward. PMID:21072040

  10. Can a multi-factorial assessment and interventional programme decrease inpatient falls in an elderly care ward?

    PubMed

    Gibson, Rebecca Sj; Heaney, April; Hull, Karen

    2013-01-01

    Each year approximately 282,000 inpatient falls are reported to the National Patient Safety Agency (NPSA). A significant number result in death, or moderate to severe injury. (1) Research shows that falls may be reduced by 18 to 31% through multi-factorial assessments and interventions. (4) If a fall cannot be prevented, the patient should receive a prompt and effective response to achieve the best possible recovery and avoidance of further falls. Using 'Plan-Do-Study-Act' learning cycles, our aims were to decrease the inpatient falls rate in an Elderly Care ward by 20% and to improve post-fall care. A baseline audit reviewed incident report forms to establish the number of falls per 1000 patient bed days for one calendar year; the baseline falls rate was 14.70 falls per 1000 bed days between November 2010 and October 2011. A care plan to highlight at-risk patients and allow adaptation of care, a 'walking-stick' incentive poster to encourage nursing staff, and post-fall guidelines, were introduced. Feedback sessions with ward staff and a re-audit were organised subsequent to each intervention. Completion of the care plan was monitored to improve compliance. A re-audit at one year was conducted to assess impact. Feedback was positive regarding the interventions. Monthly monitoring of care plans achieved a compliance rate of 89% and highlighted up to 81% of patients were considered high-risk. The inpatient falls rate, re-audited at one year, was 12.44 falls / 1000 patient bed days, November 2011 to October 2012; a 15.4% reduction. This study demonstrates a 15.4% reduction in falls through use of a multi-factorial assessment and care plan and an incentive poster. As we are yet to obtain our initial goal of 20%, implementation and re-audit is ongoing. PMID:26734206

  11. Field Study on Runoff Processes at a Snow-covered Hillslope in Ward Valley, Lake Tahoe Basin

    NASA Astrophysics Data System (ADS)

    Ohara, N.; Kavvas, M. L.; Easton, D.; Dogrul, E. C.; Yoon, J.; Chen, Z.

    2012-12-01

    At the snow covered hillslope in Ward Creek watershed, Lake Tahoe Basin, overland flow, subsurface stormflow, channel flow, atmospheric quantities, and groundwater table underneath the snowpack were measured during the water years, 2000 and 2001. The analyses of the hillslope runoff measurements revealed that majority of the snowmelt water infiltrated into the top soil layer, and that the saturated subsurface flow was the largest contributor to the stream channel flow throughout the observation period. However, it was found that the overland flow or longitudinal flow within the snowpack may still happen even over unfrozen and unsaturated topsoil on a relatively mild hillslope (16 %). Analysis of the major rain-on-snow event of May 7, 2000, showed that the snowmelt water, caused by the energy flux from raindrops, might not be the major contributor to the runoff peak discharge since very little snowmelt was observed during the rain-on-snow event. Consequently, spring storm hydrographs in the Sierra Nevada may be enhanced by the high soil-water in the topsoil due to the daily water supply by snowmelt as well as by overland/within snowpack flow. (A) Observed and simulated snow water equivalence (SWE) and estimated snowmelt rate, (B) observed overland flow, (C) observed rootzone discharge and consolidated discharge, and (D) observed stream discharge and precipitation at Ward Creek observation site. Schematic of hillslope runoff pathways at a riparian cross-section in a snow covered watershed. It may be reasonable to assume that the capillary suction may be able to help sustain some portion of water within the snowpack even over a highly permeable soil.

  12. Which Medication Is the Patient Taking at Admission to the Emergency Ward? Still Unclear Despite the Swedish Prescribed Drug Register

    PubMed Central

    Engqvist, Ida; Wyss, Katja; Asker-Hagelberg, Charlotte; Bergman, Ulf; Odar-Cederlöf, Ingegerd; Stiller, Carl-Olav; Fryckstedt, Jessica

    2015-01-01

    Introduction Correct information on patients’ medication is crucial for diagnosis and treatment in the Emergency Department. The aim of this study was to investigate the concordance between the admission chart and two other records of the patient’s medication. Methods This cohort study includes data on 168 patients over 18 years admitted to the Emergency Ward between September 1 and 30, 2008. The record kept by the general practitioner and the patient record of dispensed drugs in the Swedish Prescribed Drug Register were compared to the admission chart record. Results Drug record discrepancies of potential clinical significance between the admission chart record and the Swedish Prescribed Drug Register or general practitioner record were present in 79 and 82 percent, respectively. For 63 percent of the studied patients the admission chart record did not include all drugs registered in the Swedish Prescribed Drug Register. For 62 percent the admission chart record did not include all drugs registered in the general practitioner record. In addition, for 32 percent of the patients the admission chart record included drugs not registered in the Swedish Prescribed Drug Register and for 52 percent the admission chart record included drugs not found in the general practitioner record. The most discordant drug classes were cardiovascular and CNS-active drugs. Clinically significant drug record discrepancies were more frequent in older patients with multiple medication and caregivers. Conclusion The apparent absence of an accurate record of the patient’s drugs at admission to the Emergency Ward constitutes a potential patient safety hazard. The available sources in Sweden, containing information on the drugs a particular patient is taking, do not seem to be up to date. These results highlight the importance of an accurate list of currently used drugs that follows the patient and can be accessed upon acute admission to the hospital. PMID:26068920

  13. Specific character of anaerobic bacterial infections in patients treated in transplantation wards at one of the clinical hospitals in Warsaw.

    PubMed

    Kierzkowska, M; Majewska, A; Sawicka-Grzelak, A; Mlynarczyk, A; Chmura, A; Durlik, M; Deborska-Materkowska, D; Paczek, L; Mlynarczyk, G

    2014-10-01

    Immunocompromised patients and patients undergoing invasive procedures are predisposed to bacterial infections, due to the possibility of micro-organism translocation from their physiological habitat. Infectious complications may occur both in the early and late post-transplantation periods. The purpose of this study was to evaluate the proportion as well as susceptibility profiles of obligatory anaerobes in the etiology of infections in patients hospitalized at transplantation wards of a large clinical hospital in Warsaw. A total of 104 strains of obligatory anaerobes derived from patients hospitalized in two transplantation clinics at a clinical hospital in Warsaw were evaluated. The strains were isolated from 87 clinical samples collected from 84 patients of two transplantation wards between 2007 and 2012. A total of 104 obligatory anaerobic bacterial strains were isolated and identified, with Gram-positive and Gram-negative bacteria constituting 60.6% and 39.4% of the isolates, respectively. Almost exclusively non-spore-forming anaerobes were detected in evaluated samples. The present study showed all isolated Gram-positive bacteria to be susceptible to ß-lactam antibiotics. Metronidazole-resistant bacteria were found among the genera Propionibacterium and Actinomyces. All Gram-negative rods were susceptible to imipenem and metronidazole. Among them, Bacteroides spp. and Parabacteroides distasonis showed resistance to penicillin G (100%). Because of their pathogenicity and altered antibiotic susceptibility profiles, the bacteria of the genera Bacteroides and Parabacteroides are of greatest clinical importance. Approximately 25% of isolates exhibit also resistance to clindamycin. Because of the growing rates of clindamycin resistance, the role of metronidazole in the treatment of Bacteroides spp. is of increasing importance. PMID:25380872

  14. Sensory signals and neuronal groups involved in guiding the sea-ward motor behavior in turtle hatchlings of Chelonia agassizi

    NASA Astrophysics Data System (ADS)

    Fuentes, A. L.; Camarena, V.; Ochoa, G.; Urrutia, J.; Gutierrez, G.

    2007-05-01

    Turtle hatchlings orient display sea-ward oriented movements as soon as they emerge from the nest. Although most studies have emphasized the role of the visual information in this process, less attention has been paid to other sensory modalities. Here, we evaluated the nature of sensory cues used by turtle hatchlings of Chelonia agassizi to orient their movements towards the ocean. We recorded the time they took to crawl from the nest to the beach front (120m long) in control conditions and in visually, olfactory and magnetically deprived circumstances. Visually-deprived hatchlings displayed a high degree of disorientation. Olfactory deprivation and magnetic field distortion impaired, but not abolished, sea-ward oriented movements. With regard to the neuronal mapping experiments, visual deprivation reduced dramatically c-fos expression in the whole brain. Hatchlings with their nares blocked revealed neurons with c-fos expression above control levels principally in the c and d areas, while those subjected to magnetic field distortion had a wide spread activation of neurons throughout the brain predominantly in the dorsal ventricular ridge The present results support that Chelonia agassizi hatchlings use predominantly visual cues to orient their movements towards the sea. Olfactory and magnetic cues may also be use but their influence on hatchlings oriented motor behavior is not as clear as it is for vision. This conclusion is supported by the fact that in the absence of olfactory and magnetic cues, the brain turns on the expression of c- fos in neuronal groups that, in the intact hatchling, are not normally involved in accomplishing the task.

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

    NASA Astrophysics Data System (ADS)

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

    2004-05-01

    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.

  16. Assessment of selected quality fields of nursing care in neurosurgical wards: a prospective study of 530 people – multicenter studies

    PubMed Central

    ƒlusarz, Robert; Biercewicz, Monika; Barczykowska, Ewa; Haor, Beata; GƂowacka, Mariola

    2014-01-01

    Background One of the elements influencing the assessment of nursing care quality is the assessment of the nurse’s functions that determine the nurse’s particular tasks. The aim of this work was to assess selected tasks involved in the nurse’s caring function, which influence nursing care quality on neurosurgical wards, on the basis of patients’ and nursing staff’s opinions. Materials and methods The research was carried out on neurosurgical wards in Poland on a group of 455 patients and 75 nurses. In order to assess nursing care quality, an author’s original questionnaire (Questionnaire – Patient Satisfaction) was used. Results Statistically significant differences concerned particular groups (both patients and nurses) in the assessment of selected issues: providing information about performed activities and operations (P=0.000 and P=0.040), respecting personal dignity and assuring discretion during the operations (P=0.000 and P=0.001), speed of response to patient’s requests (P=0.000 and P=0.000), time availability of nurses for the patient (P=0.000 and P=0.000), providing information about further self-care at home (P=0.032, P=0.008), and nurses’ attitude (kindness, courtesy, tenderness, care) to patients (patient’s assessment only P=0.000). Conclusion Selected tasks in the field of the caring function of nurses were assessed differently by particular groups. There were no statistically significant differences in the assessment of particular tasks in the opinions of patients and nurses, which means that both examined groups similarly assessed tasks involved in the nurse’s caring function, which influence nursing care quality. PMID:25170257

  17. Reducing short-stay hospital admissions by ruling out non-ST elevation myocardial infarction and estimating coronary artery disease likelihood on an emergency department observation ward

    PubMed Central

    Wiese, Martin

    2013-01-01

    Chest pain is an important presentation in adult patients attending emergency departments (ED). The process of ruling out an acute coronary syndrome (ACS) conventionally requires a short in-patient stay. This places a significant burden on healthcare systems. Recent developments have encouraged us to explore the role of an ED observation ward in the management of these patients. We designed and implemented two proformas (‘flowformas’). The first provides integrated guidance and documentation for the management of chest pain in the ED. In patients determined to be at low risk of short-term adverse outcomes the ACS rule-out process is now completed on the ED observation ward rather than on the cardio-respiratory admission ward. The second proforma is used before discharge to determine the likelihood of underlying coronary artery disease (CAD), thereby allowing risk-based follow-up arrangements to be made. We collected data on all patients admitted to EDU on the NSTEMI rule-out pathway over a 12-month period. Between Feb 2012 and Feb 2013, 816 patients fulfilling the criteria were admitted on the pathway. 67 patients (8%) required admission due to ACS. 15 patients were admitted on two, and one on three occasions. In conclusion, it is possible to deliver ACS rule-out on an emergency observation ward. This reduces healthcare costs and shortens hospital stay.

  18. Effectiveness of a Web-Based Simulation in Improving Nurses’ Workplace Practice With Deteriorating Ward Patients: A Pre- and Postintervention Study

    PubMed Central

    Wong, Lai Fun; Lim, Eunice Ya Ping; Ang, Sophia Bee Leng; Mujumdar, Sandhya; Ho, Jasmine Tze Yin; Mordiffi, Siti Zubaidah; Ang, Emily Neo Kim

    2016-01-01

    Background Nurses play an important role in detecting patients with clinical deterioration. However, the problem of nurses failing to trigger deteriorating ward patients still persists despite the implementation of a patient safety initiative, the Rapid Response System. A Web-based simulation was developed to enhance nurses’ role in recognizing and responding to deteriorating patients. While studies have evaluated the effectiveness of the Web-based simulation on nurses’ clinical performance in a simulated environment, no study has examined its impact on nurses’ actual practice in the clinical setting. Objective The objective of this study was to evaluate the impact of Web-based simulation on nurses' recognition of and response to deteriorating patients in clinical settings. The outcomes were measured across all levels of Kirkpatrick’s 4-level evaluation model with clinical outcome on triggering rates of deteriorating patients as the primary outcome measure. Methods A before-and-after study was conducted on two general wards at an acute care tertiary hospital over a 14-month period. All nurses from the two study wards who undertook the Web-based simulation as part of their continuing nursing education were invited to complete questionnaires at various time points to measure their motivational reaction, knowledge, and perceived transfer of learning. Clinical records on cases triggered by ward nurses from the two study wards were evaluated for frequency and types of triggers over a period of 6 months pre- and 6 months postintervention. Results The number of deteriorating patients triggered by ward nurses in a medical general ward increased significantly (P<.001) from pre- (84/937, 8.96%) to postintervention (91/624, 14.58%). The nurses reported positively on the transfer of learning (mean 3.89, SD 0.49) from the Web-based simulation to clinical practice. A significant increase (P<.001) on knowledge posttest score from pretest score was also reported. The nurses also perceived positively their motivation (mean 3.78, SD 0.56) to engage in the Web-based simulation. Conclusions This study provides evidence on the effectiveness of Web-based simulation in improving nursing practice when recognizing and responding to deteriorating patients. This educational tool could be implemented by nurse educators worldwide to address the educational needs of a large group of hospital nurses responsible for patients in clinical deterioration. PMID:26895723

  19. Governing patient safety: lessons learned from a mixed methods evaluation of implementing a ward-level medication safety scorecard in two English NHS hospitals

    PubMed Central

    Ramsay, Angus I G; Turner, Simon; Cavell, Gillian; Oborne, C Alice; Thomas, Rebecca E; Cookson, Graham; Fulop, Naomi J

    2014-01-01

    Background Relatively little is known about how scorecards presenting performance indicators influence medication safety. We evaluated the effects of implementing a ward-level medication safety scorecard piloted in two English NHS hospitals and factors influencing these. Methods We used a mixed methods, controlled before and after design. At baseline, wards were audited on medication safety indicators; during the ‘feedback’ phase scorecard results were presented to intervention wards on a weekly basis over 7?weeks. We interviewed 49 staff, including clinicians and managers, about scorecard implementation. Results At baseline, 18.7% of patients (total n=630) had incomplete allergy documentation; 53.4% of patients (n=574) experienced a drug omission in the preceding 24?h; 22.5% of omitted doses were classified as ‘critical’; 22.1% of patients (n=482) either had ID wristbands not reflecting their allergy status or no ID wristband; and 45.3% of patients (n=237) had drugs that were either unlabelled or labelled for another patient in their drug lockers. The quantitative analysis found no significant improvement in intervention wards following scorecard feedback. Interviews suggested staff were interested in scorecard feedback and described process and culture changes. Factors influencing scorecard implementation included ‘normalisation’ of errors, study duration, ward leadership, capacity to engage and learning preferences. Discussion Presenting evidence-based performance indicators may potentially influence staff behaviour. Several practical and cultural factors may limit feedback effectiveness and should be considered when developing improvement interventions. Quality scorecards should be designed with care, attending to evidence of indicators’ effectiveness and how indicators and overall scorecard composition fit the intended audience. PMID:24029440

  20. Microbial Contamination on Used Surgical Masks among Hospital Personnel and Microbial Air Quality in their Working Wards: A Hospital in Bangkok

    PubMed Central

    Luksamijarulkul, Pipat; Aiempradit, Natkitta; Vatanasomboon, Pisit

    2014-01-01

    Objective To assess the relationship of bacterial and fungal contamination on used surgical masks worn by the hospital personnel and microbial air quality in their working wards. Methods This is a cross-sectional study of 230 used surgical masks collected from 214 hospital personnel, and 215 indoor air samples collected from their working wards to culture for bacterial and fungal counts. This study was carried out at the hospital in Bangkok. Group or genus of isolated bacteria and fungi were preliminarily identified by Gram’s stain and lacto-phenol cotton blue. Data were analyzed using paired t-test and Pearson’s correlation coefficient at the significant level of p<0.050. Results Means and standard deviation of bacterial and fungal contamination on inside area of the used masks were 47 ± 56 and 15 ± 9 cfu/ml/piece, and on outside area were 166 ± 199 and 34 ± 18 cfu/ml/piece, respectively, p<0.001. The bacterial and fungal contamination on used masks from hospital personnel working in the male and female medical wards and out-patient department, as well as the bacterial and fungal counts of the indoor air sample collected from the same area were relatively higher than the other wards. The predominant isolated bacteria and fungi contaminated on inside and outside areas of the used masks and air samples were similar (Staphylococcus spp. and Aspergillus spp.; respectively). For its relationship, results found that bacterial and fungal counts in air samples showed significantly positive correlation with the bacterial contamination load on outside area of the used masks, r=0.16, p=0.018 and r=0.21, p=0.003, respectively. Conclusion High bacterial contamination on outside area of the used masks was demonstrated, and it showed a significant correlation with microbial air quality of working wards. PMID:25337311

  1. Do “trainee-centered ward rounds” help overcome barriers to learning and improve the learning satisfaction of junior doctors in the workplace?

    PubMed Central

    Acharya, Vikas; Reyahi, Amir; Amis, Samuel M; Mansour, Sami

    2015-01-01

    Ward rounds are widely considered an underutilized resource with regard to medical education, and therefore, a project was undertaken to assess if the initiation of “trainee-centered ward rounds” would help improve the confidence, knowledge acquisition, and workplace satisfaction of junior doctors in the clinical environment. Data were collated from junior doctors, registrar grade doctors, and consultants working in the delivery suite at Luton and Dunstable University Hospital in Luton over a 4-week period in March–April 2013. A review of the relevant literature was also undertaken. This pilot study found that despite the reservations around time constraints held by both junior and senior clinicians alike, feedback following the intervention was largely positive. The junior doctors enjoyed having a defined role and responsibility during the ward round and felt they benefited from their senior colleagues’ feedback. Both seniors and junior colleagues agreed that discussing learning objectives prior to commencing the round was beneficial and made the round more learner-orientated; this enabled maximal learner-focused outcomes to be addressed and met. The juniors were generally encouraged to participate more during the round and the consultants endeavored to narrate their decision-making, both were measures that led to greater satisfaction of both parties. This was in keeping with the concept of “Legitimate peripheral participation” as described by Lave and Wenger. Overall, trainee-centered ward rounds did appear to be effective in overcoming some of the traditional barriers to teaching in the ward environment, although further work to formalize and quantify these findings, as well as using greater sample sizes from different hospital departments and the inclusion of a control group, is needed. PMID:26508899

  2. Spatial variation of heart failure and air pollution in Warwickshire, UK: an investigation of small scale variation at the ward-level

    PubMed Central

    Bennett, Oscar; Kandala, Ngianga-Bakwin; Ji, Chen; Linnane, John; Clarke, Aileen

    2014-01-01

    Objectives To map using geospatial modelling techniques the morbidity and mortality caused by heart failure within Warwickshire to characterise and quantify any influence of air pollution on these risks. Design Cross-sectional. Setting Warwickshire, UK. Participants Data from all of the 105 current Warwickshire County wards were collected on hospital admissions and deaths due to heart failure. Results In multivariate analyses, the presence of higher mono-nitrogen oxide (NOx) in a ward (3.35:1.89, 4.99), benzene (Ben) (31.9:8.36, 55.85) and index of multiple deprivation (IMD; 0.02: 0.01, 0.03), were consistently associated with a higher risk of heart failure morbidity. Particulate matter (Pm; ?12.93: ?20.41, ?6.54) was negatively associated with the risk of heart failure morbidity. No association was found between sulfur dioxide (SO2) and heart failure morbidity. The risk of heart failure mortality was higher in wards with a higher NOx (4.30: 1.68, 7.37) and wards with more inhabitants 50+ years old (1.60: 0.47, 2.92). Pm was negatively associated (?14.69: ?23.46, ?6.50) with heart failure mortality. SO2, Ben and IMD scores were not associated with heart failure mortality. There was a prominent variation in heart failure morbidity and mortality risk across wards, the highest risk being in the regions around Nuneaton and Bedworth. Conclusions This study showed distinct spatial patterns in heart failure morbidity and mortality, suggesting the potential role of environmental factors beyond individual-level risk factors. Air pollution levels should therefore be taken into account when considering the wider determinants of public health and the impact that changes in air pollution might have on the health of a population. PMID:25468504

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

    NASA Astrophysics Data System (ADS)

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

    2012-12-01

    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.

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

    PubMed Central

    2010-01-01

    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. PMID:20663166

  5. Catheter associated urinary tract infection (CA-UTI) incidence in an Internal Medicine Ward of a Northern Italian Hospital.

    PubMed

    Izzo, Ilaria; Lania, Donatella; Bella, Daniele; Formaini Marioni, Cesare; Coccaglio, Romana; Colombini, Paolo

    2015-09-01

    Catheter-associated urinary tract infections (CA-UTI) are estimated to be the most frequent nosocomial infections (40%). A catheter is introduced to 10-25% of inpatients, and is often left on site for a long period of time. We carried out a prospective study on inpatients of our Internal Medicine ward to assess the incidence of CA-UTI under the implementation of corrective action. All inpatients who underwent introduction of a urinary catheter upon or after admission to our ward were included in the study. Patients with bacteriuria or positive urine culture before catheterization, others with less than 24 hours catheterism, or bearing a catheter on admission were all excluded from the study. CA-UTI diagnosis was assessed on the basis of CDC 2009 guidelines. The investigation was held between June 2010 and March 2013 in five steps or phases. In the first phase open circuit drainage catheterism was used, in the second phase close circuit drainage catheterism was introduced, while in the third phase disposable lubrification was added to closed circuit drainage catheterism. In the next step (phase 4) we introduced number of days of catheterism control and nurse training; in the last phase (5) emptying urine collection bags on a container was added. In phase 1 we estimated six UTIs out of 18 patients (incidence 33%), in phase 2 we had four infections out of 10 patients (40%). Given the results, we had to reflect on the quality of the procedures of catheter positioning and management . Where feasible, we improved technical practices and during follow-up there was evidence of CA-UTI in 10 patients over 25 (phase 3, 40%), and eight infections over 25 (phase 4, 32%). Once all these steps had been implemented, in phase 5 we determined a sharp reduction in CA-UTI (2 patients over 27, or 7.5%, p=0.025). This improvement was particularly evident in the rate of infection per days of catheter, which was reduced from 43.4/1000 to 13.6/1000. Although the statistical power of the present study has its limitations, we attained a significant reduction in catheter-associated UTIs through the implementation of close circuit catheterism and improvements in care practices. PMID:26397293

  6. The effect of a virtual ward program on emergency services utilization and quality of life in frail elderly patients after discharge: a pilot study

    PubMed Central

    Leung, Doris YP; Lee, Diana Tze-Fan; Lee, Iris FK; Lam, Lai-Wah; Lee, Susanna WY; Chan, May WM; Lam, Yin-Ming; Leung, Siu-Hung; Chiu, Pui-Chi; Ho, Nelly KF; Ip, Ming-Fai; Hui, May MY

    2015-01-01

    Introduction Attendance at emergency departments and unplanned hospital readmissions are common for frail older patients after discharge from hospitals. A virtual ward service was piloted to deliver “hospital-at-home” services by community nurses and geriatricians to frail older patients immediately after their discharge from hospital to reduce emergency services utilization. Objectives This study examined the impacts of the virtual ward service on changes in the patients’ emergency attendance and medical readmissions, and their quality of life (QOL). Methods A matched-control quasi-experimental study was conducted at four hospitals, with three providing the virtual ward service (intervention) and one providing the usual community nursing care (control). Subjects in the intervention group were those who are at high risk of readmission and who are supported by home carers recruited from the three hospitals providing the virtual ward service. Matched control patients were those recruited from the hospital providing usual care. Outcome measures include emergency attendance and medical readmission in the past 90 days as identified from medical records, and patient-reported QOL as measured by the modified Quality-of-Life Concerns in the End of Life Questionnaire (Chinese version). Wilcoxon signed-rank tests compared the changes in the outcome variables between groups. Results A total of 39 patients in each of the two groups were recruited. The virtual ward group showed a greater significant reduction in the number of unplanned emergency hospital readmissions (?1.41±1.23 versus ?0.77±1.31; P=0.049) and a significant improvement in their overall QOL (n=18; 0.60±0.56 versus 0.07±0.56; P=0.02), but there was no significant difference in the number of emergency attendances (?1.51±1.25 versus ?1.08±1.48; P=0.29). Conclusion The study results support the effectiveness of the virtual ward service in reducing unplanned emergency medical readmissions and in improving the QOL in frail older patients after discharge. PMID:25678782

  7. Results of a multicentre randomised controlled trial of statistical process control charts and structured diagnostic tools to reduce ward-acquired meticillin-resistant Staphylococcus aureus: the CHART Project.

    PubMed

    Curran, E; Harper, P; Loveday, H; Gilmour, H; Jones, S; Benneyan, J; Hood, J; Pratt, R

    2008-10-01

    Statistical process control (SPC) charts have previously been advocated for infection control quality improvement. To determine their effectiveness, a multicentre randomised controlled trial was undertaken to explore whether monthly SPC feedback from infection control nurses (ICNs) to healthcare workers of ward-acquired meticillin-resistant Staphylococcus aureus (WA-MRSA) colonisation or infection rates would produce any reductions in incidence. Seventy-five wards in 24 hospitals in the UK were randomised into three arms: (1) wards receiving SPC chart feedback; (2) wards receiving SPC chart feedback in conjunction with structured diagnostic tools; and (3) control wards receiving neither type of feedback. Twenty-five months of pre-intervention WA-MRSA data were compared with 24 months of post-intervention data. Statistically significant and sustained decreases in WA-MRSA rates were identified in all three arms (P<0.001; P=0.015; P<0.001). The mean percentage reduction was 32.3% for wards receiving SPC feedback, 19.6% for wards receiving SPC and diagnostic feedback, and 23.1% for control wards, but with no significant difference between the control and intervention arms (P=0.23). There were significantly more post-intervention 'out-of-control' episodes (P=0.021) in the control arm (averages of 0.60, 0.28, and 0.28 for Control, SPC and SPC+Tools wards, respectively). Participants identified SPC charts as an effective communication tool and valuable for disseminating WA-MRSA data. PMID:18723251

  8. Developing and testing an intervention to prevent homelessness among individuals discharged from psychiatric wards to shelters and 'No Fixed Address'.

    PubMed

    Forchuk, C; MacClure, S K; Van Beers, M; Smith, C; Csiernik, R; Hoch, J; Jensen, E

    2008-09-01

    Shelter data in a recent study revealed discharges from psychiatric facilities to shelters or the street occurred at least 194 times in 2002 in London, Ontario, Canada. This problem must be addressed to reduce the disastrous effects of such discharge, including re-hospitalization and prolonged homelessness. An intervention was developed and tested to prevent homelessness associated with discharge directly to no fixed address. A total of 14 participants at-risk of being discharged without housing were enrolled, with half randomized into the intervention group. The intervention group was provided with immediate assistance in accessing housing and assistance in paying their first and last month's rent. The control group received usual care. Data was collected from participants prior to discharge, at 31 and 6-months post-discharge. All the individuals in the intervention group maintained housing after 3 and 6 months. All but one individual in the control group remained homeless after 3 and 6 months. The exception joined the sex trade to avoid homelessness. The results of this pilot were so dramatic that randomizing to the control group was discontinued. Discussions are underway to routinely implement the intervention. Systemic improvements can prevent homelessness for individuals being discharged from psychiatric wards. PMID:18768009

  9. Effect of the maternity ward system on the lactation success of low-income urban Mexican women.

    PubMed

    Perez-Escamilla, R; Segura-Millán, S; Pollitt, E; Dewey, K G

    1992-11-01

    We compared the lactation performance of 165 healthy mothers who planned to breastfeed and gave birth by vaginal delivery, without complications to a healthy infant in either a nursery (NUR) (n = 58) or a rooming-in hospital where formula supplementation was not allowed. In the rooming-in hospital, women were randomly assigned to a group that received breastfeeding guidance during the hospital stay (RIBFG) (n = 53) or to a control group (RI) (n = 54). Women were interviewed in the hospital and at 8, 70 and 135 days post-partum (pp). The groups were similar in socio-economic, demographic, anthropometric, previous breastfeeding experience and prenatal care variables. Non-parametric survival analyses adjusting for potential confounding factors show that breastfeeding guidance had a positive impact (P < or = 0.05) on breastfeeding duration among primiparous women who delivered in the rooming-in hospital. Among primiparae, the RI and RIBFG groups had higher (P < or = 0.05) full breastfeeding rates than the NUR group in the short term. In the longer term, only the difference between the RIBFG and the NUR group remained statistically significant. The maternity ward system did not have a statistically significant effect on the lactation performance of multiparae. PMID:1486816

  10. The use of typing methods and infection prevention measures to control a bullous impetigo outbreak on a neonatal ward

    PubMed Central

    2012-01-01

    Background We describe an outbreak of Bullous Impetigo (BI), caused by a (methicillin susceptible, fusidic acid resistant) Staphylococcus aureus (SA) strain, spa-type t408, at the neonatal and gynaecology ward of the Jeroen Bosch hospital in the Netherlands, from March-November 2011. Methods We performed an outbreak investigation with revision of the hygienic protocols, MSSA colonization surveillance and environmental sampling for MSSA including detailed typing of SA isolates. Spa typing was performed to discriminate between the SA isolates. In addition, Raman-typing was performed on all t408 isolates. Results Nineteen cases of BI were confirmed by SA positive cultures. A cluster of nine neonates and three health care workers (HCW) with SA t408 was detected. These strains were MecA-, PVL-, Exfoliative Toxin (ET)A-, ETB+, ETAD-, fusidic acid-resistant and methicillin susceptible. Eight out of nine neonates and two out of three HCW t408 strains yielded a similar Raman type. Positive t408 HCW were treated and infection control procedures were reinforced. These measures stopped the outbreak. Conclusions We conclude that treatment of patients and HCW carrying a predominant SA t408, and re-implementing and emphasising hygienic measures were effective to control the outbreak of SA t408 among neonates. PMID:23168170

  11. Infant feeding policies in maternity wards and their effect on breast-feeding success: an analytical overview.

    PubMed Central

    Pérez-Escamilla, R; Pollitt, E; Lönnerdal, B; Dewey, K G

    1994-01-01

    OBJECTIVES. The purpose of this review is to examine the plausibility of a causal relationship between maternity ward practices and lactation success. METHODS. Studies were located with MEDLINE, from our personal files, and by contacting researchers working in this field. Of the 65 studies originally reviewed, 18 met our inclusion criteria (i.e., hospital-based intervention, experimental design with randomization procedures, or quasi-experimental design with adequate documentation). RESULTS. Meta-analysis indicated that commercial discharge packs had an adverse effect on lactation performance. The impact of early mother-infant contact on lactation success was unclear. Rooming-in and breast-feeding guidance in a rooming-in context had a beneficial impact on breast-feeding among primiparae. Breast-feeding on demand was positively associated with lactation success. In-hospital formula supplementation of 48 mL per day was not associated with poor breast-feeding performance. CONCLUSIONS. Hospital-based breast-feeding interventions can have a beneficial effect on lactation success, particularly among primiparous women. PMID:8279619

  12. An IBCLC in the Maternity Ward of a Mother and Child Hospital: A Pre- and Post-Intervention Study

    PubMed Central

    Chiurco, Antonella; Montico, Marcella; Brovedani, Pierpaolo; Monasta, Lorenzo; Davanzo, Riccardo

    2015-01-01

    Published evidence on the impact of the integration of International Board Certified Lactation Consultants (IBCLCs) for breastfeeding promotion is growing, but still relatively limited. Our study aims at evaluating the effects of adding an IBCLC for breastfeeding support in a mother and child hospital environment. We conducted a prospective study in the maternity ward of our maternal and child health Institute, recruiting 402 mothers of healthy term newborns soon after birth. The 18-month intervention of the IBCLC (Phase II) was preceded (Phase I) by data collection on breastfeeding rates and factors related to breastfeeding, both at hospital discharge and two weeks later. Data collection was replicated just before the end of the intervention (Phase III). In Phase III, a significantly higher percentage of mothers: (a) received help to breastfeed, and also received correct information on breastfeeding and community support, (b) started breastfeeding within two hours from delivery, (c) reported a good experience with the hospital staff. Moreover, the frequency of sore and/or cracked nipples was significantly lower in Phase III. However, no difference was found in exclusive breastfeeding rates at hospital discharge or at two weeks after birth. PMID:26308018

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

    PubMed

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

    2010-01-01

    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

  14. Risk Factors and Scoring System for Predicting Bacterial Resistance to Cefepime as Used Empirically in Haematology Wards

    PubMed Central

    El Maaroufi, Hicham; Goubard, Agathe; Redjoul, Rabah; Legrand, Patrick; Pautas, Cécile; Mikdame, Mohamed; Doghmi, Kamal; Toma, Andréa; Maury, Sébastien; Schwarzinger, Michael; Cordonnier, Catherine

    2015-01-01

    Objectives. Bacterial resistance is of growing concern in haematology wards. As the inappropriate administration of empirical antibacterial may alter survival, we studied risk factors for resistance to our usual empirical first-line antibacterial therapy, cefepime. Methods. We retrospectively studied 103 first episodes of bacteraemia recorded in our haematology department over 2.5 years. Risk factors for cefepime-resistance were identified by multivariate logistic regression with backward selection (P < 0.05). A scoring system for predicting cefepime-resistance was built on independent factor, with an internal validation by the bootstrap resampling technique. Results. 38 (37%) episodes were due to Gram-negative bacteria. Fifty (49%) were due to bacteria resistant to cefepime. Cefepime resistance was significantly associated with a decreased survival at day 30 (P < 0.05). Three risk factors were independently associated with cefepime-resistance: acute lymphoblastic leukaemia; ?18 days since hospital admission; and receipt of any ?-lactam in the last month. Patients with ?2 of these risk factors had a probability of 86% (CI 95%, 25 to 100%) to carry a cefepime-resistant strain. Conclusion. Using our scoring system should reduce the indication of very broad antibacterial regimens in the empirical, first-line treatment of febrile hematology patients in more than 80% of the cases. PMID:26075276

  15. A Case of Neurological Symptoms and Severe Urinary Retention on a Pediatric Ward: Is this Conversion Disorder?

    PubMed Central

    Parmar, Varinderjit; Roberts, Nasreen

    2013-01-01

    Objective a) To illustrate the etiological role of sexual and physical abuse in the development of childhood conversion disorder b) to highlight the importance of collaborative care in cases of conversion disorder c) to identify particular areas or needs for future research in the topic. Method We discuss the case of a fifteen-year old girl who was admitted to pediatrics with medically unexplained neurological complaints, chiefly urinary retention. Psychiatry was consulted after all organic work up was completed. Patient was transferred to the psychiatry ward and we present the unfolding of this case. Pediatrics and psychiatry generated a collaborative management plan. Results The patient presented, initially, with tremors, severe urinary retention and constipation. After her second admission to pediatrics, for severe urinary retention, the girl disclosed chronic sexual and physical abuse and neglect. Conclusions Conversion symptoms often occur in cases of severe psychosocial stresses including sexual and physical abuse. This case highlights the importance of interdisciplinary professional collaboration in the management of complex presentations with unexplained symptoms and psychosocial stressors. PMID:23390435

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

    NASA Astrophysics Data System (ADS)

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

    1993-06-01

    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.

  17. Nurses' knowledge, attitudes, and current practice of daily oral hygiene care to patients on acute aged care wards in two Australian hospitals.

    PubMed

    Gibney, J; Wright, C; Sharma, A; Naganathan, V

    2015-11-01

    This study aimed to identify nurses' knowledge, attitudes, and current practice in relation to oral hygiene (OH) by means of a questionnaire. It was conducted on the aged care wards of two acute tertiary referral hospitals in New South Wales, Australia. We found that 74% of nurses have a set OH practice. Fifty-four percent of nurses learn their OH practice at university or TAFE. The main nurse qualification is a registered nurse (72%). Denture cleaning, toothbrushing, and swabbing the mouth with a toothette are the main OH practices. Nurses (99%) considered OH to be important. The main barriers to conducting OH practices were patient behaviors, lack of time and staff, and patient physical difficulties. Nurses considered OH important however patient behaviors impact on their ability to undertake the task. Education institutions and hospitals should consider the joint development of a formal OH procedure and training package that can be used on acute geriatric care wards. PMID:26297474

  18. Is methicillin-resistant Staphylococcus aureus (MRSA) contamination of ward-based computer terminals a surrogate marker for nosocomial MRSA transmission and handwashing compliance?

    PubMed

    Devine, J; Cooke, R P; Wright, E P

    2001-05-01

    A survey of two acute district general hospitals (A and B) was undertaken to investigate the extent of methicillin-resistant Staphylococcus aureus (MRSA) contamination of ward-based computer terminals. Of 25 terminals examined, MRSA was identified in six (24%). Environmental contamination was of a low level. Five of the MRSA positive terminals were from hospital A which had a significantly higher rate of MRSA transmission compared to hospital B (1.02 vs. 0.49 new inpatient MRSA cases per 100 hospital admissions for 1999). MRSA containment and handwashing policies were similar at both hospitals, though only hospital B actively audited handwashing compliance and had a 44% higher rate of paper towel usage per hospital bed. Ward-based computer terminals pose a low risk of MRSA cross-infection. This risk can be further reduced if all staff wash their hands before and after patient contact. PMID:11358473

  19. Identification, investigation and management of patient-to-patient hepatitis B transmission within an inpatient renal ward in North West England

    PubMed Central

    Kliner, Merav; Dardamissis, Evdokia; Abraham, K. Abraham; Sen, Rachel; Lal, Pankaj; Pandya, Bhavna; Mutton, Ken J.; Wong, Christopher

    2015-01-01

    Background Transmission of hepatitis B virus (HBV) is rare within healthcare settings in developed countries. The aim of the article is to outline the process of identification and management of transmission of acute hepatitis B in a renal inpatient ward. Methods The case was identified through routine reporting to public health specialists, and epidemiological, virological and environmental assessment was undertaken to investigate the source of infection. An audit of HBV vaccination in patients with chronic kidney disease was undertaken. Results Investigations identified inpatient admission to a renal ward as the only risk factor and confirmed a source patient with clear epidemiological, virological and environmental links to the case. Multiple failures in infection control leading to a contaminated environment and blood glucose testing equipment, failure to isolate a non-compliant, high-risk patient and incomplete vaccination for patients with chronic kidney disease may have contributed to the transmission. Conclusions Patient-to-patient transmission of hepatitis B was shown to have occurred in a renal ward in the UK, due to multiple failures in infection control. A number of policy changes led to improvements in infection control, including reducing multi-function use of wards, developing policies for non-compliant patients, improving cleaning policies and implementing competency assessment for glucometer use and decontamination. HBV vaccination of renal patients may prevent patient-to-patient transmission of HBV. Consistent national guidance should be available, and clear pathways should be in place between primary and secondary care to ensure appropriate hepatitis B vaccination and follow-up testing. PMID:25713718

  20. Methicillin-Resistant Staphylococcus aureus (MRSA) Contamination in Bedside Surfaces of a Hospital Ward and the Potential Effectiveness of Enhanced Disinfection with an Antimicrobial Polymer Surfactant

    PubMed Central

    Yuen, John W. M.; Chung, Terence W. K.; Loke, Alice Y.

    2015-01-01

    The aim in this study was to assess the effectiveness of a quaternary ammonium chloride (QAC) surfactant in reducing surface staphylococcal contamination in a routinely operating medical ward occupied by patients who had tested positive for methicillin-resistant Staphylococcus aureus (MRSA). The QAC being tested is an antibacterial film that is sprayed onto a surface and can remain active for up to 8 h. A field experimental study was designed with the QAC plus daily hypochlorite cleaning as the experimental group and hypochlorite cleaning alone as the control group. The method of swabbing on moistened surfaces was used for sampling. It was found that 83% and 77% of the bedside surfaces of MRSA-positive and MRSA-negative patients respectively were contaminated with staphylococci at 08:00 hours, and that the staphylococcal concentrations increased by 80% at 1200 h over a 4-hour period with routine ward and clinical activities. Irrespective of the MRSA status of the patients, high-touch surfaces around the bed-units within the studied medical ward were heavily contaminated (ranged 1 to 276 cfu/cm2 amongst the sites with positive culture) with staphylococcal bacteria including MRSA, despite the implementation of daily hypochlorite wiping. However, the contamination rate dropped significantly from 78% to 11% after the application of the QAC polymer. In the experimental group, the mean staphylococcal concentration of bedside surfaces was significantly (p < 0.0001) reduced from 4.4 ± 8.7 cfu/cm2 at 08:00 hours to 0.07 ± 0.26 cfu/cm2 at 12:00 hours by the QAC polymer. The results of this study support the view that, in addition to hypochlorite wiping, the tested QAC surfactant is a potential environmental decontamination strategy for preventing the transmission of clinically important pathogens in medical wards. PMID:25768241

  1. Methicillin-resistant Staphylococcus aureus (MRSA) contamination in bedside surfaces of a hospital ward and the potential effectiveness of enhanced disinfection with an antimicrobial polymer surfactant.

    PubMed

    Yuen, John W M; Chung, Terence W K; Loke, Alice Y

    2015-03-01

    The aim in this study was to assess the effectiveness of a quaternary ammonium chloride (QAC) surfactant in reducing surface staphylococcal contamination in a routinely operating medical ward occupied by patients who had tested positive for methicillin-resistant Staphylococcus aureus (MRSA). The QAC being tested is an antibacterial film that is sprayed onto a surface and can remain active for up to 8 h. A field experimental study was designed with the QAC plus daily hypochlorite cleaning as the experimental group and hypochlorite cleaning alone as the control group. The method of swabbing on moistened surfaces was used for sampling. It was found that 83% and 77% of the bedside surfaces of MRSA-positive and MRSA-negative patients respectively were contaminated with staphylococci at 08:00 hours, and that the staphylococcal concentrations increased by 80% at 1200 h over a 4-hour period with routine ward and clinical activities. Irrespective of the MRSA status of the patients, high-touch surfaces around the bed-units within the studied medical ward were heavily contaminated (ranged 1 to 276 cfu/cm2 amongst the sites with positive culture) with staphylococcal bacteria including MRSA, despite the implementation of daily hypochlorite wiping. However, the contamination rate dropped significantly from 78% to 11% after the application of the QAC polymer. In the experimental group, the mean staphylococcal concentration of bedside surfaces was significantly (p<0.0001) reduced from 4.4±8.7 cfu/cm2 at 08:00 hours to 0.07±0.26 cfu/cm2 at 12:00 hours by the QAC polymer. The results of this study support the view that, in addition to hypochlorite wiping, the tested QAC surfactant is a potential environmental decontamination strategy for preventing the transmission of clinically important pathogens in medical wards. PMID:25768241

  2. A quality improvement project using a problem based post take ward round proforma based on the SOAP acronym to improve documentation in acute surgical receiving

    PubMed Central

    Dolan, R.; Broadbent, P.

    2015-01-01

    Objectives Ward round documentation provides one of the most important means of communication between healthcare professionals. We aimed to establish if the use of a problem based standardised proforma can improve documentation in acute surgical receiving. Methods Gold standards were established using the RCSE record keeping guidelines. We audited documentation for seven days using the following headings: patient name/identification number, subjective findings, objective findings, clinical impression/diagnosis, plan, diet status, discharge decision, discharge planning, signature, and grade. After the initial audit cycle, a ward round proforma was introduced using the above headings and re-audited over a seven day period. Results The pre-intervention arm contained 50 patients and the post intervention arm contained 47. The following headings showed an improvement in documentation compliance to 100%: patient name/identification number vs 96%, subjective findings vs 84%, objective findings vs 48%, plan vs 98%, signature vs 96%, and grade vs 62%. Documentation of the clinical impression/diagnosis improved to 98% vs 30%, diet status rose to 83% vs 16%, discharge decision to 66% vs 16%, and discharge planning to 40% vs 20%. Conclusions Standardised proformas improve the documentation of post-take ward round notes. This helps to clarify the onward management plan for all aspects of a patient's care and will help avoid adverse events and litigation. This should improve the quality and safety of Patient Care. PMID:26858834

  3. Study of Different Involutive Changes in Bone Mineral Density Measured in Ward's Triangle and Trabecular Volume Measured in Iliac Crest in Relation to Age

    PubMed Central

    Castillo, RF; Gallegos, RF

    2015-01-01

    ABSTRACT Background: The ageing process causes changes in the bone structure, in bone mineral density, and musculoskeletal disorders. Aims: The purpose of this study is to evaluate and compare involutive changes in bone structure that occur in relation to age in men and women through the study of bone mineral density at the Ward's triangle and trabecular volume. Subjects and Methods: In this study, we analysed bone mineral density at Ward's triangle in 70 people (38 men and 32 women) and did a histomorphometric study of trabecular volume at the right iliac crest in 66 samples (42 males and 24 females) obtained from autopsies of court cases, aged between 13 and 83 years. Results: The results show significant correlations between measurements of bone mineral density, trabecular volume values and anthropometric measures of age, gender and body mass index. Conclusions: This study shows involutional changes that occur in the bone mineral density and Ward's triangle in the bone structure during the process of ageing. In addition, both weight and height have a great influence on bone mineral density and changes in bone that occur; and body mass index is a very important determinant of bone mineral density. PMID:26360671

  4. Ward leadership styles.

    PubMed

    Bowman, G

    1989-01-01

    The purpose of this study was to devise a leadership style scale based in the authoritarian/democratic concept of leadership and to test it with a group of nurses. The working hypothesis was that nurses, working by primary nursing methods, would have a more democratic attitude to leadership than those nurses working in a traditional task allocation system. Recent papers such as that of Henry & Tuxill (1) plead for the caring professions to take on board the concept of the 'person'. Not only is the traditional model of nursing care seen as bad for the patient; it is seen also as harmful to the nurses. Fretwell (2) describes the task system as essentially an industrial model rather than a professional one which tends to satisfy the needs of the doctor rather than the patient or nurse. Kinston (3) describes nursing decision-making and work as Level I work (tradesmen). Current models of care that individualize the nurse's response to work and decision-making become Level II type (professional). Primary nursing fulfils the need for professionalizing nursing and meeting the need for more independence as well as respecting the patient as a 'person' with the organisation there to facilitate interaction between qualified nurse and patient. Changes in attitude and relationships are essential if work is to change from task to person-centred. Styles of leadership in nurses need to alter as our orientation to care issues change (4).(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2615867

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

    PubMed Central

    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

    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. PMID:24489715

  6. Delivering dementia care differently—evaluating the differences and similarities between a specialist medical and mental health unit and standard acute care wards: a qualitative study of family carers’ perceptions of quality of care

    PubMed Central

    Spencer, Karen; Foster, Pippa; Whittamore, Kathy H; Goldberg, Sarah E; Harwood, Rowan H

    2013-01-01

    Objectives To examine in depth carers’ views and experiences of the delivery of patient care for people with dementia or delirium in an acute general hospital, in order to evaluate a specialist Medical and Mental Health Unit (MMHU) compared with standard hospital wards. This qualitative study complemented the quantitative findings of a randomised controlled trial. Design Qualitative semistructured interviews were conducted with carers of patients with cognitive impairment admitted to hospital over a 4-month period. Setting A specialist MMHU was developed in an English National Health Service acute hospital aiming to deliver the best-practice care. Specialist mental health staff were integrated with the ward team. All staff received enhanced training in dementia, delirium and person-centred care. A programme of purposeful therapeutic and leisure activities was introduced. The ward environment was optimised to improve patient orientation and independence. A proactive and inclusive approach to family carers was encouraged. Participants 40 carers who had been recruited to a randomised controlled trial comparing the MMHU with standard wards. Results The main themes identified related closely to family carers’ met or unmet expectations and included activities and boredom, staff knowledge, dignity and fundamental care, the ward environment and communication between staff and carers. Carers from MMHU were aware of, and appreciated, improvements relating to activities, the ward environment and staff knowledge and skill in the appropriate management of dementia and delirium. However, communication and engagement of family carers were still perceived as insufficient. Conclusions Our data demonstrate the extent to which the MMHU succeeded in its goal of providing the best-practice care and improving carer experience, and where deficiencies remained. Neither setting was perceived as neither wholly good nor wholly bad; however, greater satisfaction (and less dissatisfaction) with care was experienced by carers from MMHU compared with standard care wards. PMID:24362015

  7. Characteristics and clinical management of patients admitted to cholera wards in a regional referral hospital during the 2012 epidemic in Sierra Leone

    PubMed Central

    Blacklock, Alexander; Sesay, Andrew; Kamara, Abdul; Kamara, Mamud; Blacklock, Claire

    2015-01-01

    Background and objectives In 2012, Sierra Leone suffered a nationwide cholera epidemic which affected the capital Freetown and also the provinces. This study aims to describe the characteristics and clinical management of patients admitted to cholera isolation wards of the main referral hospital in the Northern Province and compare management with standard guidelines. Design All available clinical records of patients from the cholera isolation wards were reviewed retrospectively. There was no active case finding. The following data were collected from the clinical records after patients had left the ward: date of admission, demographics, symptoms, dehydration status, diagnoses, tests and treatments given, length of stay, and outcomes. Results A total of 798 patients were admitted, of whom 443 (55.5%) were female. There were 18 deaths (2.3%). Assessment of dehydration status was recorded in 517 (64.8%) of clinical records. An alternative or additional diagnosis was made for 214 patients (26.8%). Intravenous (IV) fluids were prescribed to 767 patients (96.1%), including 95% of 141 patients who had documentation of being not severely dehydrated. A history of vomiting was documented in 92.1% of all patients. Oral rehydration solution (ORS) was given to 629 (78.8%) patients. Doxycycline was given to 380 (47.6%) patients, erythromycin to 34 (4.3%), and other antibiotics were used on 247 occasions. Zinc was given to 209 (26.2%). Discussion This retrospective study highlights the need for efforts to improve the quality of triage, adherence to clinical guidance, and record keeping. Conclusions Data collection and analysis of clinical practices during an epidemic situation would enable faster identification of those areas requiring intervention and improvement. PMID:25566807

  8. The Teamwork Assessment Scale: A Novel Instrument to Assess Quality of Undergraduate Medical Students' Teamwork Using the Example of Simulation-based Ward-Rounds

    PubMed Central

    Kiesewetter, Jan; Fischer, Martin R.

    2015-01-01

    Background: Simulation-based teamwork trainings are considered a powerful training method to advance teamwork, which becomes more relevant in medical education. The measurement of teamwork is of high importance and several instruments have been developed for various medical domains to meet this need. To our knowledge, no theoretically-based and easy-to-use measurement instrument has been published nor developed specifically for simulation-based teamwork trainings of medical students. Internist ward-rounds function as an important example of teamwork in medicine. Purposes: The purpose of this study was to provide a validated, theoretically-based instrument that is easy-to-use. Furthermore, this study aimed to identify if and when rater scores relate to performance. Methods: Based on a theoretical framework for teamwork behaviour, items regarding four teamwork components (Team Coordination, Team Cooperation, Information Exchange, Team Adjustment Behaviours) were developed. In study one, three ward-round scenarios, simulated by 69 students, were videotaped and rated independently by four trained raters. The instrument was tested for the embedded psychometric properties and factorial structure. In study two, the instrument was tested for construct validity with an external criterion with a second set of 100 students and four raters. Results: In study one, the factorial structure matched the theoretical components but was unable to separate Information Exchange and Team Cooperation. The preliminary version showed adequate psychometric properties (Cronbach’s ?=.75). In study two, the instrument showed physician rater scores were more reliable in measurement than those of student raters. Furthermore, a close correlation between the scale and clinical performance as an external criteria was shown (r=.64) and the sufficient psychometric properties were replicated (Cronbach’s ?=.78). Conclusions: The validation allows for use of the simulated teamwork assessment scale in undergraduate medical ward-round trainings to reliably measure teamwork by physicians. Further studies are needed to verify the applicability of the instrument. PMID:26038684

  9. Frequent Prescription of Antibiotics and High Burden of Antibiotic Resistance among Deceased Patients in General Medical Wards of Acute Care Hospitals in Korea

    PubMed Central

    Kwak, Yee Gyung; Moon, Chisook; Kim, Eu Suk; Kim, Baek-Nam

    2016-01-01

    Background Antibiotics are often administered to terminally ill patients until death, and antibiotic use contributes to the emergence of multidrug-resistant organisms (MDROs). We investigated antibiotic use and the isolation of MDROs among patients who died in general medical wards. Methods All adult patients who died in the general internal medicine wards at four acute care hospitals between January and June 2013 were enrolled. For comparison with these deceased patients, the same number of surviving, discharged patients was selected from the same divisions of internal medicine subspecialties during the same period. Results During the study period, 303 deceased patients were enrolled; among them, 265 (87.5%) had do-not-resuscitate (DNR) orders in their medical records. Antibiotic use was more common in patients who died than in those who survived (87.5% vs. 65.7%, P<0.001). Among deceased patients with DNR orders, antibiotic use was continued in 59.6% of patients after obtaining their DNR orders. Deceased patients received more antibiotic therapy courses (two [interquartile range (IQR) 1–3] vs. one [IQR 0–2], P<0.001). Antibiotics were used for longer durations in deceased patients than in surviving patients (13 [IQR 5–23] vs. seven days [IQR 0–18], P<0.001). MDROs were also more common in deceased patients than in surviving patients (25.7% vs. 10.6%, P<0.001). Conclusions Patients who died in the general medical wards of acute care hospitals were exposed to more antibiotics than patients who survived. In particular, antibiotic prescription was common even after obtaining DNR orders in patients who died. The isolation of MDROs during the hospital stay was more common in these patients who died. Strategies for judicious antibiotic use and appropriate infection control should be applied to these patient populations. PMID:26761461

  10. Standardized Glycemic Management with a Computerized Workflow and Decision Support System for Hospitalized Patients with Type 2 Diabetes on Different Wards

    PubMed Central

    Neubauer, Katharina M.; Höll, Bernhard; Aberer, Felix; Donsa, Klaus; Augustin, Thomas; Schaupp, Lukas; Spat, Stephan; Beck, Peter; Fruhwald, Friedrich M.; Schnedl, Christian; Rosenkranz, Alexander R.; Lumenta, David B.; Kamolz, Lars-Peter; Plank, Johannes; Pieber, Thomas R.

    2015-01-01

    Abstract Background: This study investigated the efficacy, safety, and usability of standardized glycemic management by a computerized decision support system for non-critically ill hospitalized patients with type 2 diabetes on four different wards. Materials and Methods: In this open, noncontrolled intervention study, glycemic management of 99 patients with type 2 diabetes (62% acute admissions; 41 females; age, 67±11 years; hemoglobin A1c, 65±21 mmol/mol; body mass index, 30.4±6.5 kg/m2) on clinical wards (Cardiology, Endocrinology, Nephrology, Plastic Surgery) of a tertiary-care hospital was guided by GlucoTabÂź (Joanneum Research GmbH [Graz, Austria] and Medical University of Graz [Graz, Austria]), a mobile decision support system providing automated workflow support and suggestions for insulin dosing to nurses and physicians. Results: Adherence to insulin dosing suggestions was high (96.5% bolus, 96.7% basal). The primary outcome measure, percentage of blood glucose (BG) measurements in the range of 70–140 mg/dL, occurred in 50.2±22.2% of all measurements. The overall mean BG level was 154±35 mg/dL. BG measurements in the ranges of 60–70 mg/dL, 40–60 mg/dL, and <40 mg/dL occurred in 1.4%, 0.5%, and 0.0% of all measurements, respectively. A regression analysis showed that acute admission to the Cardiology Ward (+30 mg/dL) and preexisting home insulin therapy (+26 mg/dL) had the strongest impact on mean BG. Acute admission to other wards had minor effects (+4 mg/dL). Ninety-one percent of the healthcare professionals felt confident with GlucoTab, and 89% believed in its practicality and 80% in its ability to prevent medication errors. Conclusions: An efficacious, safe, and user-accepted implementation of GlucoTab was demonstrated. However, for optimized personalized patient care, further algorithm modifications are required. PMID:26355756

  11. A stepped wedge, cluster controlled trial of an intervention to improve safety and quality on medical wards: the HEADS-UP study protocol

    PubMed Central

    Pannick, Samuel; Beveridge, Iain; Ashrafian, Hutan; Long, Susannah J; Athanasiou, Thanos; Sevdalis, Nick

    2015-01-01

    Introduction The majority of preventable deaths in healthcare are due to errors on general wards. Staff perceptions of safety correlate with patient survival, but effectively translating ward teams’ concerns into tangibly improved care remains problematic. The Hospital Event Analysis Describing Significant Unanticipated Problems (HEADS-UP) trial evaluates a structured, multidisciplinary team briefing, capturing safety threats and adverse events, with rapid feedback to clinicians and service managers. This is the first study to rigorously assess a simpler intervention for general medical units, alongside an implementation model applicable to routine clinical practice. Methods/analysis 7 wards from 2 hospitals will progressively incorporate the intervention into daily practice over 14 months. Wards will adopt HEADS-UP in a pragmatic sequence, guided by local clinical enthusiasm. Initial implementation will be facilitated by a research lead, but rapidly delegated to clinical teams. The primary outcome is excess length of stay (a surplus stay of 24 h or more, compared to peer institutions’ Healthcare Resource Groups-predicted length of stay). Secondary outcomes are 30-day readmission or excess length of stay; in-hospital death or death/readmission within 30 days; healthcare-acquired infections; processes of escalation of care; use of traditional incident-reporting systems; and patient safety and teamwork climates. HEADS-UP will be analysed as a stepped wedge cluster controlled trial. With 7840 patients, using best and worst case predictions, the study would achieve between 75% and 100% power to detect a 2–14% absolute risk reduction in excess length of stay (two-sided p<0.05). Regression analysis will use generalised linear mixed models or generalised estimating equations, and a time-to-event regression model. A qualitative analysis will evaluate facilitators and barriers to HEADS-UP implementation and impact. Ethics and dissemination Participating institutions’ Research and Governance departments approved the study. Results will be published in peer-reviewed journals and at conference presentations. Trial registration number ISRCTN34806867. PMID:26100026

  12. Use of audit and feedback with fluorescent targeting to achieve rapid improvements in room cleaning in the intensive care unit and ward settings.

    PubMed

    Ragan, Kelsey; Khan, Anjum; Zeynalova, Nurana; McKernan, Patricia; Baser, Karine; Muller, Matthew P

    2012-04-01

    Environmental contamination of high-touch surfaces in patient rooms can lead to the transmission of clinically significant pathogens; thus, such surfaces should be cleaned routinely and thoroughly. Fluorescent targeting can be used to provide feedback to frontline cleaning staff on the thoroughness of room cleaning, which can result in substantial improvements in performance. We demonstrate that auditing with fluorescent targeting can be implemented in both the ward and intensive care unit settings using only modest resources, resulting in rapid improvements in cleaning thoroughness. PMID:21820762

  13. Differences in ward-to-cath lab systolic blood pressure predicts long-term adverse outcomes after drug-eluting stent implantation.

    PubMed

    Her, Ae-Young; Ann, Soe Hee; Lee, Jun Ho; Kim, Jong Min; Kim, Yong Hoon; Garg, Scot; Singh, Gillian Balbir; Shin, Eun-Seok

    2015-11-01

    We sought to investigate the effect of ward-to-cath lab blood pressure (BP) differences on long-term clinical outcomes in patients undergoing percutaneous coronary intervention (PCI) with drug-eluting stent (DES). There are limited data available on the association between PCI with DES and BP differences on long-term clinical outcomes. This study enrolled 994 patients who underwent PCI with DES from March 2003 to August 2007. Resting BP was measured in a ward environment before transfer to the cardiac catheterization lab (cath lab), and again when the patient was laid down on the cath lab table. Patients were divided into two groups according to the difference in ward-to-cath lab systolic BP. Large difference group (n = 383) was defined as the absolute systolic difference of >20 mmHg and small difference group (n = 424) as the absolute systolic difference of ?20 mmHg. The primary endpoints were all-cause mortality, cardiac death, nonfatal myocardial infarction and stroke. A total of 807 patients (mean age 60 ± 10 years, 522 males) received follow-up for 5.1 ± 2.4 years. The rate of all-cause mortality was significantly higher in the large difference group compared to the small difference group (6.6 vs. 2.8 %; adjusted hazard ratio (HR) 2.43; 95 % confidence interval (CI) 1.22-4.83; p = 0.012). There were higher cardiac deaths seen in the large difference group compared to the small difference group (3.9 vs. 1.4 %; adjusted HR 2.84; 95 % CI 1.1-7.31; p = 0.031). Stroke (2.4 vs. 1.2 %, p = 0.125) and TVR (3.7 vs. 1.7 %, p = 0.051) had higher trends in the large difference group compared to the small difference group. The composite of primary endpoints (all-cause mortality, cardiac death, nonfatal MI and stroke) occurred more frequently in the large difference group compared to the small difference group (10.0 vs. 6.4 %; adjusted HR 1.71; 95 % CI 1.04-2.81; p = 0.033). A difference in ward-to-cath lab systolic BP of >20 mmHg may contribute to increased adverse outcomes in the form of all-cause mortality and cardiac deaths in patients undergoing PCI with DES. PMID:25062712

  14. Accelerated HIV testing for PMTCT in maternity and labour wards is vital to capture mothers at a critical point in the programme at district level in Malawi.

    PubMed

    Beltman, J J; Fitzgerald, M; Buhendwa, L; Moens, M; Massaquoi, M; Kazima, J; Alide, N; van Roosmalen, J

    2010-11-01

    Round the clock (24 hours×7 days) HIV testing is vital to maintain a high prevention of mother to child transmission (PMTCT) coverage for women delivering in district health facilities. PMTCT coverage increases when most of the pregnant women will have their HIV status tested. Therefore routine offering of HIV testing should be integrated and seen as a part of comprehensive antenatal care. For women who miss antenatal care and deliver in a health facility without having had their HIV status tested, the labour and maternity ward could still serve as other entry points. PMID:20711887

  15. The value of purpose built mental health facilities: Use of the Ward Atmosphere Scale to gauge the link between milieu and physical environment.

    PubMed

    Nicholls, Daniel; Kidd, Kevin; Threader, Jennifer; Hungerford, Catherine

    2015-08-01

    This study investigated changes in the 'atmosphere' of an acute adult mental health setting following relocation to a new purpose-built facility. The Ward Atmosphere Scale (WAS) was designed and validated for specific use in hospital-based psychiatric facilities, and measures several dimensions of an environment. In this study, the WAS was administered to consumers and staff at periods before and also after their relocation to a new purpose-built acute adult mental health facility. There were significant improvements in the physical atmosphere of the new facility, when compared with the old facility. In terms of ward atmosphere, however, improvements were seen to occur in only a small number of measures and there were minor differences between consumers' and staff perspectives on some indicators. Interestingly, it was found that consumers noted less 'staff control' in the new setting, raising the question of the differences in understanding of control. For staff only, there was a perception of greater levels of consumer 'involvement' in the new facility. Despite the minor differences in perception, the study does confirm that architecture is an important influence on the 'atmosphere' of a health facility, for both staff and consumers. PMID:25975388

  16. Limits of patient isolation measures to control extended-spectrum beta-lactamase–producing Enterobacteriaceae: model-based analysis of clinical data in a pediatric ward

    PubMed Central

    2013-01-01

    Background Extended-spectrum beta-lactamase–producing Enterobacteriaceae (ESBL-E) are a growing concern in hospitals and the community. How to control the nosocomial ESBL-E transmission is a matter of debate. Contact isolation of patients has been recommended but evidence supporting it in non-outbreak settings has been inconclusive. Methods We used stochastic transmission models to analyze retrospective observational data from a two-phase intervention in a pediatric ward, successively implementing single-room isolation and patient cohorting in an isolation ward, combined with active ESBL-E screening. Results For both periods, model estimates suggested reduced transmission from isolated/cohorted patients. However, most of the incidence originated from sporadic sources (i.e. independent of cross-transmission), unaffected by the isolation measures. When sporadic sources are high, our model predicted that even substantial efforts to prevent transmission from carriers would have limited impact on ESBL-E rates. Conclusions Our results provide evidence that, considering the importance of sporadic acquisition, e.g. endogenous selection of resistant strains following antibiotic treatment, contact-isolation measures alone might not suffice to control ESBL-E. They also support the view that estimating cross-transmission extent is key to predicting the relative success of contact-isolation measures. Mathematical models could prove useful for those estimations and guide decisions concerning the most effective control strategy. PMID:23618041

  17. The association between air pollution and weather conditions with increase in the number of admissions of asthmatic patients in emergency wards: a case study in Kermanshah

    PubMed Central

    Khamutian, Razieh; Najafi, Farid; Soltanian, Mohammad; Shokoohizadeh, Mohamad Javad; Poorhaghighat, Saeedeh; Dargahi, Abdollah; Sharafi, Kiomars; Afshari, Alireza

    2015-01-01

    Background: Industrialization and urbanization had a devastating impact on public health and caused an increase in health related morbidity and mortality. In fact, asthma is a chronic condition which is considered as one of the significant challenges of public health. In this study, we investigated the association of air pollution and weather conditions with excess emergency ward admissions of asthmatic patients in Kermanshah hospitals. Methods: This was an ecological study. The total number of hospital admissions to emergency wards from all related and major hospitals of Kermanshah was collected from September 2008 through August 2009. In addition, data on air pollution as well as meteorological data were collected from the Environmental Protection Agency and Meteorological Organization of Kermanshah. To determine the association between the number of hospitalization due to asthma with those parameters, Poisson regression was used. Results: The results of Poisson regression revealed a significant association between carbon monoxide, ozone, nitrogen dioxide and temperature with emergency room visits due to asthma in Kermanshah. No associations were found for sulfur dioxide or for particulate matter. Conclusion: This study provides further evidence for the significant effect of monoxide carbon on asthma; and it suggests that temperature may have a role in the exacerbation of asthma. However, due to the multi-factorial nature of asthma, other factors also play a major role in the development and exacerbation of this illness. PMID:26478887

  18. Genetic dissimilarity and selection of putative mutants of Terra MaranhĂŁo plantain cultivar using the Ward-MLM strategy.

    PubMed

    Reis, R V; Amorim, E P; Amorim, V B O; Ferreira, C F; Pestana, R K N; Ledo, C A S; Gonçalves, Z; Borém, A

    2015-01-01

    The objective of this study was to evaluate genetic variability and select putative mutants of Terra MaranhĂŁo plantain cultivar (AAB genome) subjected to gamma radiation based on agronomic data and inter simple sequence repeat molecular marker profiles using the Ward-MLM strategy. A total of 233 irradiated plants and 41 controls were assessed. The agronomic and molecular data were subjected to the Ward-MLM statistical algorithm in the SAS program. Cluster analysis was performed by the average distance method (UPGMA), based on the distance matrix of the Gower algorithm, and the cophenetic correlation coefficient calculated using the R software. The distance between the putative mutants ranged from 0.321 to 0.524, with an average distance of 0.426, and a cophenetic correlation coefficient of 0.79. Three putative mutants, which were selected based on the best agronomic traits and low height, will undergo further evaluation in the next stages of the banana breeding program at Embrapa. These results describe the first attempt of using combined data of Terra MaranhĂŁo plantain cultivar for the purpose of selecting mutants and assessing genetic variability. PMID:26634499

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

    PubMed

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

    2013-01-01

    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

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

    PubMed Central

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

    2013-01-01

    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

  1. Modified Early Warning Score (MEWS) Identifies Critical Illness among Ward Patients in a Resource Restricted Setting in Kampala, Uganda: A Prospective Observational Study

    PubMed Central

    Kruisselbrink, Rebecca; Kwizera, Arthur; Crowther, Mark; Fox-Robichaud, Alison; O'Shea, Timothy; Nakibuuka, Jane; Ssinabulya, Isaac; Nalyazi, Joan; Bonner, Ashley; Devji, Tahira; Wong, Jeffrey; Cook, Deborah

    2016-01-01

    Introduction Providing optimal critical care in developing countries is limited by lack of recognition of critical illness and lack of essential resources. The Modified Early Warning Score (MEWS), based on physiological parameters, is validated in adult medical and surgical patients as a predictor of mortality. The objective of this study performed in Uganda was to determine the prevalence of critical illness on the wards as defined by the MEWS, to evaluate the MEWS as a predictor of death, and to describe additional risk factors for mortality. Methods We conducted a prospective observational study at Mulago National Referral Teaching Hospital in Uganda. We included medical and surgical ward patients over 18 years old, excluding patients discharged the day of enrolment, obstetrical patients, and patients who self-discharged prior to study completion. Over a 72-hour study period, we collected demographic and vital signs, and calculated MEWS; at 7-days we measured outcomes. Patients discharged prior to 7 days were assumed to be alive at study completion. Descriptive and inferential statistical analyses were performed. Results Of 452 patients, the median age was 40.5 (IQR 29–54) years, 53.3% were male, 24.3% were HIV positive, and 45.1% had medical diagnoses. MEWS ranged from 0 to 9, with higher scores representing hemodynamic instability. The median MEWS was 2 [IQR 1–3] and the median length of hospital stay was 9 days [IQR 4–24]. In-hospital mortality at 7-days was 5.5%; 41.4% of patients were discharged and 53.1% remained on the ward. Mortality was independently associated with medical admission (OR: 7.17; 95% CI: 2.064–24.930; p = 0.002) and the MEWS ≄ 5 (OR: 5.82; 95% CI: 2.420–13.987; p<0.0001) in the multivariable analysis. Conclusion There is a significant burden of critical illness at Mulago Hospital, Uganda. Implementation of the MEWS could provide a useful triage tool to identify patients at greatest risk of death. Future research should include refinement of MEWS for low-resource settings, and development of appropriate interventions for patients identified to be at high risk of death based on early warning scores. PMID:26986466

  2. Patterns of ‘balancing between hope and despair’ in the diagnostic phase: a grounded theory study of patients on a gastroenterology ward

    PubMed Central

    Giske, Tove; Artinian, Barbara

    2008-01-01

    Title Patterns of ‘balancing between hope and despair' in the diagnostic phase: a grounded theory study of patients on a gastroenterology ward Aim The aim of the study was to learn how patients going through the diagnostic phase experienced and handled their situation. Background Many studies report about the stressful diagnostic phase; however, none has presented a conceptual theory where the concepts are sufficiently related to each other. The Theory of Preparative Waiting has previously been published as a descriptive grounded theory and describes the experience of a group of gastroenterology patients going through the diagnostic phase. Method A classical grounded theory design was used, with data derived from 18 in-depth interviews with 15 patients in a gastroenterology ward at a Norwegian University Hospital. Interviews were conducted during 2002–2003. Findings Participants' main concern was found to be how they could prepare themselves for the concluding interview and life after diagnosis. The theoretical code of ‘balancing’ had four patterns; controlling pain, rational awaiting, denial, and accepting. These patterns of ‘balancing’ guided how participants used the categories of ‘Preparative Waiting Theory’‘seeking and giving information’, ‘interpreting clues’, ‘handling existential threats’ and ‘seeking respite’. Patterns were strategies, so one person could use more than one pattern. Conclusion The diagnostic phase was a difficult time for the participants and the ‘Preparative Waiting Theory’ can assist nurses in assessing how patients prepare themselves differently for getting a diagnosis. All patients would find it helpful to be followed up by a designated contact person at the ward; however, patients using mostly the patterns of controlling pain and denial would benefit most from such support. What is already known about this topic Theoretical coding is the least understood part of grounded theory analysis. The ambiguity of the diagnostic phase causes uncertainty and is experienced as the most stressful part of the illness trajectory for patients. The informational needs and different ways of dealing with the emotional challenge of waiting in the diagnostic phase are widely acknowledged. What this paper adds A conceptual grounded theory where the processes of preparing for a diagnosis are related to each other through the theoretical code of ‘balancing’. Articulation of how the four ‘balancing’ patterns of controlling pain, rational awaiting, denial and accepting explain how patients prepare differently for getting a diagnosis. A model which could be used in developing the nursing role for patients in the diagnostic phase. PMID:18352961

  3. Implementation and Operational Research: Implementation of Routine Counselor-Initiated Opt-Out HIV Testing on the Adult Medical Ward at Kamuzu Central Hospital, Lilongwe, Malawi.

    PubMed

    LaCourse, Sylvia M; Chester, Frances M; Matoga, Mitch; Munthali, Charles; Nsona, Dominic; Haac, Bryce; Hoffman, Irving F; Hosseinipour, Mina C

    2015-05-01

    The optimal approach of provider-initiated HIV testing and counseling (PITC) for inpatients in high-burden settings is unknown. We prospectively evaluated the implementation of task shifting from clinician-referral to counselor-initiated PITC on the medical wards of Kamuzu Central Hospital, Malawi. Most of patients (1905/3154, 60.4%) had an unknown admission HIV status. Counselors offered testing to 66.6% (1268/1905). HIV prevalence was 39.3%. Counselor-initiated PITC significantly increased HIV testing by 79% (643/2957 vs. 1228/3154), resulting in an almost 2-fold increase in patients with known HIV status (2447/3154 vs. 1249/3154) (both P < 0.0001), with 18.4% of those tested receiving a new diagnosis of HIV. PMID:25622063

  4. Comprehensive complexity assessment as a key tool for the prediction of in-hospital mortality in heart failure of aged patients admitted to internal medicine wards.

    PubMed

    Nardi, R; Fiorino, S; Borioni, D; Agostini, D; D'Anastasio, C; Marchetti, C; Muratori, M

    2007-01-01

    Congestive heart failure (CHF) and cognitive impairment are both common problems in old age, associated with significant mortality, impaired quality of life and disability. This study evaluated patients with CHF, admitted to internal medicine and geriatric wards. We identified factors associated with a high risk of in-hospital mortality. Hospitalized CHF subjects with increased risk of in-hospital death present a clinical profile including: very old age, overt cognitive dysfunction, predisposition to falls, dependency, social-family problems, impairment in sphincter control and feeding ability, presence of bedsores, digoxin but not warfarin treatment, hypo-dysproteinemia and hypernatremia and mild renal impairment. We observed that patients admitted to our Internal Medicine Departments, in addition to CHF, present a high grade of complex therapeutic needs and that comorbidity, by itself, does not reflect complexity. Our data support the hypothesis that CHF has different patterns of severity and prognosis in young and in old or very old age groups. PMID:17317463

  5. Using Self-Organizing Neural Network Map Combined with Ward's Clustering Algorithm for Visualization of Students' Cognitive Structural Models about Aliveness Concept.

    PubMed

    Yorek, Nurettin; Ugulu, Ilker; Aydin, Halil

    2016-01-01

    We propose an approach to clustering and visualization of students' cognitive structural models. We use the self-organizing map (SOM) combined with Ward's clustering to conduct cluster analysis. In the study carried out on 100 subjects, a conceptual understanding test consisting of open-ended questions was used as a data collection tool. The results of analyses indicated that students constructed the aliveness concept by associating it predominantly with human. Motion appeared as the most frequently associated term with the aliveness concept. The results suggest that the aliveness concept has been constructed using anthropocentric and animistic cognitive structures. In the next step, we used the data obtained from the conceptual understanding test for training the SOM. Consequently, we propose a visualization method about cognitive structure of the aliveness concept. PMID:26819579

  6. Using Self-Organizing Neural Network Map Combined with Ward's Clustering Algorithm for Visualization of Students' Cognitive Structural Models about Aliveness Concept

    PubMed Central

    Ugulu, Ilker; Aydin, Halil

    2016-01-01

    We propose an approach to clustering and visualization of students' cognitive structural models. We use the self-organizing map (SOM) combined with Ward's clustering to conduct cluster analysis. In the study carried out on 100 subjects, a conceptual understanding test consisting of open-ended questions was used as a data collection tool. The results of analyses indicated that students constructed the aliveness concept by associating it predominantly with human. Motion appeared as the most frequently associated term with the aliveness concept. The results suggest that the aliveness concept has been constructed using anthropocentric and animistic cognitive structures. In the next step, we used the data obtained from the conceptual understanding test for training the SOM. Consequently, we propose a visualization method about cognitive structure of the aliveness concept. PMID:26819579

  7. Assessment of the MSF triage system, separating patients into different wards pending Ebola virus laboratory confirmation, Kailahun, Sierra Leone, July to September 2014.

    PubMed

    Vogt, Florian; Fitzpatrick, Gabriel; Patten, Gabriela; van den Bergh, Rafael; Stinson, Kathryn; Pandolfi, Luigi; Squire, James; Decroo, Tom; Declerck, Hilde; Van Herp, Michel

    2015-12-17

    Prevention of nosocomial Ebola virus (EBOV) infection among patients admitted to an Ebola management centre (EMC) is paramount. Current MĂ©decins Sans FrontiĂšres (MSF) guidelines recommend classifying admitted patients at triage into suspect and highly-suspect categories pending laboratory confirmation. We investigated the performance of the MSF triage system to separate patients with subsequent EBOV-positive laboratory test (true-positive admissions) from patients who were initially admitted on clinical grounds but subsequently tested EBOV-negative (false-positive admissions). We calculated standard diagnostic test statistics for triage allocation into suspect or highly-suspect wards (index test) and subsequent positive or negative laboratory results (reference test) among 433 patients admitted into the MSF EMC Kailahun, Sierra Leone, between 1 July and 30 September 2014. 254 (59%) of admissions were classified as highly-suspect, the remaining 179 (41%) as suspect. 276 (64%) were true-positive admissions, leaving 157 (36.3%) false-positive admissions exposed to the risk of nosocomial EBOV infection. The positive predictive value for receiving a positive laboratory result after being allocated to the highly-suspect ward was 76%. The corresponding negative predictive value was 54%. Sensitivity and specificity were 70% and 61%, respectively. Results for accurate patient classification were unconvincing. The current triage system should be changed. Whenever possible, patients should be accommodated in single compartments pending laboratory confirmation. Furthermore, the initial triage step on whether or not to admit a patient in the first place must be improved. What is ultimately needed is a point-of-care EBOV diagnostic test that is reliable, accurate, robust, mobile, affordable, easy to use outside strict biosafety protocols, providing results with quick turnaround time. PMID:26727011

  8. Clinical and Organizational Factors Related to the Reduction of Mechanical Restraint Application in an Acute Ward: An 8-Year Retrospective Analysis

    PubMed Central

    Di Lorenzo, Rosaria; Miani, Fiorenza; Formicola, Vitantonio; Ferri, Paola

    2014-01-01

    Background: The purpose of this study was to describe the frequency of mechanical restraint use in an acute psychiatric ward and to analyze which variables may have significantly influenced the use of this procedure. Methods: This retrospective study was conducted in the Servizio Psichiatrico di Diagnosi e Cura (SPDC) of Modena Centro. The following variables of our sample, represented by all restrained patients admitted from 1-1-2005 to 31-12-2012, were analyzed: age, gender, nationality, psychiatric diagnoses, organic comorbidity, state and duration of admission, motivation and duration of restraints, nursing shift and hospitalization day of restraint, number of patients admitted at the time of restraint and institutional changes during the observation period. The above variables were statistically compared with those of all other non-restrained patients admitted to our ward in the same period. Results: Mechanical restraints were primarily used as a safety procedure to manage aggressive behavior of male patients, during the first days of hospitalization and night shifts. Neurocognitive disorders, organic comorbidity, compulsory state and long duration of admission were statistically significantly related to the increase of restraint use (p<.001, multivariate logistic regression). Institutional changes, especially more restricted guidelines concerning restraint application, were statistically significantly related to restraint use reduction (p<.001, chi2 test, multivariate logistic regression). Conclusion: The data obtained highlight that mechanical restraint use was influenced not only by clinical factors, but mainly by staff and policy factors, which have permitted a gradual but significant reduction in the use of this procedure through a multidimensional approach. PMID:25320635

  9. Clinical Assessment of Nursing Care Regarding Hemovigilance in Neonatal Wards and Neonatal Intensive Care Units in Selected Hospitals Affiliated to Shahid Beheshti University of Medical Sciences (2013 - 2014)

    PubMed Central

    Tajalli, Saleheh; Nourian, Manijeh; Rassouli, Maryam; Baghestani, Ahmad Reza

    2015-01-01

    Background: Hemovigilance is a series of surveillance procedures encompassing the entire transfusion chain from the collection of blood and its components to the follow-up of its recipients. It is intended to collect and access information on unanticipated or adverse effects stemming from the therapeutic use of labile blood products. Blood transfusion, particularly in neonates, requires meticulous clinical assessment to ensure safety before, during, and after the procedure. Therefore, it is essential to investigate how nurses and other health care providers implement hemovigilance with a view to elevating the standards of care. Objectives: The aim of this study, conducted between 2013 and 2014, was to assess nursing care regarding hemovigilance in the neonatal wards and neonatal intensive care units (NICUs) of selected hospitals affiliated to Shahid Beheshti University of Medical Sciences. Materials and Methods: This descriptive study assessed nursing care concerning hemovigilance in 144 neonates. Data were collected using a checklist at the neonatal wards and NICUs of Mahdiyeh, Mofid, and Imam Hussain hospitals affiliated to Shahid Beheshti University of Medical Sciences. The checklist contained information on the standard of care in relation to neonatal hemovigilance in three components of request, transfusion, and documentation. Descriptive statistics with the Statistical Package for the Social Sciences (version 21) were used to analyze the collected data. Results: The rates of compliance with the hemovigilance guidelines in terms of request, transfusion, and documentation were 47%, 63.2%, and 68%, correspondingly, with a total score of 59.6% in all areas of research. Accordingly, compliance with hemovigilance guidelines was highest in documentation (68%), followed by transfusion (63.2%) and request (47%). Conclusions: The overall score of nursing care as regards adherence to the neonatal hemovigilance guidelines was 59.6% in the present study, indicating a lack of care and failure in training in this regard. PMID:26421167

  10. Pharmacotherapy for Adverse Events Reduces the Length of Hospital Stay in Patients Admitted to Otolaryngology Ward: A Single Arm Intervention Study

    PubMed Central

    Suzuki, Akio; Kobayashi, Ryo; Okayasu, Shinji; Kuze, Bunya; Aoki, Mitsuhiro; Mizuta, Keisuke; Itoh, Yoshinori

    2014-01-01

    Background To determine whether adverse events extend the duration of hospitalization, and to evaluate the effectiveness of medical intervention in ameliorating adverse events and reducing the prolonged hospital stay associated with adverse events. Methods A single arm intervention study was conducted from October 2012 to March 2014 in the otolaryngology ward of a 614-bed, university-affiliated hospital. Adverse events were monitored daily by physicians, pharmacists and nurses, and recorded in the electronic medical chart for each patient. Appropriate drug management of adverse events was performed by physicians in liaison with pharmacists. The Kaplan-Meier method was used to assess the length of hospitalization of patients who underwent medical intervention for adverse events. Results Of 571 patients admitted to the otolaryngology ward in a year, 219 patients (38.4%) experienced adverse events of grade ?2. The duration of hospitalization was affected by the grade of adverse events, with a mean duration of hospital stay of 9.2, 17.2, 28.3 and 47.0 days for grades 0, 1, 2, and 3–4, respectively. Medical intervention lowered the incidence of grade ?2 adverse events to 14.5%. The length of hospitalization was significantly shorter in patients who showed an improvement of adverse events after medical intervention than those who did not (26.4 days vs. 41.6 days, hazard ratio 1.687, 95% confidence interval: 1.260–2.259, P<0.001). A multivariate Cox proportional hazard analysis indicated that insomnia, constipation, nausea/vomiting, infection, non-cancer pain, oral mucositis, odynophagia and neutropenia were significant risk factors for prolongation of hospital stay. Conclusion Patients who experienced adverse events are at high risk of prolonged hospitalization. Medical intervention for adverse events was found to be effective in reducing the length of hospital stay associated with adverse events. PMID:25549093

  11. Meningitis Caused by Escherichia coli Producing TEM-52 Extended-Spectrum ÎČ-Lactamase within an Extensive Outbreak in a Neonatal Ward: Epidemiological Investigation and Characterization of the Strain▿

    PubMed Central

    Moissenet, Didier; Salauze, BĂ©atrice; Clermont, Olivier; Bingen, Edouard; Arlet, Guillaume; Denamur, Erick; MĂ©rens, Audrey; Mitanchez, Delphine; Vu-Thien, Hoang

    2010-01-01

    Outbreaks caused by Enterobacteriaceae isolates producing extended-spectrum ÎČ-lactamases (ESBL) in neonatal wards can be difficult to control. We report here an extensive outbreak in a neonatal ward with a case of meningitis caused by an ESBL-producing Escherichia coli strain. Between 24 March and 29 April 2009, among the 59 neonates present in the ward, 26 neonates with ESBL-producing E. coli rectal colonization were detected (44%). One of the colonized neonates developed meningitis with a favorable outcome after treatment combining imipenem, gentamicin, and ciprofloxacin. Despite strict intensification of hygiene and isolation procedures for more than 1 month, ward closure to new admissions was necessary to control the outbreak. Randomly amplified polymorphic DNA and pulsed-field gel electrophoresis analysis performed on 31 isolates recovered from 26 neonates and two mother's milk samples showed a clonal strain. ESBL PCR assays indicated that the strain harbored a TEM-52 ESBL encoded by an IncI1 replicon. Phylogenetic analysis by multilocus sequence typing showed that the strain belonged to rare phylogenetic group C, which is closely related to group B1 but appears as group A by the triplex PCR phylogrouping method. The strain harbored the virulence genes fuyA, aer, and iroN and was virulent in a mouse model of septicemia. This work indicates the high potential of colonization, transmission, and virulence of some ESBL-producing E. coli clones. PMID:20519482

  12. Meningitis caused by Escherichia coli producing TEM-52 extended-spectrum beta-lactamase within an extensive outbreak in a neonatal ward: epidemiological investigation and characterization of the strain.

    PubMed

    Moissenet, Didier; Salauze, Béatrice; Clermont, Olivier; Bingen, Edouard; Arlet, Guillaume; Denamur, Erick; Mérens, Audrey; Mitanchez, Delphine; Vu-Thien, Hoang

    2010-07-01

    Outbreaks caused by Enterobacteriaceae isolates producing extended-spectrum beta-lactamases (ESBL) in neonatal wards can be difficult to control. We report here an extensive outbreak in a neonatal ward with a case of meningitis caused by an ESBL-producing Escherichia coli strain. Between 24 March and 29 April 2009, among the 59 neonates present in the ward, 26 neonates with ESBL-producing E. coli rectal colonization were detected (44%). One of the colonized neonates developed meningitis with a favorable outcome after treatment combining imipenem, gentamicin, and ciprofloxacin. Despite strict intensification of hygiene and isolation procedures for more than 1 month, ward closure to new admissions was necessary to control the outbreak. Randomly amplified polymorphic DNA and pulsed-field gel electrophoresis analysis performed on 31 isolates recovered from 26 neonates and two mother's milk samples showed a clonal strain. ESBL PCR assays indicated that the strain harbored a TEM-52 ESBL encoded by an IncI1 replicon. Phylogenetic analysis by multilocus sequence typing showed that the strain belonged to rare phylogenetic group C, which is closely related to group B1 but appears as group A by the triplex PCR phylogrouping method. The strain harbored the virulence genes fuyA, aer, and iroN and was virulent in a mouse model of septicemia. This work indicates the high potential of colonization, transmission, and virulence of some ESBL-producing E. coli clones. PMID:20519482

  13. How the drainage of melting ponds leads to cracks? - Evidence revealed from Formosat-2 high spatiotemporal optical images of Ward-Hunt Ice Shelf, Summer 2008

    NASA Astrophysics Data System (ADS)

    Chang, Y.-C.; Liu, C.-C.

    2009-04-01

    For years, formation and extinction of melting pond have been regarded as one of the main precursors to the "rapid" disintegration of large ice shelves. Many models of calving and crack propagation have been proposed in regard with melting ponds as well. However, the existing spaceborne sensors all have constraints over the Polar Regions. Narrow cracks and their propagation are not easily observed and measured, and the area change of many small melting ponds is easily under-estimated. Formosat-2 is able to provide high spatiotemporal imagery of the Polar Regions, which provides an ideal source of data to investigate the rapid disintegration caused by tiny cracks and melting ponds over the ice shelves. In this research, we compiled a series of Formosat-2 time-sequential (16 scenes) and high-spatiotemporal (daily revisited orbit; 4 multispectral bands with 8 m, plus 1 panchromatic with 2 m) optical imagery of the Ward-Hunt Ice Shelf (WHIS) taken in the summer of 2008. Sea ice and open regions were masked prior to semi-automatic warping, minimizing errors of change detection. Fifteen out of sixteen scenes of multi-temporal imagery (from June 5th to August 30th, 2008) have been spatially co-registered with the base of the middle date (July 28th). A total of 16 sub-sets were intensively investigated, including the calved (ice island A and B, separated on July 24 and July 26 respectively) and non-calved coastal areas (in the North-eastern coast of WHIS), the southern calved coast, the crack complex in the south of Ward-Hunt Island (WHI), and other typical undulated ice shelf regions. Finally, length of cracks and area of melting ponds in the sub-sets were carefully extracted, estimated and assessed. The results show that a series of melting ponds drained and rifts formed and propagated consequently at various scales in most regions of WHIS. In addition, in some coastal areas, drainage of melting ponds is also highly related to the process of calving events. In conclusion, the propagation of the rifts (length) was highly correlated with the abrupt decreasing of the area of melting ponds, especially in the coastal areas. Capability for change detection over cracks and melting ponds with small scale would enhance the understanding of their impacts to ice shelves.

  14. Anammox moving bed biofilm reactor pilot at the 26th Ward wastewater treatment plants in Brooklyn, New York: start-up, biofilm population diversity and performance optimization.

    PubMed

    Mehrdad, M; Park, H; Ramalingam, K; Fillos, J; Beckmann, K; Deur, A; Chandran, K

    2014-01-01

    New York City Environmental Protection in conjunction with City College of New York assessed the application of the anammox process in the reject water treatment using a moving bed biofilm reactor (MBBR) located at the 26th Ward wastewater treatment plant, in Brooklyn, NY. The single-stage nitritation/anammox MBBR was seeded with activated sludge and consequently was enriched with its own 'homegrown' anammox bacteria (AMX). Objectives of this study included collection of additional process kinetic and operating data and assessment of the effect of nitrogen loading rates on process performance. The initial target total inorganic nitrogen removal of 70% was limited by the low alkalinity concentration available in the influent reject water. Higher removals were achieved after supplementing the alkalinity by adding sodium hydroxide. Throughout startup and process optimization, quantitative real-time polymerase chain reaction (qPCR) analyses were used for monitoring the relevant species enriched in the biofilm and in the suspension. Maximum nitrogen removal rate was achieved by stimulating the growth of a thick biofilm on the carriers, and controlling the concentration of dissolved oxygen in the bulk flow and the nitrogen loading rates per surface area; all three appear to have contributed in suppressing nitrite-oxidizing bacteria activity while enriching AMX density within the biofilm. PMID:25401307

  15. Epidemiological and Clinical Aspects and Therapy of Chronic Otitis Media in the “ENT” and Cervicofacial Surgery Ward in the University Hospital of Ouagadougou

    PubMed Central

    Gyebre, Y. M. C.; Ouedraogo, R. W.-L.; Elola, A.; Ouedraogo, B. P.; Sereme, M.; Ouattara, M.; Ouoba, K.

    2013-01-01

    Objectives. The aim of this study was to analyze the epidemiological and clinical aspects of chronic otitis media and its therapeutic processes in our context. Patients and Methods. In a prospective study over a period of 1 year (March 2009–February 2010), 79 patients with chronic otitis media have been cared for in the otolaryngology ward of the University Hospital of Ouagadougou. Results. Chronic otitis media (COM) commonly occurs in the age group from 0 to 15 years (40.50%). Otorrhea was the main reason for consultation in 53 cases (67.10%); the most frequently encountered clinicopathological forms were simple COM (71%) followed by otitis media with effusion (24.30%). Intra-auricular instillations of traditional products (46.09%) were the dominant favoring factor. Treatment was essentially through medication in 59 cases with a stabilization of lesions. Endotemporal complications were noticed in 6 cases. Conclusion. The fight against chronic otitis media is carried out through preventive measures of education the of people. PMID:24066241

  16. Assessing the utility of Xpert(ź) MTB/RIF as a screening tool for patients admitted to medical wards in South Africa.

    PubMed

    Heidebrecht, Christine L; Podewils, Laura J; Pym, Alexander S; Cohen, Ted; Mthiyane, Thuli; Wilson, Douglas

    2016-01-01

    Many hospital inpatients in South Africa have undiagnosed active and drug-resistant tuberculosis (TB). Early detection of TB is essential to inform immediate infection control actions to minimize transmission risk. We assessed the utility of Xpert(ź) MTB/RIF (GeneXpert) as a screening tool for medical admissions at a large public hospital in South Africa. Consecutive adult patients admitted to medical wards between March-June 2013 were enrolled; sputum specimens were collected and tested by GeneXpert, smear microscopy, and culture. Chest X-rays (CXRs) were conducted as standard care for all patients admitted. We evaluated the proportion of patients identified with TB disease through each diagnostic method. Among enrolled patients whose medical charts were available for review post-discharge, 61 (27%) were diagnosed with TB; 34 (56% of diagnosed TB cases) were GeneXpert positive. When patients in whom TB was identified by other means were excluded, GeneXpert yielded only four additional TB cases. However, GeneXpert identified rifampicin-resistant TB in one patient, who was initially diagnosed based on CXR. The utility of GeneXpert for TB screening was limited in an institution where CXR is conducted routinely and which serves a population in which TB and TB/HIV co-infection are highly prevalent, but it allowed for rapid detection of rifampicin resistance. PMID:26786396

  17. 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

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

    2013-01-01

    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

  18. Application of low-pressure gas chromatography-ion-trap mass spectrometry to the analysis of the essential oil of Turnera diffusa (Ward.) Urb.

    PubMed

    Godoi, Ana F L; Vilegas, Wagner; Godoi, Ricardo H M; Van Vaeck, Luc; Van Grieken, René

    2004-02-20

    Turnera diffusa Willd. var. afrodisiaca (Ward) Urb. (syn. T. aphrodisiaca) belongs to the family of Turneraceae and is an aromatic plant growing wild in the subtropical regions of America and Africa. It is widely used in the traditional medicine as e.g. anti-cough, diuretic, and aphrodisiac agent. This work presents a 3 min chromatographic analysis using low-pressure (LP) gas chromatography (GC)-ion-trap (IT) mass spectrometry (MS). The combination of a deactivated 0.6 m x 0.10 mm i.d., restrictor with a wide-bore CP-Wax 52 capillary column (10 m x 0.53 mm i.d., 1 microm) reduces the analysis time by a factor of 3-7 in comparison to the use of a conventional narrow bore column. Chromatographic conditions have been optimized to achieve the fastest separation with the highest signal/noise ratio in MS detection. These results allow fast and reliable quality control of the essential oil to be achieved. PMID:14971493

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

    PubMed

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

    2013-01-01

    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

  20. Assessing the utility of XpertÂź MTB/RIF as a screening tool for patients admitted to medical wards in South Africa

    PubMed Central

    Heidebrecht, Christine L.; Podewils, Laura J.; Pym, Alexander S.; Cohen, Ted; Mthiyane, Thuli; Wilson, Douglas

    2016-01-01

    Many hospital inpatients in South Africa have undiagnosed active and drug-resistant tuberculosis (TB). Early detection of TB is essential to inform immediate infection control actions to minimize transmission risk. We assessed the utility of XpertÂź MTB/RIF (GeneXpert) as a screening tool for medical admissions at a large public hospital in South Africa. Consecutive adult patients admitted to medical wards between March-June 2013 were enrolled; sputum specimens were collected and tested by GeneXpert, smear microscopy, and culture. Chest X-rays (CXRs) were conducted as standard care for all patients admitted. We evaluated the proportion of patients identified with TB disease through each diagnostic method. Among enrolled patients whose medical charts were available for review post-discharge, 61 (27%) were diagnosed with TB; 34 (56% of diagnosed TB cases) were GeneXpert positive. When patients in whom TB was identified by other means were excluded, GeneXpert yielded only four additional TB cases. However, GeneXpert identified rifampicin-resistant TB in one patient, who was initially diagnosed based on CXR. The utility of GeneXpert for TB screening was limited in an institution where CXR is conducted routinely and which serves a population in which TB and TB/HIV co-infection are highly prevalent, but it allowed for rapid detection of rifampicin resistance. PMID:26786396

  1. Molecular characterization of the bla(KPC-2) gene in clinical isolates of carbapenem-resistant Klebsiella pneumoniae from the pediatric wards of a Chinese hospital.

    PubMed

    Liu, Yang; Li, Xiang-Yang; Wan, La-Gen; Jiang, Wei-Yan; Li, Fang-Qu; Yang, Jing-Hong

    2012-10-01

    The present study was conducted to confirm the presence of Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae associated with a nosocomial outbreak in a Chinese pediatric hospital. From July 2009 to January 2011, 124 nonduplicated K. pneumoniae isolates were collected from specimens from patients of pediatric units in the hospital. Twelve of the 124 isolates possessed the bla(KPC-2) gene and showed 7 different pulsed-field gel electrophoresis (PFGE) patterns. Meanwhile, 16S rRNA methylase, acc(6')-Ib-cr, and several types of ÎČ-lactamases were also produced by the majority of the KPC-producing isolates. Class 1 integron-encoded intI1 integrase gene was subsequently found in all strains, and amplification, sequencing, and comparison of DNA between 5' conserved segment and 3' conserved segment region showed the presence of several known antibiotic resistance gene cassettes of various sizes. The conjugation and plasmid-curing experiments indicated some KPC-2-encoding genes were transmissible. In addition, conjugal cotransfer of multidrug-resistant phenotypes with KPC-positive phenotypes was observed in KPC-producing strains. Restriction endonuclease analysis and DNA hybridization with a KPC-specific probe showed that the bla(KPC-2) gene was carried by plasmid DNA from K. pneumoniae of PFGE pattern B. The overall results indicate that the emergence and outbreak of KPC-producing K. pneumoniae in our pediatric wards occurred in conjunction with plasmids coharboring 16S rRNA methylase and extended-spectrum ÎČ-lactamases. PMID:22978676

  2. Cost-Minimization Model of a Multidisciplinary Antibiotic Stewardship Team Based on a Successful Implementation on a Urology Ward of an Academic Hospital

    PubMed Central

    Dik, Jan-Willem H.; Hendrix, Ron; Friedrich, Alex W.; Luttjeboer, Jos; Nannan Panday, Prashant; Wilting, Kasper R.; Lo-Ten-Foe, Jerome R.; Postma, Maarten J.; Sinha, Bhanu

    2015-01-01

    Background In order to stimulate appropriate antimicrobial use and thereby lower the chances of resistance development, an Antibiotic Stewardship Team (A-Team) has been implemented at the University Medical Center Groningen, the Netherlands. Focus of the A-Team was a pro-active day 2 case-audit, which was financially evaluated here to calculate the return on investment from a hospital perspective. Methods Effects were evaluated by comparing audited patients with a historic cohort with the same diagnosis-related groups. Based upon this evaluation a cost-minimization model was created that can be used to predict the financial effects of a day 2 case-audit. Sensitivity analyses were performed to deal with uncertainties. Finally, the model was used to financially evaluate the A-Team. Results One whole year including 114 patients was evaluated. Implementation costs were calculated to be €17,732, which represent total costs spent to implement this A-Team. For this specific patient group admitted to a urology ward and consulted on day 2 by the A-Team, the model estimated total savings of €60,306 after one year for this single department, leading to a return on investment of 5.9. Conclusions The implemented multi-disciplinary A-Team performing a day 2 case-audit in the hospital had a positive return on investment caused by a reduced length of stay due to a more appropriate antibiotic therapy. Based on the extensive data analysis, a model of this intervention could be constructed. This model could be used by other institutions, using their own data to estimate the effects of a day 2 case-audit in their hospital. PMID:25955494

  3. Simple interventions can greatly improve clinical documentation: a quality improvement project of record keeping on the surgical wards at a district general hospital.

    PubMed

    Glen, Peter; Earl, Naomi; Gooding, Felix; Lucas, Emily; Sangha, Nicole; Ramcharitar, Steve

    2015-01-01

    Clinical documentation is an integral part of the healthcare professional's job. Good record keeping is essential for patient care, accurate recording of consultations and for effective communication within the multidisciplinary team. Within the surgical department at the Great Western Hospital, Swindon, the case notes were deemed to be bulky and cumbersome, inhibiting effective record keeping, potentially putting patients' at risk. The aim of this quality improvement project was therefore to improve the standard of documentation, the labelling of notes and the overall filing. A baseline audit was firstly undertaken assessing the notes within the busiest surgical ward. A number of variables were assessed, but notably, only 12% (4/33) of the case notes were found to be without loose pages. Furthermore, less than half of the pages with entries written within the last 72 hours contained adequate patient identifiers on them. When assessing these entries further, the designation of the writer was only recorded in one third (11/33) of the cases, whilst the printed name of the writer was only recorded in 65% (21/33) of the entries. This project ran over a 10 month period, using a plan, do study, act methodology. Initial focus was on simple education. Afterwards, single admission folders were introduced, to contain only information required for that admission, in an attempt to streamline the notes and ease the filing. This saw a global improvement across all data subsets, with a sustained improvement of over 80% compliance seen. An educational poster was also created and displayed in clinical areas, to remind users to label their notes with patient identifying stickers. This saw a 4-fold increase (16%-68%) in the labelling of notes. In conclusion, simple, cost effective measures in streamlining medical notes, improves the quality of documentation, facilitates the filing and ultimately improves patient care. PMID:26734440

  4. Simple interventions can greatly improve clinical documentation: a quality improvement project of record keeping on the surgical wards at a district general hospital

    PubMed Central

    Glen, Peter; Earl, Naomi; Gooding, Felix; Lucas, Emily; Sangha, Nicole; Ramcharitar, Steve

    2015-01-01

    Clinical documentation is an integral part of the healthcare professional's job. Good record keeping is essential for patient care, accurate recording of consultations and for effective communication within the multidisciplinary team. Within the surgical department at the Great Western Hospital, Swindon, the case notes were deemed to be bulky and cumbersome, inhibiting effective record keeping, potentially putting patients' at risk. The aim of this quality improvement project was therefore to improve the standard of documentation, the labelling of notes and the overall filing. A baseline audit was firstly undertaken assessing the notes within the busiest surgical ward. A number of variables were assessed, but notably, only 12% (4/33) of the case notes were found to be without loose pages. Furthermore, less than half of the pages with entries written within the last 72 hours contained adequate patient identifiers on them. When assessing these entries further, the designation of the writer was only recorded in one third (11/33) of the cases, whilst the printed name of the writer was only recorded in 65% (21/33) of the entries. This project ran over a 10 month period, using a plan, do study, act methodology. Initial focus was on simple education. Afterwards, single admission folders were introduced, to contain only information required for that admission, in an attempt to streamline the notes and ease the filing. This saw a global improvement across all data subsets, with a sustained improvement of over 80% compliance seen. An educational poster was also created and displayed in clinical areas, to remind users to label their notes with patient identifying stickers. This saw a 4-fold increase (16%-68%) in the labelling of notes. In conclusion, simple, cost effective measures in streamlining medical notes, improves the quality of documentation, facilitates the filing and ultimately improves patient care. PMID:26734440

  5. Cellular mechanisms of mutations in Kv7.1: auditory functions in Jervell and Lange-Nielsen syndrome vs. Romano–Ward syndrome

    PubMed Central

    Mousavi Nik, Atefeh; Gharaie, Somayeh; Jeong Kim, Hyo

    2015-01-01

    As a result of cell-specific functions of voltage-activated K+ channels, such as Kv7.1, mutations in this channel produce profound cardiac and auditory defects. At the same time, the massive diversity of K+ channels allows for compensatory substitution of mutant channels by other functional channels of their type to minimize defective phenotypes. Kv7.1 represents a clear example of such functional dichotomy. While several point mutations in the channel result in a cardio-auditory syndrome called Jervell and Lange-Nielsen syndrome (JLNS), about 100-fold mutations result in long QT syndrome (LQTS) denoted as Romano–Ward syndrome (RWS), which has an intact auditory phenotype. To determine whether the cellular mechanisms for the diverse phenotypic outcome of Kv7.1 mutations, are dependent on the tissue-specific function of the channel and/or specialized functions of the channel, we made series of point mutations in hKv7.1 ascribed to JLNS and RWS. For JLNS mutations, all except W248F yielded non-functional channels when expressed alone. Although W248F at the end of the S4 domain yielded a functional current, it underwent marked inactivation at positive voltages, rendering the channel non-functional. We demonstrate that by definition, none of the JLNS mutants operated in a dominant negative (DN) fashion. Instead, the JLNS mutants have impaired membrane trafficking, trapped in the endoplasmic reticulum (ER) and Cis-Golgi. The RWS mutants exhibited varied functional phenotypes. However, they can be summed up as exhibiting DN effects. Phenotypic differences between JLNS and RWS may stem from tissue-specific functional requirements of cardiac vs. inner ear non-sensory cells. PMID:25705178

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

    SciTech Connect

    Colleary, W.M.; Hulme, J.R. ); Crafton, J.W. Gas Research Institute, Chicago, IL )

    1992-04-01

    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 the distribution of reserves in the reservoir suggests a strong stratigraphic component. The reservoir is composed of fractured dolomites and cherts of the Silurian Fusselman and overlying Wristen formations. Unconformities and their accompanying diagenetic processes play a major role in the reservoir. The occurrence of pervasive dolomitization and nodular cherts are interpreted to indicate diagenesis associated with subaerial exposure and karsting. Thick sections also may be absent due to erosion over paleostructures, and preserved in flanking positions. Detailed paleostructural interpretation of the Vermejo-Moore Hooper field reveals a history of recurrent movement of the basement and demonstrates the influence of structural growth on the development and distribution of porosity and permeability in the Fusselman reservoir. Early structural growth can influence the distribution of both depositional facies and erosional processes. Paleostructure maps in the Silurian-Devonian indicate that a series of northwest-southeast-trending, low-relief structures existed during the Silurian. Growth of these structures through the Devonian can be documented and the presence of fault-bounded basement blocks can be inferred. The influence of this structural growth on the development of the reservoir is also demonstrated.

  7. Pathogen distribution and drug resistance in a burn ward: a three-year retrospective analysis of a single center in China

    PubMed Central

    Cen, Hanghui; Wu, Zhenbo; Wang, Fan; Han, Chunmao

    2015-01-01

    To investigate the spread of multiple-resistant strain in a burn ward to inform clinical administration of antibiotic drugs, burn wound treatment and decision-making for infection control. A 3-year retrospective analysis was conducted. Specimens from wounds, blood, catheter, sputum, urine and stool collected from inpatients of the Second Affiliated Hospital of Zhejiang University of Medicine between January 1, 2011 and December 31, 2013 were cultured and strains were identified by automatic bacteria analysis. Sensitivity to 30 commonly used antibiotics was assessed by K-B disk diffusion. A total of 2212 strains of pathogenic bacteria or fungi were isolated (33.9% Gram-positive and 52.7% Gram-negative bacteria and 13.4% fungi), including 1466 from wound extracts, 128 from blood culture, 335 from urine culture, 5 from stool culture, 153 from sputum culture and 125 from catheters. The most frequently detected pathogens in wound secretions were Staphylococcus aureus, Pseudomonas aeruginosa and Acinetobacter baumannii. The Gram-positive bacteria Staphylococcus epidermidis, Enterococcus faecalis and Enterococcus faecium, and the Gram-negative bacteria Escherichia coli, Klebsiella pneumoniae, Enterobacter cloacae, Stenotrophomonas maltophilia, Proteus mirabilis were also frequently detected. The most frequently detected strains of fungi were Candida albicans; tropicalis, glabrata and parapsilosis, and all were highly sensitive to itraconazole, fluconazole and voriconazole but resistant to ketoconazole. Attention should be paid to MRSA, multi-resistant A. baumanni, ESBL-producing enterobacteriaceae and Carbapenem-resistant P. aeruginosa. Understanding the distribution of bacterial infections in Chinese hospitals will be crucial to reduce hospital-acquired infection and drug resistance. PMID:26770555

  8. The Cancer Ward: Scapegoating Revisited.

    ERIC Educational Resources Information Center

    Yeargan, Linda D.; Nehemkis, Alexis M.

    1983-01-01

    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…

  9. Increasing the frequency of hand washing by healthcare workers does not lead to commensurate reductions in staphylococcal infection in a hospital ward

    PubMed Central

    Beggs, Clive B; Shepherd, Simon J; Kerr, Kevin G

    2008-01-01

    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 by other factors and that improved compliance in excess of a given level, in itself, will result in a commensurate reduction in the incidence of HAI. However, several researchers have found the law of diminishing returns to apply to hand hygiene, with the greatest benefits occurring in the first 20% or so of compliance, and others have demonstrated that poor cohorting of nursing staff profoundly influences the effectiveness of hand hygiene measures. Collectively, these findings raise intriguing questions about the extent to which increasing compliance alone can further reduce rates of HAI. Methods In order to investigate these issues further, we constructed a deterministic Ross-Macdonald model and applied it to a hypothetical general medical ward. In this model the transmission of staphylococcal infection was assumed to occur after contact with the transiently colonized hands of HCWs, who, in turn, acquire contamination only by touching colonized patients. The aim of the study was to evaluate the impact of imperfect hand cleansing on the transmission of staphylococcal infection and to identify, whether there is a limit, above which further hand hygiene compliance is unlikely to be of benefit. Results The model demonstrated that if transmission is solely via the hands of HCWs, it should, under most circumstances, be possible to prevent outbreaks of staphylococcal infection from occurring at a hand cleansing frequencies < 50%, even with imperfect hand hygiene. The analysis also indicated that the relationship between hand cleansing efficacy and frequency is not linear – as efficacy decreases, so the hand cleansing frequency required to ensure R0 < 1 increases disproportionately. Conclusion Although our study confirmed hand hygiene to be an effective control measure, it demonstrated that the law of diminishing returns applies, with the greatest benefit derived from the first 20% or so of compliance. Indeed, our analysis suggests that there is little benefit to be accrued from very high levels of hand cleansing and that in most situations compliance > 40% should be enough to prevent outbreaks of staphylococcal infection occurring, if transmission is solely via the hands of HCWs. Furthermore we identified a non-linear relationship between hand cleansing efficacy and frequency, suggesting that it is important to maximise the efficacy of the hand cleansing process. PMID:18764942

  10. Application of a trigger tool in near real time to inform quality improvement activities: a prospective study in a general medicine ward

    PubMed Central

    Wong, Brian M; Dyal, Sonia; Etchells, Edward E; Knowles, Sandra; Gerard, Lauren; Diamantouros, Artemis; Mehta, Rajin; Liu, Barbara; Baker, G Ross; Shojania, Kaveh G

    2015-01-01

    Background Retrospective record review using trigger tools remains the most widely used method for measuring adverse events (AEs) to identify targets for improvement and measure temporal trends. However, medical records often contain limited information about factors contributing to AEs. We implemented an augmented trigger tool that supplemented record review with debriefing front-line staff to obtain details not included in the medical record. We hypothesised that this would foster the identification of factors contributing to AEs that could inform improvement initiatives. Method A trained observer prospectively identified events in consecutive patients admitted to a general medical ward in a tertiary care academic medical centre (November 2010 to February 2011 inclusive), gathering information from record review and debriefing front-line staff in near real time. An interprofessional team reviewed events to identify preventable and potential AEs and characterised contributing factors using a previously published taxonomy. Results Among 141 patients, 14 (10%; 95% CI 5% to 15%) experienced at least one preventable AE; 32 patients (23%; 95% CI 16% to 30%) experienced at least one potential AE. The most common contributing factors included policy and procedural problems (eg, routine protocol violations, conflicting policies; 37%), communication and teamwork problems (34%), and medication process problems (23%). However, these broad categories each included distinct subcategories that seemed to require different interventions. For instance, the 32 identified communication and teamwork problems comprised 7 distinct subcategories (eg, ineffective intraprofessional handovers, poor interprofessional communication, lacking a shared patient care, paging problems). Thus, even the major categories of contributing factors consisted of subcategories that individually related to a much smaller subset of AEs. Conclusions Prospective application of an augmented trigger tool identified a wide range of factors contributing to AEs. However, the majority of contributing factors accounted for a small number of AEs, and more general categories were too heterogeneous to inform specific interventions. Successfully using trigger tools to stimulate quality improvement activities may require development of a framework that better classifies events that share contributing factors amenable to the same intervention. PMID:25749028

  11. Situation analysis and issues in management of biomedical waste in select small health care facilities in a ward under Bruhat Bengaluru Mahanagara Palike, Bangalore, India.

    PubMed

    Chethana, Thirthahalli; Thapsey, Hemanth; Gautham, Melur Sukumar; Sreekantaiah, Pruthvish; Suryanarayana, Suradhenupura Puttajois

    2014-04-01

    Smaller health care facilities especially clinics though believed to generate lesser quantum/categories of medical waste, the number of clinics/small health care settings are considerable. The movement to manage biomedical waste in a safe and scientific manner has gathered momentum among the medium and large hospitals in Bangalore, but there has been a little understanding and focus on the smaller health care facilities/clinics in this aspect. It is important to gather evidence regarding the current situation of bio-medical waste (BMW) management and issues in smaller health care settings, so as to expand the safe management to all points of generation in Bangalore and will also help to plan relevant interventional strategies for the same. Hence an exploratory study was conducted to assess the current situation and issues in management of BMW among small health care facilities (sHCF). This cross sectional study was conducted in T. Dasarahalli (ward number 15) under Bruhat Bengaluru Mahanagar Palike (BBMP) of Bangalore. Data was collected from a convenient sample of 35 nursing homes (<50 beds) and clinics in December 2011. The results of this study indicate that 3 (20 %) of nursing homes had a Policy for Health Care Waste Management, though committees for Infection control and Hospital waste management were absent. Recording system like injury and waste management registers were non-existent. In our study the Common Bio-medical Waste Treatment Facility operator collected waste from 28 (80 %) of the sHCF. Segregation at the point of generation was present in 22 (62.9 %) of the sHCF. Segregation process was compliant as per BMW rules 1998 among 5 (16.1 %) of the sHCF. 18 sHCF workers were vaccinated with hepatitis B and tetanus. Deficiencies were observed in areas of containment, sharps management and disinfection. It was observed that though the quantum and category of waste generated was limited there exist deficiencies which warrant initiation of system development measures including capacity building. PMID:23982773

  12. Improving the Quality of Assessment and Management of Hypoglycaemia in Hospitalised Patients with Diabetes Mellitus by Introducing ‘Hypo Boxes’ to General Medical Wards with a Specialist Interest in Diabetes

    PubMed Central

    Livingstone, Rachel; Boyle, James

    2015-01-01

    Diabetes is becoming more prevalent in the UK and this is represented in the in-patient cohort, such that 1 in 6 hospital patients have diabetes (1). The UK National Diabetes In-Patient Audit in 2012 estimated that 30% of patients experience one episode of hypoglycaemia during admission. Hypoglycaemia is associated with increased morbidity and mortality, and longer length of hospital stay. It is therefore important that hypoglycaemia is managed promptly and effectively to reduce associated morbidity. The Joint British Diabetes Society recommends that all wards should have access to ‘Hypo Boxes’ (2). We assessed all episodes of hypoglycaemia (<4.0 mmol/l) in the diabetes wards in over a 4 week period. ‘Hypo Boxes’ were installed to the wards and the appropriateness of treatment and time to correction of hypoglycaemia was re-assessed. Assessment of hypoglycaemia pre-intervention revealed 45 episodes of hypoglycaemia in 14 patients, and 42% (n=19) of episodes were deemed to have been treated appropriately. Only 17.8% of episodes were corrected within 30 minutes, and 33.3% were corrected within 60 minutes. A third of patients (35%) did not have a further blood glucose checked. Following intervention, there was a marked improvement in management. The proportion of appropriately managed episodes increased to 82% (n=35) and management of episodes of severe hypoglycaemia (<3.0 mmol/l) increased to 94%. The time to correction increased with 40% of episodes corrected to >4.0 mmol/l within 30 minutes, and a further 54% between 30-60 minutes. In conclusion, the introduction of ‘Hypo Boxes’ improved the assessment and management of hypoglycaemia.

  13. Reviewing the effect of nursing interventions on delirious patients admitted to intensive care unit of neurosurgery ward in Al-Zahra Hospital, Isfahan University of Medical Sciences

    PubMed Central

    Khalifezadeh, Asghar; Safazadeh, Shima; Mehrabi, Tayebeh; Mansour, Bahram Amin

    2011-01-01

    BACKGROUND: Disease is an abnormal process that affects all aspects of the human life. The hospital environment and particularly the intensive care unit (ICU) causes stress in the patient and hi/her family. Delirium, due to its sudden onset and startle, unconsciousness, memory impairment, illusion and dynamic or sedentary behaviors, is known as one of the stressor agents. Despite its high prevalence and the high cost complications such as long term mechanical ventilation, hospital pneumonia, pressure ulcer, prolongation of hospitalization in the hospital or the intensive care units, performance reduction and increase in mortality, this disorder remains unknown in most cases. In line with the other treatment team members, nurses should also participate in controlling the discountable factors, helping patients to cope with uncontrollable factors and using pharmacological methods to manage the delirium and feature their own unique capacity more through quick recognition, reviewing the causes and providing scientific care in improving the quality of patient care and improving the patients’ health status. Hence, this study aimed to review the effect of nursing interventions on delirium of the patients admitted to ICU of the neurosurgery ward in Al-Zahra hospital in Isfahan. METHODS: A two-group multi-stage clinical trial study was carried out on 40 patients with hyperactive delirium admitted to ICU. The questionnaire included demographic data, Richmond Agitation Sedation Scale to assess the irritability rate and study method and also cognitive confusion in intensive care unit to determine delirium status of the study population. Simple sampling method was conducted and the study samples were randomly divided into two intervention and control groups. The following nursing interventions performed on the intervention group: assuring, emotional support, clear information and effective communication with the patients and their families and also allowing family visits twice a day. In the control group, the sample received the normal and routine ICU cares. The irritability and delirium severity status of the samples were analyzed on the day of admission and the fifth day using descriptive and inferential statistical methods and also SPSS software. RESULTS: Statistical analysis showed that although there was no significant difference between the groups on the first day of admission in terms of the irritability and delirium severity status, this was significant on the fifth day of the study. Wilcoxon test in the intervention and control groups indicated a significant difference between the study subjects in terms of the irritability and delirium severity status on the first day of admission and the fifth day which indicated the reduction in the irritability severity. But, this reduction was higher in the intervention group than in the control group. Furthermore, McNemar test showed that the number of the subjects with delirium in both groups reduced on the fifth day compared to the first day of admission and there was a significant difference between these two days, the number of samples without delirium in the intervention group was almost two times higher than that in the control group on the fifth day. CONCLUSIONS: Nursing interventions are considered as one of the non-pharmacological methods in treating delirium and by using these methods appropriately in ICUs, the patients’ hypoactive delirium can be reduced. PMID:22039387

  14. An Investigation into Reliability of Knee Extension Muscle Strength Measurements, and into the Relationship between Muscle Strength and Means of Independent Mobility in the Ward: Examinations of Patients Who Underwent Femoral Neck Fracture Surgery.

    PubMed

    Katoh, Munenori; Kaneko, Yoshihiro

    2014-01-01

    [Purpose] The purpose of the present study was to investigate the reliability of isometric knee extension muscle strength measurement of patients who underwent femoral neck fracture surgery, as well as the relationship between independent mobility in the ward and knee muscle strength. [Subjects] The subjects were 75 patients who underwent femoral neck fracture surgery. [Methods] We used a hand-held dynamometer and a belt to measure isometric knee extension muscle strength three times, and used intraclass correlation coefficients (ICCs) to investigate the reliability of the measurements. We used a receiver operating characteristic curve to investigate the cutoff values for independent walking with walking sticks and non-independent mobility. [Results] ICCs (1, 1) were 0.9 or higher. The cutoff value for independent walking with walking sticks was 0.289 kgf/kg on the non-fractured side, 0.193 kgf/kg on the fractured side, and the average of both limbs was 0.238 kgf/kg. [Conclusion] We consider that the test-retest reliability of isometric knee extension muscle strength measurement of patients who have undergone femoral neck fracture surgery is high. We also consider that isometric knee extension muscle strength is useful for investigating means of independent mobility in the ward. PMID:24567667

  15. Understanding and evaluating the effects of implementing an electronic paediatric prescribing system on care provision and hospital work in paediatric hospital ward settings: a qualitatively driven mixed-method study protocol

    PubMed Central

    Farre, Albert; Cummins, Carole

    2016-01-01

    Introduction Electronic prescribing systems can improve the quality and safety of healthcare services, but their implementation is not straightforward and may create unexpected change. However, the added complexity of paediatric prescribing (eg, dose calculations, dilutions, manipulations) may pose additional challenges. This study will aim to (1) understand the complex organisational reality of a paediatric hospital in which a new electronic paediatric prescribing (ePP) system will be introduced; (2) describe ePP-related change, over time, in paediatric hospital ward settings; (3) explore staff perspectives in relation to currently established practices and processes; and (4) assess the impact of ePP on care provision and hospital work from the perspective of paediatricians, paediatric nurses and managers. Methods and analysis A qualitatively driven mixed-method approach will be adopted, including 3 inter-related substudies. The core component of the study will be qualitative (substudy 1): we will use ethnographic research methods, including non-participant observation in wards and informal conversational interviews with members of staff. In addition, the design will include 2 embedded supplementary components: a qualitative 1 (substudy 2) based on in-depth interviews and/or focus groups with paediatricians, paediatric nurses, paediatric pharmacists/pharmacy technicians and managers; and a quantitative 1 (substudy 3) in which a staff survey will be developed and administered before and after the ePP implementation. Analytic themes will be identified from ethnographic field notes and interview data. Survey data will be analysed using descriptive statistics and baseline and follow-up data compared to establish impact evaluation measures. Ethics and dissemination A favourable ethical opinion has been obtained from a National Health Service (NHS) Research Ethics Committee (15/SS/0157). NHS research governance approval has been obtained at the relevant hospital site. The results of the study will be disseminated through conferences and peer-reviewed journals, as well as fed back to those involved in clinical practice and policy development at the study site. PMID:26842275

  16. [The assessment of exposure to and the activity of the manual lifting of patients in wards: methods, procedures, the exposure index (MAPO) and classification criteria. Movimientazione e Assistenza Pazienti Ospedalizzati (Lifting and Assistance to Hospitalized Patients)].

    PubMed

    Menoni, O; Ricci, M G; Panciera, D; Occhipinti, E

    1999-01-01

    Since a method for quantifying exposure to patient handling in hospital wards is lacking, the authors describe and propose a model for identifying the main risk factors in this type of occupational exposure: presence of disabled patients, staff engaged on manual handling of patients, structure of the working environment, equipment and aids for moving patients, training of workers according to the specific risk. For each factor a procedure for identification and assessment is proposed that is easily applicable in practice. The authors also propose a formula for the calculation of a condensed exposure index (MAPO Index), which brings together the various factors. The exposure index, which requires further, detailed study and validation, makes it possible, in practice, to plan the preventive and health measures according to a specific order of priority, thus complying with the requirements of Chapter V of Law 626/94. From a practical point of view, in the present state of knowledge, it can be stated that for MAPO Index values between 0 and 1.5, risk is deemed negligible, average for values between 1.51 and 5, and high for values exceeding 5. PMID:10371812

  17. Anisakid nematodes (Nematoda: Anisakidae) from the marine fishes Plectropomus laevis Lacépède (Serranidae) and Sphyraena qenie Klunzinger (Sphyraenidae) off New Caledonia, including two new species of Hysterothylacium Ward & Magath, 1917.

    PubMed

    Moravec, František; Justine, Jean-Lou

    2015-11-01

    Based on light and scanning electron microscopical studies, two new species of Hysterothylacium Ward & Magath, 1917 (Nematoda: Anisakidae) are described from the digestive tract of perciform fishes off New Caledonia: H. alatum n. sp. from Plectropomus laevis (Lacépède) (Serranidae) and H. sphyraenae n. sp. from Sphyraena qenie Klunzinger (Sphyraenidae). The former species (H. alatum) is mainly characterised by its large body (male 42.05 mm, gravid females 51.18-87.38 mm long), the shape of the dorsal lip, conspicuously broad cervical alae, a short caecum and a long ventricular appendix, the length of the spicules (925 ”m), the number (25 pairs) and distribution of the genital papillae and the tail tip bearing numerous minute cuticular protuberances. The other species (H. sphyraenae) is mainly characterised by the presence of narrow lateral alae, a short caecum and a long ventricular appendix, the length (762-830 ”m) and shape of the spicules, the number (37-38 pairs) and arrangement of the genital papillae, and by the tail tip which lacks any distinct cuticular projections visible under the light microscope. In addition, and unidentifiable at the species level, conspicuously large (45.71-66.10 mm long) larvae of Contracaecum Railliet & Henry, 1912, were found in the body cavity of P. laevis, which serves as a paratenic host for this parasite. PMID:26446541

  18. Genetics Home Reference: Romano-Ward syndrome

    MedlinePLUS

    ... cell membrane. These channels transport positively charged atoms (ions), such as potassium and sodium, into and out of cells. In cardiac muscle, ion channels play critical roles in maintaining the heart's ...

  19. Genetics Home Reference: Romano-Ward syndrome

    MedlinePLUS

    ... as channels across the cell membrane. These channels transport positively charged atoms (ions), such as potassium and ... of ions between cells. A disruption in ion transport alters the way the heart beats, leading to ...

  20. Methods of Transposition of Nurses between Wards

    NASA Astrophysics Data System (ADS)

    Miyazaki, Shigeji; Masuda, Masakazu

    In this paper, a computer-implemented method for automating the transposition of a hospital’s nursing staff is proposed. The model is applied to the real case example ‘O’ hospital, which performs a transposition of its nursing staff once a year. Results are compared with real data obtained from this hospital’s current manual transposition system. The proposed method not only significantly reduces the time taken to construct the transposition, thereby significantly reducing management labor costs, but also is demonstrated to increase nurses’ levels of satisfaction with the process.

  1. Using Exercise to Ward Off Depression.

    ERIC Educational Resources Information Center

    Nicoloff, George; Schwenk, Thomas L.

    1995-01-01

    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)

  2. Cruelty in Maternity Wards: Fifty Years Later

    PubMed Central

    Goer, Henci

    2010-01-01

    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. PMID:21629381

  3. 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

    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

    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

  4. Residential mobility among patients admitted to acute psychiatric wards.

    PubMed

    Tulloch, Alex D; Fearon, Paul; David, Anthony S

    2011-07-01

    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

  5. Corroborating indicates nurses' ethical values in a geriatric ward.

    PubMed

    Jonasson, Lise-Lotte; Liss, Per-Erik; Westerlind, Björn; Berterö, Carina

    2011-01-01

    The aim of the study was to identify nurses' ethical values, which become apparent through their behaviour in the interactions with older patients in caring encounters at a geriatric clinic.Descriptions of ethics in a caring practice are a problem since they are vague compared with the four principles of autonomy, beneficence, non-maleficence, and justice.A Grounded Theory methodology was used. In total, 65 observations and follow-up interviews with 20 nurses were conducted, and data were analysed by constant comparative analysis.THREE CATEGORIES WERE IDENTIFIED: showing consideration, connecting, and caring for. These categories formed the basis of the core category: "Corroborating." In corroborating, the focus is on the person in need of integrity and self-determination; that is, the autonomy principle. A similar concept was earlier described in regard to confirming. Corroborating deals more with support and interaction. It is not enough to be kind and show consideration (i.e., to benefit someone); nurses must also connect and care for the older person (i.e., demonstrate non-maleficence) in order to corroborate that person.The findings of this study can improve the ethics of nursing care. There is a need for research on development of a high standard of nursing care to corroborate the older patients in order to maintain their autonomy, beneficence, and non-maleficence. The principal of justice was not specifically identified as a visible nursing action. However, all older patients received treatment, care, and reception in an equivalent manner. PMID:21931577

  6. Ward Burdick Award article. The Golden Age of American Medicine.

    PubMed

    Conn, R B

    1989-06-01

    Commercialization of medicine with introduction of the profit motive is changing the patient care process, reducing the professional independence of physicians and inflating the total cost of medical care. The payers for medical care, governments at all levels and employers, are no longer willing or able to accept continuing escalation in the costs of medical care. Correction of financial distortions is an inevitable process in every economic milieu, and distortions in the health care system will be corrected in one way or another. Medicine is an unusual enterprise in that there are no sharp dividing lines between what is necessary and what is clearly unnecessary or between perfectly acceptable and unacceptable outcomes. Initiatives to define what is necessary and what is acceptable are being taken by organized medicine and by the federal government. This has been described as a "revolution" in medicine, but there is no other viable approach to balancing medical care requirements with available resources. PMID:2729185

  7. Suicide Attempts and Ideation: Adolescents Evaluated on a Pediatric Ward.

    ERIC Educational Resources Information Center

    Paluszny, Maria; And Others

    1991-01-01

    Compared psychological, familial, and demographic data for 42 suicidal, 16 suicide ideation, and 42 control pediatric patients. Chaotic families, behavior problems, depression, constriction, and lack of insight differentiated suicide attempters from controls. Suicide ideation group was similar to both attempters and controls. Constriction was only…

  8. Cancer Ward Staff Group: An Intervention Designed to Prevent Disaster.

    ERIC Educational Resources Information Center

    Barber, William H.

    1985-01-01

    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…

  9. Wards Cove Packing Co., Inc. v. Atonio [5 June 1989].

    PubMed

    1989-01-01

    Among other things, the UK Supreme Court held that for workers to challenge employment practices as discriminatory they must show more than the fact that there is a disparity in the number of nonwhites and whites in specific jobs. It concluded that they must also show that the disparity results from specific employment practices that are challenged before the employers will be required to present legitimate business justifications for the practices. Although the suit was brought by minority cannery workers in Alaska, its holding is equally applicable to women workers. PMID:12344148

  10. Reflections by clinical nurse specialists on changing ward practice.

    PubMed

    Thomas, Catherine; Ramcharan, Angie

    In September 2010, palliative care clinical nurse specialists at North Middlesex University Hospital Trust introduced competencies for all nurses in setting up and using syringe drivers. This was done after the trust identified a high level of clinical incidents involving syringe drivers. This article discusses how the competencies were implemented and assessed, explores the importance of understanding change management to achieve change, and how different leadership styles affect changes to practice. PMID:21957520

  11. N = 4 superconformal Ward identities for correlation functions

    NASA Astrophysics Data System (ADS)

    Belitsky, A. V.; Hohenegger, S.; Korchemsky, G. P.; Sokatchev, E.

    2016-03-01

    In this paper we study the four-point correlation function of the energy-momentum supermultiplet in theories with N = 4 superconformal symmetry in four dimensions. We present a compact form of all component correlators as an invariant of a particular abelian subalgebra of the N = 4 superconformal algebra. This invariant is unique up to a single function of the conformal cross-ratios which is fixed by comparison with the correlation function of the lowest half-BPS scalar operators. Our analysis is independent of the dynamics of a specific theory, in particular it is valid in N = 4 super Yang-Mills theory for any value of the coupling constant. We discuss in great detail a subclass of component correlators, which is a crucial ingredient for the recent study of charge-flow correlations in conformal field theories. We compute the latter explicitly and elucidate the origin of the interesting relations among different types of flow correlations previously observed in arXiv:1309.1424.

  12. The pain-free ward: myth or reality.

    PubMed

    Morton, Neil S

    2012-06-01

    Over the last 25 years, pediatric care has changed dramatically with increased survival after premature birth, more complex care, better outcomes, and reduced mortality. There is a better understanding of how pain pathways and receptor systems develop and also how to assess pain at different stages of development. The myth that children do not feel pain has been comprehensively dispelled. Safe analgesic dose regimens for neonates, infants, and children have been developed based upon a better understanding of developmental pharmacokinetics and pharmacodynamics. It is a myth that pain in children cannot be prevented or treated safely and effectively because of the risks of adverse effects and addiction. Large-scale prospective audits have clarified the safety profile and risk-benefit balance for different techniques. There is now a substantial evidence base supporting many techniques of postoperative and procedural pain management for all age-groups of children. Guidelines based upon systematic review of this evidence have been published and updated, but the real challenge is in implementation of accurate pain assessment and safe, effective pain management comprehensively to all children whatever the procedure, clinical setting, developmental stage of the child, or comorbidities. In developed countries, these are core topics in the education of all doctors and nurses who care for children, and they are integrated into clinical practice by acute pediatric pain teams for most hospitals. However, it is disappointing that many country's healthcare systems do not give pediatric pain management a priority and in many parts of the world there are no analgesics available. So pain-free healthcare is sadly lacking in many hospitals. My hope is that the current knowledge can be used more effectively to relieve the unnecessary suffering of children in the 21st century. PMID:22594405

  13. Evaluation of Mental Workload among ICU Ward's Nurses

    PubMed Central

    Mohammadi, Mohsen; Mazloumi, Adel; Kazemi, Zeinab; Zeraati, Hojat

    2015-01-01

    Background: High level of workload has been identified among stressors of nurses in intensive care units (ICUs). The present study investigated nursing workload and identified its influencing perfor­mance obstacles in ICUs. Methods: This cross-sectional study was conducted, in 2013, on 81 nurses working in ICUs in Imam Khomeini Hospital in Tehran, Iran. NASA-TLX was applied for assessment of workload. Moreover, ICUs Performance Obstacles Questionnaire was used to identify performance obstacles associated with ICU nursing. Results: Physical demand (mean=84.17) was perceived as the most important dimensions of workload by nurses. The most critical performance obstacles affecting workload included: difficulty in finding a place to sit down, hectic workplace, disorganized workplace, poor-conditioned equipment, waiting for using a piece of equipment, spending much time seeking for supplies in the central stock, poor quality of medical materials, delay in getting medications, unpredicted problems, disorganized central stock, outpatient surgery, spending much time dealing with family needs, late, inadequate, and useless help from nurse assistants, and ineffective morning rounds (P-value<0.05). Conclusion: Various performance obstacles are correlated with nurses' workload, affirms the significance of nursing work system characteristics. Interventions are recommended based on the results of this study in the work settings of nurses in ICUs. PMID:26933647

  14. Navigating the Wards: Teaching Medical Students to Use Their Moral Compasses.

    ERIC Educational Resources Information Center

    Swensen, Sara L.; Rothstein, Julie A.

    1996-01-01

    This paper argues that medical ethics education relies too much on strategies that target ethical thinking and should focus more on students as ethical actors in specific clinical contexts, responding to ethical dilemmas. Traditional approaches may not offer the skills students need to learn norms of ethical behavior. Strategies for encouraging


  15. Reference-dependent preferences for maternity wards: an exploration of two reference points

    PubMed Central

    Neuman, Einat

    2014-01-01

    It is now well established that a person's valuation of the benefit from an outcome of a decision is determined by the intrinsic “consumption utility” of the outcome itself and also by the relation of the outcome to some reference point. The most notable expression of such reference-dependent preferences is loss aversion. What precisely this reference point is, however, is less clear. This paper claims and provides empirical evidence for the existence of more than one reference point. Using a discrete choice experiment in the Israeli public health-care sector, within a sample of 219 women who had given birth, it is shown that respondents refer to two reference points: (i) a constant scenario that is used in the experiment; and (ii) also the actual state of the quantitative attributes of the service (number of beds in room of hospitalization; and travel time from residence to hospital). In line with the loss aversion theory, it is also shown that losses (vis-à-vis the constant scenario and vis-à-vis the actual state) accumulate and have reinforced effects, while gains do not. PMID:25750793

  16. An Audit of Ward Experience as a Tool for Teaching Diagnosis in Pulmonary Medicine

    ERIC Educational Resources Information Center

    Kale, Madhav K.; and others

    1969-01-01

    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)

  17. Preliminary report on the lignite resources of the Niobe area, Burke and Ward counties, North Dakota

    USGS Publications Warehouse

    Owen, Hal E.

    1977-01-01

    Two lignite beds, the Niobe and the Bonus, occur at strippable depths within the Niobe area. The Niobe bed averages 5 feet (1.5 meters) in thickness and the Bonus bed averages 8 feet (2.4 meters) in thickness. These beds lie in the lower part of the Sentinel Butte Member of the Fort Union Formation (Paleocene). The demonstrated resources of both beds combined is 122 million tons (110 million tonnes), all of which are under less than 120 feet (37 meters) of overburden. The overburden consists of glacial till and shale. The lateral continuity of the coal has been locally interrupted by faulting, glacial outwash channels, and erosion. Folding and/or faulting occurs parallel to the Missouri Coteau escarpment and faulting occurs roughly perpendicular to the escarpment.

  18. Malondialdehyde-Deoxyguanosine Adduct Formation in Workers of Pathology Wards. The Role of Air Formaldehyde Exposure

    PubMed Central

    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

    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 ÎŒg/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 ÎŒg/m3 is associated with increased levels of M1-dG adducts. PMID:20707408

  19. Calcrete profiles and porosity development in the Wagon Wheel (Pennsylvanian) field, Ward County, Texas

    SciTech Connect

    Abegg, F.E. ); Grover, G.A. )

    1990-05-01

    The Cisco and Canyon formations in the Wagon Wheel field, located on the western edge of the Central Basin platform, contain 10-15 previously unrecognized calcrete profiles, providing excellent evidence of repeated Late Pennsylvanian subaerial exposure. Evidence for calcretes includes (1) rhizoliths, (2) alveolar texture, (3) circumgranular cracking, (4) tangential needle fibers, (5) calcrete glaebules, (6) light shifts in {delta}{sup 13}C profiles, (7) autobrecciation, and (8) laminated crusts. Extreme lateral variability of calcrete profiles makes correlation of subaerial exposure surfaces difficult. Porosity within calcrete profiles is occluded, providing a seal for underlying reservoir facies. Porosity in the Wagon Wheel field is strongly facies dependent. Porous intervals consist of lenticular skeletal grainstone-packstone facies, typically capped by calcrete profiles. Repeated meteoric phreatic lenses established during Late Pennsylvanian exposure events are interpreted to have formed moldic porosity through selective dissolution in strata containing mineralogically metastable allochems. Secondary porosity development, however, is often balanced by precipitation of eogenetic calcite cement. Therefore, meteoric diagenesis associated with Wagon Wheel calcrete development commonly occludes and only rarely enhances primary porosity. Two stages of calcite cementation are recognized: (1) an early pore-rimming nonferroan nonluminescent calcite cement with thin moderate to brightly luminescent microzones, and (2) a later ferroan, dully luminescent calcite cement with broad, indistinct zones. Truncated cements in Cisco- and Canyon-derived lithoclasts indicate nonluminescent cement was precipitated from oxidizing meteoric phreatic waters. Microzones were precipitated during brief periods of stagnation in the phreatic lenses.

  20. A critical assessment of monitoring practices, patient deterioration, and alarm fatigue on inpatient wards: a review.

    PubMed

    Curry, J Paul; Jungquist, Carla R

    2014-01-01

    Approximately forty million surgeries take place annually in the United States, many of them requiring overnight or lengthier post operative stays in the over five thousand hospitals that comprise our acute healthcare system. Leading up to this Century, it was common for most hospitalized patients and their families to believe that being surrounded by well-trained nurses and physicians assured their safety. That bubble burst with the Institute of Medicine's 1999 report: To Err Is Human, followed closely by its 2001 report: Crossing the Quality Chasm. This review article discusses unexpected, potentially lethal respiratory complications known for being difficult to detect early, especially in postoperative patients recovering on hospital general care floors (GCF). We have designed our physiologic explanations and simplified cognitive framework to give our front line clinical nurses a thorough, easy-to-recall understanding of just how these events evolve, and how to detect them early when most amenable to treatment. Our review will also discuss currently available practices in general care floor monitoring that can both improve patient safety and significantly reduce monitor associated alarm fatigue. PMID:25093041

  1. From Classroom to Boardroom and Ward: Developing Generic Intercultural Skills in Diverse Disciplines

    ERIC Educational Resources Information Center

    Barker, Michelle C.; Mak, Anita S.

    2013-01-01

    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


  2. Treme/7th Ward Griots: A New Orleans Ethnic Heritage Program. Field Edition.

    ERIC Educational Resources Information Center

    1979

    Three units comprise the New Orleans Ethnic Heritage Program developed for students in grade 8. Objectives are to increase student appreciation of New Orleans cultural heritage, help them understand their own racial and ethnic groups, and build analytical and evaluative decision making skills. The units are entitled "The Ethnic Heritage of New…

  3. Feasibility of ASsisTed WARfarin Dosing by Clinical Pharmacy Support Assistants (FAST-WARD Study)

    PubMed Central

    Man, Damen; Mabasa, Vincent H

    2014-01-01

    Background: Pharmacy-managed warfarin dosing has been established at Burnaby Hospital, in Burnaby, British Columbia, for over 10 years. With increases in the number and acuity of patients enrolled, it has become challenging to maintain a successful anticoagulation program. The clinical pharmacy support assistant (CPSA) program was initiated to support the provision of clinical pharmacy services. At the time of the study, Burnaby Hospital had 2 CPSAs. It was anticipated that the pharmacy-managed inpatient warfarin dosing service might benefit from support through the CPSA program to maintain a consistent level of delivery. Objective: To examine the feasibility of CPSAs supporting the pharmacy-managed inpatient warfarin dosing service at Burnaby Hospital. Feasibility was based on 4 key parameters: knowledge base, accuracy of data collection, dosage recommendations, and time spent on the process. Methods: An observational, prospective pilot study was conducted over 3 months. The CPSAs were given appropriate education and training, and their performance was assessed to determine the feasibility of CPSA-assisted warfarin dosing. The CPSAs had to achieve a priori target scores for each of the 4 parameters in order for CPSA-assisted warfarin dosing to be considered feasible. Results: After the didactic sections, both CPSAs answered all review questions correctly. The accuracy of data collection (based on 60 patient encounters) was 98.3%. The warfarin regimens recommended by the CPSAs were similar to those recommended by the clinical pharmacists, with doses differing by a mean of 0.46 mg. For 39 (65%) of the 60 patient encounters, the dosing recommendations of CPSAs and clinical pharmacists were identical. The average time spent per patient encounter was 10.5 min. Conclusion: With appropriate training and education, it is feasible for CPSAs to support the pharmacy-managed inpatient warfarin dosing program at Burnaby Hospital. PMID:24970942

  4. $35-Million Helps Cornell University Recruit Faculty and Ward off Poachers

    ERIC Educational Resources Information Center

    June, Audrey Williams

    2008-01-01

    When it comes to building a top-notch faculty, racing to land prominent scholars is only half the battle for colleges. The other half: Fighting off poachers intent on swiping the college's existing talented mid-career professors. At Cornell University, a $35-million gift announced by officials in late September will give the institution an edge in…

  5. Prevalence and Clinical Features of Patients with the Cardiorenal Syndrome Admitted to an Internal Medicine Ward

    PubMed Central

    Gigante, Antonietta; Liberatori, Marta; Gasperini, Maria Ludovica; Sardo, Liborio; Di Mario, Francesca; Dorelli, Barbara; Barbano, Biagio; Rosato, Edoardo; Rossi Fanelli, Filippo; Amoroso, Antonio

    2014-01-01

    Background Many patients admitted to a Department of Internal Medicine have different degrees of heart and kidney dysfunction. Mortality, morbidity and cost of care greatly increase when cardiac and renal diseases coexist. Methods A retrospective cohort study was conducted on 1,087 patients admitted from December 2009 to December 2012 to evaluate the prevalence of the cardiorenal syndrome (CRS) and clinical features. Results Out of 1,087 patients discharged from our unit during the study period, 190 (17.5%) were diagnosed as having CRS and classified into five types. CRS was more common in males (68.9%). CRS type 1 was associated with higher age (79.9 ± 8.9 years) and accounted for 61.5% of all deaths (p < 0.001), representing a risk factor for mortality (OR 4.23, 95% CI 1.8-10). Congestive heart failure was significantly different among the five CRS types (p < 0.0001) with a greater frequency in type 1 patients. Infectious diseases were more frequent in CRS types 1, 3 and 5 (p < 0.05). Pneumonia presented a statistically higher frequency in CRS types 1 and 5 compared to other classes (p < 0.01), and community-acquired infections were statistically more frequent in CRS types 1 and 5 (p < 0.05). The distribution of community-acquired pneumonia was different among the classes (p < 0.01) with a higher frequency in CRS types 1, 3 and 5. Conclusion CRS is a condition that is more frequently observed in the clinical practice. The identification of predisposing trigger factors, such as infectious diseases, particularly in the elderly, plays a key role in reducing morbidity and mortality. An early recognition can be useful to optimize therapy, encourage a multidisciplinary approach and prevent complications. PMID:25254030

  6. Everyday practices at the medical ward: a 16-month ethnographic field study

    PubMed Central

    2012-01-01

    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. PMID:22748059

  7. [When should a patient with headaches be referred to the emergency ward?].

    PubMed

    Morel, Philippe; Rutschmann, Olivier; Delémont, Cécile

    2010-08-25

    Secondary headaches are rare though potentially severe. A systematic search of red flags helps to suspect headaches of secondary origin that require further urgent investigation. Main red flags are: sudden onset, exceptionally severe headache, new headache in patient over 50, vomiting or syncope, focal neurological sign or neck stiffness, recent trauma, uncommon headache during pregnancy or anticoagulant therapy, suspicion of glaucoma. PMID:20873430

  8. A critical assessment of monitoring practices, patient deterioration, and alarm fatigue on inpatient wards: a review

    PubMed Central

    2014-01-01

    Approximately forty million surgeries take place annually in the United States, many of them requiring overnight or lengthier post operative stays in the over five thousand hospitals that comprise our acute healthcare system. Leading up to this Century, it was common for most hospitalized patients and their families to believe that being surrounded by well-trained nurses and physicians assured their safety. That bubble burst with the Institute of Medicine’s 1999 report: To Err Is Human, followed closely by its 2001 report: Crossing the Quality Chasm. This review article discusses unexpected, potentially lethal respiratory complications known for being difficult to detect early, especially in postoperative patients recovering on hospital general care floors (GCF). We have designed our physiologic explanations and simplified cognitive framework to give our front line clinical nurses a thorough, easy-to-recall understanding of just how these events evolve, and how to detect them early when most amenable to treatment. Our review will also discuss currently available practices in general care floor monitoring that can both improve patient safety and significantly reduce monitor associated alarm fatigue. PMID:25093041

  9. 77 FR 10960 - Security Zone, East River and Bronx Kill; Randalls and Wards Islands, NY

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-02-24

    ... SECURITY Coast Guard 33 CFR Part 165 RIN 1625-AA87 Security Zone, East River and Bronx Kill; Randalls and... establishing a temporary security zone on the waters of the East River and Bronx Kill, in the vicinity of... is intended to restrict vessels from a portion of the East River and Bronx Kill when public...

  10. Model Determination of Delayed Causes of Analgesics Prescription in the Emergency Ward in Arak, Iran

    PubMed Central

    Cyrus, Ali; Moghimi, Mehrdad; Jokar, Abolfazle; Rafeie, Mohammad; Moradi, Ali; Ghasemi, Parisa; Shahamat, Hanieh

    2014-01-01

    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. PMID:24748944

  11. An on-line work scheduling and ward requesting pattern information system.

    PubMed

    Undrill, P E; Gibson, P

    1978-07-01

    The organisational efficiency of sample admission to the routine laboratory and the allocation to test methods has been improved by a scheduling system based on an on-line mini-computer. A flexible system has been constructed using multiple visual displays, which produce work allocation lists. Computer techniques have been developed which enable maximal use of the on-line system while retaining the general flexibility of high-level language coding, as implemented on an unsophisticated 12-bit processor. The file structure has been designed to provide cumulative information on the requesting patterns appropriate to any of the many sources of samples to the laboratory, and to allow the automatic merging of worksheet and laboratory data, the latter being generated and transmitted from a second mini-computer system. PMID:697313

  12. Estimating Potential Infection Transmission Routes in Hospital Wards Using Wearable Proximity Sensors

    PubMed Central

    Vanhems, Philippe; Barrat, Alain; Cattuto, Ciro; Pinton, Jean-François; Khanafer, Nagham; Régis, Corinne; Kim, Byeul-a; Comte, Brigitte; Voirin, Nicolas

    2013-01-01

    Background Contacts between patients, patients and health care workers (HCWs) and among HCWs represent one of the important routes of transmission of hospital-acquired infections (HAI). A detailed description and quantification of contacts in hospitals provides key information for HAIs epidemiology and for the design and validation of control measures. Methods and Findings We used wearable sensors to detect close-range interactions (“contacts”) between individuals in the geriatric unit of a university hospital. Contact events were measured with a spatial resolution of about 1.5 meters and a temporal resolution of 20 seconds. The study included 46 HCWs and 29 patients and lasted for 4 days and 4 nights. 14,037 contacts were recorded overall, 94.1% of which during daytime. The number and duration of contacts varied between mornings, afternoons and nights, and contact matrices describing the mixing patterns between HCW and patients were built for each time period. Contact patterns were qualitatively similar from one day to the next. 38% of the contacts occurred between pairs of HCWs and 6 HCWs accounted for 42% of all the contacts including at least one patient, suggesting a population of individuals who could potentially act as super-spreaders. Conclusions Wearable sensors represent a novel tool for the measurement of contact patterns in hospitals. The collected data can provide information on important aspects that impact the spreading patterns of infectious diseases, such as the strong heterogeneity of contact numbers and durations across individuals, the variability in the number of contacts during a day, and the fraction of repeated contacts across days. This variability is however associated with a marked statistical stability of contact and mixing patterns across days. Our results highlight the need for such measurement efforts in order to correctly inform mathematical models of HAIs and use them to inform the design and evaluation of prevention strategies. PMID:24040129

  13. The art of (re)learning to walk: trust on the rehabilitation ward.

    PubMed

    Manderson, Lenore; Warren, Narelle

    2010-10-01

    Although trust has significant implications for health outcomes, the mechanisms by which its presence or absence influences these outcomes require elucidation. Drawing on ethnographic research conducted in southeast Australia, we explore the tasks of rehabilitation for people who lost a limb because of vascular disease, and the importance of trust in the relationships of patients with their health professionals. Trust underpins procedures and practices designed to minimize problems that might delay rehabilitation or result in the continuing need for medical support and surveillance. Patients develop trust in the rehabilitation team based on three factors: competence, agency, and caring. Our findings emphasize how social skills, as well as technical competence, enable health professionals to gain and maintain their patients' trust. PMID:20555012

  14. Brain injury and deprivation of liberty on neurosciences wards: 'a gilded cage is still a cage'.

    PubMed

    Ashby, Gillian Alice; Griffin, Colette; Agrawal, Niruj

    2015-10-01

    In March 2014, a UK Supreme Court case, known as Cheshire West, reached a judgement that greatly expanded the group of people in England and Wales who could be considered deprived of their liberty when under the care of the state. This now includes anyone meeting what is known as the 'acid test': whether the person is under 'continuous supervision and control' and 'not free to leave'. The case concerned three people with learning disability, living in community residential placements; all were judged to have been deprived of their liberty, despite being apparently content, and having 'relative normality' for people in their situation. Many people consider the case to apply to hospital settings. Clearly, many neurosciences inpatients are under 'continuous supervision and control'. This might include being told when to eat or sleep, what medication to take or being under close nursing observation. Many also are not free to leave because of safety concerns. Inpatients may also be eligible for detention under Mental Health Act--if they have a mental disorder sufficient to warrant this--such as a risk to that person's health or safety, or the safety of others. Thus, we have a confusing combination of two laws that might apply. This article aims to demystify the legal background and apply it to clinical practice in England and Wales and elsewhere. PMID:26038584

  15. $35-Million Helps Cornell University Recruit Faculty and Ward off Poachers

    ERIC Educational Resources Information Center

    June, Audrey Williams

    2008-01-01

    When it comes to building a top-notch faculty, racing to land prominent scholars is only half the battle for colleges. The other half: Fighting off poachers intent on swiping the college's existing talented mid-career professors. At Cornell University, a $35-million gift announced by officials in late September will give the institution an edge in


  16. Ward identities and consistency relations for the large scale structure with multiple species

    SciTech Connect

    Peloso, Marco; Pietroni, Massimo E-mail: pietroni@pd.infn.it

    2014-04-01

    We present fully nonlinear consistency relations for the squeezed bispectrum of Large Scale Structure. These relations hold when the matter component of the Universe is composed of one or more species, and generalize those obtained in [1,2] in the single species case. The multi-species relations apply to the standard dark matter + baryons scenario, as well as to the case in which some of the fields are auxiliary quantities describing a particular population, such as dark matter halos or a specific galaxy class. If a large scale velocity bias exists between the different populations new terms appear in the consistency relations with respect to the single species case. As an illustration, we discuss two physical cases in which such a velocity bias can exist: (1) a new long range scalar force in the dark matter sector (resulting in a violation of the equivalence principle in the dark matter-baryon system), and (2) the distribution of dark matter halos relative to that of the underlying dark matter field.

  17. [Hospital readmission after postpartum discharge of term newborns in two maternity wards in Stockholm and Marseille].

    PubMed

    Boubred, F; Herlenius, E; Andres, V; des Robert, C; Marchini, G

    2016-03-01

    The consequences of early postpartum discharge (EPPD, within 2days after birth) on newborn health remain debated. Early discharge has been associated with increased neonatal morbidity. However, neonatal re-hospitalization can be prevented by careful follow-up during the 1st week after birth. We compared the early neonatal hospitalization of term newborns over 2years in two hospitals: Karolinska University Hospital in Stockholm (n=7300births), which allowed early discharge from 6h after birth with specific neonatal follow-up, and Marseille University Hospital (AP-HM) (n=4385) where postpartum discharge was more conventional after 72h. During the study period, the EPPD rate was 41% vs. 2% in Stockholm and Marseille, respectively (P<0.001). Hospital readmission was comparable (5.6‰ vs. 7‰, P=0.2). The leading cause associated with hospitalization was icterus in Stockholm (76% vs. 26%, P<0.001) and feeding difficulties in Marseille (17% vs. 48%, P<0.001). In conclusion, close neonatal follow-up during the 1st week of life associated with restricted maternal and neonatal eligibility criteria for EPPD are required to prevent early neonatal re-hospitalization. PMID:26899902

  18. Every ward is a 'Nut Island'? Preventing good health-care teams 'going bad'.

    PubMed

    McKimm, Judy; Coupe, Bryony; Edwards, Luke; Gibson, Russell; Morgan, Holly; Paramore, Louise; Ramcharn, Meera

    2015-08-01

    This article explores how Levy's 'Nut Island effect' can be used to help identify health-care teams at risk of becoming isolated, disenchanted and separated physically and psychologically from senior management. Such isolation can lead to disastrous effects. PMID:26255920

  19. A Pill to Ward Off Cavities? Scientists Say It Could Happen

    MedlinePLUS

    ... biology at the University of Florida College of Dentistry. "We got interested in what activities keep the ... is an associate professor in the College of Dentistry's department of restorative dental sciences. The research team ...

  20. Brief reconnaissance study for the addition of hydropower for Ward Dam, Sugar Grove, North Carolina

    SciTech Connect

    Gebhard, T.G. Jr.

    1983-04-01

    The following are presented: summary sheet; site description; business data; environmental, institutional, and safety data; plant characteristics and power potential; project economics; and photographs. It is concluded that the addition of hydroelectric generators appear to be economically feasible at this site. (MHR)

  1. Introducing an osteopathic approach into neonatology ward: the NE-O model

    PubMed Central

    2014-01-01

    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. PMID:24904746

  2. 76 FR 37002 - Safety Zone; Central Astoria Independence Celebration Fireworks Event, Wards Island, NY

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-06-24

    ... of Energy Effects under Executive Order 13211. Technical Standards The National Technology Transfer... with the fireworks display. Due to the dangers posed by the pyrotechnics used in this fireworks...

  3. Enterobacter sakazakii in dried infant formulas and milk kitchens of maternity wards in Săo Paulo, Brazil.

    PubMed

    Palcich, Gabriela; Gillio, Cintia de Moraes; Aragon-Alegro, Lina Casale; Pagotto, Franco J; Farber, Jeffrey M; Landgraf, Mariza; Destro, Maria Teresa

    2009-01-01

    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

  4. From Classroom to Boardroom and Ward: Developing Generic Intercultural Skills in Diverse Disciplines

    ERIC Educational Resources Information Center

    Barker, Michelle C.; Mak, Anita S.

    2013-01-01

    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…

  5. Prevalence of Nosocomial Diarrhea Due to Adenoviruses 40 and 41 in a Paediatric Ward in Iran

    PubMed Central

    Khoshdel, Abolfazl; Doosti, Abbas; Famouri, Fatemeh

    2015-01-01

    Background Enteric adenoviruses 40 (Ad40) and adenovirus 41 (Ad41) have been shown to be a significant cause of paediatric gastroenteritis worldwide, but no data are available for nosocomial diarrhea due to adenovirus in Iran. Aim The present study was performed to determine the incidence of Ad40 and Ad41 in children less than five years with nosocomial diarrhea in Shahrekord, southwest Iran. Materials and Methods Adenovirus was detected by polymerase chain reaction (PCR) in stool samples collected during one year (2010-2011) from children less than five years with nosocomial diarrhea admitted to a paediatric center in Shahrekord, Iran. Nosocomial diarrhea was defined as those occurring more than 72 hours after admission to hospital for non-diarrheal causes. PCR technique was used for investigation of Ad40 and Ad41. Results In total of 100 samples, Ad40 and Ad41 DNA was found to be positive in 14/100 (14%), and 8/100 (8%) of diarrheic patients less than five years, respectively. Conclusion Ad40 and Ad41 are important causes of nosocomial diarrhea in less than five-year, hospitalized Iranian children. PMID:26816963

  6. Therapeutic relationships and involuntary treatment orders: service users' interactions with health-care professionals on the ward.

    PubMed

    Wyder, Marianne; Bland, Robert; Blythe, Andrew; Matarasso, Beth; Crompton, David

    2015-04-01

    There is increasing evidence that an involuntary hospital admission and treatment can undermine the therapeutic relationship. While good relationships with staff are important factors influencing long-term recovery, there is little information on how people experience their relationships with staff while under an involuntary treatment order (ITO). Twenty-five involuntary inpatients were interviewed about their experiences of an ITO. The interviews were analysed by a general inductive approach. Participants described the following themes: (i) the ITO admission was a daunting and frightening experience; (ii) staff behaviours and attitudes shaped their experiences in hospital; (iii) importance of staff listening to their concerns; (iv) importance of having a space to make sense of their experiences; (v) importance of staff ability to look beyond their illness and diagnosis; and (vi) importance of staff working in partnership. These findings highlight that when using recovery principles, such as an empathic engagement with the patients' lived experience, forging partnerships with patients in treatment decision-making to enhance agency, an involuntary treatment order does not have to limit the ability to establish positive relationships. PMID:25628260

  7. Polyimide-isolated ridge waveguide InGaN/GaN laser diodes based on back-ward exposure

    NASA Astrophysics Data System (ADS)

    Meng, Linghai; Kang, Xiangning; Wang, Ping; Yan, Tongxing; Ma, Jian; Lu, Cimang; Liu, Ningyang; Wu, Yong; Liu, Shiyu; Wang, Jingshen; Hu, Xiaodong

    2016-03-01

    The manufacture of metal electrode window on the ridge structure of laser diodes (LDs) is a confused issue in the LDs fabrication process. We show that the processing of the self-aligned step and negative photosensitive polyimide (NPP) thermal imidization which can achieve both accurate alignment of p-electrode window on the ridge structure and integrated dielectric layer at once time. This back word exposure technic can effectively simplify the process of accuracy of alignment and avoid etching of isolating layer. The optical and electrical performance of the LD chip measured at room temperature under a pulse current condition (the current duty ratio was 25%) were shown. The output optical power was greater than 20 mW, at 7.7 V operating voltage, and the reversed current is 3.9 × 10-5 mA when the bias voltage is -5 V. A lasing peak wavelength at around 442 nm became dominant at 320 mA. Our results provide an alternative effective approach to fabricate the well behavior LDs.

  8. Contaminated handwashing sinks as the source of a clonal outbreak of KPC-2-producing Klebsiella oxytoca on a hematology ward.

    PubMed

    Leitner, Eva; Zarfel, Gernot; Luxner, Josefa; Herzog, Kathrin; Pekard-Amenitsch, Shiva; Hoenigl, Martin; Valentin, Thomas; Feierl, Gebhard; Grisold, Andrea J; Högenauer, Christoph; Sill, Heinz; Krause, Robert; Zollner-Schwetz, Ines

    2015-01-01

    We investigated sinks as possible sources of a prolonged Klebsiella pneumonia carbapenemase (KPC)-producing Klebsiella oxytoca outbreak. Seven carbapenem-resistant K. oxytoca isolates were identified in sink drains in 4 patient rooms and in the medication room. Investigations for resistance genes and genetic relatedness of patient and environmental isolates revealed that all the isolates harbored the blaKPC-2 and blaTEM-1 genes and were genetically indistinguishable. We describe here a clonal outbreak caused by KPC-2-producing K. oxytoca, and handwashing sinks were a possible reservoir. PMID:25348541

  9. Effect of Frailty on Functional Gain, Resource Utilisation, and Discharge Destination: An Observational Prospective Study in a GEM Ward

    PubMed Central

    Kawryshanker, Sujatha; Raymond, Warren; Inderjeeth, Charles A.

    2014-01-01

    Background. A geriatric evaluation and management unit (GEM) manages elderly inpatients with functional impairments. There is a paucity of literature on frailty and whether this impacts on rehabilitation outcomes. Objectives. To examine frailty score (FS) as a predictor of functional gain, resource utilisation, and destinations for GEM patients. Methods. A single centre prospective case study design. Participants (n = 136) were ?65 years old and admitted to a tertiary hospital GEM. Five patients were excluded by the preset exclusion criteria, that is, medically unstable, severe dementia or communication difficulties after stroke. Core data included demographics, frailty score (FS), and functional independence. Results. The mean functional improvement (FIM) from admission to discharge was 11.26 (95% CI 8.87, 13.66; P < 0.001). Discharge FIM was positively correlated with admission FIM (? = 0.748; P < 0.001) and negatively correlated with frailty score (? = ?1.151; P = 0.014). The majority of the patients were in the “frail” group. “Frail” and “severely frail” subgroups improved more on mean FIM scores at discharge, relative to that experienced by the “pre-frail” group. Conclusion. All patients experienced functional improvement. Frailer patients improved more on their FIM and improved relatively more than their prefrail counterparts. Higher frailty correlated with reduced independence and greater resource utilisation. This study demonstrates that FS could be a prognostic indicator of physical independence and resource utilisation. PMID:24695584

  10. Discussing Patient Management Online: The Impact of Roles on Knowledge Construction for Students Interning at the Paediatric Ward

    ERIC Educational Resources Information Center

    De Wever, Bram; Van Winckel, Myriam; Valcke, Martin

    2008-01-01

    The objectives of this study are to explore the use of asynchronous discussion groups during medical students' clinical rotation in paediatrics. In particular, the impact of role assignment on the level of knowledge construction through social negotiation is studied. Case-based asynchronous discussion groups were introduced to enhance reflection…

  11. Contaminated Handwashing Sinks as the Source of a Clonal Outbreak of KPC-2-Producing Klebsiella oxytoca on a Hematology Ward

    PubMed Central

    Leitner, Eva; Zarfel, Gernot; Luxner, Josefa; Herzog, Kathrin; Pekard-Amenitsch, Shiva; Hoenigl, Martin; Valentin, Thomas; Feierl, Gebhard; Grisold, Andrea J.; Högenauer, Christoph; Sill, Heinz; Krause, Robert

    2014-01-01

    We investigated sinks as possible sources of a prolonged Klebsiella pneumonia carbapenemase (KPC)-producing Klebsiella oxytoca outbreak. Seven carbapenem-resistant K. oxytoca isolates were identified in sink drains in 4 patient rooms and in the medication room. Investigations for resistance genes and genetic relatedness of patient and environmental isolates revealed that all the isolates harbored the blaKPC-2 and blaTEM-1 genes and were genetically indistinguishable. We describe here a clonal outbreak caused by KPC-2-producing K. oxytoca, and handwashing sinks were a possible reservoir. PMID:25348541

  12. [Prospective study of spontaneous medical utilization of antibiotics on the normal surgical ward--rationale and economic aspects].

    PubMed

    Schmidt-Matthiesen, A; Schellmann, J; Encke, A

    1998-01-01

    For 8 months, the spontaneous behaviour of the surgeons concerning the use of antibiotics (AB) was studied. The study focused on the indication itself, the chosen substance, the method of drug administration, and the treatment duration. It was evaluated whether the use of AB was rational and what the economic consequences of inadequate use of AB are. Of a total of 1168 pts 21.1% received AB, 88% of them i.v. The intention of AB treatment was therapy in 56.3%, and prophylaxis in 43.7% beside the regular perioperative single shot regimen. More than every second AB prescription was irrational. More rational behaviour (indication, therapy once daily, sequential therapy, no postoperative prophylaxis, less i.v. AB) by the prescribing surgeons would have led to a saving of more than 60% of the total costs of DM 215,000 without any loss of antiinfective efficacy. Moreover, a more rational use of AB would mean prevention of infectious hospitalism and would save a lot of staff time. PMID:9931739

  13. [Psychic hospitalism in patients confined to bed for long periods of time in the septic ward for posttraumatic osteomyelitis].

    PubMed

    Jenny, G

    1980-12-01

    It has to be emphasized that the reconstruction of the soft tissue cover of the lower leg is an important procedure. Plastic surgery has to be performed primarily. Otherwise the consequences beside multiple procedures are a very long hospitalization. In this connection, the evaluation of patients shows very grave psychological changes and difficulties in regard to social rehabilitation. PMID:7222928

  14. [Initial epidemiological data on the clinical effects in health workers employed in the manual lifting of patients in wards].

    PubMed

    Colombini, D; Riva, F; Luè, D; Nava, C; Petri, A; Basilico, S; Linzalata, M; Morselli, G; Cotroneo, L; Ricci, M G; Menoni, O; Battevi, N

    1999-01-01

    An investigation was carried out by teams from various centres coordinated by the EPM (Ergonomics of Posture and Movement) Research Unit on 54 different hospitals in various regions of northern and central Italy. The teams examined a total of 3341 health workers whose job involved manual handling of patients (553 male and 2788 females, 1568 working in hospitals and 1773 in geriatric residences). Numerous meetings were held to ensure that the methods of assessing the exposure indexes and spinal impairment were identical in the various teams. The final data were processed centrally at the EPM Research Unit. The sample analyzed may be considered as representative of the situation in hospitals in Italy, at least for northern and central Italy. The mean age was 36 years, mean length of service in the department 6 years and mean length of job duration not exceeding 10 years; staff turnover was high. Physical examination revealed that 8.4% of the workers had had at least one episode of acute low back pain in the previous 12 months: i.e., 4 times the values of the reference groups. Also in the case of clinical-functional spondyloarthropathies of the lumbosacral spine, in the females there was a significantly higher prevalence than in the reference groups. All disorders were more severe in sectors more at risk, i.e., old peoples homes, rehabilitation centres, orthopaedic and surgical departments, and in any case higher in old peoples homes and geriatric residences. The initial data concerning the ratio between presence of spinal disease and risk index were also positive. PMID:10371815

  15. VizieR Online Data Catalog: M-dwarfs in Multiples (MinMs) survey. I. (Ward-Duong+, 2015)

    NASA Astrophysics Data System (ADS)

    Ward-Duong, K.; Patience, J.; De Rosa, R. J.; Bulger, J.; Rajan, A.; Goodwin, S. P.; Parker, R. J.; McCarthy, D. W.; Kulesa, C.

    2015-11-01

    The MinMs sample is derived from the new reduction of the Hipparcos catalogue (van Leeuwen, 2007, Cat. I/311). We selected all stars with parallaxes greater than π>=66.67mas, corresponding to stars located within a distance limit of D<=15pc. In order to obtain precise distances and absolute magnitudes, stars with parallax errors larger than σπ/π>=0.10 were excluded from the sample. Johnson V-band magnitudes were obtained from the original Hipparcos catalogue (Perryman et al., 1997, Cat. I/239), which comprises ground- and space-based photometry with uncertainties <=0.08mag, and KS-band magnitudes were obtained from the Two Micron All Sky Survey (2MASS; Skrutskie et al., 2006, Cat. VII/233), providing V-Ks colours. (4 data files).

  16. Mirror mirror on the ward, who’s the most narcissistic of them all? Pathologic personality traits in health care

    PubMed Central

    Bucknall, Vittoria; Burwaiss, Suendoss; MacDonald, Deborah; Charles, Kathy; Clement, Rhys

    2015-01-01

    Background: Stereotypes in medicine have become exaggerated for the purpose of workplace amusement. Our objective was to assess the levels of “dark triad” personality traits expressed by individuals working in different health care specialties in comparison with the general population. Methods: We conducted a prospective, cross-sectional study within multiple departments of a UK secondary care teaching hospital. A total of 248 health care professionals participated, and 159 members of the general population were recruited as a comparison group. We measured 3 personality traits — narcissism, Machiavellianism and psychopathy — through the validated self-reported personality questionnaires Narcissistic Personality Inventory (NPI), MACH-IV and the Levenson Self-Report Psychopathy Scale (LSRP), respectively. Results: Health care professionals scored significantly lower on narcissism, Machiavellianism and psychopathy (mean scores 12.0, 53.0 and 44.7, respectively) than the general population (p < 0.001). Nursing professionals exhibited a significantly higher level of secondary psychopathy than medical professionals (p = 0.04, mean LSRP score 20.3). Within the cohort of medical professionals, surgeons expressed significantly higher levels of narcissism (p = 0.03, mean NPI score 15.0). Interpretation: Health care professionals expressed low levels of dark triad personality traits. The suggestion that health care professionals are avaricious and untrustworthy may be refuted, even for surgeons. PMID:26644545

  17. Monitoring Ambulation of Patients in Geriatric Rehabilitation Wards: The Accuracy of Clinicians' Prediction of Patients' Walking Time

    ERIC Educational Resources Information Center

    Cheung, Vivian H. Y.; Salih, Salih A.; Crouch, Alisa; Karunanithi, Mohanraj K.; Gray, Len

    2012-01-01

    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…

  18. New Short Tandem Repeat-Based Molecular Typing Method for Pneumocystis jirovecii Reveals Intrahospital Transmission between Patients from Different Wards

    PubMed Central

    Gits-Muselli, Maud; Peraldi, Marie-Noelle; de Castro, Nathalie; Delcey, Véronique; Menotti, Jean; Guigue, Nicolas; Hamane, Samia; Raffoux, Emmanuel; Bergeron, Anne; Valade, Sandrine; Molina, Jean-Michel; Bretagne, Stéphane; Alanio, Alexandre

    2015-01-01

    Pneumocystis pneumonia is a severe opportunistic infection in immunocompromised patients caused by the unusual fungus Pneumocystis jirovecii. Transmission is airborne, with both immunocompromised and immunocompetent individuals acting as a reservoir for the fungus. Numerous reports of outbreaks in renal transplant units demonstrate the need for valid genotyping methods to detect transmission of a given genotype. Here, we developed a short tandem repeat (STR)-based molecular typing method for P. jirovecii. We analyzed the P. jirovecii genome and selected six genomic STR markers located on different contigs of the genome. We then tested these markers in 106 P. jirovecii PCR-positive respiratory samples collected between October 2010 and November 2013 from 91 patients with various underlying medical conditions. Unique (one allele per marker) and multiple (more than one allele per marker) genotypes were observed in 34 (32%) and 72 (68%) samples, respectively. A genotype could be assigned to 55 samples (54 patients) and 61 different genotypes were identified in total with a discriminatory power of 0.992. Analysis of the allelic distribution of the six markers and minimum spanning tree analysis of the 61 genotypes identified a specific genotype (Gt21) in our hospital, which may have been transmitted between 10 patients including six renal transplant recipients. Our STR-based molecular typing method is a quick, cheap and reliable approach to genotype Pneumocystis jirovecii in hospital settings and is sensitive enough to detect minor genotypes, thus enabling the study of the transmission and pathophysiology of Pneumocystis pneumonia. PMID:25933203

  19. Mathematical models for assessing the role of airflow on the risk of airborne infection in hospital wards

    PubMed Central

    Noakes, Catherine J.; Sleigh, P. Andrew

    2009-01-01

    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. PMID:19812072

  20. Drug utilisation and off-label use of medications in anaesthesia in surgical wards of a teaching hospital

    PubMed Central

    Patil, Amol E; Shetty, Yashashri C; Gajbhiye, Snehalata V; Salgaonkar, Sweta V

    2015-01-01

    Background and Aims: When a drug is used in a way that is different from that described in regulatory body approved drug label, it is said to be ‘off label use’. Perioperative phase is sensitive from the point of view of patient safety and off-label drug use in this setup can prove to be hazardous to patient. Hence, it was planned to assess the pattern of drug utilisation and off-label use of perioperative medication during anaesthesia. Methods: Preoperatively, demographic details and adverse events check list were filled from a total of 400 patients from general surgery, paediatric surgery and orthopaedics departments scheduled to undergo surgery. The perioperative assessment form was assessed to record all prescriptions followed by refilling of adverse events checklist in case record form. World Health Organization (WHO) prescribing indicators were used for analysis of drug utilisation data. National Formulary of India 2011 was used as reference material to decide off-label drug use in majority instances along with package insert. Results: A total of 3705 drugs were prescribed to the 400 participants and average number of drugs per patient was 9.26 ± 3.33. Prescriptions by generic name were 68.07% whereas 85.3% drugs were prescribed from hospital schedule. Off-label drugs overall formed 20.19% of the drugs prescribed. At least one off-label drug was prescribed to 82.5% of patients. Inappropriate dose was the most common form of off-label use. There was 1.6 times greater risk of occurrence of adverse events associated with the use of off-label drugs. Conclusion: Prescription indicators were WHO compliant. Off-label drug use was practiced in anaesthesia department with questionable clinical justification in some instances. PMID:26755837

  1. Superfund record of decision (EPA Region 2): Barceloneta Landfill Site (Florida Afuera Ward), Barceloneta, PR, July 5, 1996

    SciTech Connect

    1996-12-01

    This Record of Decision (ROD) documents the U.S. Environmental Protection Agency`s (EPA`s) selection of the remedial action for the Barceloneta Landfill Site. The primary objective of this remedy is to control the source of contamination at the Site and to reduce and minimize the migration of contaminants into Site media thereby minimizing any health and environmental impacts. The major component of the selected remedy includes installing a low permeability cover system for the three landfill cells meeting the requirements of the Resource Conservation and Recovery Act Subtitle D and Puerto Rico`s Regulations Governing Landfill Closure. This cover system or landfill cap(s) will further reduce infiltration of precipitation water into the landfill and reduce leachate generation thus mitigating impacts to ground water.

  2. Evaluation of organizational maturity based on people capacity maturity model in medical record wards of Iranian hospitals

    PubMed Central

    Yarmohammadian, Mohammad H.; Tavakoli, Nahid; Shams, Assadollah; Hatampour, Farzaneh

    2014-01-01

    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. PMID:25077147

  3. Discussing Patient Management Online: The Impact of Roles on Knowledge Construction for Students Interning at the Paediatric Ward

    ERIC Educational Resources Information Center

    De Wever, Bram; Van Winckel, Myriam; Valcke, Martin

    2008-01-01

    The objectives of this study are to explore the use of asynchronous discussion groups during medical students' clinical rotation in paediatrics. In particular, the impact of role assignment on the level of knowledge construction through social negotiation is studied. Case-based asynchronous discussion groups were introduced to enhance reflection


  4. Antibiotics Use Patterns for Surgical Prophylaxis Site Infection in Different Surgical Wards of a Teaching Hospital in Ahvaz, Iran

    PubMed Central

    Alavi, Seyed Mohammad; Roozbeh, Fatemeh; Behmanesh, Farzaneh; Alavi, Leila

    2014-01-01

    Background: Despite the effectiveness of prophylactic antimicrobials to prevent surgical site infection the use of antibiotic prophylaxis is often inappropriate. Objectives: The current study aimed to determine the pattern of prophylactic antibiotic use in a teaching hospital affiliated to Jundishapur University of Medical Sciences, Ahvaz, Iran. Patients and Methods: The current descriptive study included 8586 patients who received prophylactic antibiotics before surgery from April 2011 to March 2012, in Razi Hospital affiliated to Jundishapur University of Medical Sciences. Indications for antibiotic use, proper or inappropriate antibiotics, an antibiotic or combination of antibiotics, dosage and length of treatment for each patient based on the infectious disease textbook (Mandel's Principle and practice of infectious diseases) definitions were administrated. Results: Of the total 8586 patients who took antibiotics for preventive purposes, 4815 (56%) required antimicrobial prophylaxis, and 3771 (44%) patients did not. Of the 4815 patients who received prophylaxis, 86.9% received it appropriately, 13.1% received it inappropriately; 8.2% received inappropriate dosage, and 9.5% received antibiotic longer than 24 hours. Conclusions: The current study revealed that 44% of those who received prophylaxis did not need it. In the patients who received antibiotics, the most common mistakes were antibiotic selection followed by prolonged prophylaxis (> 24 hours) and excess dose. PMID:25774270

  5. A Decolonizing Encounter: Ward Churchill and Antonia Darder in Dialogue. Counterpoints: Studies in the Postmodern Theory of Education. Volume 430

    ERIC Educational Resources Information Center

    Orelus, Pierre W., Ed.

    2012-01-01

    "A Decolonizing Encounter" examines the effects of western colonialism on historically marginalized and colonized populations living both in the West and the "third world". Specifically, it explores crucial issues such as the decolonizing of schools and communities of color; the decentralization of power of the capitalist and colonial state;…

  6. Use of FMEA analysis to reduce risk of errors in prescribing and administering drugs in paediatric wards: a quality improvement report

    PubMed Central

    Lago, Paola; Bizzarri, Giancarlo; Scalzotto, Francesca; Parpaiola, Antonella; Amigoni, Angela; Putoto, Giovanni; Perilongo, Giorgio

    2012-01-01

    Objective Administering medication to hospitalised infants and children is a complex process at high risk of error. Failure mode and effect analysis (FMEA) is a proactive tool used to analyse risks, identify failures before they happen and prioritise remedial measures. To examine the hazards associated with the process of drug delivery to children, we performed a proactive risk-assessment analysis. Design and setting Five multidisciplinary teams, representing different divisions of the paediatric department at Padua University Hospital, were trained to analyse the drug-delivery process, to identify possible causes of failures and their potential effects, to calculate a risk priority number (RPN) for each failure and plan changes in practices. Primary outcome To identify higher-priority potential failure modes as defined by RPNs and planning changes in clinical practice to reduce the risk of patients harm and improve safety in the process of medication use in children. Results In all, 37 higher-priority potential failure modes and 71 associated causes and effects were identified. The highest RPNs related (>48) mainly to errors in calculating drug doses and concentrations. Many of these failure modes were found in all the five units, suggesting the presence of common targets for improvement, particularly in enhancing the safety of prescription and preparation of endovenous drugs. The introductions of new activities in the revised process of administering drugs allowed reducing the high-risk failure modes of 60%. Conclusions FMEA is an effective proactive risk-assessment tool useful to aid multidisciplinary groups in understanding a process care and identifying errors that may occur, prioritising remedial interventions and possibly enhancing the safety of drug delivery in children. PMID:23253870

  7. Judging Thieves of Attention: Commentary on "Assessing Cognitive Distraction in the Automobile," by Strayer, Turrill, Cooper, Coleman, Medeiros-Ward, and Biondi (2015).

    PubMed

    Hancock, Peter A; Sawyer, Ben D

    2015-12-01

    The laudable effort by Strayer and his colleagues to derive a systematic method to assess forms of cognitive distraction in the automobile is beset by the problem of nonstationary in driver response capacity. At the level of the overall goal of driving, this problem conflates actual on-road behavior; characterized by underspecified task satisficing, with our own understandable, scientifically inspired aspiration for measuring deterministic performance optimization. Measures of response conceived under this latter imperative are, at best, only shadowy reflections of the actual phenomenological experience involved in real-world vehicle control. Whether we, as a research community, can resolve this issue remains uncertain. However, we believe we can mount a positive attack on what is arguably another equally important dimension of the collision problem. PMID:26534852

  8. 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

    Asiimwe, Stephen B.; Okello, Samson; Moore, Christopher C.

    2014-01-01

    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. PMID:24587094

  9. Clinical Risk Factors of Death From Pneumonia in Children with Severe Acute Malnutrition in an Urban Critical Care Ward of Bangladesh

    PubMed Central

    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

    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. PMID:24040043

  10. "Junior Doctor Decision Making: Isn't that an Oxymoron?" A Qualitative Analysis of Junior Doctors' Ward-Based Decision-Making

    ERIC Educational Resources Information Center

    Bull, Stephanie; Mattick, Karen; Postlethwaite, Keith

    2013-01-01

    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…

  11. Discharged from a mental health admission ward: is it safe to go home? A review on the negative outcomes of psychiatric hospitalization

    PubMed Central

    Loch, Alexandre Andrade

    2014-01-01

    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. PMID:24812527

  12. The meaning and significance of clinical group supervision and supervised individually planned nursing care as narrated by nurses on a general team psychiatric ward.

    PubMed

    Berg, A; Hallberg, I R

    2000-09-01

    By interviewing 22 psychiatric nurses, the present study aimed to reveal the meaning and significance of systematic clinical group supervision and supervised individually planned nursing care, using latent content analysis. The interpreted meaning was 'confronting the complexity of ongoing life in daily nursing care' and the interpreted significance was 'strengthening the foundation for nursing care'. Reflection on action and confirmation seemed to be core components in the process of clinical supervision. Focusing on the relational and task aspects in nursing care within a group approach may have contributed to the positive experiences of development that occurred. PMID:11887255

  13. Characteristics associated with recurrent falls among the elderly within aged-care wards in a tertiary hospital: the effect of cognitive impairment.

    PubMed

    Chen, Xueli; Van Nguyen, Huong; Shen, Qing; Chan, Daniel K Y

    2011-01-01

    In this study, we aimed to determine the factors associated with recurrent falls in aged-care inpatients at a tertiary hospital, with a focus on the cognitive domains of recurrent fallers. We retrospectively examined the characteristics of 70 aged-care inpatients who sustained ≄ 2 falls; 269 patients who sustained 1 fall; and 69 non-fallers during their hospital admission. We also analyzed the available Mini-Mental State Examination (MMSE) scores and sub-scores of 37 recurrent fallers, 163 single fallers, and 37 non-fallers. The independent risk factors for recurrent falls were a history of dementia, stroke, or atrial fibrillation; and patients' hospital length of stay >5 weeks. Protective factors were the patients' ability to speak English and a history of depression. Recurrent fallers had significantly lower MMSE scores than single fallers and non-fallers (17.3 ± 6.7, 20.2 ± 6.2, 24.0 ± 5.1, respectively, p < 0.01); and a larger proportion of recurrent fallers had MMSE <18 than in the other two groups (54.1%, 34.4% and 10.8%, respectively, p < 0.01). In addition, patients with recurrent falls were more likely to have significantly lower scores in the 'registration', 'attention and calculation', 'recall' and 'praxis' domains of the MMSE than single fallers. The findings from this study suggest that cognitive impairment particularly affecting short-term memory, recall and visuospatial perception may contribute to recurrent falls in the inpatient population. Prospective studies to elucidate a causal relationship may be worthwhile. PMID:20875920

  14. "Junior Doctor Decision Making: Isn't that an Oxymoron?" A Qualitative Analysis of Junior Doctors' Ward-Based Decision-Making

    ERIC Educational Resources Information Center

    Bull, Stephanie; Mattick, Karen; Postlethwaite, Keith

    2013-01-01

    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


  15. Using in situ simulation to identify and resolve latent environmental threats to patient safety: case study involving operational changes in a labor and delivery ward.

    PubMed

    Hamman, William R; Beaudin-Seiler, Beth M; Beaubien, Jeffrey M; Gullickson, Amy M; Orizondo-Korotko, Krystyna; Gross, Amy C; Fuqua, Wayne; Lammers, Richard

    2010-01-01

    Since the publication of "To Err Is Human" in 1999, health care professionals have looked to high-reliability industries such as aviation for guidance on improving system safety. One of the most widely adopted aviation-derived approaches is simulation-based team training, also known as crew resource management training. In the health care domain, crew resource management training often takes place in custom-built simulation laboratories that are designed to replicate operating rooms or labor and delivery rooms. Unlike these traditional crew resource management training programs, "in situ simulation" occurs on actual patient care units, involves actual health care team members, and uses actual organization processes to train and assess team performance. During the past 24 months, our research team has conducted nearly 40 in situ simulations. In this article, we present the results from 1 such simulation: a patient who experienced a difficult labor that resulted in an emergency caesarian section and hysterectomy. During the simulation, a number of latent environmental threats to safety were identified. This article presents the latent threats and the steps that the hospital has taken to remedy them. PMID:20588141

  16. Using in situ simulation to identify and resolve latent environmental threats to patient safety: case study involving a labor and delivery ward.

    PubMed

    Hamman, William R; Beaudin-Seiler, Beth M; Beaubien, Jeffrey M; Gullickson, Amy M; Gross, Amy C; Orizondo-Korotko, Krystyna; Fuqua, Wayne; Lammers, Richard

    2009-09-01

    Since the publication of To Err is Human, health care professionals have looked to high-reliability industries such as commercial aviation for guidance on improving system safety. One of the most widely adopted aviation-derived approaches is simulation-based team training, also known as crew resource management (CRM) training. In the health care domain, CRM training often takes place in custom-built simulation laboratories that are designed to replicate operating rooms or labor and delivery rooms. Unlike these traditional CRM training programs, in situ simulation occurs on actual patient care units, involves actual health care team members, and uses actual organization processes to train and assess team performance. During the past 24 months, our research team has conducted nearly 40 in situ simulations. In this paper, we present the results from one such simulation: a patient who experienced a difficult labor and delivery resulting in an emergency caesarean section and a hysterectomy. During the simulation, a number of latent environmental threats to safety were identified. The following article presents not only the latent threats but also the steps that the hospital has taken to remedy them. Results from clinical simulations in operational health care settings can help identify and resolve latent environmental threats to patient safety. PMID:19927053

  17. Outbreak of bullous impetigo caused by Staphylococcus aureus strains of phage type 3C/71 in a maternity ward linked to nasal carriage of a healthcare worker.

    PubMed

    Piechowicz, Lidia; Garbacz, Katarzyna; Budzy?ska, Anna; D?browska-Szponar, Maria

    2012-01-01

    We describe an outbreak of bullous impetigo (BI) that occurred in a maternity unit and show phenotypic and genotypic properties and relatedness of isolated Staphylococcus aureus strains. Clinical material was obtained from 11 affected neonates. Additionally, nasal swabs from 67 healthy care workers (HCWs) as well as 107 environmental swabs were investigated. All isolates were screened for exfoliative toxin genes (eta, etb), antibiotic susceptibility and phage typed. Chromosomal DNA was genotyped by MLVF method and PCR/RFLP of coagulase gene were tested. Affected neonates were infected by two clusters of eta-positive S. aureus of phage type 3C/71: (1) MLVF type A isolates resistant only to penicillin, and (2) MLVF type B isolates resistant to penicillin and erythromycin/clindamycin. All isolates were susceptible to methicillin. We found 19 of 67 HCWs to be S. aureus nasal carriers. Two nasal isolates from HCWs were related to the outbreak on the basis of phage typing, PCR detection of eta/etb genes, antibiotyping and genotyping. Additionally, environmental swabs from the maternity unit revealed a 3C/71 S. aureus in the mattress of a baby bed. This is the first documented case of an outbreak of BI caused by phage type 3C/71 eta-positive strain of S. aureus. PMID:22378195

  18. Public health assessment for Vega Baja Solid Waste Disposal, Rio Abajo Ward/La Trocha, Vega Baja County, Puerto Rico, Region 2: CERCLIS Number PRD980512669. Final report

    SciTech Connect

    1998-11-30

    The Vega Baja Waste Disposal Site is a public health hazard because long-term exposure to lead in soil in some yards cause harmful effects in children. Children and especially preschool children who live in yards with elevated levels of soil lead might be exposed to small amounts of lead when they accidentally swallow soil and dust that cling to their hands. The level of lead in garden vegetables from the site is not a public health threat. It is safe for residents to grow and eat garden vegetables. ATSDR recommends that EPA prevent long-term exposure to lead-contaminated soil where lead levels are consistently elevated. ATSDR also recommends that EPA consult with ATSDR officials to ensure that Superfund activities to stop exposure to lead-contaminated soil at the site continues to be protective of public health.

  19. The Effect of Educational Intervention on Nurses’ Attitudes Toward the Importance of Family-Centered Care in Pediatric Wards in Iran

    PubMed Central

    Rostami, Forouzan; Syed Hassan, Syed Tajuddin; Yaghmai, Farideh; Ismaeil, Suriani Binti; BinSuandi, Turiman

    2015-01-01

    Introduction: Family-centered care sustains the unity of the child’s and the family’s health. The aim of this study was to determine nurses’ attitudes toward parents’ participation in the care of their hospitalized children in Iran in 2015. Methods: In this experimental study, 200 pediatric nurses from hospitals affiliated with the Shaheed Beheshti University of Medical Sciences in Tehran were selected using the multi-stage, random-sampling method. Data were gathered using a questionnaire that covered demographic information and nurses’ attitudes. The questionnaire consisted of 31 items and was completed by the nurses in three stages: 1) before intervention (pre-test), 2) immediately after intervention (post-test), and 3) three months after intervention (follow-up). The data were analyzed via SPSS software and using descriptive and analytical methods. Descriptive statistics, the Spearman Correlation Coefficient, and Repeated Measure Analysis (the Bonferroni method) were used to assess the data. Results: The results indicated that there was a significant increase in the mean score of attitude after intervention [M (pre) = 3.35%, M (post) = 3.97%, p < 0.001)]. Most of subjects had neutral attitudes toward family participation in their children’s care. There were no significant relationship between the nurses’ socio-demographic characteristics and their attitudes. Conclusion: The nurses’ attitudes toward the family’s participation in the care of their hospitalized children were moderate. The nurses’ attitudes should be improved by taking part in continuous training programs. PMID:26435826

  20. "We Have to Be Satisfied with the Scraps": South African Nurses' Experiences of Care on Adult Psychiatric Intellectual Disability Inpatient Wards

    ERIC Educational Resources Information Center

    Capri, Charlotte; Buckle, Chanellé

    2015-01-01

    Background: Migrating nursing labour inadvertently reinforces South Africa's care drain, contributes to a global care crisis and forces us to reconsider migration motivation. This paper highlights issues that complicate psychiatric intellectual disability nursing care and identifies loci for change in an attempt to redress this care challenge.…

  1. A comparison of symptoms and drug use between patients with methamphetamine associated psychoses and patients diagnosed with schizophrenia in two acute psychiatric wards.

    PubMed

    Medhus, Sigrid; Mordal, Jon; Holm, Bjűrn; Műrland, Jűrg; Bramness, Jűrgen G

    2013-03-30

    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

  2. A study of snake bite among children presenting to a paediatric ward in the main Teaching Hospital of North Central Province of Sri Lanka

    PubMed Central

    2014-01-01

    Background Snake bite is a common problem in the North Central province of Sri Lanka. Common krait (Bungarus careuleus), Ceylon krait (Bungarus ceylonicus), Cobra (Naja naja), Russell’s viper (Daboia russelii), Saw-scaled viper (Echis carinatus) and Hump-nosed pit viper (Hypnale hypnale) are the six species of venomous land snakes in Sri Lanka. A significant number of adults and children are bitten by snakes every year. However, the majority of research studies done in Sri Lanka and other countries show adults bitten by snakes and studies describing children bitten by snakes are very sparse. Methods A descriptive cross sectional study was performed in the Teaching Hospital Anuradhapura in the North Central Province of Sri Lanka from May 2010 to 2011 May to describe the characteristics associated with cases of snake bite. Results There were 24 males and 20 females. The highest numbers of bites (48%) were in the range of ages 6-12 years. The majority of the bites occurred between 6 pm to 6 am (59%).The foot was the most common bitten site (48%). Out of all the venomous bites, the Hump-nosed pit viper (Hypnale hypnale) accounted for the highest number (44%) and Russell’s viper (Daboia ruselii) accounted for the second highest number (27%). A significant number of venomous bites occurred indoors while sleeping (22%). Antivenom serum was given to (39%) of venomous bites. Deaths occurred in (11%) of the venomous bites. Conclusions Hump-nosed pit viper (Hypnale hypnale) accounted for the highest number of venomous bites. Majority of the bites occurred between 6 pm and 6 am. Foot was the most common bitten site. A significant number of venomous bites occurred indoor while sleeping. Antivenom serum was given to a significant number of venomous bites. Educating the public on making their houses snake proof and using a torch when going out during night time will help in the prevention of getting bitten by snakes. PMID:25073710

  3. "We Have to Be Satisfied with the Scraps": South African Nurses' Experiences of Care on Adult Psychiatric Intellectual Disability Inpatient Wards

    ERIC Educational Resources Information Center

    Capri, Charlotte; Buckle, Chanellé

    2015-01-01

    Background: Migrating nursing labour inadvertently reinforces South Africa's care drain, contributes to a global care crisis and forces us to reconsider migration motivation. This paper highlights issues that complicate psychiatric intellectual disability nursing care and identifies loci for change in an attempt to redress this care challenge.


  4. A Novel Biological Dosimetry Method for Monitoring Occupational Radiation Exposure in Diagnostic and Therapeutic Wards: From Radiation Dosimetry to Biological Effects

    PubMed Central

    Heydarheydari, S.; Haghparast, A.; Eivazi, M.T.

    2016-01-01

    Background and Objective Professional radiation workers are occupationally exposed to long-term low levels of ionizing radiation. Occupational health hazards from radiation exposure, in a large occupational segment of the population, are of special concern. Biological dosimetry can be performed in addition to physical dosimetry with the aim of individual dose assessment and biological effects. Methods In this biodosimetry study, some hematological parameters have been examined in 40 exposed and 40 control subjects who were matched by gender, age and occupational records (±3 years) in Kermanshah hospitals in Iran (2013-2014). The occupational radiation dose was measured by personal dosimetry device (film badges). The data was analyzed using SPSS V.20 and statistical tests such as two-sided Student’s t-test. Results Exposed subjects had a median exposure of 0.68±1.58 mSv/year by film badge dosimetry. Radiation workers with at least a 10-year record showed lower values of Mean Hemoglobin (Hb) and Mean Corpuscular Volume (MCV) compared to the control group (p<0.05). The mean value of Red Blood Cells (RBCs) in personnel working in Radiology departments seemed to show decrease in comparison with other radiation workers. Conclusion Although the radiation absorbed doses were below the permissible limits based on the ICRP, this study showed the role of low-level chronic exposure in decreasing Hb and MCV in the blood of radiation workers with at least 10 years records. Therefore, the findings from the present study suggest that monitoring of hematological parameters of radiation workers can be useful as biological dosimeter, and also the exposed medical personnel should carefully follow the radiation protection instructions and radiation exposure should be minimized as possible.

  5. Comparison of susceptibility of cystic-fibrosis-related and non-cystic-fibrosis-related Pseudomonas aeruginosa to chlorine-based disinfecting solutions: implications for infection prevention and ward disinfection.

    PubMed

    Moore, John E; Rendall, Jacqueline C

    2014-09-01

    Multidrug-resistant (MDR) Pseudomonas aeruginosa isolated from cystic fibrosis (CF) sputum was shown to be more tolerant to the most commonly used chlorine-based disinfecting agent in the UK, with approximately 7 out of 10 isolates surviving a residual free chlorine (RFC) concentration of 500 p.p.m., when compared with antibiotic-sensitive invasive P. aeruginosa from a non-CF blood culture source, where 8 out of 10 isolates were killed at a RFC concentration of 100 p.p.m. All CF isolates were killed at 1000 p.p.m. chlorine. Additional studies were performed to examine factors that influenced the concentration of RFC from chlorine-based (sodium dichloroisocyanurate) disinfecting agents in contact with CF sputum and their components (bacterial cells, glycocalyx) to assess the reduction of the bactericidal activity of such disinfecting agents. Pseudomonas glycocalyx had a greater inhibitory effect of chlorine deactivation than bacterial cells. Calibration curves demonstrated the relative deactivating capacity on RFC from clinical soils, in the order pus>CF sputum>wound discharge fluid/synovial fluid>ascites fluid>bile, where quantitatively each 1?% (w/v) CF sputum reduced the RFC by 43 p.p.m. Sublethal stressing of P. aeruginosa with chlorine resulted in lowered susceptibility to colistin (P?=?0.0326) but not to meropenem, tobramycin or ciprofloxacin. In conclusion, heavy contamination of healthcare fomites with CF sputum containing MDR P. aeruginosa may result in exhaustion of RFC, and this, combined with an increased resistance to chlorine with such strains, may lead to their survival and increased antibiotic resistance in such environments. CF infection prevention strategies in such scenarios should therefore target interventions with increased concentrations of chlorine to ensure the eradication of MDR P. aeruginosa from the CF healthcare environment. PMID:24925907

  6. 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

    1998-12-30

    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 groundwater remediation should minimize the potential for future exposures and adverse human health effects.

  7. 75 FR 12252 - Final Fair Market Rents for the Housing Choice Voucher Program and Moderate Rehabilitation Single...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-03-15

    ... updated the FMRs for Reno-Sparks, NV, and Ward County, ND. The March 11, 2010, notice inadvertently listed...-Sparks, NV, and Ward County, ND. As discussed in that notice, the update was based on Random...

  8. A Principal's Reaction

    ERIC Educational Resources Information Center

    Zaretsky, Lindy

    2004-01-01

    This article presents a principal's reaction to Catherine Marshall and Michael Ward's article on research on social justice and training for leadership. The author applauds Marshall and Ward's efforts to address what is undoubtedly among the most fundamentally important issues facing principals today. Marshall and Ward illuminate the importance of…

  9. 7. View to northwest showing (from L to R) ends ...

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

    7. View to northwest showing (from L to R) ends of 1941 NW wing, original NW ward wing, and original SE ward wing, with ends of Medical Wards C and B (HABS Nos. VA-1287-I and -H) at left - Portsmouth Naval Hospital, Hospital Building, Rixey Place, bounded by Williamson Drive, Holcomb Road, & The Circle, Portsmouth, Portsmouth, VA

  10. 42 CFR 409.22 - Bed and board.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... HOSPITAL INSURANCE BENEFITS Posthospital SNF Care § 409.22 Bed and board. (a) Semiprivate and ward... room if— (i) The patient's condition requires him to be isolated; (ii) The SNF has no semiprivate or ward accommodations; or (iii) The SNF semiprivate and ward accommodations are fully occupied by...

  11. 42 CFR 409.22 - Bed and board.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... HOSPITAL INSURANCE BENEFITS Posthospital SNF Care § 409.22 Bed and board. (a) Semiprivate and ward... room if— (i) The patient's condition requires him to be isolated; (ii) The SNF has no semiprivate or ward accommodations; or (iii) The SNF semiprivate and ward accommodations are fully occupied by...

  12. 42 CFR 409.22 - Bed and board.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... HOSPITAL INSURANCE BENEFITS Posthospital SNF Care § 409.22 Bed and board. (a) Semiprivate and ward... room if— (i) The patient's condition requires him to be isolated; (ii) The SNF has no semiprivate or ward accommodations; or (iii) The SNF semiprivate and ward accommodations are fully occupied by...

  13. 42 CFR 409.22 - Bed and board.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... HOSPITAL INSURANCE BENEFITS Posthospital SNF Care § 409.22 Bed and board. (a) Semiprivate and ward... room if— (i) The patient's condition requires him to be isolated; (ii) The SNF has no semiprivate or ward accommodations; or (iii) The SNF semiprivate and ward accommodations are fully occupied by...

  14. 42 CFR 409.22 - Bed and board.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... HOSPITAL INSURANCE BENEFITS Posthospital SNF Care § 409.22 Bed and board. (a) Semiprivate and ward... room if— (i) The patient's condition requires him to be isolated; (ii) The SNF has no semiprivate or ward accommodations; or (iii) The SNF semiprivate and ward accommodations are fully occupied by...

  15. 77 FR 39694 - National Currents Energy Services, LLC; Notice of Declaration of Intention and Petition for...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-07-05

    ..., 2012. d. Applicant: National Currents Energy Services, LLC. e. Name of Project: Wards Island Tidal Energy Project. f. Location: The proposed Wards Island Tidal Energy Project will be located off the south...: The proposed Wards Island Tidal Energy Project would consist of: (1) A 15-meter-long,...

  16. A Principal's Reaction

    ERIC Educational Resources Information Center

    Zaretsky, Lindy

    2004-01-01

    This article presents a principal's reaction to Catherine Marshall and Michael Ward's article on research on social justice and training for leadership. The author applauds Marshall and Ward's efforts to address what is undoubtedly among the most fundamentally important issues facing principals today. Marshall and Ward illuminate the importance of


  17. Evidence of the importance of specialist nursing care dealing with patients with feet at risk of tissue damage. Possible implications for reforms of NHS hospital care?

    PubMed

    Radley, David

    2014-02-01

    Recent media attention has highlighted recommendations from 'Future hospital: caring for medical patients' about specialist medical care being less ward-based. This article gives evidence of the value of specialist nursing in a particular patient group. Here we present data regarding foot care for patients on vascular surgical wards. Ward B recently started to regularly care for vascular patients prior to this study, whereas ward A was previously the only specialised vascular ward in the hospital. All patients on the wards were surveyed on 3 occasions and it was recorded whether each patient's feet were touching the bed footplate. 52% of patients on ward B vs. 23% of patients on ward A had their feet touching the end of the bed (p = 0.03, n = 57). After an intervention of targeted training, alterations to routine manual handling training, and monitoring by matrons, repeat data collection took place. Only 18% of patients on ward B had their feet touching the end of the bed post intervention (p = 0.03). There was no statistical difference between wards post intervention. While looking at a simple, but nonetheless important, aspect of patient care; this audit provides evidence of the importance that nursing staff are familiar with the challenges posed by a particular patient group. If plans for specialised medical care to work across the hospital come to fruition, some patients may be nursed by staff less familiar with their needs. Vigilance and training interventions are likely to be needed for developing problems. PMID:24388768

  18. A standardised storage solution for venepuncture/cannulation equipment could save an NHS hospital the equivalent of a whole junior doctor

    PubMed Central

    Lindley, Steven; Robertson, Ian

    2014-01-01

    Junior doctors, nursing staff, and phlebotomists spend a large proportion of their time taking blood samples and siting (venous) cannulae. Approximately 350 blood samples are taken daily across 25 wards at the Royal United Hospital Bath NHS Trust. There is no standard storage solution for venepuncture or cannulation equipment. On-call junior doctors cover most of the hospital's wards. Time is wasted locating essential equipment on unfamiliar wards and nurses are frequently interrupted to assist. These delays can compromise patient safety in emergencies as well as contributing to a source of daily inefficiency. Junior doctors were timed collecting equipment needed for venepuncture and cannulation on unfamiliar wards. Initial results suggested large variation between timings on different wards. The medical admissions unit (MAU), which organises items for venepuncture and cannulation on a single trolley, was 4 times quicker than the mean of all other wards. MAU mean time 21.0s vs. Non-standardised wards mean time 103.0s (p<0.0001). Estimates suggest approximately 47 hours per week (the equivalent of a fulltime doctor) could be saved by implementing a standard trust-wide storage solution. We set out to introduce the MAU trolley format to all adult inpatient wards. All ward managers agreed to implement the trolley. 18 wards (72% of adult inpatient wards) already possessed the ‘MAU style’ trolley, which we standardised using an easy-to-follow inventory and laminated draw inlays. Feedback was very positive from doctors and ward staff alike. We repeated timings to validate the change and successfully presented a business case to senior management for a further 10 trolleys (£3623.78) for full adult inpatient ward coverage. As junior doctors, we identified a common problem, tested solutions, and made early simple affordable changes. Initial work helped us present a compelling case for patient safety and efficiency improvements, releasing money to implement modest trust-wide quality improvement changes. PMID:26734212

  19. Patient and organisational variables associated with pressure ulcer prevalence in hospital settings: a multilevel analysis

    PubMed Central

    Bredesen, Ida Marie; Bjűro, Karen; Gunningberg, Lena; Hofoss, Dag

    2015-01-01

    Objectives To investigate the association of ward-level differences in the odds of hospital-acquired pressure ulcers (HAPUs) with selected ward organisational variables and patient risk factors. Design Multilevel approach to data from 2 cross-sectional studies. Settings 4 hospitals in Norway were studied. Participants 1056 patients at 84 somatic wards. Primary outcome measure HAPU. Results Significant variance in the odds of HAPUs was found across wards. A regression model using only organisational variables left a significant variance in the odds of HAPUs across wards but patient variables eliminated the across-ward variance. In the model including organisational and patient variables, significant ward-level HAPU variables were ward type (rehabilitation vs surgery/internal medicine: OR 0.17 (95% CI 0.04 to 0.66)), use of preventive measures (yes vs no: OR 2.02 (95% CI 1.12 to 3.64)) and ward patient safety culture (OR 0.97 (95% CI 0.96 to 0.99)). Significant patient-level predictors were age >70 vs <70 (OR 2.70 (95% CI 1.54 to 4.74)), Braden scale total score (OR 0.73 (95% CI 0.67 to 0.80)) and overweight (body mass index 25–29.99?kg/m2) (OR 0.32 (95% CI 0.17 to 0.62)). Conclusions The fact that the odds of HAPU varied across wards, and that across-ward variance was reduced when the selected ward-level variables entered the explanatory model, indicates that the HAPU problem may be reduced by ward-level organisation of care improvements, that is, by improving the patient safety culture and implementation of preventive measures. Some wards may prevent pressure ulcers better than other wards. The fact that ward-level variation was eliminated when patient-level HAPU variables were included in the model indicates that even wards with the best HAPU prevention will be challenged by an influx of high-risk patients. PMID:26316647

  20. Ecological correlates of adolescent attempted suicide.

    PubMed

    Lester, D

    1990-01-01

    Rates of adolescent attempted suicide were correlated with social indicators over the electoral wards of Edinburgh (Scotland). Rates were found to be higher in wards where child neglect and misbehavior were more common. Rates of attempted suicide in the total population also were related to the housing pattern/social class of the wards. The importance of identifying similarities and differences in the patterns of suicidal behavior of adolescents and adults was noted. PMID:2375273