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Sample records for admissions unit evaluation

  1. [Nutritional evaluation of children with respiratory failure (RF): anthropometric evaluation upon admission to the pediatric intensive care units].

    PubMed

    Almeida Santos, L; Ruza, F; Guerra, A J; Alves, A; Dorao, P; García, S; Santos, N T

    1998-07-01

    Protein-energy malnutrition (PEM) constitutes an important complication in children submitted to intensive care treatment for respiratory failure (RF). This complication is not usually evaluated in assessment protocols. Nutrition assessment in a Pediatric Intensive Care Unit (PICU) was performed in children with respiratory failure. A prospective study involving 65 children (1-158 months of age) with RF at admission to the PICU was carried out. The patients studied were divided into four groups according to their etiology: Group I (n = 29) included those with acute bronchial pathology; Group II (n = 17) those with pneumonia: Group III (n = 11) those in the post-operative period following cardiac surgery; and Group IV (n = 8) those patients with multiple-organ dysfunction. All patients in Groups I, II, and III had chronic diseases. Anthropometrical and nutritional evaluation included weight, height and body mass index (w/h2). The weight for age was low (59%). Height deficit was observed in a significantly lower percentage of the patients (13.1%). The body mass index showed values in relationship to the 50th percentile that varied between 83.4 +/- 23.1% and 97.1 +/- 4.7%. In 68.9% of the patients the criteria of global malnutrition were met according to the classification of McLaren and Read. The data confirm that PEM is frequent in patients with RF in the PICU and emphasize the usefulness of anthropometrical evaluation as an important, simple and non-invasive method of nutritional evaluation. Early and intensive nutritional intervention can reduce or prevent the vicious circle of malnutrition in RF patients hospitalized in the PICU.

  2. Evaluation of a flexible acute admission unit: effects on transfers to other hospitals and patient throughput times.

    PubMed

    van der Linden, Christien; Lucas, Cees; van der Linden, Naomi; Lindeboom, Robert

    2013-07-01

    To prevent overcrowding of the emergency department, a flexible acute admission unit (FAAU) was created, consisting of 15 inpatient regular beds located in different departments. We expected the FAAU to result in fewer transfers to other hospitals and in a lower length of stay (LOS) of patients needing hospital admission. A before-and-after interventional study was performed in a level 1 trauma center in the Netherlands. Number of transfers and LOS of admitted ED patients in a 4-month period in 2008 (control period) and a 4-month period in 2009 (intervention period) were analyzed. Of 1,619 regular admission patients, 768 were admitted in the control period and 851 in the intervention period. The number of transfers decreased from 80 (10.42%) to 54 (6.35%) (P = .0037). The mean ED LOS of both the non-admitted patients and the admitted patients needing special care significantly increased (105 minutes vs 117 minutes [P = .022] and 176 minutes vs 191 minutes [P < .001], respectively). However, the mean LOS of FAAU-admissible patients was unaltered (226 minutes vs 225 minutes, P = .865). The FAAU reduced the number of transfers of admitted patients to other hospitals. The increase in LOS for special care patients and non-admitted patients was not observed for regular, FAAU-admissible patients. Flexible bed management might be useful in preventing overcrowding. Copyright © 2013 Emergency Nurses Association. Published by Mosby, Inc. All rights reserved.

  3. Characteristics of delayed admission to stroke unit.

    PubMed

    Silvestrelli, Giorgio; Parnetti, Lucilla; Tambasco, Nicola; Corea, Francesco; Capocchi, Giuseppe

    2006-01-01

    Early admission to stroke unit (SU) and factors that may cause admission delay represent relevant issues to obtain an optimal management of acute stroke. This study was aimed at recording timing from clinical onset to admission to our SU and to identify the reasons for delay. We prospectively examined acute stroke patients consecutively admitted to the Perugia SU. Baseline characteristics of stroke patients, stroke type and etiology, time from symptom onset to arrival in the SU were obtained from the Hospital-Based Perugia Stroke Registry. 60.8% of 2,213 consecutive stroke patients admitted to the SU arrived within 6 hrs and 39.2% after 6 hrs. Underestimation of symptoms was the cause of delay in 48.7% of cases. Younger age, especially for females, ischemic stroke, mild and/or unspecific symptoms and the underestimation of symptoms seem to be the main reasons for delayed arrival in the SU. To increase the proportion of stroke patients arriving in the SU within 3 hr of symptom onset, it is necessary to improve public and general practitioner awareness of stroke through educational programs.

  4. The Economics of an Admissions Holding Unit

    PubMed Central

    Schreyer, Kraftin E.; Martin, Richard

    2017-01-01

    Introduction With increasing attention to the actual cost of delivering care, return-on-investment calculations take on new significance. Boarded patients in the emergency department (ED) are harmful to clinical care and have significant financial opportunity costs. We hypothesize that investment in an admissions holding unit for admitted ED patients not only captures opportunity cost but also significantly lowers direct cost of care. Methods This was a three-phase study at a busy urban teaching center with significant walkout rate. We first determined the true cost of maintaining a staffed ED bed for one patient-hour and compared it to alternative settings. The opportunity cost for patients leaving without being seen was then conservatively estimated. Lastly, a convenience sample of admitted patients boarding in the ED was observed continuously from one hour after decision-to-admit until physical departure from the ED to capture a record of every interaction with a nurse or physician. Results Personnel costs per patient bed-hour were $58.20 for the ED, $24.80 for an inpatient floor, $19.20 for the inpatient observation unit, and $10.40 for an admissions holding area. An eight-bed holding unit operating at practical capacity would free 57.4 hours of bed space in the ED and allow treatment of 20 additional patients. This could yield increased revenues of $27,796 per day and capture opportunity cost of $6.09 million over 219 days, in return for extra staffing costs of $218,650. Analysis of resources used for boarded patients was determined by continuous observation of a convenience sample of ED-boarded patients, which found near-zero interactions with both nursing and physicians during the boarding interval. Conclusion Resource expense per ED bed-hour is more than twice that in non-critical care inpatient units. Despite the high cost of available resources, boarded non-critical patients receive virtually no nursing or physician attention. An admissions holding unit

  5. 28 CFR 541.47 - Admission to control unit.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 28 Judicial Administration 2 2012-07-01 2012-07-01 false Admission to control unit. 541.47 Section... INMATE DISCIPLINE AND SPECIAL HOUSING UNITS Control Unit Programs § 541.47 Admission to control unit. Staff shall provide an inmate admitted to a control unit with: (a) Notice of the projected duration...

  6. Investigation into the reasons for preventable drug related admissions to a medical admissions unit: observational study

    PubMed Central

    Howard, R; Avery, A; Howard, P; Partridge, M

    2003-01-01

    Objective: To describe the drugs and types of medicine management problems most frequently associated with preventable drug related admissions to an acute medical admissions unit. Design: Observation study. Setting: Medical admissions unit in a teaching hospital in Nottingham, UK. Participants: 4093 patients seen by pharmacists on the medical admissions unit between 1 January and 30 June 2001. Main outcome measures: Proportion of admissions that were drug related and preventable, classification of the underlying causes of preventable drug related admissions, and identification of drugs most commonly associated with preventable drug related admissions. Results: Of the admissions seen by pharmacists, 265 (6.5%) were judged to be drug related and 178 (67%) of these were judged to be preventable. Preventable admissions were mainly due to problems with prescribing (63 cases (35%)), monitoring (46 cases (26%)), and adherence to medication (53 cases (30%)). The drugs most commonly implicated were NSAIDs, antiplatelets, antiepileptics, hypoglycaemics, diuretics, inhaled corticosteroids, cardiac glycosides, and beta-blockers. Conclusions: Potentially preventable drug related morbidity was associated with 4.3% of admissions to a medical admissions unit. In 91% of cases these admissions were related to problems with either prescribing, monitoring, or adherence. PMID:12897361

  7. 28 CFR 541.47 - Admission to control unit.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 28 Judicial Administration 2 2011-07-01 2011-07-01 false Admission to control unit. 541.47 Section 541.47 Judicial Administration BUREAU OF PRISONS, DEPARTMENT OF JUSTICE INSTITUTIONAL MANAGEMENT INMATE DISCIPLINE AND SPECIAL HOUSING UNITS Control Unit Programs § 541.47 Admission to control unit...

  8. 28 CFR 541.47 - Admission to control unit.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Admission to control unit. 541.47 Section 541.47 Judicial Administration BUREAU OF PRISONS, DEPARTMENT OF JUSTICE INSTITUTIONAL MANAGEMENT INMATE DISCIPLINE AND SPECIAL HOUSING UNITS Control Unit Programs § 541.47 Admission to control...

  9. The impact of emergency department observation units on United States emergency department admission rates.

    PubMed

    Capp, Roberta; Sun, Benjamin; Boatright, Dowin; Gross, Cary

    2015-11-01

    Prior studies suggesting that the presence of emergency department (ED) observation units decrease overall ED hospital admissions have been either single-center studies or based on model simulations. The objective of this preliminary national study is to determine if the presence of ED observation units is associated with hospitals having lower ED admission rates. We conducted a retrospective cross-sectional analysis using the 2010 National Hospital Ambulatory Care Survey and estimated ED risk-standardized hospital admission rates (RSHAR) for each center. The following were excluded from the study: ages <18 years, leaving prior to completion of ED visit, died in the ED, transferred to another facility, and missing disposition. Hospitals with less than 30 ED visits or unknown observation unit status were also excluded. We used linear regression analysis to determine the association between ED RSHAR and presence of observation units. There were 24,232 ED visits in 315 hospitals in the United States. Of these, 82 (20.6%) hospitals had an ED observation unit. The average ED risk-standardized hospital admission rates for hospitals with observation units and without hospital observation units were 13.7% (95% confidence interval [CI]: 11.3-16.0) and 16.0% (95% CI: 14.1-17.7), respectively. The difference of 2.3% was not statistically significant. In this preliminary study, we did not find an association between the presence of observation units and ED hospital admission rates. Further studies with larger sample sizes should be performed to further evaluate the impact of ED observation units on ED hospital admission rates. © 2015 Society of Hospital Medicine.

  10. Surgical intensive care unit admission variables predict subsequent readmission.

    PubMed

    Lissauer, Matthew E; Diaz, Jose J; Narayan, Mayur; Shah, Paulesh K; Hanna, Nader N

    2013-06-01

    Intensive care unit (ICU) readmissions are associated with increased resource use. Defining predictors may improve resource use. Surgical ICU patients requiring readmission will have different characteristics than those who do not. We conducted a retrospective cohort study of a prospectively maintained database. The Acute Physiology and Chronic Health Evaluation (APACHE) IV quality database identified patients admitted January 1 through December 31, 2011. Patients were divided into groups: NREA = patients admitted to the ICU, discharged, and not readmitted versus REA = patients admitted to the ICU, discharged, and readmitted. Comparisons were made at index admission, not readmission. Categorical variables were compared by Fisher's exact testing and continuous variables by t test. Multivariate logistic regression identified independent predictors of readmission. There were 765 admissions. Seventy-seven patients required readmission 94 times (12.8% rate). Sixty-two patients died on initial ICU admission. Admission severity of illness was significantly higher (APACHE III score: 69.54 ± 21.11 vs 54.88 ± 23.48) in the REA group. Discharge acute physiology scores were equal between groups (47.0 ± 39.2 vs 44.2 ± 34.0, P = nonsignificant). In multivariate analysis, REA patients were more likely admitted to emergency surgery (odds ratio, 1.9; 95% confidence interval, 1.01 ± 3.5) more likely to have a history of immunosuppression (2.7, 1.4 ± 5.3) or higher Acute Physiology Score (1.02; 1.0 ± 1.03) than NREA. Patients who require ICU readmission have a different admission profile than those who do not "bounce back." Understanding these differences may allow for quality improvement projects such as instituting different discharge criteria for different patient populations.

  11. Cognitive impairment after intensive care unit admission: a systematic review.

    PubMed

    Wolters, Annemiek E; Slooter, Arjen J C; van der Kooi, Arendina W; van Dijk, Diederik

    2013-03-01

    There is increasing evidence that critical illness and treatment in an intensive care unit (ICU) may result in significant long-term morbidity. The purpose of this systematic review was to summarize the current literature on long-term cognitive impairment in ICU survivors. PubMed/MEDLINE, CINAHL, Cochrane Library, PsycINFO and Embase were searched from January 1980 until July 2012 for relevant articles evaluating cognitive functioning after ICU admission. Publications with an adult population and a follow-up duration of at least 2 months were eligible for inclusion in the review. Studies in cardiac surgery patients or subjects with brain injury or cardiac arrest prior to ICU admission were excluded. The main outcome measure was cognitive functioning. The search strategy identified 1,128 unique studies, of which 19 met the selection criteria and were included. Only one article compared neuropsychological test performance before and after ICU admission. The 19 studies that were selected reported a wide range of cognitive impairment in 4-62 % of the patients after a follow-up of 2-156 months. The results of most studies of the studies reviewed suggest that critical illness and ICU treatment are associated with long-term cognitive impairment. Due to the complexity of defining cognitive impairment, it is difficult to standardize definitions and to reach consensus on how to categorize neurocognitive dysfunction. Therefore, the magnitude of the problem is uncertain.

  12. Emergency department orthopedics observation unit as an alternative to admission.

    PubMed

    Ernst, Amy A; Jones, Jaime; Weiss, Steven J; Silva, Otono

    2014-10-01

    Inclusion of select orthopedic problems in the orthopedics observation unit (OOU) may reduce hospital admissions. Our system allows OOU status for 24 hours, but the effect on admissions is unknown. Our primary hypothesis was that we could predict which OOU patients required admission based on the presence of uncontrolled pain. Data were prospectively collected for all OOU patients in this prospective observational study, including data on extremity cellulitis, fractures, and spine injuries awaiting brace placement.The primary outcome variable was admission to the hospital versus discharge home. The a priori hypotheses were that patients with more persistent or worsening pain would require admission more often and that the OOU would result in fewer patients needing a costlier inpatient admission to the hospital. An a priori power analysis showed adequate power of 80% to detect a difference between admitted and discharged patients. Data were prospectively collected from August 2011 to August 2012 for 199 consecutive OOU patients, 62% of whom were men. Diagnoses included infection (cellulitis or abscess of extremity) in 76%, fracture in 15% and other in 9% of the patients. Sixty-two patients (31%) were admitted and 7 patients (4%) made return visits for the same problem within a 30-day period. No significant relations existed between any of the independent variables and admission on bivariate analysis. Multivariable logistic regression found no significant predictors of hospital admission. Logistic regression was not performed on 30-day returns because of the low event rate (4%). An OOU prevented 138 of 199 (69%) patients from being admitted to a hospital. There were no significant predictors of which patients would require admission. Pain was not a predictor of need for admission. The lack of significant predictors is important in suggesting that without the ability to predict which patients require admission, a system using an OOU can reduce admissions by more than

  13. Analysis of Unplanned Postoperative Admissions to the Intensive Care Unit.

    PubMed

    Quinn, Timothy D; Gabriel, Rodney A; Dutton, Richard P; Urman, Richard D

    2017-08-01

    To investigate factors associated with unplanned postoperative admissions to the intensive care unit (ICU). Data from the National Anesthesia Clinical Outcomes Registry (NACOR) were analyzed. We performed univariate and multivariate logistic regression to identify patient- and surgery-specific characteristics associated with unplanned postoperative ICU admission. We also recorded the prevalence of Current Procedural Terminology (CPT) and International Classification of Diseases, ninth revision ( ICD-9) billing codes and outcomes for unplanned postoperative ICU admissions. Of 23 341 130 records in the database, 2 910 738 records met our inclusion criteria. A higher American Society of Anesthesiologists physical status (ASA PS) class, case duration greater than 4 hours, and advanced age were associated with a greater likelihood of unplanned ICU admission. Vascular and thoracic surgery patients were more likely to have an unplanned ICU admission. The most common CPT and ICD-9 codes involved repair of femur/hip fracture, bowel resection, and acute postoperative pain. Large community hospitals were more likely than university hospitals to have unplanned postoperative ICU admissions. Patients in the unplanned postoperative ICU admission group were more likely to have experienced intraoperative cardiac arrest, hemodynamic instability, or respiratory failure and were more likely to die in the immediate perioperative period. Our study is the first diverse analysis of unplanned postoperative ICU admissions in the literature across multiple specialties and practice models. We found an association of advanced age, higher ASA PS class, and duration of procedure with unplanned ICU admission after surgery. Surgical specialties and procedures with the most unplanned ICU admissions could be areas for quality improvement and clinical pathways in the future.

  14. Pediatric intensive care unit admission tool: a colorful approach.

    PubMed

    Biddle, Amy

    2007-12-01

    This article discusses the development, implementation, and utilization of our institution's Pediatric Intensive Care Unit (PICU) Color-Coded Admission Status Tool. Rather than the historical method of identifying a maximum number of staffed beds, a tool was developed to color code the PICU's admission status. Previous methods had been ineffective and led to confusion between the PICU leadership team and the administration. The tool includes the previously missing components of staffing and acuity, which are essential in determining admission capability. The PICU tool has three colored levels: green indicates open for admissions; yellow, admission alert resulting from available beds or because staffing is not equal to the projected patient numbers or required acuity; and red, admissions on hold because only one trauma or arrest bed is available or staffing is not equal to the projected acuity. Yellow and red designations require specific actions and the medical director's approval. The tool has been highly successful and significantly impacted nursing with the inclusion of the essential component of nurse staffing necessary in determining bed availability.

  15. 42 CFR 456.122 - Evaluation criteria for admission review.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Evaluation criteria for admission review. 456.122...: Review of Need for Admission 1 § 456.122 Evaluation criteria for admission review. The UR plan must provide that— (a) The committee develops written medical care criteria to assess the need for...

  16. Routine dyspnea assessment on unit admission.

    PubMed

    Baker, Kathy; Barsamian, Jennifer; Leone, Danielle; Donovan, Barbara C; Williams, Donna; Carnevale, Kerry; Lansing, Robert; Banzett, Robert

    2013-11-01

    Dyspnea assessment is valuable in diagnosis, prognosis, symptom management, and targeted intervention, and in the allotment and management of patient care resources. The assessment of dyspnea, like that of pain, depends on patient self-report. Expert consensus panels have called for dyspnea to be measured quantitatively and documented on a routine basis, as is the practice with pain. But little information is available on how to measure and record dyspnea ratings systematically. Consequently, the prevalence of dyspnea in hospital settings may be greater than is generally recognized, and dyspnea may be insufficiently managed. This article describes a pilot study that sought to test the feasibility of measuring dyspnea as part of the initial patient assessment performed by nurses within several inpatient units of a large urban hospital.

  17. Admission source and mortality in a pediatric intensive care unit

    PubMed Central

    El Halal, Michel Georges dos Santos; Barbieri, Evandro; Filho, Ricardo Mombelli; Trotta, Eliana de Andrade; Carvalho, Paulo Roberto Antonacci

    2012-01-01

    Background and Aims: Studies carried out in different countries have shown that source of patient admission in Intensive Care Units (ICUs) is associated to death. Patients admitted from wards show a greater ICU mortality. The aim of the present study was to investigate the association between admission source and outcome in a Pediatric Intensive Care Unit (PICU). Materials and Methods: We studied all PICU admissions that took place between January 2002 and December 2005 in a tertiary hospital in Brazil. The major outcome studied was death while in the PICU. The independent variable analyzed was admission source, defined either as pediatric emergency room (PER), wards, operating room (OR) of the same hospital or other sources. Results: A total of 1823 admissions were studied. The overall expected mortality based on the Pediatric Index of Mortality 2 was 6.5% and the observed mortality was 10.3%. In adjusted analysis, the mortality was doubled in patients admitted from wards when compared with the PER patients. Conclusions: Observed mortality rates were higher in patients admitted from wards within the same hospital, even after adjustment. PMID:22988362

  18. Admission source and mortality in a pediatric intensive care unit.

    PubMed

    El Halal, Michel Georges Dos Santos; Barbieri, Evandro; Filho, Ricardo Mombelli; Trotta, Eliana de Andrade; Carvalho, Paulo Roberto Antonacci

    2012-04-01

    Studies carried out in different countries have shown that source of patient admission in Intensive Care Units (ICUs) is associated to death. Patients admitted from wards show a greater ICU mortality. The aim of the present study was to investigate the association between admission source and outcome in a Pediatric Intensive Care Unit (PICU). We studied all PICU admissions that took place between January 2002 and December 2005 in a tertiary hospital in Brazil. The major outcome studied was death while in the PICU. The independent variable analyzed was admission source, defined either as pediatric emergency room (PER), wards, operating room (OR) of the same hospital or other sources. A total of 1823 admissions were studied. The overall expected mortality based on the Pediatric Index of Mortality 2 was 6.5% and the observed mortality was 10.3%. In adjusted analysis, the mortality was doubled in patients admitted from wards when compared with the PER patients. Observed mortality rates were higher in patients admitted from wards within the same hospital, even after adjustment.

  19. Preferred Admission: The Case Before the United States Supreme Court.

    ERIC Educational Resources Information Center

    Bickel, Robert D.

    In March 1973, in the case of DeFunis vs. Odegaard, the Supreme Court of the State of Washington held constitutional procedures established by the University of Washington Law School to grant preferred admission to disadvantaged racial and ethnic minority applicants. The United States Supreme Court agreed to review the decision. This paper…

  20. Prospective, randomised, controlled study evaluating early modification of oral microbiota following admission to the intensive care unit and oral hygiene with chlorhexidine.

    PubMed

    Tuon, Felipe Francisco; Gavrilko, Oleg; Almeida, Saulo de; Sumi, Eigi Ricardo; Alberto, Thiago; Rocha, Jaime Luis; Rosa, Edvaldo Antonio

    2017-03-01

    Chlorhexidine (CHX) is the most commonly used oral hygiene product for the prevention of ventilator-associated pneumonia (VAP) in patients undergoing mechanical ventilation (MV). The change in dental plaque (DP) microbiota following CHX use in patients under MV has not been described previously. The aim of this study was to evaluate the incidence of pathogenic bacteria associated with VAP and the coverage of DP within the oral cavity in patients administered CHX. This was a prospective, randomised, controlled, double-blind study in patients (n=16) under MV who were mouth-rinsed with either CHX or placebo. Microbiology samples were collected from the oral mucosa (OM) and DP after admission to the ICU and on Days 3, 5, 7 and 10. Minimum inhibitory concentrations (MICs) and minimum bactericidal concentrations (MBCs) of CHX were determined. Upon admission, the occurrence of multidrug-resistant (MDR) bacteria, including carbapenem-resistant Klebsiella pneumoniae, was reported. The CHX group had a lower incidence of methicillin-resistant Staphylococcus aureus (MRSA) compared with the placebo group for the OM (RR=0.51, 95% CI 0.27-0.98; P=0.011). There was high agreement between the culture results of OM and DP (κ=0.825). VAP developed in six patients. The species identified following tracheal aspiration of VAP patients were similar to those found in the OM for four cases. The strains showed low MICs and MBCs for CHX (<0.039mg/mL). Although DP is rapidly colonised by MDR bacteria, use of 2% CHX reduced the incidence of S. aureus colonisation. Copyright © 2017 International Society for Chemotherapy of Infection and Cancer. Published by Elsevier Ltd. All rights reserved.

  1. Racial disparities in pediatric intensive care unit admissions.

    PubMed

    Turner, Dawn; Simpson, Pippa; Li, Shun-Hwa; Scanlon, Matthew; Quasney, Michael W

    2011-09-01

    Racial disparities in therapies and outcomes in adult and neonatal ICUs are well documented; however, little is known regarding racial disparities in pediatric intensive care unit (PICU). Our objective was to determine whether racial disparities exist in the admission of critically ill children to the PICU. We retrospectively analyzed admissions to a PICU in a tertiary care pediatric hospital. Summarized demographic data was analyzed from the county health department. Of the 4676 admissions to the PICU between January 1, 1997 and December 31, 1999, 1030 children were <48 months of age, lived in Shelby County, TN, and were either African American (789, 76.6%) or non-Hispanic white (241, 23.4%). The surrounding county was comprised of approximately 58% African American and 41% non-Hispanic white children ≤ 48 months of age. A history of premature birth was more common in African American children than non-Hispanic white children (46.8% vs. 32.8%; P < 0.0001). Mortality was 5.7% overall and was not significantly different between African Americans and non-Hispanic whites but was higher for those children with a history of premature birth (4.6% vs. 7.1%, P < 0.026). The overall relative risk of admission to the PICU for African American children was 2.12 (95% CI, 1.66-2.74), for African American children with a history of premature birth was 1.44 (95% CI, 0.96-2.21), and for full-term African American children was 1.82 (95% CI, 1.33 -2.49). Racial differences in admission to the PICU exist with African American children having a greater risk for PICU admission than non-Hispanic white children.

  2. Evaluating Admission Criteria Effects for Under-Represented Groups

    ERIC Educational Resources Information Center

    Childs, Ruth A.; Ferguson, Amanda K.; Herbert, Monique B.; Broad, Kathryn; Zhang, Jingshun

    2016-01-01

    The effects that admission criteria may have for under-represented groups are an important concern for programs seeking to improve access to post-secondary education. Using data from a large preservice teacher education program in the Canadian province of Ontario, we demonstrate two approaches to evaluating the effects of admission criteria. The…

  3. Evaluating the Predictive Validity of Graduate Management Admission Test Scores

    ERIC Educational Resources Information Center

    Sireci, Stephen G.; Talento-Miller, Eileen

    2006-01-01

    Admissions data and first-year grade point average (GPA) data from 11 graduate management schools were analyzed to evaluate the predictive validity of Graduate Management Admission Test[R] (GMAT[R]) scores and the extent to which predictive validity held across sex and race/ethnicity. The results indicated GMAT verbal and quantitative scores had…

  4. Evaluating the Predictive Validity of Graduate Management Admission Test Scores

    ERIC Educational Resources Information Center

    Sireci, Stephen G.; Talento-Miller, Eileen

    2006-01-01

    Admissions data and first-year grade point average (GPA) data from 11 graduate management schools were analyzed to evaluate the predictive validity of Graduate Management Admission Test[R] (GMAT[R]) scores and the extent to which predictive validity held across sex and race/ethnicity. The results indicated GMAT verbal and quantitative scores had…

  5. Evaluating Admission Criteria Effects for Under-Represented Groups

    ERIC Educational Resources Information Center

    Childs, Ruth A.; Ferguson, Amanda K.; Herbert, Monique B.; Broad, Kathryn; Zhang, Jingshun

    2016-01-01

    The effects that admission criteria may have for under-represented groups are an important concern for programs seeking to improve access to post-secondary education. Using data from a large preservice teacher education program in the Canadian province of Ontario, we demonstrate two approaches to evaluating the effects of admission criteria. The…

  6. Virginia Western Community College's Health Technology Admissions Evaluation System.

    ERIC Educational Resources Information Center

    Houston, Charles A.; Sellers, Harry

    Due to factors such as high enrollment demands, limited institutional space, and high program costs, certain admissions requirements in the guidance/selection of students for health technology programs at Virginia Western Community College (VWCC) have become necessary. A Health Technology Admissions Evaluation System was created to develop and…

  7. Potentially Avoidable Surgical Intensive Care Unit Admissions and Disposition Delays.

    PubMed

    Dhillon, Navpreet K; Ko, Ara; Smith, Eric J T; Kharabi, Mayumi; Castongia, Joseph; Nurok, Michael; Gewertz, Bruce L; Ley, Eric J

    2017-07-19

    High health care costs encourage initiatives that avoid overuse of resources and identify opportunities to promote appropriate care. To investigate the causes of potentially avoidable surgical intensive care unit (SICU) admissions and disposition delays to determine whether targeted interventions could decrease these stays. This prospective, observational study focused on potentially avoidable SICU days, as determined by observers with input from the rounding intensivists at a 24-bed open SICU at an urban, academic hospital. The preintervention phase occurred from April 6 through June 21, 2015; after implementation of targeted interventions, the postintervention phase occurred from April 4 through June 28, 2016. Data collected included demographic characteristics, reason for admission, and length of stay. All patients admitted to the SICU during the preintervention and postintervention phases were included in the analysis. Based on results collected in the preintervention phase, targeted interventions were designed and implemented from July 1, 2015, through March 31, 2016, including (1) reducing SICU care for minor traumatic brain injury, (2) optimizing postoperative airway management, (3) enhancing communication between services regarding transfers to the SICU, (4) identifying and facilitating more timely end-of-life conversations and supportive care consultations, and (5) encouraging early disposition of patients to floor beds. Changes in the proportion of potentially avoidable SICU days owing to potentially avoidable admissions and/or disposition delays. A total of 459 patients (253 men [55.1%] and 206 women [44.9%]; median age, 62 years [interquartile range, 46-75 years]) were admitted during the preintervention and postintervention phases. Of 261 patients admitted during the preintervention period and 245 during the postintervention period, median SICU and hospital length of stay remained unchanged. A reduction was noted in the percentage of postintervention

  8. Refusal of intensive care unit admission due to a full unit: impact on mortality.

    PubMed

    Robert, René; Reignier, Jean; Tournoux-Facon, Caroline; Boulain, Thierry; Lesieur, Olivier; Gissot, Valérie; Souday, Vincent; Hamrouni, Mouldi; Chapon, Cécile; Gouello, Jean-Paul

    2012-05-15

    Intensive care unit (ICU) beds are a scarce resource, and patients denied intensive care only because the unit is full may be at increased risk of death. To compare mortality after first ICU referral in admitted patients and in patients denied admission because the unit was full. Prospective observational multicenter cohort study of consecutive patients referred for ICU admission during two 45-day periods, conducted in 10 ICUs. Of 1,762 patients, 430 were excluded from the study, 116 with previously denied admission to another ICU and 270 because they were deemed too sick or too well to benefit from ICU admission. Of the remaining 1,332 patients, 1,139 were admitted, and 193 were denied admission because the unit was full (65 were never admitted, 39 were admitted after bumping of another patient, and 89 were admitted on subsequent referral). Crude Day 28 and Day 60 mortality rates in the nonadmitted and admitted groups were 30.1 versus 24.3% (P = 0.07) and 33.3 versus 27.2% (P = 0.06), respectively. Day 28 mortality adjusted on age, previous disease, Glasgow scale score less than or equal to 8, shock, creatinine level greater than or equal to 250 μmol/L, and prothrombin time greater than or equal to 30 seconds was nonsignificantly higher in patients refused ICU admission only because of a full unit compared with patients admitted immediately. Patients admitted after subsequent referral had higher mortality rates on Day 28 (P = 0.05) and Day 60 (P = 0.04) compared with directly admitted patients. Delayed ICU admission due to a full unit at first referral is associated with increased mortality.

  9. Glycated hemoglobin at admission in the intensive care unit: clinical implications and prognostic relevance.

    PubMed

    Kompoti, Maria; Michalia, Martha; Salma, Vaia; Diogou, Evangelia; Lakoumenta, Anthi; Clouva-Molyvdas, Phyllis-Maria

    2015-02-01

    This study investigated the clinical significance of HbA1c levels on admission in the intensive care unit (ICU) as a prognostic marker for morbidity and mortality in critically ill patients. This prospective observational study included consecutive patients admitted in an 8-bed multidisciplinary ICU. Patients were prospectively followed from ICU admission until ICU outcome (death/discharge). All patients had an HbA1c measurement upon admission in the ICU. Five hundred fifty-five consecutive patients (376 males, 179 females) were included in the study. In patients without prior diabetes mellitus (DM) diagnosis, a cutoff of 6.5% for HbA1c (diagnostic cutoff for DM) predicted more severe disease (as described by Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment scores at admission) and higher ICU mortality (adjusted odds ratio, 2.33; 95% confidence interval, 1.04-5.25). In the subgroup of patients with a history of DM, a cutoff of 7% for HbA1c (glycemic target) had no predicting ability for ICU mortality. HbA1c is a useful tool for the diagnosis of a previously undiagnosed DM. This study showed that in critically ill patients with previously undiagnosed DM, HbA1c at admission is significantly associated with ICU mortality. Copyright © 2014 Elsevier Inc. All rights reserved.

  10. Consciousness levels one week after admission to a palliative care unit improve survival prediction in advanced cancer patients.

    PubMed

    Tsai, Jaw-Shiun; Chen, Chao-Hsien; Wu, Chih-Hsun; Chiu, Tai-Yuan; Morita, Tatsuya; Chang, Chin-Hao; Hung, Shou-Hung; Lee, Ya-Ping; Chen, Ching-Yu

    2015-02-01

    Consciousness is an important factor of survival prediction in advanced cancer patients. However, effects on survival of changes over time in consciousness in advanced cancer patients have not been fully explored. This study evaluated changes in consciousness after admission to a palliative care unit and their correlation with prognosis in terminal cancer patients. This is a prospective observational study. From a palliative care unit in Taiwan, 531 cancer patients (51.8% male) were recruited. Consciousness status was assessed at admission and one week afterwards and recorded as normal or impaired. The mean age was 65.28±13.59 years, and the average survival time was 23.41±37.69 days. Patients with normal consciousness at admission (n=317) had better survival than those with impaired consciousness at admission (n=214): (17.0 days versus 6.0 days, p<0.001). In the analysis on survival within one week after admission, those with normal consciousness at admission had a higher percentage of survival than the impaired (78.9% versus 44.3%, p<0.001). Patients were further classified into four groups according to consciousness levels: (1) normal at admission and one week afterwards, (2) impaired at admission but normal one week afterwards, (3) normal at admission but impaired one week afterwards, and (4) impaired both at admission and one week afterwards. The former two groups had significantly better survival than the latter two groups: (median survival counted from day 7 after admission), 25.5, 27.0, 7.0, and 7.0 days, respectively. Consciousness levels one week after admission should be integrated into survival prediction in advanced cancer patients.

  11. Outcomes of Older Adults With Sepsis at Admission to an Intensive Care Unit.

    PubMed

    Rowe, Theresa; Araujo, Katy L B; Van Ness, Peter H; Pisani, Margaret A; Juthani-Mehta, Manisha

    2016-01-01

    Background.  Sepsis is a major cause of morbidity and mortality among older adults. The main goals of this study were to assess the association of sepsis at intensive care unit (ICU) admission with mortality and to identify predictors associated with increased mortality in older adults. Methods.  We conducted a prospective cohort study of 309 participants ≥60 years admitted to an ICU. Sepsis was defined as 2 of 4 systemic inflammatory response syndrome criteria plus a documented infection within 2 calendar days before or after admission. The main outcome measure was time to death within 1 year of ICU admission. Sepsis was evaluated as a predictor for mortality in a Cox proportional hazards model. Results.  Of 309 participants, 196 (63%) met the definition of sepsis. Among those admitted with and without sepsis, 75 (38%) vs 20 (18%) died within 1 month of ICU admission (P < .001) and 117 (60%) vs 48 (42%) died within 1 year (P < .001). When adjusting for baseline characteristics, sepsis had a significant impact on mortality (hazard ratio [HR] = 1.80; 95% confidence interval [CI], 1.28-2.52; P < .001); however, after adjusting for baseline characteristics and process covariates (antimicrobials and vasopressor use within 48 hours of admission), the impact of sepsis on mortality became nonsignificant (HR = 1.26; 95% CI, .87-1.84; P = .22). Conclusions.  The diagnosis of sepsis in older adults upon ICU admission was associated with an increase in mortality compared with those admitted without sepsis. After controlling for early use of antimicrobials and vasopressors for treatment, the association of sepsis with mortality was reduced.

  12. Outcomes of Older Adults With Sepsis at Admission to an Intensive Care Unit

    PubMed Central

    Rowe, Theresa; Araujo, Katy L. B.; Van Ness, Peter H.; Pisani, Margaret A.; Juthani-Mehta, Manisha

    2016-01-01

    Background. Sepsis is a major cause of morbidity and mortality among older adults. The main goals of this study were to assess the association of sepsis at intensive care unit (ICU) admission with mortality and to identify predictors associated with increased mortality in older adults. Methods. We conducted a prospective cohort study of 309 participants ≥60 years admitted to an ICU. Sepsis was defined as 2 of 4 systemic inflammatory response syndrome criteria plus a documented infection within 2 calendar days before or after admission. The main outcome measure was time to death within 1 year of ICU admission. Sepsis was evaluated as a predictor for mortality in a Cox proportional hazards model. Results. Of 309 participants, 196 (63%) met the definition of sepsis. Among those admitted with and without sepsis, 75 (38%) vs 20 (18%) died within 1 month of ICU admission (P < .001) and 117 (60%) vs 48 (42%) died within 1 year (P < .001). When adjusting for baseline characteristics, sepsis had a significant impact on mortality (hazard ratio [HR] = 1.80; 95% confidence interval [CI], 1.28–2.52; P < .001); however, after adjusting for baseline characteristics and process covariates (antimicrobials and vasopressor use within 48 hours of admission), the impact of sepsis on mortality became nonsignificant (HR = 1.26; 95% CI, .87–1.84; P = .22). Conclusions. The diagnosis of sepsis in older adults upon ICU admission was associated with an increase in mortality compared with those admitted without sepsis. After controlling for early use of antimicrobials and vasopressors for treatment, the association of sepsis with mortality was reduced. PMID:26925430

  13. Validating the Performance of the Modified Early Obstetric Warning System Multivariable Model to Predict Maternal Intensive Care Unit Admission.

    PubMed

    Ryan, Helen M; Jones, Meghan A; Payne, Beth A; Sharma, Sumedha; Hutfield, Anna M; Lee, Tang; Ukah, U Vivian; Walley, Keith R; Magee, Laura A; von Dadelszen, Peter

    2017-09-01

    To evaluate the performance of the Modified Early Obstetric Warning System (MEOWS) to predict maternal ICU admission in an obstetric population. Case-control study. Two maternity units in Vancouver, Canada, one with ICU facilities, between January 1, 2000, and December 31, 2011. Pregnant or recently delivered (≤6 weeks) women admitted to the hospital for >24 hours. Three control patients were randomly selected per case and matched for year of admission. Retrospective, observational, case-control validation study investigating the physiologic predictors of admission in the 24-hour period preceding either ICU admission >24 hours (cases) or following admission (control patients). Model performance was assessed based on sensitivity, specificity, and predictive values. Forty-six women were admitted to the ICU for >24 hours (0.51/1000 deliveries); the study included 138 randomly selected control patients. There were no maternal deaths in the cohort. MEOWS had high sensitivity (0.96) but low specificity (0.54) for ICU admission >24 hours, whereas ≥1 one red trigger maintained sensitivity (0.96) and improved specificity (0.73). Altering MEOWS trigger parameters may improve the accuracy of MEOWS in predicting ICU admission. Formal modelling of a MEOWS scoring system is required to support evidence-based care. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

  14. Altering Public University Admission Standards to Preserve White Group Position in the United States: Results from a Laboratory Experiment

    ERIC Educational Resources Information Center

    Samson, Frank L.

    2013-01-01

    This study identifies a theoretical mechanism that could potentially affect public university admissions standards in a context of demographic change. I explore how demographic changes at a prestigious public university in the United States affect individuals' evaluations of college applications. Responding to a line graph that randomly displays a…

  15. Altering Public University Admission Standards to Preserve White Group Position in the United States: Results from a Laboratory Experiment

    ERIC Educational Resources Information Center

    Samson, Frank L.

    2013-01-01

    This study identifies a theoretical mechanism that could potentially affect public university admissions standards in a context of demographic change. I explore how demographic changes at a prestigious public university in the United States affect individuals' evaluations of college applications. Responding to a line graph that randomly displays a…

  16. Retrospective study on prognostic importance of serum procalcitonin and amino-terminal pro-brain natriuretic peptide levels as compared to Acute Physiology and Chronic Health Evaluation IV Score on Intensive Care Unit admission, in a mixed Intensive Care Unit population

    PubMed Central

    Mehta, Chitra; Dara, Babita; Mehta, Yatin; Tariq, Ali M.; Joby, George V.; Singh, Manish K.

    2016-01-01

    Background: Timely decision making in Intensive Care Unit (ICU) is very essential to improve the outcome of critically sick patients. Conventional scores like Acute Physiology and Chronic Health Evaluation (APACHE IV) are quite cumbersome with calculations and take minimum 24 hours. Procalcitonin has shown to have prognostic value in ICU/Emergency department (ED) in disease states like pneumonia, sepsis etc. NTproBNP has demonstrated excellent diagnostic and prognostic importance in cardiac diseases. It has also been found elevated in non-cardiac diseases. We chose to study the prognostic utility of these markers on ICU admission. Settings and Design: Retrospective observational study. Materials and Methods: A Retrospective analysis of 100 eligible patients was done who had undergone PCT and NTproBNP measurements on ICU admission. Their correlations with all cause mortality, length of hospital stay, need for ventilator support, need for vasopressors were performed. Results: Among 100 randomly selected ICU patients, 28 were non-survivors. NTproBNP values on admission significantly correlated with all cause mortality (P = 0.036, AUC = 0.643) and morbidity (P = 0.000, AUC = 0.763), comparable to that of APACHE-IV score. PCT values on admission did not show significant association with mortality, but correlated well with morbidity and prolonged hospital length of stay (AUC = 0.616, P = 0.045). Conclusion: The current study demonstrated a good predictive value of NTproBNP, in terms of mortality and morbidity comparable to that of APACHE-IV score. Procalcitonin, however, was found to have doubtful prognostic importance. These findings need to be confirmed in a prospective larger study. PMID:27052066

  17. Health care utilization before and after intensive care unit admission in multiple sclerosis.

    PubMed

    Marrie, Ruth Ann; Bernstein, Charles N; Peschken, Christine A; Hitchon, Carol A; Chen, Hui; Fransoo, Randall; Garland, Allan

    2015-07-01

    The incidence of intensive care unit (ICU) admission is elevated in the multiple sclerosis (MS) population but the reasons for this are incompletely understood, as are outcomes post-ICU admission. Among MS patients we examined the association between ICU admission and health care utilization in the year preceding admission, and compared health care utilization following ICU admission among persons with MS and persons from the general population. We used population-based administrative data from Manitoba, Canada to identify 4237 MS cases of which 2547 were incident. We compared the incidence rates of ICU admission in the prevalent MS population according to health care utilization in the year before admission, adjusting for age, sex, comorbidity and socioeconomic status. Among incident cases of MS we compared rates of health care utilization after ICU admission to those in a matched general population cohort. We used generalized linear models adjusting for age, sex, socioeconomic status, region, comorbidity and utilization before admission. Of 4219 prevalent MS cases, 222 (5.3%) were admitted to the ICU. After adjustment, any hospitalization in the prior year conferred an 80% increased incidence, and physician visits in the highest tertile and prescription costs in the highest quartile in the prior year each conferred a more than two-fold increased incidence of admission. Among 2547 incident cases of MS, 109 (4.3%) were admitted to the ICU and 93 survived their admission. Thirty-eight percent of the MS population were re-hospitalized in the year following admission, similar to the matched population (33.8%). Seven percent of both populations were readmitted to the ICU. The MS population had more hospital days after ICU admission than the matched population (adjusted RR 3.11; 95% CI: 1.34-5.90). After adjustment the number of physician visits did not differ between populations. The incidence of ICU admission is higher among persons with MS who have higher prior

  18. Impact of delayed admission to intensive care units on mortality of critically ill patients: a cohort study

    PubMed Central

    2011-01-01

    Introduction When the number of patients who require intensive care is greater than the number of beds available, intensive care unit (ICU) entry flow is obstructed. This phenomenon has been associated with higher mortality rates in patients that are not admitted despite their need, and in patients that are admitted but are waiting for a bed. The purpose of this study is to evaluate if a delay in ICU admission affects mortality for critically ill patients. Methods A prospective cohort of adult patients admitted to the ICU of our institution between January and December 2005 were analyzed. Patients for whom a bed was available were immediately admitted; when no bed was available, patients waited for ICU admission. ICU admission was classified as either delayed or immediate. Confounding variables examined were: age, sex, originating hospital ward, ICU diagnosis, co-morbidity, Acute Physiology and Chronic Health Evaluation (APACHE) II score, therapeutic intervention, and Sequential Organ Failure Assessment (SOFA) score. All patients were followed until hospital discharge. Results A total of 401 patients were evaluated; 125 (31.2%) patients were immediately admitted and 276 (68.8%) patients had delayed admission. There was a significant increase in ICU mortality rates with a delay in ICU admission (P = 0.002). The fraction of mortality risk attributable to ICU delay was 30% (95% confidence interval (CI): 11.2% to 44.8%). Each hour of waiting was independently associated with a 1.5% increased risk of ICU death (hazard ratio (HR): 1.015; 95% CI 1.006 to 1.023; P = 0.001). Conclusions There is a significant association between time to admission and survival rates. Early admission to the ICU is more likely to produce positive outcomes. PMID:21244671

  19. Effect of advanced age and vital signs on admission from an emergency department observation unit

    PubMed Central

    Caterino, Jeffrey M.; Hoover, Emily; Moseley, Mark G.

    2012-01-01

    Objectives The primary objective was to determine the relationship between advanced age and need for admission from an emergency department (ED) observation unit. The secondary objective was to determine the relationship between initial ED vital signs and admission. Methods We conducted a prospective, observational cohort study of ED patients placed in an ED-based observation unit. Multivariable penalized maximum likelihood logistic regression was used to identify independent predictors of need for hospital admission. Age was examined continuously and at a cutoff of ≥65 years. Vital signs were examined continuously and at commonly accepted cutoffs. We additionally controlled for demographics, co-morbid conditions, laboratory values, and observation protocol. Results Three hundred patients were enrolled, 12% (n=35) ≥65 years old and 11% (n=33) requiring admission. Admission rates were 2.9% (95% confidence interval [CI], 0.07-14.9%) in older adults and 12.1% (95% CI, 8.4-16.6%) in younger adults. In multivariable analysis, age was not associated with admission (odds ratio [OR] 0.30, 95% CI 0.05-1.67). Predictors of admission included: systolic pressure ≥180 mmHg (OR 4.19, 95% CI 1.08-16.30), log Charlson co-morbidity score (OR 2.93, 95% CI 1.57-5.46), and white blood cell count ≥14,000/mm3 (OR11.35, 95% CI 3.42-37.72). Conclusions Among patients placed in an ED observation unit, age ≥65 years is not associated with need for admission. Older adults can successfully be discharged from these units. Systolic pressure≥180 mmHg was the only predictive vital sign. In determining appropriateness of patients selected for an ED observation unit, advanced age should not be an automatic disqualifying criterion. PMID:22386358

  20. Unplanned intensive care unit admission after general anaesthesia in children: A single centre retrospective analysis.

    PubMed

    Mitchell, John; Clément de Clety, Stephan; Collard, Edith; De Kock, Marc; Detaille, Thierry; Houtekie, Laurent; Jadin, Laurence; Bairy, Laurent; Veyckemans, Francis

    2016-06-01

    To determine the main causes for unplanned admission of children to the paediatric intensive care unit (PICU) following anaesthesia in our centre. To compare the results with previous publications and propose a data sheet for the prospective collection of such information. Inclusion criteria were any patient under 16 years who had an unplanned post-anaesthetic admission to the PICU from 1999 to 2010 in our university hospital. Age, ASA score, type of procedure, origin and causes of the incident(s) that prompted admission and time of the admission decision were recorded. Out of a total of 44,559 paediatric interventions performed under anaesthesia during the study period, 85 were followed with an unplanned admission to the PICU: 67% of patients were younger than 5 years old. Their ASA status distribution from I to IV was 13, 47, 39 and 1%, respectively. The cause of admission was anaesthetic, surgical or mixed in 50, 37 and 13% of cases, respectively. The main causes of anaesthesia-related admission were respiratory or airway management problems (44%) and cardiac catheterisation complications (29%). In 62%, the admission decision was taken in the operating room. Unplanned admission to the PICU after general anaesthesia is a rare event. In our series, most cases were less than 5 years old and were associated with at least one comorbidity. The main cause of admission was respiratory distress and the main type of procedure associated with admission was cardiac catheterisation. Copyright © 2016 Société française d'anesthésie et de réanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.

  1. Prognosis of patients presenting extreme acidosis (pH <7) on admission to intensive care unit.

    PubMed

    Allyn, Jérôme; Vandroux, David; Jabot, Julien; Brulliard, Caroline; Galliot, Richard; Tabatchnik, Xavier; Combe, Patrice; Martinet, Olivier; Allou, Nicolas

    2016-02-01

    The purpose was to determine prognosis of patients presenting extreme acidosis (pH <7) on admission to the intensive care unit (ICU) and to identify mortality risk factors. We retrospectively analyzed all patients who presented with extreme acidosis within 24 hours of admission to a polyvalent ICU in a university hospital between January 2011 and July 2013. Multivariate analysis and survival analysis were used. Among the 2156 patients admitted, 77 patients (3.6%) presented extreme acidosis. Thirty (39%) patients suffered cardiac arrest before admission. Although the mortality rate predicted by severity score was 93.6%, death occurred in 52 cases (67.5%) in a median delay of 13 (5-27) hours. Mortality rate depended on reason for admission, varying between 22% for cases linked to diabetes mellitus and 100% for cases of mesenteric infarction (P = .002), cardiac arrest before admission (P < .001), type of lactic acidosis (P = .007), high Simplified Acute Physiology Score II (P = .008), and low serum creatinine (P = .012). Patients with extreme acidosis on admission to ICU have a less severe than expected prognosis. Whereas mortality is almost 100% in cases of cardiac arrest before admission, mortality is much lower in the absence of cardiac arrest before admission, which justifies aggressive ICU therapies. Copyright © 2015 Elsevier Inc. All rights reserved.

  2. Factors affecting admission to anesthesiology residency in the United States: choosing the future of our specialty.

    PubMed

    de Oliveira, Gildàsio S; Akikwala, Tulsi; Kendall, Mark C; Fitzgerald, Paul C; Sullivan, John T; Zell, Christopher; McCarthy, Robert J

    2012-08-01

    Admission to an anesthesiology residency in the United States is competitive, and the odds associated with a successful match based on the applicants' characteristics have not been determined. The objective of this study was to examine factors associated with admission to anesthesiology residency in the United States. The study was a retrospective cohort evaluation of the 2010 to 2011 residency applicants. Applicants' characteristics and objective factors used to select trainees were extracted. The primary outcome was a successful match to an anesthesiology residency. Data were analyzed using conditional inference tree analysis and propensity score matching. Data available from 1,976 applications were examined corresponding to 58% of the national sample. The odds (99% CI) for successful match were 3.6 (3.1-4.2) for U.S. medical school graduates, 2.6 (2.3 to 3.0) for applicants with United States Medical Licensing Examination Step 2 scores more than 210, and 1.2 (1.1 to 1.3) for female applicants. The odds (99% CI) for a successful match for international and U.S. graduate applicants younger than 29 yr was 3.3 (2.0-5.4) and (1.9 to 4.2), respectively, even after propensity matching for medical school, exam scores, and gender. The average applicant had no peer-reviewed scholarly productivity. Although anesthesiology residency acceptance was primarily associated with U.S. medical school attendance and United States Medical Licensing Examination Step 2 scores, our study suggest an influence of age and gender bias in the selection process. Peer-reviewed scholarly production among applicants and prior graduate education did not appear to influence candidate selection.

  3. [Meningococcal disease admissions in a paediatric intensive care unit].

    PubMed

    Mação, Patrícia; Januário, Gustavo; Ferreira, Sofia; Dias, Andrea; Dionísio, Teresa; Pinto, Carla; Carvalho, Leonor

    2014-01-01

    Introdução: A infecção meningocócica tem uma elevada mortalidade e morbilidade em crianças. O tratamento agressivo do choque, a referenciação precoce, o transporte secundário especializado e a vacinação são factores com impacto potencial na redução da mortalidade. Foram objectivos caracterizar as crianças com doença invasiva meningocócica admitidas em cuidados intensivos, avaliar parâmetros de gravidade e mortalidade. Material e Métodos: Estudo observacional, cujo método de colheita de dados foi retrospectivo. Foram constituídos dois períodos, de seis anos cada, de acordo com o ano de admissão (A: 2000-2005 e B: 2006-2011) e nestes compararam-se índices de gravidade, disfunção orgânica e mortalidade. Resultados: Foram admitidas 70 crianças com doença invasiva meningocócica. Quando comparadas com as outras causas verificouse uma redução nas admissões por doença invasiva meningocócica (período A: 3,4%; período B: 1,5%; p = 0,001). A ocorrência de meningite foi de 41% no período A e de 29% no período B (p = 0,461). Tiveram púrpura rapidamente progressiva 78% no período A e 50% no período B (p = 0,0032). As crianças do período A tiveram disfunção multi-órgão (80%), coagulação intravascular disseminada (76%) e coma (22%) mais frequentemente que as crianças do período B (29%, 29%, 0%; p < 0,05). A mortalidade foi 26% no período A e 0% no período B (p = 0,006) e a mortalidade estandardizada pelo PRISM foi 1,3 e 0 no período A e B respectivamente. Discussão: A redução do número de admissões por doença menigocócica invasiva pode ser explicada pela introdução da vacina anti-meningocócica C em 2006. Pensa-se que a redução da mortalidade observada, possa ser atribuível à melhoria da estabilização inicial e ao transporte secundário. Conclusão: Nos últimos anos houve uma redução significativa no número de admissões e na mortalidade por doença invasiva meningocócica.

  4. Association of Intensive Care Unit Admission With Mortality Among Older Patients With Pneumonia

    PubMed Central

    Valley, Thomas S.; Sjoding, Michael W.; Ryan, Andrew M.; Iwashyna, Theodore J.; Cooke, Colin R.

    2016-01-01

    IMPORTANCE Among patients whose need for intensive care is uncertain, the relationship of intensive care unit (ICU) admission with mortality and costs is unknown. OBJECTIVE To estimate the relationship between ICU admission and outcomes for elderly patients with pneumonia. DESIGN, SETTING, AND PATIENTS Retrospective cohort study of Medicare beneficiaries (aged >64 years) admitted to 2988 acute care hospitals in the United States with pneumonia from 2010 to 2012. EXPOSURES ICU admission vs general ward admission. MAIN OUTCOMES AND MEASURES Primary outcome was 30-day all-cause mortality. Secondary outcomes included Medicare spending and hospital costs. Patient and hospital characteristics were adjusted to account for differences between patients with and without ICU admission. To account for unmeasured confounding, an instrumental variable was used—the differential distance to a hospital with high ICU admission (defined as any hospital in the upper 2 quintiles of ICU use). RESULTS Among 1 112 394 Medicare beneficiaries with pneumonia, 328 404 (30%) were admitted to the ICU. In unadjusted analyses, patients admitted to the ICU had significantly higher 30-day mortality, Medicare spending, and hospital costs than patients admitted to a general hospital ward. Patients (n = 553 597) living closer than the median differential distance (<3.3 miles) to a hospital with high ICU admission were significantly more likely to be admitted to the ICU than patients living farther away (n = 558 797) (36%for patients living closer vs 23%for patients living farther, P < .001). In adjusted analyses, for the 13%of patients whose ICU admission decision appeared to be discretionary (dependent only on distance), ICU admission was associated with a significantly lower adjusted 30-day mortality (14.8%for ICU admission vs 20.5%for general ward admission, P = .02; absolute decrease, −5.7%[95%CI, −10.6%, −0.9%]), yet there were no significant differences in Medicare spending or hospital

  5. [Severe thrombocytopenia on admission to the intensive care unit in patients with multiple organ failure].

    PubMed

    Marco-Schulke, C M; Sánchez-Casado, M; Hortigüela-Martín, V A; Quintana-Díaz, M; Rodríguez-Villar, S; Pérez-Pedrero, M J; Velasco-Ramos, A; Canabal-Berlanga, A; Arrese-Cosculluela, M Á

    2012-04-01

    To evaluate the frequency of severe thrombocytopenia (STCP) (≤ 50,000/μl) in the first 24 hours in patients with multiple organ dysfunction syndrome, and the factors that influence its occurrence. A retrospective, observational study. AREA: Medical-surgical intensive care unit (ICU). Tertiary hospital. Those with failure of at least two organs, according to SOFA criteria, with the exclusion of neurological and traumatologic critical cases. Medical history, regular medication, baseline functional status, demographic variables, severity scores in ICU, multiple-organ failure data, course in ICU and main hospital data. A total of 587 patients were included; 6.3% (37 patients) presented with STCP during the first day of admission; 64.6% were men; SOFA 8 (5-10); APACHE II 18 (13-24); APACHE IV 59 (46-73); 32.5% were surgical patients. A total of 79.9% subsequently needed mechanical ventilation, and 71.4% required vasoactive drugs. Overall stay in ICU: 4 (2-10) days, main hospital stay 18 (9-35) days. A total of 29.2% died in the ICU; 11.7% developed STCP during admission to the ICU. Multivariate analysis found the main determining factors in the occurrence of thrombocytopenia on admission to be: history of hospitalization in the last year, albumin and bilirubin levels, and sepsis. The prevalence of STCP among critical patients was 6.3%. Its occurrence was associated with albumin and bilirubin levels, sepsis, and with patient admittance in the last year. Copyright © 2011 Elsevier España, S.L. and SEMICYUC. All rights reserved.

  6. Supervising anesthesiologists cannot be effectively compared according to their patients' postanesthesia care unit admission pain scores.

    PubMed

    Wanderer, Jonathan P; Shi, Yaping; Schildcrout, Jonathan S; Ehrenfeld, Jesse M; Epstein, Richard H

    2015-04-01

    Measurement of postoperative pain scores on arrival to the postanesthesia care unit (PACU) is a potential quality metric for supervising anesthesiologists. Our goal in this study was to determine whether rank-ordering by initial PACU numeric rating scale (NRS) pain score, as collected by nurses in a nonresearch clinical setting, could be used to compare anesthesiologists after adjusting for confounding factors. For a large population of adult patients, the admission PACU NRS pain scores (0-10) were evaluated using proportional odds mixed effects models. Fixed effects included age, gender, race, opioids in the preoperative medication list, American Society of Anesthesiologists (ASA) physical status classification, emergency surgery, laparoscopic approach, outpatient status, anesthesiologist, and PACU nurse; surgeon and surgical procedure were included as random effects. A total of 26,680 initial PACU pain scores were analyzed. The PACU nurse had the largest observed association with initial PACU pain score. Compared with the nurse with the median covariate adjusted NRS score, the odds ratio (OR) for an increased reported pain score ranged from 0.16 (95% confidence interval [CI] 0.11 to 0.24) to 2.95 (95% CI 2.43 to 3.59). For anesthesiologists, the ORs for an increase in reported pain ranged from 0.60 (95% CI 0.37 to 0.99) to 1.44 (95% CI 0.98 to 2.11). Factors associated with increased pain scores were preoperative opioids, female gender, and ASA physical status 2 and 3. Lower pain scores were associated with outpatient surgery, laparoscopy, African American race, and older patients. There is little to no evidence to suggest that supervising anesthesiologists can be compared with one another effectively using admission PACU NRS pain scores. The confounding association of the PACU nurse eliciting the admission pain score greatly exceeded the contribution by the anesthesiologist.

  7. Factors associated with mortality after an asthma admission: a national United Kingdom database analysis.

    PubMed

    Watson, Louise; Turk, Florian; James, Philip; Holgate, Stephen T

    2007-08-01

    Lack of a United Kingdom (UK) fatal asthma registry has resulted in few recent analyses regarding patient characteristics, co-morbidities, and admission type in relation to mortality post an asthma admission. This study aims to report these factors in addition to season of event for the years 2000-2005 to provide data regarding asthma burden in the in-patient hospital setting. Data were analysed from the CHKS database collated from UK National Health Service data providing 70% of in-patient coverage in the UK. Patients with admissions under ICD-10 codes J45 "Asthma" and J46 "acute severe asthma" were included. Codes for associated co-morbidity at time of admission were identified, as well as month of admission and death, age, gender and length of stay. The mortality rate over the 5-year period was 1063 patients from 250,043 asthma admissions (0.43%). Critical care mortality was far higher and an annual rate indicated that for every 100,000 admissions 2878 (95% CI 2091;3857) patients died. Respiratory infection, cardiovascular disease and diabetes were common co-morbidities for all admissions. December and January had the peak number of deaths post asthma admission which were nearly all in adults, death being rarer in children. Women and those over 45 years had the highest rate of death which may reflect asthma prevalence. Co-morbid conditions experienced by older asthma patients may contribute to mortality post an asthma admission and greater understanding of risk factors contributing to fatality are required.

  8. Patients' dreams and unreal experiences following intensive care unit admission.

    PubMed

    Roberts, Brigit; Chaboyer, Wendy

    2004-01-01

    Dreams and unreal experiences occur commonly in critically ill patients admitted to intensive care unit. This study describes 31 patients' dreams and explores the relationship between patients' subjective recall 12-18 months after intensive care unit discharge and their observed behaviour during their intensive care unit stay. Semi-structured interviews revealed that 74% of longer-term ICU patients (> or = 3 days) reported dreaming, with the majority also describing frightening hallucinations. Only two patients reported long-term negative psychological sequelae, but the short-term consequence of hallucinations may also have an undiscovered impact on patients' recovery.

  9. Impact of Hospital Admission Care At a Pediatric Unit: A Qualitative Study.

    PubMed

    Macías, Marta; Zornoza, Carmen; Rodriguez, Elena; García, José A; Fernández, José A; Luque, Rafaela; Collado, Rosa

    2015-01-01

    The time of admission to a hospital, especially when unplanned, has been reported as the most stressful moment of hospitalization for both parents and children (Odievre, 2001). This qualitative study explored parents and hospital staff's perceptions and experiences related to the process of admission to a pediatric unit. Focus groups, two with parents (total n = 12) and one with health care professionals (n = 6), were conducted, and content analysis inspired by Graneheim and Lundman (2004) was performed. Parents identified four categories of perceptions: 1) management of an uncertain situation at the time of admission, 2) feelings related to the child's illness, 3) parent perception of professional's performance, and 4) parent experience of their role. Health care professionals identified two categories: 1) hospital admission as a continuous care process, and 2) undertaking improvements in the admission process. A common theme emerged about the importance of parents' trust in professionals in order to build a therapeutic relationship. Findings underscore the need for strategies to improve the hospital pediatric admission process based on a parent-professional relationship of trust and confidence through continuous quality communication and support. These strategies would include providing a nurse in charge of the admission process to assure continuity of care throughout the child's hospitalization.

  10. Variation and outcomes associated with direct hospital admission among children with pneumonia in the United States.

    PubMed

    Leyenaar, JoAnna K; Shieh, Meng-Shiou; Lagu, Tara; Pekow, Penelope S; Lindenauer, Peter K

    2014-09-01

    Although the majority of children with an unplanned admission to the hospital are admitted through the emergency department (ED), direct admissions constitute a significant proportion of hospital admissions nationally. Despite this, past studies of children have not characterized direct admission practices or outcomes. Pneumonia is the leading cause of pediatric hospitalization in the United States, providing an ideal lens to examine variation and outcomes associated with direct admissions. To describe rates and patterns of direct admission in a large sample of US hospitals and to compare resource utilization and outcomes between children with pneumonia admitted directly to a hospital and those admitted from an ED. Retrospective cohort study of children 1 to 17 years of age with pneumonia who were admitted to hospitals contributing data to Perspective Data Warehouse. We developed hierarchical generalized linear models to examine associations between admission type and outcomes. Outcome measures included (1) length of stay, (2) high turnover hospitalization, (3) total hospital cost, (4) transfer to the intensive care unit, and (5) readmission within 30 days of hospital discharge. A total of 19,736 children from 278 hospitals met eligibility criteria, including 7100 (36.0%) who were admitted directly and 12,636 (64.0%) through the ED. Rates of direct admission varied considerably across hospitals, with a median direct admission rate of 33.3% (interquartile range, 11.1%-50.0%). Children admitted directly were more likely to be white, to have private health insurance, and to be admitted to small, general community hospitals. In adjusted models, children admitted directly had a 9% higher length of stay (risk ratio, 1.09 [95% CI, 1.07-1.11]), 39% lower odds of high turnover hospitalization (odds ratio [OR], 0.61 [95% CI, 0.56-0.66]), and 12% lower cost (risk ratio, 0.88 [95% CI, 0.87-0.90]) than those admitted through the ED, with no significant differences in transfers

  11. Evaluating Admission Alternatives in an Outpatient Substance Abuse Treatment Program for Adolescents.

    ERIC Educational Resources Information Center

    Garner, Bryan R.; Godley, Susan H.; Funk, Rodney R.

    2002-01-01

    Evaluated streamlined admission procedures for adolescents entering outpatient substance abuse treatment, comparing 128 adolescents receiving existing procedures with 149 receiving the new admission and admission tracking procedures. Results show that adolescents were admitted to treatment sooner under the new procedures, but the percentage who…

  12. Predictors and outcome of obstetric admissions to intensive care unit: A comparative study.

    PubMed

    Jain, Shruti; Guleria, Kiran; Vaid, Neelam B; Suneja, Amita; Ahuja, Sharmila

    2016-01-01

    This descriptive observational study was carried out in Guru Teg Bahadur Hospital to identify predictors and outcome of obstetric admission to Intensive Care Unit (ICU). Ninety consecutive pregnant patients or those up to 42 days of termination of pregnancy admitted to ICU from October 2010 to December 2011 were enrolled as study subjects with selection of a suitable comparison group. Qualitative statistics of both groups were compared using Pearson's Chi-square test and Fisher's exact test. Odds ratio was calculated for significant factors. Low socioeconomic status, duration of complaints more than 12 h, delay at intermediary facility, and peripartum hysterectomy increased probability of admission to ICU. High incidence of obstetric admissions to ICU as compared to other countries stresses on need for separate obstetric ICU. Availability of high dependency unit can decrease preload to ICU by 5%. Patients with hemorrhagic disorders and those undergoing peripartum hysterectomy need more intensive care.

  13. Long-acting beta-agonists and the risk of intensive care unit admission in children.

    PubMed

    Jacobs, Tammy S; Jones, Bobby L; MacGinnitie, Andrew J

    2012-06-01

    A possible association between long-acting beta-agonists (LABA) and severe asthma exacerbations including death remains controversial. We examined whether LABA in the setting of combination therapy with inhaled corticosteroids (ICS) increase the risk of near-fatal asthma in children using a case-control study design. Medical records from admissions for asthma exacerbations in children 4-18 years of age during the 2005 calendar year at Children's Hospital of Pittsburgh of UPMC were reviewed. Cases and controls were determined by pediatric intensive care unit (PICU) and floor admission, respectively. Exposure was defined by LABA use in combination with ICS versus ICS alone. Records from 85 PICU and 96 pediatric floor admissions were reviewed. LABA use in combination with ICS did not increase the risk of PICU admission (odds ratio 1.07, 95% CI 0.46-2.52) compared to ICS only without LABA. After adjusting for demographics, asthma severity, history of PICU admissions, and concurrent infection, LABA/ICS use still did not increase the risk of PICU admission (adjusted odds ratio 0.84, 95% CI 0.26-2.76) compared to ICS alone. There were no deaths and five intubations within the study period. The combination of LABA and ICS did not appear to increase the risk of near-fatal asthma in children.

  14. An Evaluation of the Pharmacy College Admissions Test as a Tool for Pharmacy College Admissions Committees.

    ERIC Educational Resources Information Center

    Kelley, Katherine A.; Secnik, Kristina; Boye, Mark E.

    2001-01-01

    Investigated the capacity of the Pharmacy College Admissions Test (PCAT) to predict success in pharmacy school. Found demographic differences in PCAT scores, and that the PCAT used in combination with pre-pharmacy grade point average is meaningful in assessing applicants to pharmacy school; applicants with PCAT composite percentile scores below 40…

  15. An Evaluation of the Pharmacy College Admissions Test as a Tool for Pharmacy College Admissions Committees.

    ERIC Educational Resources Information Center

    Kelley, Katherine A.; Secnik, Kristina; Boye, Mark E.

    2001-01-01

    Investigated the capacity of the Pharmacy College Admissions Test (PCAT) to predict success in pharmacy school. Found demographic differences in PCAT scores, and that the PCAT used in combination with pre-pharmacy grade point average is meaningful in assessing applicants to pharmacy school; applicants with PCAT composite percentile scores below 40…

  16. Intensive care unit admission of obstetric cases: a single centre experience with contemporary update.

    PubMed

    Ng, Vivian K S; Lo, T K; Tsang, H H; Lau, W L; Leung, W C

    2014-02-01

    OBJECTIVES. To review the characteristics of a series of obstetric patients admitted to the intensive care unit in a regional hospital in 2006-2010, to compare them with those of a similar series reported from the same hospital in 1989-1995 and a series reported from another regional hospital in 1998-2007. DESIGN. Retrospective case series. SETTING. A regional hospital in Hong Kong. PATIENTS. Obstetric patients admitted to the Intensive Care Unit of Kwong Wah Hospital from 1 January 2006 to 31 December 2010. RESULTS. From 2006 to 2010, there were 67 such patients admitted to the intensive care unit (0.23% of total maternities and 2.34% of total intensive care unit admission), which was a higher incidence than reported in two other local studies. As in the latter studies, the majority were admitted postpartum (n=65, 97%), with postpartum haemorrhage (n=39, 58%) being the commonest cause followed by pre-eclampsia/eclampsia (n=17, 25%). In the current study, significantly more patients had had elective caesarean sections for placenta praevia but fewer had had a hysterectomy. The duration of intensive care unit stay was shorter (mean, 1.8 days) with fewer invasive procedures performed than in the two previous studies, but maternal and neonatal mortality was similar (3% and 6%, respectively). CONCLUSION. Postpartum haemorrhage and pregnancy-induced hypertension were still the most common reasons for intensive care unit admission. There was an increasing trend of intensive care unit admissions following elective caesarean section for placenta praevia and for early aggressive intervention of pre-eclampsia. Maternal mortality remained low but had not decreased. The intensive care unit admission rate by itself might not be a helpful indicator of obstetric performance.

  17. Cystatin C at Admission in the Intensive Care Unit Predicts Mortality among Elderly Patients.

    PubMed

    Dalboni, Maria Aparecida; Beraldo, Daniel de Oliveira; Quinto, Beata Marie Redublo; Blaya, Rosângela; Narciso, Roberto; Oliveira, Moacir; Monte, Júlio César Martins; Durão, Marcelino de Souza; Cendoroglo, Miguel; Pavão, Oscar Fernando; Batista, Marcelo Costa

    2013-01-01

    Introduction. Cystatin C has been used in the critical care setting to evaluate renal function. Nevertheless, it has also been found to correlate with mortality, but it is not clear whether this association is due to acute kidney injury (AKI) or to other mechanism. Objective. To evaluate whether serum cystatin C at intensive care unit (ICU) entry predicts AKI and mortality in elderly patients. Materials and Methods. It was a prospective study of ICU elderly patients without AKI at admission. We evaluated 400 patients based on normality for serum cystatin C at ICU entry, of whom 234 (58%) were selected and 45 (19%) developed AKI. Results. We observed that higher serum levels of cystatin C did not predict AKI (1.05 ± 0.48 versus 0.94 ± 0.36 mg/L; P = 0.1). However, it was an independent predictor of mortality, H.R. = 6.16 (95% CI 1.46-26.00; P = 0.01), in contrast with AKI, which was not associated with death. In the ROC curves, cystatin C also provided a moderate and significant area (0.67; P = 0.03) compared to AKI (0.47; P = 0.6) to detect death. Conclusion. We demonstrated that higher cystatin C levels are an independent predictor of mortality in ICU elderly patients and may be used as a marker of poor prognosis.

  18. Cystatin C at Admission in the Intensive Care Unit Predicts Mortality among Elderly Patients

    PubMed Central

    Dalboni, Maria Aparecida; Beraldo, Daniel de Oliveira; Quinto, Beata Marie Redublo; Blaya, Rosângela; Narciso, Roberto; Oliveira, Moacir; Monte, Júlio César Martins; Durão, Marcelino de Souza; Cendoroglo, Miguel; Pavão, Oscar Fernando; Batista, Marcelo Costa

    2013-01-01

    Introduction. Cystatin C has been used in the critical care setting to evaluate renal function. Nevertheless, it has also been found to correlate with mortality, but it is not clear whether this association is due to acute kidney injury (AKI) or to other mechanism. Objective. To evaluate whether serum cystatin C at intensive care unit (ICU) entry predicts AKI and mortality in elderly patients. Materials and Methods. It was a prospective study of ICU elderly patients without AKI at admission. We evaluated 400 patients based on normality for serum cystatin C at ICU entry, of whom 234 (58%) were selected and 45 (19%) developed AKI. Results. We observed that higher serum levels of cystatin C did not predict AKI (1.05 ± 0.48 versus 0.94 ± 0.36 mg/L; P = 0.1). However, it was an independent predictor of mortality, H.R. = 6.16 (95% CI 1.46–26.00; P = 0.01), in contrast with AKI, which was not associated with death. In the ROC curves, cystatin C also provided a moderate and significant area (0.67; P = 0.03) compared to AKI (0.47; P = 0.6) to detect death. Conclusion. We demonstrated that higher cystatin C levels are an independent predictor of mortality in ICU elderly patients and may be used as a marker of poor prognosis. PMID:24967238

  19. Airborne pollutants and lacunar stroke: a case cross-over analysis on stroke unit admissions.

    PubMed

    Corea, Francesco; Silvestrelli, Giorgio; Baccarelli, Andrea; Giua, Alessandra; Previdi, Paolo; Siliprandi, Giorgio; Murgia, Nicola

    2012-06-14

    Particulate air pollution is known to be associated with cardiovascular disease. The relation of particulate air pollution with cerebrovascular disease (CVD) has not been extensively studied, particularly in relation to different subtypes of stroke. A time-series study was conducted to evaluate the association between daily air pollution and acute stroke unit hospitalizations in Mantua, Italy. We analyzed 781 CVD consecutive patients living in Mantua county admitted between 2006-08. Data on stroke types, demographic variables, risk factors were available from the Lombardia Stroke Registry. Daily mean value of particulate matter with a diameter <10 µm (PM(10)), carbon monoxide, nitric oxide, nitrogen dioxide, sulphur dioxide, benzene and ozone were used in the analysis. The association between CVD, ischemic strokes subtypes and pollutants was investigated with a case-crossover design, using conditional logistic regression analysis, adjusting for temperature, humidity, barometric pressure and holidays. Among the 781 subjects admitted 75.7% had ischemic stroke, 11.7% haemorrhagic stroke 12.6% transient ischemic attack. In men admission for stroke was associated with PM(10) [odds ratio (OR) 1.01, 95%; confidence interval (CI) 1.00-1.02; P<0.05]. According to the clinical classification, lacunar anterior circulation syndrome stroke type was related to PM(10) level registered on the day of admission for both genders (OR: 1.01, 95%; CI: 1.00-1.02; P<0.05) while for total anterior circulation syndrome stroke only in men (OR: 1.04, 95%; CI 1.01-1.07; P<0.05).In conclusion, our study confirms that air pollution peaks may contribute to increase the risk of hospitalization for stroke and particulate matter seems to be a significant risk factor, especially for lacunar stroke.

  20. Preoperative predictive factors for intensive care unit admission after pulmonary resection*

    PubMed Central

    Pinheiro, Liana; Santoro, Ilka Lopes; Perfeito, João Aléssio Juliano; Izbicki, Meyer; Ramos, Roberta Pulcheri; Faresin, Sonia Maria

    2015-01-01

    Objective: To determine whether the use of a set of preoperative variables can predict the need for postoperative ICU admission. Methods: This was a prospective observational cohort study of 120 patients undergoing elective pulmonary resection between July of 2009 and April of 2012. Prediction of ICU admission was based on the presence of one or more of the following preoperative characteristics: predicted pneumonectomy; severe/very severe COPD; severe restrictive lung disease; FEV1 or DLCO predicted to be < 40% postoperatively; SpO2 on room air at rest < 90%; need for cardiac monitoring as a precautionary measure; or American Society of Anesthesiologists physical status ≥ 3. The gold standard for mandatory admission to the ICU was based on the presence of one or more of the following postoperative characteristics: maintenance of mechanical ventilation or reintubation; acute respiratory failure or need for noninvasive ventilation; hemodynamic instability or shock; intraoperative or immediate postoperative complications (clinical or surgical); or a recommendation by the anesthesiologist or surgeon to continue treatment in the ICU. Results: Among the 120 patients evaluated, 24 (20.0%) were predicted to require ICU admission, and ICU admission was considered mandatory in 16 (66.6%) of those 24. In contrast, among the 96 patients for whom ICU admission was not predicted, it was required in 14 (14.5%). The use of the criteria for predicting ICU admission showed good accuracy (81.6%), sensitivity of 53.3%, specificity of 91%, positive predictive value of 66.6%, and negative predictive value of 85.4%. Conclusions: The use of preoperative criteria for predicting the need for ICU admission after elective pulmonary resection is feasible and can reduce the number of patients staying in the ICU only for monitoring. PMID:25750672

  1. Indications and outcome for obstetric patients' admission to intensive care unit: a 7-year review.

    PubMed

    Lataifeh, I; Amarin, Z; Zayed, F; Al-Mehaisen, L; Alchalabi, H; Khader, Y

    2010-05-01

    The objective of this retrospective study was to investigate the indications, interventions and clinical outcome of pregnant and newly delivered women admitted to the multidisciplinary intensive care unit at the King Abdullah University Hospital in Jordan over a 7-year period from January 2002 to December 2008. The collected data included demographic characteristics of the patients, mode of delivery, pre-existing medical conditions, reason for admission, specific intervention, length of stay and maternal outcome. A total of 43 women required admission to the intensive care unit (ICU), which represented 0.37% of all deliveries. The majority (95.3%) of patients were admitted to the ICU postpartum. The most common reasons for admissions were (pre)eclampsia (48.8%) and obstetric haemorrhage (37.2). The remainder included adult respiratory distress syndrome (6.9%), pulmonary embolism (2.3%) and neurological disorders (4.6%). Mechanical ventilation was required to support 18.6% of patients and transfusion of red blood cells was needed for 48.8% of patients. There were three maternal deaths (6.9%). A multidisciplinary team approach is essential to improve the management of hypertensive disorders and postpartum haemorrhage to achieve significant improvements in maternal outcome. A large, prospective study to know which women are at high risk of admission to the intensive care units and to prevent serious maternal morbidity and mortality is warranted.

  2. Disciplinary Logics in Doctoral Admissions: Understanding Patterns of Faculty Evaluation

    ERIC Educational Resources Information Center

    Posselt, Julie R.

    2015-01-01

    Ph.D. attainment rates by race and gender vary widely across the disciplines, and previous research has found disciplinary variation in graduate admissions criteria and practices. To better understand how disciplines shape admissions preferences and practices, which in turn may shape student access to graduate education, this article uncovers…

  3. An Evaluation of the Simulated Minority Admissions Exercise.

    ERIC Educational Resources Information Center

    Sedlacek, William E.; Prieto, Dario O.

    1982-01-01

    The Simulated Minority Admissions Exercise, an educational technique that simulates a typical medical school admissions situation, is described. The main objective is to help medical schools to select potentially successful minority applicants and to improve their retention by ensuring that they enter medical school under positive circumstances.…

  4. Evaluation of the Special Tertiary Admissions Test (STAT)

    ERIC Educational Resources Information Center

    Coates, Hamish; Friedman, Tim

    2010-01-01

    This paper reports findings from the first national Australian study of the predictive validity of the Special Tertiary Admissions Test (STAT). Background on tertiary admissions procedures in Australia is presented, followed by information on STAT and the research methods. The results affirm that STAT, through the provision of baseline and…

  5. How many schools adopt interviews during the student admission process across the health professions in the United States of America?

    PubMed

    Glazer, Greer; Startsman, Laura F; Bankston, Karen; Michaels, Julia; Danek, Jennifer C; Fair, Malika

    2016-01-01

    Health profession schools use interviews during the admissions process to identify certain non-cognitive skills that are needed for success in diverse, inter-professional settings. This study aimed to assess the use of interviews during the student admissions process across health disciplines at schools in the United States of America in 2014. The type and frequency of non-cognitive skills assessed were also evaluated. Descriptive methods were used to analyze a sample of interview rubrics collected as part of a national survey on admissions in the health professions, which surveyed 228 schools of medicine, dentistry, pharmacy, nursing, and public health. Of the 228 schools, 130 used interviews. The most desirable non-cognitive skills from 34 schools were identified as follows: communication skills (30), motivation (22), readiness for the profession (17), service (12), and problem-solving (12). Ten schools reported using the multiple mini-interview format, which may indicate potential for expanding this practice. Disparities in the use of interviewing across health professions should be verified to help schools adopt interviews during student admissions processes.

  6. Evaluation of a Medical and Mental Health Unit compared with standard care for older people whose emergency admission to an acute general hospital is complicated by concurrent 'confusion': a controlled clinical trial. Acronym: TEAM: Trial of an Elderly Acute care Medical and mental health unit.

    PubMed

    Harwood, Rowan H; Goldberg, Sarah E; Whittamore, Kathy H; Russell, Catherine; Gladman, John Rf; Jones, Rob G; Porock, Davina; Lewis, Sarah A; Bradshaw, Lucy E; Elliot, Rachel A

    2011-05-13

    Patients with delirium and dementia admitted to general hospitals have poor outcomes, and their carers report poor experiences. We developed an acute geriatric medical ward into a specialist Medical and Mental Health Unit over an eighteen month period. Additional specialist mental health staff were employed, other staff were trained in the 'person-centred' dementia care approach, a programme of meaningful activity was devised, the environment adapted to the needs of people with cognitive impairment, and attention given to communication with family carers. We hypothesise that patients managed on this ward will have better outcomes than those receiving standard care, and that such care will be cost-effective. We will perform a controlled clinical trial comparing in-patient management on a specialist Medical and Mental Health Unit with standard care. Study participants are patients over the age of 65, admitted as an emergency to a single general hospital, and identified on the Acute Medical Admissions Unit as being 'confused'. Sample size is 300 per group. The evaluation design has been adapted to accommodate pressures on bed management and patient flows. If beds are available on the specialist Unit, the clinical service allocates patients at random between the Unit and standard care on general or geriatric medical wards. Once admitted, randomised patients and their carers are invited to take part in a follow up study, and baseline data are collected. Quality of care and patient experience are assessed in a non-participant observer study. Outcomes are ascertained at a follow up home visit 90 days after randomisation, by a researcher blind to allocation. The primary outcome is days spent at home (for those admitted from home), or days spent in the same care home (if admitted from a care home). Secondary outcomes include mortality, institutionalisation, resource use, and scaled outcome measures, including quality of life, cognitive function, disability, behavioural and

  7. Evaluation of a Medical and Mental Health Unit compared with standard care for older people whose emergency admission to an acute general hospital is complicated by concurrent 'confusion': a controlled clinical trial. Acronym: TEAM: Trial of an Elderly Acute care Medical and mental health unit

    PubMed Central

    2011-01-01

    Background Patients with delirium and dementia admitted to general hospitals have poor outcomes, and their carers report poor experiences. We developed an acute geriatric medical ward into a specialist Medical and Mental Health Unit over an eighteen month period. Additional specialist mental health staff were employed, other staff were trained in the 'person-centred' dementia care approach, a programme of meaningful activity was devised, the environment adapted to the needs of people with cognitive impairment, and attention given to communication with family carers. We hypothesise that patients managed on this ward will have better outcomes than those receiving standard care, and that such care will be cost-effective. Methods/design We will perform a controlled clinical trial comparing in-patient management on a specialist Medical and Mental Health Unit with standard care. Study participants are patients over the age of 65, admitted as an emergency to a single general hospital, and identified on the Acute Medical Admissions Unit as being 'confused'. Sample size is 300 per group. The evaluation design has been adapted to accommodate pressures on bed management and patient flows. If beds are available on the specialist Unit, the clinical service allocates patients at random between the Unit and standard care on general or geriatric medical wards. Once admitted, randomised patients and their carers are invited to take part in a follow up study, and baseline data are collected. Quality of care and patient experience are assessed in a non-participant observer study. Outcomes are ascertained at a follow up home visit 90 days after randomisation, by a researcher blind to allocation. The primary outcome is days spent at home (for those admitted from home), or days spent in the same care home (if admitted from a care home). Secondary outcomes include mortality, institutionalisation, resource use, and scaled outcome measures, including quality of life, cognitive function

  8. Imperfect physician assistant and physical therapist admissions processes in the United States

    PubMed Central

    2014-01-01

    We compared and contrasted physician assistant and physical therapy profession admissions processes based on the similar number of accredited programs in the United States and the co-existence of many programs in the same school of health professions, because both professions conduct similar centralized application procedures administered by the same organization. Many studies are critical of the fallibility and inadequate scientific rigor of the high-stakes nature of health professions admissions decisions, yet typical admission processes remain very similar. Cognitive variables, most notably undergraduate grade point averages, have been shown to be the best predictors of academic achievement in the health professions. The variability of non-cognitive attributes assessed and the methods used to measure them have come under increasing scrutiny in the literature. The variance in health professions students’ performance in the classroom and on certifying examinations remains unexplained, and cognitive considerations vary considerably between and among programs that describe them. One uncertainty resulting from this review is whether or not desired candidate attributes highly sought after by individual programs are more student-centered or graduate-centered. Based on the findings from the literature, we suggest that student success in the classroom versus the clinic is based on a different set of variables. Given the range of positions and general lack of reliability and validity in studies of non-cognitive admissions attributes, we think that health professions admissions processes remain imperfect works in progress. PMID:24810020

  9. Pattern of Otorhinolaryngological Admissions via Emergency Unit in a Suburban Tertiary Center

    PubMed Central

    Adedeji, Taiwo O.; Sogebi, Olusola A.; Tobih, James E.

    2015-01-01

    Background: Patients with ORL lesions sometimes present to the general emergency room. This study reviews the common ENT admissions via emergency room in a sub-urban town in Nigeria Methods: A retrospective study spanning five years from January 2009 to December 2013 Results: A total of 211 cases consisting of 131 (62.1%) males with male: female ratio 1.6: 1 and a mean age of 32.8 ± 22.4 years. About a quarter of the patients were children, the peak age was 21-40 years (in 37%). The common indications for emergency otorhinolaryngological admissions were Epistaxis (16.1%), Nasal/facial trauma (14.7%), pharyngo-esophageal foreign bodies (13.3%) and upper airway obstruction (8.1%). Majority 16 (57.1%) of the Pharyngo-esophageal FBs occurred in children. Most of the airway obstructions in children were due to juvenile recurrent respiratory papillomatosis while laryngeal cancer was the major cause among the adult. Sixty percent had surgical procedures, 86.7% had satisfactory outcome and mortalities were recorded in 1.4%. Conclusion: Majority of causes for ORL admissions via emergency unit are of pharyngo-esophageal origin. There is apparent reversal of the otological origin trend in ENT admissions via A&E unit. PMID:26508908

  10. Maternal and neonatal separation and mortality associated with concurrent admissions to intensive care units

    PubMed Central

    Ray, Joel G.; Urquia, Marcelo L.; Berger, Howard; Vermeulen, Marian J.

    2012-01-01

    Background: Concurrent admission of a mother and her newborn to separate intensive care units (herein referred to as co-ICU admission), possibly in different centres, can magnify family discord and stress. We examined the prevalence and predictors of mother–infant separation and mortality associated with co-ICU admissions. Methods: We completed a population-based study of all 1 023 978 singleton live births in Ontario between Apr. 1, 2002, and Mar. 31, 2010. We included data for maternal–infant pairs that had co-ICU admission (n = 1216), maternal ICU admission only (n = 897), neonatal ICU (NICU) admission only (n = 123 236) or no ICU admission (n = 898 629). The primary outcome measure was mother–infant separation because of interfacility transfer. Results: The prevalence of co-ICU admissions was 1.2 per 1000 live births and was higher than maternal ICU admissions (0.9 per 1000). Maternal–newborn separation due to interfacility transfer was 30.8 (95% confidence interval [CI] 26.9–35.3) times more common in the co-ICU group than in the no-ICU group and exceeded the prevalence in the maternal ICU group and NICU group. Short-term infant mortality (< 28 days after birth) was higher in the co-ICU group (18.1 per 1000 live births; maternal age–adjusted hazard ratio [HR] 27.8, 95% CI 18.2–42.6) than in the NICU group (7.6 per 1000; age-adjusted HR 11.5, 95% CI 10.4–12.7), relative to 0.7 per 1000 in the no-ICU group. Short-term maternal mortality (< 42 days after delivery) was also higher in the co-ICU group (15.6 per 1000; age-adjusted HR 328.7, 95% CI 191.2–565.2) than in the maternal ICU group (6.7 per 1000; age-adjusted HR 140.0, 95% CI 59.5–329.2) or the NICU group (0.2 per 1000; age-adjusted HR 4.6, 95% CI 2.8–7.4). Interpretation: Mother–infant pairs in the co-ICU group had the highest prevalence of separation due to interfacility transfer and the highest mortality compared with those in the maternal ICU and NICU groups. PMID:23091180

  11. [A community short-term crisis unit does not reduce acute admissions to psychiatric wards].

    PubMed

    Bergerud, Tone; Møller, Paul; Larsen, Frode; Veenstra, Marijke; Ruud, Torleif

    2009-10-08

    Due to long-term capacity problems in the psychiatric acute ward, we tried to canalise acute admissions due to life crises (and not serious mental disease) to a new short-term in-patient crisis unit. Our hypothesis was that the opening of this unit would lead to fewer admissions to the psychiatric acute ward and that this change would be reflected by an increase of patients with a more severe psychopathology. The study had a quasi-experimental design. Two patient groups in a psychiatric acute ward (from separate catchment areas) were compared before (2.1.2003-1.6.2003) and after (2.1.2004-1.6.2004) establishment of a community based short-term inpatient crisis unit in one of the catchment areas. 234 patients were included in the study. Admissions to the psychiatric acute ward did not decline from any of the catchment areas from the first to the second time-period . The second time-period was associated with less psychopathology, but only for men in the area with a crisis unit. The reduction was largest for self-harm and suicidal behaviour (p = 0.02) and depression (p = 0.01). None of our hypotheses were confirmed. Our main conclusion is that patient flow in acute mental health services involves a multitude of complex and unpredictable factors. The services continuously reorganise. Different ways of organising mental health services are rarely studied systematically, and such studies are difficult and resource demanding.

  12. Re-admission to Level 2 unit after hip-fracture surgery - Risk factors, reasons and outcome.

    PubMed

    Buecking, Benjamin; Eschbach, Daphne; Koutras, Christos; Kratz, Thomas; Balzer-Geldsetzer, Monika; Dodel, Richard; Ruchholtz, Steffen

    2013-12-01

    Hip fractures are common geriatric fractures with increasing incidence. Treatment of these fractures is still associated with high rates of complications and poor outcome. Data concerning unexpected re-admission to a Level 2 unit after an initial inconspicuous postoperative course are limited. We aimed to identify causes and associated risk factors for admission as well as impact of re-admission on acute care and short-term outcome. Patients over 60 years of age with hip fractures were included in this prospective single-centre observational study. Patients with polytrauma or malignancy-associated fractures were excluded. Age, gender, fracture type, pre-fracture residential, physical and cognitive status, recording to the American Society of Anesthesiologists (ASA) score, Barthel Index (BI) and Mini-Mental State Examination (MMSE) were recorded on admission. Date, type of surgery and operation time were evaluated. Postoperatively, the prevalence of and reasons for unexpected re-admission to the Level 2 unit and patients' outcome were measured. Parameters were hospital mortality, BI at discharge, length of stay in hospital and type of discharge. Univariate and multivariate analyses were performed to identify risk factors for admission to the Level 2 unit and influence on patients' outcome. Out of 402 included patients, 48 (12%) were re-admitted to the Level 2 unit. The most frequent reasons were non-surgical (n=38), such as respiratory failure (n=12), cardiovascular diseases (n=8) and acute renal failure (n=5). Ten patients were re-admitted due to a revision surgery of the hip. We identified two independent risk factors for readmission: male gender (odds ratio (OR)=2.38, confidence interval (95% CI)=1.10-5.15, p=0.027) and type of fracture, especially femoral neck fracture (OR=7.40, 95% CI=2.39-23.26, p=0.001). Patients who were re-admitted to the Level 2 unit had a higher mortality (β=2.09, OR=8.07, 95% CI=2.44-26.75, p=0.001), an increase in hospital stay (β=7

  13. Intensive Care Unit Admission Parameters Improve the Accuracy of Operative Mortality Predictive Models in Cardiac Surgery

    PubMed Central

    Ranucci, Marco; Ballotta, Andrea; Castelvecchio, Serenella; Baryshnikova, Ekaterina; Brozzi, Simonetta; Boncilli, Alessandra

    2010-01-01

    Background Operative mortality risk in cardiac surgery is usually assessed using preoperative risk models. However, intraoperative factors may change the risk profile of the patients, and parameters at the admission in the intensive care unit may be relevant in determining the operative mortality. This study investigates the association between a number of parameters at the admission in the intensive care unit and the operative mortality, and verifies the hypothesis that including these parameters into the preoperative risk models may increase the accuracy of prediction of the operative mortality. Methodology 929 adult patients who underwent cardiac surgery were admitted to the study. The preoperative risk profile was assessed using the logistic EuroSCORE and the ACEF score. A number of parameters recorded at the admission in the intensive care unit were explored for univariate and multivariable association with the operative mortality. Principal Findings A heart rate higher than 120 beats per minute and a blood lactate value higher than 4 mmol/L at the admission in the intensive care unit were independent predictors of operative mortality, with odds ratio of 6.7 and 13.4 respectively. Including these parameters into the logistic EuroSCORE and the ACEF score increased their accuracy (area under the curve 0.85 to 0.88 for the logistic EuroSCORE and 0.81 to 0.86 for the ACEF score). Conclusions A double-stage assessment of operative mortality risk provides a higher accuracy of the prediction. Elevated blood lactates and tachycardia reflect a condition of inadequate cardiac output. Their inclusion in the assessment of the severity of the clinical conditions after cardiac surgery may offer a useful tool to introduce more sophisticated hemodynamic monitoring techniques. Comparison between the predicted operative mortality risk before and after the operation may offer an assessment of the operative performance. PMID:21042411

  14. Prevalence and risk factors for carriage of methicillin-resistant Staphylococcus aureus at admission to the intensive care unit: results of a multicenter study.

    PubMed

    Lucet, Jean-Christophe; Chevret, Sylvie; Durand-Zaleski, Isabelle; Chastang, Claude; Régnier, Bernard

    2003-01-27

    Detection of methicillin-resistant Staphylococcus aureus (MRSA) carriers on admission to the intensive care unit (ICU) is an important component of strategies for controlling the spread of MRSA. A prospective multicenter study was conducted in 14 French ICUs for 6 months. All patients were screened within 24 hours after admission, using nasal and cutaneous swabs In addition, clinical samples were obtained. Patient data collected on ICU admission included presence of immunosuppression; history of hospital stay, surgery, antimicrobial treatments, or previous colonization with MRSA; chronic health evaluation and McCabe scores; reason for admission; whether the patient was transferred from another ward; severity of illness; presence of skin lesions; and invasive procedures. Risk factors for MRSA carriage at ICU admission were estimated, and significantly associated variables were used to develop a predictive score for MRSA carriage. A cost-benefit analysis was then performed. Of the 2347 admissions with MRSA screening, 162 (6.9%; range, 3.7%-20.0% among ICUs) were positive for MRSA, of whom 54.3% were detected through screening specimens only. Of the 2310 first admissions (vs repeat admissions) to the ICU, 96 were newly identified MRSA carriers. Factors associated with MRSA carriage in the multivariate analysis were age older than 60 years, prolonged hospital stay in transferred patients, history of hospitalization or surgery, and presence of open skin lesions in directly admitted patients. Only universal screening detected MRSA carriage with acceptable sensitivity. A cost-benefit analysis confirmed that universal screening and preventive isolation were beneficial. The prevalence of MRSA carriage on admission to the ICU is high in this endemic setting. Screening for MRSA on admission is useful to identify the imported cases and should be performed in all ICU-admitted patients.

  15. Elective delivery before 39 weeks: the risk of infant admission to the neonatal intensive care unit.

    PubMed

    Hoffmire, Claire A; Chess, Patricia R; Ben Saad, Taha; Glantz, J Christopher

    2012-07-01

    Despite American College of Obstetricians and Gynecologists guidelines suggesting that non-urgent planned deliveries be scheduled at/after 39 weeks; elective delivery before 39 weeks occurs often in the United States. The objective of this study is to estimate the elective delivery rate between 36(0/7) and 38(6/7) weeks gestation and compare NICU admission rates between elective and non-elective deliveries. We conducted a retrospective cohort (n = 1,577) study. Charts were reviewed for all singleton deliveries (2006-2007) between 36(0/7) and 38(6/7) weeks gestation taking place at one hospital in NYS to determine delivery status. We computed adjusted relative risks (RR) with 95% confidence intervals (CI) for elective delivery in relation to NICU admission using robust Poisson regression. 32.8% of all births were elective: 20.7% of vaginal and 55.7% of cesarean births. Elective delivery increased with increasing gestational age. After controlling for potential confounders, infants born via a vaginal elective delivery (RR = 1.40, CI: 1.00, 1.94), an elective cesarean (RR = 2.05, CI: 1.53, 2.76), or a non-elective cesarean (RR = 2.00, CI: 1.50, 2.66) are at significantly increased risk of NICU admission compared to infants born via a non-elective vaginal delivery. Elective delivery before 39 weeks is common and increases the risk of infant NICU admission.

  16. Improving neonatal unit admission temperatures in preterm babies: exothermic mattresses, polythene bags or a traditional approach?

    PubMed

    Singh, A; Duckett, J; Newton, T; Watkinson, M

    2010-01-01

    To investigate whether exothermic sodium acetate mattresses were associated with an improvement in the thermal care of babies <30 weeks gestation between birth and admission to a neonatal unit. Analysis of a three case series of babies: the first with traditional thermal care of drying and wrapping in a towel, the second with wrapping in food standard polythene bags and the third with wrapping in polythene bags and nursing on an activated exothermic mattress. The main outcome measure was the temperature on admission to the neonatal unit. There were no significant differences between the groups for gestation and birth weight. Hypothermia was less frequent in the 'bag and mattress' group compared with the 'bag only' and traditional care groups (26 vs 69 vs 84%, respectively) even though the median time to admission was longest in the 'bag and mattress' group (23 min). The proportions of babies admitted with temperatures in the target range of 36.5 to 37.5 degrees C were 46, 27 and 16%, respectively. Multiple regression analysis showed that use of the mattress raised admission temperatures by 1.04 degrees C. The median temperature of babies in the 'bag and mattress' group was higher compared with the other groups (36.9 vs 36.0 vs 35.8 degrees C), but significantly more were hyperthermic (28 vs 4 and 0.4%, respectively). Use of exothermic mattresses for babies <30 weeks gestation was associated with a significantly greater proportion of babies being admitted to the neonatal unit with a temperature in the euthermic range, but there was also an increased risk of hyperthermia.

  17. "Skimming the Cream"? Admissions to Charter Schools in the United States and to Autonomous Schools in England

    ERIC Educational Resources Information Center

    West, Anne; Ingram, Dabney; Hind, Audrey

    2006-01-01

    This article focuses on student admissions to charter schools in the United States and to autonomous (foundation and voluntary-aided) secondary schools in England. Analyses of the admissions criteria used by autonomous and nonautonomous secondary schools in England revealed that more autonomous than nonautonomous schools reported using potentially…

  18. Prognostic impact of the time of admission and discharge from the intensive care unit

    PubMed Central

    Moreira, Héctor Eduardo; Verga, Federico; Barbato, Marcelo; Burghi, Gastón

    2017-01-01

    Objective To determine the impact of the day and time of admission and discharge from the intensive care unit on mortality. Methods Prospective observational study that included patients admitted to the intensive care unit of the Hospital Maciel in Montevideo between April and November 2014. Results We analyzed 325 patients with an average age of 55 (36 - 71) years and a SAPS II value of 43 (29 - 58) points. No differences were found in the mortality of patients in the intensive care unit when time of admission (35% on the weekend versus 31% on weekdays, p = ns) or the hour of entry (35% at night versus 31% in the daytime, p = ns) were compared. The time of discharge was associated with higher hospital mortality rates (57% for weekend discharges versus 14% for weekday discharges, p = 0.000). The factors independently associated with hospital mortality after discharge from the intensive care unit were age > 50 years (OR 2.4, 95%CI, 1.1 - 5.4) and weekend discharge (OR 7.7, 95%CI, 3.8-15.6). Conclusion This study identified the time of discharge from the intensive care unit as a factor that was independently associated with hospital mortality. PMID:28444074

  19. Epidemiology of Obstetric-Related Intensive Care Unit Admissions in Maryland: 1999–2008

    PubMed Central

    Wanderer, Jonathan P.; Leffert, Lisa R.; Mhyre, Jill M.; Kuklina, Elena V.; Callaghan, William M.; Bateman, Brian T.

    2013-01-01

    Objective To define the incidence, indications, and temporal trends in obstetric-related intensive care unit (ICU) admissions Design Descriptive analysis of utilization patterns Setting All hospitals within the State of Maryland Patients All antepartum, delivery and postpartum patients who were hospitalized between 1999 and 2008 Interventions None Measurements and Main Results We identified 2,927 ICU admissions from 765,598 admissions for antepartum, delivery, or postpartum conditions using appropriate International Classification of Diseases, 9th revision-Clinical Modification (ICD-9 CM) codes. The overall rate of ICU utilization was 419.1 per 100,000 deliveries, with rates of 162.5, 202.6 and 54.0 per 100,000 deliveries for the antepartum, delivery and postpartum periods, respectively. The leading diagnoses associated with ICU admission were pregnancy-related hypertensive disease (present in 29.9% of admissions), hemorrhage (18.8%), cardiomyopathy or other cardiac disease (18.3%), genitourinary infection (11.5%), complications from ectopic pregnancies and abortions (10.3%), non-genitourinary infection (10.1%), sepsis (7.1%), cerebrovascular disease (5.8%) and pulmonary embolism (3.7%). We assessed for changes in the most common diagnoses in the ICU population over time and found rising rates of sepsis (10.1 per 100,000 deliveries to 16.6 per 100,000 deliveries, p=0.003) and trauma (9.2 per 100,000 deliveries to 13.6 per 100,000 deliveries, p=0.026) with decreasing rates of anesthetic complications (11.3 per 100,000 to 4.7 per 100,000, p=0.006). The overall frequency of obstetric-related ICU admission and the rates for other indications remained relatively stable. Conclusions Between 1999 and 2008, 419.1 per 100,000 deliveries in Maryland were complicated by ICU admission. Hospitals providing obstetric services should plan for appropriate critical care management and/or transfer of women with severe morbidities during pregnancy. PMID:23648568

  20. Trauma admissions to the intensive care unit at a reference hospital in Northwestern Tanzania.

    PubMed

    Chalya, Phillipo L; Gilyoma, Japhet M; Dass, Ramesh M; Mchembe, Mabula D; Matasha, Michael; Mabula, Joseph B; Mbelenge, Nkinda; Mahalu, William

    2011-10-24

    Major trauma has been reported to be a major cause of hospitalization and intensive care utilization worldwide and consumes a significant amount of the health care budget. The aim of this study was to describe the characteristics and treatment outcome of major trauma patients admitted into our ICU and to identify predictors of outcome. Between January 2008 and December 2010, a descriptive prospective study of all trauma admissions to a multidisciplinary intensive care unit (ICU) of Bugando Medical Centre in Northwestern Tanzania was conducted. A total of 312 cases of major trauma were admitted in the ICU, representing 37.1% of the total ICU admissions. Males outnumbered females by a ratio of 5.5:1. Their median age was 27 years. Trauma admissions were almost exclusively emergencies (95.2%) and came mainly from the Accident and Emergency (60.6%) and Operating room (23.4%). Road traffic crash (RTC) was the most common cause of injuries affecting 70.8% of patients. Two hundred fourteen patients (68.6%) required surgical intervention. The overall ICU length of stay (LOS) for all trauma patients ranged from 1 to 59 days (median = 8 days). The median ICU length of hospital stay (LOS) for survivors and non-survivors were 8 and 5 days respectively. (P = 0.002). Mortality rate was 32.7%. Mortality rate of trauma patients was significantly higher than that of all ICU admissions (32.7% vs. 18.8%, P = 0.0012). According to multivariate logistic regression analysis, multiple injuries, severe head injuries and burns were responsible for a longer mean ICU stay (P < 0.001) whereas admission Glasgow Coma Score < 9, systolic blood pressure < 90 mmHg, injury severity core >16, prolonged duration of loss of consciousness, delayed ICU admission (0.028), the need for ventilatory support and finding of space occupying lesion on computed tomography scan significantly influenced mortality (P < 0.001). Trauma resulting from road traffic crashes is a leading cause of intensive care

  1. Trauma admissions to the Intensive care unit at a reference hospital in Northwestern Tanzania

    PubMed Central

    2011-01-01

    Background Major trauma has been reported to be a major cause of hospitalization and intensive care utilization worldwide and consumes a significant amount of the health care budget. The aim of this study was to describe the characteristics and treatment outcome of major trauma patients admitted into our ICU and to identify predictors of outcome. Methods Between January 2008 and December 2010, a descriptive prospective study of all trauma admissions to a multidisciplinary intensive care unit (ICU) of Bugando Medical Centre in Northwestern Tanzania was conducted. Results A total of 312 cases of major trauma were admitted in the ICU, representing 37.1% of the total ICU admissions. Males outnumbered females by a ratio of 5.5:1. Their median age was 27 years. Trauma admissions were almost exclusively emergencies (95.2%) and came mainly from the Accident and Emergency (60.6%) and Operating room (23.4%). Road traffic crash (RTC) was the most common cause of injuries affecting 70.8% of patients. Two hundred fourteen patients (68.6%) required surgical intervention. The overall ICU length of stay (LOS) for all trauma patients ranged from 1 to 59 days (median = 8 days). The median ICU length of hospital stay (LOS) for survivors and non-survivors were 8 and 5 days respectively. (P = 0.002). Mortality rate was 32.7%. Mortality rate of trauma patients was significantly higher than that of all ICU admissions (32.7% vs. 18.8%, P = 0.0012). According to multivariate logistic regression analysis, multiple injuries, severe head injuries and burns were responsible for a longer mean ICU stay (P < 0.001) whereas admission Glasgow Coma Score < 9, systolic blood pressure < 90 mmHg, injury severity core >16, prolonged duration of loss of consciousness, delayed ICU admission (0.028), the need for ventilatory support and finding of space occupying lesion on computed tomography scan significantly influenced mortality (P < 0.001). Conclusion Trauma resulting from road traffic crashes is a

  2. A mathematical model for the admission process in intensive care units

    NASA Astrophysics Data System (ADS)

    Rokni Lamooki, Gholam Reza; Maleki, Farzaneh; Hajihosseini, Amirhossein

    2014-01-01

    A mathematical model is given for the admission process in Intensive Care Units (ICUs). It is shown that the model exhibits bistability for certain values of its parameters. In particular, it is observed that in a two-dimensional parameter space, two saddle-node bifurcation curves terminate at a single point of the cusp bifurcation, creating an enclosed region in which the model has one unstable and two stable states. It is shown that in the presence of bistability, variations in the value of parameters may lead to undesired outcomes in the admission process as the value of state variables abruptly changes. Using numerical simulations, it is also discussed how such outcomes can be avoided by appropriately adjusting the parameter values.

  3. 14 CFR 135.76 - DOD Commercial Air Carrier Evaluator's Credentials: Admission to pilots compartment: Forward...

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... Credentials: Admission to pilots compartment: Forward observer's seat. 135.76 Section 135.76 Aeronautics and... Commercial Air Carrier Evaluator's Credentials: Admission to pilots compartment: Forward observer's seat. (a.... (b) A forward observer's seat on the flight deck or forward passenger seat with headset or speaker...

  4. 14 CFR 135.76 - DOD Commercial Air Carrier Evaluator's Credentials: Admission to pilots compartment: Forward...

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... Credentials: Admission to pilots compartment: Forward observer's seat. 135.76 Section 135.76 Aeronautics and... Commercial Air Carrier Evaluator's Credentials: Admission to pilots compartment: Forward observer's seat. (a.... (b) A forward observer's seat on the flight deck or forward passenger seat with headset or speaker...

  5. 14 CFR 135.76 - DOD Commercial Air Carrier Evaluator's Credentials: Admission to pilots compartment: Forward...

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... Credentials: Admission to pilots compartment: Forward observer's seat. 135.76 Section 135.76 Aeronautics and... Commercial Air Carrier Evaluator's Credentials: Admission to pilots compartment: Forward observer's seat. (a.... (b) A forward observer's seat on the flight deck or forward passenger seat with headset or speaker...

  6. 14 CFR 135.76 - DOD Commercial Air Carrier Evaluator's Credentials: Admission to pilots compartment: Forward...

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... Credentials: Admission to pilots compartment: Forward observer's seat. 135.76 Section 135.76 Aeronautics and... Commercial Air Carrier Evaluator's Credentials: Admission to pilots compartment: Forward observer's seat. (a.... (b) A forward observer's seat on the flight deck or forward passenger seat with headset or speaker...

  7. 14 CFR 135.76 - DOD Commercial Air Carrier Evaluator's Credentials: Admission to pilots compartment: Forward...

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... Credentials: Admission to pilots compartment: Forward observer's seat. 135.76 Section 135.76 Aeronautics and... Commercial Air Carrier Evaluator's Credentials: Admission to pilots compartment: Forward observer's seat. (a.... (b) A forward observer's seat on the flight deck or forward passenger seat with headset or speaker...

  8. The Administration and Evaluation of Open Admissions at the City University of New York.

    ERIC Educational Resources Information Center

    Professional Staff Congress of the City Univ. of New York, NY.

    The Professional Staff Congress of the City University of New York (CUNY) presents in this document a critique of the open admissions policy at CUNY. If open admissions students were given a reasonable opportunity for collegiate success, then retention rates would lose much of their significance in evaluating the programs at the CUNY. But…

  9. Admissions; Evaluation of Credentials; Financial Aids; Marketing and Recruitment; Articulation Agreements and Practices.

    ERIC Educational Resources Information Center

    College and University, 1980

    1980-01-01

    Proceedings of the 66th Annual Meeting of the American Association of Collegiate Registrars and Admissions Officers that relate to admissions, evaluation of credentials, financial aid, marketing and recruitment, and articulation agreements and practices are summarized. Names and institutions of conference participants are included. (MSE)

  10. Admissions; Evaluation of Credentials; Financial Aids; Marketing and Recruitment; Articulation Agreements and Practices.

    ERIC Educational Resources Information Center

    College and University, 1981

    1981-01-01

    Proceedings of the 67th Annual Meeting of the American Association of Collegiate Registrars and Admissions Officers which relate to admissions, evaluation of credentials, student financial aid, marketing and recruitment, and articulation agreements and practices are summarized. Names and institutions of conference participants are included. (MSE)

  11. A Freshman Admissions Prediction Equation: An Evaluation and Recommendation.

    ERIC Educational Resources Information Center

    Chou, Tungshan; Huberty, Carl J.

    The effectiveness of the freshman admissions prediction equation (FAPE) at the University of Georgia (Athens) was studied, using data for 3,378 freshman (1,490 males and 1,888 females) in 1987-88. For the 1987-88 data, a previous (1982) prediction equation functioned poorly in terms of predictive accuracy. New prediction models were constructed…

  12. Evaluation of the Early Admission to First Grade Program.

    ERIC Educational Resources Information Center

    Hebbeler, Kathleen; And Others

    This report presents findings from the first year of a pilot program permitting kindergarten age students to enter school at the first grade level (K-1 program for 5-year-olds). The purposes of the study were: (1) to compare the academic and social behavior of the early admissions (EA) students with that of the regular first graders; (2) to…

  13. Variation exists in rates of admission to intensive care units for heart failure patients across hospitals in the United States

    PubMed Central

    Safavi, Kyan C.; Dharmarajan, Kumar; Kim, Nancy; Strait, Kelly M.; Li, Shu-Xia; Chen, Serene I.; Lagu, Tara; Krumholz, Harlan M.

    2013-01-01

    Background Despite increasing attention on reducing relatively costly hospital practices while maintaining the quality of care, few studies have examined how hospitals use the intensive care unit (ICU), a high-cost setting, for patients admitted with heart failure (HF). We characterized hospital patterns of ICU admission for patients with HF and determined their association with the use of ICU-level therapies and patient outcomes. Methods and Results We identified 166,224 HF discharges from 341 hospitals in the 2009–10 Premier Perspective® database. We excluded hospitals with <25 HF admissions, patients <18 years old, and transfers. We defined ICU as including medical ICU, coronary ICU, and surgical ICU. We calculated the percent of patients admitted directly to an ICU. We compared hospitals in the top-quartile (high ICU admission) with the remaining quartiles. The median percentage of ICU admission was 10% (Interquartile Range 6% to 16%; range 0% to 88%). In top-quartile hospitals, treatments requiring an ICU were used less often: percentage of ICU days receiving mechanical ventilation (6% top quartile versus 15% others), non-invasive positive pressure ventilation (8% versus 19%), vasopressors and/or inotropes (9% versus 16%), vasodilators (6% versus 12%), and any of these interventions (26% versus 51%). Overall HF in-hospital risk standardized mortality was similar (3.4% versus 3.5%; P = 0.2). Conclusions ICU admission rates for HF varied markedly across hospitals and lacked association with in-hospital risk-standardized mortality. Greater ICU use correlated with fewer patients receiving ICU interventions. Judicious ICU use could reduce resource consumption without diminishing patient outcomes. PMID:23355624

  14. New Study Shows Flu Vaccine Reduced Children's Risk of Intensive Care Unit Flu Admission by Three-Fourths

    MedlinePlus

    ... study published today in the Journal of Infectious Diseases. The study is the first to estimate vaccine effectiveness (VE) against flu admissions to pediatric intensive care units (PICU). It illustrates the important ...

  15. Risk of Death Influences Regional Variation in Intensive Care Unit Admission Rates among the Elderly in the United States

    PubMed Central

    2016-01-01

    Rationale The extent to which geographic variability in ICU admission across the United States is driven by patients with lower risk of death is unknown. Objectives To determine whether patients at low to moderate risk of death contribute to geographic variation in ICU admission. Methods Retrospective cohort of hospitalizations among Medicare beneficiaries (age > 64 years) admitted for ten common medical and surgical diagnoses (2004 to 2009). We examined population-adjusted rates of ICU admission per 100 hospitalizations in 304 health referral regions (HRR), and estimated the relative risk of ICU admission across strata of regional ICU and risk of death, adjusted for patient and regional characteristics. Measurement and Main Results ICU admission rates varied nearly two-fold across HRR quartiles (quartile 1 to 4: 13.6, 17.3, 20.0, and 25.2 per 100 hospitalizations, respectively). Observed mortality for patients in regions (quartile 4) with the greatest ICU use was 17% compared to 21% in regions with lowest ICU use (quartile 1) (p<0.001). After adjusting for patient and regional characteristics, including regional differences in ICU, skilled nursing, and long-term acute care bed capacity, individuals’ risk of death modified the relationship between regional ICU use and an individual’s risk of ICU admission (p for interaction<0.001). Region was least important in predicting ICU admission among patients with high (quartile 4) risk of death (RR 1.27, 95% CI 1.22–1.31, for high versus low ICU use regions), and most important for patients with moderate (quartile 2; RR 1.63, 95% CI 1.53–1.72, quartile 3; RR 1.56 95% CI 1.47–1.65) and low (quartile 1) risk of death (RR 1.50, 95% CI 1.41–1.59). Conclusions There is wide variation in in ICU use by geography, independent of ICU beds and physician supply, for patients with low and moderate risks of death. PMID:27898697

  16. Paediatric head injury admissions over a 10-year period in a regional neurosurgical unit.

    PubMed

    Phang, I; Mathieson, C; Sexton, I; Forsyth, S; Brown, J; St George, E J

    2012-08-01

    Traumatic brain injury is a leading cause of death and disability in childhood. A retrospective study of all paediatric head injuries admitted to the neurosurgical unit for the West of Scotland over a 10-year period was performed to assess the impact of the National Institute for Health and Clinical Excellence head injury guidelines on the admission rate and to determine the associated risk factors, causes, severity and outcomes of these injuries. There were 564 admissions between 1998 and 2007. The median age at presentation was nine years and two months. There was no change in the admission rate, injury mechanism or severity of head injury admitted over the period studied. A relationship was observed between the Scottish Index of Multiple Deprivation Score and the incidence of head injury (P = 0.05). Alcohol was reported as a causative factor in only a small number of cases, and moderate to severe head injuries were more commonly identified as a result of road traffic accidents.

  17. Risk factors for neonatal intensive care unit admission in Amman, Jordan.

    PubMed

    Quinn, C E; Sivasubramaniam, P; Blevins, M; Al Hajajra, A; Znait, A Taleb; Khuri-Bulos, N; Faouri, S; Halasa, N

    2016-06-15

    A better understanding of risk factors for neonatal intensive care unit (NICU) admission can inform interventions to improve neonatal survival. This study aimed to describe a population of newborns admitted to a NICU in Amman, Jordan, and compare them with newborns discharged to home. Newborns born within 96 hours at Al-Bashir Hospital were enrolled from February 2010 to June 2011. Demographic and clinical data were collected for mothers and newborns. Of 5466 enrolled neonates, 373 (6.8%) were admitted to the NICU. The median gestational age of NICU infants was 36 weeks, median birth weight was 2.2 kg and 49.5% were delivered by non-elective caesarean section. Lower gestational age, lower birth weight, delivery by caesarean section and birth in the month of May were statistically significant risk factors for NICU admission. Risk factors for NICU admission were consistent with other populations worldwide; however, median gestational age and birth weight were higher than in developed countries.

  18. Effectiveness of a Surgery Admission Unit for patients undergoing major elective surgery in a tertiary university hospital

    PubMed Central

    2010-01-01

    Background The increasing demand on hospitalisation, either due to elective activity from the waiting lists or due to emergency admissions coming from the Emergency Department (ED), requires looking for strategies that lead to effective bed management. The aim of this study was to evaluate the effectiveness of a surgery admission unit for major elective surgery patients who were admitted for same-day surgery. Methods We included all patients admitted for elective surgery in a university tertiary hospital between the 1st of September and the 31st of December 2006, as well as those admitted during the same period of 2008, after the introduction of the Surgery Admission Unit. The main outcome parameters were global length of stay, pre-surgery length of stay, proportion of patients admitted the same day of the surgery and number of cancellations. Differences between the two periods were evaluated by the T-test and Chi-square test. Significance at P < 0.05 was assumed throughout. Results We included 6,053 patients, 3,003 during 2006 and 3,050 patients during 2008. Global length of stay was 6.2 days (IC 95%:6.4-6) in 2006 and 5.5 days (IC 95%:5.8-5.2) in 2008 (p < 0.005). Pre-surgery length of stay was reduced from 0.46 days (IC 95%:0.44-0.48) in 2006 to 0.29 days (IC 95%:0.27-0.31) in 2008 (p < 0.005). The proportion of patients admitted for same-day surgery was 67% (IC 95%:69%-65%) in 2006 and 76% (IC 95%:78%-74%) in 2008 (p < 0.005). The number of cancelled interventions due to insufficient preparation was 31 patients in 2006 and 7 patients in 2008. Conclusions The implementation of a Surgery Admission Unit for patients undergoing major elective surgery has proved to be an effective strategy for improving bed management. It has enabled an improvement in the proportion of patients admitted on the same day as surgery and a shorter length of stay. PMID:20096114

  19. The epidemiology of admissions of nontraumatic subarachnoid hemorrhage in the United States.

    PubMed

    Rincon, Fred; Rossenwasser, Robert H; Dumont, Aaron

    2013-08-01

    Subarachnoid hemorrhage (SAH) is the cause of 5% to 10% of strokes annually in the United States. To study the incidence and mortality trends of admissions of SAH from 1979 to 2008 using a nationally representative sample of all nonfederal acute-care hospitals in the United States: The National Hospital Discharge Survey. The sample was obtained from the hospital discharge records according to the International Classification of Disease, 9th Revision, Clinical Modification code 430. We reviewed data on approximately 1 billion hospitalizations in the United States over a 30-year study period and identified 612,500 cases of SAH, which was more common in women (relative risk 1.71, 95% confidence interval 1.7-1.72) and nonwhite persons than white persons (relative risk 1.46, 95% confidence interval 1.4-1.5). The estimated incidence rate of admission after SAH was 7.2 to 9.0 per 100,000/year and did not significantly change over the study period. Overall, in-hospital mortality after SAH fell from 30% during the period from 1979 to 1983 to 20% during the subperiod from 2004 to 2008 (P = .03) and was lower in larger treating hospitals. The average days of care for SAH hospitalizations decreased, but the rate of discharge to long-term care facilities increased. The incidence rate of admission after SAH has remained stable over the past 30 years. Total deaths and in-hospital mortality after SAH have decreased significantly. In-hospital mortality after SAH is lower in larger treating hospitals.

  20. Mortality and morbidity among elderly people with burns--evaluation of data on admission.

    PubMed

    Lumenta, D B; Hautier, A; Desouches, C; Gouvernet, J; Giorgi, R; Manelli, J-C; Magalon, G

    2008-11-01

    People aged >or=65 years represent a growing population within burns units in the Western world. In 2001, this group was reported to rise to 20% of such admissions. We reviewed the records of 265 burn cases with complete admission and discharge histories, from January 1990 to December 2003 in an A-level regional burns centre. The predictive value of age, gender, total body surface area burned (TBSA), inhalation trauma (IT), premorbid conditions and currently used burn scores (Baux, ABSI, Ryan) for haemodynamic or respiratory complications, mortality and morbidity were analysed. Additionally a subset of patients with diabetes mellitus and >30% total body surface area burned were reviewed. About 16% of all admissions with burns were >or=65 years of age, with a mortality rate of 30.6% (81/265). Only gender and premorbid conditions did not influence mortality. Haemodynamic and respiratory complications were significantly related to TBSA, presence of I and any of the three scores (all p<0.001). Among survivors (184/265), the median duration of hospital stay was 26.0 days. Factors contributing to a significantly increased length of stay were, in decreasing order, total body surface area burned, high levels of burn scores, inhalation trauma, flame injury and certain premorbid conditions (cardiovascular disease, alcoholism). About 77.7% of all patients were discharged either to a rehabilitation centre or back to their previous form of housing. This study showed that among burned people aged >or=65 years a good outcome as evaluated on discharge can be achieved. Studies pooling different centres' results are needed to improve the significance of conclusions drawn from these data.

  1. Trauma admissions into the intensive care unit and outcome of care in a tertiary health facility.

    PubMed

    Olajumoke, T O; Oyebamiji, E O; Afolayan, J M; Adekunle, M

    2014-01-01

    Trauma remains a leading cause of morbidity and mortality in resource challenged economies I. In Nigeria, the number of deaths due to trauma-induced injuries is on the rise. Major trauma victims are usually from road traffic accidents and are managed at the accident and emergency unit while the severe ones are admitted into the intensive care unit. All trauma admissions to the intensive care unit (ICU) of LAUTECHTeaching Hospital Osogbo over a 5 year period (2008-2012) after ethical approval from the ethical unit of the hospital were reviewed. During the study period, 112 trauma patients were admitted to the ICU, representing 68% of total ICU admissions. The male:female ratio of ICU trauma cases was 3:1. Out of the trauma admissions 83 (74.1%) of the cases came as emergency from the accident and emergency unit while 2.4% and 1.6% respectively came from operating theatre-- and the general ward respectively. 83 (74.1%) of trauma cases admitted were road traffic accidents, while 20 (17.9%) were burns not related to RTA and the remaining 8(9%) were due to falls, fight/ssault. Most of the road traffic accidents related trauma patients admitted to the intensive care unit had head injuries (66.3%) while 7% and 12% had multiple fractures and chest injuries respectively. The mean patient age 35 years and the mean duration of ICU stay was 6.3 ± 8.4 days. Survivors had a longer ICU stay Trauma is a major cause of hospitalization and intensive care utilization. It also consumes a significant amount of the health care budget.In most instances it is preventtable.Trauma prevention, the most effective management strategy should include increased public education, improved security, better implementation of legislative measures to ensure safety for all road users, control of firearms, and minimizing domestic and intentional violence. Appropriate, aggressive intensive care in combination with efficient communications,rapid medical evacuation, and an organized emergency

  2. Admission time to hospital: a varying standard for a critical definition for admissions to an intensive care unit from the emergency department.

    PubMed

    Nanayakkara, Shane; Weiss, Heike; Bailey, Michael; van Lint, Allison; Cameron, Peter; Pilcher, David

    2014-11-01

    Time spent in the emergency department (ED) before admission to hospital is often considered an important key performance indicator (KPI). Throughout Australia and New Zealand, there is no standard definition of 'time of admission' for patients admitted through the ED. By using data submitted to the Australian and New Zealand Intensive Care Society Adult Patient Database, the aim was to determine the differing methods used to define hospital admission time and assess how these impact on the calculation of time spent in the ED before admission to an intensive care unit (ICU). Between March and December of 2010, 61 hospitals were contacted directly. Decision methods for determining time of admission to the ED were matched to 67,787 patient records. Univariate and multivariate analyses were conducted to assess the relationship between decision method and the reported time spent in the ED. Four mechanisms of recording time of admission were identified, with time of triage being the most common (28/61 hospitals). Reported median time spent in the ED varied from 2.5 (IQR 0.83-5.35) to 5.1 h (2.82-8.68), depending on the decision method. After adjusting for illness severity, hospital type and location, decision method remained a significant factor in determining measurement of ED length of stay. Different methods are used in Australia and New Zealand to define admission time to hospital. Professional bodies, hospitals and jurisdictions should ensure standardisation of definitions for appropriate interpretation of KPIs as well as for the interpretation of studies assessing the impact of admission time to ICU from the ED. WHAT IS KNOWN ABOUT THE TOPIC?: There are standards for the maximum time spent in the ED internationally, but these standards vary greatly across Australia. The definition of such a standard is critically important not only to patient care, but also in the assessment of hospital outcomes. Key performance indicators rely on quality data to improve decision

  3. Prevention of unplanned intensive care unit admissions and hospital mortality by early warning systems.

    PubMed

    Mapp, Ila D; Davis, Leslie L; Krowchuk, Heidi

    2013-01-01

    Researchers have found that patients exhibit physiological changes up to 8 hours prior to an arrest event. Deaths have been attributed to a lack of observation, lack of documentation of observations, inability of a caregiver to recognize early signs of deterioration, and lack of communication between healthcare providers. This integrative review examines early warning scoring systems and their effectiveness in predicting a patient's potential for deterioration and considers whether these scoring systems prevent unplanned intensive care unit admissions and/or death. Three databases (MEDLINE, CINAHL [Cumulative Index to Nursing and Allied Health Literature], and the Cochrane Collaboration) were searched to identify the instruments and clinical support systems available to assist healthcare personnel in recognizing early clinical deterioration. Key search words included modified early warning score, early warning score, early warning systems, deteriorating patient, patients at risk, shock index, track and trigger systems, and failure to rescue. Two prior literature reviews examined early warning scoring systems and their effects on patient outcomes; however, the most recent one reviewed only articles published before 2007. This review examined studies of early warning systems and the incorporation of clinical support published from 2007 to 2012. Nine studies fitting the search criteria were included in this review. Early warning scoring systems that interface with electronic medical records and are supplemented with decision aides (algorithms) and clinical support systems produce an effective screening system for early identification of deteriorating patients. This multifaceted approach decreases unplanned intensive care unit admissions and hospital mortality.

  4. [Distribution and appropriateness of hospital admissions, resource utilization in the Italian intensive cardiac care units. The BLITZ-3 study].

    PubMed

    Visconti, Luigi Oltrona; Scorcu, Giampaolo; Cassin, Matteo; Casella, Gianni; Chinaglia, Alessandra; Conte, Maria Rosa; Fradella, Giuseppe; Lucci, Donata; Maggioni, Aldo Pietro; Pirelli, Salvatore; Chiarella, Francesco

    2011-01-01

    The BLITZ-3 study prospectively evaluated the epidemiology of hospital admissions, the patterns of care and the most important comorbidities in intensive cardiac care unit (ICCU) patients. Distribution and level of appropriateness of hospital admissions in relation to type of ICCU were analyzed (type A, 32%, without cardiac cath lab or cardiac surgery; type B, 49%, with cath lab; type C, 19%, with both cath lab and cardiac surgery). The caseload was estimated on the basis of different levels of mortality risk during the ICCU stay: high (>5.1%), intermediate (0.7-5.1%), low (< or = 0.7%). A total of 6986 consecutive patients admitted to 332 ICCUs were enrolled. A median number of 19 patients (interquartile range 15-26) was admitted to each center during the 14 days of enrollment; 28% of the ICCUs admitted more than 25 patients, 48% between 15 and 25, and 24% less than 15. A higher number of type A ICCUs admitted less than 15 patients (p<0.0001), whereas a higher number of type C ICCUs admitted more than 25 patients (p<0.0001). Hospital admissions for ST-elevation myocardial infarction occurred more frequently in type B or C ICCUs (p<0.0001), whereas hospital admission for heart failure mostly occurred in type A ICCUs (p<0.0001). The number of patients not undergoing reperfusion (p<0.0001) or treated with thrombolytic therapy (p<0.0001) was higher in the type A ICCUs. Coronary revascularization with primary percutaneous coronary intervention was performed more frequently in type B and C ICCUs (p<0.0001). Similarly, patients hospitalized for acute coronary syndrome underwent coronary angiography (p<0.0001) and percutaneous coronary intervention more frequently in type B and C ICCUs (p<0.0001). Prevalence of low-risk rather than intermediate- or high-risk patients was higher in type A ICCUs (p<0.05), and prevalence of high- or intermediate-risk patients was higher in type C ICCUs (p<0.05). The results of the BLITZ-3 study should lead the Italian cardiological community

  5. Unplanned Intensive Care Unit Admission following Elective Surgical Adverse Events: Incidence, Patient Characteristics, Preventability, and Outcome

    PubMed Central

    Meziane, Mohammed; El Jaouhari, Sidi Driss; ElKoundi, Abdelghafour; Bensghir, Mustapha; Baba, Hicham; Ahtil, Redouane; Aboulaala, Khalil; Balkhi, Hicham; Haimeur, Charki

    2017-01-01

    Context: Adverse events (AEs) are a persistent and an important reason for Intensive Care Unit (ICU) admission. They lead to death, disability at the time of discharge, unplanned ICU admission (UIA), and prolonged hospital stay. They impose large financial costs on health-care systems. Aims: This study aimed to determine the incidence, patient characteristics, type, preventability, and outcome of UIA following elective surgical AE. Settings and Design: This is a single-center prospective study. Methods: Analysis of 15,372 elective surgical procedures was performed. We defined UIA as an ICU admission that was not anticipated preoperatively but was due to an AE occurring within 5 days after elective surgery. Statistical Analysis: Descriptive analysis using SPSS software version 18 was used for statistical analysis. Results: There were 75 UIA (0.48%) recorded during the 2-year study period. The average age of patients was 54.64 ± 18.02 years. There was no sex predominance, and the majority of our patients had an American Society of Anesthesiologist classes 1 and 2. Nearly 29% of the UIA occurred after abdominal surgery and 22% after a trauma surgery. Regarding the causes of UIA, we observed that 44 UIA (58.7%) were related to surgical AE, 24 (32%) to anesthetic AE, and 7 (9.3%) to postoperative AE caused by care defects. Twenty-three UIA were judged as potentially preventable (30.7%). UIA was associated with negative outcomes, including increased use of ICU-specific interventions and high mortality rate (20%). Conclusions: Our analysis of UIA is a quality control exercise that helps identify high-risk patient groups and patterns of anesthesia or surgical care requiring improvement.

  6. Life-threatening onset of systemic vasculitis requiring intensive care unit admission: a case series.

    PubMed

    Monti, S; Montecucco, C; Pieropan, S; Mojoli, F; Braschi, A; Caporali, R

    2015-01-01

    Onset of ANCA-associated vasculitis (AAV) can be abrupt with life-threatening manifestations requiring Intensive Care Unit (ICU) admission. A high level of suspicion leading to prompt diagnosis is essential. Our objective was to investigate the epidemiologic characteristics and the type of life-threatening manifestations. Medical records of AAV patients were analysed, selecting those with an ICU onset to identify predictive signs or symptoms and past medical history warnings useful for diagnosis. Out of 90 patients with AAV, 10 (11.1%) showed an ICU onset. The most frequent AAV diagnosed in the ICU was eosinophilic granulomatosis with polyangiitis (EGPA) (60%), followed by granulomatosis with polyangiitis (GPA) (20%) and microscopic polyangiitis (MPA) (20%). Cardio-pulmonary involvement was the main cause for ICU admission (70%) and significantly distinguished the ICU onset group from other AAV. The most frequent anamnestic warnings were history of asthma (50%), nasal polyps (30%), eosinophilia (30%). Symptoms shortly preceding ICU admission were arthralgia, fever (30%) and purpuric lesions (20%). ANCA were positive in 60% of patients. Mean Birmingham Vasculitis Activity Score (BVAS) at diagnosis was 16±8.43 and 0.88±1.45 at the end of follow up. All patients survived with a 10% rate of chronic kidney disease and a mean Vasculitis Damage Index (VDI) of 2±1.15. Keeping a high level of suspicion for AAV is mandatory, particularly when treating life-threatening onset manifestations in the ICU. A history of asthma, nasal polyps, eosinophilia and arthralgia should always be investigated. ANCA are negative in about half of cases, therefore clinical expertise and strict collaboration with the rheumatologist are still pivotal.

  7. 22 CFR 50.11 - Certificate of identity for travel to the United States to apply for admission.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 22 Foreign Relations 1 2013-04-01 2013-04-01 false Certificate of identity for travel to the United States to apply for admission. 50.11 Section 50.11 Foreign Relations DEPARTMENT OF STATE NATIONALITY AND PASSPORTS NATIONALITY PROCEDURES Procedures for Determination of United States Nationality of...

  8. 22 CFR 50.11 - Certificate of identity for travel to the United States to apply for admission.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Certificate of identity for travel to the United States to apply for admission. 50.11 Section 50.11 Foreign Relations DEPARTMENT OF STATE NATIONALITY AND PASSPORTS NATIONALITY PROCEDURES Procedures for Determination of United States Nationality of...

  9. 22 CFR 50.11 - Certificate of identity for travel to the United States to apply for admission.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 22 Foreign Relations 1 2011-04-01 2011-04-01 false Certificate of identity for travel to the United States to apply for admission. 50.11 Section 50.11 Foreign Relations DEPARTMENT OF STATE NATIONALITY AND PASSPORTS NATIONALITY PROCEDURES Procedures for Determination of United States Nationality of...

  10. 22 CFR 50.11 - Certificate of identity for travel to the United States to apply for admission.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 22 Foreign Relations 1 2012-04-01 2012-04-01 false Certificate of identity for travel to the United States to apply for admission. 50.11 Section 50.11 Foreign Relations DEPARTMENT OF STATE NATIONALITY AND PASSPORTS NATIONALITY PROCEDURES Procedures for Determination of United States Nationality of...

  11. 22 CFR 50.11 - Certificate of identity for travel to the United States to apply for admission.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 22 Foreign Relations 1 2014-04-01 2014-04-01 false Certificate of identity for travel to the United States to apply for admission. 50.11 Section 50.11 Foreign Relations DEPARTMENT OF STATE NATIONALITY AND PASSPORTS NATIONALITY PROCEDURES Procedures for Determination of United States Nationality of...

  12. Duration of Maternal Stress and Depression: Predictors of Newborn Admission to Neonatal Intensive Care Unit and Postpartum Depression.

    PubMed

    Latendresse, Gwen; Wong, Bob; Dyer, Jane; Wilson, Barbara; Baksh, Laurie; Hogue, Carol

    2015-01-01

    Maternal psychosocial factors contribute to adverse pregnancy outcome, but very few studies have assessed associations of duration and experiences of stress, depression, and intimate partner violence (IPV) with maternal and newborn outcomes. It was hypothesized that duration and level of maternal stress, depression, and IPV would predict increased risk of adverse maternal/newborn outcomes. A secondary data analysis of a population-based data set collected by the Utah Department of Health Pregnancy Risk Assessment and Monitoring System and birth certificates for 4682 live births was conducted, reflecting a total population size of 143,373 live births in 2009-2011. Exposures of interest were experiences and duration of maternal stress, depression, and IPV before and during pregnancy. Outcomes were gestational age, birth weight, newborn admission to the neonatal intensive care unit (NICU), and postpartum depression (PPD) symptoms and diagnosis. After controlling for maternal demographics, body mass index, and smoking, women with greater duration of depression before and during pregnancy showed an increase in admission of their newborn to NICU (adjusted odds ratios [aORs] = 1.66-2.48, p < .001), PPD symptoms (aORs = 3.94-9.13, p < .001), and diagnosis of PPD (aORs = 7.72-59.60, p < .001). More kinds of experiences of maternal stress were associated with higher odds of PPD symptoms (aORs = 1.34-5.51, p < .001), but not PPD diagnosis or NICU admissions. Longer lasting maternal depression and stress are associated with poorer outcomes for mothers and newborns. Future prospective studies should evaluate the usefulness of preconception and continuous prenatal risk identification of maternal depression and stress. This would facilitate timely psychosocial interventions as an approach to improving maternal/newborn outcomes for these higher risk women.

  13. Lumbar puncture for suspected meningitis after intensive care unit admission is likely to change management.

    PubMed

    Khasawneh, Faisal A; Smalligan, Roger D; Mohamad, Tammam N; Moughrabieh, Mohamad K; Soubani, Ayman O

    2011-02-01

    The aim of this study was to determine the outcome of lumbar punctures (LPs) in critically ill medical patients and how likely the results were to change case management. A retrospective review was conducted on the medical records of all 168 patients who underwent LP during their medical intensive care unit (MICU) admission at a university hospital during a 4.5-year period beginning in January 2000. Lumbar puncture was performed a mean of 2.8 days after MICU admission. The most common symptoms that prompted LP were changes in mental status and fever. Seventy-four percent of patients were on antibiotics at the time of LP, and 98% of patients had a computed tomography scan of the head performed before the procedure. Lumbar puncture confirmed meningitis in 47 (30%) patients and provided a specific bacteriologic diagnosis in 5 (3%) patients. The results of the procedure led to a change in management in 50 (30%) patients. The presence of meningeal signs and use of antibiotics at the time of the procedure were the factors that predicted change in management. Although the likelihood that LP will yield a specific bacteriologic diagnosis in critically ill patients is low, the procedure frequently provides important information that can lead to a change in case management, most commonly de-escalation of antibiotic therapy.

  14. Analysis of the discrepancies identified during medication reconciliation on patient admission in cardiology units: a descriptive study

    PubMed Central

    Lombardi, Natália Fracaro; Mendes, Antonio Eduardo Matoso; Lucchetta, Rosa Camila; Reis, Wálleri Christini Torelli; Fávero, Maria Luiza Drechsel; Correr, Cassyano Januário

    2016-01-01

    ABSTRACT Objectives: this observational study aimed to describe the discrepancies identified during medication reconciliation on patient admission to cardiology units in a large hospital. Methods: the medication history of patients was collected within 48 hours after admission, and intentional and unintentional discrepancies were classified as omission, duplication, dose, frequency, timing, and route of drug administration. Results: most of the patients evaluated were women (58.0%) with a mean age of 59 years, and 75.5% of the patients had a Charlson comorbidity index score between 1 and 3. Of the 117 discrepancies found, 50.4% were unintentional. Of these, 61.0% involved omission, 18.6% involved dosage, 18.6% involved timing, and 1.7% involved the route of drug administration. Conclusion: this study revealed a high prevalence of discrepancies, most of which were related to omissions, and 50% were unintentional. These results reveal the number of drugs that are not reincorporated into the treatment of patients, which can have important clinical consequences. PMID:27533269

  15. Incidence and risk factors for intensive care unit admission after bariatric surgery: a multicentre population-based cohort study.

    PubMed

    Morgan, D J R; Ho, K M; Armstrong, J; Baker, S

    2015-12-01

    With increasing rates of bariatric surgery and the consequential involvement of increasingly complex patients, uncertainty remains regarding the use of intensive care unit (ICU) services after bariatric surgery. Our objective was to define the incidence, indications, and outcomes of patients requiring ICU admission after bariatric surgery and assess whether unplanned ICU admission could be predicted using preoperative factors. All adult bariatric surgery patients between 2007 and 2011 in Western Australia were identified from the Department of Health Data Linkage Unit database and merged with a separate database encompassing all subsequent ICU admissions pertaining to bariatric surgery. The minimal and mean follow-up periods were 12 months and 3.4 yr, respectively. Of the 12 062 patients who underwent bariatric surgery during the study period, 590 patients (4.9%; 650 ICU admissions) were admitted to an ICU after their bariatric surgery. Patients admitted to the ICU were older (48 vs 43 yr, P<0.001), more likely to be male (49.7 vs 20.2%, P<0.001), and more likely to require revisional bariatric surgery (14.4 vs 7.1%, P<0.001). One hundred and seventy-six patients required an emergent unplanned ICU admission, with 51 requiring multiple ICU admissions. Revisional or open surgery, diabetes mellitus, chronic respiratory disease, and obstructive apnoea were the strongest preoperative factors associated with unplanned ICU admission. Intensive care unit admission after bariatric surgery was uncommon (4.9% of all patients), with 30.9% of all referrals being unplanned. A nomogram and smartphone application based on five important preoperative factors may assist anaesthetists to conduct preoperative planning for high-risk bariatric surgical patients. © The Author 2015. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  16. Primary immunodeficiencies in Chile evaluated through ICD-10 coded hospital admissions.

    PubMed

    Poli, C; Hoyos-Bachiloglu, R; Borzutzky, A

    The epidemiology and hospitalisation trends of primary immunodeficiency (PID) in Chile are unknown. We aimed to evaluate hospitalisation trends and demographic characteristics of PID admissions in Chile. PID admissions between 2001 and 2010 (ICD-10 codes D70.0, D70.4, D71, 72.0, D76.1, D80-D84, E70.3, G11.3) were reviewed using national hospital discharge databases. During the study period, 5486 admissions due to PID were registered (0.03% of total). 58.5% of patients were male and 66.3% were under 18 years. Median length of stay was one day (range 1-403 days). The most frequent diagnoses were hypogammaglobulinaemia (27.6%), unspecified immunodeficiency (21.9%), haemophagocytic lymphohystiocytosis (18.3%) and common variable immunodeficiency (11.2%). There was a significant increase in PID admission rate and in one-day hospitalisations during this period (β=0.2; P=0.001 and β=33; P≤0.001, respectively), however no significant variation was found for longer admissions (β=4.8; P=0.175). The increasing trend in PID admission rate was significant in patients with private, but not public insurance (β=0.53; P≤0.001 vs. β=0.08; P=0.079, respectively). We report an increasing trend in admissions due to PID in Chile over a 10-year period. Increase is mainly due to short hospitalisations, possibly accounting for improvements in IVIG access. Higher admission rates in patients with private vs. public insurance suggest socioeconomic disparities in access to PID treatment. ICD-10 coded hospitalisation databases may be useful to determine hospitalisation trends and demographic characteristics of PID admissions worldwide. Copyright © 2016 SEICAP. Published by Elsevier España, S.L.U. All rights reserved.

  17. Preventable pediatric intensive care unit admissions over a 13-year period at a level 1 pediatric trauma center.

    PubMed

    Fenton, Stephen J; Campbell, Stephen J; Stevens, Austin M; Zhang, Chong; Presson, Angela P; Lee, Justin H

    2016-10-01

    No formal criteria exist to determine the need for admission of injured children to the pediatric intensive care unit. Our objective was to analyze trauma patient admissions to the PICU at a level 1 pediatric trauma center. The trauma registry was analyzed between 2002 and 2015. A preventable PICU admission was defined as a child discharged home or transferred out of the PICU within 30h without surgical intervention, blood transfusion, or ventilator support. Of 16,209 children, 19% were admitted to the PICU: mean age 7.3years, median ISS 17, and overall mortality 7%. Per our definition, 36% were preventable PICU admissions of which 83% suffered a head injury. The preventable admissions were younger (6.9 vs. 7.6years, p<0.001) with a lower median ISS (16 vs. 21, p<0.001), shorter median PICU LOS (17 vs. 41h, p<0.001) and shorter median hospital LOS (51 vs. 121h, p<0.001). These admissions resulted in total facility charges of $9,981,454.76 with 54% produced by children with an isolated head injury. A significant number of children admitted to our PICU were classified as preventable. They carry a substantial economic burden to the health care system with an overutilization of resources. Methods to limit such admissions should be actively pursued. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. Association of antidepressant treatment with emergency admission to medical units for patients 65 years or older.

    PubMed

    Ortuño, Noèlia; Cobo, Jesús; González, Espe; García, Imma; Ferrer, María-Dolores; Campos, Carmen; Planet, Núria; Oliva, Joan-Carles; Suárez, Mónica; Iglesias-Lepine, María-Luisa; García-Parés, Gemma

    There is increasing evidence relating the presence of depression in seniors and the risk of hospital admission in medical departments from the Emergency Services. To determine the impact of antidepressant treatment (ATD) as a protective factor for emergency hospitalization in older people. All patients aged 65 and over who required urgent attention for medical reasons at the Emergency Department of the Corporació Sanitària i Universitària Parc Taulí (Sabadell, Barcelona, Spain) for the period between January and October 2012 were included in the study. Sociodemographic variables, alcohol and tobacco use, medical history and psychopharmacological treatment were obtained. The necessary sample size was calculated and a simple randomization was performed. Subsequently, a descriptive statistical analysis and parametric tests were conducted. A total of 674 patients (53% women) were evaluated, with a mean age of 78.45 years, and 27.6% of the cases (71% women) were receiving ATD. Among the 333 admitted patients (50%), 83 individuals (24.6%) had previously received ATD; this contrasts with the 103 cases (30.6%) of prior ATD treatment among the patients who were not admitted. After comparative analysis, the relationship between previous use of ATD and being admitted to hospital was not statistically significant in our global sample. This relationship was only statistically significant among the group aged 75 and over (neg. sig. 0.012). In our study, ATD was associated with a decreased risk of hospital admission for urgent medical conditions in people aged 75 and over. Treating depression may protect the elderly against admission to the Emergency department and may potentially be a quality criterion in preventing complications in this population. Copyright © 2014 SEP y SEPB. Publicado por Elsevier España, S.L.U. All rights reserved.

  19. Preoperative and surgical factors associated with postoperative intensive care unit admission following operative treatment for degenerative lumbar spine disease.

    PubMed

    Kay, Harrison F; Chotai, Silky; Wick, Joseph B; Stonko, David P; McGirt, Matthew J; Devin, Clinton J

    2016-03-01

    Evaluate the factors associated with postoperative ICU admission in patients undergoing surgical management of degenerative lumbar spine disease. Patients undergoing surgery for degenerative lumbar spine disease were enrolled into a prospective registry over a 2-year period. Preoperative variables (age, gender, ASA grade, ODI%, CAD, HTN, MI, CHF, DM, BMI, depression, anxiety) and surgical variables (instrumentation, arthrodesis, estimated blood loss, length of surgery) were collected prospectively. Postoperative ICU admission details were retrospectively determined from the electronic medical record. Student's t test (continuous variables) and Chi-square test (categorical variables) were used to determine the association of each preoperative and surgical variable with ICU admission. 808 Patients (273 laminectomy, 535 laminectomy and fusion) were evaluated. Forty-one (5.1%) patients were found to have postoperative ICU admissions. Reasons for admission included blood loss (12.2%), cardiac (29.3%), respiratory (19.5%), neurologic (31.7%), and other (7.3%). For preoperative variables, female gender (P < 0.001), history of CAD (P = 0.003), history of MI (P = 0.008), history of CHF (P = 0.001), age (P = 0.025), and ASA grade (P = 0.008) were significantly associated with ICU admission. For surgical variables, estimated blood loss (P < 0.001) and length of surgery (P < 0.001) were significantly associated with ICU admission. Age, female gender, ASA grade, cardiac comorbidities, intraoperative blood loss, and length of surgery were associated with increased risk of postoperative ICU admission. Knowledge of these factors can aid surgeons in patient selection and preoperative discussion with patients about potential need for unexpected admission to the ICU.

  20. Factors potentially associated with the decision of admission to the intensive care unit in a middle-income country: a survey of Brazilian physicians

    PubMed Central

    Ramos, João Gabriel Rosa; Passos, Rogerio da Hora; Baptista, Paulo Benigno Pena; Forte, Daniel Neves

    2017-01-01

    Objective To evaluate the factors potentially associated with the decision of admission to the intensive care unit in Brazil. Methods An electronic survey of Brazilian physicians working in intensive care units. Fourteen variables that were potentially associated with the decision of admission to the intensive care unit were rated as important (from 1 to 5) by the respondents and were later grouped as "patient-related," "scarcity-related" and "administrative-related" factors. The workplace and physician characteristics were evaluated for correlation with the factor ratings. Results During the study period, 125 physicians completed the survey. The scores on patient-related factors were rated higher on their potential to affect decisions than scarcity-related or administrative-related factors, with a mean ± SD of 3.42 ± 0.7, 2.75 ± 0.7 and 2.87 ± 0.7, respectively (p < 0.001). The patient's underlying illness prognosis was rated by 64.5% of the physicians as always or frequently affecting decisions, followed by acute illness prognosis (57%), number of intensive care unit beds available (56%) and patient's wishes (53%). After controlling for confounders, receiving specific training on intensive care unit triage was associated with higher ratings of the patient-related factors and scarcity-related factors, while working in a public intensive care unit (as opposed to a private intensive care unit) was associated with higher ratings of the scarcity-related factors. Conclusions Patient-related factors were more frequently rated as potentially affecting intensive care unit admission decisions than scarcity-related or administrative-related factors. Physician and workplace characteristics were associated with different factor ratings. PMID:28977256

  1. The Educational System of the United Kingdom. The Admission and Placement of Students from the United Kingdom and Study Abroad Opportunities. A Workshop Report.

    ERIC Educational Resources Information Center

    Higashi, Sylvia K., Ed.; Margolis, Alan, Ed.

    This report, the result of a workshop on admissions, placement and study abroad in United Kingdom higher education, focuses on areas of significant change in the educational system since 1976. A chapter on study abroad provides an overview of educational change in Britain focusing on the issue of assisting United States students who might want or…

  2. Simulated minority admissions exercise at Louisiana State University School of Medicine: an evaluation.

    PubMed

    Helm, E G; Prieto, D O; Sedlacek, W E

    1997-09-01

    The Louisiana State University (LSU) School of Medicine-New Orleans has been active in recruiting minority students to create a diverse medical student body. Recognizing the need to explore ways to assess minority applicants, over the past 10 years, LSU has offered Stimulated Minority Admissions Exercise (SMAE) workshops to its admission committee members. Participants in six of LSU's SMAE workshops were asked to respond anonymously to an evaluation form immediately following the workshop. Sixty of the 64 participants responded. The overall evaluation of the workshops was positive. More than 80% of participants indicated that due to their participation in SMAE, they knew how to locate and assess application data particularly relevant to minority applicants. The results suggest that identifying variables that enhance minority student admission and retention is desirable.

  3. Simulated minority admissions exercise at Louisiana State University School of Medicine: an evaluation.

    PubMed Central

    Helm, E. G.; Prieto, D. O.; Sedlacek, W. E.

    1997-01-01

    The Louisiana State University (LSU) School of Medicine-New Orleans has been active in recruiting minority students to create a diverse medical student body. Recognizing the need to explore ways to assess minority applicants, over the past 10 years, LSU has offered Stimulated Minority Admissions Exercise (SMAE) workshops to its admission committee members. Participants in six of LSU's SMAE workshops were asked to respond anonymously to an evaluation form immediately following the workshop. Sixty of the 64 participants responded. The overall evaluation of the workshops was positive. More than 80% of participants indicated that due to their participation in SMAE, they knew how to locate and assess application data particularly relevant to minority applicants. The results suggest that identifying variables that enhance minority student admission and retention is desirable. PMID:9302857

  4. Clinical prediction rule for identifying patients with vancomycin-resistant enterococci (VRE) at the time of admission to the intensive care unit in a low VRE prevalence setting.

    PubMed

    Yoon, Young Kyung; Kim, Hyeon Jeong; Lee, Won Jin; Lee, Sung Eun; Yang, Kyung Sook; Park, Dae Won; Sohn, Jang Wook; Kim, Min Ja

    2012-12-01

    The purpose of this study was to develop and validate a clinical prediction rule to screen patients at risk of vancomycin-resistant enterococci (VRE) carriage at intensive care unit (ICU) admission in a hospital setting with low VRE prevalence. This study was retrospectively conducted in the ICUs of a university-affiliated hospital in Korea, where active surveillance cultures for VRE had been run at ICU admission and weekly thereafter. In the derivation cohort from April 2008 to September 2010, risk factors for VRE carriage at ICU admission were determined and assigned weighted point values using a multivariate logistic regression model. In the validation cohort from October 2010 to March 2011, predictability of the prediction rule was evaluated. Of a total of 4445 cultures taken from patients at ICU admission, 153 (3.4%) patients carried VRE. In the derivation cohort, independent risk factors (assigned points) for VRE carriage at ICU admission were ICU readmission during hospitalization (1 point), chronic obstructive lung disease (2 points), recent antibiotic treatment (3 points) and recent vancomycin use (2 points). In the validation cohort, the sensitivity, specificity, and positive and negative predictive values of the prediction rule, on the basis of risk scores ≥3 points, were 84.2%, 82.5%, 15.2% and 99.3%, respectively. This clinical prediction rule for identifying VRE carriage at the time of ICU admission is expected to markedly reduce the screening volume (by 80.1%) in our healthcare facility. For use in clinical practice, the rule needs to be prospectively validated in other settings.

  5. [Patient admission: hospitality in the hospital--concept and evaluation].

    PubMed

    Vandenbulcke, C

    1999-06-01

    Welcoming is an everyday act, performed all day long, in different places. But, when it comes to welcoming a patient, it is a matter of health care, for which we are the only responsible. Since this person arrives in a place where his (her) body and mind are going to be ill-treated (s)he will be all the more receptive to his (her) new environment. Faced with feelings of fear, anguish, stress, the patient and ourselves try to establish a relationship made of confidence and a feeling of safety, which are necessary to his (her) integration. This will be achieved by means of verbal and non-verbal communication, by reducing or even getting round the obstacles. By studying this moment, this meeting, with different evaluation tools, I have been able to sort out the strong and weak points of my Institution, in order to propose adequate means of improvements, (creation of a team dynamics on this subject, working out of a definition, evaluation grids and application). The staff will thus be able to readjust his care as well as possible, at the level of the information to be given, and above all the attitude to adopt, in order to improve the quality of welcoming, as, eventually, it is what the patient will keep in mind and what he will use for his evaluation.

  6. Low vitamin B12 in patients on admission to an amputation rehabilitation unit: a retrospective study.

    PubMed

    Earl, Eric; Wong, Renee; Payne, Michael W C

    2015-02-01

    The purpose of this study was to determine the prevalence of low vitamin B12 (VB12) in patients on admission to an amputation rehabilitation unit and identify specific populations at risk. A retrospective chart review was performed for 127 participants comprising patients with major lower limb amputations admitted to a regional amputation rehabilitation program between January 1, 2011 and December 31, 2012. Electronic medical records were reviewed for demographic data, amputation data, medication history, serum VB12 levels, and other related blood work. A literature-based cutoff of VB12 <260 pmol/L was used as the criterion for low VB12. The prevalence of low VB12 was 59.8%. Patients aged ≥55 years were found to have an increased prevalence of low VB12 (P = .05). Serum VB12 levels were significantly lower among patients aged ≥55 years (P < .05) and among patients with a mean corpuscular volume >97 fL (P < .01). No other differences in prevalence were determined among different demographics, etiologies, or comorbidities. Patients with an amputation have a high prevalence of low VB12 levels compared with the general population. Low VB12 status may impact rehabilitation outcomes through anemia, cognitive decline, and neuropathy. No reliable indicators for which patients should be screened were found, and therefore, a universal approach to screening and treatment is needed. © 2014 American Society for Parenteral and Enteral Nutrition.

  7. Diaphragm dysfunction on admission to the intensive care unit. Prevalence, risk factors, and prognostic impact-a prospective study.

    PubMed

    Demoule, Alexandre; Jung, Boris; Prodanovic, Hélène; Molinari, Nicolas; Chanques, Gerald; Coirault, Catherine; Matecki, Stefan; Duguet, Alexandre; Similowski, Thomas; Jaber, Samir

    2013-07-15

    Diaphragmatic insults occurring during intensive care unit (ICU) stays have become the focus of intense research. However, diaphragmatic abnormalities at the initial phase of critical illness remain poorly documented in humans. To determine the incidence, risk factors, and prognostic impact of diaphragmatic impairment on ICU admission. Prospective, 6-month, observational cohort study in two ICUs. Mechanically ventilated patients were studied within 24 hours after intubation (Day 1) and 48 hours later (Day 3). Seventeen anesthetized intubated control anesthesia patients were also studied. The diaphragm was assessed by twitch tracheal pressure in response to bilateral anterior magnetic phrenic nerve stimulation (Ptr,stim). Eighty-five consecutive patients aged 62 (54-75) (median [interquartile range]) were evaluated (medical admission, 79%; Simplified Acute Physiology Score II, 54 [44-68]). On Day 1, Ptr,stim was 8.2 (5.9-12.3) cm H2O and 64% of patients had Ptr,stim less than 11 cm H2O. Independent predictors of low Ptr,stim were sepsis (linear regression coefficient, -3.74; standard error, 1.16; P = 0.002) and Simplified Acute Physiology Score II (linear regression coefficient, -0.07; standard error, 1.69; P = 0.03). Compared with nonsurvivors, ICU survivors had higher Ptr,stim (9.7 [6.3-13.8] vs. 7.3 [5.5-9.7] cm H2O; P = 0.004). This was also true for hospital survivors versus nonsurvivors (9.7 [6.3-13.5] vs. 7.8 [5.5-10.1] cm H2O; P = 0.004). Day 1 and Day 3 Ptr,stim were similar. A reduced capacity of the diaphragm to produce inspiratory pressure (diaphragm dysfunction) is frequent on ICU admission. It is associated with sepsis and disease severity, suggesting that it may represent another form of organ failure. It is associated with a poor prognosis. Clinical trial registered with www.clinicaltrials.gov (NCT 00786526).

  8. Methicillin-resistant Staphylococcus aureus colonization is not associated with higher rate of admission to pediatric intensive care unit.

    PubMed

    Naeem, Mohammed; Banyan, Esam Al; Sindhu, Sardar Tanvir

    2013-04-01

    Methicillin-resistant Staphylococcus aureus (MRSA) colonization is consistently rising. The question whether the MRSA colonization places the patients at higher risk, requiring higher levels of care when being admitted, has never been studied. We conducted this study to determine the impact of MRSA colonization status on the required level of care upon admission to hospital. We conducted a retrospective chart review in 1000 plus-bed tertiary care academic institute. Our study population composed of all the patients who were admitted from January 2011 to March 2011. We found 7413 pediatric admissions that were identified as the study subjects. We assessed and divided study subjects into 2 groups, MRSA colonized and MRSA noncolonized. Methicillin-resistant Staphylococcus aureus-colonized patients were further grouped into those admitted to either pediatric intensive care unit (PICU) or ward, and these 2 groups were analyzed using P value, Fisher exact test, relative risks, and odds ratios. We found a total of 7413 admissions, 753 were admitted in PICU (average pediatric risk of mortality score 18), and 6660 were admitted in pediatric wards (average pediatric risk of mortality score, 5). We found that MRSA colonization was 20 (2.66%) of 753 in PICU admissions and 155 (2.33%) of 6660 in ward admissions. We found that rate of admissions difference between MRSA colonized and MRSA noncolonized groups was clinically insignificant (P > .05). We conclude that MRSA colonization does not increase the need of care in PICU upon admission to hospital from emergency department. However, these preliminary results need to be confirmed through larger, multicenter, and multicountry data analysis. Copyright © 2013 Elsevier Inc. All rights reserved.

  9. The age-specific incidence of admission to the intensive care unit for acute myocardial infarction in Antigua and Barbuda.

    PubMed

    Martin, T C; Van Longhuyzen, H; Bennett, B; Peterson, S; Beazer, C; Thomas, C V

    2007-09-01

    This study was done to assess the age-specific incidence of admission for acute myocardial infarction in Antigua and Barbuda from 1990 to 2001. A retrospective review of Intensive Care Unit admissions for possible acute myocardial infarction was performed. Data obtained included age, gender, country of residence, electrocardiogram, creatine kinase results and intensive care unit outcome. There were, 250 admissions, 194 (78%) having data available for review. Acute myocardial infarction was found in 107/194 (55.2%) patients, age 59.9 +/- 13.7 years, 28% female, 70% from Antigua and Barbuda, 90/107 (85%) were between 35 and 75 years old. The incidence would be 7.5 per year or 9.7 per year if the confirmation rate documented was similar for all admissions. With a yearly population of 9555 men age 35 to 75 years in Antigua and Barbuda, with men accounting for 72% of acute myocardial infarctions, the incidence rate was 0.57 (confirmed) to 0.73 (all admissions) per year per 1000 men. For women, the yearly population was 10822 age 35 to 75 years, and the incidence rate was 0.19 to 0.24 per year per 1000 women. The mortality rate was 12/107 (11.2%), with women being older (67 vs 57 years, p = 0.001) and dying more often (17% vs 9%) compared with men. The mortality rate in the Intensive Care Unit was 0.07 per year for men, 0.04 per year for women per 1000 aged 35 to 75 years. In the United States of America (USA), the admission rate is 4.1 for men and 1.8 for women per year per 1000 aged 35 to 75 years; the mortality rate is 1.0 for men and 0.5 for women per year per 1000 aged 35 to 75 years. Rates of admission to the Intensive Care Unit for acute myocardial infarction in Antigua and Barbuda are 20%, and mortality rates are 10% of those reported in the USA.

  10. An analysis of admissions from 155 United States hospitals to determine the influence of weather on stroke incidence.

    PubMed

    Cowperthwaite, Matthew C; Burnett, Mark G

    2011-05-01

    Weather is the most frequently proposed factor driving apparent seasonal trends in stroke admissions. Here, we present the largest study of the association between weather and ischemic stroke in the USA to date. We consider admissions to 155 United States hospitals in 20 states during the five-year period from 2004 to 2008. The data set included 196,439 stroke admissions, which were classified as ischemic (n=98,930), hemorrhagic (n=18,960), or transient ischemic attack (n=78,549). Variations in stroke admissions were tested to determine if they tracked seasonal and transient weather patterns over the same time period. Using autocorrelation analyses, no significant seasonal changes in stroke admissions were observed over the study period. Using time-series analyses, no significant association was observed between any weather variable and any stroke subtype over the five-year study. This study suggests that seasonal associations between weather and stroke are highly confounded, and an association between weather and stroke is virtually non-existent. Therefore, previous studies reporting an association between specific weather patterns and stroke should be interpreted with caution. Copyright © 2010. Published by Elsevier Ltd.

  11. Admission factors associated with intensive care unit readmission in critically ill oncohematological patients: a retrospective cohort study

    PubMed Central

    Rodrigues, Cinthia Mendes; Pires, Ellen Maria Campos; Feliciano, Jorge Patrick Oliveira; Vieira Jr., Jose Mauro; Taniguchi, Leandro Utino

    2016-01-01

    Objective The purpose of our study was to determine the admission factors associated with intensive care unit readmission among oncohematological patients. Methods Retrospective cohort study using an intensive care unit database from a tertiary oncological center. The participants included 1,872 critically ill oncohematological patients who were admitted to the intensive care unit from January 2012 to December 2014 and who were subsequently discharged alive. We used univariate and multivariate analysis to identify the admission risk factors associated with later intensive care unit readmission. Results One hundred seventy-two patients (9.2% of 1,872 oncohematological patients discharged alive from the intensive care unit) were readmitted after intensive care unit discharge. The readmitted patients were sicker compared with the non-readmitted group and had higher hospital mortality (32.6% versus 3.7%, respectively; p < 0.001). In the multivariate analysis, the independent risk factors for intensive care unit readmission were male sex (OR: 1.5, 95% CI: 1.07 - 2.12; p = 0.019), emergency surgery as the admission reason (OR: 2.91, 95%CI: 1.53 - 5.54; p = 0.001), longer hospital length of stay before intensive care unit transfer (OR: 1.02, 95%CI: 1.007 - 1.035; p = 0.003), and mechanical ventilation (OR: 2.31, 95%CI: 1.57 - 3.40; p < 0.001). Conclusions In this cohort of oncohematological patients, we identified some risk factors associated with intensive care unit readmission, most of which are not amenable to interventions. The identification of risk factors at intensive care unit discharge might be a promising approach. PMID:27096674

  12. A new admission procedure to dental education at The Karolinska Institute. An initial evaluation.

    PubMed

    Röding, K

    1997-08-01

    This study compares the performance to date of dental under-graduates selected by a new, individual admissions procedure, and those admitted by the traditional centralised system (control groups). Admission to all full-time tertiary study in Sweden was centralised and administered by special national units until 1993, following which the universities were allowed to adopt their own admission system. The Dental School at The Karolinska Institute in 1993 introduced an individualised selection system, initially for one-third and subsequently for 60% of the freshmen intake, the remaining places being reserved for students applying through the national admissions centre. The main objective of the new selection procedure is to seek out highly motivated students (less likely to drop-out) with general competence, high academic achievement, and personal attributes considered important in a health professional. An Admissions Committee (AC) comprising seven faculty members, was appointed by the Vice-Chancellor, for the new system which has been used unaltered since 1993. In the first stage applicants with the highest academic grades are selected in descending order. In the second stage, the prospective students spend a day at The Dental School writing separate assignments, which are assessed by the AC according to defined criteria. Applicants who do well in the written assessment proceed to the third stage in which each applicant is interviewed by two AC members on separate occasions. In the final selection procedure, the AC considers the combined merits of all the interviewed applicants. Analysis of the first three intakes discloses few or no drop-outs among AC-selected undergraduates. In three major integrated examinations, designed to disclose not only factual knowledge but also comprehension and maturity and as such reflect clinical conditions, their performance is as good as or better than the control groups.

  13. How we established a new undergraduate firm on a Medical Admissions Unit.

    PubMed

    Nazir, Tahir; Wallis, Simon; Higham, Jackie; Newton, Kate; Pugh, Mark; Woywodt, Alexander

    2014-11-01

    Medical Admission Units (MAUs) were introduced in the UK in the 1980s primarily driven by a governance and service improvement agenda. In the UK this has led to the development of Acute Medicine as a specialty in its own right, together with a strong role of this specialty in postgraduate teaching. In contrast, the role of MAUs, if any, in undergraduate medical education is currently unclear. Prompted by an expansion of our undergraduate student numbers, our aim was to establish a Year 3 undergraduate firm on a 33-bedded MAU in a large academic teaching hospital in the National Health Service (NHS). Despite initial scepticism from clinicians, managers, and educators, the new firm placement on MAU became an instant success and continues to attract excellent feedback from our Year 3 undergraduate students. Students enjoy the bedside teaching with a high percentage of consultant-delivered teaching and also liked the involvement of Foundation Doctors. Here, we report our experience on how to make such a firm work, based on student feedback and the tutors' experience. We provide an overview and a step-by-step guide of how to construct a successful new undergraduate firm on a busy MAU. We also discuss opportunities and challenges and discuss the relevant literature. We conclude that undergraduate teaching is feasible and rewarding in an extremely busy MAU setting. We note that identifying enthusiastic educators within the MAU team, utilisation of peripheral learning opportunities, structured timetables and induction, and a robust framework for quality assurance are all crucial to success.

  14. Appendicectomies performed >48 hours after admission to a dedicated acute general surgical unit

    PubMed Central

    March, B; Gillies, D

    2014-01-01

    Introduction Acute general surgical units (AGSUs) are changing the way in which acute appendicitis is managed. In the AGSU at John Hunter Hospital, some patients wait more than 48 hours from admission to undergo an appendicectomy, usually because they are not unwell enough to precipitate an operation before that time. We analysed this subgroup of appendicectomy patients to determine how effectively they are being managed and how this might be improved. Methods A retrospective review of prospectively collected data was conducted of all patients who received an appendicectomy while admitted under the AGSU at John Hunter Hospital in the five years between January 2009 and December 2013. Results A total of 1,039 appendicectomies were performed in the study period, with 81 patients (7.8%) waiting >48 hours for their operation (delayed appendicectomy group). Overall, the negative appendicectomy (NA) rate was 21.6%; the NA rate in delayed appendicectomies was 50.62% and a non-therapeutic operation occurred in 47% of this group (n=38). No significant difference was found in the incidence of perforation/gangrenous appendicitis between patients having surgery in <48 hours and the delayed appendicectomy groups (11.2% vs 9.9%, p=0.85). A combination of negative diagnostic imaging result, a normal white cell count and normal C-reactive protein (ie a negative ‘triple test’) was the best predictor of a negative appendicectomy (p=0.0158, negative predictive value: 0.91, 95% confidence interval: 0.59–0.99), in the delayed appendicectomy group. Conclusions In the delayed appendicectomy group, the incidence of perforation/gangrenous appendicitis was not significantly different from that found in patients having appendicectomy performed sooner. However, the NA and non-therapeutic operation rates were unacceptably high. An appendix triple test can improve diagnostic accuracy significantly without an unacceptable rise in the rates of perforation/gangrenous appendicitis. PMID

  15. The effect of gun control laws on hospital admissions for children in the United States.

    PubMed

    Tashiro, Jun; Lane, Rebecca S; Blass, Lawrence W; Perez, Eduardo A; Sola, Juan E

    2016-10-01

    Gun control laws vary greatly between states within the United States. We hypothesized that states with strict gun laws have lower mortality and resource utilization rates from pediatric firearms-related injury admissions. Kids' Inpatient Database (1997-2012) was searched for accidental (E922), self-inflicted (E955), assault (E965), legal intervention-related (E970), or undetermined circumstance (E985) firearm injuries. Patients were younger than 20 years and admitted for their injuries. Case incidence trends were examined for the study period. Propensity score-matched analyses were performed using 38 covariates to compare outcomes between states with strict or lenient gun control laws. Overall, 38,424 cases were identified, with an overall mortality of 7%. Firearm injuries were most commonly assault (64%), followed by accidental (25%), undetermined circumstance (7%), or self-inflicted (3%). A small minority involved military-grade weapons (0.2%). Most cases occurred in lenient gun control states (48%), followed by strict (47%) and neutral (6%).On 1:1 propensity score-matched analysis, in-hospital mortality by case was higher in lenient (7.5%) versus strict (6.5%) states, p = 0.013. Lenient states had a proportionally higher rate of accidental (31%) and self-inflicted injury (4%) versus strict states (17% and 1.6%, respectively), p < 0.001. Assault-related injuries were proportionally lower in lenient (54%) versus strict (75%) states, p < 0.001. Military-grade weapons were more common in lenient (0.4%) versus strict (0.1%) states, p = 0.001. These findings highlight the importance of legislative measures and their role in injury prevention, as firearm injuries are entirely avoidable mechanisms of injury. Lenient gun control contributes not only to worse outcomes per case, but also to a more significant and detrimental impact on public health. Epidemiologic study, level III.

  16. Community acquired infections among refugees leading to Intensive Care Unit admissions in Turkey.

    PubMed

    Turktan, Mediha; Ak, Oznur; Erdem, Hakan; Ozcengiz, Dilek; Hargreaves, Sally; Kaya, Safak; Karakoc, Emre; Ozkan-Kuscu, Ozlem; Tuncer-Ertem, Gunay; Tekin, Recep; Birbicer, Handan; Durmus, Gul; Yilmaz, Canan; Kocak, Funda; Puca, Edmond; Rello, Jordi

    2017-05-01

    Data on the impact of refugees on Intensive Care Units (ICUs) are lacking in the literature, in particular for community-acquired (CA) infectious diseases, for which they are known to be at higher risk. We did a descriptive, multicenter study to analyze CA infections among refugee patients requiring ICU admission. Inclusion criteria were adult refugee patients admitted to an ICU due to CA infections. Anonymized data were collected between January 1, 2010 and December 30, 2015 across 10 referral centers. 29.885 patients were admitted to the ICUs in the study period. 37 patients were included the study, the majority were from Syria (n=31, 83.8%). Mean (SD) age of the patients was 45.92±20.16years. The 5-year prevalence rate was 123.8 per 100.000 patients in the ICUs. All patients had at least one comorbid condition. Forty-nine CA infections were diagnosed. The most common CA infection was pneumonia (49%) followed by urinary-tract infections (16.3%). 21 patients (56.7%) hospitalized in the ICU had trauma history. Mortality rate was high at 22 patients (59.5%) with 5 (22.7%) deaths directly attributed to CA infections. Refugees presented to ICUs with CA infections similar to the host populations (pneumonia and urinary-tract infections) but had high mortality rates (59.5%). It seems that Turkish ICUs were not congested with the refugee patients' influx for CA infections. More research needs to be done to better understand how to deliver preventative and timely health care services to this group of patients. Copyright © 2017 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

  17. Delayed intensive care unit admission is associated with increased mortality in patients with cancer with acute respiratory failure.

    PubMed

    Mokart, Djamel; Lambert, Jérôme; Schnell, David; Fouché, Louis; Rabbat, Antoine; Kouatchet, Achille; Lemiale, Virginie; Vincent, François; Lengliné, Etienne; Bruneel, Fabrice; Pene, Frederic; Chevret, Sylvie; Azoulay, Elie

    2013-08-01

    Acute respiratory failure (ARF) is the leading reason for intensive care unit (ICU) admission in patients with cancer. The aim of this study was to identify early predictors of death in patients with cancer admitted to the ICU for ARF who were not intubated at admission. We conducted analysis of a prospective randomized controlled trial including 219 patients with cancer with ARF in which day-28 mortality was a secondary endpoint. Mortality at day 28 was 31.1%. By multivariate analysis, independent predictors of day-28 mortality were: age (odds ratio [OR] 1.30/10 years, 95% confidence interval [CI] [1.01-1.68], p = 0.04), more than one line of chemotherapy (OR 2.14, 95% CI [1.08-4.21], p = 0.03), time between respiratory symptoms onset and ICU admission > 2 days (OR 2.50, 95% CI [1.25-5.02], p = 0.01), oxygen flow at admission (OR 1.07/L, 95% CI [1.00-1.14], p = 0.04) and extra-respiratory symptoms (OR 2.84, 95%CI [1.30-6.21], p = 0.01). After adjustment for the logistic organ dysfunction (LOD) score at admission, only time between respiratory symptoms onset and ICU admission > 2 days and LOD score were independently associated with day-28 mortality. Determinants of death include both factors non-amenable to change, and delay in ARF management. These results suggest that early intensive care management of patients with cancer with ARF may translate to better survival.

  18. No effect of lunar cycle on psychiatric admissions or emergency evaluations.

    PubMed

    McLay, Robert N; Daylo, Amado A; Hammer, Paul S

    2006-12-01

    It is a popularly held belief that psychiatric behavior worsens during a full moon. Research in this area has yielded mixed results. Records from Naval Medical Center San Diego for 1993-2001 were examined to see whether there were higher rates of psychiatric admission associated with particular phases of the moon. Records from 8,473 admissions revealed that there were no more admission on days with a full moon, a new moon, any quarter of the moon, a waxing moon, or a waning moon. This held true for psychiatric patients as a whole, as well as for individuals with particular diagnoses, such as those with a mood disorder or psychotic disorder. Records from 1,909 emergency psychiatric evaluations that occurred between 2002 and 2003 were also examined to see whether a higher percentage of patients might present, but not require hospitalization, during a particular phase of the moon. Once again, no significant effect was found. In summary, lunar phase was not associated in any significant way with psychiatric admissions or emergency presentation.

  19. Evaluation at the Unit Level.

    DTIC Science & Technology

    2014-09-26

    RD-fli56 922 EVALUATION AT THE UNIT LEVEL(U) ARMYV WAR COLL CARLISLE i/i BARRACKS PA J F NAU 15 APR 85 UNCLASSIFIED F/G 5/9 N MENMhEEhE... EVALUATION AT THE UNIT LEVEL BY COLONEL JOHN F. NA!, JR., FA DISTRIBUTION STATEMENT 4: Approved for public release; distribution is unlimited. C) .4C.1...been cleared by the appropriate military service or government agency. Evaluation at the Unit Level An Individual Essay by Colonel John F. Nau, Jr

  20. Identifying patients with cellulitis who are likely to require inpatient admission after a stay in an ED observation unit.

    PubMed

    Volz, Kathryn A; Canham, Louisa; Kaplan, Emily; Sanchez, Leon D; Shapiro, Nathan I; Grossman, Shamai A

    2013-02-01

    Emergency department observation units (EDOU) are often used for patients with cellulitis to provide intravenous antibiotics followed by a transition to an oral regimen for discharge. Because institutional regulations typically limit EDOU stays to 24 hours, patients lacking a clinical response within this period will often be subsequently admitted to the hospital for further treatment. The aim of this study was to determine the rate of hospital admission and characteristics predictive of admission in patients with cellulitis who are initially placed in an ED observation unit. A retrospective cohort study of patients placed into EDOU with a diagnosis of skin infection was conducted. Age, sex, history of diabetes mellitus, immunosuppression, intravenous drug use, location of cellulitis, presence of abscess, laboratory infectious markers, vital signs, and outpatient antibiotic treatment were recorded. The primary outcome was a hospital admission due to failure to respond to treatment within the 24-hour observation time window. Significant variables on univariate analysis were used to create a multivariate analysis, which identified predictive characteristics. Four hundred six patient charts were reviewed, with 377 meeting inclusion criteria; the inpatient admission rate from EDOU was 29.2%. Using logistic regression techniques, we created a model of independent predictors for need of admission after 24 hours: cellulitis of the hand (odds ratio [OR], 2.9; 95% confidence interval [CI], 1.8-4.9), measured temperature higher than 100.4°F (OR, 2.5; 95% CI, 1.1-5.5), and lactate greater than 2 (OR, 3.1; 95% CI, 1.3-7.3) were predictive of failure of ED observation. Patients with cellulitis placed into ED observation status were more likely to fail an observation trial if they had an objective fever in the ED, an elevated lactate, or a cellulitis that involved the hand. Copyright © 2013 Elsevier Inc. All rights reserved.

  1. Risk factors for maternal deaths in unplanned obstetric admissions to the intensive care unit-lessons for sub-Saharan Africa.

    PubMed

    Okafor, Ugochukwu V; Efetie, Efenae R; Amucheazi, Adaobi

    2011-12-01

    This study was undertaken to determine the risk factors for maternal deaths in unplanned or unbooked obstetric admissions to the intensive care unit of a tertiary health centre. Hospital records of unbooked obstetric admissions to the intensive care unit of the hospital from January 1997 to December 2006 were retrospectively reviewed. Data collected included patients' demographics, diagnosis, duration of stay in the ICU and patient outcome. The intensive care unit records showed that there were 25 unbooked obstetric admissions. Major diagnoses for unplanned admissions to the ICU were preeclampsia/eclampsia (41.1%), obstetric haemorrhage (37.5%), and respiratory distress (12.5%). There were 12 deaths (48%). Organ dysfunction on admission, massive blood loss and late presentation were the risk factors for mortality. The high maternal mortality was mainly due to limited supply of blood products and inadequate prenatal care resulting in disease severity.

  2. National Trends in Admission for Aspiration Pneumonia in the United States, 2002-2012.

    PubMed

    Wu, Chao-Ping; Chen, Yu-Wei; Wang, Min-Jung; Pinelis, Evgeny

    2017-06-01

    Aspiration pneumonia is a subset of pneumonias prevalent in elderly patients and patients with neurologic disorders. Researchers in previous studies mostly reported incidence and/or mortality rates based on regional data or in specific subgroups of patients. There is a paucity of nationwide data in the contemporary U.S. To describe U.S. national trends in acute care hospital admission for aspiration pneumonia from 2002 to 2012. We used the U.S. National (Nationwide) Inpatient Sample database to identify patients admitted with a primary diagnosis of aspiration pneumonia between 2002 and 2012. We estimated trends in the incidence, in-hospital mortality, length of stay, and total hospitalization cost for patients admitted for aspiration pneumonia and stratified on the basis of patient age (≥65 yr vs. <65 yr). Multivariable logistic regression analysis was used to identify independent predictors for in-hospital mortality. A total of 406,798 patients (weighted total, 1,741,517) admitted for aspiration pneumonia were included in this study. There were 84,200 (20.7%) patients younger than 65 years of age and 322,598 patients (79.3%) aged 65 years or older. From 2002 to 2012, the overall incidence of aspiration pneumonia decreased from 8.2 to 7.1 cases per 10,000 people, and in-hospital mortality decreased from 18.6 to 9.8%. For patients aged 65 years or older, the incidence decreased from 40.7 to 30.9 cases per 10,000 people, and the in-hospital mortality decreased from 20.7 to 11.3%. The median total hospitalization charges increased in both groups (age ≥65 yr, from $16,173 to $30,280; age <65 yr, from $17,517 to $30,526). In multivariable logistic analysis, patients aged 65 years or older or treatment in a nonteaching hospital were independent predictors of in-hospital mortality. The incidence and mortality of patients admitted to acute care hospitals for aspiration pneumonia decreased between 2002 and 2012 in the United States. This difference was more evident for

  3. Initiation and evaluation of an Admission, Discharge, Transfer (ADT) Nursing Program in a pediatric setting.

    PubMed

    Giangiulio, Martha; Aurilio, Lisa; Baker, Pam; Brienza, Beth; Moss, Ellie; Twinem, Nicole

    2008-01-01

    Finding ways to improve patient throughput through efficient use of nursing time led one pediatric medical center to develop an Admission, Discharge, Transfer (ADT) Nursing Program that included specialized nurses devoted to nursing activities that normally disrupt continuity of care on patient units. It was found that the ADT nurses improved patient throughput. Additionally, a nursing-staff satisfaction survey found that 93% of nursing staff felt that the ADT program made a worthwhile contribution to decreasing the workload of nurses, and all nurses answering felt that the ADT program assisted in providing high-quality care and services.

  4. Predictive validity of the Biomedical Admissions Test: an evaluation and case study.

    PubMed

    McManus, I C; Ferguson, Eamonn; Wakeford, Richard; Powis, David; James, David

    2011-01-01

    There has been an increase in the use of pre-admission selection tests for medicine. Such tests need to show good psychometric properties. Here, we use a paper by Emery and Bell [2009. The predictive validity of the Biomedical Admissions Test for pre-clinical examination performance. Med Educ 43:557-564] as a case study to evaluate and comment on the reporting of psychometric data in the field of medical student selection (and the comments apply to many papers in the field). We highlight pitfalls when reliability data are not presented, how simple zero-order associations can lead to inaccurate conclusions about the predictive validity of a test, and how biases need to be explored and reported. We show with BMAT that it is the knowledge part of the test which does all the predictive work. We show that without evidence of incremental validity it is difficult to assess the value of any selection tests for medicine.

  5. The relationship between pain management and psychospiritual distress in patients with advanced cancer following admission to a palliative care unit.

    PubMed

    Lee, Ya-Ping; Wu, Chih-Hsun; Chiu, Tai-Yuan; Chen, Ching-Yu; Morita, Tatsuya; Hung, Shou-Hung; Huang, Sin-Bao; Kuo, Chia-Sheng; Tsai, Jaw-Shiun

    2015-12-02

    Although many cross-sectional studies have demonstrated the association between cancer pain and psychospiritual distress, the time-dependent relationship has not been fully explored. For that reason, this study aims to investigate the time-dependent relationship between psychospiritual distress and cancer pain management in advanced cancer patients. This is a prospective observational study. Two hundred thirty-seven advanced cancer patients were recruited from a palliative care unit in Taiwan. Demographic and clinical data were retrieved at admission. Pain and psychospiritual distress (i.e.: anxiety, depression, anger, level of family and social support, fear of death) were assessed upon admission and one week later, by using a "Symptom Reporting Form". Patients were divided into two groups according to the pain status one week post-admission (improved versus not improved groups). One hundred sixty-three (68.8 %) patients were assigned to the improved group, and 74 (31.2 %) patients were assigned to the not improved group. There were no differences in the psychospiritual variables between groups upon admission. In overall patients, all psychospiritual variables improved one week post-admission, but the improvement of depression and family/social support in the not improved group was not significant. Consistent with this, for depression scores, there was a statistically significant pain group x time interaction effect detected, meaning that the pain group effect on depression scores was dependent on time. We demonstrated a time-dependent relationship between depression and pain management in advanced cancer patients. Our results suggest that poor pain management may be associated with intractable depression. The inclusion of interventions that effectively improve psychospiritual distress may contribute to pain management strategies for advanced cancer patients.

  6. Nontraumatic spinal cord injury at the neurological intensive care unit: spectrum, causes of admission and predictors of mortality

    PubMed Central

    Grassner, Lukas; Marschallinger, Julia; Dünser, Martin W.; Novak, Helmut F.; Zerbs, Alexander; Aigner, Ludwig; Trinka, Eugen; Sellner, Johann

    2015-01-01

    Objective: Nontraumatic spinal cord injuries (NTSCIs) form a heterogeneous group of diseases, which may evolve into a life-threatening condition. We sought to characterize spectrum, causes of admission and predictors of death in patients with NTSCI treated at the neurological intensive care unit (NICU). Methods: We performed a retrospective observational analysis of NTSCI cases treated at a tertiary care center between 2001 and 2013. Among the 3937 NICU admissions were 93 patients with NTSCI (2.4%). Using multivariate logistic regression analysis, we examined predictors of mortality including demographics, etiology, reasons for admission and GCS/SAPS (Glasgow Coma Scale/Simplified Acute Physiology Score) scores. Results: Infectious and inflammatory/autoimmune causes made up 50% of the NTSCI cases. The most common reasons for NICU admission were rapidly progressing paresis (49.5%) and abundance of respiratory insufficiency (26.9%). The mortality rate was 22.6% and 2.5-fold higher than in the cohort of all other patients treated at the NICU. Respiratory insufficiency as the reason for NICU admission [odds ratio (OR) 4.97, 95% confidence interval (CI) 1.38–17.9; p < 0.01], high initial SAPS scores (OR 1.04; 95% CI 1.003–1.08; p = 0.04), and the development of acute kidney injury throughout the stay (OR 7.25, 1.9–27.5; p = 0.004) were independent risk factors for NICU death. Conclusions: Patients with NTSCI account for a subset of patients admitted to the NICU and are at risk for adverse outcome. A better understanding of predisposing conditions and further knowledge of management of critically ill patients with NTSCI is mandatory. PMID:27006696

  7. A Population-Based Analysis of Ethnic Differences in Admission to the Intensive Care Unit after Stroke

    PubMed Central

    Fletcher, Jeffrey J.; Morgenstern, Lewis B.; Lisabeth, Lynda D.; Sánchez, Brisa N.; Skolarus, Lesli E.; Smith, Melinda A.; Garcia, Nelda M.; Zahuranec, Darin B.

    2012-01-01

    Background Mexican Americans (MAs) have shown lower post-stroke mortality compared to non-Hispanic whites (NHWs). Limited evidence suggests race/ethnic differences exist in intensive care unit (ICU)admissions following stroke. Our objective was to investigate the association of ethnicity with admission to the ICU following stroke. Methods Cases of intracerebral hemorrhage and acute ischemic stroke were prospectively ascertained as part of the Brain Attack Surveillance in Corpus Christi (BASIC) project for the period January, 2000 through December, 2009. Logistic regression models fitted within the generalized additive model framework were used to test associations between ethnicity and ICU admission and potential confounders. An interaction term between age and ethnicity was investigated in the final model. Results A total 1,464 cases were included in analysis. MAs were younger, more likely to have diabetes, and less likely to have atrial fibrillation, health insurance, or high school diploma than NHWs. On unadjusted analysis, there was a trend toward MAs being more likely to be admitted to ICU than NHWs (34.6% versus 30.3%; OR=1.22; 95% CI 0.98–1.52; p=0.08). However, on adjusted analysis, no overall association between MA ethnicity and ICU admission (OR=1.13; 95% CI 0.85–1.50) was found. When an interaction term for age and ethnicity was added to this model, there was only borderline evidence for effect modification by age of the ethnicity/ICU relationship (p=0.16). Conclusions No overall association between ethnicity and ICU admission was observed in this community. ICU utilization alone does not likely explain ethnic differences in survival following stroke between MAs and NHWs. PMID:22892883

  8. Secondary School Admissions: The Choice for Black Parents in the London Borough of Hackney, United Kingdom

    ERIC Educational Resources Information Center

    McCalman, Lionel

    2008-01-01

    In the UK, the law places a lot of emphasis on parental rights and choice--the right to choose the school that suits the needs of your child. Parents can list in order of preference and this ranked order is lodged with the education authority (through one common application form), and hope that within the complexities of the admissions process,…

  9. Patterns in admission delays to outpatient methadone treatment in the United States.

    PubMed

    Gryczynski, Jan; Schwartz, Robert P; Salkever, David S; Mitchell, Shannon Gwin; Jaffe, Jerome H

    2011-12-01

    Waiting lists for methadone treatment have existed in many U.S. communities, but little is known nationally about what patient and service system factors are related to admission delays that stem from program capacity shortfalls. Using a combination of national data sources, this study examined patterns in capacity-related admission delays to outpatient methadone treatment in 40 U.S. metropolitan areas (N = 28,920). Patient characteristics associated with admission delays included racial/ethnic minority status, lower education, criminal justice referral, prior treatment experience, secondary cocaine or alcohol use, and co-occurring psychiatric problems. Injection drug users experienced fewer delays, as did self-pay patients and referrals from health care and addiction treatment providers. Higher community-level utilization of methadone treatment was associated with delay, whereas delays were less common in communities with higher utilization of alternative modalities. These findings highlight potential disparities in timely admission to outpatient methadone treatment. Implications for improving treatment access and service system monitoring are discussed.

  10. Admissions Standards and the Use of Key Marketing Techniques by United States' Colleges and Universities.

    ERIC Educational Resources Information Center

    Goldgehn, Leslie A.

    1989-01-01

    A survey of admissions deans and directors investigated the use and perceived effectiveness of 15 well-known marketing techniques: advertising, advertising research, a marketing plan, market positioning, market segmentation, marketing audit, marketing research, pricing, program and service accessibility, program development, publicity, target…

  11. Admissions Standards and the Use of Key Marketing Techniques by United States' Colleges and Universities.

    ERIC Educational Resources Information Center

    Goldgehn, Leslie A.

    1989-01-01

    A survey of admissions deans and directors investigated the use and perceived effectiveness of 15 well-known marketing techniques: advertising, advertising research, a marketing plan, market positioning, market segmentation, marketing audit, marketing research, pricing, program and service accessibility, program development, publicity, target…

  12. Partnered pharmacist charting on admission in the General Medical and Emergency Short-stay Unit - a cluster-randomised controlled trial in patients with complex medication regimens.

    PubMed

    Tong, E Y; Roman, C; Mitra, B; Yip, G; Gibbs, H; Newnham, H; Smit, D P; Galbraith, K; Dooley, M J

    2016-08-01

    Patients admitted to general medical units and emergency short-stay units are often complex with multiple comorbidities, polypharmacy and at risk for drug-related problems associated with increased morbidity and mortality. The aim of this study was to evaluate the effectiveness of a partnered pharmacist charting model completed at the time of admission to prevent medication errors. We conducted an unblinded cluster randomized controlled trial comparing partnered pharmacist charting to standard medical charting among patients admitted to general medical units and emergency short-stay units with complex medication regimens or polypharmacy. This trial was conducted at an adult major referral hospital in metropolitan Melbourne, Australia, with an annual emergency department attendance of approximately 60 000 patients. The evaluation included patients' medication charts written in the period of 16 March 2015 to 27 July 2015. Patients randomized to the intervention were managed using the partnered pharmacist charting model. The primary outcome variable was a medication error identified by an independent assessor within 24 h of admission, who was not part of the patient's admission process. Of the 473 patients who received standard medical staff charting during the study period, 372 (78·7%) had at least one medication error identified compared to 15 patients (3·7%) on the partnered pharmacist charting arm (P < 0·001). The relative risk of an error with standard medical charting was 21·4 (95% CI: 13·0-35·0) with a number needed to treat (NNT) to prevent one error of 1·3 (95% CI: 1·3-1·4), and the relative risk of a high or extreme risk error with standard medical charting was 150·9 (95% CI: 21·2-1072·9) with a NNT to prevent one high or extreme error of 2·7 (95% CI 2·4-3·1). Partnering between medical staff and pharmacists to jointly chart initial medications on admission significantly reduced inpatient medication errors (including errors of high and extreme

  13. Are elderly patients' opinions sought before admission to an intensive care unit? Results of the ICE-CUB study.

    PubMed

    Le Guen, Julien; Boumendil, Ariane; Guidet, Bertrand; Corvol, Aline; Saint-Jean, Olivier; Somme, Dominique

    2016-03-01

    demand for intensive care of the very elderly is growing, but few studies report inclusion of their opinions in the admission decision-making process. Whether or not to refer a very elderly patient to intensive care unit is a difficult decision that should take into account individual wishes, out of respect for the patient's decision-making autonomy. in 15 emergency departments, patients over 80 years old who had a potential indication for admission to intensive care, and that were capable of expressing their opinion were included. Frequency of opinions sought before referral decision and individual and organisational factors associated were recorded and analysed. a total of 2,115 patients were included. Only 270 (12.7%) of them were asked for their opinion, and there were marked variations between study centres (minimum: 1.1% and maximum: 53.6%). A history of dementia reduced the probability of a patient being asked for his or her opinion (OR 0.47, 95% CI: 0.25-0.83). Patients' opinion was most often sought when their functional autonomy was conserved (OR 2.10, 95% CI: 1.39-3.21) and when a relative had been questioned (OR 5.46, 95% CI: 3.8-7.88). Older attending physicians were less likely to ask for the patient's opinion (older physician versus younger physician, OR 0.48, 95% CI: 0.35-0.66). elderly patients are therefore rarely asked for their opinion prior to intensive care admission. Our results indicate that respect of the decision-making autonomy of elderly subjects in the admission process to an intensive care unit should be reinforced. © The Author 2016. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  14. The Academic Medical Center Linear Disability Score for evaluation of physical reserve on admission to the ICU: can we query the relatives?

    PubMed

    Hofhuis, José G M; Dijkgraaf, Marcel G W; Hovingh, Aly; Braam, Richard L; van de Braak, Lisa; Spronk, Peter E; Rommes, Johannes H

    2011-01-01

    Evaluating the pre-morbid functional status in critically ill patients is important and frequently done using the physical component score (PCS) of the Short Form 36, although this approach has its limitations. The Academic Medical Center Linear Disability Score (ALDS) is a recently developed generic item bank used to measure the disability status of patients with a broad range of diseases. We aimed to study whether proxy scoring with the ALDS could be used to assess the patients' functional status on admission for cardiac care unit (CCU) or ICU patients and how the ALDS relates to the PCS using the Short Form 12 (SF-12). Patients and proxies completed the ALDS and SF-12 score in the first 72 hours following ICU scheduled surgery (n = 14), ICU emergency admission (n = 56) and CCU emergency admission (n = 70). In all patients (n = 140) a significant intra-class correlation was found for the ALDS (0.857), the PCS (0.798) and the mental component score (0.679) between patients and their proxy. In both scheduled and emergency admissions, a significant correlation was found between patients and their proxy for the ALDS, although the lowest correlation was found for the ICU scheduled admissions (0.755) compared with the ICU emergency admissions (0.889). In CCU patients, the highest significant correlation between patients and proxies was found for the ALDS (0.855), for the PCS (0.807) and for the mental component score (0.740). Relatives in close contact with critically ill patients can adequately reflect the patient's level of disability on ICU and CCU admission when using the ALDS item bank, which performed at least as well as the PCS. The ALDS could therefore be a useful alternative for the PCS of the SF-12.

  15. Analysis of the discrepancies identified during medication reconciliation on patient admission in cardiology units: a descriptive study.

    PubMed

    Lombardi, Natália Fracaro; Mendes, Antonio Eduardo Matoso; Lucchetta, Rosa Camila; Reis, Wálleri Christini Torelli; Fávero, Maria Luiza Drechsel; Correr, Cassyano Januário

    2016-08-15

    this observational study aimed to describe the discrepancies identified during medication reconciliation on patient admission to cardiology units in a large hospital. the medication history of patients was collected within 48 hours after admission, and intentional and unintentional discrepancies were classified as omission, duplication, dose, frequency, timing, and route of drug administration. most of the patients evaluated were women (58.0%) with a mean age of 59 years, and 75.5% of the patients had a Charlson comorbidity index score between 1 and 3. Of the 117 discrepancies found, 50.4% were unintentional. Of these, 61.0% involved omission, 18.6% involved dosage, 18.6% involved timing, and 1.7% involved the route of drug administration. this study revealed a high prevalence of discrepancies, most of which were related to omissions, and 50% were unintentional. These results reveal the number of drugs that are not reincorporated into the treatment of patients, which can have important clinical consequences. este estudo observacional teve como objetivo descrever discrepâncias encontradas na realização de conciliação medicamentosa de pacientes admitidos em unidades de cardiologia de um hospital de grande porte. a história de medicação dos pacientes foi coletada dentro de 48h após a admissão, e as discrepâncias, identificadas como intencionais ou não intencionais, foram classificadas como de: omissão, duplicidade, dose, frequência, intervalo e via. a maioria dos pacientes incluídos pertençia ao sexo feminino (58,0%), com idade média de 59 anos, e com índice de comorbidades de Charlson entre 1 e 3 (75,5% dos casos). Das 117 discrepâncias encontradas, 50,4% foram não intencionais. Dessas, 61,0% foram de omissão, 18,6% de dose, 18,6% de intervalo e 1,7% de via de administração. o estudo mostra a alta prevalência de discrepâncias, principalmente de omissão, sendo quase metade não intencionais. Esse dado remete ao número de medicamentos que n

  16. Do health checks for adults with intellectual disability reduce emergency hospital admissions? Evaluation of a natural experiment

    PubMed Central

    Hosking, Fay J; Harris, Tess; DeWilde, Stephen; Beighton, Carole; Shah, Sunil M; Cook, Derek G

    2017-01-01

    Background Annual health checks for adults with intellectual disability (ID) have been incentivised by National Health Service (NHS) England since 2009, but it is unclear what impact they have had on important health outcomes such as emergency hospitalisation. Methods An evaluation of a ‘natural experiment’, incorporating practice and individual-level designs, to assess the effectiveness of health checks for adults with ID in reducing emergency hospital admissions using a large English primary care database. For practices, changes in admission rates for adults with ID between 2009–2010 and 2011–2012 were compared in 126 fully participating versus 68 non-participating practices. For individuals, changes in admission rates before and after the first health check for 7487 adults with ID were compared with 46 408 age-sex-practice matched controls. Incident rate ratios (IRRs) comparing changes in admission rates are presented for: all emergency, preventable emergency (for ambulatory care sensitive conditions (ACSCs)) and elective emergency. Results Practices with high health check participation showed no change in emergency admission rate among patients with ID over time compared with non-participating practices (IRR=0.97, 95% CI 0.78 to 1.19), but emergency admissions for ACSCs did fall (IRR=0.74, 0.58 to 0.95). Among individuals with ID, health checks had no effect on overall emergency admissions compared with controls (IRR=0.96, 0.87 to 1.07), although there was a relative reduction in emergency admissions for ACSCs (IRR=0.82, 0.69 to 0.99). Elective admissions showed no change with health checks in either analysis. Conclusions Annual health checks in primary care for adults with ID did not alter overall emergency admissions, but they appeared influential in reducing preventable emergency admissions. PMID:27312249

  17. Association between timing of intensive care unit admission and outcomes for emergency department patients with community-acquired pneumonia.

    PubMed

    Renaud, Bertrand; Santin, Aline; Coma, Eva; Camus, Nicolas; Van Pelt, Dave; Hayon, Jan; Gurgui, Merce; Roupie, Eric; Hervé, Jérôme; Fine, Michael J; Brun-Buisson, Christian; Labarère, José

    2009-11-01

    To compare the 28-day mortality and hospital length of stay of patients with community-acquired pneumonia who were transferred to an intensive care unit on the same day of emergency department presentation (direct-transfer patients) with those subsequently transferred within 3 days of presentation (delayed-transfer patients). Secondary analysis of the original data from two North American and two European prospective, multicenter, cohort studies of adult patients with community-acquired pneumonia. In all, 453 non-institutionalized patients transferred within 3 days of emergency department presentation to an intensive care unit were included in the analysis. Supplementary analysis was restricted to patients without an obvious indication for immediate transfer to an intensive care unit. None. The sample consisted of 138 delayed-transfer and 315 direct-transfer patients, among whom 150 (33.1%) were considered to have an obvious indication for immediate intensive care unit admission. After adjusting for the quintile of propensity score, delayed intensive care unit transfer was associated with an increased odds ratio for 28-day mortality (2.07; 95% confidence interval, 1.12-3.85) and a decreased odds ratio for discharge from hospital for survivors (0.53; 95% confidence interval, 0.39-0.71). In a propensity-matched analysis, delayed-transfer patients had a higher 28-day mortality rate (23.4% vs. 11.7%; p = 0.02) and a longer median hospital length of stay (13 days vs. 7 days; p < .001) than direct-transfer patients. Similar results were found after excluding the 150 patients with an obvious indication for immediate intensive care unit admission. Our findings suggest that some patients without major criteria for severe community-acquired pneumonia, according to the recent Infectious Diseases Society of America/American Thoracic Society consensus guideline, may benefit from direct transfer to the intensive care unit. Further studies are needed to prospectively identify

  18. Case mix, outcome and length of stay for admissions to adult, general critical care units in England, Wales and Northern Ireland: the Intensive Care National Audit & Research Centre Case Mix Programme Database

    PubMed Central

    Harrison, David A; Brady, Anthony R; Rowan, Kathy

    2004-01-01

    Introduction The present paper describes the methods of data collection and validation employed in the Intensive Care National Audit & Research Centre Case Mix Programme (CMP), a national comparative audit of outcome for adult, critical care admissions. The paper also describes the case mix, outcome and activity of the admissions in the Case Mix Programme Database (CMPD). Methods The CMP collects data on consecutive admissions to adult, general critical care units in England, Wales and Northern Ireland. Explicit steps are taken to ensure the accuracy of the data, including use of a dataset specification, of initial and refresher training courses, and of local and central validation of submitted data for incomplete, illogical and inconsistent values. Criteria for evaluating clinical databases developed by the Directory of Clinical Databases were applied to the CMPD. The case mix, outcome and activity for all admissions were briefly summarised. Results The mean quality level achieved by the CMPD for the 10 Directory of Clinical Databases criteria was 3.4 (on a scale of 1 = worst to 4 = best). The CMPD contained validated data on 129,647 admissions to 128 units. The median age was 63 years, and 59% were male. The mean Acute Physiology and Chronic Health Evaluation II score was 16.5. Mortality was 20.3% in the CMP unit and was 30.8% at ultimate discharge from hospital. Nonsurvivors stayed longer in intensive care than did survivors (median 2.0 days versus 1.7 days in the CMP unit) but had a shorter total hospital length of stay (9 days versus 16 days). Results for the CMPD were comparable with results from other published reports of UK critical care admissions. Conclusions The CMP uses rigorous methods to ensure data are complete, valid and reliable. The CMP scores well against published criteria for high-quality clinical databases. PMID:15025784

  19. Case mix, outcome and length of stay for admissions to adult, general critical care units in England, Wales and Northern Ireland: the Intensive Care National Audit & Research Centre Case Mix Programme Database

    PubMed Central

    2005-01-01

    Introduction The present paper describes the methods of data collection and validation employed in the Intensive Care National Audit & Research Centre Case Mix Programme (CMP), a national comparative audit of outcome for adult, critical care admissions. The paper also describes the case mix, outcome and activity of the admissions in the Case Mix Programme Database (CMPD). Methods The CMP collects data on consecutive admissions to adult, general critical care units in England, Wales and Northern Ireland. Explicit steps are taken to ensure the accuracy of the data, including use of a dataset specification, of initial and refresher training courses, and of local and central validation of submitted data for incomplete, illogical and inconsistent values. Criteria for evaluating clinical databases developed by the Directory of Clinical Databases were applied to the CMPD. The case mix, outcome and activity for all admissions were briefly summarised. Results The mean quality level achieved by the CMPD for the 10 Directory of Clinical Databases criteria was 3.4 (on a scale of 1 = worst to 4 = best). The CMPD contained validated data on 129,647 admissions to 128 units. The median age was 63 years, and 59% were male. The mean Acute Physiology and Chronic Health Evaluation II score was 16.5. Mortality was 20.3% in the CMP unit and was 30.8% at ultimate discharge from hospital. Nonsurvivors stayed longer in intensive care than did survivors (median 2.0 days versus 1.7 days in the CMP unit) but had a shorter total hospital length of stay (9 days versus 16 days). Results for the CMPD were comparable with results from other published reports of UK critical care admissions. Conclusions The CMP uses rigorous methods to ensure data are complete, valid and reliable. The CMP scores well against published criteria for high-quality clinical databases.

  20. Surgical management of pneumothorax: significance of effective admission or communication strategies between the district general hospitals and specialized unit.

    PubMed

    Aslam, Muhammad I; Martin-Ucar, Antonio E; Nakas, Apostolos; Waller, David A

    2011-11-01

    A preoperative delay in emergency surgery for spontaneous pneumothorax is associated with a poor outcome after surgery and a prolonged hospital stay. To reduce preoperative delays, all tertiary referrals from district general hospitals to our thoracic surgery unit were processed through a 'clinical decisions unit' (CDU). Prior to the establishment of the CDU, these patients were added to a waiting list for a surgical bed. This study has reviewed the effect of this change in admission policy on the efficiency of treatment for non-elective spontaneous pneumothorax. An intergroup comparison (pre-CDU group vs. post-CDU group) was made of the following parameters: referral to transfer time, transfer to surgery time and length of inpatient stay in the referring and tertiary hospitals. There were no significant differences in gender, diagnosis, treatment in the referring hospitals, postoperative clinical outcome, or indications for or type of surgery. The total length of inpatient stay in the referring and tertiary hospitals was significantly reduced for the post-CDU group (12 vs. 15 days; P<0.001), which was attributed to the earlier transfer of patients (18 vs. 78 hours; P<0.001) hours. Allowing surgical access to a traditional medical admission unit is therefore, cost-effective and significantly improves the efficiency of non-elective pneumothorax surgery.

  1. An audit of intensive care unit admission in a pediatric cardio-thoracic population in Enugu, Nigeria.

    PubMed

    Ugochukwu, Okafor; Jerome, Azike

    2010-08-18

    The study aimed to perform an audit of intensive care unit admissions in the paediatric cardio-thoracic population in Enugu, Nigeria and examine the challenges and outcome in this high risk group. Ways of improvement based on this study are suggested. The hospital records of consecutive postoperative pediatric cardiothoracic admissions to the multidisciplinary and cardiothoracic intensive care units of the University of Nigeria Teaching Hospital (UNTH) Enugu, Nigeria to determine their Intensive Care Unit management and outcome over a 2 year span--June 2002 to June 2004--were retrospectively reviewed. Data collected included patient demographics, diagnosis, duration of stay in the intensive care unit, therapeutic interventions and outcome. There were a total of thirty consecutive postoperative paediatric admissions to the intensive care unit over the 2 year study period. The average age of the patients was 5.1 years with a range of 2 weeks to 13 years. Twelve patients had cardiac surgery with cardiopulmonary bypass (CPB), three patients had colon transplant, four patients had pericardiotomy/pericardicectomy, and five patients had diagnostic/therapeutic bronchoscopy. The remaining patients had the following surgeries, thoracotomy for repair of diaphragmatic hernia/decortications, delayed primary repair of esophageal atresia and gastrostomy. Two patients had excision of a cervical teratoma and cystic hygroma. The average duration of stay in the intensive care unit was 6.2 days. Ten patients (33%) received pressor agents for organ support. Five patients (17%) had mechanical ventilation, while twenty-five patients (83%) received oxygen therapy via intranasal cannula or endotracheal tube. Seven patients (23%) received blood transfusion in the ICU. There was a 66% survival rate with ten deaths. Paediatric cardio-thoracic services in Nigeria suffer from the problems of inadequate funding and manpower flight to better paying jobs. Government should invest in their people

  2. Increasing trend in admissions for malignant hypertension and hypertensive encephalopathy in the United States.

    PubMed

    Polgreen, Linnea A; Suneja, Manish; Tang, Fan; Carter, Barry L; Polgreen, Philip M

    2015-05-01

    Malignant hypertension and hypertensive encephalopathy are life-threating manifestations of hypertension. These syndromes primarily occur in patients with a history of poorly controlled hypertension. The purpose of this study was to investigate national trends in hospital admissions for malignant hypertension, hypertensive encephalopathy, and essential hypertension. This was a retrospective cohort study that used the Nationwide Inpatient Sample. We identified all hospitalizations between 2000 and 2011, during which a primary diagnosis of malignant hypertension (ICD 9 code: 401.0), hypertensive encephalopathy (ICD 9 code: 437.2), or essential hypertension (ICD 9 code: 401.9) was recorded. Time series models were estimated for malignant hypertension, hypertensive encephalopathy, essential hypertension and also for the combined series. A piecewise linear regression analyses was performed to investigate whether there were changes in the trends of these series. In addition, we also compared the characteristics of patients with these diagnoses. The estimated number of admissions for both malignant hypertension and hypertensive encephalopathy increased dramatically after 2007, whereas discharges for essential hypertension fell, and there was no change in trend for the combined series. Costs rose substantially for patients with these diagnoses after 2007, but mortality significantly fell for malignant hypertension and mortality for hypertensive encephalopathy did not change. The dramatic increase in the number of hospital admissions for hypertensive encephalopathy and malignant hypertension should have resulted in dramatic increases in morbidity, but it did not. The change is most likely related to changes in coding related to diagnostic-related groups that occurred in 2007. © 2015 American Heart Association, Inc.

  3. Epidemiological trends and geographic variation in hospital admissions for diverticulitis in the United States

    PubMed Central

    Nguyen, Geoffrey C; Sam, Justina; Anand, Nitasha

    2011-01-01

    AIM: To characterize the increasing incidence and geographic variation of acute diverticulitis. METHODS: Using the nationwide inpatient sample (NIS) we identified a cohort who had been admitted with diverticulitis between 1998 and 2005. We calculated age-, sex-, and region-specific rates of hospitalizations for diverticulitis over time. RESULTS: The age-adjusted hospitalization rate for diverticulitis increased from 61.8 per 100 000 to 75.5 per 100 000 between 1998 and 2005, and increased similarly in both sexes. Diverticulitis-associated admissions were male-predominant in those younger than age 45 years but were female-predominant thereafter. Admission rates increased the most among those < 45 years, while remaining unchanged for those ≥ 65 years. By 2005, the majority of hospitalized patients were < 65 years. Age-adjusted rates of diverticulitis-associated hospitalizations were lower in the West (50.4/100 000) compared to the Northeast (77.7/100 000), South (73.9/100 000), and Midwest (71.0/100 000). CONCLUSION: Diverticulitis-associated hospitalizations have steeply risen, especially in young adults. These epidemiological trends vary by geographic region and warrant further investigation into potential dietary and environmental etiologies. PMID:21472127

  4. [The factors inducing status asthmaticus and changes in physical examination on admission to intensive care unit].

    PubMed

    Karwat, Krzysztof

    2002-01-01

    During the last 10 years 342 patients with status asthmaticus were admitted (mean age 42 years, 63% female) to ICU of Pneumonology Department in Warsaw Medical University. After admission respiratory rate (mean 28/min), heart rate (mean 121 beats/min), blood pressure (mean 139/83 mmHg), pulsus paradoxus (mean 19.9 mmHg) and peak expiratory flow rate (mean 109.3 L/min) were recorded. Arterial blood gas tension was analyzed as well. Mean PaO2 was 65.7 mmHg (range 31.4-128 mmHg) and mean PaCO2 was 39.1 mmHg (range 18-130.9 mmHg). Electrocardiography showed p-pulmonale in 24.4% of cases. 18.9% of the patients had ST-T changes and rotation of heart axis in 9% of cases. X-ray examination performed on admission showed changes characteristic for pneumonia in 15 patients. Status asthmaticus was caused by infection in 57.6%, exercise 6.1%, emotion and stress 3.2%, allergens 2.3% of cases. Underlying factors were unknown in 24.3%.

  5. Physical health assessment and medicines reconciliation on admission to an acute mental health unit: a quality improvement project.

    PubMed

    Vivekanantham, Arani; Sheikh, Abdur-Raoof; Omer, Hisham; Bescoby-Chambers, Nicholas

    2017-09-01

    Individuals with mental health disorders are at greater risk of physical health problems. Medicines reconciliation reduces medication errors on admission. The aim of this project was to improve compliance with the completion of physical health assessments and medicines reconciliation forms by using a set standard stating that all patients must have the above completed at the point of admission to an acute mental health unit. The notes for all inpatients were reviewed for evidence of completed physical assessments and medicines reconciliation forms. This was done at three different time points: baseline, 2 months after the introduction of recommendations (1st intervention) and 2 months later when an online system of record keeping was trialled (2nd intervention). At baseline (n=33), 16 (49%) had a physical examination, 15 (46%) had an ECG, 17 (52%) had baseline bloods and 4 (12%) had a completed medicine reconciliation form. After the 2nd intervention (n=31), 25 (81%) had a physical examination, 25 (81%) had an ECG, 23 (74%) had baseline bloods and 23 (74%) had a completed medicine reconciliation form. Physical health assessments and medicines reconciliation are important aspects of patient care. The interventions introduced have improved the quality of practice at an acute mental health unit.

  6. Are therapeutic decisions made on the medical admissions unit any more evidence-based than they used to be?

    PubMed

    Ayre, Stephen; Walters, Gareth

    2009-12-01

    To determine whether inpatients in a medical admissions unit in a UK district general hospital received evidence-based therapies in 2008. The diagnoses of and therapies received by inpatients at the George Eliot Hospital National Health Service Trust in Nuneaton were recorded. A clinical librarian searched the literature (Clinical Knowledge Summaries, Cochrane Library, Medline and Embase) for the best evidence for each diagnosis-therapy pair. Evidence was graded on the following scale: systematic review, randomized controlled trial, non-experimental evidence and no or contrary evidence. One hundred and two patients generated 150 diagnosis-therapy pairs. Of these 61 (41%) had systematic review level evidence supporting them, 17 (11%) randomized controlled trial evidence, 48 (32%) non-experimental evidence and 24 (16%) no evidence. Results were comparable with previous studies. Care in a medical admissions unit in 2008 is still evidence-based, but, despite the vast growth in medical literature, no more than it was. The process was a useful collaboration between medical and library staff to audit the quality of patient care.

  7. Effect of a Multi-Diagnosis Observation Unit on Emergency Department Length of Stay and Inpatient Admission Rate at Two Canadian Hospitals.

    PubMed

    Cheng, Amy H Y; Barclay, Neil G; Abu-Laban, Riyad B

    2016-12-01

    Observation units (OUs) have been shown to reduce emergency department (ED) lengths of stay (LOS) and admissions. Most published studies have been on OUs managing single complaints. Our aim was to determine whether an OU reduces ED LOS and hospital admission rates for adults with a variety of presenting complaints. We comparatively evaluated two hospitals in British Columbia, Canada (hereafter ED A and ED B) using a pre-post design. Data were extracted from administrative databases. The post-OU cohort included all adults presenting 6 months after OU implementation. The pre-OU cohort included all adults presenting in the same 6-month period 1 year before OU implementation. There were 109,625 patient visits during the study period. Of the 56,832 visits during the post-OU period (27,512 to ED A and 29,318 to ED B), 1.9% were managed in the OU in ED A and 1.4% in ED B. Implementation was associated with an increase in the median ED LOS at ED A (179.0 min pre vs. 192.0 min post [+13.0 min]; p < 0.001; mean difference -12.5 min, 95% confidence interval [CI] -15.2 to -9.9 min), but no change at ED B (182.0 min pre vs. 182.0 min post; p = 0.55; mean difference +2.0 min, 95% CI -0.7 to +4.7 min). Implementation significantly decreased the hospital admission rate for ED A (17.8% pre to 17.0% post [-0.8%], 95% CI -0.18% to 0.15%; p < 0.05) and did not significantly change the hospital admission rate at ED B (18.9% pre to 18.3% post [-0.6%], 95% CI -1.19% to -0.09%; p = 0.09). A multi-diagnosis OU can reduce hospital admission rate in a site-specific manner. In contrast to previous studies, we did not find that an OU reduced ED LOS. Further research is needed to determine whether OUs can reduce ED overcrowding. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. Long-term PM2.5 Exposure and Neurological Hospital Admissions in the Northeastern United States

    PubMed Central

    Kioumourtzoglou, Marianthi-Anna; Schwartz, Joel D.; Weisskopf, Marc G.; Melly, Steven J.; Wang, Yun; Dominici, Francesca; Zanobetti, Antonella

    2015-01-01

    Background Long-term exposure to fine particles (particulate matter ≤ 2.5 μm; PM2.5) has been consistently linked to heart and lung disease. Recently, there has been increased interest in examining the effects of air pollution on the nervous system, with evidence showing potentially harmful effects on neurodegeneration. Objective Our objective was to assess the potential impact of long-term PM2.5 exposure on event time, defined as time to first admission for dementia, Alzheimer’s (AD), or Parkinson’s (PD) diseases in an elderly population across the northeastern United States. Methods We estimated the effects of PM2.5 on first hospital admission for dementia, AD, and PD among all Medicare enrollees ≥ 65 years in 50 northeastern U.S. cities (1999–2010). For each outcome, we first ran a Cox proportional hazards model for each city, adjusting for prior cardiopulmonary-related hospitalizations and year, and stratified by follow-up time, age, sex, and race. We then pooled the city-specific estimates by employing a random effects meta-regression. Results We followed approximately 9.8 million subjects and observed significant associations of long-term PM2.5 city-wide exposure with all three outcomes. Specifically, we estimated a hazard ratio (HR) of 1.08 (95% CI: 1.05, 1.11) for dementia, an HR of 1.15 (95% CI: 1.11, 1.19) for AD, and an HR of 1.08 (95% CI: 1.04, 1.12) for PD admissions per 1-μg/m3 increase in annual PM2.5 concentrations. Conclusions To our knowledge, this is the first study to examine the relationship between long-term exposure to PM2.5 and time to first hospitalization for common neurodegenerative diseases. We found strong evidence of association for all three outcomes. Our findings provide the basis for further studies, as the implications of such exposures could be crucial to public health. Citation Kioumourtzoglou MA, Schwartz JD, Weisskopf MG, Melly SJ, Wang Y, Dominici F, Zanobetti A. 2016. Long-term PM2.5 exposure and neurological

  9. Long-term PM2.5 Exposure and Neurological Hospital Admissions in the Northeastern United States.

    PubMed

    Kioumourtzoglou, Marianthi-Anna; Schwartz, Joel D; Weisskopf, Marc G; Melly, Steven J; Wang, Yun; Dominici, Francesca; Zanobetti, Antonella

    2016-01-01

    Long-term exposure to fine particles (particulate matter ≤ 2.5 μm; PM2.5) has been consistently linked to heart and lung disease. Recently, there has been increased interest in examining the effects of air pollution on the nervous system, with evidence showing potentially harmful effects on neurodegeneration. Our objective was to assess the potential impact of long-term PM2.5 exposure on event time, defined as time to first admission for dementia, Alzheimer's (AD), or Parkinson's (PD) diseases in an elderly population across the northeastern United States. We estimated the effects of PM2.5 on first hospital admission for dementia, AD, and PD among all Medicare enrollees ≥ 65 years in 50 northeastern U.S. cities (1999-2010). For each outcome, we first ran a Cox proportional hazards model for each city, adjusting for prior cardiopulmonary-related hospitalizations and year, and stratified by follow-up time, age, sex, and race. We then pooled the city-specific estimates by employing a random effects meta-regression. We followed approximately 9.8 million subjects and observed significant associations of long-term PM2.5 city-wide exposure with all three outcomes. Specifically, we estimated a hazard ratio (HR) of 1.08 (95% CI: 1.05, 1.11) for dementia, an HR of 1.15 (95% CI: 1.11, 1.19) for AD, and an HR of 1.08 (95% CI: 1.04, 1.12) for PD admissions per 1-μg/m3 increase in annual PM2.5 concentrations. To our knowledge, this is the first study to examine the relationship between long-term exposure to PM2.5 and time to first hospitalization for common neurodegenerative diseases. We found strong evidence of association for all three outcomes. Our findings provide the basis for further studies, as the implications of such exposures could be crucial to public health. Kioumourtzoglou MA, Schwartz JD, Weisskopf MG, Melly SJ, Wang Y, Dominici F, Zanobetti A. 2016. Long-term PM2.5 exposure and neurological hospital admissions in the northeastern United States. Environ

  10. Trauma intensive care unit 'bouncebacks': identifying risk factors for unexpected return admission to the intensive care unit.

    PubMed

    Christmas, A Britton; Freeman, Elizabeth; Chisolm, Angela; Fischer, Peter E; Sachdev, Gaurav; Jacobs, David G; Sing, Ronald F

    2014-08-01

    Return transfer (RT) to the intensive care unit (ICU) negatively impacts patient outcomes, length of stay (LOS), and hospital costs. This study assesses the most common events necessitating RT in trauma patients. We performed a retrospective chart review of ICU RT from 2004 to 2008. Patient demographics, injuries and injury severity, reason for transfer, LOS, interventions, and outcomes data were collected. Overall, 158 patients required readmission to the ICU. Respiratory insufficiency/failure (48%) was the most common reason for RT followed by cardiac (16%) and neurological (13%) events. The most commonly associated injuries were traumatic brain injuries (TBIs) (32%), rib fractures (30%), and pulmonary contusions (20%). Initial ICU LOS was 6.6 ± 8 days (range, 1 to 44 days) with 4.4 ± 7.8 ventilator days. Mean floor time before ICU RT was 5.7 ± 6.3 days (range, 0 to 33 days). Forty-nine patients (31%) required intubation and mechanical ventilation on RT. ICU RT incurred an additional ICU LOS of 8 ± 8.5 days (range, 1 to 40 days) and 5.2 ± 7.5 ventilator days. Mortality after a single RT was 10 per cent (n = 16). RT to the ICU most often occurs as a result of respiratory compromise, and patients with TBI are particularly vulnerable. Trauma pulmonary hygiene practices should be evaluated to determine strategies that could decrease RT.

  11. Admission to a dedicated cardiac intensive care unit is associated with decreased resource use for infants with prenatally diagnosed congenital heart disease.

    PubMed

    Johnson, Joyce T; Tani, Lloyd Y; Puchalski, Michael D; Bardsley, Tyler R; Byrne, Janice L B; Minich, L LuAnn; Pinto, Nelangi M

    2014-12-01

    Many factors in the delivery and perinatal care of infants with a prenatal diagnosis of congenital heart disease (CHD) have an impact on outcome and costs. This study sought to determine the modifiable factors in perinatal management that have an impact on postnatal resource use for infants with CHD. The medical records of infants with prenatally diagnosed CHD (August 2006-December 2011) who underwent cardiac surgery before discharge were reviewed. The exclusion criteria ruled out prematurity and intervention or transplantation evaluation before surgery. Clinical characteristics, outcomes, and cost data were collected. Multivariate linear regression models were used to determine the impact of perinatal decisions on hospitalization cost and surrogates of resource use after adjustment for demographic and other risk factors. For the 126 patients who met the study criteria, the median hospital stay was 22 days (range 4-122 days), and the median inflation-adjusted total hospital cost was $107,357 (range $9,746-602,320). The initial admission to the neonatal versus the cardiac intensive care unit (NICU vs. CICU) was independently associated with a 19 % longer hospital stay, a 26 % longer ICU stay, and 47 % more mechanical ventilation days after adjustment for Risk Adjustment for Congenital Heart Surgery, version 1 score, gestation age, genetic abnormality, birth weight, mode of delivery, and postsurgical complications. Weekend versus weekday delivery was not associated with hospital cost or length of hospital stay. For term infants with prenatally diagnosed CHD undergoing surgery before discharge, preoperative admission to the NICU (vs. the CICU) resulted in a longer hospital stay and greater intensive care use. Prenatal planning for infants with CHD should consider the initial place of admission as a modifiable factor for potential lowering of resource use.

  12. Risk stratification of early admission to the intensive care unit of patients with no major criteria of severe community-acquired pneumonia: development of an international prediction rule.

    PubMed

    Renaud, Bertrand; Labarère, José; Coma, Eva; Santin, Aline; Hayon, Jan; Gurgui, Mercé; Camus, Nicolas; Roupie, Eric; Hémery, François; Hervé, Jérôme; Salloum, Mirna; Fine, Michael J; Brun-Buisson, Christian

    2009-01-01

    To identify risk factors for early (< three days) intensive care unit (ICU) admission of patients hospitalised with community-acquired pneumonia (CAP) and not requiring immediate ICU admission, and to stratify the risk of ICU admission on days 1 to 3. Using the original data from four North American and European prospective multicentre cohort studies of patients with CAP, we derived and validated a prediction rule for ICU admission on days 1 to 3 of emergency department (ED) presentation, for patients presenting with no obvious reason for immediate ICU admission (not requiring immediate respiratory or circulatory support). A total of 6560 patients were included (4593 and 1967 in the derivation and validation cohort, respectively), 303 (4.6%) of whom were admitted to an ICU on days 1 to 3. The Risk of Early Admission to ICU index (REA-ICU index) comprised 11 criteria independently associated with ICU admission: male gender, age younger than 80 years, comorbid conditions, respiratory rate of 30 breaths/minute or higher, heart rate of 125 beats/minute or higher, multilobar infiltrate or pleural effusion, white blood cell count less than 3 or 20 G/L or above, hypoxaemia (oxygen saturation < 90% or arterial partial pressure of oxygen (PaO2) < 60 mmHg), blood urea nitrogen of 11 mmol/L or higher, pH less than 7.35 and sodium less than 130 mEq/L. The REA-ICU index stratified patients into four risk classes with a risk of ICU admission on days 1 to 3 ranging from 0.7 to 31%. The area under the curve was 0.81 (95% confidence interval (CI) = 0.78 to 0.83) in the overall population. The REA-ICU index accurately stratifies the risk of ICU admission on days 1 to 3 for patients presenting to the ED with CAP and no obvious indication for immediate ICU admission and therefore may assist orientation decisions.

  13. Intensive care unit admission in children with malignant or nonmalignant disease: incidence, outcome, and prognostic factors: a single-center experience.

    PubMed

    Faraci, Maura; Bagnasco, Francesca; Giardino, Stefano; Conte, Massimo; Micalizzi, Concetta; Castagnola, Elio; Lampugnani, Elisabetta; Moscatelli, Andrea; Franceschi, Alessia; Carcillo, Joseph A; Haupt, Riccardo

    2014-10-01

    To investigate pediatric intensive care unit (PICU) admission in children with malignant and nonmalignant diseases who developed life-threatening complications. Between 1999 and 2010, of the 1278 eligible pediatric patients treated for a malignant or nonmalignant disease, 54 were admitted to the PICU for respiratory distress (40.7%), neurological events (33.3%), severe sepsis (14.8%), and organ failure (11.2%). Rate of PICU admission was 4.2%, with a 2-year cumulative incidence of 4.5%. Risk factors associated with higher cumulative incidence of PICU admission were older age at study entry (P=0.003), nonmalignant underlying disease (P=0.015), and hematopoietic stem cell transplantation (P<0.001). Patients with leukemia/lymphoma were more likely to be admitted to the PICU compared with patients with solid tumors (P<0.001). Patients admitted because of organ failure had the highest frequency of death within 90 days. Factors significantly associated with survival at 90 days from PICU admission included: no mechanical ventilation (P<0.001), nonmalignant underlying disease (P=0.030), and year of PICU admission after 2005 (P=0.038). Nonmalignant disease and use of alternative hematopoietic stem cell transplantation were associated with higher risk of PICU admission. Close cooperation between hematologists and intensivists and definition of criteria for PICU admission and discharge contributed to increase in survival of these patients.

  14. Evaluation of an Interview Process for Admission Into a School of Pharmacy

    PubMed Central

    Friesner, Daniel L.

    2012-01-01

    Objective. To evaluate the doctor of pharmacy (PharmD) admissions interview process at North Dakota State University (NDSU). Methods. Faculty pairs interviewed candidates using a standardized grading rubric to evaluate qualitative parameters or attributes such as ethics, relevant life and work experience, emotional maturity, commitment to patient care, leadership, and understanding of the pharmacy profession. Total interview scores, individual attribute domain scores, and the consistency and reliability of the interviewers were assessed. Results. The total mean interview score for the candidate pool was 17.4 of 25 points. Mean scores for individual domains ranged from 2.3 to 3.0 on a Likert-scale of 0-4. Nine of the 11 faculty pairs showed no mean differences from their interview partner in total interview scores given. Evaluations by 8 of the 11 faculty pairs produced high interrater reliability. Conclusions. The current interview process is generally consistent and reliable; however, future improvements such as additional interviewer training and adoption of a multiple mini-interview format could be made. PMID:22438594

  15. The effects of cognitive intervention on cognitive impairments after intensive care unit admission.

    PubMed

    Zhao, Jingjing; Yao, Li; Wang, Changqing; Sun, Yun; Sun, Zhongwu

    2017-04-01

    Patients who survive critical illness commonly suffer cognitive impairments. We aimed to study the effects of cognitive intervention to treat the long-term impairments observed among different populations of intensive care unit (ICU) survivors. The results showed that the intervention significantly suppressed the deterioration of cognitive function in these patients. Medical and neurological ICU survivors were more susceptible than post-anaesthesia ICU patients to severe cognitive damage. In the former, the deterioration of impairments can be slowed by cognitive intervention. In comparison, intervention exerted significantly positive effects on the recovery of the cognitive functions of post-anaesthesia care unit patients. Furthermore, young populations were more likely than older populations to recover from acute cognitive impairments, and the impairment observed among the older population seemed to be multi-factorial and irreversible.

  16. [Acute non-allergic angioedema. Rare cause for intensive care unit admission].

    PubMed

    van der Heide, V; Woehrle, T; Ripperger, M; Huge, V

    2015-08-01

    Angiotensin-converting enzyme (ACE) inhibitor-induced angioedema usually follows an uneventful clinical course; however, if upper airway structures are involved, life-threatening complications may develop. Thus, affected patients should be carefully monitored in an intensive care unit and, if need be, the airway has to be secured early on. This case report discusses diagnostic and therapeutic approaches in a patient with suspected ACE inhibitor-induced angioedema, who had initially been admitted for neoadjuvant radiochemotherapy of rectal cancer.

  17. HIV testing and clinical status upon admission to a specialized health care unit in Pará, Brazil

    PubMed Central

    Abati, Paulo Afonso Martins; Segurado, Aluisio Cotrim

    2015-01-01

    OBJECTIVE To analyze the clinical and laboratory characteristics of HIV-infected individuals upon admission to a reference health care center. METHODS This cross-sectional study was conducted between 1999 and 2010 on 527 individuals with confirmed serological diagnosis of HIV infection who were enrolled in an outpatient health care service in Santarém, PA, Northern Brazil. Data were collected from medical records and included the reason for HIV testing, clinical status, and count of peripheral CD4+ T lymphocytes upon enrollment. The data were divided into three groups, according to the patient’s year of admission – P1 (1999-2002), P2 (2003-2006), and P3 (2007-2010) – for comparative analysis of the variables of interest. RESULTS In the study group, 62.0% of the patients were assigned to the P3 group. The reason for undergoing HIV testing differed between genders. In the male population, most tests were conducted because of the presence of symptoms suggesting infection. Among women, tests were the result of knowledge of the partner’s seropositive status in groups P1 and P2. Higher proportion of women undergoing testing because of symptoms of HIV/AIDS infection abolished the difference between genders in the most recent period. A higher percentage of patients enrolling at a more advanced stage of the disease was observed in P3. CONCLUSIONS Despite the increased awareness of the number of HIV/AIDS cases, these patients have identified their serological status late and were admitted to health care units with active disease. The HIV/AIDS epidemic in Pará presents specificities in its progression that indicate the complex characteristics of the epidemic in the Northern region of Brazil and across the country. PMID:25741647

  18. Limitation of life-sustaining treatment in severe trauma in the elderly after admission to an intensive care unit.

    PubMed

    Peñasco, Y; González-Castro, A; Rodríguez Borregán, J C; Ortiz-Lasa, M; Jáuregui Solórzano, R; Sánchez Arguiano, M J; Escudero Acha, P

    2017-05-18

    To analyze the factors associated to limitation of life-sustaining treatment (LLST) measures in elderly patients admitted to an intensive care unit (ICU) due to trauma. A retrospective, descriptive, observational study was carried out. ICU. A total of 149 patients aged 65 years or older admitted to the ICU due to trauma. Hospital mortality, the decision to limit life-sustaining treatment and the factors associated to these measures were analyzed. None. The mean patient age was 76.3±6.36 years. The average APACHE II and ISS scores were 15.9±7.4 and 19.6±11.4 points, respectively. LLST were used in 37 patients (24.8%). Factors associated to the use of these measures were patient age (OR 1.16; 95% CI 1.08 to 1.25], APACHE II score (OR 1.11; 95% CI 1.05-1.67), ISS score (OR 1.03; 95% CI 1.01 to 1.06), admission due to neurological impairment (OR 19.17; 95% CI 2.33 to 157.83) and traumatic brain injury (OR 2.89; 95% CI 1.05 to 7.96). LLST is frequently established in elderly patients admitted to the ICU due to trauma, and is associated to hospital mortality. Factors associated with the use of these measures are patient age, higher APACHE II and ISS scores, admission due to neurological impairment, and the presence of head injuries. Copyright © 2017 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

  19. [Analysis of factors conditioning admission at the critical care unit of surgical patients. Prospective study of 764 patients operated for 1 year at a university and reference hospital].

    PubMed

    Gil Bona, J; Pascual Bellosta, A; Ojeda Cabrera, J; Ortega Lucea, S; Muñoz Rodríguez, L; Martínez Ubieto, J; Pérez-Navarro, G

    2015-02-01

    Assess what factors determine the income of surgical patients in critical care unit after surgery. It included a survey of the 10% of all patients operated by the services of General Surgery, Thoracic Surgery, Maxillofacial Surgery, Vascular Surgery, Urology and Otolaryngology during 2012. We performed a prospective, observational study. Pre-, intra-, and post-operative variables were analyzed. Comparisons were made between patients operated under elective and emergency surgery, and between patients admitted in critical care and admitted directly in the ward, using χ(2) of Pearson correlation with a confidence interval of 95%. Seven hundred and sixty-four patients were included into the study, 304 were admitted in critical care after surgery and 460 were admitted in the ward. The medical history showed a statistically significant association with intensive care unit admission, well as the fact of being labeled with a high risk for the risk scales. Complexity and duration of the surgery showed a statistically significant association with intensive care unit admission, as well as the fact of present intra-operative complications. Emergency surgery was not significantly associated with intensive care unit admission of surgical patients, although these patients had significantly higher numbers of intra- and post-operative complications, and more exitus than those undergoing elective surgery. A greater incidence of intensive care unit admission of patients undergoing emergency surgery should significantly reduce morbimortality rate. The existence of specific protocols for intensive care unit admission for urgent surgery, and greater availability of beds could be useful in this regard. Copyright © 2014 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  20. Utility of serum concentration of protein S100 at admission to the medical intensive care unit in prediction of permanent neurological injury

    PubMed Central

    Knapik, Małgorzata; Partyka, Robert; Broll, Iwona; Cieśla, Daniel; Wawrzyńczyk, Maciej; Kokocińska, Danuta; Jałowiecki, Przemysław

    2016-01-01

    Introduction Admission to the intensive care unit (ICU) may be preceded by dramatic events leading to permanent neurological injury. Plasma S100 protein levels are proved to be clinically useful in predicting neurological outcome following cardiac arrest. It is unclear, however, whether this may be extrapolated to a broader population of ICU patients. Aim To assess the utility of plasma S100 protein in predicting death, permanent neurological damage, or unfavourable outcome at admission to the intensive care unit. Material and methods The concentration of plasma S100 protein was established in 102 patients on admission to the ICU, regardless of their neurological status and the reason for admission. The majority of patients were admitted with various cardiac diseases, excluding trauma patients. The patients were classified into three groups with the following binary outcomes: permanent neurological deficit or restoration of consciousness; unfavourable outcome (death or survival with permanent neurological deficit) or favourable outcome; and death or survival. Results Plasma S100 protein levels at admission facilitated the identification of patients who later developed a permanent neurological deficit or regained consciousness (p < 0.0001). All patients with plasma S100 protein over 0.532 μg/l at ICU admission either developed a permanent neurological deficit or had an unfavourable outcome (death or survival with permanent neurological deficit). However, sensitivity for this cut-off value was only 48% and 40%, respectively. Conclusions Plasma S100 protein levels over 0.532 μg/l are specific but not sensitive for both permanent neurological deficit and unfavourable outcome when assessed in a heterogeneous population at admission to the ICU. PMID:28096833

  1. Family Carers' Experience of the Need for Admission of Their Relative with an Intellectual Disability to an Assessment and Treatment Unit

    ERIC Educational Resources Information Center

    James, Neil

    2016-01-01

    Background: There is limited research that explores the experiences of family carers of individuals with an intellectual disability requiring admission to a specialist National Health Service Assessment and Treatment Unit. Accordingly, this study aimed to explore family carers' experience in respect of this phenomenon and their relationships with…

  2. Family Carers' Experience of the Need for Admission of Their Relative with an Intellectual Disability to an Assessment and Treatment Unit

    ERIC Educational Resources Information Center

    James, Neil

    2016-01-01

    Background: There is limited research that explores the experiences of family carers of individuals with an intellectual disability requiring admission to a specialist National Health Service Assessment and Treatment Unit. Accordingly, this study aimed to explore family carers' experience in respect of this phenomenon and their relationships with…

  3. Risk factors for intensive care unit admission in patients with severe leptospirosis: a comparative study according to patients' severity.

    PubMed

    Daher, Elizabeth De Francesco; Soares, Douglas Sousa; de Menezes Fernandes, Anna Tereza Bezerra; Girão, Marília Maria Vasconcelos; Sidrim, Pedro Randal; Pereira, Eanes Delgado Barros; Rocha, Natalia Albuquerque; da Silva, Geraldo Bezerra

    2016-02-01

    The aim of this study is to investigate predictive factors for intensive care unit (ICU) admission among patients with severe leptospirosis. This is a retrospective study with all patients with severe leptospirosis admitted to a tertiary hospital. Patients were divided in ICU and ward groups. Demographical, clinical and laboratory data of the groups were compared as well as acute kidney injury (AKI) severity, according to the RIFLE criteria (R = Risk, I = Injury, F = Failure, L = Loss, E = End-stage kidney disease). A total of 206 patients were included, 83 admitted to ICU and 123 to ward. Mean age was 36 ± 15.8 years, with 85.9% males. Patients in ICU group were older (38.8 ± 15.7 vs. 34.16 ± 15.9 years, p = 0.037), had a shorter hospital stay (4.13 ± 3.1 vs. 9.5 ± 5.2 days, p = 0.0001), lower levels of hematocrit (29.6 ± 6.4 vs. 33.1 ± 8.6%, p = 0.003), hemoglobin (10.2 ± 2.4 vs. 11.6 ± 1.9 g/dL, p < 0.0001), and platelets (94,427 ± 86,743 vs. 128,896 ± 137,017/mm(3), p = 0.035), as well as higher levels of bilirubin (15.0 ± 12.2 vs. 8.6 ± 9.5 mg/dL, p = 0.001). ICU group also had a higher frequency of severe AKI (RIFLE-"Failure": 73.2% vs. 54.2%, p < 0.0001) and a higher prevalence of dialysis requirement (57.3% vs. 27.6%, p < 0.0001). Mortality was higher among ICU patients (23.5% vs. 5.7%, p < 0.0001). Independent predictors for ICU admission were tachypnea (p = 0.027, OR = 13, CI = 1.3-132), hypotension (p = 0.009, OR = 5.27, CI = 1.5-18) and AKI (p = 0.029, OR = 14, CI = 1.3-150). Ceftriaxone use was a protective factor (p = 0.001, OR = 0.13, CI = 0.04-0.4). Independent risk factors for ICU admission in leptospirosis include tachypnea, hypotension and AKI. Ceftriaxone was a protective factor for ICU admission, suggesting that its use may prevent severe forms of the disease.

  4. Intensive Care Unit Admission after Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy. Is It Necessary?

    PubMed Central

    López-Basave, Horacio N.; Morales-Vasquez, Flavia; Mendez-Herrera, Carmen; Ñamendys-Silva, Silvio A.; Luna-Ortiz, Kuauhyama; Calderillo-Ruiz, German; Cabrera Rojas, Jesús; Ruiz-Garcia, Erika; Herrera-Gomez, Angel; Ruiz-Molina, Juan M.; Meneses Garcia, Abelardo

    2014-01-01

    Introduction. Cytoreductive surgery (CS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is a new approach for peritoneal carcinomatosis. However, high rates of complications are associated with CS and HIPEC due to treatment complexity; that is why some patients need stabilization and surveillance for complications in the intensive care unit. Objective. This study analyzed that ICU stay is necessary after HIPEC. Methods. 39 patients with peritoneal carcinomatosis were treated according to strict selection criteria with CS and HIPEC, with closed technique, and the chemotherapy administered were cisplatin 25 mg/m2/L and mitomycin C 3.3 mg/m2/L for 90-minutes at 40.5°C. Results. 26 (67%) of the 39 patients were transferred to the ICU. Major postoperative complications were seen in 14/26 patients (53%). The mean time on surgical procedures was 7.06 hours (range 5−9 hours). The mean blood loss was 939 ml (range 100–3700 ml). The mean time stay in the ICU was 2.7 days. Conclusion. CS with HIPEC for the treatment of PC results in low mortality and high morbidity. Therefore, ICU stay directly following HIPEC should not be standardized, but should preferably be based on the extent or resections performed and individual patient characteristics and risk factors. Late complications were comparable to those reported after large abdominal surgery without HIPEC. PMID:24864143

  5. Short- and Long-Term Validity of High School GPA for Admission to Colleges outside the United States

    ERIC Educational Resources Information Center

    Al-Hattami, Abdulghani

    2014-01-01

    High school GPA is the only admission criterion that is currently used by many colleges in Yemen to select their potential students. Its predictive validity was investigated to ensure the accuracy of the admission decisions in these colleges. The relationship between students' persistence in the 4 years of college and high school GPA was studied…

  6. Short- and Long-Term Validity of High School GPA for Admission to Colleges outside the United States

    ERIC Educational Resources Information Center

    Al-Hattami, Abdulghani

    2014-01-01

    High school GPA is the only admission criterion that is currently used by many colleges in Yemen to select their potential students. Its predictive validity was investigated to ensure the accuracy of the admission decisions in these colleges. The relationship between students' persistence in the 4 years of college and high school GPA was studied…

  7. [Structure, organization and capacity problems in emergency medical services, emergency admission and intensive care units].

    PubMed

    Dick, W

    1994-01-01

    Emergency medicine is subjected worldwide to financial stringencies and organizational evaluations of cost-effectiveness. The various links in the chain of survival are affected differently. Bystander assistance or bystander CPR is available in only 30% of the emergencies, response intervals--if at all required by legislation--are observed to only a limited degree or are too extended for survival in cardiac arrest. A single emergency telephone number is lacking. Too many different phone numbers for emergency reporting result in confusion and delays. Organizational realities are not fully overcome and impair efficiency. The position of the emergency physician in the EMS System is inadequately defined, the qualification of too many emergency physicians are unsatisfactory. In spite of this, emergency physicians are frequently forced to answer out-of-hospital emergency calls. Conflicts between emergency physicians and EMTs may be overcome by providing both groups with comparable qualifications as well as by providing an explicit definition of emergency competence. A further source of conflict occurs at the juncture of prehospital and inhospital emergency care in the emergency department. Deficiencies on either side play a decisive role. At least in principle there are solutions to the deficiencies in the EMSS and in intensive care medicine. They are among others: Adequate financial compensation of emergency personnel, availability of sufficient numbers of highly qualified personnel, availability of a central receiving area with an adjacent emergency ward, constant information flow to the dispatch center on the number of available emergency beds, maintaining 5% of all beds as emergency beds, establishing intermediate care facilities. Efficiency of emergency physician activities can be demonstrated in polytraumatized patients or in patients with ventricular fibrillation or acute myocardial infarction, in patients with acute myocardial insufficiency and other emergency

  8. Risk stratification of early admission to the intensive care unit of patients with no major criteria of severe community-acquired pneumonia: development of an international prediction rule

    PubMed Central

    Renaud, Bertrand; Labarère, José; Coma, Eva; Santin, Aline; Hayon, Jan; Gurgui, Mercé; Camus, Nicolas; Roupie, Eric; Hémery, François; Hervé, Jérôme; Salloum, Mirna; Fine, Michael J; Brun-Buisson, Christian

    2009-01-01

    Introduction To identify risk factors for early (< three days) intensive care unit (ICU) admission of patients hospitalised with community-acquired pneumonia (CAP) and not requiring immediate ICU admission, and to stratify the risk of ICU admission on days 1 to 3. Methods Using the original data from four North American and European prospective multicentre cohort studies of patients with CAP, we derived and validated a prediction rule for ICU admission on days 1 to 3 of emergency department (ED) presentation, for patients presenting with no obvious reason for immediate ICU admission (not requiring immediate respiratory or circulatory support). Results A total of 6560 patients were included (4593 and 1967 in the derivation and validation cohort, respectively), 303 (4.6%) of whom were admitted to an ICU on days 1 to 3. The Risk of Early Admission to ICU index (REA-ICU index) comprised 11 criteria independently associated with ICU admission: male gender, age younger than 80 years, comorbid conditions, respiratory rate of 30 breaths/minute or higher, heart rate of 125 beats/minute or higher, multilobar infiltrate or pleural effusion, white blood cell count less than 3 or 20 G/L or above, hypoxaemia (oxygen saturation < 90% or arterial partial pressure of oxygen (PaO2) < 60 mmHg), blood urea nitrogen of 11 mmol/L or higher, pH less than 7.35 and sodium less than 130 mEq/L. The REA-ICU index stratified patients into four risk classes with a risk of ICU admission on days 1 to 3 ranging from 0.7 to 31%. The area under the curve was 0.81 (95% confidence interval (CI) = 0.78 to 0.83) in the overall population. Conclusions The REA-ICU index accurately stratifies the risk of ICU admission on days 1 to 3 for patients presenting to the ED with CAP and no obvious indication for immediate ICU admission and therefore may assist orientation decisions. PMID:19358736

  9. Evaluation of a consultant audit and feedback programme to improve the quality of antimicrobial prescribing in acute medical admissions.

    PubMed

    Roberts, Elaine; Dawoud, Dalia M; Hughes, Dyfrig A; Cefai, Christopher

    2015-10-01

    This study aims to evaluate the effectiveness and acceptability of a pharmacist-led antimicrobial stewardship intervention, consisting of consultant performance audit and feedback, on antimicrobial prescribing quality. From October 2010 to September 2012, the prescribing performance of medical consultant teams rotating on the acute medical admissions unit was measured against four quality indicators. Measurements were taken at baseline then at quarterly intervals during which time consultants received feedback. Proportion of prescriptions adhering to each indicator was compared with baseline using paired sample z-test (significance level P < 0.01, Bonferroni corrected). Consultants' views were explored using anonymous questionnaires. Overall, 2609 antimicrobial prescriptions were reviewed. Improvement from baseline was statistically significant in all follow-up periods for two indicators: 'antimicrobials should have a documented indication in the medical notes' and 'antimicrobials should adhere to guideline choice or have a justification for deviation', reaching 6.0% (95% CI 2.5, 9.6) and 8.7% (95% CI 3.7, 13.7), respectively. Adherence to the indicator 'antimicrobials should have a documented stop/review prompt' improved significantly in all but the first follow-up period. For the indicator: 'antimicrobial assessed by antimicrobial specialists as unnecessary', improvement was statistically significant in the first (-4.7%, 95% CI -8.0, -1.4) and fourth (-4.2%, 95% CI -7.7%, -0.8%) periods. Service evaluation showed support for the pharmacist-led stewardship activities. There were significant and sustained improvements in prescribing quality as a result of the intervention. Consultants' engagement and acceptance of stewardship activities were demonstrated. © 2015 Royal Pharmaceutical Society.

  10. Evaluating Psychiatric Hospital Admission Decisions for Children in Foster Care: An Optimal Classification Tree Analysis

    ERIC Educational Resources Information Center

    Snowden, Jessica A.; Leon, Scott C.; Bryant, Fred B.; Lyons, John S.

    2007-01-01

    This study explored clinical and nonclinical predictors of inpatient hospital admission decisions across a sample of children in foster care over 4 years (N = 13,245). Forty-eight percent of participants were female and the mean age was 13.4 (SD = 3.5 years). Optimal data analysis (Yarnold & Soltysik, 2005) was used to construct a nonlinear…

  11. Development of a Readiness Evaluation Procedure for Early Admissions to Kindergarten.

    ERIC Educational Resources Information Center

    Spillman, Carolyn V.; And Others

    1980-01-01

    This research bulletin provides criteria and procedures for determining the readiness of children to enter kindergarten early. The first section of the bulletin reviews the results of a literature search conducted to delineate areas of development from which admissions criteria should be defined. The review of the literature disclosed the…

  12. Evaluation of the California Psychological Inventory as an Effective Admission Standard for PsyD Programs

    ERIC Educational Resources Information Center

    Kobylinski, Amy

    2009-01-01

    A current admission criterion of a PsyD program was examined for effective profiling of personality characteristics of professional clinical psychology students. The California Psychological Inventory (CPI) was used as the personality assessment of all applicants to the PsyD program. The CPI quadrant score of "Alpha" with a CPI score of…

  13. Evaluation of the California Psychological Inventory as an Effective Admission Standard for PsyD Programs

    ERIC Educational Resources Information Center

    Kobylinski, Amy

    2009-01-01

    A current admission criterion of a PsyD program was examined for effective profiling of personality characteristics of professional clinical psychology students. The California Psychological Inventory (CPI) was used as the personality assessment of all applicants to the PsyD program. The CPI quadrant score of "Alpha" with a CPI score of…

  14. Investigation of the degree of organisational influence on patient experience scores in acute medical admission units in all acute hospitals in England using multilevel hierarchical regression modelling

    PubMed Central

    Sullivan, Paul

    2017-01-01

    Objectives Previous studies found that hospital and specialty have limited influence on patient experience scores, and patient level factors are more important. This could be due to heterogeneity of experience delivery across subunits within organisations. We aimed to determine whether organisation level factors have greater impact if scores for the same subspecialty microsystem are analysed in each hospital. Setting Acute medical admission units in all NHS Acute Trusts in England. Participants We analysed patient experience data from the English Adult Inpatient Survey which is administered to 850 patients annually in each acute NHS Trusts in England. We selected all 8753 patients who returned the survey and who were emergency medical admissions and stayed in their admission unit for 1–2 nights, so as to isolate the experience delivered during the acute admission process. Primary and secondary outcome measures We used multilevel logistic regression to determine the apportioned influence of host organisation and of organisation level factors (size and teaching status), and patient level factors (demographics, presence of long-term conditions and disabilities). We selected ‘being treated with respect and dignity’ and ‘pain control’ as primary outcome parameters. Other Picker Domain question scores were analysed as secondary parameters. Results The proportion of overall variance attributable at organisational level was small; 0.5% (NS) for respect and dignity, 0.4% (NS) for pain control. Long-standing conditions and consequent disabilities were associated with low scores. Other item scores also showed that most influence was from patient level factors. Conclusions When a single microsystem, the acute medical admission process, is isolated, variance in experience scores is mainly explainable by patient level factors with limited organisational level influence. This has implications for the use of generic patient experience surveys for comparison between

  15. Intensive care unit admission in chronic obstructive pulmonary disease: patient information and the physician's decision-making process.

    PubMed

    Schmidt, Matthieu; Demoule, Alexandre; Deslandes-Boutmy, Emmanuelle; Chaize, Marine; de Miranda, Sandra; Bèle, Nicolas; Roche, Nicolas; Azoulay, Elie; Similowski, Thomas

    2014-06-04

    ICU admission is required in more than 25% of patients with chronic obstructive pulmonary disease (COPD) at some time during the course of the disease. However, only limited information is available on how physicians communicate with COPD patients about ICU admission. COPD patients and relatives from 19 French ICUs were interviewed at ICU discharge about their knowledge of COPD. French pulmonologists self-reported their practices for informing and discussing intensive care treatment preferences with COPD patients. Finally, pulmonologists and ICU physicians reported barriers and facilitators for transfer of COPD patients to the ICU and to propose invasive mechanical ventilation. Self-report questionnaires were filled in by 126 COPD patients and 102 relatives, and 173 pulmonologists and 135 ICU physicians were interviewed. For 41% (n = 39) of patients and 54% (n = 51) of relatives, ICU admission had never been expected prior to admission. One half of patients were not routinely informed by their pulmonologist about possible ICU admission at some time during the course of COPD. Moreover, treatment options (that is, non-invasive ventilation, intubation and mechanical ventilation or tracheotomy) were not explained to COPD patients during regular pulmonologist visits. Pulmonologists and ICU physician have different perceptions of the decision-making process pertaining to ICU admission and intubation. The information provided by pulmonologists to patients and families concerning the prognosis of COPD, the risks of ICU admission and specific care could be improved in order to deliver ICU care in accordance with the patient's personal values and preferences. Given the discrepancies in the decision-making process between pulmonologists and intensivists, a more collaborative approach should probably be discussed.

  16. Does lack of routine postnatal examination on maternity unit increase the risk of hospital admission in the first week of life?

    PubMed

    Abelian, Arthur; Turner, Jim; Cusack, Jonathan

    2010-02-01

    The purpose of this study is to establish whether omitting routine postnatal examination on maternity units increases the risk of hospitalisation in the first week of life of the newborn. Retrospective analysis of maternal and baby details and paediatric admission data spanning 12 months in the setting of two maternity units and children's admission unit (CAU) at the University Hospitals of Leicester NHS Trust, Leicester, UK looking at all live-born babies not admitted to neonatal units (n = 7,058). For babies within first week of life, main outcome measures are: (1) risk of the need to be assessed on CAU and (2) risk of hospitalisation for 48 h. Babies who had routine postnatal examination on maternity unit (n = 3,631) and babies who had no such examination (n = 3,427) had similar risks of the need to be seen on CAU (3% and 2.4%, respectively; p = 0.057) and of hospitalisation for 48 h (0.82% and 0.67%, respectively; p = 0.22). Babies born to first-time mothers and/or premature were more likely to have postnatal examination on the maternity unit and were at a higher risk of hospitalisation in the first week of life. With prudent selection and extended surveillance of at-risk babies, lack of routine postnatal examination on maternity unit did not increase the risks of hospital review or admission in the first week of life. Worryingly, however, as many as 27% of all babies might not have had routine postnatal examination at all.

  17. Time from accident to admission to a burn intensive care unit: how long does it actually take? A 25-year retrospective data analysis from a german burn center

    PubMed Central

    Schiefer, J.L.; Alischahi, A.; Perbix, W.; Grigutsch, D.; Graeff, I.; Zinser, M.; Demir, E.; Fuchs, P.C.; Schulz, A.

    2016-01-01

    Summary Severe burn injuries often require specialized treatment at a burn center. It is known that prompt admission to an intensive care unit is essential for achieving good outcome. Nevertheless, very little is known about the duration of time before a patient is admitted to a specialized center after a burn injury in Germany, and whether the situation has improved over time. We retrospectively analyzed time from burn injury to admission to the burn intensive care unit in the Cologne-Merheim Medical Center - one of Germany’s specialized burn centers - over the last 25 years. Moreover, we analyzed the data based on differences according to time of injury and day of the week, as well as severity of the burn injury. There was no weekend effect with regard to transfer time; instead transfer time was particularly short on a Monday or on Sundays. Furthermore, patients with severe burn injuries of 40-89% total body surface area (TBSA) showed the least differences in transfer time. Interestingly, the youngest and the oldest patients arrived at the burn intensive care unit (BICU) the fastest. This study should help elucidate published knowledge regarding transfer time from the scene of the accident to admission to a BICU in Germany. PMID:27857646

  18. Time from accident to admission to a burn intensive care unit: how long does it actually take? A 25-year retrospective data analysis from a german burn center.

    PubMed

    Schiefer, J L; Alischahi, A; Perbix, W; Grigutsch, D; Graeff, I; Zinser, M; Demir, E; Fuchs, P C; Schulz, A

    2016-03-31

    Severe burn injuries often require specialized treatment at a burn center. It is known that prompt admission to an intensive care unit is essential for achieving good outcome. Nevertheless, very little is known about the duration of time before a patient is admitted to a specialized center after a burn injury in Germany, and whether the situation has improved over time. We retrospectively analyzed time from burn injury to admission to the burn intensive care unit in the Cologne-Merheim Medical Center - one of Germany's specialized burn centers - over the last 25 years. Moreover, we analyzed the data based on differences according to time of injury and day of the week, as well as severity of the burn injury. There was no weekend effect with regard to transfer time; instead transfer time was particularly short on a Monday or on Sundays. Furthermore, patients with severe burn injuries of 40-89% total body surface area (TBSA) showed the least differences in transfer time. Interestingly, the youngest and the oldest patients arrived at the burn intensive care unit (BICU) the fastest. This study should help elucidate published knowledge regarding transfer time from the scene of the accident to admission to a BICU in Germany.

  19. Shocking Admission

    ERIC Educational Resources Information Center

    Hoover, Eric; Millman, Sierra

    2007-01-01

    Marilee Jones's career had been a remarkable success. She joined Massachusetts Institute of Technology's (MIT's) admissions office in 1979, landing a job in Cambridge at a time when boys ruled the sandbox of the admissions profession. Her job was to help MIT recruit more women, who then made up less than one-fifth of the institute's students. She…

  20. Shocking Admission

    ERIC Educational Resources Information Center

    Hoover, Eric; Millman, Sierra

    2007-01-01

    Marilee Jones's career had been a remarkable success. She joined Massachusetts Institute of Technology's (MIT's) admissions office in 1979, landing a job in Cambridge at a time when boys ruled the sandbox of the admissions profession. Her job was to help MIT recruit more women, who then made up less than one-fifth of the institute's students. She…

  1. A model for the evaluation of respiratory therapy program admissions criteria.

    PubMed

    Flanigan, K S

    1985-05-01

    Attrition in respiratory therapy programs is a waste of both human and economic resources and may be one cause of the current shortage of qualified personnel. Poor academic performance has been shown to be the leading cause of program attrition. The purposes of this study were to establish the predictive abilities of aptitude and performance measures for classroom and laboratory performance in a respiratory therapy program and to describe a methodology for the development of academic admissions criteria. The preprogram college cumulative grade point average (pPGPA), the preprogram science-mathematics grade point average (S-M GPA), the American College Test (ACT) composite, and four ACT subtest scores of 39 graduates of The Ohio State University Respiratory Therapy Division were compared to their program grade point average (PGPA). We applied a multiple regression analysis and derived regression equations. Multiple regression analysis demonstrated that the S-M GPA is the most significant predictor of program academic performance (P less than or equal to 0.05). The derived regression equation was applied to calculate the minimum S-M GPA for admission by using the standard error of the estimate (SEE) of the regression equation and the mean minimum acceptable PGPA at a 95% confidence interval. For those students who have met the minimum S-M GPA, we have experienced no academic attrition. Multiple regression analysis of student data and the derived regression equations may be used to determine program-specific admissions criteria.

  2. A comparison of zinc metabolism, inflammation, and disease severity in critically ill infected and noninfected adults early after intensive care unit admission123

    PubMed Central

    Besecker, Beth Y; Exline, Matthew C; Hollyfield, Jennifer; Phillips, Gary; DiSilvestro, Robert A; Wewers, Mark D; Knoell, Daren L

    2011-01-01

    Background: Zinc deficiency is a cause of immune dysfunction and infection. Previous human studies have shown that the activation of the acute phase response alters zinc metabolism. Whether the alteration in zinc metabolism is predictive of disease severity in the setting of critical illness is unclear. Objective: We sought to determine whether differences occur in zinc metabolism at the onset of critical illness between infected (septic) and noninfected subjects. Design: We conducted this prospective study in an adult medical intensive care unit (MICU) at a tertiary care hospital. Subjects were enrolled within 24 h of intensive care unit admission. Subjects who did not meet sepsis criteria were considered for the critically ill control (CIC) arm. After patient consent, blood was immediately collected to measure plasma zinc and cytokine concentrations and zinc transporter gene expression in peripheral blood monocytes. Clinical data during the MICU stay were also recorded. Results: A total of 56 patients were evaluated (22 septic, 22 CIC, and 12 healthy subjects). Plasma zinc concentrations were below normal in CIC patients and further reduced in the septic cohort (57.2 ± 18.2 compared with 45.5 ± 18.1 μg/dL). Cytokine concentrations increased with decreasing plasma zinc concentrations (P = 0.05). SLC39A8 gene expression was highest in patients with the lowest plasma zinc concentrations and the highest severity of illness. Conclusions: The alteration of zinc metabolism was more pronounced in septic patients than in noninfected critically ill patients. Specifically, sepsis was associated with lower plasma zinc concentrations and higher SLC39A8 mRNA expression, which correlated with an increased severity of illness, including cardiovascular dysfunction. PMID:21525204

  3. Admissions Testing & Institutional Admissions Processes

    ERIC Educational Resources Information Center

    Hossler, Don; Kalsbeek, David

    2009-01-01

    The array of admissions models and the underlying, and sometimes conflicting goals people have for college admissions, create the dynamics and the tensions that define the contemporary context for enrollment management. The senior enrollment officer must ask, for example, how does an institution try to assure transparency, equality of access,…

  4. Impact of Delayed Admission to the Intensive Care Unit from the Emergency Department upon Sepsis Outcomes and Sepsis Protocol Compliance

    PubMed Central

    Price, Lori Lyn; Andoh-Duku, Augustine; LaCamera, Peter

    2017-01-01

    Rationale. The impact of emergency department length of stay (EDLOS) upon sepsis outcomes needs clarification. We sought to better understand the relationship between EDLOS and both outcomes and protocol compliance in sepsis. Methods. We performed a retrospective observational study of septic patients admitted to the ICU from the ED between January 2012 and December 2015 in a single tertiary care teaching hospital. 287 patients with severe sepsis and septic shock were included. Study population was divided into patients with EDLOS < 6 hrs (early admission) versus ≥6 hours (delayed admission). We assessed the impact of EDLOS on hospital mortality, compliance with sepsis protocol, and resuscitation. Statistical significance was determined by chi-square test. Results. Of the 287 septic ED patients, 137 (47%) were admitted to the ICU in <6 hours. There was no significant in-hospital mortality difference between early and delayed admissions (p = 0.68). Both groups have similar compliance with the 3-hour protocol (p = 0.77). There was no significant difference in achieving optimal resuscitation within 12 hours (p = 0.35). Conclusion. We found that clinical outcomes were not significantly different between early and delayed ICU admissions. Additionally, EDLOS did not impact compliance with the sepsis protocol with the exception of repeat lactate draw. PMID:28409028

  5. Particulate matter and daily mortality and hospital admissions in the west midlands conurbation of the United Kingdom: associations with fine and coarse particles, black smoke and sulphate.

    PubMed

    Anderson, H R; Bremner, S A; Atkinson, R W; Harrison, R M; Walters, S

    2001-08-01

    There is considerable evidence linking ambient particles measured as particulate matter with aerodynamic diameter <10 microm (PM(10)) to daily mortality and hospital admissions but it is not clear which physical or chemical components of the particle mixture are responsible. The relative effects of fine particles (PM(2.5)), coarse particles (PM(2.5-10)), black smoke (mainly fine particles of primary origin) and sulphate (mainly fine particles of secondary origin) were investigated, together with ozone, SO(2), NO(2), and CO, on daily mortality and hospital admissions in the west Midlands conurbation of the United Kingdom. Time series of health outcome and environmental data were obtained for the period 1994-6. The relative risk of death or hospital admission was estimated with regression techniques, controlling for long term time trends, seasonal patterns, influenza epidemics, effects of day of the week, and temperature and humidity. Models were adjusted for any remaining residual serial correlation and overdispersion. The sensitivities of the estimates for the effects of pollution to the inclusion of a second pollutant and seasonal interactions (warm or cool) were also examined. Daily all cause mortality was not associated with any gaseous or particulate air pollutant in the all year analysis, although all measures of particles apart from PM(2.5-10) showed significant positive effects of the warm season. Neither respiratory nor cardiovascular admissions (all ages) were associated with any air pollutant, and there were no important seasonal interactions. However, analysis of admissions by age found evidence for various associations-notably between PM(10), PM(2.5), black smoke, SO(2,) and ozone (negative) and respiratory admissions in the 0-14 age group. The coarse fraction, PM(2.5-10) differed from PM(2.5) in having smaller and less consistent associations (including several large significant negative associations) and a different lag distribution. The results for

  6. Booking patients for hospital admissions: evaluation of a pilot programme for day cases

    PubMed Central

    McLeod, Hugh; Ham, Chris; Kipping, Ruth

    2003-01-01

    Problem NHS patients requiring elective surgery usually have to wait before being treated and are usually told when a date becomes available. Design 18 month pilot programme to enable day case patients to book date of hospital admission at time of decision to operate. Background and setting 24 pilot sites in England with relatively short waiting times and some experience of booking appointments. Key measures for improvement Proportion of patients with booked or “to come in” date during and after pilot programme, proportion not attending for admission, and proportion waiting ≥ 6 months. Comparison of pilot sites with non-pilot sites. Strategies for change National Patients' Access Team established to help pilot sites enable patients to book admission dates. Provision of £9.9m to pilot sites to employ project managers, purchase equipment, buy extra time from clinical and other staff, and invest in information and communications technology. Effects of change Proportion of patients with booked or “to come in” date increased from 51.1% to 72.7% between end of March 1999 and end of March 2000, and then fell to 66.2% by end of March 2001. Over the same periods, the proportion of patients waiting ≥ 6 months fell from 10.9% to 10.5% and then increased to 11.9%. The proportion of patients failing to attend fell from 5.7% to 3.1% between the first quarter of 1999 and the first quarter of 2000, and then increased to 4.0% in the first quarter of 2001. Pilot sites varied widely in performance during and after the pilot phase. Pilot sites had higher proportions of patients with booked or “to come in” date than non-pilot sites at end of each period. Lessons learnt Increasing the proportion of patients who book their date of hospital admission is possible, but there are difficulties in sustaining this. Several factors facilitated or hindered the implementation of booking, and the roll out of the programme across the NHS is seeking to incorporate these factors. PMID

  7. Changes in Perceptions of Opioids Before and After Admission to Palliative Care Units in Japan: Results of a Nationwide Bereaved Family Member Survey.

    PubMed

    Kinoshita, Satomi; Miyashita, Mitsunori; Morita, Tatsuya; Sato, Kazuki; Miyazaki, Tamana; Shoji, Ayaka; Chiba, Yurika; Tsuneto, Satoru; Shima, Yasuo

    2016-06-01

    This study aimed to clarify perspectives of bereaved family members regarding opioids and compare perceptions before admission and after bereavement. A cross-sectional questionnaire survey for bereaved family members in 100 inpatient palliative care units was administered. Participants were 297 bereaved family members of patients who used opioids. Many bereaved family members had misconceptions of opioids before admission. There was improvement after bereavement, but understanding remained low. Respondents less than 65 years old showed significantly greater decreases in misconceptions regarding opioids compared to older generations, after bereavement. Bereaved family members who were misinformed about opioids by physicians were significantly more likely to have misconceptions about opioids. Educational interventions for physicians are needed to ensure that they offer correct information to the general population.

  8. The ED-inpatient dashboard: Uniting emergency and inpatient clinicians to improve the efficiency and quality of care for patients requiring emergency admission to hospital.

    PubMed

    Staib, Andrew; Sullivan, Clair; Jones, Matt; Griffin, Bronwyn; Bell, Anthony; Scott, Ian

    2016-09-04

    Patients who require emergency admission to hospital require complex care that can be fragmented, occurring in the ED, across the ED-inpatient interface (EDii) and subsequently, in their destination inpatient ward. Our hospital had poor process efficiency with slow transit times for patients requiring emergency care. ED clinicians alone were able to improve the processes and length of stay for the patients discharged directly from the ED. However, improving the efficiency of care for patients requiring emergency admission to true inpatient wards required collaboration with reluctant inpatient clinicians. The inpatient teams were uninterested in improving time-based measures of care in isolation, but they were motivated by improving patient outcomes. We developed a dashboard showing process measures such as 4 h rule compliance rate coupled with clinically important outcome measures such as inpatient mortality. The EDii dashboard helped unite both ED and inpatient teams in clinical redesign to improve both efficiencies of care and patient outcomes.

  9. Secondary infection and clinical aspects after pandemic swine–origin influenza a (H1N1) admission in an Iranian critical care unite

    PubMed Central

    Hashemian, Seyed Mohammadreza; Tabarsi, Payam; Nadji, Seyed Alireza; Jamaati, Hamidreza; Mohajerani, Seyed Amir; Shamaee, Massoud; Chitsazan, Mandana; Radmand, Golnar; Maadani, Mohammadreza; Mansouri, Seyed Davoud

    2014-01-01

    Objective: A new flu virus (H1N1) swine origin and cause of human infection with acute lung disease was published in the world and led to many patients were admitted in intensive care unit (ICU). Materials and Methods: In a prospective descriptive study, all ICU patients in a pulmonary disease specialist hospital between April 2010 and July 2011 with confirmed infection (H1N1) were evaluated. Information including demographic, clinical and microbiology using Statistical Package for Social Sciences (SPSS) software version 16 was studied and classified. Results: Of 46 patients hospitalized with confirmed diagnosis of swine flu pneumonia (H1N1), 20 cases (43.7%) admitted in ICU out of which 10 cases were males (50%), the mean age was 36.9 and the range was 21-66 years. Nine patients (45%) had underlying diseases. Most underlying disease was respiratory disease in which four cases (20%) were of asthma and one patient had chronic obstructive pulmonary disease (COPD). No admission of pregnant patient with swine flu was reported in the ICU. Cough and sputum were the most frequent symptoms (19 patients equal 95%). Four patients (20%) were admitted with decreased level of consciousness and five cases (25%) died during hospitalization. Conclusion: It seems, swine flu with high mortality and transfer rates is a worldwide health problem. Because of limited treatment regimen, the risk of secondary infection and high need to intensive care in H1N1 pneumonia, environmental control, including vaccination of high risk people and public announcement, make determining role in controlling of this disease. PMID:25625063

  10. Risk factors for methicillin-resistant Staphylococcus aureus colonisation or infection in intensive care units and their reliability for predicting MRSA on ICU admission.

    PubMed

    Callejo-Torre, Fernando; Eiros Bouza, Jose Maria; Olaechea Astigarraga, Pedro; Coma Del Corral, Maria Jesus; Palomar Martínez, Mercedes; Alvarez-Lerma, Francisco; López-Pueyo, Maria Jesús

    2016-09-01

    Predicting methicillin-resistant Staphylococcus aureus (MRSA) in intensive care units (ICUs) avoids inappropriate antimicrobial empirical treatment and enhances infection control. We describe risk factors for colonisation/infection related to MRSA (MRSA-C/I) in critically ill patients once in the ICU and on ICU admission, and search for an easy-to-use predictive model for MRSA colonisation/infection on ICU admission. This multicentre cohort study included 69,894 patients admitted consecutively (stay>24h) in April-June in the five-year period 2006-2010 from 147 Spanish ICUs participating in the National Surveillance Study of Nosocomial Infections in ICUs (ENVIN-HELICS). Data from all patients included were used to identify risk factors for MRSA-C/I during ICU stays, from admission to discharge, using uni- and multivariable analysis (Poisson regression) to check that the sample to be used to develop the predictive models was representative of standard critical care population. To identify risk factors for MRSA-C/I on ICU admission and to develop prediction models, multivariable logistic regression analysis were then performed only on those admitted in 2010 (n=16950, 2/3 for analysis and 1/3 for subsequent validation). We found that, in the period 2006-2010, 1046 patients were MRSA-C/I. Independent risk factors for MRSA-C/I in ICU were: age>65, trauma or medical patient, high APACHE-II score, admitted from a long-term care facility, urinary catheter, previous antibiotic treatment and skin-soft tissue or post-surgical superficial skin infections. Colonisation with several different MDRs significantly increased the risk of MRSA-C/I. Risk factors on ICU admission were: male gender, trauma critical patient, urgent surgery, admitted from other ICUs, hospital ward or long-term facility, immunosuppression and skin-soft tissue infection. Although the best model to identify carriers of MRSA had a good discrimination (AUC-ROC, 0.77; 95% CI, 0.72-0.82), sensitivity was 67% and

  11. Comparison of the Mortality Probability Admission Model III, National Quality Forum, and Acute Physiology and Chronic Health Evaluation IV hospital mortality models: implications for national benchmarking*.

    PubMed

    Kramer, Andrew A; Higgins, Thomas L; Zimmerman, Jack E

    2014-03-01

    To examine the accuracy of the original Mortality Probability Admission Model III, ICU Outcomes Model/National Quality Forum modification of Mortality Probability Admission Model III, and Acute Physiology and Chronic Health Evaluation IVa models for comparing observed and risk-adjusted hospital mortality predictions. Retrospective paired analyses of day 1 hospital mortality predictions using three prognostic models. Fifty-five ICUs at 38 U.S. hospitals from January 2008 to December 2012. Among 174,001 intensive care admissions, 109,926 met model inclusion criteria and 55,304 had data for mortality prediction using all three models. None. We compared patient exclusions and the discrimination, calibration, and accuracy for each model. Acute Physiology and Chronic Health Evaluation IVa excluded 10.7% of all patients, ICU Outcomes Model/National Quality Forum 20.1%, and Mortality Probability Admission Model III 24.1%. Discrimination of Acute Physiology and Chronic Health Evaluation IVa was superior with area under receiver operating curve (0.88) compared with Mortality Probability Admission Model III (0.81) and ICU Outcomes Model/National Quality Forum (0.80). Acute Physiology and Chronic Health Evaluation IVa was better calibrated (lowest Hosmer-Lemeshow statistic). The accuracy of Acute Physiology and Chronic Health Evaluation IVa was superior (adjusted Brier score = 31.0%) to that for Mortality Probability Admission Model III (16.1%) and ICU Outcomes Model/National Quality Forum (17.8%). Compared with observed mortality, Acute Physiology and Chronic Health Evaluation IVa overpredicted mortality by 1.5% and Mortality Probability Admission Model III by 3.1%; ICU Outcomes Model/National Quality Forum underpredicted mortality by 1.2%. Calibration curves showed that Acute Physiology and Chronic Health Evaluation performed well over the entire risk range, unlike the Mortality Probability Admission Model and ICU Outcomes Model/National Quality Forum models. Acute

  12. [Appropriateness of emergency hospital admissions].

    PubMed

    Ochoa-Gómez, J; Villar Arias, A; Ramalle-Gómara, E; Carpintero Escudero, J M; Bragado Blas, L; Ruiz Azpiazu, J I

    2002-09-01

    The aim of this work is to know the proportion of inadequate urgent admissions in a general hospital. A retrospective and descriptive study of patients admitted during 1,999 was performed. The Appropriatness Evaluation Protocol (AEP) was used in order to evaluate the appropriatness of the admissions. Eighteen admissions (4.5%) were inadecuated. There was a higher proportion of inappropriate admission (IA) when the physician responsible of the admission was a medical specialist (internal medicine, hematology or nephrology): odds ratio 5.3 in opposite to emergency physicians (p < 0.03). There was a low proportion of inadequate admissions (4.5%) and the risk of inappropriatness of the admission was major when it was ordered by a medical specialist.

  13. The effect of a short-stay unit on hospital admission and length of stay in acute heart failure: REDUCE-AHF study.

    PubMed

    Miró, Òscar; Carbajosa, Virginia; Peacock, W Frank; Llorens, Pere; Herrero, Pablo; Jacob, Javier; Collins, Sean P; Fernández, Cristina; Pastor, Antoni Juan; Martín-Sánchez, Francisco Javier

    2017-05-01

    To determine whether the presence of a short-stay unit(SSU) in a hospital influences the percentage of admissions, length of hospital stay(LOS) and outcomes in emergency department(ED) patients with acute heart failure(AHF). Retrospective analysis of AHF patients presenting to one of 34 Spanish ED included in EAHFE registry. Baseline and ED data of patients were collected. Patients were classified into two groups in function of being attended at hospitals with or without a SSU. Main outcome variables were the percentage of admissions from ED, and LOS for admitted patients. Secondary variables were all-cause death and ED revisits for worsening heart failure within 30days following discharge. Of 9078 patients presenting to the ED (SSU 5191; no SSU 3887), 6796 (74.8%) were admitted. Compared to hospitals without a SSU, the admission rate in hospitals with a SSU was 8.9% higher (95%CI 6.5%-11.4%), but 30-day ED revisit and mortality rates were lower among patients discharged directly from the ED (-10.3%, 95%CI -16,9% to -3.7%; and -10.0%, 95%CI -16.6 to -3.4%, respectively). For admitted patients, the overall LOS was 9.3±9.5days, being 2.2days shorter (95%CI -2.7 to -1.7) in hospitals with a SSU, with no significant differences in in-hospital, 30-day mortality or 30-day ED revisit rates. The data suggest that SSU may improve the safety of emergency care of patients with AHF, but at the cost of a higher rate of hospital admissions, and it may also reduce the LOS for admitted patients without affecting post discharge safety. Copyright © 2017 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

  14. Association of bystander interventions and hospital length of stay and admission to intensive care unit in out-of-hospital cardiac arrest survivors.

    PubMed

    Riddersholm, Signe; Kragholm, Kristian; Mortensen, Rikke Nørmark; Pape, Marianne; Hansen, Carolina Malta; Lippert, Freddy K; Torp-Pedersen, Christian; Christiansen, Christian F; Rasmussen, Bodil Steen

    2017-10-01

    The impact of bystander interventions on post-arrest hospital course is sparsely studied. We examined the association between bystander interventions and length of hospital stay and admission to intensive care unit (ICU) in one-day survivors after OHCA. This cohort study linked data of 4641 one-day OHCA survivors from 2001 to 2014 to data on hospital length of stay and ICU admission. We examined associations between bystander efforts and outcomes using regression, adjusted for age, sex, comorbidities, calendar year and witnessed status. We divided bystander efforts into three categories: 1. No bystander interventions; 2.Bystander CPR only; 3. Bystander defibrillation with or without bystander CPR. For patients surviving to hospital discharge, hospital length of stay was 20days for patients without bystander interventions, compared to 16 for bystander CPR, and 13 for bystander defibrillation. 82% of patients without bystander interventions were admitted to ICU compared to 77.2% for bystander CPR, and 61.2% for bystander defibrillation. In-hospital mortality was 60% in the first category compared to 40.5% and 21.7% in the two latter categories. In regression models, bystander CPR and bystander defibrillation were associated with a reduction of length of hospital stay of 21% (Estimate: 0.79 [95% CI: 0.72-0.86]) and 32% (Estimate: 0.68 [95% CI: 0.59-0.78]), respectively. Both bystander CPR (OR: 0.94 [95% CI: 0.91-0.97]) and bystander defibrillation (OR: 0.81 [0.76-0.85]), were associated with lower risk of ICU admission. Bystander interventions were associated with reduced hospital length of stay and ICU admission, suggesting that these efforts improve recovery in OHCA survivors. Copyright © 2017 Elsevier B.V. All rights reserved.

  15. Lack of utility of a decision support system to mitigate delays in admission from the operating room to the postanesthesia care unit.

    PubMed

    Ehrenfeld, Jesse M; Dexter, Franklin; Rothman, Brian S; Minton, Betty Sue; Johnson, Diane; Sandberg, Warren S; Epstein, Richard H

    2013-12-01

    When the phase I postanesthesia care unit (PACU) is at capacity, completed cases need to be held in the operating room (OR), causing a "PACU delay." Statistical methods based on historical data can optimize PACU staffing to achieve the least possible labor cost at a given service level. A decision support process to alert PACU charge nurses that the PACU is at or near maximum census might be effective in lessening the incidence of delays and reducing over-utilized OR time, but only if alerts are timely (i.e., neither too late nor too early to act upon) and the PACU slot can be cleared quickly. We evaluated the maximum potential benefit of such a system, using assumptions deliberately biased toward showing utility. We extracted 3 years of electronic PACU data from a tertiary care medical center. At this hospital, PACU admissions were limited by neither inadequate PACU staffing nor insufficient PACU beds. We developed a model decision support system that simulated alerts to the PACU charge nurse. PACU census levels were reconstructed from the data at a 1-minute level of resolution and used to evaluate if subsequent delays would have been prevented by such alerts. The model assumed there was always a patient ready for discharge and an available hospital bed. The time from each alert until the maximum census was exceeded ("alert lead time") was determined. Alerts were judged to have utility if the alert lead time fell between various intervals from 15 or 30 minutes to 60, 75, or 90 minutes after triggering. In addition, utility for reducing over-utilized OR time was assessed using the model by determining if 2 patients arrived from 5 to 15 minutes of each other when the PACU census was at 1 patient less than the maximum census. At most, 23% of alerts arrived 30 to 60 minutes prior to the admission that resulted in the PACU exceeding the specified maximum capacity. When the notification window was extended to 15 to 90 minutes, the maximum utility was <50%. At most, 45

  16. Serious neck injuries in U19 rugby union players: an audit of admissions to spinal injury units in Great Britain and Ireland.

    PubMed

    MacLean, James G B; Hutchison, James D

    2012-06-01

    To obtain data regarding admissions of U19 rugby players to spinal injury units in Great Britain and Ireland and to compare this with a recent peak in presentation in Scotland. To assess the current state of data collection and subsequent analysis of serious neck injuries. To analyse the mechanism of injury in this group of at-risk players. Retrospective case series. Spinal injury units in Great Britain and Ireland. Annual frequency of serious neck injuries. Analysis of injury types, neurological deficit and mechanism of injury. 36 Injuries were recorded. 10 Of these occurred in Scotland since 1996 of which six have occurred in the past 4 years. This compared with 14 in Ireland over the same period. 12 Cases were traced in England and Wales since 2000; records were not available before this date. No prospective collation of data is performed by the home unions and inconsistency of data collection exists. The mean age was 16.2 years. 16 Of the 36 admissions had complete neurological loss, 9 had incomplete neurological injury and 11 had cervical column injury without spinal cord damage. The mechanism of injury was tackle in 17 (47%), scrum in 13 (36%), two each due to the maul and collision, and one each due to a kick and a ruck. Some degree of spinal cord injury occurred in 92% of scrum injuries (61% complete) and 53% of tackle injuries (29% complete). U19 rugby players continue to sustain serious neck injuries necessitating admission to spinal injury units with a low but persistent frequency. The recent rate of admission in Scotland is disproportionately high when the respective estimated playing populations are considered. While more injuries were sustained in the tackle, spinal cord injury was significantly more common in neck injury sustained in the scrum (p<0.001). No register of catastrophic neck injuries exists despite repeated calls over the past three decades, and a study such as this has not been reported before. Data collection of this serious category of

  17. Experiences of nurses caring for mental health care users in an acute admission unit at a psychiatric hospital in the Western Cape Province.

    PubMed

    Sobekwa, Zintle C; Arunachallam, Sathasivan

    2015-12-18

    Caring for mental health care users (MHCUs) with mental illnesses is a major task that confronts nurses globally. It has been argued that caring for this group of patients is accompanied by unique challenges. Despite the available abundance of data about nursing patients suffering from mental illnesses, little is known about the lived experiences of nurses who care for MHCUs in acute admission units in the Western Cape province. This study's aim is to explore and describe the lived experiences of nurses who care for MHCUs in an acute admission unit at a psychiatric hospital in the Western Capeprovince. A qualitative, descriptive, phenomenological study was conducted. A purposive sampling procedure was applied which resulted in a sample that comprised eight nurses. Indepth, individual, semi-structured interviews were conducted with these eight participants. Interviews were audio-recorded and transcribed verbatim and the researcher utilised Collaizzi's method to analyse collected data. Both positive and negative experiences were reported. Positive experiences werethe recovery of patients, teamwork, and passion for caring. Negative experiences were thefeelings of being unappreciated and unsupported by authorities. Physical assault by MHCUs,shortage of staff, increased workload and burnout was also reported. In-service training about management of aggression needs to be provided,debriefing sessions to deal with burnout needs to be arranged, and research to quantify levelsof burnout should be conducted.

  18. Insomnia among patients with advanced disease during admission in a Palliative Care Unit: a prospective observational study on its frequency and association with psychological, physical and environmental factors

    PubMed Central

    2014-01-01

    Background The aims of this study were: 1) to assess the frequency of insomnia among patients during admission in a Palliative Care Unit (PCU); 2) to study the association between emotional distress and insomnia, taking physical, environmental and other psychological factors into account. Methods Prospective observational study including patients consecutively admitted to a PCU during eight months, excluding those with severe cognitive problems or too low performance status. Insomnia was assessed by asking a single question and by using the Sleep Disturbance Scale (SDS), and emotional distress using the Hospital Anxiety and Depression Scale (HADS). Physical, environmental and other psychological factors potentially interfering with sleep quality were evaluated. Association between insomnia and the factors evaluated was studied using univariate and multivariate regression analyses. Results 61 patients were included (mean age 71.5 years; 95% with oncological disease); 38 (62%) answered “yes” to the insomnia single question and 29 (47%) showed moderate to severe insomnia according to the SDS. 65% showed clinically significant emotional distress and 79% had nocturnal rumination. The physical symptoms most often mentioned as interfering with sleep quality were pain (69%) and dyspnoea (36%). 77% reported at least one environmental disturbance. In the univariate analysis, answering “yes” to the insomnia single question was significantly associated with higher HADS score, anxiety, nocturnal rumination, clear knowledge of the diagnosis, higher performance status and dyspnoea; moderate to severe insomnia was significantly associated with nocturnal rumination, higher performance status, environmental disturbances and daytime sleepiness. In the multivariate regression analysis, answering “yes” to the single question was associated with dyspnoea (OR 7.2 [1.65-31.27]; p = 0.009), nocturnal rumination (OR 5.5 [1.05-28.49]; p = 0.04) and higher performance

  19. Evaluating MEDEVAC Force Structure Requirements Using an Updated Army Scenario, Total Army Analysis Admission Data, Monte Carlo Simulation, and Theater Structure.

    PubMed

    Fulton, Lawrence; Kerr, Bernie; Inglis, James M; Brooks, Matthew; Bastian, Nathaniel D

    2015-07-01

    In this study, we re-evaluate air ambulance requirements (rules of allocation) and planning considerations based on an Army-approved, Theater Army Analysis scenario. A previous study using workload only estimated a requirement of 0.4 to 0.6 aircraft per admission, a significant bolus over existence-based rules. In this updated study, we estimate requirements for Phase III (major combat operations) using a simulation grounded in previously published work and Phase IV (stability operations) based on four rules of allocation: unit existence rules, workload factors, theater structure (geography), and manual input. This study improves upon previous work by including the new air ambulance mission requirements of Department of Defense 51001.1, Roles and Functions of the Services, by expanding the analysis over two phases, and by considering unit rotation requirements known as Army Force Generation based on Department of Defense policy. The recommendations of this study are intended to inform future planning factors and already provided decision support to the Army Aviation Branch in determining force structure requirements. Reprint & Copyright © 2015 Association of Military Surgeons of the U.S.

  20. Systematic Review of Economic Evaluations of Units Dedicated to Acute Coronary Syndromes.

    PubMed

    Azeredo-Da-Silva, André Luis Ferreira; Perini, Silvana; Rigotti Soares, Pedro Henrique; Polaczyk, Carisi Anne

    2016-01-01

    Dedicated units for the care of acute coronary syndrome (ACS) have been submitted to economic evaluations; however, the results have not been systematically presented. To identify and summarize economic outcomes of studies on hospital units dedicated to the initial care of patients with suspected or confirmed ACS. A systematic review of literature to identify economic evaluations of chest pain unit (CPU), coronary care unit (CCU), or equivalent units was done. Two search strategies were used: the first one to identify economic evaluations irrespective of study design, and the second one to identify randomized clinical trials that reported economic outcomes. The following databases were searched: MEDLINE, EMBASE, CENTRAL, and National Health Service (NHS)Economic Evaluation Database. Data extraction was performed by two independent reviewers. Costs were inflated to 2012 values. Search strategies retrieved five partial economic evaluations based on observational studies, six randomized clinical trials that reported economic outcomes, and five model-based economic evaluations. Overall, cost estimates based on observational studies and randomized clinical trials reported statistically significant cost savings of more than 50% with the adoption of CPU care instead of routine hospitalization or CCU care for suspected low-to-intermediate risk patients with ACS (median per-patient cost US $1,969.89; range US $1,002.12-13,799.15). Model-based economic evaluations reported incremental cost-effectiveness ratios below US $ 50,000/quality-adjusted life-year for all comparisons between intermediate care unit, CPU, or CCU with routine hospital admissions. This finding was sensible to myocardial infarction probability. Published economic evaluations indicate that more intensive care is likely to be cost-effective in comparison to routine hospital admission for patients with suspected ACS. Copyright © 2016. Published by Elsevier Inc.

  1. Evaluation of relationships between haemodialysis unit professionals.

    PubMed

    Rivares, A V; Navarrete, I G; Pueyo, C G; Torrent, A M; Durán, M M; Gatius, J R; Mussol, L R; Solano, M

    2004-01-01

    This paper focuses on the dynamics of a workgroup in a nephrology and haemodialysis unit. Teamwork is indispensable in nephrology units, as it provides support and help to professionals but working closely together may also cause conflict and great strain. This study describes how much and in what way the anxiety and the relationship between these professionals influences their work, depending on skills and personal preferences among the staff. A questionnaire was used to analyse the following issues: stress, changes, routine, confrontation, comparisons, preferences, support, valuation, assertiveness, self-evaluation, technical competence, affiliation, motivation, work atmosphere and training.

  2. Pre-admission nursing assessment in a Welsh Medium Secure Unit (1991-2000): Part 2--comparison of traditional nursing assessment with the HCR-20 risk assessment tool.

    PubMed

    Watt, Andrew; Topping-Morris, Barry; Rogers, Paul; Doyle, Mike; Mason, Tom

    2003-08-01

    Pre-admission forensic nursing assessment is a tradition that has no research evidence base, little documentary support and is an expensive drain on nursing resources from clinical environments. Such an expensive practice warrants some evaluation of the quality of these nursing assessments. This study assessed the quality of nursing risk assessments through comparison with the HCR-20, a well-established and widely validated violence risk assessment instrument. There was a high degree of correspondence between nurse assessments and the contents of the HCR-20. The results offer support for forensic nurses' abilities to develop effective measures and practices based upon nursing knowledge and experience where no formal evidence base previously existed.

  3. Impact of routine surgical ward and intensive care unit admission surveillance cultures on hospital-wide nosocomial methicillin-resistant Staphylococcus aureus infections in a university hospital: an interrupted time-series analysis.

    PubMed

    Chaberny, Iris F; Schwab, Frank; Ziesing, Stefan; Suerbaum, Sebastian; Gastmeier, Petra

    2008-12-01

    To determine whether a routine admission screening in surgical wards and intensive care units (ICUs) was effective in reducing methicillin-resistant Staphylococcus aureus (MRSA) infections-particularly nosocomial MRSA infections-for the whole hospital. The study used a single-centre prospective quasi-experimental design to evaluate the effect of the MRSA screening policy on the incidence density of MRSA-infected/nosocomial MRSA-infected patients/1000 patient-days (pd) in the whole hospital. The effect on incidence density was calculated by a segmented regression analysis of interrupted time series with 30 months prior to and 24 months after a 6 month implementation period. The MRSA screening policy had a highly significant hospital-wide effect on the incidence density of MRSA infections. It showed a significant change in both level [-0.163 MRSA-infected patients/1000 pd, 95% confidence interval (CI): -0.276 to -0.050] and slope (-0.01 MRSA-infected patients/1000 pd per month, 95% CI: -0.018 to -0.003) after the implementation of the MRSA screening policy. A decrease in the MRSA infections by 57% is a conservative estimate of the reduction between the last month before (0.417 MRSA-infected patients/1000 pd) and month 24 after the implementation of the MRSA screening policy (0.18 MRSA-infected patients/1000 pd). Equivalent results were found in the analysis of nosocomial MRSA-infected patients/1000 pd. This is the first hospital-wide study that investigates the impact of introducing admission screening in ICUs and non-ICUs as a single intervention to prevent MRSA infections performed with a time-series regression analysis. Admission screening is a potent tool in controlling the spread of MRSA infections in hospitals.

  4. Evaluation of medical devices in thoracic radiograms in intensive care unit - time to pay attention!

    PubMed Central

    Moreira, Ana Sofia Linhares; Afonso, Maria da Graça Alves; Dinis, Mónica Ribeiro dos Santos Alves; dos Santos, Maria Cristina Granja Teixeira

    2016-01-01

    Objective To identify and evaluate the correct positioning of the most commonly used medical devices as visualized in thoracic radiograms of patients in the intensive care unit of our center. Methods A literature search was conducted for the criteria used to evaluate the correct positioning of medical devices on thoracic radiograms. All the thoracic radiograms performed in the intensive care unit of our center over an 18-month period were analyzed. All admissions in which at least one thoracic radiogram was performed in the intensive care unit and in which at least one medical device was identifiable in the thoracic radiogram were included. One radiogram per admission was selected for analysis. The radiograms were evaluated by an independent observer. Results Out of the 2,312 thoracic radiograms analyzed, 568 were included in this study. Several medical devices were identified, including monitoring leads, endotracheal and tracheostomy tubes, central venous catheters, pacemakers and prosthetic cardiac valves. Of the central venous catheters that were identified, 33.6% of the subclavian and 23.8% of the jugular were malpositioned. Of the endotracheal tubes, 19.9% were malpositioned, while all the tracheostomy tubes were correctly positioned. Conclusion Malpositioning of central venous catheters and endotracheal tubes is frequently identified in radiograms of patients in an intensive care unit. This is relevant because malpositioned devices may be related to adverse events. In future studies, an association between malpositioning and adverse events should be investigated. PMID:27737432

  5. Admission of hematopoietic cell transplantation patients to the intensive care unit at the Pontificia Universidad Católica de Chile Hospital.

    PubMed

    Escobar, Karen; Rojas, Patricio; Ernst, Daniel; Bertin, Pablo; Nervi, Bruno; Jara, Veronica; Garcia, Maria Jose; Ocqueteau, Mauricio; Sarmiento, Mauricio; Ramirez, Pablo

    2015-01-01

    Patients undergoing hematopoietic cell transplantation (HCT) can have complications that require management in the intensive care unit (ICU). We conducted a retrospective study of patients undergoing HCT between 2007 and 2011 with admission to the ICU. We analyzed 97 patients, with an average age of 37 (range, 15 to 68). The main indications for HCT were hematologic malignancies (84%, n = 82). Ninety percent (n = 87) received myeloablative conditioning. Thirty-one percent were admitted (autologous transplant recipients 15%, allogeneic transplant recipients 34%, and umbilical cord blood [UCB] transplant recipients 48%) with an average length of stay of 19 days (range, 1 to 73 days). The average time between transplantation and transfer was 15 days. The main causes of admission were acute respiratory failure (63%) and septic shock (20%). ICU mortality was 20% for autologous transplantations and 64% for allogeneic transplantations (adult donor and UCB combined). On average, patients died 108 days after the transplantation (range, 4 to 320 days). One-year overall survival, comparing patients entering the ICU with those never admitted, was 16% versus 82% (P < .0001) for allogeneic transplantations (adult donor and UCB combined) and 80% versus 89% (P = not significant) for autologous transplantations. Acute graft-versus-host disease was significantly associated with death in ICU after UCB HCT. ICU support is satisfactory in about one half of patients admitted, characterized by a short and medium term prognosis not as unfavorable as has been previously reported.

  6. Family carers' experience of the need for admission of their relative with an intellectual disability to an Assessment and Treatment Unit.

    PubMed

    James, Neil

    2016-03-01

    There is limited research that explores the experiences of family carers of individuals with an intellectual disability requiring admission to a specialist National Health Service Assessment and Treatment Unit. Accordingly, this study aimed to explore family carers' experience in respect of this phenomenon and their relationships with professionals at this time. Interpretative phenomenological analysis was used. Six family carers (three mothers and three fathers) participated and were interviewed via the use of semi-structured interviews. Five major themes were developed to represent how carers made sense and gave meaning to their experience. They illustrate how this experience had a significant influence on their sense of value and self-identity. It resulted in higher levels of anxiety, stress and uncertainty about the future of their relative and their identity as a carer. Significantly, professionals are identified as having a pivotal role in influencing how carers come to view their sense of self, identity, value and importance. The admission of their relative was a time of increased vulnerability for carers in respect of maintaining a sense of self-identity. Engaging with services and professionals had a major influence on situating them within the social structure that makes up the formal system of support. This had a pivotal role in influencing and determining how participants identified with their sense of self. © The Author(s) 2015.

  7. Evaluating Higher Education Policy in Turkey: Assessment of the Admission Procedure to Architecture, Planning, and Engineering Schools

    ERIC Educational Resources Information Center

    Cubukcu, Kemal Mert; Cubukcu, Ebru

    2009-01-01

    The admission procedure to higher education institutions in Turkey is based on the student's high school grades and Central University Entrance Examination (CUEE) score, with a much greater weight on the latter. However, whether the CUEE is an appropriate measure in the admission process to universities is still a much-debated question. This study…

  8. Association of Risk Factors, Mortality, and Care Costs of Adults With Acute Myeloid Leukemia With Admission to the Intensive Care Unit.

    PubMed

    Halpern, Anna B; Culakova, Eva; Walter, Roland B; Lyman, Gary H

    2017-03-01

    Adults with acute myeloid leukemia (AML) commonly require support in the intensive care unit (ICU), but risk factors for admission to the ICU and adverse outcomes remain poorly defined. To examine risk factors, mortality, length of stay, and cost associated with admission to the ICU for patients with AML. This study extracted information from the University HealthSystem Consortium database on patients 18 years or older with AML who were hospitalized for any cause between January 1, 2004, and December 31, 2012. The University HealthSystem Consortium database contains demographic, clinical, and cost variables prospectively abstracted by certified coders from discharge summaries. Outcomes were analyzed using univariate and multivariable statistical techniques. Data analysis was performed from November 15, 2013, to August 15, 2016. Primary outcomes were admission to the ICU and inpatient mortality among patients requiring ICU care. Secondary outcomes included length of stay in the ICU, total hospitalization length of stay, and cost. Of the 43 249 patients with AML (mean [SD] age, 59.5 [16.6] years; 23 939 men and 19 310 women), 11 277 (26.1%) were admitted to the ICU. On multivariable analysis (with results reported as odds ratios [95% CIs]), independent risk factors for admission to the ICU included age younger than 80 years (1.56 [1.42-1.70]), hospitalization in the South (1.81 [1.71-1.92]), hospitalization at a low- or medium-volume hospital (1.25 [1.19-1.31]), number of comorbidities (10.64 [8.89-12.62] for 5 vs none), sepsis (4.61 [4.34-4.89]), invasive fungal infection (1.24 [1.11-1.39]), and pneumonia (1.73 [1.63-1.82]). In-hospital mortality was higher for patients requiring ICU care (4857 of 11 277 [43.1%] vs 2959 of 31 972 [9.3%]). On multivariable analysis, independent risk factors for death in patients requiring ICU care included age 60 years or older (1.16 [1.06-1.26]), nonwhite race/ethnicity (1.18 [1.07-1.30]), hospitalization on the West

  9. Medical necessity of routine admission of children with mild traumatic brain injury to the intensive care unit.

    PubMed

    Ament, Jared D; Greenan, Krista N; Tertulien, Patrick; Galante, Joseph M; Nishijima, Daniel K; Zwienenberg, Marike

    2017-04-07

    OBJECTIVE Approximately 475,000 children are treated for traumatic brain injury (TBI) in the US each year; most are classified as mild TBI (Glasgow Coma Scale [GCS] Score 13-15). Patients with positive findings on head CT, defined as either intracranial hemorrhage or skull fracture, regardless of severity, are often transferred to tertiary care centers for intensive care unit (ICU) monitoring. This practice creates a significant burden on the health care system. The purpose of this investigation was to derive a clinical decision rule (CDR) to determine which children can safely avoid ICU care. METHODS The authors retrospectively reviewed patients with mild TBI who were ≤ 16 years old and who presented to a Level 1 trauma center between 2008 and 2013. Data were abstracted from institutional TBI and trauma registries. Independent covariates included age, GCS score, pupillary response, CT characteristics, and Injury Severity Score. A composite outcome measure, ICU-level care, was defined as cardiopulmonary instability, transfusion, intubation, placement of intracranial pressure monitor or other invasive monitoring, and/or need for surgical intervention. Stepwise logistic regression defined significant predictors for model inclusion with p < 0.10. The authors derived the CDR with binary recursive partitioning (using a misclassification cost of 20:1). RESULTS A total of 284 patients with mild TBI were included in the analysis; 40 (14.1%) had ICU-level care. The CDR consisted of 5 final predictor variables: midline shift > 5 mm, intraventricular hemorrhage, nonisolated head injury, postresuscitation GCS score of < 15, and cisterns absent. The CDR correctly identified 37 of 40 patients requiring ICU-level care (sensitivity 92.5%; 95% CI 78.5-98.0) and 154 of 244 patients who did not require an ICU-level intervention (specificity 63.1%; 95% CI 56.7-69.1). This results in a negative predictive value of 98.1% (95% CI 94.1-99.5). CONCLUSIONS The authors derived a clinical

  10. Admission to Medical Education in Ten Countries.

    ERIC Educational Resources Information Center

    Burn, Barbara B., Ed.

    As part of a study of access and admission to higher education in Germany and the United States, a group of papers on medical admissions in various countries was commissioned. The papers presented in this book reveal wide differences in admissions policies and procedures. Barbara Burn examines some of the major issues in a foreword: representation…

  11. Admission to Medical Education in Ten Countries.

    ERIC Educational Resources Information Center

    Burn, Barbara B., Ed.

    As part of a study of access and admission to higher education in Germany and the United States, a group of papers on medical admissions in various countries was commissioned. The papers presented in this book reveal wide differences in admissions policies and procedures. Barbara Burn examines some of the major issues in a foreword: representation…

  12. Should We Pay Attention to the Delay Before Admission to a Pediatric Intensive Care Unit for Children With Cancer? Impact on 1-Month Mortality. A Report From the French Children's Oncology Study Group, GOCE.

    PubMed

    Fausser, Jeanne-L; Tavenard, Aude; Rialland, Fanny; Le Moine, Philippe; Minckes, Odile; Jourdain, Anne; Tirel, Olivier; Pellier, Isabelle; Gandemer, Virginie

    2017-03-06

    Acute complications requiring admission to pediatric intensive care unit (PICU) are frequent for children with cancer. Our objective was to determine early prognostic factors of mortality in a cohort of children with cancer hospitalized in PICU for acute complications and particularly to assess whether the delay before admission to a PICU is an early predictor of mortality. We conduct a retrospective multicenter analysis. All patients transferred in PICU for acute complications between January 2002 and December 2012 were included. One-month mortality of the 224 patients analyzed was 24.5%. Delay before PICU admission was a significant prognostic factor of 1-month mortality with nonsurvivors experiencing a longer median delay than survivors (24 vs. 12 h, respectively, P<0.05). Time from diagnosis to PICU admission (P<0.001), hematopoietic stem cell transplant (P<0.05), the duration of neutropenia (P<0.01), infection type (P<0.001), number of organ dysfunctions (P<0.001), and reaching any grade 4 toxicity before PICU admission (P<0.001) also affected mortality rate at 1-month post-PICU discharge. In the multivariate analysis, only reaching any grade 4 toxicity before PICU admission influenced 1-month mortality (odds ratio, 2.30; 95% confidence interval, 1.07-4.96; P<0.05). These results suggest that PICU admission before severe impairment leads to a better outcome for children with cancer.

  13. Managing acute medical admissions: a survey of acute medical services and medical assessment and planning units in New Zealand.

    PubMed

    Providence, C; Gommans, J; Burns, A

    2012-01-01

    To determine the current provision of acute medical services, including the development of medical assessment and planning units (MAPUs), by district health boards (DHBs) throughout New Zealand (NZ). A questionnaire-based survey about organisation of acute medical services and establishment of MAPUs was sent to all 21 DHBs in NZ. All 21 DHBs responded. Seven DHBs serving 42% of the population have established MAPUs since 2003 and a further six have plans to do so over the next 3 years, potentially expanding service to 73% of the NZ population. All seven current MAPUs are in close proximity to and accept patients directly from emergency departments. Each MAPU has a documented target length of stay, four units have referral protocols, five provide guidelines for management of common medical emergencies and five routinely audit unit performance. Five MAPUs have cardiac monitored beds and isolation rooms. Rapid access is available to computed tomography scanning (six units), ultrasound (five) and echocardiography (four). Two units have no nominated physician leadership and two lack dedicated therapy resources. General physicians are involved in provision of acute medical services in 20 of 21 DHBs. Medical assessment and planning units have become an important component of acute medical service provision in NZ. The established units largely comply with Australasian recommendations, although important deficiencies exist. Training of physicians must combine the needs of acute medical patients and clinical roles of physicians within MAPUs with local DHB requirements for services to be most effective. © 2010 The Authors. Internal Medicine Journal © 2010 Royal Australasian College of Physicians.

  14. Admission-Group Salary Differentials in the United States: The Significance of Labor Market Institutional Selection of High-Skilled Workers*

    PubMed Central

    Hao, Lingxin

    2015-01-01

    In 1990 a temporary-to-permanent pathway was established for highly skilled workers admitted to the United States under nonimmigrant programs. The paper argues that this policy shift has allowed employers to play a crucial role in the immigration of highly skilled workers, thereby creating labor-market institutional selection that gives a salary advantage to highly skilled temporary-admitted workers retained in the United States. Through analyses of the salary differentials among admission-category groups, the paper finds that the salary advantage is based on recruitment from Western countries, adjustment from temporary to permanent status after a second employer screening, working in the information technology sector and the private sector, holding a supervisory position, or having a skill-matched job, all of which are consequences of institutional selection rather than individual self-selection. Our results also reveal a difference between those admitted from abroad and those recruited from graduating foreign students in USA higher educational institutions, which suggests a distinction between overseas hiring and domestic hiring. Policy implications for the United States and other receiving countries are discussed. PMID:26269690

  15. The Admission and Academic Placement of Students from: Bahrain, Oman, Qatar, United Arab Emirates, Yemen Arab Republic.

    ERIC Educational Resources Information Center

    Johnson, J. K., Ed.

    Information is provided on the educational systems of Bahrain, Oman, Qatar, the United Arab Emirates, and the Yemen Arab Republic in order to assist U.S. colleges and universities as they work with international student agencies and representatives from these countries. For each country, placement recommendations are offered, along with notes to…

  16. The Admission and Academic Placement of Students from: Bahrain, Oman, Qatar, United Arab Emirates, Yemen Arab Republic.

    ERIC Educational Resources Information Center

    Johnson, J. K., Ed.

    Information is provided on the educational systems of Bahrain, Oman, Qatar, the United Arab Emirates, and the Yemen Arab Republic in order to assist U.S. colleges and universities as they work with international student agencies and representatives from these countries. For each country, placement recommendations are offered, along with notes to…

  17. Electronic Nose: Evaluation of Kamina Prototype Unit

    NASA Technical Reports Server (NTRS)

    Schattke, Nathan

    2001-01-01

    The Kamina, Sam and Cyranose electronic nose systems were evaluated and partially trained. Much work was performed on the Kamina as it has the ability to respond to low (less than 10 ppb) concentrations of hydrazine compounds. We were able to tell the difference between Hydrazine (Hz) and Monomethylhydrazine (MMH) in standard clean humid air. We were able to detect MMH in reduced pressure (1/3 atm) at about 250 ppb, however the training set was to far from the real situation to be useful now. Various engineering and usability aspects of both the noses was noted, especially the software. One serious physical engineering flaw was remedied in the Kamina system. A gas flow manifold was created for the Sam system. Different chips were evaluated for the Kamina system. It is still unclear if they can be exchanged without retraining the software.The Sam Detect commercial unit was evaluated for solvent detection and evaluation. It was able to successfully identify some solvents. The Cyranose, was observed and evaluated for two days. It has the ability to detect gasses in the 100 parts per million level but not the 10 parts per billion level. It is very sensitive to humidity changes; there is software to partially handle this.

  18. External validation of the simple clinical score and the HOTEL score, two scores for predicting short-term mortality after admission to an acute medical unit.

    PubMed

    Stræde, Mia; Brabrand, Mikkel

    2014-01-01

    Clinical scores can be of aid to predict early mortality after admission to a medical admission unit. A developed scoring system needs to be externally validated to minimise the risk of the discriminatory power and calibration to be falsely elevated. We performed the present study with the objective of validating the Simple Clinical Score (SCS) and the HOTEL score, two existing risk stratification systems that predict mortality for medical patients based solely on clinical information, but not only vital signs. Pre-planned prospective observational cohort study. Danish 460-bed regional teaching hospital. We included 3046 consecutive patients from 2 October 2008 until 19 February 2009. 26 (0.9%) died within one calendar day and 196 (6.4%) died within 30 days. We calculated SCS for 1080 patients. We found an AUROC of 0.960 (95% confidence interval [CI], 0.932 to 0.988) for 24-hours mortality and 0.826 (95% CI, 0.774-0.879) for 30-day mortality, and goodness-of-fit test, χ(2) = 2.68 (10 degrees of freedom), P = 0.998 and χ(2) = 4.00, P = 0.947, respectively. We included 1470 patients when calculating the HOTEL score. Discriminatory power (AUROC) was 0.931 (95% CI, 0.901-0.962) for 24-hours mortality and goodness-of-fit test, χ(2) = 5.56 (10 degrees of freedom), P = 0.234. We find that both the SCS and HOTEL scores showed an excellent to outstanding ability in identifying patients at high risk of dying with good or acceptable precision.

  19. External Validation of the Simple Clinical Score and the HOTEL Score, Two Scores for Predicting Short-Term Mortality after Admission to an Acute Medical Unit

    PubMed Central

    Stræde, Mia; Brabrand, Mikkel

    2014-01-01

    Background Clinical scores can be of aid to predict early mortality after admission to a medical admission unit. A developed scoring system needs to be externally validated to minimise the risk of the discriminatory power and calibration to be falsely elevated. We performed the present study with the objective of validating the Simple Clinical Score (SCS) and the HOTEL score, two existing risk stratification systems that predict mortality for medical patients based solely on clinical information, but not only vital signs. Methods Pre-planned prospective observational cohort study. Setting Danish 460-bed regional teaching hospital. Findings We included 3046 consecutive patients from 2 October 2008 until 19 February 2009. 26 (0.9%) died within one calendar day and 196 (6.4%) died within 30 days. We calculated SCS for 1080 patients. We found an AUROC of 0.960 (95% confidence interval [CI], 0.932 to 0.988) for 24-hours mortality and 0.826 (95% CI, 0.774–0.879) for 30-day mortality, and goodness-of-fit test, χ2 = 2.68 (10 degrees of freedom), P = 0.998 and χ2 = 4.00, P = 0.947, respectively. We included 1470 patients when calculating the HOTEL score. Discriminatory power (AUROC) was 0.931 (95% CI, 0.901–0.962) for 24-hours mortality and goodness-of-fit test, χ2 = 5.56 (10 degrees of freedom), P = 0.234. Conclusion We find that both the SCS and HOTEL scores showed an excellent to outstanding ability in identifying patients at high risk of dying with good or acceptable precision. PMID:25144186

  20. Is Hospital Admission for Heart Failure Really Necessary? The Role of the ED and Observation Unit in Preventing Hospitalization and Rehospitalization

    PubMed Central

    Collins, Sean P.; Pang, Peter S.; Fonarow, Gregg C.; Yancy, Clyde W.; Bonow, Robert O.; Gheorghiade, Mihai

    2012-01-01

    Approximately 800,000 times a year, an emergency physician admits a patient with symptomatic heart failure (HF). Yet, only a minority of emergency department (ED) patients with HF are severely ill as a result of pulmonary edema, myocardial ischemia or cardiogenic shock. The majority of patients are not in need of an acute intervention beyond decongestion, and few patients during hospitalization have invasive diagnostic testing or therapeutic procedures that require intense monitoring. While hospitalization is clearly an inflection point, marking a threshold that independently predicts a worse outcome, the exact impact of hospitalization on post-discharge events has not been well elucidated. Thus, large subsets of HF patients are hospitalized without a clear need for time-sensitive therapies or procedures. We estimate up to 50% of ED patients with HF could be safely discharged after a brief period of observation, thus avoiding unnecessary admissions, and minimizing readmissions. Observation unit (OU) management may be beneficial for low- and intermediate-risk HF patients as continued treatment and more precise risk-stratification may ensue, avoiding inpatient admission. Whether OU management is comparable or superior to the current approach must be compared in a randomized clinical trial. Critical endpoints include time to symptom resolution and discharge, post-discharge event rates, and a cost-effective analysis of each management strategy. It is our strong assertion that now is the time for such a trial and that the results will be critically important if we are to effectively impact hospitalizations for HF in the near future. PMID:23273288

  1. A case of an avoidable admission to an Ebola treatment unit with malaria and an associated heat illness.

    PubMed

    Cox, Andrew T; Schoonbaert, I; Trinick, T; Phillips, A; Marion, D

    2016-06-01

    We present a 27-year old British nurse admitted to the Kerry Town Ebola Treatment Unit, Sierra Leone, with symptoms fitting suspect-Ebola virus disease (EVD) case criteria. A diagnosis of Plasmodium falciparum malaria and heat illness was ultimately made, both of which could have been prevented through employing simple measures not utilised in this case. The dual pathology of her presentation was atypical for either disease meaning EVD could not be immediately excluded. She remained isolated in the red zone until 72 h from symptom onset. This case highlights why force protection measures are important to reduce the incidence of both malaria and heat illness in deployed military and civilian populations. These prevention measures are particularly pertinent during the current EVD epidemic where presenting with these pathologies requires clinical assessment in the 'red zone' of an Ebola treatment unit. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  2. Evaluation of developing inertial stabilization unit

    NASA Astrophysics Data System (ADS)

    Haruna, Masaki; Kodeki, Kazuhide; Shimizu, Seiichi; Fukushima, Kazuhiko; Takahara, Osamu; Ando, Toshiyuki; Suzuki, Jiro; Haraguchi, Eisuke

    2015-03-01

    Micro vibrations generated from some internal disturbance sources such as a reaction wheel degrades the pointing stability of an observation satellite. To suppress the pointing error, we have been developing an inertial stabilization unit. A prototype mechanism is designed based on concepts that it has non-contact actuators and sensors, and rotational leaf springs are applied to support a stabilized platform in order to meet two requirements which are precise drive and tolerance for launch load. Two kind of inertial sensors are installed on the platform to measure the attitude directly. Each of these two inertial sensors covers low or high bandwidth signal respectively. These signals will be able to be combined as one wideband signal to stabilize the platform in inertial space. In this paper, the developing prototype mechanism and control equipment are described and the basic evaluation results are reported. Less than 0.3urad as a drive precision and more than 100Hz as a local sensor control bandwidth are verified. The development of the system has not completely finished yet, but the basic performance is certified to meet the design specification. From now on, we continue to develop the unit. These future results can be applied to inter-satellite laser communication system.

  3. Merit and Competition in Selective College Admissions

    ERIC Educational Resources Information Center

    Killgore, Leslie

    2009-01-01

    Using interview data from 34 admissions officers at 17 elite colleges, this paper compares two perspectives shaping admissions policy. Admissions officers apply a "merit" perspective that relies on indicators of student academic and nonacademic achievement. They also employ a "competition" perspective that evaluates student characteristics…

  4. Bed Utilisation in an Irish Regional Paediatric Unit - A Cross-Sectional Study Using the Paediatric Appropriateness Evaluation Protocol (PAEP).

    PubMed

    ÓhAiseadha, Coilín; Mannix, Mai; Saunders, Jean; Philip, Roy K

    2016-05-10

    Increasing demand for limited healthcare resources raises questions about appropriate use of inpatient beds. In the first paediatric bed utilisation study at a regional university centre in Ireland, we conducted a cross-sectional study to audit the utilisation of inpatient beds at the Regional Paediatric Unit (RPU) in University Hospital Limerick (UHL), Limerick, Ireland and also examined hospital activity data, to make recommendations for optimal use of inpatient resources. We used a questionnaire based on the paediatric appropriateness evaluation protocol (PAEP), modified and validated for use in the United Kingdom, to prospectively gather data regarding reasons for admission and for ongoing care after 2 days, from case records for all inpatients during 11 days in February (winter) and 7 days in May-June (summer). We conducted bivariate and multivariate analysis to explore associations between failure to meet PAEP criteria and patient attributes including age, gender, admission outside of office hours, arrival by ambulance, and private health insurance. Inpatient bed occupancy and day ward activity were also scrutinised. Mean bed occupancy was 84.1%. In all, 12/355 (3.4%, 95% CI: 1.5%-5.3%) of children failed to meet PAEP admission criteria, and 27/189 (14.3%, 95% CI: 9.3%-19.3%) who were still inpatients after 2 days failed to meet criteria for ongoing care. 35/355 (9.9%, 95% CI: 6.8%-13.0%) of admissions fulfilled only the PAEP criterion for intravenous medications or fluid replacement. A logistic regression model constructed by forward selection identified a significant association between failure to meet PAEP criteria for ongoing care 2 days after admission and admission during office hours (08.00-17.59) (P = .020), and a marginally significant association between this outcome and arrival by ambulance (P = .054). At a mean bed occupancy of 84.1%, an Irish RPU can achieve 96.6% appropriate admissions. Although almost all inpatients met PAEP criteria

  5. [Evaluation of the appropriateness of hospital admissions using the iso-gravity classification systems APR-DRG and Disease Staging and the Italian version of Appropriateness Evaluation Protocol (AEP)].

    PubMed

    D'Andrea, G; Capalbo, G; Volpe, M; Marchetti, M; Vicentini, F; Capelli, G; Cambieri, A; Cicchetti, A; Ricciardi, G; Catananti, C

    2006-01-01

    Our main purpose was to evaluate the organizational appropriateness of admissions made in a university hospital, by comparing two iso-gravity classification systems, APR-DRG and Disease Staging, with the Italian version of AEP (PRUO). Our analysis focused on admissions made in 2001, related to specific Diagnosis Related Groups (DRGs), which, according an Italian Law, would be considered at high risk of inappropriateness, if treated as ordinary admissions. The results obtained by using the 2 classification systems did not show statistically significant differences with respect to the total number of admissions. On the other hand, some DRGs showed statistically significant differences due to different algorithms of attribution of the severity levels used by the two systems. For almost all of the DRGs studied, the AEP-based analysis of a sample of medical records showed an higher number of inappropriate admissions in comparison with the number expected by iso-gravity classification methods. The difference is possibly due to the percentage limits of tolerability fixed by the Law for each DRG. Therefore, the authors suggest an integrated use of the two methods to evaluate organizational appropriateness of hospital admissions.

  6. Case mix, outcome and activity for patients with severe acute kidney injury during the first 24 hours after admission to an adult, general critical care unit: application of predictive models from a secondary analysis of the ICNARC Case Mix Programme database.

    PubMed

    Kolhe, Nitin V; Stevens, Paul E; Crowe, Alex V; Lipkin, Graham W; Harrison, David A

    2008-01-01

    This study pools data from the UK Intensive Care National Audit and Research Center (ICNARC) Case Mix Programme (CMP) to evaluate the case mix, outcome and activity for 17,326 patients with severe acute kidney injury (AKI) occurring during the first 24 hours of admission to intensive care units (ICU). Severe AKI admissions (defined as serum creatinine >/=300 mumol/l and/or urea >/=40 mmol/l during the first 24 hours) were extracted from the ICNARC CMP database of 276,326 admissions to UK ICUs from 1995 to 2004. Subgroups of oliguric and nonoliguric AKI were identified by daily urine output. Data on surgical status, survival and length of stay were also collected. Severity of illness scores and mortality prediction models were compared (UK Acute Physiology and Chronic Health Evaluation [APACHE] II, Stuivenberg Hospital Acute Renal Failure [SHARF] T0, SHARF II0 and the Mehta model). Severe AKI occurred in 17,326 out of 276,731 admissions (6.3%). The source of admission was nonsurgical in 83.7%. Sepsis was present in 47.3% and AKI was nonoliguric in 63.9% of cases. Admission to ICU with severe AKI accounted for 9.3% of all ICU bed-days. Oliguric AKI was associated with longer length of stay for survivors and shorter length of stay for nonsurvivors compared with nonoliguric AKI. Oliguric AKI was associated with significantly greater ICU and hospital mortality (55.8% and 77.3%, respectively) compared with nonoliguric AKI (33.4% and 49.3%, respectively). Surgery during the 1 week before admission or during the first week in the CMP unit was associated with decreased odds of mortality. UK APACHE II and the Mehta scores under-predicted the number of deaths, whereas SHARF T0 and SHARF II0 over-predicted the number of deaths. Severe AKI accounts for over 9% of all bed-days in adult, general ICUs, representing a considerable drain on resources. Although nonoliguric AKI continues to confer a survival benefit, overall survival from AKI in the ICU and survival to leave hospital

  7. Case mix, outcome and activity for patients with severe acute kidney injury during the first 24 hours after admission to an adult, general critical care unit: application of predictive models from a secondary analysis of the ICNARC Case Mix Programme Database

    PubMed Central

    Kolhe, Nitin V; Stevens, Paul E; Crowe, Alex V; Lipkin, Graham W; Harrison, David A

    2008-01-01

    Introduction This study pools data from the UK Intensive Care National Audit and Research Center (ICNARC) Case Mix Programme (CMP) to evaluate the case mix, outcome and activity for 17,326 patients with severe acute kidney injury (AKI) occurring during the first 24 hours of admission to intensive care units (ICU). Methods Severe AKI admissions (defined as serum creatinine ≥300 μmol/l and/or urea ≥40 mmol/l during the first 24 hours) were extracted from the ICNARC CMP database of 276,326 admissions to UK ICUs from 1995 to 2004. Subgroups of oliguric and nonoliguric AKI were identified by daily urine output. Data on surgical status, survival and length of stay were also collected. Severity of illness scores and mortality prediction models were compared (UK Acute Physiology and Chronic Health Evaluation [APACHE] II, Stuivenberg Hospital Acute Renal Failure [SHARF] T0, SHARF II0 and the Mehta model). Results Severe AKI occurred in 17,326 out of 276,731 admissions (6.3%). The source of admission was nonsurgical in 83.7%. Sepsis was present in 47.3% and AKI was nonoliguric in 63.9% of cases. Admission to ICU with severe AKI accounted for 9.3% of all ICU bed-days. Oliguric AKI was associated with longer length of stay for survivors and shorter length of stay for nonsurvivors compared with nonoliguric AKI. Oliguric AKI was associated with significantly greater ICU and hospital mortality (55.8% and 77.3%, respectively) compared with nonoliguric AKI (33.4% and 49.3%, respectively). Surgery during the 1 week before admission or during the first week in the CMP unit was associated with decreased odds of mortality. UK APACHE II and the Mehta scores under-predicted the number of deaths, whereas SHARF T0 and SHARF II0 over-predicted the number of deaths. Conclusions Severe AKI accounts for over 9% of all bed-days in adult, general ICUs, representing a considerable drain on resources. Although nonoliguric AKI continues to confer a survival benefit, overall survival from AKI

  8. Performance Evaluation of the United Nations Environment ...

    EPA Pesticide Factsheets

    A request for technical collaboration between the UNEP and the US EPA resulted in the establishment of a MCRADA. The purpose of this agreement was to evaluate an air quality monitoring system (referred to as the UNEP pod) developed by the UNEP for use in environmental situations where more sophisticated monitoring instrumentation was not available. The US EPA has conducted numerous evaluations of other similar sensor pods at its Research Triangle Park, NC research campus and has trained staff as well as established research designs for such efforts. Under the terms of the MCRADA, the US EPA would operate the pod using UNEP provided operating procedures in a manner consistent with its planned intent of deployment. The US EPA would collect air quality monitoring data from the pod involving select environmental measures over a period of approximately one month. Reference monitoring data collected from collocated federal regulatory monitors would be used to establish a comparison between the two systems and thus establishment of performance characteristics. In addition, the US EPA would provide feedback information to the UNEP as to observed ease of use features of the pod that would be beneficial in its future evolution and deployment. The UNEP recently developed a multipollutant sensor pod called the UNEP Air Quality Monitoring Unit, herein simply defined as the UNEP pod (http://aqicn.org/faq/2015-10-28/unep-air-quality-monitoring-station/). First introduced in 20

  9. Effectiveness of pre-admission data and letters of recommendation to predict students who will need professional behavior intervention during clinical rotations in the United States

    PubMed Central

    2016-01-01

    The study aimed at finding the value of letters of recommendation in predicting professional behavior problems in the clinical portion of a Doctor of Physical Therapy program learning cohorts from 2009-2014 in the United States. De-identified records of 137 Doctor of Physical Therapy graduates were examined by the descriptive statistics and comparison analysis. Thirty letters of recommendation were investigated based on grounded theory from 10 student applications with 5 randomly selected students of interest and 5 non-students of interest. Critical thinking, organizational skills, and judgement were statistically significant and quantitative differentiating characteristics. Qualitatively, significant characteristics of the student of interest included effective communication and cultural competency. Meanwhile, those of nonstudents of interest included conflicting personality descriptor, commitment to learning, balance, teamwork skills, potential future success, compatible learning skills, effective leadership skills, and emotional intelligence. Emerged significant characteristics did not consistently match common non-professional behavior issues encountered in clinic. Pre-admission data and letters of recommendation appear of limited value in predicting professional behavior performance in clinic. PMID:27378011

  10. Effectiveness of pre-admission data and letters of recommendation to predict students who will need professional behavior intervention during clinical rotations in the United States.

    PubMed

    Engelhard, Chalee; Leugers, Rebecca; Stephan, Jenna

    2016-01-01

    The study aimed at finding the value of letters of recommendation in predicting professional behavior problems in the clinical portion of a Doctor of Physical Therapy program learning cohorts from 2009-2014 in the United States. De-identified records of 137 Doctor of Physical Therapy graduates were examined by the descriptive statistics and comparison analysis. Thirty letters of recommendation were investigated based on grounded theory from 10 student applications with 5 randomly selected students of interest and 5 non-students of interest. Critical thinking, organizational skills, and judgement were statistically significant and quantitative differentiating characteristics. Qualitatively, significant characteristics of the student of interest included effective communication and cultural competency. Meanwhile, those of nonstudents of interest included conflicting personality descriptor, commitment to learning, balance, teamwork skills, potential future success, compatible learning skills, effective leadership skills, and emotional intelligence. Emerged significant characteristics did not consistently match common non-professional behavior issues encountered in clinic. Pre-admission data and letters of recommendation appear of limited value in predicting professional behavior performance in clinic.

  11. Ethical and Clinical Aspects of Intensive Care Unit Admission in Patients with Hematological Malignancies: Guidelines of the Ethics Commission of the French Society of Hematology

    PubMed Central

    Malak, Sandra; Sotto, Jean-Jacques; Ceccaldi, Joël; Colombat, Philippe; Casassus, Philippe; Jaulmes, Dominique; Rochant, Henri; Cheminant, Morgane; Beaussant, Yvan; Zittoun, Robert; Bordessoule, Dominique

    2014-01-01

    Admission of patients with hematological malignancies to intensive care unit (ICU) raises recurrent ethical issues for both hematological and intensivist teams. The decision of transfer to ICU has major consequences for end of life care for patients and their relatives. It also impacts organizational human and economic aspects for the ICU and global health policy. In light of the recent advances in hematology and critical care medicine, a wide multidisciplinary debate has been conducted resulting in guidelines approved by consensus by both disciplines. The main aspects developed were (i) clarification of the clinical situations that could lead to a transfer to ICU taking into account the severity criteria of both hematological malignancy and clinical distress, (ii) understanding the process of decision-making in a context of regular interdisciplinary concertation involving the patient and his relatives, (iii) organization of a collegial concertation at the time of the initial decision of transfer to ICU and throughout and beyond the stay in ICU. The aim of this work is to propose suggestions to strengthen the collaboration between the different teams involved, to facilitate the daily decision-making process, and to allow improvement of clinical practice. PMID:25349612

  12. A longitudinal investigation of posttraumatic stress and depressive symptoms over the course of the year following medical-surgical intensive care unit admission.

    PubMed

    Davydow, Dimitry S; Zatzick, Douglas; Hough, Catherine L; Katon, Wayne J

    2013-01-01

    The objective was to identify risk factors for posttraumatic stress disorder (PTSD) and depressive symptoms after medical-surgical intensive care unit (ICU) admission. This longitudinal investigation included 150 medical-surgical ICU patients. We assessed acute stress and post-ICU PTSD symptoms with the PTSD Checklist-Civilian Version and post-ICU depressive symptoms with the Patient Health Questionnaire-9. Mixed-model linear regression ascertained associations between patient and clinical characteristics and repeated measures of post-ICU PTSD and depressive symptoms. The prevalences of substantial PTSD and depressive symptoms were 16% and 31% at 3 months post-ICU and 15% and 17% at 12 months post-ICU, respectively. In-hospital substantial acute stress symptoms [beta: 16.9, 95% confidence Interval (CI): 11.4, 22.4] were independently associated with increased post-ICU PTSD symptoms. Lifetime history of major depression (beta: 2.2, 95% CI: 0.1, 4.2), greater prior trauma exposure (beta: 0.5, 95% CI: 0.2, 0.9) and in-hospital substantial acute stress symptoms (beta: 3.5, 95% CI: 0.8, 6.2) were independently associated with increased post-ICU depressive symptoms. In-hospital acute stress symptoms may represent a modifiable risk factor for psychiatric morbidity in ICU survivors. Early interventions for at-risk ICU survivors may improve longer-term psychiatric outcomes. Copyright © 2013 Elsevier Inc. All rights reserved.

  13. How Well Do All Patient Refined–Diagnosis-Related Groups Explain Costs of Pediatric Cancer Chemotherapy Admissions in the United States?

    PubMed Central

    Street, Andrew; Ho, Vivian

    2016-01-01

    Purpose: State-based Medicaid programs have begun using All Patient Refined–Diagnosis-Related Groups (APR-DRGs) to determine hospital reimbursement rates. Medicaid provides coverage for 45% of childhood cancer admissions. This study aimed to examine how well APR-DRGs reflect admission costs for childhood cancer chemotherapy to inform clinicians, hospitals, and policymakers in the wake of policy changes. Methods: We identified 25,613 chemotherapy admissions in the 2009 Kids’ Inpatient Database. To determine how well APR-DRGs explain costs, we applied a hierarchic linear regression model of hospital costs, allowing for a variety of patient, hospital, and geographic confounders. Results: APR-DRGs proved to be the most important predictors of admission costs (P < .001), with costs increasing by DRG severity code. Diagnosis, age, and hospital characteristics also predicted costs above and beyond those explained by APR-DRGs. Compared with admissions for patients with acute lymphoblastic leukemia, costs of admissions for patients with acute myelomonocytic leukemia were 82% higher; non-Hodgkin lymphoma, 20% higher; Hodgkin lymphoma, 25% lower; and CNS tumors, 27% lower. Admissions for children who were 10 years of age or older cost 26% to 35% more than admissions for infants. Admissions to children’s hospitals cost 46% more than admissions to other hospital types. Conclusion: APR-DRGs developed for adults are applicable to childhood cancer chemotherapy but should be refined to account for cancer diagnosis and patient age. Possible policy and clinical management changes merit further study to address factors not captured by APR-DRGs. PMID:27118158

  14. Evaluation of a modified early warning system for acute medical admissions and comparison with C-reactive protein/albumin ratio as a predictor of patient outcome.

    PubMed

    Fairclough, Emily; Cairns, Eleanor; Hamilton, Jennifer; Kelly, Clive

    2009-02-01

    The modified early warning score (MEWS) was developed as a track and trigger tool for the prompt identification of seriously ill patients on an acute medical ward. This paper examines its value in the setting of an acute medical admissions unit (MAU) and compares it to biochemical markers of acute and chronic disease. Three hundred unselected acute admissions to the MAU of the Queen Elizabeth Hospital, Gateshead, were assessed. Correlations between MEWS score and C-reactive protein (CRP) and albumin separately were assessed, and then the relationship between MEWS and the CRP/albumin ratio across the age spectrum was examined. The findings demonstrated a strong correlation between the MEWS score and CRP/albumin ratio (r=0.88, p<0.001) across the whole age spectrum. Length of stay correlated poorly with MEWS (r=0.08) and CRP/albumin ratio (r=0.15). Overall mortality was 5% and was predicted by both tools, with a MEWS score of >4 (relative risk (RR)=7.8) outperforming a CRP/albumin of >2 (RR=2.6). MEWS remains the gold standard for assessing outcome in acute medical admissions, but does have limitations in the elderly (those aged over 70 years). A raised CRP/albumin ratio was less sensitive for overall mortality than MEWS. It did, however, appear to be of greater value in the elderly, especially in those with acute exacerbations of chronic disease. Neither test accurately predicted length of stay.

  15. Clinical evaluation of terconazole. United states experience.

    PubMed

    Thomason, J L

    1989-08-01

    Terconazole is the first of a new class of antifungal agents, the triazoles. The results of numerous European studies have demonstrated the efficacy and safety of this agent in both cream and suppository form in the treatment of vulvovaginal candidiasis. Recently, results of short- and long-term analyses in the United States confirmed the efficacy and safety of 0.4% terconazole cream and 80-mg terconazole suppositories. In short-term evaluations (eight to ten days after therapy), 0.4% terconazole cream was as effective as 2.0% miconazole nitrate cream and significantly superior microbiologically in one study. The clinical cure rates with terconazole cream ranged from 87.3% to 95.5% and the microbiologic cure rates, from 76.9% to 91.1%. Thirty- to 35-day microbiologic relapse rates with terconazole cream ranged from 10.4% to 22.2%. In the short-term evaluations of vaginal suppositories the cure rates of 80-mg terconazole suppositories for three days were comparable to those of 100-mg miconazole nitrate suppositories for seven days. The clinical cure rates with 80-mg terconazole suppositories ranged from 90.0% to 92.2% and the microbiologic cure rates, from 80.4% to 85.0%. The 30- to 35-day microbiologic relapse rates of the 80-mg terconazole suppositories ranged from 20.0% to 28.1%. Terconazole cream and suppositories demonstrated an excellent safety profile in all the studies; no life-threatening side effects occurred with any of the regimens. The frequency of common side effects was similar with terconazole and miconazole nitrate formulations.

  16. Screening, isolation, and decolonisation strategies in the control of meticillin resistant Staphylococcus aureus in intensive care units: cost effectiveness evaluation.

    PubMed

    Robotham, Julie V; Graves, Nicholas; Cookson, Barry D; Barnett, Adrian G; Wilson, Jennie A; Edgeworth, Jonathan D; Batra, Rahul; Cuthbertson, Brian H; Cooper, Ben S

    2011-10-05

    To assess the cost effectiveness of screening, isolation, and decolonisation strategies in the control of meticillin resistant Staphylococcus aureus (MRSA) in intensive care units. Economic evaluation based on a dynamic transmission model. England and Wales. Population Theoretical population of patients on an intensive care unit. Infections, deaths, costs, quality adjusted life years (QALYs), incremental cost effectiveness ratios for alternative strategies, and net monetary benefits. All decolonisation strategies improved health outcomes and reduced costs. Although universal decolonisation (regardless of MRSA status) was the most cost effective in the short term, strategies using screening to target MRSA carriers may be preferred owing to the reduced risk of selecting for resistance. Among such targeted strategies, universal admission and weekly screening with polymerase chain reaction coupled with decolonisation using nasal mupirocin was the most cost effective. This finding was robust to the size of intensive care units, prevalence of MRSA on admission, proportion of patients classified as high risk, and precise value of willingness to pay for health benefits. All strategies using isolation but not decolonisation improved health outcomes but costs were increased. When the prevalence of MRSA on admission to the intensive care unit was 5% and the willingness to pay per QALY gained was between £20,000 (€23,000; $32,000) and £30,000, the best such strategy was to isolate only those patients at high risk of carrying MRSA (either pre-emptively or after identification by admission and weekly screening for MRSA using chromogenic agar). Universal admission and weekly screening using polymerase chain reaction based detection of MRSA coupled with isolation was unlikely to be cost effective unless prevalence was high (10% of patients colonised with MRSA on admission). MRSA control strategies that use decolonisation are likely to be cost saving in an intensive care unit

  17. Evaluation of medication reconcilliation in a Trauma Unit.

    PubMed

    Pascual, O; Real, J M; Uriarte, M; Larrodé, I; Alonso, Y M; Abad, M R

    2015-01-01

    The aim of this study was to assess the rate of discrepancies in medication reconciliation on admission patients in a trauma unit, and identifying potential risk factors associated with these discrepancies. A cross-sectional, observational study was carried out to identify reconciliation errors in a tertiary hospital during the period from May 1 to July 16 of 2012. Medication history of the patient was compared with home medication data collected on admission, to identify reconciliation errors. These were classified according to the type and severity of the discrepancies. Statistical analysis by logistic regression was performed, using the presence of discrepancies as dependent variable. The study included 164 patients, and reconciliation errors were found in 48.8%, of which 14.4% were considered highly relevant. Around two-thirds (66.7%) of the patients admitted to the emergency department showed unjustified discrepancies compared to 44.8% in scheduled patients. In total, 153 reconciliation errors were identified, being omitted drug the most frequent type of discrepancie (72%). The risk of discrepancies increases by 33% for each drug added to the usual home treatment. This study demonstrates the lack of quality in home medication recording in patients admitted to the trauma unit. Copyright © 2014 SECOT. Published by Elsevier Espana. All rights reserved.

  18. Evaluation of pain incidence and pain management in a South African paediatric trauma unit.

    PubMed

    Thiadens, Tessa; Vervat, Elleke; Albertyn, Rene; Van Dijk, Monique; Van As, A B Sebastian

    2011-07-25

    OBJECTIVES. To evaluate pain incidence and pain management in a South African paediatric trauma unit, and to compare the usefulness of 5 different assessment tools. DESIGN. A prospective observational study, using the Numerical Rating Scale for pain (NRS pain), Numerical Rating Scale for anxiety (NRS anxiety), the Alder Hey Triage Pain Score (AHTPS), the COMFORT behaviour scale and the Touch Visual Pain Scale (TVPS). All patients were assessed at admission; those who were hospitalised were again assessed every 3 hours until discharge. RESULTS. A total of 165 patients, with a mean age of 5.3 years (range 0 - 13), were included. NRS scores were indicative of moderate to severe pain in 13.3% of the patients, and no pain in 24% at admission. Two-thirds of the patients received no analgesics; for them, NRS pain, AHTPS and TVP scores were lower than the scores for the other children. CONCLUSION. Pain and anxiety incidences in this paediatric trauma unit are relatively low. Implementation of a standard pain assessment tool in the emergency department triage system can improve pain management. The AHTPS is the most promising for use in non-Western settings.

  19. National trends in inpatient admissions following stereotactic radiosurgery and the in-hospital patient outcomes in the United States from 1998 to 2011

    PubMed Central

    Ho, Allen L.; Li, Alexander Y.; Sussman, Eric S.; Pendharkar, Arjun V.; Iyer, Aditya; Thompson, Patricia A.; Tayag, Armine T.; Chang, Steven D.

    2016-01-01

    Purpose This study sought to examine trends in stereotactic radiosurgery (SRS) and in-hospital patient outcomes on a national level by utilizing national administrative data from the Nationwide Inpatient Sample (NIS) database. Methods and materials Using the NIS database, all discharges where patients underwent inpatient SRS were included in our study from 1998 – 2011 as designated by the ICD9-CM procedural codes. Trends in the utilization of primary and adjuvant SRS, in-hospital complications and mortality, and resource utilization were identified and analyzed. Results Our study included over 11,000 hospital discharges following admission for primary SRS or for adjuvant SRS following admission for surgery or other indication. The most popular indication for SRS continues to be treatment of intracranial metastatic disease (36.7%), but expansion to primary CNS lesions and other non-malignant pathology beyond trigeminal neuralgia has occurred over the past decade. Second, inpatient admissions for primary SRS have declined by 65.9% over this same period of time. Finally, as inpatient admissions for SRS become less frequent, the complexity and severity of illness seen in admitted patients has increased over time with an increase in the average comorbidity score from 1.25 in the year 2002 to 2.29 in 2011, and an increase in over-all in-hospital complication rate of 2.8 times over the entire study period. Conclusions As the practice of SRS continues to evolve, we have seen several trends in associated hospital admissions. Overall, the number of inpatient admissions for primary SRS has declined while adjuvant applications have remained stable. Over the same period, there has been associated increase in complication rate, length of stay, and mortality in inpatients. These associations may be explained by an increase in the comorbidity-load of admitted patients as more high-risk patients are selected for admission at inpatient centers while more stable patients are

  20. Responding to the UNDP Evaluations Unit

    ERIC Educational Resources Information Center

    Lempert, David H.

    2012-01-01

    The author of an indicator that tests evaluation system compliance with good governance principles addresses the UNDP's response to his article by offering an empirical test of the UNDP's commitment to reform. While the UNDP Evaluations Office claims to be working on reforms, the test exposes the unwillingness of the UNDP Evaluations Office to…

  1. Effect of the timing of admission upon patient prognosis in the Intensive Care Unit: On-hours versus off-hours.

    PubMed

    Abella, A; Hermosa, C; Enciso, V; Torrejón, I; Molina, R; Díaz, M; Mozo, T; Gordo, F; Salinas, I

    2016-01-01

    To assess the repercussion of the timing of admission to the ICU upon patient prognosis. A prospective, observational, non-interventional cohort study was carried out. A second level hospital with 210 operational beds and a general ICU with 8 operational beds. The study comprised all patients admitted to the ICU during 3 years (January 2010 to December 2012), excluding those subjects admitted from the operating room after scheduled surgery. The patients were divided into 2 groups according to the timing of admission (on-hours or off-hours). Non-interventional study. An analysis was made of demographic variables (age, sex), origin (emergency room, hospital ward, operating room), comorbidities and SAPS 3 as severity score upon admission, length of stay in the ICU and hospital ward, and ICU and hospital mortality. A total of 504 patients were included in the on-hours group, versus 602 in the off-hours group. Multivariate analysis showed the factors independently associated to hospital mortality to be SAPS 3 (OR 1.10; 95% CI 1.08-1.12), and off-hours admission (OR 2.00; 95% CI 1.20-3.33). In a subgroup analysis of the off-hours group, the admission of patients on weekends or non-working days compared to daily night shifts was found to be independently associated to hospital mortality (OR 2.30; 95% CI 1.23-4.30). Admission to the ICU in off-hours is independently associated to patient mortality, which is also higher in patients admitted on weekends and non-working days compared to the daily night shifts. Copyright © 2015 Elsevier España, S.L.U. and SEMICYUC. All rights reserved.

  2. Evaluation of echocardiography on the neonatal unit

    PubMed Central

    Moss, S; Kitchiner, D; Yoxall, C; Subhedar, N; Wren, C

    2003-01-01

    Background: Echocardiography is an investigation that is being used increasingly on the neonatal unit. There is some controversy as to whether this service can be provided safely and effectively by neonatologists or whether it should only be performed by paediatric cardiologists. Aims: To describe (a) the indications for an echocardiogram, (b) the yield and range of positive findings, (c) the resulting changes in clinical management, and (d) the reliability of echocardiography in the hands of neonatologists when it is performed on the neonatal unit. Methods: Information about all echocardiograms performed on the neonatal unit was collected prospectively. Indications for performing echocardiography, echocardiographic findings, and any resulting changes in clinical management were determined. The concordance of findings in infants who underwent echocardiograms performed by both a neonatologist and a paediatric cardiologist was described. Results: A total of 157 echocardiograms were performed in 82 infants. Echocardiography identified 44 infants with a structural cardiac abnormality and a further 17 infants with a trivial abnormality. In addition, 13 babies were found to have an important functional abnormality. Echocardiography prompted a specific change in clinical management in 64 (78%) babies. In 31 of the 38 infants who had paired scans performed, there was complete concordance between the two examinations. No infants had scans that were completely different. Some discrepancy was identified in seven infants, but this did not prevent appropriate immediate clinical management. Conclusions: Echocardiography on the neonatal unit has a high yield for the diagnosis of structural and functional cardiac abnormalities, often results in a change in clinical management, and can be a reliable tool in the hands of neonatologists. PMID:12819159

  3. Admissions and Public Relations

    ERIC Educational Resources Information Center

    Huddleston, Thomas

    1974-01-01

    Discusses the present limitations of public-relations operations within college admissions offices. Suggests a more active role for public relations specialists and better familiarization with the goals and functions of the admissions office. (Author/PC)

  4. Use of patient-controlled psychiatric hospital admissions: patients' perspective.

    PubMed

    Ellegaard, Trine; Bliksted, Vibeke; Lomborg, Kirsten; Mehlsen, Mimi

    2017-07-01

    By patient-controlled admission (PCA), psychiatric patients with a PCA contract can initiate a brief admission without a health professional gatekeeper. However, research regarding use of PCA is scarce. In this Danish multi-centre study, motives for and satisfaction with PCA were explored. During a 1-year period, patients from 11 Danish mental health units evaluated PCA using a questionnaire developed for the purpose. In total, 190 patients evaluated 462 admissions. The majority had concluded a PCA contract to receive early help. PCA was mostly initiated because of mental health conditions, but also because of social and everyday problems. The purpose was mainly to be at peace and prevent symptom increase. Patients from units with a quarantine period felt more ready for discharge than the others. Patients were in general satisfied with PCA (61.7%), but patients who hoped for improved medication or wished to obtain more care were less satisfied. Patients can use PCA as a means to receive timely help. Motives for patients seeking help are not limited to mental conditions. Expectations that cannot be met within the organizational structure of the PCA programme are associated with less satisfaction. However, regional differences in structures were associated with satisfaction. Patients who had access to shorter PCAs were more satisfied, and a quarantine period may even help patients become more ready for discharge. A brief admission period does not cause dissatisfaction at discharge and can be used in the clinical setting.

  5. Seeking the Admission Hybrid

    ERIC Educational Resources Information Center

    Lucido, Jerome A.

    2012-01-01

    When one thinks of seminal publications in college admission, the first piece that comes to mind is B. Alden Thresher's "College Admissions in the Public Interest" (1966). Thresher's work, relevant to this day, is credited with being the foundational document of the admission profession. McDonough and Robertson's 1995 study, commissioned by NACAC,…

  6. Marketing and Selective Admissions.

    ERIC Educational Resources Information Center

    Blackburn, James C.

    1980-01-01

    Marketing techniques have proven useful in several types of admissions situations. The results of a 1979 study of admissions officers' use of marketing techniques indicate that several marketing techniques have been used successfully in situations where selective admissions procedures pertain. (Author)

  7. Evaluation of inpatient multidisciplinary palliative care unit on terminally ill cancer patients from providers' perspectives: a propensity score analysis.

    PubMed

    Cheng, Shao-Yi; Dy, Sydney; Fang, Pai-Han; Chen, Ching-Yu; Chiu, Tai-Yuan

    2013-02-01

    The effectiveness of inpatient palliative care units, a complex intervention, is challenging to evaluate due to methodological and practical difficulties. We conducted a study to evaluate providers' perceived effectiveness of one such unit. A non-concurrent, prospective, controlled study using the Audit Scale for good death services as an indicator of process of care and the Good Death Scale as the outcome of provider assessment of quality of dying was conducted. Eighty of 212 terminally ill cancer patients were matched from a tertiary medical center in Taiwan. Patients in the unit served as the intervention group and patients in the oncology ward served as controls. Multiple logistic regression was applied to estimate the propensity of choosing the unit for each patient, and linear regression analysis was conducted to identify predictive factors for mean change scores of the Good Death Scale. Male gender (P < 0.001, 95% confidence interval = 0.73-2.43) was associated with better quality of dying while having hepatocellular carcinoma (P < 0.004, 95% confidence interval = -2.22 to -0.44) was associated with worse quality. For those in the unit, higher total Audit Scale scores were positively related to the outcome of quality of dying. The unit (P < 0.001, 95% confidence interval = 8.67-12.97) and higher Good Death Scale at admission (P < 0.001, 95% confidence interval = 0.44-1.13) were predictors of Audit Scale scores. Admission to a palliative care unit was associated with higher provider assessments of quality of dying for terminally ill cancer patients. These units should be considered as options for hospitals looking for ways to improve the quality of dying for patients.

  8. Evaluating pharmaceutical waste disposal in pediatric units.

    PubMed

    Almeida, Maria Angélica Randoli de; Wilson, Ana Maria Miranda Martins; Peterlini, Maria Angélica Sorgini

    2016-01-01

    To verify the disposal of pharmaceutical waste performed in pediatric units. A descriptive and observational study conducted in a university hospital. The convenience sample consisted of pharmaceuticals discarded during the study period. Handling and disposal during preparation and administration were observed. Data collection took place at pre-established times and was performed using a pre-validated instrument. 356 drugs disposals were identified (35.1% in the clinic, 31.8% in the intensive care unit, 23.8% in the surgical unit and 9.3% in the infectious diseases unit). The most discarded pharmacological classes were: 22.7% antimicrobials, 14.8% electrolytes, 14.6% analgesics/pain killers, 9.5% diuretics and 6.7% antiulcer agents. The most used means for disposal were: sharps' disposable box with a yellow bag (30.8%), sink drain (28.9%), sharps' box with orange bag (14.3%), and infectious waste/bin with a white bag (10.1%). No disposal was identified after drug administration. A discussion of measures that can contribute to reducing (healthcare) waste volume with the intention of engaging reflective team performance and proper disposal is necessary. Verificar o descarte dos resíduos de medicamentos realizado em unidades pediátricas. Estudo descritivo e observacional, realizado em um hospital universitário. A amostra de conveniência foi constituída pelos medicamentos descartados durante o período de estudo. Observaram-se a manipulação e o descarte durante o preparo e a administração. A coleta dos dados ocorreu em horários preestabelecidos e realizada por meio de instrumento pré-validado. Identificaram-se 356 descartes de medicamentos (35,1% na clínica, 31,8% na unidade de cuidados intensivos, 23,8% na cirúrgica e 9,3% na infectologia). As classes farmacológicas mais descartadas foram: 22,7% antimicrobianos, 14,8% eletrólitos, 14,6% analgésicos, 9,5% diuréticos e 6,7% antiulcerosos. Vias mais utilizadas: caixa descartável para perfurocortante com

  9. A Professional Development Unit for Reflecting on Program Evaluator Competencies

    ERIC Educational Resources Information Center

    Ghere, Gail; King, Jean A.; Stevahn, Laurie; Minnema, Jane

    2006-01-01

    This article describes an interactive professional development unit that engages both novice and experienced evaluators in (a) learning about the Essential Competencies for Program Evaluators (ECPE), (b) applying the competencies to program evaluation contexts, and (c) using the ECPE to reflect on their own professional practices. The article…

  10. Small-Scale Evaluation of the Expeditionary Unit Water Purifier

    EPA Science Inventory

    The U.S. EPA’s Technology Testing and Evaluation Program has been charged by EPA to evaluate the performance of commercially available water security-related technologies. Throughout 2007, an evaluation the Expeditionary Unit Water Purifier (EUWP), a mobile water treatment techno...

  11. Small-Scale Evaluation of the Expeditionary Unit Water Purifier

    EPA Science Inventory

    The U.S. EPA’s Technology Testing and Evaluation Program has been charged by EPA to evaluate the performance of commercially available water security-related technologies. Throughout 2007, an evaluation the Expeditionary Unit Water Purifier (EUWP), a mobile water treatment techno...

  12. 8 CFR 235.11 - Admission of conditional permanent residents.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... admission, the alien shall be notified that the alien and his or her petitioning spouse must file a Form I... based on entrepreneurship. An alien seeking admission to the United States with an immigrant visa as an... admission, the alien shall be notified that the principal alien (entrepreneur) must file a Form I-829...

  13. 8 CFR 235.11 - Admission of conditional permanent residents.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... admission, the alien shall be notified that the alien and his or her petitioning spouse must file a Form I... based on entrepreneurship. An alien seeking admission to the United States with an immigrant visa as an... admission, the alien shall be notified that the principal alien (entrepreneur) must file a Form I-829...

  14. 8 CFR 235.11 - Admission of conditional permanent residents.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... admission, the alien shall be notified that the alien and his or her petitioning spouse must file a Form I... based on entrepreneurship. An alien seeking admission to the United States with an immigrant visa as an... admission, the alien shall be notified that the principal alien (entrepreneur) must file a Form I-829...

  15. Historical Perspective on Undergraduate Pharmacy Student Admissions: The PCAT.

    ERIC Educational Resources Information Center

    Cunny, Kelley A.; Perri, Matthew

    1990-01-01

    The history of the process of admission to pharmacy colleges in the United States since the early 1900s is chronicled. The origins, development, and use of the Pharmacy College Admissions Test are also outlined, and directions for the future of pharmacy college admissions are examined briefly. (MSE)

  16. Spatial units of land use potential evaluation on regional scales

    NASA Astrophysics Data System (ADS)

    Yang, Zhiheng; Zhu, Shisong; Li, Feixue; Chen, Dong

    2007-06-01

    In the course of studying on regional land use potential evaluation a certain spatial basic unit is often used as the analysis groundwork. The analysis result relies on unit division methods and research scales. In the same area space unit characters correlate with the space scales. In geography, the conclusions made on a scale can't be applied to other scales. Modifiable Area Unit Problem, MAUP, is the classical theory to solve the effects of spatial scale, that is, there are many different ways to divide the surface into non-overlapping million units for spatial analysis. This paper studies on the spatial unit scale transformation process of land use potential evaluation in the same area on different scales, such as at local, regional and global levels .etc. Characteristic Scales is defined in the transformation process from large scale to Small Scale. Then the fractal characteristic of spatial unit is raised on different scales to form land use potential geospatial hierarchy. Using geo-statistical procedures, we mainly study on the transformation progress of SUs of land use potential evaluation on different scales in the same area, define the eigenvalue of SUs on each scale. We find the definition of spatial units (SUs) makes a point of the spatial analyses results on regional scales. Finally, aiding the fractal dimension, the fractal characteristic of spatial unit is raised in a broader area. Land use potential geospatial hierarchical structure is explored to aid the regional development policymaking.

  17. Advanced RTU Campaign Rooftop Unit Evaluation Methodology - DOE

    SciTech Connect

    Deru, Michael; Leach, Matt

    2014-12-31

    New technologies for replacement and retrofits of existing rooftop air conditioning units (RTUs) offer tremendous savings opportunities. However, building owners lack a process for identifying and evaluating cost-saving RTU replacement and retrofit options.

  18. Re-evaluating the need for hospital admission and observation of pediatric traumatic brain injury after a normal head CT.

    PubMed

    Plackett, Timothy P; Asturias, Sabrina; Tadlock, Matthew; Wright, Franklin; Ton-That, Hieu; Demetriades, Demetrios; Esposito, Thomas; Inaba, Kenji

    2015-10-01

    There is no consensus on the optimal management of pediatric patients with suspected trauma brain injury and a normal head CT. This study characterizes the clinical outcomes of patients with a normal initial CT scan of the head. A retrospective chart review of pediatric blunt trauma patients who underwent head CT for closed head injury at two trauma centers was performed. Charts were reviewed for demographics, neurologic function, CT findings, and complications. 631 blunt pediatric trauma patients underwent a head CT. 63% had a negative CT, 7% had a non-displaced skull fracture, and 31% had an intracranial hemorrhage and/or displaced skull fracture. For patients without intracranial injury, the mean age was 8 years, mean ISS was 5, and 92% had a GCS of 13-15 on arrival. All patients with an initial GCS of 13-15 and no intracranial injury were eventually discharged to home with a normal neurologic exam and no patient required craniotomy. Not admitting those children with an initial GCS of 13-15, normal CT scan, and no other injuries would have saved 1.8 ± 1.5 hospital days per patient. Pediatric patients who have sustained head trauma, have a negative CT scan, and present with a GCS 13-15 can safely be discharged home without admission. Published by Elsevier Inc.

  19. Grade Inflation and Law School Admissions

    ERIC Educational Resources Information Center

    Wongsurawat, Winai

    2008-01-01

    Purpose: The purpose of this paper is to evaluate the evidence on whether grade inflation has led to an increasing emphasis on standardized test scores as a criterion for law school admissions. Design/methodology/approach: Fit probabilistic models to admissions data for American law schools during the mid to late 1990s, a period during which…

  20. Alphabetical Order Effects in School Admissions

    ERIC Educational Resources Information Center

    Jurajda, Štepán; Münich, Daniel

    2016-01-01

    If school admission committees use alphabetically sorted lists of applicants in their evaluations, one's position in the alphabet according to last name initial may be important in determining access to selective schools. Jurajda and Münich (2010) "Admission to Selective Schools, Alphabetically". "Economics of Education…

  1. Strategies and Trends in Admissions Research

    ERIC Educational Resources Information Center

    Fincher, Cameron

    1975-01-01

    Noting that the technical service rendered by the national testing agencies may be an undesirable tradeoff for the active involvement of admissions workers in admissions research, the author suggests that the use of decision theory, quasi-actuarial assessment, quasi-experimental design, and program evaluation strategies would place admissions…

  2. Alphabetical Order Effects in School Admissions

    ERIC Educational Resources Information Center

    Jurajda, Štepán; Münich, Daniel

    2016-01-01

    If school admission committees use alphabetically sorted lists of applicants in their evaluations, one's position in the alphabet according to last name initial may be important in determining access to selective schools. Jurajda and Münich (2010) "Admission to Selective Schools, Alphabetically". "Economics of Education…

  3. Evaluating State Principal Evaluation Plans across the United States

    ERIC Educational Resources Information Center

    Fuller, Edward J.; Hollingworth, Liz; Liu, Jing

    2015-01-01

    Recent federal legislation has created strong incentives for states to adopt principal evaluation systems, many of which include new measures of principal effectiveness such as estimates of student growth and changes in school climate. Yet, there has been little research on principal evaluation systems and no state-by-state analysis of the…

  4. Evaluating State Principal Evaluation Plans across the United States

    ERIC Educational Resources Information Center

    Fuller, Edward J.; Hollingworth, Liz; Liu, Jing

    2015-01-01

    Recent federal legislation has created strong incentives for states to adopt principal evaluation systems, many of which include new measures of principal effectiveness such as estimates of student growth and changes in school climate. Yet, there has been little research on principal evaluation systems and no state-by-state analysis of the…

  5. United Parcel Service Evaluates Hybrid Electric Delivery Vans (Fact Sheet)

    SciTech Connect

    Not Available

    2010-02-01

    This fact sheet describes how the National Renewable Energy Laboratory's Fleet Test and Evaluation team evaluated the 12-month, in-service performance of six Class 4 hybrid electric delivery vans - fueled by regular diesel - and six comparable conventional diesel vans operated by the United Parcel Service.

  6. Unit 1103: The Nature and Evaluation of Argument.

    ERIC Educational Resources Information Center

    Minnesota Univ., Minneapolis. Center for Curriculum Development in English.

    This 11th-grade unit on language of discourse is designed to help students gain the ability to evaluate argument, to construct logical and reasonable discourse, and to recognize ethical standards of free speech and inquiry. Stephen Toulmin's model of "evidence-warrant-claim" is used as a basic pattern for both the evaluation and…

  7. Forensic human identification in the United States and Canada: a review of the law, admissible techniques, and the legal implications of their application in forensic cases.

    PubMed

    Holobinko, Anastasia

    2012-10-10

    Forensic human identification techniques are successful if they lead to positive personal identification. However, the strongest personal identification is of no use in the prosecution--or vindication--of an accused if the associated evidence and testimony is ruled inadmissible in a court of law. This review examines the U.S. and Canadian legal rulings regarding the admissibility of expert evidence and testimony, and subsequently explores four established methods of human identification (i.e., DNA profiling, forensic anthropology, forensic radiography, forensic odontology) and one complementary technique useful in determining identity, and the legal implications of their application in forensic cases. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  8. Bed Utilisation in an Irish Regional Paediatric Unit – A Cross-Sectional Study Using the Paediatric Appropriateness Evaluation Protocol (PAEP)

    PubMed Central

    ÓhAiseadha, Coilín; Mannix, Mai; Saunders, Jean; Philip, Roy K.

    2016-01-01

    Background: Increasing demand for limited healthcare resources raises questions about appropriate use of inpatient beds. In the first paediatric bed utilisation study at a regional university centre in Ireland, we conducted a cross-sectional study to audit the utilisation of inpatient beds at the Regional Paediatric Unit (RPU) in University Hospital Limerick (UHL), Limerick, Ireland and also examined hospital activity data, to make recommendations for optimal use of inpatient resources. Methods: We used a questionnaire based on the paediatric appropriateness evaluation protocol (PAEP), modified and validated for use in the United Kingdom, to prospectively gather data regarding reasons for admission and for ongoing care after 2 days, from case records for all inpatients during 11 days in February (winter) and 7 days in May–June (summer). We conducted bivariate and multivariate analysis to explore associations between failure to meet PAEP criteria and patient attributes including age, gender, admission outside of office hours, arrival by ambulance, and private health insurance. Inpatient bed occupancy and day ward activity were also scrutinised. Results: Mean bed occupancy was 84.1%. In all, 12/355 (3.4%, 95% CI: 1.5%–5.3%) of children failed to meet PAEP admission criteria, and 27/189 (14.3%, 95% CI: 9.3%–19.3%) who were still inpatients after 2 days failed to meet criteria for ongoing care. 35/355 (9.9%, 95% CI: 6.8%–13.0%) of admissions fulfilled only the PAEP criterion for intravenous medications or fluid replacement. A logistic regression model constructed by forward selection identified a significant association between failure to meet PAEP criteria for ongoing care 2 days after admission and admission during office hours (08.00–17.59) (P = .020), and a marginally significant association between this outcome and arrival by ambulance (P = .054). Conclusion: At a mean bed occupancy of 84.1%, an Irish RPU can achieve 96.6% appropriate admissions

  9. The impact of assertive outreach teams on hospital admissions for psychosis: a time series analysis.

    PubMed

    Hamilton, I; Lloyd, C; Bland, J M; Savage Grainge, A

    2015-09-01

    Although the assertive outreach model was developed in the United States and imported to the United Kingdom to date, there is only limited evidence to support its wide-scale implementation within the United Kingdom. This is the first study to have combined a large dataset with this type of research method to explore the impact of assertive outreach teams on hospital admissions. The introduction and expansion of assertive outreach teams was associated with reducing hospital admissions for people with psychosis. This study found a consistent summer peak in hospital admissions which community and in-patient mental health nurses should take account of and plan for. Ever since the Mental Health Policy Implementation Policy Guide paved the way for the introduction of the Assertive Outreach Treatment (AOT) model in England, the impact of this approach has been the subject of considerable debate but limited evaluation. To date, most of the evidence supporting this model has originated from outside the United Kingdom. A central aim of the AOT was to reduce the need for in-patient treatment. We aimed to assess the impact of the AOT model on hospital admissions for people with psychosis in England. Interrupted time series analysis was used in this study to evaluate the impact of the policy change. Following the introduction of the AOT model, a statistically significant reduction in hospital admissions for psychosis was found. In addition, we observed a repeated, annual summer peak in admissions. This study adds to the international evidence which supports the effectiveness of the AOT model in reducing hospital admissions for people with severe mental health problems. We offer five suggested implications for mental health nurses and clients based on our findings. © 2015 John Wiley & Sons Ltd.

  10. Ignalina NPP Unit 2 Gas Gap Probabilistic Evaluation

    SciTech Connect

    Jurgita Simaityte Volskiene; Augutis, Juozas; Uspuras, Eugenijus

    2006-07-01

    One of the factors limiting RMBK service life is the closure of the gas gap between the pressure tubes and the graphite masonry. The objective of the present work is to develop a mathematical model for Unit 2 of the Ignalina nuclear power plant (NPP) reactor, in Lithuania, which estimates the probability of the presence of a gas gap for different periods of operation. The calculations are based on collected data of graphite and pressure tube diameters and burn up measurements in period 1983-2005. There were no performed enough measurements for Unit 2, but big amount of statistical data was available for Unit 1. Therefore Unit 1 data properties were analyzed and constructed model was applied for INPP reactor Unit 2. The main analysis results are gas gap existence probabilities evaluation and the issued channel measuring strategies for the next planed preventive maintenance period for Ignalina NPP. (authors)

  11. Re-Examination of Traditional Admissions Criteria in Predicting Academic Success in a Counselor Education Program

    ERIC Educational Resources Information Center

    Hatchett, Gregory T.; Lawrence, Christopher; Coaston, Susannah C.

    2017-01-01

    The purpose of this study was to re-evaluate the validity of traditional admissions criteria--UGPA and GRE scores--in predicting academic success for students admitted to a counselor education program in the United States. In contrast to prior research, we also included the newer GRE-Analytical Writing scores in our analyses. In general, we found…

  12. Re-Examination of Traditional Admissions Criteria in Predicting Academic Success in a Counselor Education Program

    ERIC Educational Resources Information Center

    Hatchett, Gregory T.; Lawrence, Christopher; Coaston, Susannah C.

    2017-01-01

    The purpose of this study was to re-evaluate the validity of traditional admissions criteria--UGPA and GRE scores--in predicting academic success for students admitted to a counselor education program in the United States. In contrast to prior research, we also included the newer GRE-Analytical Writing scores in our analyses. In general, we found…

  13. An Admissions Officer's Credentials

    ERIC Educational Resources Information Center

    Chronicle of Higher Education, 2007

    2007-01-01

    Marilee Jones has resigned as a dean of admissions at the Massachusetts Institute of Technology after admitting that she had misrepresented her academic degrees when first applying to work at the university in 1979. As one of the nation's most prominent admissions officers--and a leader in the movement to make the application process less…

  14. The Administration of Admissions

    ERIC Educational Resources Information Center

    Campbell, Clifford C.

    1978-01-01

    Among all the tasks of the admissions officer in developing a successful marketing program, the hardest may be that of convincing other college administrators of the importance of admissions to the institution's survival. Discussed are long-range planning, budgeting, staff selection and training, and implementing a plan. (Author/LBH)

  15. Technology in International Admissions

    ERIC Educational Resources Information Center

    White, Elizabeth

    2012-01-01

    In a relatively short time, technology applications have become an essential feature of the admissions business. They make the jobs of international admissions professionals easier in many ways, allowing for more robust communication with applicants and counselors, a streamlined application process, and quicker access to information about…

  16. What Admissions Officials Think

    ERIC Educational Resources Information Center

    Hoover, Eric

    2008-01-01

    Over the past two decades, college admissions has become a prime-time preoccupation. Most people know at least something about the process, especially if they have a teenager in high school and a college guide on their coffee table. Nonetheless, widespread public misconceptions persist about admissions requirements, the selection process, and the…

  17. Technology in International Admissions

    ERIC Educational Resources Information Center

    White, Elizabeth

    2012-01-01

    In a relatively short time, technology applications have become an essential feature of the admissions business. They make the jobs of international admissions professionals easier in many ways, allowing for more robust communication with applicants and counselors, a streamlined application process, and quicker access to information about…

  18. Marketing in Admissions: The Information System Approach.

    ERIC Educational Resources Information Center

    Wofford, O. Douglas; Timmerman, Ed

    1982-01-01

    A marketing information system approach for college admissions is outlined that includes objectives, information needs and sources, a data collection format, and information evaluation. Coordination with other institutional information systems is recommended. (MSE)

  19. Using the Admitted Class Evaluation Service (ACES) to Conduct Institution-Specific Admission or Placement Validity Studies

    ERIC Educational Resources Information Center

    Shaw, Emily J.

    2011-01-01

    Presented at the 23rd Annual Historically Black Colleges & Universities (HBCU) Conference in Atlanta, GA, in September 2011. Admitted Class Evaluation Service (ACES) is the College Board's free online service that predicts how admitted students will perform at a college or university generally, and how successful students will be in specific…

  20. Evaluation of indoor air quality using the decibel concept. Part I--proposal of new units.

    PubMed

    Jokl, M V

    1997-03-01

    Weber-Fechner's law concerning the perception of sound by man with time expressed as a logarithmic function can also be used for the odour constituent used in the evaluation of indoor air quality in buildings. A new unit dB (odour) based on the concentration of Total Volatile Organic Compounds (TVOC) is proposed as it is currently the basis for determining the air change rate. On the Psycho-Physical Scale according to Yaglou, the weakest odour that can be detected by the human small sensors is equal to one and corresponds to the lower limit of percentage dissatisfaction (PD) of 5.8% and a threshold concentration (TVOC) of 50 micrograms/m3-0 dB (odour). The upper limit is determined by the initial value of toxicity TVOC-25,000 micrograms/m3-135 dB (odour). Optimal values corresponding to PD = 20% (according to EUR 14449 EN) and admissible values corresponding to PD = 30% (see Table 3) are proposed, therefore the same values used to evaluate noise can be used to evaluate air quality and additionally the contribution of individual constituents (at present acoustic and odour) to the overall quality of the environment can be ascertained. The determination of the required volume of fresh air for ventilation and air-conditioning systems according to the new principles is the subject of the Part II of this paper.

  1. Equity of Access. New Approaches to Minority Admissions

    ERIC Educational Resources Information Center

    Bingham, Rebecca Saady

    1978-01-01

    One new approach to the admission of minorities to medical schools is that of the Simulated Minority Admission Exercises (SMAE). It sensitizes admission committee members to the different backgrounds of minority applicants and teaches them to evaluate them more effectively. (Author/AM)

  2. Combined medical-psychiatric inpatient units: evaluation of the Centre for the Elderly.

    PubMed

    Maier, A B; Wächtler, C; Hofmann, W

    2007-08-01

    Considering the large number of elderly patients in acute hospitals who receive medical as well as psychiatric treatment because of relevant comorbidity, adequate interdisciplinary treatment models have to be developed and applied. The Centre for Elderly, a cooperation project between the departments of geriatric and psychogeriatric medicine in a community hospital in Germany, was founded in 2000. In addition to traditionally structured units, the centre consists of interdisciplinary units. Patient-, staff- and hospital-related characteristics influenced by the reformation of both departments were evaluated by comparing hospital-based registry data records containing age, gender, main and minor diagnoses, length of stay and patient transferrals within the centre. Experts working at the centre were asked to take a stand on the development of the treatment quality, allocation of patients, diagnostic procedures, consultation services and information transmission. The number of admissions to the Centre for the Elderly increased within one year. The distribution of the main diagnose groups remained unchanged, with an overlap between the geriatric and psychogeriatric department consisting of the main diagnoses dementia and depression. The length of stay and the number of transferrals decreased significantly in both departments. The majority of the interviewed employees stated that the treatment quality and the allocation of patients were improved. We conclude that interdisciplinary treatment between the departments of psychiatry and geriatric medicine may contribute to the medical needs of subgroups of elderly inpatients suffering from medical-psychiatric comorbidity.

  3. Effectiveness of the United States Marine Corps Tiered Evaluation System

    DTIC Science & Technology

    2015-03-01

    NAVAL POSTGRADUATE SCHOOL MONTEREY, CALIFORNIA THESIS Approved for public release; distribution is unlimited EFFECTIVENESS OF THE...2015 Master’ s Thesis 4. TITLE AND SUBTITLE EFFECTIVENESS OF THE UNITED STATES MARINE CORPS TIERED EVALUATION SYSTEM 6. AUTHOR(S) Lucas A. Crider...distribution is tmlimited 13. ABSTRACT (maximum 200 words) 12b. DISTRIBUTION CODE This thesis analyzes how effective the Marine Corps Tiered Evaluation

  4. The Implementation and Evaluation of the Patient Admission Prediction Tool: Assessing Its Impact on Decision-Making Strategies and Patient Flow Outcomes in 2 Australian Hospitals.

    PubMed

    Crilly, Julia L; Boyle, Justin; Jessup, Melanie; Wallis, Marianne; Lind, James; Green, David; FitzGerald, Gerry

    2015-01-01

    To evaluate the implementation of a Patient Admission Prediction Tool (PAPT) in terms of patient flow outcomes and decision-making strategies. The PAPT was implemented in 2 Australian public teaching hospitals during October-December 2010 (hospital A) and October-December 2011 (hospital B). A multisite prospective, comparative (before and after) design was used. Patient flow outcomes measured included access block and hospital occupancy. Daily and weekly data were collected from patient flow reports and routinely collected emergency department information by the site champion and researchers. Daily decision-making strategies ranged from business as usual to use of overcensus beds. Weekly strategies included advanced approval to use of overcensus beds and prebooking nursing staff. These strategies resulted in improved weekend discharges to manage incoming demand for the following week. Following the introduction of the PAPT and workflow guidelines, patient access and hospital occupancy levels could be maintained despite increases in patient presentations (hospital A). The use of a PAPT, embedded in patient flow management processes and championed by a manager, can benefit bed and staff management. Further research that incorporates wider evaluation of the use of the tool at other sites is warranted.

  5. Short Term Survival after Admission for Heart Failure in Sweden: Applying Multilevel Analyses of Discriminatory Accuracy to Evaluate Institutional Performance

    PubMed Central

    Ghith, Nermin; Wagner, Philippe; Frølich, Anne; Merlo, Juan

    2016-01-01

    Background Hospital performance is frequently evaluated by analyzing differences between hospital averages in some quality indicators. The results are often expressed as quality charts of hospital variance (e.g., league tables, funnel plots). However, those analyses seldom consider patients heterogeneity around averages, which is of fundamental relevance for a correct evaluation. Therefore, we apply an innovative methodology based on measures of components of variance and discriminatory accuracy to analyze 30-day mortality after hospital discharge with a diagnosis of Heart Failure (HF) in Sweden. Methods We analyzed 36,943 patients aged 45–80 treated in 565 wards at 71 hospitals during 2007–2009. We applied single and multilevel logistic regression analyses to calculate the odds ratios and the area under the receiver-operating characteristic (AUC). We evaluated general hospital and ward effects by quantifying the intra-class correlation coefficient (ICC) and the increment in the AUC obtained by adding random effects in a multilevel regression analysis (MLRA). Finally, the Odds Ratios (ORs) for specific ward and hospital characteristics were interpreted jointly with the proportional change in variance (PCV) and the proportion of ORs in the opposite direction (POOR). Findings Overall, the average 30-day mortality was 9%. Using only patient information on age and previous hospitalizations for different diseases we obtained an AUC = 0.727. This value was almost unchanged when adding sex, country of birth as well as hospitals and wards levels. Average mortality was higher in small wards and municipal hospitals but the POOR values were 15% and 16% respectively. Conclusions Swedish wards and hospitals in general performed homogeneously well, resulting in a low 30-day mortality rate after HF. In our study, knowledge on a patient’s previous hospitalizations was the best predictor of 30-day mortality, and this information did not improve by knowing the sex and country

  6. Evaluation of chestnut test plantings in the Eastern United States

    Treesearch

    Frederick H. Berry

    1980-01-01

    Between 1947 and 1955, 15 plots were established in the Eastern United States to evaluate chestnut hybrids under forest conditions. During the 1978 field season these test plots were reassessed and all living chestnut trees critically examined. Ten percent of the 250 surviving hybrid chestnuts were blight resistant, and had the timber form and rapid growth of the...

  7. A Unit Price Evaluation of Severe Problem Behavior

    ERIC Educational Resources Information Center

    Borrero, John C.; Francisco, Monica T.; Haberlin, Alayna T.; Ross, Noel A.; Sran, Sandeep K.

    2007-01-01

    We evaluated problem behavior exhibited by 6 individuals with developmental disabilities using the behavioral economic conceptualization of unit price. Descriptive observations were conducted during interactions between the participants and their primary care providers in a clinical laboratory, the participants' homes, or school. Data were…

  8. Orthognathic Surgery Patients (Maxillary Impaction and Setback plus Mandibular Advancement plus Genioplasty) Need More Intensive Care Unit (ICU) Admission after Surgery

    PubMed Central

    Eftekharian, Hamidreza; Zamiri, Barbad; Ahzan, Shamseddin; Talebi, Mohamad; Zarei, Kamal

    2015-01-01

    Statement of the Problem: Due to shortage of ICU beds in hospitals, knowing what kind of orthognathic surgery patients more need ICU care after surgery would be important for surgeons and hospitals to prevent unnecessary ICU bed reservation. Purpose: The aim of the present study was to determine what kinds of orthognathic surgery patients would benefit more from ICU care after surgery. Materials and Method: 210 patients who were admitted to Chamran Hospital, Shiraz, for bimaxillary orthognathic surgery (2008-2013) were reviewed based on whether they had been admitted to ICU or maxillofacial surgery ward. Operation time, sex, intraoperative Estimated Blood Loss (EBL), postoperative complications, ICU admission, and unwanted complications resulting from staying in ICU were assessed. Results: Of 210 patients undergoing bimaxillary orthognathic surgery, 59 patients (28.1%) were postoperatively admitted to the ICU and 151 in the maxillofacial ward (71.9%). There was not statistically significant difference in age and sex between the two groups (p> 0.05). The groups were significantly different in terms of operation time (p< 0.001). Blood loss For ICU admitted patients was 600.00±293.621mL and for those who were hospitalized in the ward was 350.00±298.397 mL. Statistically significant differences were found between the two groups (p< 0.001). Moreover, there was a direct linear correlation between operation time and intraoperative estimated blood loss and this relationship was statistically significant (r=0.42, p< 0.001). Patients with maxillary impaction and setback plus mandibular advancement plus genioplasty were among the most ICU admitted patients (44%), while these patients were only 20% of all patients who were admitted to the ward. As a final point, the result illustrated that patients who were admitted to the ICU experienced more complication such as bleeding, postoperative nausea, and pain (p< 0.001). Conclusion: Orthognathic surgery patients (maxillary

  9. Does the United States Naval Academy Admissions Board Evaluate an Applicant’s Moral Values? If So, How?

    DTIC Science & Technology

    2005-06-01

    trigonometry, four years of English, one year of chemistry , and suggests two years of modern foreign language, one year of physics, one year of U.S...And if it is one of social use ( marijuana ) and if self-reported, nobody else has commented on it, then actually I tend to think that, that is more...an inner city youth is honest enough to admit experimenting with marijuana , there may be a propensity toward leniency and understanding given his

  10. Fostering a culture of engagement: a pilot study of the outcomes of training mental health nurses working in two UK acute admission units in brief solution-focused therapy techniques.

    PubMed

    Hosany, Z; Wellman, N; Lowe, T

    2007-10-01

    It is widely acknowledged that there are major concerns about quality of care, ward atmosphere, the nature of nurse-patient interactions and patient outcomes in UK psychiatric acute admission units. Brief solution-focused therapy (SFT) is an approach which aims to shift the focus of interactions in professional care away from the traditional concentration on an individual's problems and weaknesses towards a more proactive identification of their strengths and positive coping mechanisms. This approach relies on a collaborative engagement with patients, in which the nurse or therapist using simple language aims to help the patient construct a plan to ensure their immediate safety while working to identify, focus on and reinforce their strengths and coping mechanisms in the achievement of identified future goals. This paper reports on a pilot study whose principal objective was to determine whether a short training in brief SFT for psychiatric nurses can produce measurable improvements in nurse-patient interactions in two psychiatric acute admission wards. In this study, 36 nurses undertook a 2-day training course in SFT and were followed up 3 months after training. Positive results were obtained on a number of measures indicating that nurses had acquired knowledge and skills and were applying SFT techniques in their clinical work.

  11. Hospice Admission Assessment.

    PubMed

    Moon, Paul J

    2017-04-01

    Hospice admission assessment is a pivotal encounter for patient/family and hospice representative. For patient/family, the admission is the threshold by which a particular level of care can commence and, symbolically, a certain marker in health status trajectory is reached. For hospice representative, the admission episode is an occasion to inaugurate an ambience that can serve to frame future hospice care experiences for the patient/family. Through a narrative lens, hospice admission assessment can be seen as experiential time and space, where patient's and family's stories are mindfully and deliberately witnessed and explored. Through the practice of narrative mining, the hospice representative can better understand others' offered stories of reality, which will better inform the plan of palliation and hospice care.

  12. Pre-admission reassurance.

    PubMed

    1987-11-14

    The stressful experience of Emma, aged six, who entered hospital for a tonsilectomy without any pre-admission preparation, was told to a conference of paediatric nurses by Jan Williams, Clinical Nurse Specialist at Nottingam's Children's Hospital.

  13. Student Admission and Attendance.

    ERIC Educational Resources Information Center

    Majestic, Ann L.

    1988-01-01

    Considers the North Carolina statutes that define the process for admitting students to public schools and ensuring their attendance. Examines cases relating to issues of school admission and compulsory attendance. (MLF)

  14. The impact of chronic obstructive pulmonary disease on intensive care unit admission and 30-day mortality in patients undergoing colorectal cancer surgery: a Danish population-based cohort study.

    PubMed

    Platon, Anna Maria; Erichsen, Rune; Christiansen, Christian Fynbo; Andersen, Lea Kjær; Sværke, Claus; Montomoli, Jonathan; Sørensen, Henrik Toft

    2014-01-01

    Chronic obstructive pulmonary disease (COPD) may increase the risk of postoperative complications and thus mortality after colorectal cancer (CRC) surgery, but the evidence is sparse. We conducted this nationwide population-based cohort study in Denmark, including all patients undergoing CRC surgery in the period 2005-2011, identified through medical databases. We categorised the patients according to the history of COPD. We assessed the rate of complications within 30 days. We computed 30-day mortality among patients with/without COPD using the Kaplan-Meier method. We used Cox regression to compute HRs for death, controlling for age, gender, type of admission, cancer stage, hospital volume, alcohol-related diseases, obesity and Charlson comorbidity score. We identified 18 302 CRC surgery patients. Of these, 7.9% had a prior diagnosis of COPD. Among patients with COPD, 16.1% were admitted postoperatively to the intensive care unit, 1.9% were treated with mechanical ventilation, and 3.6% were treated with non-invasive ventilation. In patients without COPD, the corresponding proportions were 9.7%, 1.1% and 1.1%. The reoperation rate was 10.6% among patients with COPD and 8% among patients with cancer without COPD. 30-day mortality was 13% (95% CI 11.4% to 14.9%) among patients with COPD and 5.3% (95% CI 5.0% to 5.7%) among patients without COPD, corresponding to an adjusted HR of 1.7 (95% CI 1.5 to 2.0). COPD is a strong predictor for intensive care unit admission and mortality after CRC surgery.

  15. The impact of chronic obstructive pulmonary disease on intensive care unit admission and 30-day mortality in patients undergoing colorectal cancer surgery: a Danish population-based cohort study

    PubMed Central

    Platon, Anna Maria; Erichsen, Rune; Christiansen, Christian Fynbo; Andersen, Lea Kjær; Sværke, Claus; Montomoli, Jonathan; Sørensen, Henrik Toft

    2014-01-01

    Background and purpose Chronic obstructive pulmonary disease (COPD) may increase the risk of postoperative complications and thus mortality after colorectal cancer (CRC) surgery, but the evidence is sparse. Methods We conducted this nationwide population-based cohort study in Denmark, including all patients undergoing CRC surgery in the period 2005–2011, identified through medical databases. We categorised the patients according to the history of COPD. We assessed the rate of complications within 30 days. We computed 30-day mortality among patients with/without COPD using the Kaplan-Meier method. We used Cox regression to compute HRs for death, controlling for age, gender, type of admission, cancer stage, hospital volume, alcohol-related diseases, obesity and Charlson comorbidity score. Results We identified 18 302 CRC surgery patients. Of these, 7.9% had a prior diagnosis of COPD. Among patients with COPD, 16.1% were admitted postoperatively to the intensive care unit, 1.9% were treated with mechanical ventilation, and 3.6% were treated with non-invasive ventilation. In patients without COPD, the corresponding proportions were 9.7%, 1.1% and 1.1%. The reoperation rate was 10.6% among patients with COPD and 8% among patients with cancer without COPD. 30-day mortality was 13% (95% CI 11.4% to 14.9%) among patients with COPD and 5.3% (95% CI 5.0% to 5.7%) among patients without COPD, corresponding to an adjusted HR of 1.7 (95% CI 1.5 to 2.0). Conclusions COPD is a strong predictor for intensive care unit admission and mortality after CRC surgery. PMID:25478184

  16. Use of poisson regression and box-jenkins models to evaluate the short-term effects of environmental noise levels on daily emergency admissions in Madrid, Spain.

    PubMed

    Tobias, A; Díaz, J; Saez, M; Alberdi, J C

    2001-01-01

    The relationship between environmental factors and hospital admissions has usually been analysed without taking into account the influence of a factor closely related to traffic in big cities, that is, environmental noise levels. We analysed the relationship between environmental noise and emergency admissions, for all causes and specific causes in Madrid (Spain), for the study period 1995-1997, using two statistical methods for the analysis of epidemiological time series data: Poisson autoregressive models and Box Jenkins (ARIMA) methodology. Both methods produce a clear association between emergency admissions for all and specific causes and environmental noise levels. We found very similar results from both methods for all and circulatory causes, but slightly different for respiratory causes. Around 5% of all emergency admissions can be attributed to high noise levels, with a lower figure for specific causes. Current levels of environmental noise have a considerable epidemiological impact on emergency admissions in Madrid. A reduction of environmental noise levels could be accompanied by a possible reduction in the number of emergency admissions.

  17. Noncontrast computed tomographic Hounsfield unit evaluation of cerebral venous thrombosis: a quantitative evaluation.

    PubMed

    Besachio, David A; Quigley, Edward P; Shah, Lubdha M; Salzman, Karen L

    2013-08-01

    Our objective is to determine the utility of noncontrast Hounsfield unit values, Hounsfield unit values corrected for the patient's hematocrit, and venoarterial Hounsfield unit difference measurements in the identification of intracranial venous thrombosis on noncontrast head computed tomography. We retrospectively reviewed noncontrast head computed tomography exams performed in both normal patients and those with cerebral venous thrombosis, acquiring Hounsfield unit values in normal and thrombosed cerebral venous structures. Also, we acquired Hounsfield unit values in the internal carotid artery for comparison to thrombosed and nonthrombosed venous structures and compared the venous Hounsfield unit values to the patient's hematocrit. A significant difference is identified between Hounsfield unit values in thrombosed and nonthrombosed venous structures. Applying Hounsfield unit threshold values of greater than 65, a Hounsfield unit to hematocrit ratio of greater than 1.7, and venoarterial difference values greater than 15 alone and in combination, the majority of cases of venous thrombosis are identifiable on noncontrast head computed tomography. Absolute Hounsfield unit values, Hounsfield unit to hematocrit ratios, and venoarterial Hounsfield unit value differences are a useful adjunct in noncontrast head computed tomographic evaluation of cerebral venous thrombosis.

  18. Elderly patients are at high risk of night-time admission to the intensive care unit following a rapid response team call.

    PubMed

    Sundararajan, K; Flabouris, A; Thompson, C; Seppelt, I

    2016-12-01

    Previous studies have shown that elderly patients (age ≥65 years) are less likely to be admitted to the intensive care unit following a rapid response team call and have high hospital mortality rates. This study has shown that elderly patients have a significantly higher probability of being admitted to an intensive care unit following a rapid response team call at night than during the day. However, at no time are they at greater risk than younger patients of incomplete vital sign recording, a failure to escalate care for acute deterioration or mortality.

  19. The association between prior statin use and long-term outcomes after critical care admission.

    PubMed

    Beed, M; Brindley, P G; Mahajan, R; Juttner, I; Campion-Smith, J; Wilson, V G

    2016-10-01

    Statins may have immunomodulatory effects that benefit critically ill patients. Therefore, we retrospectively examined the association between survival and the prescription of statins prior to admission to an intensive care unit (ICU), or high dependency unit (HDU), as a result of major elective surgery or as an emergency with a presumed diagnosis of sepsis. We retrospectively studied critical care patients (ICU or HDU) from a tertiary referral UK teaching hospital. Nottingham University Hospitals have more than 2200 beds, of which 39 are critical care beds. Over a 5-year period (2000-2005), 414 patients were identified with a presumed diagnosis of sepsis, and 672 patients were identified who had planned ICU/HDU admissions following elective major surgery. Patients prescribed statins prior to hospital admission were compared with those who were not. Demographics, medical history, drug history, and Acute Physiology and Chronic Health Evaluation II scores were examined. Univariate and multivariate analyses were applied using the primary end point of survival at 5 years after admission. Patients prescribed statins prior to critical care admission were, on average, older and had higher initial Acute Physiology and Chronic Health Evaluation II scores and more preexisting comorbidities. Statins were almost invariably stopped following admission to critical care. Statin use was not associated with significantly altered survival during hospital admission, or at 5 years, for either patients with sepsis (9% vs 15%, P=.121; 73% vs 84%, P=.503, respectively) or postoperative patients (55% vs 58%, P=.762; 57% vs 63%, P=.390). Prior statin use was not associated with improved outcomes in patients admitted to critical care after elective surgical cases or with a presumed diagnosis of sepsis. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. Use of patient-controlled psychiatric hospital admissions: mental health professionals' perspective.

    PubMed

    Ellegaard, Trine; Mehlsen, Mimi; Lomborg, Kirsten; Bliksted, Vibeke

    2017-07-01

    In a patient-controlled admission (PCA) programme, the decision about hospital admission is made solely by the patient, with no gatekeeper function allocated to the mental health professionals (MHPs). Current knowledge about how MHPs experience and evaluate PCA is sparse. This Danish multi-centre study examined the MHP assessment of the PCA programme in daily clinical practice, and compared PCA evaluations made by MHPs and patients. A questionnaire was developed and a survey conducted over the course of a year at all Danish mental health units included in the PCA programme. MHPs made an overall evaluation of the PCA programme. At each unique PCA, both patient and MHP evaluated the specific admission when the patient entered the unit and at discharge. In total, 546 questionnaires were included in the survey, based on 252 unique MHPs. The MHPs rated the PCA programme positively. The MHPs believed that PCA helped patients receive early help and avoid long admissions. Overall, agreement was poor when comparing patients' and MHPs' evaluation of the same PCA. MHPs (and patients) seem to be in favour of implementing the PCA programme. However, results revealed that MHPs and patients have different views of what caused the patient to admit themselves and why patients were discharged. MHPs should be aware that patients might have other reasons for admitting and discharging themselves than what seems most obvious to the MHP.

  1. Objective evaluation of oral presentation skills using Inertial Measurement Units.

    PubMed

    Sessa, Salvatore; Kong, Weisheng; Zhang, Di; Cosentino, Sarah; Manawadu, Udara; Kawasaki, Motoji; Thomas, George Thuruthel; Suzuki, Tomohiro; Tsumura, Ryosuke; Takanishi, Atsuo

    2015-01-01

    Oral presentation is considered as one of the most sought after skills by companies and professional organizations and program accreditation agencies. However, both learning process and evaluation of this skill are time demanding and complex tasks that need dedication and experience. Furthermore, the role of the instructor is fundamental during the presentation assessment. The instructor needs to consider several verbal and nonverbal communications cues sent in parallel and this kind of evaluation is often subjective. Even if there are oral presentation rubrics that try to standardize the evaluation, they are not an optimal solution because they do not provide the presenter a real-time feedback. In this paper, we describe a system for behavioral monitoring during presentations. We propose an ecological measurement system based on Inertial Measurement Units to evaluate objectively the presenter's posture through objective parameters. The system can be used to provide a real-time feedback to the presenters unobtrusively.

  2. Evaluation of the impact of fetal fibronectin test implementation on hospital admissions for preterm labour in Ontario: a multiple baseline time-series design.

    PubMed

    Fell, D B; Sprague, A E; Grimshaw, J M; Yasseen, A S; Coyle, D; Dunn, S I; Perkins, S L; Peterson, W E; Johnson, M; Bunting, P S; Walker, M C

    2014-03-01

    To determine the impact of a health system-wide fetal fibronectin (fFN) testing programme on the rates of hospital admission for preterm labour (PTL). Multiple baseline time-series design. Canadian province of Ontario. A retrospective population-based cohort of antepartum and delivered obstetrical admissions in all Ontario hospitals between 1 April 2002 and 31 March 2010. International Classification of Diseases codes in a health system-wide hospital administrative database were used to identify the study population and define the outcome measure. An aggregate time series of monthly rates of hospital admissions for PTL was analysed using segmented regression models after aligning the fFN test implementation date for each institution. Rate of obstetrical hospital admission for PTL. Estimated rates of hospital admission for PTL following fFN implementation were lower than predicted had pre-implementation trends prevailed. The reduction in the rate was modest, but statistically significant, when estimated at 12 months following fFN implementation (-0.96 hospital admissions for PTL per 100 preterm births; 95% confidence interval [CI], -1.02 to -0.90, P = 0.04). The statistically significant reduction was sustained at 24 and 36 months following implementation. Using a robust quasi-experimental study design to overcome confounding as a result of underlying secular trends or concurrent interventions, we found evidence of a small but statistically significant reduction in the health system-level rate of hospital admissions for PTL following implementation of fFN testing in a large Canadian province. © 2013 Royal College of Obstetricians and Gynaecologists.

  3. Evaluating Midwifery Units (EMU): a prospective cohort study of freestanding midwifery units in New South Wales, Australia

    PubMed Central

    Monk, Amy; Tracy, Mark; Foureur, Maralyn; Grigg, Celia; Tracy, Sally

    2014-01-01

    Objective To compare maternal and neonatal birth outcomes and morbidities associated with the intention to give birth in two freestanding midwifery units and two tertiary-level maternity units in New South Wales, Australia. Design Prospective cohort study. Participants 494 women who intended to give birth at freestanding midwifery units and 3157 women who intended to give birth at tertiary-level maternity units. Participants had low risk, singleton pregnancies and were at less than 28+0 weeks gestation at the time of booking. Primary and secondary outcome measures Primary outcomes were mode of birth, Apgar score of less than 7 at 5 min and admission to the neonatal intensive care unit or special care nursery. Secondary outcomes were onset of labour, analgesia, blood loss, management of third stage of labour, perineal trauma, transfer, neonatal resuscitation, breastfeeding, gestational age at birth, birth weight, severe morbidity and mortality. Results Women who planned to give birth at a freestanding midwifery unit were significantly more likely to have a spontaneous vaginal birth (AOR 1.57; 95% CI 1.20 to 2.06) and significantly less likely to have a caesarean section (AOR 0.65; 95% CI 0.48 to 0.88). There was no significant difference in the AOR of 5 min Apgar scores, however, babies from the freestanding midwifery unit group were significantly less likely to be admitted to neonatal intensive care or special care nursery (AOR 0.60; 95% CI 0.39 to 0.91). Analysis of secondary outcomes indicated that planning to give birth in a freestanding midwifery unit was associated with similar or reduced odds of intrapartum interventions and similar or improved odds of indicators of neonatal well-being. Conclusions The results of this study support the provision of care in freestanding midwifery units as an alternative to tertiary-level maternity units for women with low risk pregnancies at the time of booking. PMID:25361840

  4. Anaphylaxis fatalities and admissions in Australia.

    PubMed

    Liew, Woei Kang; Williamson, Elizabeth; Tang, Mimi L K

    2009-02-01

    Detailed data on fatal anaphylaxis are limited, with national anaphylaxis fatality data for the United Kingdom and food-induced anaphylaxis fatality data for the United States. Time trends for anaphylaxis fatalities are not available. We examined causes, demographics, and time trends for anaphylaxis fatalities in Australia between January 1997 and December 2005 and compared these with findings for anaphylaxis admissions. Data on anaphylaxis deaths and hospital admissions were extracted from a national database. Death certificate codes were analyzed to determine the likely cause and associated comorbidities. There were 112 anaphylaxis fatalities in Australia over 9 years. Causes were as follows: food, 7 (6%); drugs, 22 (20%); probable drugs, 42 (38%); insect stings, 20 (18%); undetermined, 15 (13%); and other, 6 (5%). All food-induced anaphylaxis fatalities occurred between 8 and 35 years of age with female preponderance, despite the majority of food-induced anaphylaxis admissions occurring in children less than 5 years of age. Most insect sting-induced anaphylaxis deaths occurred between 35 and 84 years almost exclusively in male subjects, although bee sting-induced admissions peak between 5 and 9 years of age with a male/female ratio of 2.7. However, most drug-induced anaphylaxis deaths occurred between 55 and 85 years with equal sex distribution similar to drug-induced anaphylaxis admissions. There was no evidence of an increase in death rates for food-induced anaphylaxis, despite food-induced anaphylaxis admissions increasing approximately 350%. In contrast, drug-induced anaphylaxis deaths increased approximately 300% compared with an approximately 150% increase in drug-induced anaphylaxis admissions. The demographics for anaphylaxis deaths are different to those for anaphylaxis presentations. Anaphylaxis mortality rates remain low and stable, despite increasing anaphylaxis prevalence, with the exception of drug-induced anaphylaxis deaths, which have increased.

  5. Dosimetrical evaluation of Leksell Gamma Knife 4C radiosurgery unit

    NASA Astrophysics Data System (ADS)

    Sajeev, Thomas; Mustafa, Mohamed M.; Supe, Sanjay S.

    2011-01-01

    A number of experiments was performed using standard protocols, in order to evaluate the dosimetric accuracy of Leksell Gamma Knife 4C unit. Verification of the beam alignment has been performed for all collimators using solid plastic head phantom and Gafchromic™ type MD-55 films. The study showed a good agreement of Leksell Gammaplan calculated dose profiles with experimentally determined profiles in all three axes. Isocentric accuracy is verified using a specially machined cylindrical aluminium film holder tool made with very narrow geometric tolerances aligned between trunnions of 4 mm collimator. Considering all uncertainties in all three dimensions, the estimated accuracy of the unit was 0.1 mm. Dose rate at the centre point of the unit has been determined according to the IAEA, TRS-398 protocol, using Unidose-E (PTW-Freiburg, Germany) with a 0.125 cc ion chamber, over a period of 6 years. The study showed that the Leksell Gamma Knife 4C unit is excellent radiosurgical equipment with high accuracy and precision, which makes it possible to deliver larger doses of radiation, within the limits defined by national and international guidelines, applicable for stereotactic radiosurgery procedures.

  6. ECIA Chapter 2 Evaluation Unit Final Evaluation Report. E.C.I.A. Chapter 2.

    ERIC Educational Resources Information Center

    District of Columbia Public Schools, Washington, DC. Div. of Quality Assurance.

    The purpose of the Evaluation Unit is to facilitate educational accountability by providing information to the District of Columbia Public Schools; to fulfill the requirements of the Educational Consolidation and Improvement Act (ECIA) of 1981; and to give technical assistance in evaluation to project coordinators. For each project that was…

  7. ECIA Chapter 2 Evaluation Unit Final Evaluation Report. E.C.I.A. Chapter 2.

    ERIC Educational Resources Information Center

    District of Columbia Public Schools, Washington, DC. Div. of Quality Assurance.

    The purpose of the Evaluation Unit is to facilitate educational accountability by providing information to the District of Columbia Public Schools; to fulfill the requirements of the Educational Consolidation and Improvement Act (ECIA) of 1981; and to give technical assistance in evaluation to project coordinators. For each project that was…

  8. PREP: Outreach to Online Learners through Admissions

    ERIC Educational Resources Information Center

    Gupton, Preeti

    2016-01-01

    Librarians have collaborated with academic departments within their institutions for decades now, working with professors and administrators to bring information literacy skills to students. The librarians at National American University decided to extend this collaboration to a non-academic unit, the admissions department of the university. The…

  9. PREP: Outreach to Online Learners through Admissions

    ERIC Educational Resources Information Center

    Gupton, Preeti

    2016-01-01

    Librarians have collaborated with academic departments within their institutions for decades now, working with professors and administrators to bring information literacy skills to students. The librarians at National American University decided to extend this collaboration to a non-academic unit, the admissions department of the university. The…

  10. 37 CFR 42.61 - Admissibility.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 37 Patents, Trademarks, and Copyrights 1 2013-07-01 2013-07-01 false Admissibility. 42.61 Section 42.61 Patents, Trademarks, and Copyrights UNITED STATES PATENT AND TRADEMARK OFFICE, DEPARTMENT OF COMMERCE TRIAL PRACTICE BEFORE THE PATENT TRIAL AND APPEAL BOARD Trial Practice and Procedure Testimony and...

  11. 37 CFR 42.61 - Admissibility.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 37 Patents, Trademarks, and Copyrights 1 2014-07-01 2014-07-01 false Admissibility. 42.61 Section 42.61 Patents, Trademarks, and Copyrights UNITED STATES PATENT AND TRADEMARK OFFICE, DEPARTMENT OF COMMERCE TRIAL PRACTICE BEFORE THE PATENT TRIAL AND APPEAL BOARD Trial Practice and Procedure Testimony and...

  12. 40 CFR 91.703 - Admission.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    .... (a) A nonconforming marine SI engine offered for importation may only be imported into the United... admission shall not be granted unless the marine SI engine is exempted or excluded under § 91.704. (b) In... containing the following: (1) Identification of the importer of the marine SI engine and the importer's...

  13. Evaluation plan for space station network interface units

    NASA Technical Reports Server (NTRS)

    Weaver, Alfred C.

    1990-01-01

    Outlined here is a procedure for evaluating network interface units (NIUs) produced for the Space Station program. The procedures should be equally applicable to the data management system (DMS) testbed NIUs produced by Honeywell and IBM. The evaluation procedures are divided into four areas. Performance measurement tools are hardware and software that must be developed in order to evaluate NIU performance. Performance tests are a series of tests, each of which documents some specific characteristic of NIU and/or network performance. In general, these performance tests quantify the speed, capacity, latency, and reliability of message transmission under a wide variety of conditions. Functionality tests are a series of tests and code inspections that demonstrate the functionality of the particular subset of ISO protocols which have been implemented in a given NIU. Conformance tests are a series of tests which would expose whether or not selected features within the ISO protocols are present and interoperable.

  14. Evaluating midwifery units (EMU): lessons from the pilot study.

    PubMed

    Monk, Amy R; Tracy, Sally K; Foureur, Maralyn; Tracy, Mark

    2013-08-01

    this paper describes the pilot study that was undertaken to test the feasibility of the recruitment plan designed to recruit women who booked to give birth in two freestanding midwifery units in NSW, Australia. The pilot preceded the full prospective cohort study, Evaluating Midwifery Units (EMU), which aimed to examine the antenatal, birth and postnatal outcomes of women planning to give birth in freestanding midwifery units compared to those booked to give birth in tertiary level maternity units in Australia and New Zealand. a prospective cohort study with two mutually-exclusive cohorts. two freestanding midwifery units in NSW and their corresponding tertiary referral hospitals. a total of 146 women with few identified risk factors recruited between 13 September 2009 and 31 March 2010 whose planned place of birth was either a freestanding midwifery unit or tertiary maternity unit. the pilot study identified the feasibility of relying on the booking midwife to recruit eligible women from several antenatal booking clinics to the study. Low rates of eligible women were invited resulting in a lower than expected consent rate. In addition, although mostly only low-risk women were invited to participate, some women requiring medical consultation at the time of booking were inadvertently recruited into the study. The results of this pilot study led us to revise the study protocol to find ways of including the outcomes of all women without identified risk factors who booked at either the freestanding midwifery units or the tertiary referral hospital in that area. This paper describes the revisions that were made to the study plan. five lessons were learned from the pilot study. We found that recruitment protocols employed for the cohort study were too complicated and required simplification to maximise the potential of the study. The study protocol needed to be changed for the main study to ensure a larger sample size and to ensure the risk profile of each cohort was as

  15. [Microbiological evaluation of drinking water used in feeding units].

    PubMed

    de Siqueira, Leonardo Pereira; Shinohara, Neide Kazue Sakugawa; de Lima, Rosália Maria Torres; de Paiva, José do Egito; de Lima Filho, José Luiz; de Carvalho, Irineide Teixeira

    2010-01-01

    The water for human consumption is the main vehicle for the transmission of pathogens that are capable of causing enteric parasitic diseases; therefore, its microbiological control is vital. This work had the purpose of evaluating the bacteriological quality of drinking water, in terms of the presence of total and thermotolerant coliforms, in different Feeding Units in the city of Recife, Pernambuco State, according to the potableness standards established by Ordinance No. 518 of 2004 of the Brazilian Ministry of Health/ANVISA. Forty water samples were collected in the Feeding Units located near the UFPE and UFRPE. The bacteriological tests for research on total and thermotolerant coliforms were carried out in accordance with the protocol of APHA (1995). Of the analyzed samples, 62.5% presented total coliforms and 42.5% thermotolerant coliforms. According to the results obtained, 62.5% of the samples are not in compliance with the law in force.

  16. [Radiation output evaluation of kilovoltage cone beam CT unit].

    PubMed

    Wang, Yunlai; Liao, Xiongfei; Ge, Ruigang

    2011-09-01

    To evaluate the radiation output and stability of linac-integrated kV cone beam CT unit. Air kermas in radiographic mode were measured with 0.6 cc ion chamber and Unidos electrometer for Synergy-integrated XVI kV cone beam CT unit. Air kermas vs image frames were measured in fluoroscopic mode. Output stability and depth doses were measured. The air kerma increased quadratically with the increased tube voltage, while increasing linearly with the tube current, exposure time, and number of frames. The radiation output stability and its change with the gantry angle were within +/-1%. The percentage depth dose increased with higher tube voltage. The radiation output of XVI is stable. The radiation outputs change considerably with the preset parameters. Parameters should be optimally chosen to reduce the patient dose.

  17. Communications Is from Mars, Admissions Is from Venus

    ERIC Educational Resources Information Center

    Scully, Maura King

    2010-01-01

    Marketing communications and admissions often have very different needs, priorities, and ways of conducting business, but the two units work toward the same end goal. Brad Ward of BlueFuego, a marketing company that specializes in social Web tools for educational institutions, explains that admissions doesn't necessarily need to [talk] to…

  18. 3 CFR - Refugee Admissions for Fiscal Year 2014

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 3 The President 1 2014-01-01 2014-01-01 false Refugee Admissions for Fiscal Year 2014 Presidential Documents Other Presidential Documents Presidential Determination No. 2014-1 of October 2, 2013 Refugee... admission of up to 70,000 refugees to the United States during fiscal year (FY) 2014 is justified...

  19. Communications Is from Mars, Admissions Is from Venus

    ERIC Educational Resources Information Center

    Scully, Maura King

    2010-01-01

    Marketing communications and admissions often have very different needs, priorities, and ways of conducting business, but the two units work toward the same end goal. Brad Ward of BlueFuego, a marketing company that specializes in social Web tools for educational institutions, explains that admissions doesn't necessarily need to [talk] to…

  20. Psychiatric Inpatient Admissions of Adults with Intellectual Disabilities: Predictive Factors

    ERIC Educational Resources Information Center

    Cowley, Amy; Newton, Jonathan; Sturmey, Peter; Bouras, Nick; Holt, Geraldine

    2005-01-01

    Information on admission to psychiatric inpatient units is lacking from the literature on contemporary services for people with intellectual disability and mental health needs. Here we report on predictors of admission for a cohort of 752 adults from this population living in community settings; 83 were admitted. We also report on two subsamples…

  1. Psychiatric Inpatient Admissions of Adults with Intellectual Disabilities: Predictive Factors

    ERIC Educational Resources Information Center

    Cowley, Amy; Newton, Jonathan; Sturmey, Peter; Bouras, Nick; Holt, Geraldine

    2005-01-01

    Information on admission to psychiatric inpatient units is lacking from the literature on contemporary services for people with intellectual disability and mental health needs. Here we report on predictors of admission for a cohort of 752 adults from this population living in community settings; 83 were admitted. We also report on two subsamples…

  2. The Admissions Equity Struggle

    ERIC Educational Resources Information Center

    Freedman, Eric

    2012-01-01

    It has been a long, litigious road from Heman Sweatt, an African-American mail carrier who wanted to attend the prestigious, all-White law school at the University of Texas at Austin in 1946, to Abigail Fisher, a White high school student who failed to win undergraduate admission to the same university a half-century later. Depending on what the…

  3. College Admissions: A Perspective.

    ERIC Educational Resources Information Center

    Perrone, Vito

    The author presents his view that the public has not been well informed about the limitations of college entrance examinations. Several educational trends are discussed: (1) since World War II, college admissions testing has underscored the classic American tension between egalitarianism and meritocracy; (2) more students have aspired to attend…

  4. Political Science Journals in Comparative Perspective: Evaluating Scholarly Journals in the United States, Canada, and the United Kingdom

    ERIC Educational Resources Information Center

    Garand, James C.; Giles, Micheal W.; Blais, Andre; McLean, Iain

    2009-01-01

    In this article we report the results from a new survey of political scientists regarding their evaluations of journals in the political science discipline. Unlike previous research that has focused on data from the United States, we conducted an Internet survey of political scientists in the United States, Canada, and the United Kingdom. We…

  5. Political Science Journals in Comparative Perspective: Evaluating Scholarly Journals in the United States, Canada, and the United Kingdom

    ERIC Educational Resources Information Center

    Garand, James C.; Giles, Micheal W.; Blais, Andre; McLean, Iain

    2009-01-01

    In this article we report the results from a new survey of political scientists regarding their evaluations of journals in the political science discipline. Unlike previous research that has focused on data from the United States, we conducted an Internet survey of political scientists in the United States, Canada, and the United Kingdom. We…

  6. Predictors of ICU Admission and Outcomes 1 Year Post-Admission in Persons with IBD: A Population-based Study

    PubMed Central

    Garland, Allan; Peschken, Christine A.; Hitchon, Carol A.; Chen, Hui; Fransoo, Randy; Marrie, Ruth Ann

    2015-01-01

    Background: To determine predictors of intensive care unit (ICU) admission and to assess health care utilization (HCU) post-ICU admission among persons with inflammatory bowel disease (IBD). Methods: We matched a population-based database of Manitobans with IBD to a general population cohort on age, sex, and region of residence and linked these cohorts to a population-based ICU database. We compared the incidence rates of ICU admission among prevalent IBD cases according to HCU in the year before admission using generalized linear models adjusting for age, sex, socioeconomic status, region, and comorbidity. Among incident cases of IBD who survived their first ICU admission, we compared HCU with matched controls who survived ICU admission. Results: Risk factors for ICU admission from the year before admission included cumulative corticosteroid use (incidence rate ratio, 1.006 per 100 mg of prednisone; 95% confidence interval, 1.004–1.008) and IBD-related surgery (incidence rate ratio, 2.79; 95% confidence interval, 1.99–3.92). Use of immunomodulatory therapies within 1 year, or surgery for IBD beyond 1 year prior, were not associated with ICU admission. In those who used corticosteroids and immunomodulatory medications in the year before ICU admission, the use of immunomodulatory medications conferred a 30% risk reduction in ICU admission (incidence rate ratio, 0.70; 95% confidence interval, 0.50–0.97). Persons with IBD who survived ICU admission had higher HCU in the year following ICU discharge than controls. Conclusions: Corticosteroid use and surgery within the year are associated with ICU admission in IBD while immunomodulatory therapy is not. Surviving ICU admission is associated with high HCU in the year post-ICU discharge. PMID:25989339

  7. Evaluation of a technology unit in a girls' primary school

    NASA Astrophysics Data System (ADS)

    Eke, Marion; Gardner, Paul L.

    1991-12-01

    Rapid advances in technology are changing the structure of the workforce. There are elite highly-paid hi-tech occupations and low status poorly-paid jobs. Women are unfortunately more likely to be found in the latter category. To allow them to qualify and compete for the higher-status positions, girls need to participate in the physical sciences and in technology studies. However, they are rarely attracted to them in secondary school, possibly because they are already alienated from them by the time they leave primary school. This paper reports some of the outcomes of a curriculum unit taught in two primary school classes in an independent school for girls. The unit was cross-curricular, involving technology, science and other fields of knowledge; it made extensive use of LEGO Technic materials. The evaluation of the unit, based on observations, a teacher journal and pupil questionnaires, focussed upon the issue of whether it assisted the girls to feel happier about working with unfamiliar technology and feel more capable of doing so. Implications for teaching technology are also discussed.

  8. Improving emergency department flow through Rapid Medical Evaluation unit

    PubMed Central

    Chartier, Lucas; Josephson, Timothy; Bates, Kathy; Kuipers, Meredith

    2015-01-01

    The Toronto Western Hospital is an academic hospital in Toronto, Canada, with an annual Emergency Department (ED) volume of 64,000 patients. Despite increases in patient volumes of almost six percent per annum over the last decade, there have been no commensurate increases in resources, infrastructure, and staffing. This has led to substantial increase in patient wait times, most specifically for those patients with lower acuity presentations. Despite requiring only minimal care, these patients contribute disproportionately to ED congestion, which can adversely impact resource utilization and quality of care for all patients. We undertook a retrospective evaluation of a quality improvement initiative aimed at improving wait times experienced by patients with lower acuity presentations. A rapid improvement event was organized by frontline workers to rapidly overhaul processes of care, leading to the creation of the Rapid Medical Evaluation (RME) unit – a new pathway of care for patients with lower acuity presentations. The RME unit was designed by re-purposing existing resources and re-assigning one physician and one nurse towards the specific care of these patients. We evaluated the performance of the RME unit through measurement of physician initial assessment (PIA) times and total length of stay (LOS) times for multiple groups of patients assigned to various ED care pathways, during three periods lasting three months each. Weekly measurements of mean and 90th percentile of PIA and LOS times showed special cause variation in all targeted patient groups. Of note, the patients seen in the RME unit saw their median PIA and LOS times decrease from 98min to 70min and from 165min to 130min, respectively, from baseline. Despite ever-growing numbers of patient visits, wait times for all patients with lower acuity presentations remained low, and wait times of patients with higher acuity presentations assigned to other ED care pathways were not adversely affected. By

  9. Improving emergency department flow through Rapid Medical Evaluation unit.

    PubMed

    Chartier, Lucas; Josephson, Timothy; Bates, Kathy; Kuipers, Meredith

    2015-01-01

    The Toronto Western Hospital is an academic hospital in Toronto, Canada, with an annual Emergency Department (ED) volume of 64,000 patients. Despite increases in patient volumes of almost six percent per annum over the last decade, there have been no commensurate increases in resources, infrastructure, and staffing. This has led to substantial increase in patient wait times, most specifically for those patients with lower acuity presentations. Despite requiring only minimal care, these patients contribute disproportionately to ED congestion, which can adversely impact resource utilization and quality of care for all patients. We undertook a retrospective evaluation of a quality improvement initiative aimed at improving wait times experienced by patients with lower acuity presentations. A rapid improvement event was organized by frontline workers to rapidly overhaul processes of care, leading to the creation of the Rapid Medical Evaluation (RME) unit - a new pathway of care for patients with lower acuity presentations. The RME unit was designed by re-purposing existing resources and re-assigning one physician and one nurse towards the specific care of these patients. We evaluated the performance of the RME unit through measurement of physician initial assessment (PIA) times and total length of stay (LOS) times for multiple groups of patients assigned to various ED care pathways, during three periods lasting three months each. Weekly measurements of mean and 90th percentile of PIA and LOS times showed special cause variation in all targeted patient groups. Of note, the patients seen in the RME unit saw their median PIA and LOS times decrease from 98min to 70min and from 165min to 130min, respectively, from baseline. Despite ever-growing numbers of patient visits, wait times for all patients with lower acuity presentations remained low, and wait times of patients with higher acuity presentations assigned to other ED care pathways were not adversely affected. By

  10. Evaluation of phase separator number in hydrodesulfurization (HDS) unit

    NASA Astrophysics Data System (ADS)

    Jayanti, A. D.; Indarto, A.

    2016-11-01

    The removal process of acid gases such as H2S in natural gas processing industry is required in order to meet sales gas specification. Hydrodesulfurization (HDS)is one of the processes in the refinery that is dedicated to reduce sulphur.InHDS unit, phase separator plays important role to remove H2S from hydrocarbons, operated at a certain pressure and temperature. Optimization of the number of separator performed on the system is then evaluated to understand the performance and economics. From the evaluation, it shows that all systems were able to meet the specifications of H2S in the desired product. However, one separator system resulted the highest capital and operational costs. The process of H2S removal with two separator systems showed the best performance in terms of both energy efficiency with the lowest capital and operating cost. The two separator system is then recommended as a reference in the HDS unit to process the removal of H2S from natural gas.

  11. Distribution of liver disease in a cohort of immigrants in Sicily: analysis of day-hospital admissions in a migration medicine unit.

    PubMed

    Affronti, Marco; Affronti, Andrea; Soresi, Maurizio; Giannitrapani, Lydia; Campagna, Elisa; Tramuto, Fabio; Brunori, Giuseppe; Montalto, Giuseppe

    2014-09-01

    The objective of this study was to evaluate the frequency of liver disease and its aetiology in a cohort of immigrants. We retrospectively examined the hospital discharge charts of all the immigrant patients presenting at our day hospital from July 2009 to June 2013, and after evaluating the anamnestic, clinical and laboratory data on these charts we identified subjects with liver disease and its various aetiologies. The total sample population consisted of 1218 patients, of whom 112 (9.2%) had a diagnosis of liver disease. More than two-thirds of the latter (67.8%) came from Africa, while 15.2% were from Asia and 17.0% from Eastern Europe. In most patients the disease was related to HBV (44.6%), followed by alcohol (25%) and then HCV or cryptogenic disease (both 15.2%). Forty-six patients had undergone liver biopsy, which showed eight cases of varying degrees of liver steatosis, 29 cases with a variable severity of chronic liver disease, eight cases with a definite picture of liver cirrhosis and one case of alcoholic hepatitis. These data show that a significant proportion of our immigrant population has liver disease and that the most frequent cause is hepatitis B infection.

  12. Early and Late Outcome of Premature Newborns with History of Neonatal Intensive Care Units Admission at 6 Years Old in Zanjan, Northwestern Iran.

    PubMed

    Sadeghzadeh, Mansour; Khoshnevisasl, Parisa; Parvaneh, Mehdi; Mousavinasab, Noreddin

    2016-01-01

    Premature birth is an important factor for mortality and morbidity of neonates. This study was designed to evaluate the outcome of preterm neonates who needed neonatal intensive care (NICU) hospitalization after 6 yr at their entrance to the school. This cross sectional study was conducted on premature neonates consecutively hospitalized in NICU of Valie Asr Hospital (the Academic Pediatric Hospital, Zanjan, Northwestern Iran) from September 2001 to September 2003. All children with a history of prematurity and NICU treatment were evaluated at their entrance to the school. Demographic findings, clinical examinations, IQ test, hearing and visual acuity exams were recorded. From 179 neonates, 78 (43.6%) survived and were discharged from hospital. Fifty-four of them were available and entered first grade in primary school. Only one case had severe mental retardation. One case had severe retinopathy of prematurity (ROP). Hearing abnormality was not detected in any case. There was no significant relation between IQ score, visual as well as hearing findings and gestational age. We did not find significant disability in the outcome of surviving infants. This could be explained by the high mortality rate of neonates during hospitalization.

  13. Adaptive Admissions Process for Effective and Fair Graduate Admission

    ERIC Educational Resources Information Center

    Zimmermann, Judith; von Davier, Alina; Heinimann, Hans Rudolf

    2017-01-01

    Purpose: Graduate admission has become a critical process for quality assurance in tertiary education. Hitherto, most research has investigated the validity of admissions instruments. However, surprisingly little work has been conducted on the overall organization of admission, which often remains "informal, ad hoc, and lacking in…

  14. [Involuntary admission of addict during early pregnancy].

    PubMed

    Hondius, Adger J K; Stikker, Tineke E; Wennink, J M B Hanneke; Honig, Adriaan

    2012-01-01

    A 30-year-old cocaine-dependent woman was 16 weeks pregnant. Because of possible endangerment of the fetus, an involuntary provisional admission was authorized. Of particular interest is the application of the Dutch Act on Formal Admissions to Psychiatric Hospitals for the primary diagnosis 'addiction' and the fact that the fetus was regarded as a legal 'other'. In severe cases of addiction combined with pregnancy an earlier intervention is needed and arrangement of accelerated legal custody of the newborn before birth should be considered. For the protection of the unborn, we advocate a stricter application of the United Nations Convention on the Rights of the Child. Information for addicted women with preconception counselling can help prevent a compulsory admission.

  15. Evaluation of the outcome of patients admitted to the pediatric intensive care unit in Alexandria using the pediatric risk of mortality (PRISM) score.

    PubMed

    El-Nawawy, Ahmed

    2003-04-01

    The aim of this prospective study was to evaluate the use of pediatric risk of mortality (PRISM) score to predict the patient outcome in Alexandria Pediatric Intensive Care Unit (PICU). The study included all admissions to a tertiary care teaching hospital for 13 months. All patients were subjected to thorough history taking and clinical examination. The PRISM score was obtained within 8 h from admission (including 14 parameters with 34 variables). The primary affected system, referral site, number of organ failure on admission, length of hospital stay (LOS) and outcome of patients were recorded. The bed occupancy rate, turnover rate, average LOS, total and adjusted death rates were also recorded. Results showed that the total and adjusted mortality rates were 50 and 38 per cent respectively (n = 205/406 and 125/326, respectively). The mean PRISM score on admission was 26. Non-survivors showed a significantly higher mean score compared with survivors (36 vs. 17). Non-survivors compared with survivors, were significantly younger (12 vs. 23 months), had shorter LOS (3.8 vs. 5.3 days), three or four organ system failure on admission (77 vs. 25 per cent, and 9 vs. 0 per cent of patients) and had significantly higher percentage of sepsis syndrome and neurological diseases, as the primary affected system (20 vs. 10 per cent and 26 vs. 16 per cent). The PRISM score showed a significant positive correlation only with the number of organ failure on admission (r = 0.8104; p < 0.001). The cut-off point of survival was a PRISM score 26 with expected/observed ratio of 1.05 for non-survivors with 91.6 per cent accuracy. Multiple logistic regression analysis revealed that PRISM score, LOS, and the primary affected system were relevant predictors of patient outcome in PICU. In conclusion, the PRISM score is proved to be a good predictor of outcome for children admitted to a PICU with a cut-off point of 26. The mortality in the PICU is affected by LOS, primary system affected, and

  16. Laboratory coagulation parameters in extremely premature infants born earlier than 27 gestational weeks upon admission to a neonatal intensive care unit.

    PubMed

    Neary, Elaine; Okafor, Ike; Al-Awaysheh, Faten; Kirkham, Colin; Sheehan, Katie; Mooney, Ciaran; Foran, Adrienne; Corcoran, J D; Ni Ainle, Fionnuala; Cotter, Melanie; McCallion, Naomi

    2013-01-01

    Few published data exist to guide interpretation of coagulation times in extremely premature infants. To determine coagulation reference ranges on day 1 of life in extremely premature infants. A retrospective review of day 1 coagulation tests was performed in 144 infants <27 weeks' gestation between 2004 and 2010 in a tertiary neonatal unit. Samples were drawn through a non-heparinized umbilical or peripheral venous catheter as part of routine clinical care. Mean (SD) and median (range) prothrombin times (PT) of 21.5 (5.3) and 20.2 (13.3-39) s, respectively, activated partial thromboplastin times (APTT) of 75.2 (27.8) and 67.4 (34.9-191.6) s, respectively, and plasma fibrinogen levels of 1.9 (1.1) and 1.4 (0.5-4.8) g/l, respectively, were reported. Using reference intervals derived from the 2.5th to 97.5th centiles, ranges of 14.4-36.7 s, 40.5-158.5 s and 0.7-4.8 g/l were determined for PT, APTT and plasma fibrinogen levels, respectively. In a subcohort with grade 0-2 intraventricular haemorrhage (n = 92), mean PT and APTT were 20.9 and 71.3 s, respectively, versus mean PT and APTT of 23.1 and 88.4 s (p = 0.06 and p = 0.03), respectively for those with grade 3-4 intraventricular haemorrhage. Mean PT and APTT in a cohort of infants defined to be small for gestational age were 22 and 76.8 s. These results did not differ significantly from non-small for gestational age infants, with a mean PT and APTT of 19.5 and 73.4 s (p = 0.09 and p = 0.7). Reference ranges based on retrospective data were determined for PT, APTT and fibrinogen in a large cohort of extremely preterm infants. © 2013 S. Karger AG, Basel.

  17. Admissions Criteria in Teacher Education.

    ERIC Educational Resources Information Center

    Schwanke, Dean

    1981-01-01

    A review of the literature on the topic of admissions criteria in teacher education is presented. Bibliographic annotations review surveys, studies, models, and guidelines on various aspects of admissions criteria, as well as attracting and retaining quality students. (JN)

  18. Admissions Criteria in Teacher Education.

    ERIC Educational Resources Information Center

    Schwanke, Dean

    1981-01-01

    A review of the literature on the topic of admissions criteria in teacher education is presented. Bibliographic annotations review surveys, studies, models, and guidelines on various aspects of admissions criteria, as well as attracting and retaining quality students. (JN)

  19. 8 CFR 101.1 - Presumption of lawful admission.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ..., 1924, provided that a record of his admission exists. (e) Chinese and Japanese aliens—(1) Prior to July... act; and a Chinese or Japanese alien admitted to the United States between July 1, 1924, and December...

  20. 8 CFR 101.1 - Presumption of lawful admission.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ..., 1924, provided that a record of his admission exists. (e) Chinese and Japanese aliens—(1) Prior to July... act; and a Chinese or Japanese alien admitted to the United States between July 1, 1924, and December...

  1. 8 CFR 101.1 - Presumption of lawful admission.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ..., 1924, provided that a record of his admission exists. (e) Chinese and Japanese aliens—(1) Prior to July... act; and a Chinese or Japanese alien admitted to the United States between July 1, 1924, and December...

  2. 8 CFR 101.1 - Presumption of lawful admission.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ..., 1924, provided that a record of his admission exists. (e) Chinese and Japanese aliens—(1) Prior to July... act; and a Chinese or Japanese alien admitted to the United States between July 1, 1924, and December...

  3. Minority Preference in Student Admissions

    ERIC Educational Resources Information Center

    Reidhaar, Donald L.

    1975-01-01

    Overviews current and recent preferential admissions cases other than DeFunis, particularly Bakke v. the Regents of the University of California, pointing up major issues in racial preferential admissions cases and concluding that universities and their professional schools, not the courts, must fashion and apply admissions policies responsive to…

  4. Joining the Conversation: Predictors of Success on the United States Medical Licensing Examinations (USMLE)

    ERIC Educational Resources Information Center

    Gohara, Sabry; Shapiro, Joseph I.; Jacob, Adam N.; Khuder, Sadik A.; Gandy, Robyn A.; Metting, Patricia J.; Gold, Jeffrey; Kleshinski, James; and James Kleshinski

    2011-01-01

    The purpose of this study was to evaluate whether models based on pre-admission testing, including performance on the Medical College Admission Test (MCAT), performance on required courses in the medical school curriculum, or a combination of both could accurately predict performance of medical students on the United States Medical Licensing…

  5. Reductions in hospital admissions and mortality rates observed after integrating emergency care: a natural experiment

    PubMed Central

    Ahmed, Vazeer; Palmer, Christopher R; Bennett, Tom J H; Robinson, Susan M

    2012-01-01

    Objectives Reducing emergency admissions is a priority for the NHS. A single hospital's emergency care system was reorganised with the principles of front-loaded investigations, integration of specialties, reduced duplication, earlier decision making by senior clinicians and a combined emergency assessment area. The authors relocated our Medical Assessment Unit into our emergency department in 2006. The authors evaluated changes in admissions and mortality before and after 2006, compared with other similar hospitals. Design Quasi-experimental before and after study using routinely collected data. Setting and participants 1 acute hospital in England, the intervention site, was compared with 23 other English hospitals between 2001 and 2009. Outcome measures Our outcome measures were hospital standardised mortality ratios (HSMRs) for non-elective admissions and standardised admission ratios (SARs). Results The authors observed a statistically and clinically significant decrease in HSMR and SAR. The intervention hospital had the lowest HSMR and SAR of all the hospitals in our sample. This was statistically significant, p=0.0149 and p=0.0002, respectively. Conclusion Integrating emergency care in one location is associated with a meaningful reduction in mortality and emergency admissions to hospital. PMID:22858459

  6. [Evaluation of the welcoming strategies in the Intensive Care Unit].

    PubMed

    Maestri, Eleine; do Nascimento, Eliane Regina Pereira; Bertoncello, Kátia Cilene Godinho; de Jesus Martins, Josiane

    2012-02-01

    This qualitative study was performed at the adult Intensive Care Unit (ICU) of a public hospital in Southern Brazil with the objective to evaluate the implemented welcoming strategies. Participants included 13 patients and 23 relatives. Data collection was performed from July to October 2008, utilizing semi-structured interviews. All interviews were recorded. Data analysis was performed using the Collective Subject Discourse. The collected information yielded two discourses: the family recognized the welcoming strategies and the patients found the ICU team to be considerate. By including the family as a client of nursing care, relatives felt safe and confident. Results show that by committing to the responsibility of making changes in heath care practices, nurses experience a novel outlook towards ICU care, focused on human beings and associating the welcoming to the health care model that promotes the objectivity of care.

  7. Multifaceted bench comparative evaluation of latest intensive care unit ventilators.

    PubMed

    Garnier, M; Quesnel, C; Fulgencio, J-P; Degrain, M; Carteaux, G; Bonnet, F; Similowski, T; Demoule, A

    2015-07-01

    Independent bench studies using specific ventilation scenarios allow testing of the performance of ventilators in conditions similar to clinical settings. The aims of this study were to determine the accuracy of the latest generation ventilators to deliver chosen parameters in various typical conditions and to provide clinicians with a comprehensive report on their performance. Thirteen modern intensive care unit ventilators were evaluated on the ASL5000 test lung with and without leakage for: (i) accuracy to deliver exact tidal volume (VT) and PEEP in assist-control ventilation (ACV); (ii) performance of trigger and pressurization in pressure support ventilation (PSV); and (iii) quality of non-invasive ventilation algorithms. In ACV, only six ventilators delivered an accurate VT and nine an accurate PEEP. Eleven devices failed to compensate VT and four the PEEP in leakage conditions. Inspiratory delays differed significantly among ventilators in invasive PSV (range 75-149 ms, P=0.03) and non-invasive PSV (range 78-165 ms, P<0.001). The percentage of the ideal curve (concomitantly evaluating the pressurization speed and the levels of pressure reached) also differed significantly (range 57-86% for invasive PSV, P=0.04; and 60-90% for non-invasive PSV, P<0.001). Non-invasive ventilation algorithms efficiently prevented the decrease in pressurization capacities and PEEP levels induced by leaks in, respectively, 10 and 12 out of the 13 ventilators. We observed real heterogeneity of performance amongst the latest generation of intensive care unit ventilators. Although non-invasive ventilation algorithms appear to maintain adequate pressurization efficiently in the case of leakage, basic functions, such as delivered VT in ACV and pressurization in PSV, are often less reliable than the values displayed by the device suggest. © The Author 2015. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions

  8. Cardiac arrhythmias in stroke unit patients. Evaluation of the cardiac monitoring data.

    PubMed

    Fernández-Menéndez, S; García-Santiago, R; Vega-Primo, A; González Nafría, N; Lara-Lezama, L B; Redondo-Robles, L; Montes-Montes, M; Riveira-Rodríguez, M C; Tejada-García, J

    2016-06-01

    Cardiac arrhythmias are frequent in acute stroke. Stroke units are widely equipped with cardiac monitoring systems. Pre-existing heart diseases and heart-brain interactions may be implicated in causing cardiac arrhythmias in acute stroke. This article analyses cardiac arrhythmias detected in patients hospitalised in a stroke unit. Prospective observational study of consecutive patients admitted to a stroke unit with cardiac monitoring. We collected clinical data from patients and the characteristics of their cardiac arrhythmias over a 1-year period (2013). Time of arrhythmia onset, associated predisposing factors, and the therapeutic decisions made after detection of arrhythmia were examined. All patients underwent continuous cardiac monitoring during no less than 48hours. Of a total of 332 patients admitted, significant cardiac arrhythmias occurred in 98 patients (29.5%) during their stay in the stroke unit. Tachyarrhythmia (ventricular tachyarrhythmias, supraventricular tachyarrhythmias, complex ventricular ectopy) was present in 90 patients (27.1%); bradyarrhythmia was present in 13 patients (3.91%). Arrhythmias were independently associated with larger size of brain lesion and older age. In 10% of the patient total, therapeutic actions were taken after detection of significant cardiac arrhythmias. Most events occurred within the first 48hours after stroke unit admission. Systematic cardiac monitoring in patients with acute stroke is useful for detecting clinically relevant cardiac arrhythmias. Incidence of arrhythmia is higher in the first 48hours after stroke unit admission. Age and lesion size were predicted appearance of arrhythmias. Detection of cardiac arrhythmias in a stroke unit has important implications for treatment. Copyright © 2014 Sociedad Española de Neurología. Published by Elsevier España, S.L.U. All rights reserved.

  9. Pre-admission NT-proBNP improves diagnostic yield and risk stratification – the NT-proBNP for EValuation of dyspnoeic patients in the Emergency Room and hospital (BNP4EVER) study

    PubMed Central

    Januzzi, James L; Medvedovski, Margarita; Sharist, Moshe; Shochat, Michael; Ashkar, Jalal; Peschansky, Pavel; Haim, Shmuel Bar; Blondheim, David S; Glikson, Michael; Shotan, Avraham

    2012-01-01

    Background: Amino-terminal pro-B-type natriuretic peptide (NT-proBNP) level is useful to diagnose or exclude acutely decompensated heart failure (ADHF) in dyspnoeic patients presenting to the emergency department (ED). Aim: To evaluate the impact of ED NT-proBNP testing on admission, length of stay (LOS), discharge diagnosis and long-term outcome. Methods: Dyspnoeic patients were randomized in the ED to NT-proBNP testing. Admission and discharge diagnoses, and outcomes were examined. Results: During 17 months, 470 patients were enrolled and followed for 2.0±1.3 years. ADHF likelihood, determined at study conclusion by validated criteria, established ADHF diagnosis as unlikely in 86 (17%), possible in 120 (24%), and likely in 293 (59%) patients. The respective admission rates in these subgroups were 80, 91, and 96%, regardless of blinding, and 61.9% of blinded vs. 74.5% of unblinded ADHF-likely patients were correctly diagnosed at discharge (p=0.029), with similar LOS. 2-year mortality within subgroups was unaffected by test, but was lower in ADHF-likely patients with NT-proBNP levels below median (5000 pg/ml) compared with those above median (p=0.002). Incidence of recurrent cardiac events tracked NT-proBNP levels. Conclusion: ED NT-proBNP testing did not affect admission, LOS, 2-year survival, or recurrent cardiac events among study patients but improved diagnosis at discharge, and allowed risk stratification even within the ADHF-likely group. (ClinicalTrials.gov#NCT00271128) PMID:24062895

  10. Two-electron integral evaluation on the graphics processor unit.

    PubMed

    Yasuda, Koji

    2008-02-01

    We propose the algorithm to evaluate the Coulomb potential in the ab initio density functional calculation on the graphics processor unit (GPU). The numerical accuracy required for the algorithm is investigated in detail. It is shown that GPU, which supports only the single-precision floating number natively, can take part in the major computational tasks. Because of the limited size of the working memory, the Gauss-Rys quadrature to evaluate the electron repulsion integrals (ERIs) is investigated in detail. The error analysis of the quadrature is performed. New interpolation formula of the roots and weights is presented, which is suitable for the processor of the single-instruction multiple-data type. It is proposed to calculate only small ERIs on GPU. ERIs can be classified efficiently with the upper-bound formula. The algorithm is implemented on NVIDIA GeForce 8800 GTX and the Gaussian 03 program suite. It is applied to the test molecules Taxol and Valinomycin. The total energies calculated are essentially the same as the reference ones. The preliminary results show the considerable speedup over the commodity microprocessor.

  11. Laboratory Performance Evaluation Report of SEL 421 Phasor Measurement Unit

    SciTech Connect

    Huang, Zhenyu; faris, Anthony J.; Martin, Kenneth E.; Hauer, John F.; Bonebrake, Christopher A.; Shaw, James M.

    2007-12-01

    PNNL and BPA have been in close collaboration on laboratory performance evaluation of phasor measurement units for over ten years. A series of evaluation tests are designed to confirm accuracy and determine measurement performance under a variety of conditions that may be encountered in actual use. Ultimately the testing conducted should provide parameters that can be used to adjust all measurements to a standardized basis. These tests are performed with a standard relay test set using recorded files of precisely generated test signals. The test set provides test signals at a level and in a format suitable for input to a PMU that accurately reproduces the signals in both signal amplitude and timing. Test set outputs are checked to confirm the accuracy of the output signal. The recorded signals include both current and voltage waveforms and a digital timing track used to relate the PMU measured value with the test signal. Test signals include steady-state waveforms to test amplitude, phase, and frequency accuracy, modulated signals to determine measurement and rejection bands, and step tests to determine timing and response accuracy. Additional tests are included as necessary to fully describe the PMU operation. Testing is done with a BPA phasor data concentrator (PDC) which provides communication support and monitors data input for dropouts and data errors.

  12. On Analyzing HBCU Admissions and Recruitment Material.

    ERIC Educational Resources Information Center

    Harper, Shaun R.

    2001-01-01

    Examines admissions and recruitment material mailed to prospective students from thirteen historically Black institutions. The material was analyzed and evaluated on the basis of timeliness and completeness. Results reveal variations in quality among public and privately supported institutions. Significance of these results and specific…

  13. The Utility of Routine Intensive Care Admission for Patients Undergoing Intracranial Neurosurgical Procedures: A Systematic Review.

    PubMed

    de Almeida, Cesar Cimonari; Boone, M Dustin; Laviv, Yosef; Kasper, Burkhard S; Chen, Clark C; Kasper, Ekkehard M

    2017-08-14

    Patients who have undergone intracranial neurosurgical procedures have traditionally been admitted to an intensive care unit (ICU) for close postoperative neurological observation. The purpose of this study was to systematically review the evidence for routine ICU admission in patients undergoing intracranial neurosurgical procedures and to evaluate the safety of alternative postoperative pathways. We were interested in identifying studies that examined selected patients who presented for elective, non-emergent intracranial surgery whose postoperative outcomes were compared as a function of ICU versus non-ICU admission. A systematic review was performed in July 2016 using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist of the Medline database. The search strategy was created based on the following key words: "craniotomy," "neurosurgical procedure," and "intensive care unit." The nine articles that satisfied the inclusion criteria yielded a total of 2227 patients. Of these patients, 879 were observed in a non-ICU setting. The most frequent diagnoses were supratentorial brain tumors, followed by patients with cerebrovascular diseases and infratentorial brain tumors. Three percent (30/879) of the patients originally assigned to floor or intermediate care status were transferred to the ICU. The most frequently observed neurological complications leading to ICU transfer were delayed postoperative neurological recovery, seizures, worsening of neurological deficits, hemiparesis, and cranial nerves deficits. Our systematic review demonstrates that routine postoperative ICU admission may not benefit carefully selected patients who have undergone elective intracranial neurosurgical procedures. In addition, limiting routine ICU admission may result in significant cost savings.

  14. Patient and staff satisfaction with 'day of admission' elective surgery.

    PubMed

    Sofela, Agbolahan A; Laban, James T; Selway, Richard P

    2013-04-01

    To evaluate patient and staff satisfaction with day of admission surgery in a neurosurgical unit and its effect on theatre start times. Patients were admitted to a Neurosciences admission lounge (NAL) for neurosurgery on the morning of their operation if deemed appropriate by their neurosurgical consultant. All patients in the NAL were asked to complete patient satisfaction questionnaires. Staff members involved in the care of these patients also completed a satisfaction questionnaire. Theatre start times were compared with those whose patients had been admitted prior to the day of surgery. 378 patients admitted on the day of surgery, 16 doctors (5 anaesthetists, 7 neurosurgeons and 4 neuro high dependency unit, HDU doctors) and 5 nurses. Patients completed an anonymised emotional mapping patient satisfaction questionnaire, and short interviews were carried out with staff members. Theatre start times were obtained retrospectively from the theatre database for lists starting with patients admitted on the day of surgery, and lists starting with patients admitted prior to the day of surgery. 83% of patients felt positive on arrival in the NAL and 88% felt positive on being seen by the doctors and nurses prior to surgery. Overall 79% of patients gave positive responses throughout their patient pathway. 90% of staff were positive about day of admission surgery and all staff members were satisfied that there were no negative effects on surgical outcome. Theatre start time was on average 27 minutes earlier in patients admitted on the day of surgery. Neurosurgical patients, appropriately selected, can be admitted on the day of surgery with high staff and patient satisfaction and without delaying theatre start times.

  15. [Evaluation of the status of patients with severe infection, criteria for intensive care unit admittance. Spanish Society for Infectious Diseases and Clinical Microbiology. Spanish Society of Intensive and Critical Medicine and Coronary Units].

    PubMed

    Olaechea, Pedro M; Alvarez-Lerma, Francisco; Sánchez, Miguel; Torres, Antonio; Palomar, Mercedes; Fernández, Pedro; Miró, José M; Cisneros, José Miguel; Torres, Manuel

    2009-06-01

    Recent studies have shown that early attention in patients with serious infections is associated with a better outcome. Assistance in intensive care units (ICU) can effectively provide this attention; hence patients should be admitted to the ICU as soon as possible, before clinical deterioration becomes irreversible. The objective of this article is to compile the recommendations for evaluating disease severity in patients with infections and describe the criteria for ICU admission, updating the criteria published 10 years ago. A literature review was carried out, compiling the opinions of experts from the Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (SEIMC, Spanish Society for Infectious Diseases and Clinical Microbiology) and the Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC, Spanish Society for Intensive Medicine, Critical Care and Coronary Units) as well as the working groups for infections in critically ill patients (GEIPC-SEIMC and GTEI-SEMICYUC). We describe the specific recommendations for ICU admission related to the most common infections affecting patients, who will potentially benefit from critical care. Assessment of the severity of the patient's condition to enable early intensive care is stressed.

  16. Primary and Secondary Selection Tools in an Optometry Admission Process.

    ERIC Educational Resources Information Center

    Spafford, Marlee M.

    2000-01-01

    A five-year evaluation of the admissions decision process at the University of Waterloo (Ontario) School of Optometry found that when primary tools (i.e., university grades, Optometry Admission Test scores) did not differentiate candidates, there was an increased emphasis on secondary tools (i.e., interview, autobiographic sketch, prerequisite…

  17. The Changing Nature of Teaching and Unit Evaluations in Australian Universities

    ERIC Educational Resources Information Center

    Shah, Mahsood; Nair, Chenicheri Sid

    2012-01-01

    Purpose: Teaching and unit evaluations surveys are used to assess the quality of teaching and the quality of the unit of study. An analysis of teaching and unit evaluation survey practices in Australian universities suggests significant changes. One key change discussed in the paper is the shift from voluntary to mandatory use of surveys with the…

  18. Evaluation of the Contract Management Process in the United Nations for Acquiring Peacekeeping Operations/Services

    DTIC Science & Technology

    2007-06-01

    NAVAL POSTGRADUATE SCHOOL MONTEREY, CALIFORNIA MBA PROFESSIONAL REPORT Evaluation of the Contract Management Process in the United...blank) 2. REPORT DATE June 2007 3. REPORT TYPE AND DATES COVERED MBA Professional Report 4. TITLE AND SUBTITLE Evaluation of the Contract...of Peacekeeping Operations UNTSO United Nations Truce Supervision Organization UNDP United Nations Development Programme USG Under-Secretary

  19. The Changing Nature of Teaching and Unit Evaluations in Australian Universities

    ERIC Educational Resources Information Center

    Shah, Mahsood; Nair, Chenicheri Sid

    2012-01-01

    Purpose: Teaching and unit evaluations surveys are used to assess the quality of teaching and the quality of the unit of study. An analysis of teaching and unit evaluation survey practices in Australian universities suggests significant changes. One key change discussed in the paper is the shift from voluntary to mandatory use of surveys with the…

  20. The Structured Interview and Interviewer Training in the Admissions Process

    PubMed Central

    Cox, Wendy C.; White-Harris, Carla; Blalock, Susan J.

    2007-01-01

    Objectives To determine the extent to which the structured interview is used in the PharmD admissions process in US colleges and schools of pharmacy, and the prevalence and content of interviewer training. Methods A survey instrument consisting of 7 questions regarding interviews and interviewer training was sent to 92 colleges and schools of pharmacy in the United States that were accredited or seeking accreditation. Results Sixty survey instruments (65% response rate) were returned. The majority of the schools that responded (80%) used interviews as part of the PharmD admissions process. Of the schools that used an interview as part of the admissions process, 86% provided some type of interviewer training and 13% used a set of predefined questions in admissions interviews. Conclusions Most colleges and schools of pharmacy use some components of the structured interview in the PharmD admissions process; however, training for interviewers varies widely among colleges and schools of pharmacy. PMID:17998980

  1. The structured interview and interviewer training in the admissions process.

    PubMed

    Joyner, Pamela U; Cox, Wendy C; White-Harris, Carla; Blalock, Susan J

    2007-10-15

    To determine the extent to which the structured interview is used in the PharmD admissions process in US colleges and schools of pharmacy, and the prevalence and content of interviewer training. A survey instrument consisting of 7 questions regarding interviews and interviewer training was sent to 92 colleges and schools of pharmacy in the United States that were accredited or seeking accreditation. Sixty survey instruments (65% response rate) were returned. The majority of the schools that responded (80%) used interviews as part of the PharmD admissions process. Of the schools that used an interview as part of the admissions process, 86% provided some type of interviewer training and 13% used a set of predefined questions in admissions interviews. Most colleges and schools of pharmacy use some components of the structured interview in the PharmD admissions process; however, training for interviewers varies widely among colleges and schools of pharmacy.

  2. Use of an Early Labor Lounge to Promote Admission in Active Labor.

    PubMed

    Paul, Julie A; Yount, Susan M; Breman, Rachel Blankstein; LeClair, Melissa; Keiran, Diane M; Landry, Nannette; Dever, Kimberly

    2017-03-01

    Professional maternity care organizations within the United States are aligned in the goal to prevent the first cesarean birth in nulliparous women with a term, singleton, vertex fetus. Currently, one in 3 women are at risk for having a cesarean birth. The most common reason for cesarean in the United States is labor dystocia. The evidence supports delaying admission to the birthing unit until active labor is established, thereby minimizing the inadvertent diagnosis of labor dystocia. Providers are familiar with the rationale supporting delayed admission to the birthing unit until active labor is established; however, there is very little evidence on how to effectively promote this delay. Provider apprehension and the lack of early labor support are challenges to sending women home to await the onset of active labor. Maternal anxiety, fear, pain, and unpreparedness also play a part in this reluctance. To address these obstacles, South Shore Hospital created an early labor lounge with stations aimed at instilling confidence in the birth team, promoting teamwork, facilitating relaxation, and reducing anxiety for laboring women. A literature review focusing on women's perceptions of promoting admission in active labor, maternal anxiety, and nonpharmacologic strategies for managing early labor are discussed within the context of the creation, implementation, and evaluation of an early labor lounge. © 2017 by the American College of Nurse-Midwives.

  3. Reorganisation of acute referral to an emergency department resulted in fewer admissions for chronic obstructive pulmonary disease but in higher rates of non-invasive ventilation.

    PubMed

    Titlestad, Ingrid Louise; Bryde, Jonas; Øberg-Hansen, Bo; Lassen, Annmarie Touborg; Vestbo, Jørgen

    2014-11-01

    We performed an audit on all admissions with chronic obstructive pulmonary disease (COPD) in ex-acerbation to the Department of Emergency Medicine, Odense University Hospital (DEM) in the second half of 2012 to evaluate if an organisational change had altered visitation, treatment, initiation of non-invasive ventilation (NIV) and monitoring. We chose not to include the entire year to avoid data influenced by organisational start-up difficulties. The hypothesis was that NIV was initiated according to guidelines to the same extent as prior to the implementation of DEM. Data from medical records were retrieved from two COPD cohorts: 1) all patients admitted to DEM between 1 July and 31 December 2012 and 2) all patients admitted to the Medical Emergency Ward, Odense University Hospital (MEW) in 2010. There were 300 eligible admissions comprising 236 unique patients in DEM in the second half of 2012 compared with 393 admissions in MEW in the second half of 2010, a 24% reduction. The groups were similar in gender and age, but patients admitted in 2012 had higher registered co-morbidity rates, but no significant difference in lung function values. NIV was indicated in 91 admissions (30%) and initiated in 58 admissions (19.3%) in 2012. By comparison NIV was indicated in 193 admissions (24%) and initiated in 151 admissions (18.8%) in 2010. There was a statistically significant increase in NIV indication without initiation of treatment in 2012 (28 admissions; 9.3%) compared with 2010 (36 admissions; 4.5%), but no referrals to the intensive care unit or deaths were registered during the hospitalisation in either of the groups, but one patient died within 30 days after admission from the DEM. This project was funded by an Odense University Hospital research grant. The study was approved by the Danish Data Protection Agency (record no. 2011-41-6459).

  4. Evaluating use of telemedicine within a minor injury unit.

    PubMed

    Paynter, Mike

    This article outlines a pilot study using telemedicine to assess chest pain in a minor injury unit. It discusses how the pilot was set up and the benefits of telemedicine for both patients and staff. Bridgwater Community Hospital has recently won an award from the Community Hospitals Association for its use of cardiology telemedicine in its unit.

  5. Evaluation of forensic cases admitted to pediatric intensive care unit

    PubMed Central

    Duramaz, Burcu Bursal; Yıldırım, Hamdi Murat; Kıhtır, Hasan Serdar; Yeşilbaş, Osman; Şevketoğlu, Esra

    2015-01-01

    Aim: This study aimed to determine the epidemiological and clinical characteristics of pediatric forensic cases to contribute to the literature and to preventive health care services. Material and Methods: Pediatric forensic cases hospitalized in our pediatric intensive care unit below the age of 17 years were reviewed retrospectively (January 2009–June 2014) . The patients were evaluated in two groups as physical traumas (Group A) and poisonings (Group B). The patients’ age, gender, complaints at presentation, time of presentation and referral (season, time) and, mortality rates were determined. Cases of physical trauma (Group A) were classified as traffic accidents, falling down from height, falling of device, drowning, electric shock, burns and child abuse. Poisonings (Group B) were classified as pharmaceuticals, pesticides, other chemicals and unknown drug poisonings. Results: Two hundred twenthy cases were included. The mean age was 5.1+3.1 years. One hundred fifteen (%52.5) of the cases were male and 105 (%47.5) were female. Group A consisted of 62 patients and Group B consisted of 158 patients. The patients presented most frequently in summer months. The most common reason for presentation was falling down from height (12.7%) in Group A and accidental drug poisoning (most frequently antidepressants) in Group B. The mortality rate was 5%. Conclusion: Forensic cases in the pediatric population (physical trauma and poisoning) are preventable health problems. Especially, preventive approach to improve the environment for falling down from height must be a priority. Increasing the awareness of families and the community on this issue, in summer months during which forensic cases are observed most frequently can contribute to a reduction in the number of cases. PMID:26568689

  6. Quality assurance and dosimetric evaluation for an endocavitary unit.

    PubMed

    Klein, E E; Purdy, J A

    1994-01-01

    The use of endocavitary contact therapy for selected rectal carcinomas continues to be an effective treatment option. Very small volumes are treated with an extremely high dose rate associated with rapid fall-off in depth and an overall high dose. The clinical benefits of the high dose rate leads to dosimetric and quality-assurance challenges. In addition, the operating room environment creates concerns in terms of dosimetry and radiation safety due to varying room line voltages and uncontrolled environments. The unit at our facility delivers 50 kVp X-rays using an SSD of 35 mm with lead-lined procotscopes of 24 and 29 mm. The dose rate is approximately 10 Gy per minute. Establishment of daily, monthly, and annual quality assurance reviews have been made and assessed. Parallel-plate ionization chambers measure outputs and relative depth dose with different phantoms. Silver bromide film is used to evaluate beam profiles. An electron diode system was chosen for day-of-treatment output checks. An ion chamber survey meter measures scatter and leakage exposure rates. Day-of-treatment output checks have assured output stability in various operating rooms. Trends in output have been confirmed by monthly ion chamber checks. Percent depth dose measurements carried out in liquid water compared well with accepted published data as did corrected polystyrene measurements. Radiation survey measurements detected acceptable exposure rate levels. The established comprehensive quality assurance program incorporates cross checking with multiple dosimetry systems. The confidence level of dose delivery has increased with the introduction of a day-of-treatment output checks.(ABSTRACT TRUNCATED AT 250 WORDS)

  7. Transfer from primary maternity unit to tertiary hospital in New Zealand - timing, frequency, reasons, urgency and outcomes: Part of the Evaluating Maternity Units study.

    PubMed

    Grigg, Celia P; Tracy, Sally K; Tracy, Mark; Schmied, Virginia; Monk, Amy

    2015-09-01

    to examine the transfers from primary maternity units to a tertiary hospital in New Zealand by describing the frequency, timing, reasons and outcomes of those who had antenatal or pre-admission birthplace plan changes, and transfers in labour or postnatally. mixed methods prospective (concurrent) cohort study, which analysed transfer and clinical outcome data (407 primary unit cohort, 285 tertiary hospital cohort), and data from the six week postpartum survey (571 respondents). well, pregnant women booked to give birth in a tertiary maternity hospital or primary maternity unit in one region in New Zealand (2010-2012). All women received midwifery continuity of care, regardless of their intended or actual birthplace. fewer than half of the women who planned a primary unit birth gave birth there (191 or 46.9%). A change of plan may have been made either antenatally or before admission in labour; and transfers were made after admission to the primary unit in labour or during the postnatal stay (about 48 hours). Of the 117 (28.5%) planning a primary unit birth who changed their planned birthplace type antenatally 73 (62.4%) were due to a clinical indication. Earthquakes accounted for 28.1% of birthplace change (during the research period major earthquakes occurred in the study region). Most (73.8%) labour changes occurred before admission in labour to the primary unit. For the 76 women who changed plan at this stage the most common reasons to do so were a rapid labour (25.0%) or prolonged rupture of membranes (23.7%). Transfers in labour from primary unit to tertiary hospital occurred for 27 women (12.6%) of whom 26 (96.3%) were having their first baby. "Slow progress" of labour accounted for 21 (77.8%) of these and 17 (62.9%) were classified as 'non-emergency'. The average transfer time for 'emergency' transfers was 58 minutes. The average time for all labour transfers from specialist consultation to birth was 4.5 hours. Nine postnatal transfers (maternal or neonatal

  8. The Changing College Admissions Scene.

    ERIC Educational Resources Information Center

    Sjogren, Cliff

    1983-01-01

    Discusses the status of college admissions and some of the forces that influenced college admissions policies during each of four three-year periods: the Sputnik Era (1957-60), the Postwar Baby Boom Era (1964-67), the "New Groups" Era (1971-74), and the Stable Enrollment Era (1978-81). (PGD)

  9. Optimal Admission to Higher Education

    ERIC Educational Resources Information Center

    Albaek, Karsten

    2017-01-01

    This paper analyses admission decisions when students from different high school tracks apply for admission to university programmes. I derive a criterion that is optimal in the sense that it maximizes the graduation rates of the university programmes. The paper contains an empirical analysis that documents the relevance of theory and illustrates…

  10. The Changing College Admissions Scene.

    ERIC Educational Resources Information Center

    Sjogren, Cliff

    1983-01-01

    Discusses the status of college admissions and some of the forces that influenced college admissions policies during each of four three-year periods: the Sputnik Era (1957-60), the Postwar Baby Boom Era (1964-67), the "New Groups" Era (1971-74), and the Stable Enrollment Era (1978-81). (PGD)

  11. Drug related admissions to medical wards

    PubMed Central

    Hallas, Jesper; Gram, Lars F.; Grodum, Ellen; Damsbo, Niels; Brøsen, Kim; Haghfelt, Torben; Harvald, Bent; Beck-Nielsen, Jørgen; Worm, Jørgen; Birger Jensen, Kurt; Davidsen, Otto; Frandsen, Niels E.; Hagen, Claus; Andersen, Morten; Frølund, Flemming; Kromann-Andersen, Hans; Schou, Jens

    1992-01-01

    1 In total 1999 consecutive admissions to six medical wards were subjected to a prospective high-intensity drug event monitoring scheme to assess the extent and pattern of admissions caused by adverse drug reactions (ADRs) or dose related therapeutic failures (TF), in a population-based design. The wards were sub-specialised in general medicine, geriatrics, endocrinology, cardiology, respiratory medicine and gastroenterology. 2 Considering definite, probable and possible drug events, the prevalence of drug related hospital admissions was 11.4% of which 8.4% were caused by ADRs and 3.0% by TFs. There were large inter-department differences. 3 The six classes of drugs most frequently involved in admissions caused by ADRs were anti-rheumatics and analgesics (27%), cardiovascular drugs (23%), psychotropic drugs (14%), anti-diabetics (12%), antibiotics (7%), and corticosteroids (5%). Non-compliance accounted for 66% of the TFs with diuretics and anti-asthmatics most frequently involved. 4 The pattern of drugs involved in ADRs was compared with the regional drug sales statistics. Drugs with a particularly high rate of ADR related admissions per unit dispensed were nitrofurantoin and insulin (617 and 182 admissions per 1,000,000 defined daily doses), while low rates were seen for diuretics and benzodiazepines (10 and 7 admissions per 1,000,000 defined daily doses). Confidence intervals were wide. 5 Patients who had their therapy prescribed by a hospital doctor had a slightly higher prevalence of drug events than those who were treated by a general practitioner (12.6% vs 11.8%). The reverse applied for drug events assessed as avoidable (3.3% vs 4.6%). Although these differences were not statistically significant, it may suggest general practitioners as the appropriate target for interventive measures. 6 Only one ADR was reported to The Danish Committee on Adverse Drug Reactions, indicating a severe under-reporting and a potential for gross selectivity. The data collection

  12. Economic Evaluation of a General Hospital Unit for Older People with Delirium and Dementia (TEAM Randomised Controlled Trial)

    PubMed Central

    Tanajewski, Lukasz; Franklin, Matthew; Gkountouras, Georgios; Berdunov, Vladislav; Harwood, Rowan H.; Goldberg, Sarah E.; Bradshaw, Lucy E.; Gladman, John R. F.; Elliott, Rachel A.

    2015-01-01

    Background One in three hospital acute medical admissions is of an older person with cognitive impairment. Their outcomes are poor and the quality of their care in hospital has been criticised. A specialist unit to care for older people with delirium and dementia (the Medical and Mental Health Unit, MMHU) was developed and then tested in a randomised controlled trial where it delivered significantly higher quality of, and satisfaction with, care, but no significant benefits in terms of health status outcomes at three months. Objective To examine the cost-effectiveness of the MMHU for older people with delirium and dementia in general hospitals, compared with standard care. Methods Six hundred participants aged over 65 admitted for acute medical care, identified on admission as cognitively impaired, were randomised to the MMHU or to standard care on acute geriatric or general medical wards. Cost per quality adjusted life year (QALY) gained, at 3-month follow-up, was assessed in trial-based economic evaluation (599/600 participants, intervention: 309). Multiple imputation and complete-case sample analyses were employed to deal with missing QALY data (55%). Results The total adjusted health and social care costs, including direct costs of the intervention, at 3 months was £7714 and £7862 for MMHU and standard care groups, respectively (difference -£149 (95% confidence interval [CI]: -298, 4)). The difference in QALYs gained was 0.001 (95% CI: -0.006, 0.008). The probability that the intervention was dominant was 58%, and the probability that it was cost-saving with QALY loss was 39%. At £20,000/QALY threshold, the probability of cost-effectiveness was 94%, falling to 59% when cost-saving QALY loss cases were excluded. Conclusions The MMHU was strongly cost-effective using usual criteria, although considerably less so when the less acceptable situation with QALY loss and cost savings were excluded. Nevertheless, this model of care is worthy of further evaluation

  13. Using Lean Management to Reduce Emergency Department Length of Stay for Medicine Admissions.

    PubMed

    Allaudeen, Nazima; Vashi, Anita; Breckenridge, Julia S; Haji-Sheikhi, Farnoosh; Wagner, Sarah; Posley, Keith A; Asch, Steven M

    The practice of boarding admitted patients in the emergency department (ED) carries negative operational, clinical, and patient satisfaction consequences. Lean tools have been used to improve ED workflow. Interventions focused on reducing ED length of stay (LOS) for admitted patients are less explored. To evaluate a Lean-based initiative to reduce ED LOS for medicine admissions. Prospective quality improvement initiative performed at a single university-affiliated Department of Veterans Affairs (VA) medical center from February 2013 to February 2016. We performed a Lean-based multidisciplinary initiative beginning with a rapid process improvement workshop to evaluate current processes, identify root causes of delays, and develop countermeasures. Frontline staff developed standard work for each phase of the ED stay. Units developed a daily management system to reinforce, evaluate, and refine standard work. The primary outcome was the change in ED LOS for medicine admissions pre- and postintervention. ED LOS at the intervention site was compared with other similar VA facilities as controls over the same time period using a difference-in-differences approach. ED LOS for medicine admissions reduced 26.4%, from 8.7 to 6.4 hours. Difference-in-differences analysis showed that ED LOS for combined medicine and surgical admissions decreased from 6.7 to 6.0 hours (-0.7 hours, P = .003) at the intervention site compared with no change (5.6 hours, P = .2) at the control sites. We utilized Lean management to significantly reduce ED LOS for medicine admissions. Specifically, the development and management of standard work were key to sustaining these results.

  14. Evaluation and modification of CFB units at Slough Trading Estate

    SciTech Connect

    Vincent, R.Q.; Ballantyne, J.G.

    1997-12-31

    Slough Heat and Power (SHP), located just west of London, operates two circulating fluidized bed (CFB) combustion boilers (identified as FB1 and FB2) which assist in providing both power and steam to some 450 tenants located on the Slough Trading Estate. CFB technology was selected principally for (1) its fuel flexibility, (2) its ability to comply with government requirements on emissions and (3) its ability to fit the desired capacity units (with their relatively small footprint) into the limited space at the existing plant site. Construction of these units, each sized at 207,000 lb/hr at 1,260 psia and 948 F, began in 1989 with operation beginning in the latter part of 1991. Contract boiler acceptance tests were successfully passed in 1992. The units were originally intended to be operated on coal with gas and oil as back up fuels, depending on the economics. Government initiatives, designed to stimulate the development of non-fossil fueled power generation in the UK, catalyzed the owner`s interest in alternate fuels after the plant was built. Subsequently, the units have been co-fired with a blend of coal and densified refuse derived fuel (RDF) at up to a 50/50 heat input ratio. Early operation of these units was plagued by mechanical problems which affected the reliability and performance of the units. An independent assessment was made of the CFB units by FBT engineering Services to identify causes of operating, performance, and design shortcomings and to identify modifications that could be made to improve these areas. These problems have been associated with such areas of refractory, erosion, tubes and supports, clinkering and fouling, air distribution, and generally unstable unit performance. Because of the problems, the units have been operating only intermittently since commissioning. Based on the assessment of these problems, recommendations were made and design/operating changes implemented to correct these concerns and improve unit performance

  15. Prevalence and Impact of Admission Acute Traumatic Coagulopathy on Treatment Intensity, Resource Use, and Mortality: An Evaluation of 956 Severely Injured Children and Adolescents.

    PubMed

    Liras, Ioannis N; Caplan, Henry W; Stensballe, Jakob; Wade, Charles E; Cox, Charles S; Cotton, Bryan A

    2017-04-01

    Acute coagulopathy of trauma in children is of potential importance to clinical outcomes, but knowledge is limited and has only been investigated using conventional coagulation testing. The purpose of this study was to assess the prevalence and impact of arrival coagulopathy, determined by viscoelastic hemostatic testing, in severely injured children. Pediatric patients (younger than 17 years of age) who were admitted January 2010 to May 2016 and met highest-level trauma activation were included. Patients were divided into 2 groups (coagulopathy and controls) based on arrival rapid thrombelastography values. Coagulopathy was defined as the presence of any of the following on rapid thrombelastography: activated clotting time ≥128 seconds, α-angle ≤65 degrees, maximum amplitude ≤55 mm, and lysis at 30 minutes from 20-mm amplitude ≥3%. Logistic regression was used to adjust for age, sex, blood pressure, mechanism, and injury severity. Nine hundred and fifty-six patients met inclusion; 507 (57%) were coagulopathic and 449 (43%) were not (noncoagulopathic and control cohort). Coagulopathic patients were younger (median 14 vs 15 years) and more likely to be male (68% vs 60%) and Hispanic (38% vs 31%) (all p < 0.05). Coagulopathic patients received more RBC and plasma transfusions and had fewer ICU and ventilator-free days and higher mortality (12% vs 3%; all p < 0.05). Of these 956, 197 (21%) sustained severe brain injury-123 (62%) were coagulopathic and 74 (38%) were noncoagulopathic. The mortality difference was even greater for coagulopathic head injuries (31% vs 10%; p = 0.002). Adjusting for confounders, admission coagulopathy was an independent predictor of death, with an odds ratio of 3.67 (95% CI 1.768 to 7.632; p < 0.001). Almost 60% of severely injured children and adolescents arrive with evidence of acute traumatic coagulopathy. The presence of admission coagulopathy is associated with high mortality in children, especially among those with head

  16. 48 CFR 252.225-7032 - Waiver of United Kingdom Levies-Evaluation of offers.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 48 Federal Acquisition Regulations System 3 2010-10-01 2010-10-01 false Waiver of United Kingdom... AND CONTRACT CLAUSES Text of Provisions And Clauses 252.225-7032 Waiver of United Kingdom Levies—Evaluation of offers. As prescribed in 225.1101(8), use the following provision: Waiver of United Kingdom...

  17. Holistic Admissions in Nursing: We Can Do This.

    PubMed

    Glazer, Greer; Clark, Angela; Bankston, Karen; Danek, Jennifer; Fair, Malika; Michaels, Julia

    2016-01-01

    Research shows that holistic admissions review practices can increase diversity across students without decreasing the workforce preparedness and academic success of students. Therefore, many disciplines have readily adopted the widespread use of holistic admissions review. Despite its proven effectiveness in addressing student diversity, nursing has been slow to implement holistic admissions review. The purpose of this study was to gain a better understanding of the barriers to implementing holistic admissions review in nursing and the feasibility of adopting holistic admissions review across nursing programs. A biphasic qualitative research study was conducted with nursing deans from across the United States. Qualitative data collection consisted of two phases of focus group discussions conducted over a 3-month period. The qualitative data were analyzed using content analysis. The categories and subcategories identified in Phase 1 informed the discussion in Phase 2. One overarching category from Phase 1 was identified, which was the lack of nursing schools' knowledge regarding holistic admissions review. Four subcategories also identified in Phase 1 included the need for better dissemination of evidence, the need for additional support from university leaders and administrators, the need for legal guidance to facilitate implementation of holistic admissions review, and ensuring appropriate resources to support the holistic admissions review process. Three categories emerged in Phase 2, which included everyone's buy-in is required, the need for a model, and a need for training. The adoption of holistic admissions review in nursing may be feasible. However, certain barriers need to be overcome so that nursing schools can successfully take on this process. Therefore, five recommendations have been developed to assist nursing schools in the implementation of holistic admissions review. These recommendations include increasing knowledge and understanding of holistic

  18. Psychiatric Inpatient Care for Adults with Intellectual Disabilities: Generic or Specialist Units?

    ERIC Educational Resources Information Center

    Xenitidis, K.; Gratsa, A.; Bouras, N.; Hammond, R.; Ditchfield, H.; Holt, G.; Martin, J.; Brooks, D.

    2004-01-01

    When adults with intellectual disabilities (ID) require a psychiatric admission, general adult mental health units are often used. Specialist units have emerged recently as a care option but there is only limited evidence of their effectiveness. Thus this study aims to describe and evaluate the effectiveness of a specialist inpatient unit and…

  19. The Admissions Profession: A Guide for Staff Development and Program Management.

    ERIC Educational Resources Information Center

    American Association of Collegiate Registrars and Admissions Officers, Washington, DC.

    This guide is designed to assist in college admissions staff development and program management, but is also suggested for use in training and accrediting efforts, presentations on admissions tasks, internal or external evaluations, preparation of periodic reports, and as a self-paced workbook when preparing for the admission profession, or for…

  20. British Columbia Council on Admissions & Transfer Annual Report, 2008-09

    ERIC Educational Resources Information Center

    British Columbia Council on Admissions and Transfer, 2009

    2009-01-01

    The role of the British Columbia Council on Admissions and Transfer (BCCAT) is to facilitate admission, articulation, and transfer arrangements in the BC post-secondary system. BCCAT carries out this work in various ways; for example, engaging in research on admissions and student transitions, evaluating the effectiveness of the transfer system…

  1. 42 CFR 456.171 - Medicaid agency review of need for admission.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Medicaid agency review of need for admission. 456... of need for admission. Medical and other professional personnel of the Medicaid agency or its designees must evaluate each applicant's or recipient's need for admission by reviewing and assessing...

  2. 42 CFR 456.372 - Medicaid agency review of need for admission.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Medicaid agency review of need for admission. 456... Medicaid agency review of need for admission. Medical and other professional personnel of the Medicaid agency or its designees must evaluate each applicant's or recipient's need for admission by reviewing...

  3. 42 CFR 456.171 - Medicaid agency review of need for admission.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 4 2012-10-01 2012-10-01 false Medicaid agency review of need for admission. 456... of need for admission. Medical and other professional personnel of the Medicaid agency or its designees must evaluate each applicant's or beneficiary's need for admission by reviewing and assessing the...

  4. 42 CFR 456.372 - Medicaid agency review of need for admission.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 4 2014-10-01 2014-10-01 false Medicaid agency review of need for admission. 456... Medicaid agency review of need for admission. Medical and other professional personnel of the Medicaid agency or its designees must evaluate each applicant's or beneficiary's need for admission by reviewing...

  5. 42 CFR 456.171 - Medicaid agency review of need for admission.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 4 2014-10-01 2014-10-01 false Medicaid agency review of need for admission. 456... of need for admission. Medical and other professional personnel of the Medicaid agency or its designees must evaluate each applicant's or beneficiary's need for admission by reviewing and assessing the...

  6. 42 CFR 456.171 - Medicaid agency review of need for admission.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 4 2013-10-01 2013-10-01 false Medicaid agency review of need for admission. 456... of need for admission. Medical and other professional personnel of the Medicaid agency or its designees must evaluate each applicant's or beneficiary's need for admission by reviewing and assessing the...

  7. 42 CFR 456.372 - Medicaid agency review of need for admission.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 4 2013-10-01 2013-10-01 false Medicaid agency review of need for admission. 456... Medicaid agency review of need for admission. Medical and other professional personnel of the Medicaid agency or its designees must evaluate each applicant's or beneficiary's need for admission by reviewing...

  8. 42 CFR 456.372 - Medicaid agency review of need for admission.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 4 2012-10-01 2012-10-01 false Medicaid agency review of need for admission. 456... Medicaid agency review of need for admission. Medical and other professional personnel of the Medicaid agency or its designees must evaluate each applicant's or beneficiary's need for admission by reviewing...

  9. Follicular unit extraction with the Artas robotic hair transplant system system: an evaluation of FUE yield.

    PubMed

    Rashid, Rashid M

    2014-04-16

    Hair transplants were developed and championed by dermatologists. However, dermatology literature has few contributions from within our specialty. In this manuscript, we present our evaluation of a specific graft harvesting approach for hair transplants referred to as Follicular unit extraction (FUE). In particular, we sought to evaluate the rate of harvest attempts that did not produce an actual hair folliclular unit graft.

  10. Performance Evaluation of the United Nations Environment Programme Air Quality Monitoring Unit

    EPA Pesticide Factsheets

    This report defines the specifics of the environmental test conditions used in the evaluation (systems and conditions), data observations, summarization of key performance evaluation findings, and ease of use features concerning the UNEP pod.

  11. 17 CFR 12.33 - Admissions.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... REPARATIONS Discovery § 12.33 Admissions. (a) Request for admissions. Any party may, within the time permitted... which an admission has been requested presents a genuine issue for trial may not, on that ground alone...

  12. Emergy Evaluation of Educational Attainment in the United States

    EPA Science Inventory

    The emergy of educational attainment in the United States was quantified over the period for which the necessary data were available, i.e., 1948 to 2006. We propose that the portion of the knowledge in educational attainment delivered by the active workforce be considered as part...

  13. Emergy Evaluation of Educational Attainment in the United States

    EPA Science Inventory

    The emergy of educational attainment in the United States was quantified over the period for which the necessary data were available, i.e., 1948 to 2006. We propose that the portion of the knowledge in educational attainment delivered by the active workforce be considered as part...

  14. Creating a Curriculum Unit on Evaluation of Social Media

    ERIC Educational Resources Information Center

    McLean, C. D.

    2010-01-01

    At the beginning of last year the assistant Middle Division director at the Berkeley Preparatory School challenged his faculty to collaborate with at least one teacher from another department in the division for a portion of one unit. Because the challenge was given at the beginning of the school year, it was received with trepidation, but, after…

  15. Evaluation of a University Online Information Literacy Unit

    ERIC Educational Resources Information Center

    Crawford, Nicole; Broertjes, Andrew

    2010-01-01

    Arts IRIS (Introductory Research and Information Skills) is a compulsory online information literacy unit for commencing students in the Faculty of Arts, Humanities and Social Sciences at The University of Western Australia (UWA). The aim of Arts IRIS is to provide students with a foundation in research and information literacy skills for studying…

  16. Creating a Curriculum Unit on Evaluation of Social Media

    ERIC Educational Resources Information Center

    McLean, C. D.

    2010-01-01

    At the beginning of last year the assistant Middle Division director at the Berkeley Preparatory School challenged his faculty to collaborate with at least one teacher from another department in the division for a portion of one unit. Because the challenge was given at the beginning of the school year, it was received with trepidation, but, after…

  17. Effect of time and day of admission on hospital care quality for patients with chronic obstructive pulmonary disease exacerbation in England and Wales: single cohort study.

    PubMed

    Roberts, Christopher Michael; Lowe, Derek; Skipper, Emma; Steiner, Michael C; Jones, Rupert; Gelder, Colin; Hurst, John R; Lowrey, Gillian E; Thompson, Catherine; Stone, Robert A

    2017-09-06

    To evaluate if observed increased weekend mortality was associated with poorer quality of care for patients admitted to hospital with chronic obstructive pulmonary disease (COPD) exacerbation. Prospective case ascertainment cohort study. 199 acute hospitals in England and Wales, UK. Consecutive COPD admissions, excluding subsequent readmissions, from 1 February to 30 April 2014 of whom 13 414 cases were entered into the study. Process of care mapped to the National Institute for Health and Care Excellence clinical quality standards, access to specialist respiratory teams and facilities, mortality and length of stay, related to time and day of the week of admission. Mortality was higher for weekend admissions (unadjusted OR 1.20, 95% CI 1.00 to 1.43), and for case-mix adjusted weekend mortality when calculated for admissions Friday morning through to Monday night (adjusted OR 1.19, 95% CI 1.00 to 1.43). Median time to death was 6 days. Some clinical processes were poorer on Mondays and during normal working hours but not weekends or out of hours. Specialist respiratory care was less available and less prompt for Friday and Saturday admissions. Admission to a specialist ward or high dependency unit was less likely on a Saturday or Sunday. Increased mortality observed in weekend admissions is not easily explained by deficiencies in early clinical guideline care. Further study of out-of-hospital factors, specialty care and deaths later in the admission are required if effective interventions are to be made to reduce variation by day of the week of admission. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  18. Evaluation of intoxicated patients hospitalized in a newly-opened level two pediatric intensive care unit

    PubMed Central

    Güngörer, Vildan; Yisldırım, Nurdan Kökten

    2016-01-01

    Aim: The study aimed to retrospectively examine the demographic and etiological characteristics, prognosis and length of stay in intensive care unit of intoxicated patients hospitalized in Level two Pediatric Intensive Care Unit in Maternity and Child Health Hospital of Samsun. Material and Methods: The study retrospectively examined the records of patients hospitalized between 14th March 2014 and 14th March 2015 in Level two Pediatric Intensive Care Unit in Maternity and Child Health Hospital of Samsun with respect to age, gender, cause of poisoning, time of emergency department admission, length of hospitalization and prognosis. Results: Of 82 patients admitted to the Intensive Care Unit, 29 (35.3%) were male and 53 (64.6%) were female. The mean age of the male and female patients was 7.89±6.3 years and 11.2±5.7 years, respectively and the mean age of the study group was 10.04±6.1. Twenthy one (39,6%) of the female patients were at the age group of 0–14 years and 32 (60.4%) were at the age group of 14–18 years. Twenthy (68.9%) of the male patients were at the age group of 0–14 years and nine (31.1%) were at the age group of 14–18 years. The cause of poisoning was drug intoxication (antidepressants, antibiotics, painkillers and other drugs) in 64 patients (78%) and the remaining 18 patients (22%) were admitted to hospital for other causes (rat poison, mushroom, carbonmonoxide, scorpion stings, bonzai and pesticides). Thirthy eight (46.3%) of all the patients used such substances for suicidal purpose. Thirthy three (62.2%) of these were female and 32 were at the age group of 14–18 years. Fourty (48.7%) of the patients who ingested medication ingested one drug, while 24 (29.2%) ingested multiple drugs. Antidepressants were found to be the most commonly used drugs (31.2%). The mean hospital admission time was 3.41±2 hours and the mean time of intensive care unit stay was 2.89±1.04 days. No mortality was recorded. Thirthy patients (36.5%) were referred

  19. A new state evaluation method of oil pump unit based on AHP and FCE

    NASA Astrophysics Data System (ADS)

    Lin, Yang; Liang, Wei; Qiu, Zeyang; Zhang, Meng; Lu, Wenqing

    2017-05-01

    In order to make an accurate state evaluation of oil pump unit, a comprehensive evaluation index should be established. A multi-parameters state evaluation method of oil pump unit is proposed in this paper. The oil pump unit is analyzed by Failure Mode and Effect Analysis (FMEA), so evaluation index can be obtained based on FMEA conclusions. The weights of different parameters in evaluation index are discussed using Analytic Hierarchy Process (AHP) with expert experience. According to the evaluation index and the weight of each parameter, the state evaluation is carried out by Fuzzy Comprehensive Evaluation (FCE) and the state is divided into five levels depending on status value, which is inspired by human body health. In order to verify the effectiveness and feasibility of the proposed method, a state evaluation of oil pump used in a pump station is taken as an example.

  20. Experience with a Hospital Laboratory Admission Screen

    PubMed Central

    Davey, P. W.; Letts, H. W.; Anderson, P. A.

    1970-01-01

    A comprehensive laboratory admission screen can be instituted in any large laboratory but only in one in command of conventional technology and with the co-operation of the laboratory, medical, nursing and admitting staff. The capital equipment required is costly and subject to early obsolescence. The operating costs are initially high, but the influence of the screen on the general work load indicates that the total overall procedures ordered by the physician will be reduced in number and that over a three-year period, in an economy subject to continuous inflationary pressure, the total cost will approach what might have been expected had the screen not been instituted. By presenting, shortly after admission, a truly comprehensive laboratory profile, the total number of procedures ordered will be reduced and this reduction bears no relationship to whether or not the data supplied are medically useful. The equipment more recently available for a large admission screen is far superior, from the point of view of speed of assay and cost of maintenance and production, to the equipment that has been available to us in this study. It is believed that the unit cost of assay will continue to decline and that the principle of unsolicited testing will be expanded in the future to include procedures not presently in the profile. It is predicted that in the relatively near future almost all of the laboratory procedures that a clinician could conceivably request will have been done prior to his examination of the patient. PMID:5430051

  1. 28 CFR 549.42 - Involuntary admission.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... SERVICES Administrative Safeguards for Psychiatric Treatment and Medication § 549.42 Involuntary admission... voluntarily consent either to psychiatric admission or to medication, is subject to judicial involuntary...

  2. Influence of ICU-bed availability on ICU admission decisions.

    PubMed

    Robert, René; Coudroy, Rémi; Ragot, Stéphanie; Lesieur, Olivier; Runge, Isabelle; Souday, Vincent; Desachy, Arnaud; Gouello, Jean-Paul; Hira, Michel; Hamrouni, Mouldi; Reignier, Jean

    2015-12-01

    The potential influence of bed availability on triage to intensive care unit (ICU) admission is among the factors that may influence the ideal ratio of ICU beds to population: thus, high bed availability (HBA) may result in the admission of patients too well or too sick to benefit, whereas bed scarcity may result in refusal of patients likely to benefit from ICU admission. Characteristics and outcomes of patient admitted in four ICUs with usual HBA, defined by admission refusal rate less than 11 % because of bed unavailability, were compared to patients admitted in six ICUs with usual low bed availability (LBA), i.e., an admission refusal rate higher than 10 % during a 90-day period. Over the 90 days, the mean number of days with no bed available was 30 ± 16 in HBA units versus 48 ± 21 in LBA units (p < 0.01). The proportion of admitted patients was significantly higher in the HBA (80.1 %; n = 659/823) than in the LBA units [61.6 %: n = 480/779; (p < 0.0001)]. The proportion of patients deemed too sick to benefit from admission was higher in LBA (9.0 %; n = 70) than in the HBA (6.3 %; n = 52) units (p < 0.05). The HBA group had a significantly greater proportion of patients younger than 40 years of age (22.5 %; n = 148 versus 14 %; n = 67 in LBA group; p < 0.001) and higher proportions of patients with either high or low simplified acute physiologic score II values. Bed availability affected triage decisions. Units with HBA trend to admit patients too sick or too well to benefit.

  3. Managing a Regional Education Service Agency Evaluation Unit.

    ERIC Educational Resources Information Center

    Roecks, Alan L.

    The Evaluation Office of the Region 20 Education Service Center, which serves 50 school districts in the San Antonio (Texas) area, is delineated in this report. The introduction describes the location, size, and budget of the agency as well as the structure and funding of the evaluation office. The first chapter notes the region's future needs for…

  4. Focus Groups: An Important Research Technique for Internal Evaluation Units.

    ERIC Educational Resources Information Center

    Duffy, Barbara Poitras

    1993-01-01

    The use of focus groups by the Federal Bureau of Investigation as a tool of internal evaluation is described. Focus groups are used in an environment where credibility is key to achieving meaningful cooperation. Issues for consideration by other evaluators interested in the approach are summarized. (SLD)

  5. Trends in hospital and intensive care admissions in the Netherlands attributable to the very elderly in an ageing population.

    PubMed

    Haas, Lenneke E M; Karakus, Attila; Holman, Rebecca; Cihangir, Sezgin; Reidinga, Auke C; de Keizer, Nicolette F

    2015-09-30

    The Dutch population is ageing and it is unknown how this is affecting trends in the percentage of hospital and intensive care unit (ICU) admissions attributable to patients aged 80 years or older, the very elderly. We present data on the percentage of the very elderly in the general population and the percentage of hospital admissions attributable to the very elderly. We subsequently performed a longitudinal cross-sectional study on ICU admissions from hospitals participating in the National Intensive Care Evaluation registry for the period 2005 to 2014. We modeled the percentage of adult ICU admissions and treatment days attributable to the very elderly separately for ICU admissions following cardiac surgery and other reasons. The percentage of Dutch adults aged 80 years and older, increased from 4.5 % in 2005 to 5.4 % in 2014 (p-value < 0.0001) and with this ageing of the population, the percentage of hospital admissions attributable to very elderly increased from 9.0 % in 2005 to 10.6 % in 2014 (p-value < 0.0001). The percentage of ICU admissions following cardiac surgery attributable to the very elderly increased from 6.7 % in 2005 to 11.0 % in 2014 in nine hospitals (p-value < 0.0001), while the percentage of treatment days attributable to this group rose from 8.6 % in 2005 to 11.7 % in 2014 (p-value = 0.0157). In contrast, the percentage of very elderly patients admitted to the ICU for other reasons than following cardiac surgery remained stable at 13.8 % between 2005 and 2014 in 33 hospitals (p-value = 0.1315). The number of treatment days attributable to the very elderly rose from 11,810 in 2005 to 15,234 in 2014 (p-value = 0.0002), but the percentage of ICU treatment days attributable to this group remained stable at 12.0 % (p-value = 0.1429). As in many European countries the Dutch population is ageing and the percentage of hospital admissions attributable to the very elderly rose between 2005 and 2014. However, the percentage

  6. Status of wildland fire prevention evaluation in the United States.

    Treesearch

    Larry Doolittle; Linda R. Donoghue

    1991-01-01

    Presents findings of an assessment of the evaluation of wildland prevention efforts by all U.S. Wildland fire management agencies, and offers recommendations for improvements in prevention valuation techniques and procedures.

  7. Infertility Evaluation and Treatment among Women in the United States

    PubMed Central

    Kessler, Lawrence M.; Craig, Benjamin M.; Plosker, Shayne M.; Reed, Damon R.; Quinn, Gwendolyn P.

    2013-01-01

    Objective To examine the characteristics of women seeking infertility evaluation and treatment. Design Cross-sectional survey based on in-person interviews, followed by two-step hurdle analysis. Participants 4,558 married or cohabitating women ages 25–44 Setting U.S. household population of women based on the 2006–2010 National Survey of Family Growth Intervention None Main Outcome Measure(s) Likelihood of seeking preliminary infertility evaluation. Likelihood of seeking infertility treatment once evaluated. Treatment type provided. Results 623 women (13.7%) reported seeking infertility evaluation, of which 328 reported undergoing subsequent infertility treatment. Age at marriage, marital status, education, health insurance status, race/ethnicity, and religion were associated with the likelihood of seeking infertility evaluation. For example, the predicted probability that a non-White woman who married at 25 will seek evaluation was 12%. This probability increased to 34% for White women with a graduate degree who married at age 30. Among women who are evaluated, income, employment status, and ethnicity correlated strongly with the likelihood of seeking infertility treatment. Infertility drug therapy was the most frequent treatment used. Reproductive surgery and in vitro fertilization (IVF) were used the least. Conclusions The use of infertility services is not random and understanding the socio-demographic factors correlated with use may assist new couples with family planning. Roughly 50% of the women evaluated for infertility progressed to treatment, and only a small proportion were treated with more advanced assisted reproductive technologies (ARTs) such as IVF therapy. Future research aimed at improving access to effective healthcare treatments within the boundaries of affordability is warranted. PMID:23849845

  8. Evaluation of in-office dental unit waterline testing.

    PubMed

    Momeni, Stephanie S; Tomline, Nancy; Ruby, John D; Dasanayake, Ananda P

    2012-01-01

    In-office dental unit waterline (DUWL) testing systems are commercially available for monitoring DUWL bacteria. The current study compared Aquasafe, Petrifilm, and Heterotrophic Plate Count Sampler (HPCS) with R2A plating methodology, considered the gold standard for enumerating heterotrophic bacteria in potable water. Samples were collected from 20 dental units. Heterotrophic bacterial counts of ≤500 CFUs/mL were used as the cut-off for assessing in-office testing compared to R2A laboratory plating. Validity was assessed using sensitivity and specificity, along with positive and negative predictive values. Results were also compared using concordance and kappa statistics. All in-office tests demonstrated 100% specificity and positive predictive values, while sensitivity and negative predictive values were low (Petrifilm, 57%/50%; HPCS, 50%/46%; Aquasafe, 21%/35%). Concordance and kappa values for agreement with R2A plating were as follows: Petrifilm 70% (κ = 0.44), HPCS 65% (κ = 0.38), and Aquasafe 45% (κ = 0.14). In-office DUWL testing with Aquasafe, Petrifilm, and HPCS agreed poorly with R2A plating methodology and is not valid or reliable as a means of accurately monitoring bacterial density in DUWL. These in-office test systems should not be used for assessing compliance with the ADA and CDC standard for acceptable heterotrophic bacterial counts in DUWLs (≤500 CFUs/mL).

  9. Evaluating Russian space nuclear reactor technology for United States applications

    SciTech Connect

    Polansky, G.F.; Schmidt, G.L.; Voss, S.S.; Reynolds, E.L.

    1994-08-01

    Space nuclear power and nuclear electric propulsion are considered important technologies for planetary exploration, as well as selected earth orbit applications. The Nuclear Electric Propulsion Space Test Program (NEPSTP) was intended to provide an early flight demonstration of these technologies at relatively low cost through extensive use of existing Russian technology. The key element of Russian technology employed in the program was the Topaz II reactor. Refocusing of the activities of the Ballistic Missile Defense Organization (BMDO), combined with budgetary pressures, forced the cancellation of the NEPSTP at the end of the 1993 fiscal year. The NEPSTP was faced with many unique flight qualification issues. In general, the launch of a spacecraft employing a nuclear reactor power system complicates many spacecraft qualification activities. However, the NEPSTP activities were further complicated because the reactor power system was a Russian design. Therefore, this program considered not only the unique flight qualification issues associated with space nuclear power, but also with differences between Russian and United States flight qualification procedures. This paper presents an overview of the NEPSTP. The program goals, the proposed mission, the spacecraft, and the Topaz II space nuclear power system are described. The subject of flight qualification is examined and the inherent difficulties of qualifying a space reactor are described. The differences between United States and Russian flight qualification procedures are explored. A plan is then described that was developed to determine an appropriate flight qualification program for the Topaz II reactor to support a possible NEPSTP launch.

  10. Prognostic value of on admission arterial PCO2 in hospitalized patients with community-acquired pneumonia

    PubMed Central

    Yassin, Zeynab; Saadat, Mohammad; Abtahi, Hamidreza; Rahimi Foroushani, Abbas

    2016-01-01

    Background There is little data about the correlation between the outcome of community acquired pneumonia (CAP) and the hypercapnic type respiratory failure. In this study we prospectively investigated the prognostic significance of first arterial CO2 tension in patients hospitalized with CAP. Methods In this prospective study patients with CAP, admitted to a general hospital were included. PaCO2 was measured for each subject in an arterial blood sample drawn in the first 2 hours and its correlations with three major outcomes were evaluated: intensive care unit (ICU) admission, duration of admission and mortality in 30 days. Results A total of 114 patients (mean age: 60.9±18.3; male: 51.8%) diagnosed with CAP were included. Significant relationship was not found between PaCO2 and mortality (P=0.544) or ICU admission (P=0.863). However advanced age, associated CHF, high BUN levels, high CURB-65 scores, associated pleural effusion in chest X-ray and being admitted to the ICU (P=0.012, 0.004, 0.003, <0.001, 0.045 and <0.001 respectively) were all significant prognostic factors of higher mortality risks. Prognostic factors for ICU admission were a history of malignancy (P=0.004), higher CURB-65 (P<0.001) scores and concomitant pleural effusion (P=0.028) in chest X-ray. Hypercapnic patients hospitalized for longer duration compared with normocapnic subjects. Furthermore, patients with lower pH (P=0.041) and pleural effusions (P=0.002) were hospitalized longer than the others. Conclusions There was less prominent prognostic value regarding on-admission PaCO2 in comparison to other factors such as CURB-65. Considering the inconsistent results of surveys conducted on prognostic value of PaCO2 for CAP outcomes, further investigations are required to reach a consensus on this matter. PMID:27867552

  11. Consultant input in acute medical admissions and patient outcomes in hospitals in England: a multivariate analysis.

    PubMed

    Bell, Derek; Lambourne, Adrian; Percival, Frances; Laverty, Anthony A; Ward, David K

    2013-01-01

    Recent recommendations for physicians in the UK outline key aspects of care that should improve patient outcomes and experience in acute hospital care. Included in these recommendations are Consultant patterns of work to improve timeliness of clinical review and improve continuity of care. This study used a contemporaneous validated survey compared with clinical outcomes derived from Hospital Episode Statistics, between April 2009 and March 2010 from 91 acute hospital sites in England to evaluate systems of consultant cover for acute medical admissions. Clinical outcomes studied included adjusted case fatality rates (aCFR), including the ratio of weekend to weekday mortality, length of stay and readmission rates. Hospitals that had an admitting Consultant presence within the Acute Medicine Unit (AMU, or equivalent) for a minimum of 4 hours per day (65% of study group) had a lower aCFR compared with hospitals that had Consultant presence for less than 4 hours per day (p<0.01) and also had a lower 28 day re-admission rate (p<0.01). An 'all inclusive' pattern of Consultant working, incorporating all the guideline recommendations and which included the minimum Consultant presence of 4 hours per day (29%) was associated with reduced excess weekend mortality (p<0.05). Hospitals with >40 acute medical admissions per day had a lower aCFR compared to hospitals with fewer than 40 admissions per day (p<0.03) and had a lower 7 day re-admission rate (p<0.02). This study is the first large study to explore the potential relationships between systems of providing acute medical care and clinical outcomes. The results show an association between well-designed systems of Consultant working practices, which promote increased patient contact, and improved patient outcomes in the acute hospital setting.

  12. Critically ill obstetric patients in the intensive care unit.

    PubMed

    Demirkiran, O; Dikmen, Y; Utku, T; Urkmez, S

    2003-10-01

    We aimed to determine the morbidity and mortality among obstetric patients admitted to the intensive care unit. In this study, we analyzed retrospectively all obstetric admissions to a multi-disciplinary intensive care unit over a five-year period. Obstetric patients were identified from 4733 consecutive intensive care unit admissions. Maternal age, gestation of newborns, mode of delivery, presence of coexisting medical problems, duration of stay, admission diagnosis, specific intensive care interventions (mechanical ventilation, continuous veno-venous hemofiltration, central venous catheterization, and arterial cannulation), outcome, maternal mortality, and acute physiology and chronic health evaluation (APACHE) II score were recorded. Obstetric patients (n=125) represented 2.64% of all intensive care unit admissions and 0.89% of all deliveries during the five-year period. The overall mortality of those admitted to the intensive care unit was 10.4%. Maternal age and gestation of newborns were similar in survivors and non-survivors. There were significant differences in length of stay and APACHE II score between survivors and non-survivors P < 0.05. The commonest cause of intensive care unit admission was preeclampsia/eclampsia (73.6%) followed by post-partum hemorrhage (11.2%). Intensive care specialists should be familiar with these complications of pregnancy and should work closely with obstetricians.

  13. The admission index in the dental school admissions process.

    PubMed

    Staat, R H; Yancey, J M

    1982-08-01

    Preprofessional students' grade point averages (GPAs) and aptitude test scores have been moderately successful in predicting student performance in dental school. The authors attempted to improve the predictability of the school's admission process by combining several preprofessional academic averages and selected nongraded personal attributes into a single Admission Index (AI) score. A Pearson r of 0.67 was found for the relationship between the AI and first-year dental school GPA for University of Louisville dental students accepted into the class of 1984. The correlation coefficient generated from the AI and first-year dental school GPA was markedly superior to those generated by any single predictor. The authors propose that the AI is of value not only for its use in the admission process, but also in the development of an interceptive student monitoring program for the less-qualified student.

  14. Daily weather variables and affective disorder admissions to psychiatric hospitals.

    PubMed

    McWilliams, Stephen; Kinsella, Anthony; O'Callaghan, Eadbhard

    2014-12-01

    Numerous studies have reported that admission rates in patients with affective disorders are subject to seasonal variation. Notwithstanding, there has been limited evaluation of the degree to which changeable daily meteorological patterns influence affective disorder admission rates. A handful of small studies have alluded to a potential link between psychiatric admission rates and meteorological variables such as environmental temperature (heat waves in particular), wind direction and sunshine. We used the Kruskal-Wallis test, ARIMA and time-series regression analyses to examine whether daily meteorological variables--namely wind speed and direction, barometric pressure, rainfall, hours of sunshine, sunlight radiation and temperature--influence admission rates for mania and depression across 12 regions in Ireland over a 31-year period. Although we found some very weak but interesting trends for barometric pressure in relation to mania admissions, daily meteorological patterns did not appear to affect hospital admissions overall for mania or depression. Our results do not support the small number of papers to date that suggest a link between daily meteorological variables and affective disorder admissions. Further study is needed.

  15. Impact of State Psychiatric Hospital Waitlists on Monthly Admissions.

    PubMed

    La, Elizabeth M; Morrissey, Joseph P; Lich, Kristen Hassmiller; Domino, Marisa Elena; Seibert, Julie; Waller, Anna

    2017-08-15

    This study estimated the effects of a waitlist policy on the monthly number and case mix of admissions to state psychiatric hospitals (SPHs) in North Carolina (NC). Descriptive analyses compared pre/postwaitlist differences in the monthly number and case mix of nonforensic adult admissions (N=72,035) to NC's four SPHs by using data from the three years before and the three years after the waitlist announcement. Hospital-level fixed-effects regression models further evaluated the waitlist policy's impact on the number and case mix of admissions. Regression results confirmed that the waitlist policy was associated with both fewer admissions and changes to the case mix of admissions, including a 4.2% decrease in the percentage of monthly admissions by patients with diagnoses of substance abuse disorders (p=.002) across all months postwaitlist (partially offset by an increase of patients with diagnoses of severe mental illness alone). Waitlists led to reduced monthly admissions and altered case mix following implementation at NC SPHs.

  16. Daily weather variables and affective disorder admissions to psychiatric hospitals

    NASA Astrophysics Data System (ADS)

    McWilliams, Stephen; Kinsella, Anthony; O'Callaghan, Eadbhard

    2014-12-01

    Numerous studies have reported that admission rates in patients with affective disorders are subject to seasonal variation. Notwithstanding, there has been limited evaluation of the degree to which changeable daily meteorological patterns influence affective disorder admission rates. A handful of small studies have alluded to a potential link between psychiatric admission rates and meteorological variables such as environmental temperature (heat waves in particular), wind direction and sunshine. We used the Kruskal-Wallis test, ARIMA and time-series regression analyses to examine whether daily meteorological variables—namely wind speed and direction, barometric pressure, rainfall, hours of sunshine, sunlight radiation and temperature—influence admission rates for mania and depression across 12 regions in Ireland over a 31-year period. Although we found some very weak but interesting trends for barometric pressure in relation to mania admissions, daily meteorological patterns did not appear to affect hospital admissions overall for mania or depression. Our results do not support the small number of papers to date that suggest a link between daily meteorological variables and affective disorder admissions. Further study is needed.

  17. Evaluation of 3 dental unit waterline contamination testing methods

    PubMed Central

    Porteous, Nuala; Sun, Yuyu; Schoolfield, John

    2015-01-01

    Previous studies have found inconsistent results from testing methods used to measure heterotrophic plate count (HPC) bacteria in dental unit waterline (DUWL) samples. This study used 63 samples to compare the results obtained from an in-office chairside method and 2 currently used commercial laboratory HPC methods (Standard Methods 9215C and 9215E). The results suggest that the Standard Method 9215E is not suitable for application to DUWL quality monitoring, due to the detection of limited numbers of heterotrophic organisms at the required 35°C incubation temperature. The results also confirm that while the in-office chairside method is useful for DUWL quality monitoring, the Standard Method 9215C provided the most accurate results. PMID:25574718

  18. Evaluating and Implementing Learning Environments: A United Kingdom Experience.

    ERIC Educational Resources Information Center

    Ingraham, Bruce; Watson, Barbara; McDowell, Liz; Brockett, Adrian; Fitzpatrick, Simon

    2002-01-01

    Reports on ongoing work at five universities in northeastern England that have been evaluating and implementing online learning environments known as virtual learning environments (VLEs) or managed learning environments (MLEs). Discusses do-it-yourself versus commercial systems; transferability; Web-based versus client-server; integration with…

  19. Evaluating Computer Instructional Programs and Other Teaching Units.

    ERIC Educational Resources Information Center

    Wade, T. E., Jr.

    1980-01-01

    Reviews several principles of learning theory and the characteristics of a good learning situation. The evaluation checklist included provides a list of characteristics that could be expected in any learning program which uses a particular medium such as the computer. (MER)

  20. Criteria for Evaluating United States Marine Corps Installation Strategic Management

    DTIC Science & Technology

    2001-12-01

    of developing a strategy requires a firm to examine their strengths, weaknesses, opportunities, and threats, a SWOT analysis . This involves...should include: • What is the installation’s overall strategic planning process? Does it include: a SWOT analysis , including supplier, human resource...established criteria. Through an analysis of current evaluation methods, review of pertinent literature and discussions with base business managers

  1. Evaluating application of the National Healthcare Safety Network central line-associated bloodstream infection surveillance definition: a survey of pediatric intensive care and hematology/oncology units.

    PubMed

    Gaur, Aditya H; Miller, Marlene R; Gao, Cuilan; Rosenberg, Carol; Morrell, Gloria C; Coffin, Susan E; Huskins, W Charles

    2013-07-01

    To evaluate the application of the National Healthcare Safety Network (NHSN) central line-associated bloodstream infection (CLABSI) definition in pediatric intensive care units (PICUs) and pediatric hematology/oncology units (PHOUs) participating in a multicenter quality improvement collaborative to reduce CLABSIs; to identify sources of variability in the application of the definition. Online survey using 18 standardized case scenarios. Each described a positive blood culture in a patient and required a yes- or-no answer to the question "Is this a CLABSI?" NHSN staff responses were the reference standard. Sixty-five US PICUs and PHOUs. Staff who routinely adjudicate CLABSIs using NHSN definitions. Sixty responses were received from 58 (89%) of 65 institutions; 78% of respondents were infection preventionists, infection control officers, or infectious disease physicians. Responses matched those of NHSN staff for 78% of questions. The mean (SE) percentage of concurring answers did not differ for scenarios evaluating application of 1 of the 3 criteria ("known pathogen," 78% [1.7%]; "skin contaminant, >1 year of age," 76% [SE, 2.5%]; "skin contaminant, ≤1 year of age," 81% [3.8%]; [Formula: see text]). The mean percentage of concurring answers was lower for scenarios requiring respondents to determine whether a CLABSI was present or incubating on admission (64% [4.6%]; [Formula: see text]) or to distinguish between primary and secondary bacteremia (65% [2.5%]; [Formula: see text]). The accuracy of application of the CLABSI definition was suboptimal. Efforts to reduce variability in identifying CLABSIs that are present or incubating on admission and in distinguishing primary from secondary bloodstream infection are needed.

  2. Evaluation of Learning Unit Design with Use of Page Flip Information Analysis

    ERIC Educational Resources Information Center

    Horikoshi, Izumi; Noguchi, Masato; Tamura, Yasuhisa

    2016-01-01

    In this paper, the authors attempted to evaluate design of leaning units with use of Learning Analytics technique on page flip information. Traditional formative assessment has been carried out by giving assignments and evaluating their results. However, the information that teacher can get from the evaluation is limited and coarse-grained. The…

  3. 45 CFR 618.300 - Admission.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of Sex in Admission and Recruitment Prohibited § 618.300 Admission. (a) General. No person shall, on the basis of sex, be denied admission, or be subjected to discrimination in admission, by...

  4. College Admissions Policies for the 1970's.

    ERIC Educational Resources Information Center

    College Entrance Examination Board, New York, NY.

    The papers included in this collection are (1) "Problems and Issues Confronting the Admissions Community" by Clyde Vroman; (2) "Frozen Assumptions in Admissions" by B. Alden Thresher; (3) "The Effect of Federal Programs on Admissions Policies" by John F. Morse; (4) "State Plans for Higher Education and Their Influence on Admissions" by Charles W.…

  5. 44 CFR 68.9 - Admissible evidence.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Admissible evidence. 68.9 Section 68.9 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF... admissible. (b) Documentary and oral evidence shall be admissible. (c) Admissibility of non-expert...

  6. 22 CFR 229.300 - Admission.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 22 Foreign Relations 1 2011-04-01 2011-04-01 false Admission. 229.300 Section 229.300 Foreign... and Recruitment Prohibited § 229.300 Admission. (a) General. No person shall, on the basis of sex, be denied admission, or be subjected to discrimination in admission, by any recipient to which §§...

  7. 22 CFR 146.300 - Admission.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 22 Foreign Relations 1 2011-04-01 2011-04-01 false Admission. 146.300 Section 146.300 Foreign... Recruitment Prohibited § 146.300 Admission. (a) General. No person shall, on the basis of sex, be denied admission, or be subjected to discrimination in admission, by any recipient to which §§ 146.300...

  8. 10 CFR 1042.300 - Admission.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 10 Energy 4 2013-01-01 2013-01-01 false Admission. 1042.300 Section 1042.300 Energy DEPARTMENT OF... Prohibited § 1042.300 Admission. (a) General. No person shall, on the basis of sex, be denied admission, or be subjected to discrimination in admission, by any recipient to which §§ 1042.300 through...

  9. Performance Evaluation of the United Nations Environment Programme Air Quality Monitoring Unit

    EPA Science Inventory

    A request for technical collaboration between the UNEP and the US EPA resulted in the establishment of a MCRADA. The purpose of this agreement was to evaluate an air quality monitoring system (referred to as the UNEP pod) developed by the UNEP for use in environmental situations ...

  10. A three-axis flight simulator. [for testing and evaluating inertial measuring units, and flight platforms

    NASA Technical Reports Server (NTRS)

    Mason, M. G.

    1975-01-01

    A simulator is described, which was designed for testing and evaluating inertial measuring units, and flight platforms. Mechanical and electrical specifications for the outer, middle, and inner axis are presented. Test results are included.

  11. Performance evaluation of Ormat unit at Wabuska, Nevada. Final report

    SciTech Connect

    Culver, G.

    1986-07-01

    Three nominal 24 hour tests under summer, winter and spring weather conditions, were run on an Ormat geothermal binary power generation machine. The machine, located at TAD's Enterprises in Wabuska, Nevada is supplied with approximately 830 gpm of geothermal water at 221/sup 0/F and has two spray cooling ponds. During the tests, temperature, pressure, and flows of geothermal water, freon, cooling water and instantaneous electrical production were recorded hourly. At least once during each test, energy consumption of the well pump, freon feed pump and cooling water pumps were made. Power output of the machine is limited by spray pond capacity. Net output ranged from 410.2 kW during summer conditions when cooling water was 65/sup 0/F to 610.4 kW during winter conditions when cooling water was 55/sup 0/F. Net resource utilization ranged from 1.005 Whr/lb during the summer test to 1.55 Whr/lb during the winter test. Spray pond performance averaged 63% for the fall and winter tests. Availability of the Ormat unit itself during the eight month test period was generally good, averaging 95.5%. Overall system availability, including well pumps, cooling system and electric grid was somewhat less - averaging 83%.

  12. Comparison of acute physiology and chronic health evaluation II and acute physiology and chronic health evaluation IV to predict intensive care unit mortality

    PubMed Central

    Parajuli, Bashu Dev; Shrestha, Gentle S.; Pradhan, Bishwas; Amatya, Roshana

    2015-01-01

    Context: Clinical assessment of severity of illness is an essential component of medical practice to predict the outcome of critically ill-patient. Acute Physiology and Chronic Health Evaluation (APACHE) model is one of the widely used scoring systems. Aims: This study was designed to evaluate the Performance of APACHE II and IV scoring systems in our Intensive Care Unit (ICU). Settings and Design: A prospective study in 6 bedded ICU, including 76 patients all above 15 years. Subjects and Methods: APACHE II and APACHE IV scores were calculated based on the worst values in the first 24 h of admission. All enrolled patients were followed, and outcome was recorded as survivors or nonsurvivors. Statistical Analysis Used: SPSS version 17. Results: The mean APACHE score was significantly higher among nonsurvivors than survivors (P < 0.005). Discrimination for APACHE II and APACHE IV was fair with area under receiver operating characteristic curve of 0.73 and 0.79 respectively. The cut-off point with best Youden index for APACHE II was 17 and for APACHE IV was 85. Above cut-off point, mortality was higher for both models (P < 0.005). Hosmer–Lemeshow Chi-square coefficient test showed better calibration for APACHE II than APACHE IV. A positive correlation was seen between the models with Spearman's correlation coefficient of 0.748 (P < 0.01). Conclusions: Discrimination was better for APACHE IV than APACHE II model however Calibration was better for APACHE II than APACHE IV model in our study. There was good correlation between the two models observed in our study. PMID:25722550

  13. Accessibility Evaluation of Top-Ranking University Websites in World, Oceania, and Arab Categories for Home, Admission, and Course Description Webpages

    ERIC Educational Resources Information Center

    Alahmadi, Tahani; Drew, Steve

    2017-01-01

    Evaluating accessibility is an important equity step in assessing the effectiveness and usefulness of online learning materials for students with disabilities such as visual or hearing impairments. Previous studies in this area have indicated that, over time, university websites have become gradually more inaccessible. This paper relates findings…

  14. From Admissions through Employment. Annual Report from the Office of Educational Research and Evaluation. Fall 1980, Spring 1981, and Summer 1981.

    ERIC Educational Resources Information Center

    Byrne, Robert L.; And Others

    Data collected on the Eastern Kentucky University College of Education by the Office of Educational Research and Evaluation for the 1980-81 academic year are presented. Information is included on: (1) basic skills and personality tests; (2) administration of the National Teachers Examination; (3) competency examinations; (4) establishing validity…

  15. Evaluating flood potential with GRACE in the United States

    NASA Astrophysics Data System (ADS)

    Molodtsova, T.; Molodtsov, S.; Kirilenko, A.; Zhang, X.; VanLooy, J.

    2015-11-01

    One of the Gravity Recovery and Climate Experiment (GRACE) products, the Terrestrial Water Storage Anomaly (TWSA), was used for assessing large-scale flood risk through Reager's Flood Potential Index (RFPI) by Reager and Famiglietti (2009). The efficacy of the proposed RFPI for flood risk assessment was evaluated over the continental US using multi-year flood observation data from 2003 to 2012 by the US Geological Survey and Dartmouth Flood Observatory. In general, the flood risk based on the RFPI agreed well with the observed floods on regional and even local scales. The method exhibits higher skill in predicting the large-area, long-duration floods, especially during the summer season.

  16. Evaluation of pentavalent rotavirus vaccination in neonatal intensive care units.

    PubMed

    Thrall, Samuel; Doll, Margaret K; Nhan, Charles; Gonzales, Milagros; Perreault, Thérèse; Lamer, Philippe; Quach, Caroline

    2015-09-22

    Preterm infants are at highest risk for severe rotavirus gastroenteritis. While rotavirus vaccination is recommended for age-eligible, clinically stable preterm infants, controversy exists regarding vaccination of these infants during hospitalization. The objectives of this study were to examine tolerance of pentavalent rotavirus vaccination (RV5) among hospitalized infants and nosocomial rotavirus transmission in the neonatal intensive care units (NICU) at two urban hospitals. A retrospective, medical chart review of patients receiving RV5 vaccine was conducted to examine clinical histories of vaccine recipients. Average risk differences of gastrointestinal complications were estimated between the three days prior and up to four weeks following RV5 vaccination. A generalized linear regression model was used to examine the association between days since RV5 administration and daily feeding totals, using fixed effects to account for individual-level clustering. Rates of nosocomial rotavirus from active surveillance were compared between pre- and post-NICU-based vaccination periods. From July 1, 2011 to March 30, 2013, RV5 vaccination was initiated for 102 NICU patients. No changes in the average risk of gastrointestinal complications or daily feeding among participants overall were detected following RV5 administration. Rates of nosocomial rotavirus were similar during the periods before and after NICU-based vaccination. On average, RV5 appeared to be well tolerated among vaccine recipients, with no increase in nosocomial rotavirus transmission observed following NICU-based rotavirus vaccination. While the benefits of a RV5 NICU-based vaccination program for otherwise eligible preterm infants seem to outweigh the possible risk of vaccine virus transmission, further studies are needed. Copyright © 2015 Elsevier Ltd. All rights reserved.

  17. An evaluation of mattresses and mats in two dairy units.

    PubMed

    Chaplin; Tierney; Stockwell; Logue; Kelly

    2000-03-01

    In order to investigate the relative merits of mats and mattresses in terms of cow comfort, production and performance, 29 cows were housed on ethylethene vinyl acetate (EVA) mats and 29 on mattresses of loose rubber crumb with a polypropylene cover, at each of two similar dairy units (SAC Auchincruive and Myerscough). Both mats and mattresses were newly installed at the start of the trial. The cows were housed in the autumn after calving. Milk yield was recorded daily. Cows were weighed and scored for body condition, locomotion, dirtiness and hock and knee injury at fortnightly intervals. Feed offered was recorded daily and refusals were weighed weekly. Monthly milk records of milk yield, milk composition and somatic cell count data were available for both herds. In addition, 24 h behavioural observations of 15 core cows in each group were made at weeks 0, 2, 4, 6, 8, 16, and 32 post-housing. There was no difference between cows on mats and mattresses in milk yield, composition or quality; in feed intake; in weight loss or body condition score; in severe hock or knee injury, or in the incidence of lameness. Cows on mattresses tended to have slightly higher total dirtiness scores than those on mats (7.06 vs. 6.95, P=0.074) and had dirtier udders (mattress, 7.50 vs. mat, 6.52, P<0.05). However, over the whole housing period, cows on mattresses spent longer feeding, ruminating and lying and a greater proportion of their lying time was spent ruminating. They spent less time standing doing nothing (idling) than cows on mats and less time idling in cubicles. Cows on mattresses appeared to adapt to housing more quickly than those on mats. Overall, neither mat nor mattress gave advantages in terms of production or performance, cows were slightly cleaner on mats but behavioural indices suggest that cow comfort was greater on mattresses.

  18. Empowerment evaluation in redesigning a public health unit nutrition program.

    PubMed

    Dwyer, John J M; Vavaroutsos, Denise; Lutterman, Ann; Hier, Michelle; Hughes, May; Makarchuk, Mary-Jo

    2006-01-01

    This article illustrates how empowerment evaluation was used in Toronto Public Health's (TPH) nutrition programming redesign to consult with staff about how roles, responsibilities, and organisational structure could be changed to improve how nutrition programs are delivered. One of three moderators facilitated the ten two-hour focus group sessions in TPH. TPH staff, namely 71 front-line staff and 13 managers who were responsible for providing community nutrition services, participated in the study. Focus group participants included Public Health Dietitians, Public Health Nutritionists, Public Health Nurses (PHNs), and paraprofessionals (i.e., community nutrition assistants). Participants' preferred roles, responsibilities, and organisational structure in TPH, which they believe would improve nutrition service delivery in the community, were examined. A constant comparison approach was used to develop themes inductively. It was found that participants wanted Dietitians and Nutritionists to provide current nutrition-related information to them. They felt that nutrition programs should be promoted better and made more accessible to the public. They suggested that Dietitians and Nutritionists and other staff should share information with each other better. They suggested that Dietitians and Nutritionists should provide nutrition services directly to the public and provide support to other staff, mainly PHNs, who deliver nutrition programs. In conclusion, this empowerment evaluation produced results that were used to assist in decision making about nutrition programming.

  19. An evaluation of teamwork within a specialist palliative care unit.

    PubMed

    Donaghy, Kevin; Devlin, Breige

    2002-11-01

    This small-scale 10-month study evaluated teamworking within a specialist palliative care team. The study aims were to: collect, analyse and summarize information on how team members perceive teamworking; compare team members' perceptions after a teambuilding workshop; and to evaluate the longer term effect of this training on the team. A group of practitioners from a local Marie Curie Cancer Care Centre was selected and included members from all available disciplines. A piloted questionnaire was used to obtain qualitative and quantitative input. The team as a whole scored themselves above average on almost all counts. Following the teambuilding workshop significant improvement was seen in areas such as role appreciation and communication but not all improvements were long lasting. A perception of understaffing was noted as being one of the largest negative influences on teamwork whereas the setting and maintaining of agreed team objectives and having sufficient education opportunity were positive influences. Although teambuilding sessions appear to have the potential to produce the desired benefits, they should not be initiated at a time when staff already feel anxiety over their workload.

  20. Effectiveness of a measure program to prevent admission hypothermia in very low-birth weight preterm infants.

    PubMed

    Caldas, Jamil Pedro de Siqueira; Millen, Fernanda de Castro; Camargo, Juliana Fernandes de; Castro, Paula Almeida Cavalcanti; Camilo, Ana Letícia da Fonseca; Marba, Sérgio Tadeu Martins

    2017-09-05

    To evaluate the effectiveness of a thermoregulation bundle for preventing admission hypothermia (AH) in very low-birth weight preterm infants. Interventional study with retrospective evaluation of data undertaken in a tertiary neonatal unit including all very low-birth weight preterm infants (<1500g) born at and admitted to the unit. Two periods were compared: before intervention (PI; 01/01/2012 to 02/28/2014_ and after intervention (PII; 04/01/2014 to 11/30/2016). The intervention started in March 2014. At PI procedures in the delivery room were: placement in a crib with a radiant heat source, doors always closed, polyethylene body plastic bag, double cap (plastic and cotton mesh), room temperature between 24 to 27°C and transport to neonatal unit in a pre-heated incubator (36-377°C). At PII, there was a reinforcement on not opening the plastic bag during the entire resuscitation process, even at an advanced stage, and the anthropometric measures and routine care were performed in the neonatal unit. Maternal, delivery, and neonatal variables were compared. AH was considered when admission axillary temperature was <36.07°C. Periodic results were shown to the team every six months and results were discussed. The incidence of AH was reduced significantly in PII (37.2 vs. 14.2%, p<0.0001) and admission temperature medians were higher (36.1 vs. 36.5°C, p<0.001). At PII, there was an increase in the number of infants transported with oxygen (49.5 vs. 75.5%, p<0.0001). No differences were observed regarding birth weight and gestational age. There was a very important reduction in AH incidence and a higher median admission temperature after continued protocol implementation. Copyright © 2017 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.

  1. Selective Admission and the Public Interest. Selective Admission Series.

    ERIC Educational Resources Information Center

    McPherson, Michael S.; Schapiro, Morton Owen

    This study describes the American system of higher education's distributive mechanism in the practice of selective admission and considers possible changes in that system. Chapter One presents the work's overall approach, a three level analysis of the current system from the viewpoints of the individual student and the individual college as well…

  2. From "Admissions" to "Recruitment": The Professionalisation of Higher Education Admissions

    ERIC Educational Resources Information Center

    McClaran, Anthony

    2003-01-01

    This paper deals with the strategic pressures which are reinforcing and accelerating the professionalisation of the policies and procedures for the admission of undergraduate students to higher education (HE)in the UK. It reviews the assumptions and practices which have, until fairly recently, dominated the ways in which students are admitted and…

  3. 50 CFR 25.55 - Refuge admission permits.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 50 Wildlife and Fisheries 9 2014-10-01 2014-10-01 false Refuge admission permits. 25.55 Section 25... time reasonably and ordinarily necessary for such a visit at a particular refuge unit). (2) Golden Eagle Passport. (3) Golden Age Passport. (4) Golden Access Passport. (5) Federal Migratory Bird...

  4. 50 CFR 25.55 - Refuge admission permits.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 50 Wildlife and Fisheries 8 2011-10-01 2011-10-01 false Refuge admission permits. 25.55 Section 25... time reasonably and ordinarily necessary for such a visit at a particular refuge unit). (2) Golden Eagle Passport. (3) Golden Age Passport. (4) Golden Access Passport. (5) Federal Migratory Bird...

  5. 50 CFR 25.55 - Refuge admission permits.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 50 Wildlife and Fisheries 9 2013-10-01 2013-10-01 false Refuge admission permits. 25.55 Section 25... time reasonably and ordinarily necessary for such a visit at a particular refuge unit). (2) Golden Eagle Passport. (3) Golden Age Passport. (4) Golden Access Passport. (5) Federal Migratory Bird...

  6. 8 CFR 1235.11 - Admission of conditional permanent residents.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... petitioning spouse must file a Form I-751, Petition to Remove the Conditions on Residence, within the 90-day...) Conditional residence based on entrepreneurship. An alien seeking admission to the United States with an... Form I-829, Petition by Entrepreneur to Remove Conditions, within the 90-day period immediately...

  7. 8 CFR 1235.11 - Admission of conditional permanent residents.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... petitioning spouse must file a Form I-751, Petition to Remove the Conditions on Residence, within the 90-day...) Conditional residence based on entrepreneurship. An alien seeking admission to the United States with an... Form I-829, Petition by Entrepreneur to Remove Conditions, within the 90-day period immediately...

  8. 8 CFR 1235.11 - Admission of conditional permanent residents.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... petitioning spouse must file a Form I-751, Petition to Remove the Conditions on Residence, within the 90-day...) Conditional residence based on entrepreneurship. An alien seeking admission to the United States with an... Form I-829, Petition by Entrepreneur to Remove Conditions, within the 90-day period immediately...

  9. 50 CFR 25.55 - Refuge admission permits.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 50 Wildlife and Fisheries 9 2012-10-01 2012-10-01 false Refuge admission permits. 25.55 Section 25.55 Wildlife and Fisheries UNITED STATES FISH AND WILDLIFE SERVICE, DEPARTMENT OF THE INTERIOR (CONTINUED) THE NATIONAL WILDLIFE REFUGE SYSTEM ADMINISTRATIVE PROVISIONS Fees and Charges § 25.55 Refuge...

  10. 50 CFR 25.55 - Refuge admission permits.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 50 Wildlife and Fisheries 6 2010-10-01 2010-10-01 false Refuge admission permits. 25.55 Section 25.55 Wildlife and Fisheries UNITED STATES FISH AND WILDLIFE SERVICE, DEPARTMENT OF THE INTERIOR (CONTINUED) THE NATIONAL WILDLIFE REFUGE SYSTEM ADMINISTRATIVE PROVISIONS Fees and Charges § 25.55 Refuge...

  11. Coupling Admissions and Curricular Data to Predict Medical Student Outcomes

    ERIC Educational Resources Information Center

    Sesate, Diana B.; Milem, Jeffrey F.; McIntosh, Kadian L.; Bryan, W. Patrick

    2017-01-01

    The relative impact of admissions factors and curricular measures on the first medical licensing exam (United States Medical Licensing Exam [USMLE] Step 1) scores is examined. The inclusion of first-year and second-year curricular measures nearly doubled the variance explained in Step 1 scores from the amount explained by the combination of…

  12. Evaluation and treatment of fever in intensive care unit patients.

    PubMed

    Ferguson, Anne

    2007-01-01

    Fever is a common complaint in hospitalized patients, with estimates that more than 30% of ward patients and as much as 90% of critically ill patients will experience fever. Much of the treatment of fever, however, is based on tradition and the belief the fever is harmful to the patient rather than on scientific evidence. There is a need to determine via analysis of the literature the best evidence-based approach to the identification and treatment of fever with attention to appropriate measurement of body temperature, diagnostic evaluation, changing of indwelling catheters, administration of antipyretics, and alteration in antimicrobial therapy. The advanced practice nurse is uniquely capable of gathering this evidence and implementing a plan of care that meets the individual needs of the patient, family, nursing staff, and healthcare system.

  13. Turning Over Patient Turnover: An Ethnographic Study of Admissions, Discharges, and Transfers

    PubMed Central

    Mowinski Jennings, Bonnie; Sandelowski, Margarete; Boshamer, Cary C.; Higgins, Melinda K.

    2014-01-01

    The impact on nursing work of patient turnover (admissions, discharges, and transfers) became evident in an ethnographic study of turbulence. The patient turnover data were generated from extensive observations, 21 formal interviews, and a year of admission and discharge records on one medical and one surgical unit. Timing of turnover events on the two units differed, but on both units admissions typically interrupted workflow more than did discharges, clustered admissions were more disruptive than staggered admissions, and patient turnover during change of shift was more disruptive than during medication administration. Understanding the complexity of patient turnover will elucidate the work involved and improve the evidence base for nurse staffing, a key determinant of quality and safety of care. PMID:24242196

  14. Quality of care assessment in geriatric evaluation and management units: construction of a chart review tool for a tracer condition.

    PubMed

    Kergoat, Marie-Jeanne; Leclerc, Bernard-Simon; Leduc, Nicole; Latour, Judith; Berg, Katherine; Bolduc, Aline

    2009-07-29

    The number of elderly people requiring hospital care is growing, so, quality and assessment of care for elders are emerging and complex areas of research. Very few validated and reliable instruments exist for the assessment of quality of acute care in this field. This study's objective was to create such a tool for Geriatric Evaluation and Management Units (GEMUs). The methodology involved a reliability and feasibility study of a retrospective chart review on 934 older inpatients admitted in 49 GEMUs during the year 2002-2003 for fall-related trauma as a tracer condition. Pertinent indicators for a chart abstraction tool, the Geriatric Care Tool (GCT), were developed and validated according to five dimensions: access to care, comprehensiveness, continuity of care, patient-centred care and appropriateness. Consensus methods were used to develop the content. Participants were experts representing eight main health care professions involved in GEMUs from 19 different sites. Items associated with high quality of care at each step of the multidisciplinary management of patients admitted due to falls were identified. The GCT was tested for intra- and inter-rater reliability using 30 medical charts reviewed by each of three independent and blinded trained nurses. Kappa and agreement measures between pairs of chart reviewers were computed on an item-by-item basis. Three quarters of 169 items identifying the process of care, from the case history to discharge planning, demonstrated good agreement (kappa greater than 0.40 and agreement over 70%). Indicators for the appropriateness of care showed less reliability. Content validity and reliability results, as well as the feasibility of the process, suggest that the chart abstraction tool can gather standardized and pertinent clinical information for further evaluating quality of care in GEMU using admission due to falls as a tracer condition. However, the GCT should be evaluated in other models of acute geriatric units and new

  15. Quality of care assessment in geriatric evaluation and management units: construction of a chart review tool for a tracer condition

    PubMed Central

    Kergoat, Marie-Jeanne; Leclerc, Bernard-Simon; Leduc, Nicole; Latour, Judith; Berg, Katherine; Bolduc, Aline

    2009-01-01

    Background The number of elderly people requiring hospital care is growing, so, quality and assessment of care for elders are emerging and complex areas of research. Very few validated and reliable instruments exist for the assessment of quality of acute care in this field. This study's objective was to create such a tool for Geriatric Evaluation and Management Units (GEMUs). Methods The methodology involved a reliability and feasibility study of a retrospective chart review on 934 older inpatients admitted in 49 GEMUs during the year 2002–2003 for fall-related trauma as a tracer condition. Pertinent indicators for a chart abstraction tool, the Geriatric Care Tool (GCT), were developed and validated according to five dimensions: access to care, comprehensiveness, continuity of care, patient-centred care and appropriateness. Consensus methods were used to develop the content. Participants were experts representing eight main health care professions involved in GEMUs from 19 different sites. Items associated with high quality of care at each step of the multidisciplinary management of patients admitted due to falls were identified. The GCT was tested for intra- and inter-rater reliability using 30 medical charts reviewed by each of three independent and blinded trained nurses. Kappa and agreement measures between pairs of chart reviewers were computed on an item-by-item basis. Results Three quarters of 169 items identifying the process of care, from the case history to discharge planning, demonstrated good agreement (kappa greater than 0.40 and agreement over 70%). Indicators for the appropriateness of care showed less reliability. Conclusion Content validity and reliability results, as well as the feasibility of the process, suggest that the chart abstraction tool can gather standardized and pertinent clinical information for further evaluating quality of care in GEMU using admission due to falls as a tracer condition. However, the GCT should be evaluated in other

  16. Developing and Evaluating a Machine Learning Based Algorithm to Predict the Need of Pediatric Intensive Care Unit Transfer for Newly Hospitalized Children

    PubMed Central

    Zhai, Haijun; Brady, Patrick; Li, Qi; Lingren, Todd; Ni, Yizhao; Wheeler, Derek S.; Solti, Imre

    2014-01-01

    Background Early warning scores (EWS) are designed to identify early clinical deterioration by combining physiologic and/or laboratory measures to generate a quantified score. Current EWS leverage only a small fraction of Electronic Health Record (EHR) content. The planned widespread implementation of EHRs brings the promise of abundant data resources for prediction purposes. The three specific aims of our research are: (1) to develop an EHR-based automated algorithm to predict the need for Pediatric Intensive Care Unit (PICU) transfer in the first 24 hours of admission; (2) to evaluate the performance of the new algorithm on a held-out test data set; and (3) to compare the effectiveness of the new algorithm's with those of two published Pediatric Early Warning Scores (PEWS). Methods The cases were comprised of 526 encounters with 24-hour Pediatric Intensive Care Unit (PICU) transfer. In addition to the cases, we randomly selected 6,772 control encounters from 62,516 inpatient admissions that were never transferred to the PICU. We used 29 variables in a logistic regression and compared our algorithm against two published PEWS on a held-out test data set. Results The logistic regression algorithm achieved 0.849 (95% CI 0.753–0.945) sensitivity, 0.859 (95% CI 0.850–0.868) specificity and 0.912 (95% CI 0.905–0.919) area under the curve (AUC) in the test set. Our algorithm’s AUC was significantly higher, by 11.8 percent and 22.6 percent in the test set, than two published PEWS. Conclusion The novel algorithm achieved higher sensitivity, specificity, and AUC than the two PEWS reported in the literature. PMID:24813568

  17. Test Takers' Attitudes and Beliefs about the Graduate Management Admission Test

    ERIC Educational Resources Information Center

    Stricker, Lawrence J.; Wilder, Gita Z.; Bridgeman, Brent

    2006-01-01

    The aim of this study was to assess test takers' attitudes and beliefs about an admissions test used extensively in graduate schools of business in the United States, the Graduate Management Admission Test (GMAT), and the relationships of these attitudes and beliefs to test performance. A set of attitude and belief items was administered by…

  18. Test Takers' Attitudes and Beliefs about the Graduate Management Admission Test

    ERIC Educational Resources Information Center

    Stricker, Lawrence J.; Wilder, Gita Z.; Bridgeman, Brent

    2006-01-01

    The aim of this study was to assess test takers' attitudes and beliefs about an admissions test used extensively in graduate schools of business in the United States, the Graduate Management Admission Test (GMAT), and the relationships of these attitudes and beliefs to test performance. A set of attitude and belief items was administered by…

  19. Admission Conditions and Graduates' Employability

    ERIC Educational Resources Information Center

    Alexandre, Fernando; Portela, Miguel; Sa, Carla

    2009-01-01

    In a context of increasing competition for students, admission conditions have been used as an instrument in a strategy of differentiation. Such a strategy is guided by short-run concerns, that is, the immediate need to attract more students. This article takes a longer term view, by examining graduates' employability. The authors find that…

  20. Personal Qualities and College Admissions.

    ERIC Educational Resources Information Center

    Willingham, Warren W.; Breland, Hunter M.

    The extent to which personal and academic factors are important in college admission decisions was studied in 1978, based on data on 25,000 applicants to 9 colleges (Colgate University, Williams College, Ohio Wesleyan University, Kenyon College, Kalamazoo College, Occidental College, Hartwick College, University of Richmond, and Bucknell…

  1. The Admission-Tuition Spiral

    ERIC Educational Resources Information Center

    Huddleston, Tom, Jr.

    1973-01-01

    Admissions selectivity, far from being restricted by open-door policies, is actually spiraling with everything else-both in terms of high academic scores and finances but, unlike other forms of inflation, it leads through shrinking candidate pools to nowhere. (Author)

  2. Issues in Admissions after Bakke.

    ERIC Educational Resources Information Center

    Ravenell, Mildred W.

    1978-01-01

    The author was a member of the joint committee on behalf of the American Council on Education and the Association of American Law Schools, which prepared an interpretive working document on the Bakke decision. This paper was presented at the National Association of College Admissions Counselors, Bal Harbour, Florida, 1978. (Author)

  3. How does active substance use at psychiatric admission impact suicide risk and hospital length-of-stay?

    PubMed

    Miller, Keith A; Hitschfeld, Mario J; Lineberry, Timothy W; Palmer, Brian A

    2016-01-01

    Despite their high prevalence, little is known about the effects of substance use disorders and active substance use on the suicide risk or length-of-stay of psychiatric inpatients. This study examines the relationship between active substance use at the time of psychiatric hospitalization and changes in suicide risk measures and length-of-stay. Admission and discharge ratings on the Suicide Status Form-II-R, diagnoses, and toxicology data from 2,333 unique psychiatric inpatients were examined. Data for patients using alcohol, tetrahydrocannabinol, methamphetamines, cocaine, benzodiazepines, opiates, barbiturates, phencyclidine, and multiple substances on admission were compared with data from 1,426 admissions without substance use. Patients with substance use by toxicology on admission had a 0.9 day shorter length-of-stay compared to toxicology-negative patients. During initial nurse evaluation on the inpatient unit, these patients reported lower suicide measures (i.e., suicidal ideation frequency, overall suicide risk, and wish-to-die). No significant between-group differences were seen at discharge. Patients admitted with a substance use disorder diagnosis had a 1.0 day shorter length-of-stay than those without, while those with a substance use disorder diagnosis and positive toxicology reported the lowest measures of suicidality on admission. These results remained independent of psychiatric diagnosis. For acute psychiatric inpatients, suicide risk is higher and length-of-stay is longer in patients with substance use disorders who are NOT acutely intoxicated compared with patients without a substance use disorder. Toxicology-positive patients are less suicidal on admission and improve faster than their toxicology-negative counterparts. This study gives support to the clinical observation that acutely intoxicated patients may stabilize quickly with regard to suicidal urges and need for inpatient care.

  4. Current Pediatric Tertiary Care Admission Practices Following Adenotonsillectomy.

    PubMed

    Nardone, Heather C; McKee-Cole, Katherine M; Friedman, Norman R

    2016-05-01

    Pediatric adenotonsillectomy is a frequently performed procedure. Few studies have examined perioperative practice patterns for children undergoing adenotonsillectomy. To assess current group practice patterns associated with the perioperative care of children undergoing adenotonsillectomy for sleep-disordered breathing at tertiary care children's hospitals following the release of the 2011 American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) clinical practice guidelines. A cross-sectional survey was distributed to the chiefs of 72 pediatric otolaryngology divisions at tertiary care children's hospitals in the United States and Canada from March 25 to April 16, 2014. Internet-based survey responses from the chiefs of pediatric otolaryngology at tertiary care children's hospitals in the United States and Canada, who responded regarding group, rather than individual, practices. Of the 72 surveys sent, 48 responses (67%) were received. Twenty-one respondents (44%) reported that their group has no official admission policy for children with sleep-disordered breathing. Seventy-three percent (29 of 40) reported using some measure of obesity as a criterion for postoperative admission. The AAO-HNS polysomnography criteria for severe obstructive sleep apnea were used by 40% of respondents (16 of 40) as admission criteria, whereas 15% (6 of 40) used the American Academy of Pediatrics criteria for severe obstructive sleep apnea. Seventy-three percent (29 of 40) reported requiring a child to be asleep while breathing room air without oxygen desaturation before discharge to home. An established minimum time for observation was reported by 43 of the respondents (90%). Institution size or volume of adenotonsillectomies performed did not affect the results. Many tertiary care children's hospitals in the United States do not have an official admission policy to guide adenotonsillectomy care. Even for institutions that do have an official admission policy, the policies

  5. Home management of hematological patients requiring hospital admission.

    PubMed

    Isaia, Gianluca; Tibaldi, Vittoria; Astengo, Marco; Ladetto, Marco; Marinello, Renata; Bo, Mario; Michelis, Giuliana; Ruatta, Fiorella; Ricauda, Nicoletta Aimonino

    2010-01-01

    The hospital-at-home service (HHS) could be considered as an alternative to the traditional ward for elderly patients. We aimed at evaluating the home management of elderly people requiring transfusions. The ever-increasing demand on acute hospital services requires alternative methods of delivering all aspects of health care. HHS demonstrated to be as efficacious as a traditional ward for elderly and functionally compromised patients. The method was a retrospective descriptive study enrolling patients needing an hospital admission from 1st January 2007 to 31st December 2007 and reporting an hematological discharge's diagnosis as primary or secondary diagnosis. A total of 54 patients were evaluated in this study. Of them, 34 (62.9%) needed a hemocomponent transfusion for a total volume of 112 blood units and 49 platelet pools. Patients requiring at least one blood or platelet transfusion were more functionally compromised and presented a higher level of acute physiology and chronic health evaluation, compared to the non-transfused ones. The conclusion was that hematological subjects mainly the frail ones and functionally highly compromised with acute illnesses could be treated at home as an alternative of the traditional medical ward. This could be the starting point for future studies that will be able to increase the power of hospital-at-home service for this type of patients.

  6. Challenging Appraisal Orthodoxies: Teacher Evaluation and Professional Development in the United Arab Emirates

    ERIC Educational Resources Information Center

    Mercer, Justine

    2005-01-01

    This paper presents findings from a 4-year study of faculty appraisal at two higher education institutions (HEIs) in the United Arab Emirates (UAE). It finds that neither teachers nor academic managers are opposed to evaluative appraisal, and, contrary to much of the literature, most are happy for evaluative and developmental elements to be…

  7. University-Based Evaluation Training Programs in the United States 1980-2008: An Empirical Examination

    ERIC Educational Resources Information Center

    LaVelle, John M.; Donaldson, Stewart I.

    2010-01-01

    Evaluation practice has grown in leaps and bounds in recent years. In contrast, the most recent survey data suggest that there has been a sharp decline in the number and strength of preservice evaluation training programs in the United States. In an effort to further understand this curious trend, an alternative methodology was used to examine the…

  8. University-Based Evaluation Training Programs in the United States 1980-2008: An Empirical Examination

    ERIC Educational Resources Information Center

    LaVelle, John M.; Donaldson, Stewart I.

    2010-01-01

    Evaluation practice has grown in leaps and bounds in recent years. In contrast, the most recent survey data suggest that there has been a sharp decline in the number and strength of preservice evaluation training programs in the United States. In an effort to further understand this curious trend, an alternative methodology was used to examine the…

  9. An Analysis of Grades, Class Level and Faculty Evaluation Scores in the United Arab Emirates

    ERIC Educational Resources Information Center

    Waller, Lee

    2016-01-01

    This study examined the results of a student evaluation of faculty against the grades awarded and the level of the course for a higher education institution in the United Arab Emirates. The purpose of the study was to determine if the grades awarded in the course and/or level of the course impacted the evaluation scores awarded to the faculty…

  10. The Analysis of Teaching Effectiveness Evaluation Programs in Geography Departments in the United States

    ERIC Educational Resources Information Center

    Cooper, Brian J.

    2012-01-01

    Teaching evaluation systems are an important part of the total evaluation of faculty in geography departments in the United States. As demands for accountability for teaching effectiveness continue to emerge from many groups, it has become increasingly important for geography departments to develop systems that not only provide teaching…

  11. Mobile Unit to Provide Vocational Evaluation for Handicapped Children. Final Report.

    ERIC Educational Resources Information Center

    Baltimore County Board of Education, Towson, MD.

    Presented is the final report of a 3-year project (1970-73) to provide vocational evaluation in a mobile unit for the 330 intellectually limited students in grade 10 special classes in the Baltimore County schools. Main project aims are given to be evaluation at home schools and subsequent development of recommendations for using school and…

  12. Admissions file review: applying the multiple independent sampling (MIS) methodology.

    PubMed

    Hanson, Mark D; Kulasegaram, Kulamakan Mahan; Coombs, Deborah L; Herold, Jodi

    2012-10-01

    Although multiple independent sampling (MIS) has been adapted for admissions interviews, its application for assessing written materials in the admissions file has been limited. Currently, admissions file review at the University of Toronto medical school involves one rater per file to enable holistic assessment, which may introduce a halo effect-that is, impressions of one component influencing the evaluation of other components. The authors examined whether MIS file review, through which multiple raters evaluate specific file components independently, may reduce this effect. The authors selected a stratified random sample of 300 applicant files from the 2010-2011 admissions cycle for rescoring by MIS. They divided each of the 300 applicant files into their four components (academic transcript, autobiographical sketch, personal statement, reference letters) and rebundled them into packages of 38 same-component items (purposely creating some overlap among packages to assess inter-rater reliability). The authors distributed each package to 1 of 36 raters; thus, each rater evaluated only one of four components across many applicants. The authors compared the inter-component reliability and factor analysis of MIS with that of holistic scoring. Ratings were returned for all applicants. Inter-component reliability (Cronbach alpha) was 0.69 for holistic scoring and 0.29 for MIS. Factor analysis showed all components loading heavily onto one factor in the holistic approach and onto three factors in the MIS method. Using MIS to assess the admissions file may reduce the halo effect and should be considered when evaluating applicants' written submissions.

  13. Pressurized thermal shock evaluation of the Calvert Cliffs Unit 1 Nuclear Power Plant

    SciTech Connect

    Abbott, L

    1985-09-01

    An evaluation of the risk to the Calvert Cliffs Unit 1 nuclear power plant due to pressurized thermal shock (PTS) has been completed by Oak Ridge National Laboratory (ORNL) with the assistance of several other organizations. This evaluation was part of a Nuclear Regulatory Commission program designed to study the PTS risk to three nuclear plants, the other two plants being Oconee Unit 1 and H.B. Robinson Unit 2. The specific objectives of the program were to (1) provide a best estimate of the frequency of a through-the-wall crack in the pressure vessel at each of the three plants, together with the uncertainty in the estimated frequency and its sensitivity to the variables used in the evaluation; (2) determine the dominant overcooling sequences contributing to the estimated frequency and the associated failures in the plant systems or in operator actions; and (3) evaluate the effectiveness of potential corrective measures.

  14. Somnambulism: Emergency Department Admissions Due to Sleepwalking-Related Trauma

    PubMed Central

    Sauter, Thomas C.; Veerakatty, Sajitha; Haider, Dominik G.; Geiser, Thomas; Ricklin, Meret E.; Exadaktylos, Aristomenis K.

    2016-01-01

    Introduction Somnambulism is a state of dissociated consciousness, in which the affected person is partially asleep and partially awake. There is pervasive public opinion that sleepwalkers are protected from hurting themselves. There have been few scientific reports of trauma associated with somnambulism and no published investigations on the epidemiology or trauma patterns associated with somnambulism. Methods We included all emergency department (ED) admissions to University Hospital Inselspital, Berne, Switzerland, from January 1, 2000, until August 11, 2015, when the patient had suffered a trauma associated with somnambulism. Demographic data (age, gender, nationality) and medical data (mechanism of injury, final diagnosis, hospital admission, mortality and medication on admission) were included. Results Of 620,000 screened ED admissions, 11 were associated with trauma and sleepwalking. Two patients (18.2%) had a history of known non-rapid eye movement parasomnias. The leading cause of admission was falls. Four patients required hospital admission for orthopedic injuries needing further diagnostic testing and treatment (36.4%). These included two patients with multiple injuries (18.2%). None of the admitted patients died. Conclusion Although sleepwalking seems benign in the majority of cases and most of the few injured patients did not require hospitalization, major injuries are possible. When patients present with falls of unknown origin, the possibility should be evaluated that they were caused by somnambulism. PMID:27833677

  15. Effects of time and day of admission on the outcome of critically ill patients admitted to ICU

    PubMed Central

    Orsini, Jose; Rajayer, Salil; Ahmad, Noeen; Din, Nanda; Morante, Joaquin; Malik, Ryan; Shim, Ahmed

    2016-01-01

    Background Studies have shown that patients admitted to hospitals on weekends and after-hours experience worse outcome than those admitted on weekdays and daytime hours. Although admissions of patients to intensive care units (ICUs) occur 24 hours a day, not all critical care units maintain the same level of staffing during nighttime, weekends, and holidays. This raises concerns in view of evidence showing that the organizational structure of an ICU influences the outcome of critically ill patients. The objective of this study is to evaluate the effects of day and time of admission to ICU on patients’ outcome. Methods A single-center, prospective, observational study was conducted among all consecutive admissions to ICU in a community teaching hospital during a 4-month period. Results A total of 282 patients were admitted during the study period. Their mean age was 59.5 years (median 59, range 17–96), and the majority were male (157, 55.7%). Mean Acute Physiology and Chronic Health Evaluation (APACHE)-II score was 18.9 (median 33, range 1–45), and mean ICU length of stay was 3.1 days (median 2, range 1–19). Of the patients, 104 patients (36.9%) were admitted during weekends and 178 (63.1%) during weekdays. A total of 122 patients (43.3%) were admitted after-hours, constituting 68.5% of all admissions during weekdays. Fifty-six patients (19.9%) were admitted during daytime hours, representing 31.5% of all weekday admissions. Forty-five patients (15.9%) died in ICU. Compared to patients admitted on weekends, those admitted on weekdays had increased ICU mortality (operating room (OR)=0.437; 95% confidence interval=0.2054–0.9196; p=0.0293). Conclusion Admissions to ICU during weekends were not independently associated with increased mortality. A linear relationship between weekdays and after-hours admissions to ICU with mortality was observed at our institution. PMID:27987290

  16. Psychological implications of admission to critical care.

    PubMed

    Pattison, Natalie

    Admission to critical care can have far-reaching psychological effects because of the distinct environment. Critical care services are being re-shaped to address long-term sequelae, including post-traumatic stress disorder, anxiety and depression. The long-term consequences of critical illness not only cost the individual, but also have implications for society, such as diminished areas of health-related quality-of-life in sleep, reduced ability to return to work and enjoy recreational activities (Audit Commission, 1999; Hayes et al, 2000). The debate around the phenomenon of intensive care unit (ICU) syndrome is discussed with reference to current thinking. After critical care, patients may experience amnesia, continued hallucinations or flashbacks, anxiety, depression, and dreams and nightmares. Nursing care for patients while in the critical care environment can have a positive effect on psychological well-being. Facilitating communication, explaining care and rationalizing interventions, ensuring patients are oriented as to time and place, reassuring patients about transfer, providing patients,where possible, with information about critical care before admission and considering anxiolytic use, are all practices that have a beneficial effect on patient care. Follow-up services can help patients come to terms with their experiences of critical illness and provide the opportunity for them to access further intervention if desired. Working towards providing optimal psychological care will have a positive effect on patients' psychological recovery and may also help physical recuperation after critical care.

  17. Admission avoidance hospital at home.

    PubMed

    Shepperd, Sasha; Iliffe, Steve; Doll, Helen A; Clarke, Mike J; Kalra, Lalit; Wilson, Andrew D; Gonçalves-Bradley, Daniela C

    2016-09-01

    Admission avoidance hospital at home provides active treatment by healthcare professionals in the patient's home for a condition that otherwise would require acute hospital inpatient care, and always for a limited time period. This is the third update of the original review. To determine the effectiveness and cost of managing patients with admission avoidance hospital at home compared with inpatient hospital care. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, two other databases, and two trials registers on 2 March 2016. We checked the reference lists of eligible articles. We sought unpublished studies by contacting providers and researchers who were known to be involved in the field. Randomised controlled trials recruiting participants aged 18 years and over. Studies comparing admission avoidance hospital at home with acute hospital inpatient care. We followed the standard methodological procedures expected by Cochrane and the Effective Practice and Organisation of Care (EPOC) Group. We performed meta-analysis for trials that compared similar interventions and reported comparable outcomes with sufficient data, requested individual patient data from trialists, and relied on published data when this was not available. We used the GRADE approach to assess the certainty of the body of evidence for the most important outcomes. We included 16 randomised controlled trials with a total of 1814 participants; three trials recruited participants with chronic obstructive pulmonary disease, two trials recruited participants recovering from a stroke, six trials recruited participants with an acute medical condition who were mainly elderly, and the remaining trials recruited participants with a mix of conditions. We assessed the majority of the included studies as at low risk of selection, detection, and attrition bias, and unclear for selective reporting and performance bias. Admission avoidance hospital at home probably makes little

  18. Evaluation of unit risk factors in support of the Hanford Remedial Action Environmental Impact Statement

    SciTech Connect

    Strenge, D.L.; Chamberlain, P.J. II

    1994-11-01

    This report describes the generation of unit risk factors for use with the Graphical Information System (GIS) being developed by Advanced Sciences, Inc. for the Hanford Remedial Action Environmental Impact Statement. The GIS couples information on source inventory and environmental transport with unit risk factors to estimate the potential risk from contamination at all locations on the Hanford Site. The major components of the effort to generate the unit risk factors were: determination of pollutants to include in the study, definition of media of concern, and definition of exposure assessment scenarios, methods, and parameters. The selection of pollutants was based on inventory lists which indicated the pollutants likely to be encountered at the known waste sites. The final pollutants selected included 47 chemical pollutants and 101 radionuclides. Unit risk factors have been generated for all 148 pollutants per unit initial concentration in five media: soil (per unit mass), soil (per unit area), air, groundwater, and surface water. The exposure scenarios were selected as the basis for the unit risk factor generation. The endpoint in the exposure assessment analysis is expressed as risk of developing cancer for radionuclides and carcinogenic chemicals. For noncarcinogenic chemicals, the risk endpoint is the hazard quotient. The cancer incidence and hazard quotient values are evaluated for all exposure pathways, pollutants, and scenarios. The hazard index values and unit risk values are used by the GIS to produce maps of risk for the Hanford Site.

  19. Effectiveness and outcomes of a nurse practitioner-run chest pain evaluation unit.

    PubMed

    Zhu, Zahra; Islam, Sirajul; Bergmann, Steven R

    2016-11-01

    Every year, more than 5 million patients seek medical care for chest pain. The goal of this study was to evaluate test utilization and outcomes of a nurse practitioner (NP)-based chest pain unit and compare results to data previously reported from our institution. The records from 814 consecutive patients with chest pain admitted to the NP-run unit were compared to the outcomes of 250 patients admitted to a separate hospitalist-run unit at a New York City hospital. Forty-four percent of patients in the NP unit underwent stress myocardial perfusion imaging (MPI) as the primary diagnostic test (compared to 22% in the hospitalist unit, p < .0001). The average length of stay was shorter for patients in the NP unit (2.7 ± 3.6 days compared to 3.9 ± 3.4 days, p < .0001). Additionally, the 90-day readmission rate was less for patients in the NP unit (2.7% vs. 3.9%, p < .0006). An NP-run chest pain unit resulted in decreased length of stay and reduced readmission rates compared to a hospitalist-based unit. ©2016 American Association of Nurse Practitioners.

  20. Nurse staffing and patient care costs in acute inpatient nursing units.

    PubMed

    Li, Yu-Fang; Wong, Edwin S; Sales, Anne E; Sharp, Nancy D; Needleman, Jack; Maciejewski, Matthew L; Lowy, Elliott; Alt-White, Anna C; Liu, Chuan-Fen

    2011-08-01

    Studies suggest that a business case for improving nurse staffing can be made to increase registered nurse (RN) skill mix without changing total licensed nursing hours. It is unclear whether a business case for increasing RN skill mix can be justified equally among patients of varying health needs. This study evaluated whether nursing hours per patient day (HPPD) and skill mix are associated with higher inpatient care costs within acute medical/surgical inpatient units using data from the Veterans Health Administration. Retrospective cross-sectional study, including 139,360 inpatient admissions to 292 acute medical/surgical units at 125 Veterans Health Administration medical centers between February and June 2003, was conducted. Dependent variables were inpatient costs per admission and costs per patient day. The average costs per surgical and medical admission were $18,624 and $6,636, respectively. Costs per admission were positively associated with total nursing HPPD among medical admissions ($164.49 per additional HPPD, P<0.001), but not among surgical admissions. Total nursing HPPD and RN skill mix were associated with higher costs per hospital day for both medical admissions ($79.02 per additional HPPD and $5.64 per 1% point increase in nursing skill mix, both P<0.001) and surgical admissions ($112.47 per additional HPPD and $13.31 per 1% point increase in nursing skill mix, both P<0.001). Patients experiencing complications or transferring to an intensive care unit had higher inpatient costs than other patients. The association of nurse staffing level with costs per admission differed for medical versus surgical admissions.