Levene, S; Bonfield, G
Eight hospitals reported 781 non-iatrogenic accidents occurring to patients and visitors under 16 years of age during an 18 month period up to October 1989. Accidents more often involved boys and children aged 3 to 5 years old. Falls from a height, slips, and striking accidents were common by day and falls by night. A total of 41% of accidents to inpatients occurred when parents were present. Only three accidents were serious. Altogether 27% involved beds and cots, and only one consequent injury was more than minor. Data collected routinely in case of medicolegal action can be presented in a form that may facilitate preventative work. Potentially remediable causes for concern include falls from beds and cots and the use of makeshift equipment. PMID:1929510
Noble, W. C.
The air of three hospital wards was examined frequently for staphylococci for a period of nearly four years using slit samplers. `Broadcasts' of staphylococci into the air were observed with the air count rising well above the mean of 0·2 staphylococcal particle per cubic foot and these broadcasts often appeared to be due to single patients. Eight of the 3,675 patients admitted to the wards possessed an ability to disperse staphylococci into the air of the wards which was markedly greater than normal. The actual dispersal about the ward appeared to be mediated by the bedclothes, for, when these were disturbed, large numbers of staphylococci were disseminated into the air. PMID:16810990
A case of scabies has been diagnosed in the Medical Ward where Sophie works, and the hospital is having to take appropriate measures. Scabies mites can spread quickly, and staff who are in contact with the infected patient risk catching the parasites and contaminating their own family in turn. One of the night nurses is probably infected.
Tsuji, Keiko; Matsumoto, Maki; Takai, Kiyako; Kodama, Hiromi; Hagiwara, Tomoko; Iwata, Naomi
Environmental design should be required at medical facilities for conducting medical practice safely and for making hospitalization comfortable. Many medical nursing students cannot imagine medical facilities, especially hospital wards, when they study medical environments in a basic nursing lecture. As a result, they cannot connect well with patient assistance. We employed a computer assisted designing software, "3D My Home Designer" (Mega Soft Company) that runs on Windows 8, and considered the usefulness of it for lectures on environmental design showing how to design a hospital ward for patients' optimal hospital stay. We drew a medical facility in 2-D first, transformed it into 3D images, and then created movies of a virtual hospital ward in which a patient walked around. These movies consisted of 3 kinds: a) hospital room with changeable wall color, b) different allocations of hospital room and nurse station, and c) a blurred ward which corresponded to how a patient with poor eyesight (cataract) would see a ward. We prepared as controls: a') still images of a hospital room, b') still images of ward, and c') a documentation on how a ward is seen by a patient with a cataract. We gave a questionnaire to students and nurses about these movies and still images (controls). In a) and b), there were no differences between the movies and still images in both students and nurses. In c), both students and nurses had a viewpoint from the patient with poor eyesight. From these results, we consider that the students, who have fewer experiences in a hospital, may understand the environments well by movies and the application of a virtual movie ward to nursing education may be useful in a lecture, depending on the readiness of the students.
19. First and Second Floors. Ward 'K', Letterman General Hospital, Presidio of San Francisco, Cal. Sheet No. 1. May 1917. BUILDING 1049. - Presidio of San Francisco, Letterman General Hospital, Building No. 12, Letterman Hospital Complex, Edie Road, San Francisco, San Francisco County, CA
20. West Elevation and Section, Ward 'K', Letterman General Hospital, Presidio of San Francisco, Cal. Sheet No. 2. May 1917. BUILDING 1049. - Presidio of San Francisco, Letterman General Hospital, Building No. 12, Letterman Hospital Complex, Edie Road, San Francisco, San Francisco County, CA
Some of the problems of ward management are reviewed. Methods suggested for dealing with them are probably not the ideals that should ultimately be attained but minimum standards to serve as immediate objectives. They concern indications for and methods of isolation, control of infection from staff, environmental contamination, and a few technical procedures. A new type of dressing towel for wounds is described.
Some of the problems of ward management are reviewed. Methods suggested for dealing with them are probably not the ideals that should ultimately be attained but minimum standards to serve as immediate objectives. They concern indications for and methods of isolation, control of infection from staff, environmental contamination, and a few technical procedures. A new type of dressing towel for wounds is described. Images PMID:16810967
Yam, R; Yuen, P L; Yung, R; Choy, T
Indoor ventilation with good air quality control minimises the spread of airborne respiratory and other infections in hospitals. This article considers the role of ventilation in preventing and controlling infection in hospital general wards and identifies a simple and cost-effective ventilation design capable of reducing the chances of cross-infection. Computational fluid dynamic (CFD) analysis is used to simulate and compare the removal of microbes using a number of different ventilation systems. Instead of the conventional corridor air return arrangement used in most general wards, air return is rearranged so that ventilation is controlled from inside the ward cubicle. In addition to boosting the air ventilation rate, the CFD results reveal that ventilation performance and the removal of microbes can be significantly improved. These improvements are capable of matching the standards maintained in a properly constructed isolation room, though at much lower cost. It is recommended that the newly identified ventilation parameters be widely adopted in the design of new hospital general wards to minimise cross-infection. The proposed ventilation system can also be retrofitted in existing hospital general wards with far less disruption and cost than a full-scale refurbishment. Copyright Â© 2010 The Hospital Infection Society. Published by Elsevier Ltd. All rights reserved.
Jones, Joanne; Carroll, Andrea
The ageing British population is placing increased demands on the delivery of care in mainstream health-care institutions. While people are living longer, a significant percentage is also living with one or more long-term conditions. These issues, alongside continuing financial austerity measures, require a radical improvement in the care of patients away from hospitals. The Wyre Forest Clinical Commissioning Group introduced a virtual ward model for two main purposes: to save on spiralling costs of hospital admissions, and, secondly, to ensure the preferred wishes of most patients to be cared for and even die at home were achieved. This commentary describes how the virtual ward model was implemented and the impact of preventing unplanned emergency admissions to hospitals. The setting up of enhanced care services and virtual wards in one county is discussed, aiming to highlight success points and potential pitfalls to avoid. The results from the implementation of the virtual ward model show a significant reduction in emergency and avoidable patient admissions to hospital. The success of virtual wards is dependent on integrated working between different health-care disciplines.
Luvira, Viravarn; Iamsirithaworn, Sopon; Thantamnu, Narumon; Pitisuttiithum, Punnee
In June 2012, an outbreak of Salmonella group C gastroenteritis occurred on a single hospital ward among 54.2% (13/24) of volunteers undergoing an unrelated clinical trial and among 14.3% (1/7) hospital ward worker. Food-borne transmission was suspected, so a retrospective cohort study was conducted to identify the vehicle of the outbreak along with implementing outbreak control measures. None of the food items was significantly associated with the outbreak. An epidemic curve suggests a common source of the outbreak. No cases were reported after outbreak control. Food should be stored, cooked and handled using strict hygiene to prevent future outbreaks.
Bhattacharjee, Poushali; Edelson, Dana P; Churpek, Matthew M
Sepsis contributes to up to half of all deaths in hospitalized patients, and early interventions, such as appropriate antibiotics, have been shown to improve outcomes. Most research has focused on early identification and treatment of patients with sepsis in the ED and the ICU; however, many patients acquire sepsis on the general wards. The goal of this review is to discuss recent advances in the detection of sepsis in patients on the hospital wards. We discuss data highlighting the benefits and limitations of the systemic inflammatory response syndrome (SIRS) criteria for screening patients with sepsis, such as its low specificity, as well as newly described scoring systems, including the proposed role of the quick sepsis-related organ failure assessment (qSOFA) score. Challenges specific to detecting sepsis on the wards are discussed, and future directions that use big data approaches and automated alert systems are highlighted. Copyright © 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.
Hayden, Ellen T.; Benson, Robert T.
This curriculum guide consists of materials for use in teaching a course in job skills for hospital ward clerks. Included in the front matter of the guide are an introduction, guidelines for using the guide, and a course outline. The second section contains a job description, seven categories of job duties and tasks, a final examination, sample…
Picture postcards were as popular in the beginning of the twentieth century as social media is today. Hospital wards were also depicted on them. It is curious to note the similarities between these pictures. This can be explained by developments in the architecture of hospitals. This architecture underwent radical changes in the second half of the nineteenth century: to prevent complications caused by infections, patients were cared for in pavilions. Light, clean air and space did indeed result in a considerable reduction of these complications. The prototype of such a pavilion in the Charité Hospital in Berlin was brought to fruition in many countries. This explains the remarkable uniformity of hospital wards found on old picture postcards.
History of ventilation in last 100 years, showing reversal of ideas and influence of sanatorium idea. Physiology of cool moving air. How it affects metabolism, heat-loss and heat-production. Relation to sunlight. Reactive capacity of the individual. Practice of these teachings, as illustrated by sanatorium treatment of tuberculosis and by open-air schools. Exposure to cooling air a powerful therapeutic agent. Infrequent occurrence in sanatoria of diseases or complications often ascribed to cold. Dilution of infection. Applicability to diseases other than tuberculosis. Shock and old age. Perflation and diffusion, their relative values. Uniformity or variability of effect desirable? Incompatibility of good ventilation and ordinary standards of heating. Former the more important. Conclusion that ward temperatures may be lowered without harm. Measures necessary to compensate, clothing, classification of patients, small wards. Changing standards of comfort. Psychological effects. Systems of ventilation in hospital wards. Mechanical by propulsion or extraction being displaced by natural system, usually by cross-window ventilation. Supplementary ventilators. Objection to heating of incoming air. Fallibility of human factor in management. Sash versus casement windows. Hoppers. Austral window. Orientation and exposure of wards. Ventilation of small wards. Proportion of window space to solid wall. Balconies. Floor space. Heating of wards. Heating of air or floor or walls. Open fires. Value of radiant heat. Steam or water under low or high pressure. Radiators or pipes. Lighting. Avoidance of glare from windows. Arrangement of beds in wards. Colour of walls. Blinds and curtains. Artificial lighting. ImagesFig. 1Fig. 2Fig. 3Fig. 4Fig. 5 PMID:19989481
Smith, R. M.; Rae, A.
The patient is identified as being of prime importance for comfort standards in hospital ward areas, other ward users being expected to adjust their dress to suit the conditions necessary for patients comfort. A study to identify the optimum steady state conditions for patients comfort is then described. Although this study raises some doubts as to the applicability of the standard thermal comfort assessment techniques to ward areas, it is felt that its results give a good indication of the steady-state conditions preferred by the patients. These were an air temperature of between 21-5 degrees and 22 degrees C and a relative humidity of between 30% and 70%, where the air velocity was less than 0-1 m/s and the mean radiant temperature was close to air temperature. PMID:264497
Herrero Gámiz, S; Martínez de Albornoz Torrente, P; Navarro Vidal, B; Salvador Alvarez, E; Villacorta Pérez, J; San Juan Garrido, R; Aguado García, J M
Information regarding the use intravenous catheters (IVC) in conventional hospital units and its consequence in terms of intravenous catéter-related bacteremia (ICRB) is scarce. To evaluate the use of IVC in patients admitted in conventional wards of a general hospital and to measure IVCRB incidence in such patients. We evaluated during one week IVC use in adult patients admitted in 12 de Octubre Hospital and we calculated la incidence density of ICRB. We evaluated the clinical charts of 731 patients (284 from medical wards and 447 from surgical wards), of which 338 (46.2%) had a peripheral VC inserted and 63 (8.6%) a central IVC. Central IVC had been inserted for a mean time 11.5 days globally (CI 95% 5.57-17.42), being 28.3 in medical wards and 8.32 days in surgical wards (p = 0.2). In 27.7 % of the patients with IVC intravenous antimicrobials was the only reason for the use of such catheters in spite of adequate oral tolerance in 30 % of the patients with central IVC an specific note explaining the reason for implanting such catheter was lacking in the clinical chart. IVCRB was detected in 12/401 patients (3%). The incidence density of IVCRB in central IVC was 8.28 per 1000 catheter-days. There are some aspects that could be clearly improved regarding the prevention of IVCRB, mostly in the indications, the excess of time those catheters are kept implanted and in the lost chances for catheter withdrawal when switch-therapy could be performed.
Fortini, Alberto; Morettini, Alessandro; Tavernese, Giuseppe; Facchini, Sofia; Tofani, Lorenzo; Pazzi, Maddalena
A prospective observational study was conducted to evaluate the impact of delirium on geriatric inpatients in internal medical wards and to identify predisposing factors for the development of delirium. The study included all patients aged 65 years and older, who were consecutively admitted to the internal medicine wards of two public hospitals in Florence, Italy. On admission, 29 baseline risk factors were examined, cognitive impairment was evaluated by Short Portable Mental Status Questionnaire, and prevalent delirium cases were diagnosed by Confusion Assessment Method (CAM). Enrolled patients were evaluated daily with CAM to detect incident delirium cases. Among the 560 included patients, 19 (3 %) had delirium on admission (prevalent) and 44 (8 %) developed delirium during hospitalization (incident). Prevalent delirium cases were excluded from the statistical analysis. Incident delirium was associated with increased length of hospital stay (p < 0.01) and institutionalization (p < 0.01, OR 3.026). Multivariate analysis found that cognitive impairment on admission (p < 0.0002), diabetes (p < 0.05, OR 1.936), chronic kidney failure (p < 0.05, OR 2.078) and male gender (p < 0.05, OR 2.178) was significantly associated with the development of delirium during hospitalization. Results show that delirium impact is relevant to older patients hospitalized in internal medicine wards. The present study confirms cognitive impairment as a risk factor for incident delirium. The cognitive evaluation proved to be an important instrument to improve identification of patients at high risk for delirium. In this context, our study may contribute to improve application of preventive strategies.
Toscani, Franco; Di Giulio, Paola; Brunelli, Cinzia; Miccinesi, Guido; Laquintana, Dario
To describe how patients die in hospital, 370 patients (age >18 years; in hospital for>24 hours) who died on the general wards of 40 Italian hospitals were assessed. Differences between patients whose death was expected and patients whose death was unexpected were evaluated. Data on treatments and care in proximity of death were collected after interviewing the nurse responsible for the patient within 72 hours of the patient's death, and from clinical and nursing records. For 58% of patients, death was highly expected. Symptom control was inadequate for the most severely ill patients: 75% experienced at least one "severe" symptom (42% pain and 45% dyspnea). Nurses tended to judge patients' global care as "good" or "very good" (76%), in spite of the persistence of symptoms and the scant use of analgesics. Despite some encouraging signs of sensitivity to end-of-life problems, acute inpatient institutions in Italy still deal inadequately with the needs of dying persons.
Lám, Judit; Rózsa, Erzsébet; Kis Szölgyémi, Mónika; Belicza, Eva
Medication errors occur very frequently. The limited knowledge of contributing factors and risks prevents the development and testing of successful preventive strategies. To investigate the differences between the ordered and dispensed drugs, and to identify the risks during medication. Prospective direct observation at two inpatient hospital wards. The number of observed doses was 775 and the number of ordered doses was 806. It was found that from the total opportunities of 803 errors 114 errors occurred in dispensed drugs corresponding to an error rate of 14.1%. Among the different types of errors, the most important errors were: dispensing inappropriate doses (25.4%), unauthorized tablet halving or crushing (24.6%), omission errors (16.4%) and dispensing an active ingredient different from the ordered (14.2%). 87% of drug dispensing errors were considered as errors with minor consequences, while 13% of errors were potentially serious. Direct observation of the drug dispensing procedure appears to be an appropriate method to observe errors in medication of hospital wards. The results of the study and the identified risks are worth to be reconsidered and prevention measures should be applied to everyday health care practice to improve patient safety.
Heaven, Ben; Bamford, Claire; May, Carl; Moynihan, Paula
Approximately 60 per cent of UK patients aged 65 years or older are at risk of malnutrition or their situation worsening while in hospital. We report the results of a qualitative study embedded in research to prevent malnutrition in older people in hospital (the mappmal study). Our aim was to understand and describe processes that promote or inhibit nutrition in hospital. Throughout 2009 we examined meal services at four UK hospital sites across two regional locations, focusing on older patients admitted with dementia, for stroke or for fractured neck of femur. Data were collected through semi-structured interviews with National Health Service staff (n = 54), stakeholders (n = 6), and a focus group with former patients and carers (n = 5). We identified ward-based food work as a technical and interpersonal challenge in narratives around malnutrition. Food work constituted two overlapping spheres of activity: interpersonal engagement through feeding assistance and reassurance and the arrangement of resources that facilitate meals such as the preparation of food trolleys. Our analysis is framed by the literature on emotional labour, dirty work and the professionalisation of nursing. We demonstrate how food work is overlooked by being conceptualised as common sense and as one of the most mundane and elementary tasks in hospitals.
Churpek, Matthew M.; Yuen, Trevor C.
Patients who suffer adverse events on the wards, such as cardiac arrest and death, often have vital sign abnormalities hours before the event. Early warning scores have been developed with the aim of identifying clinical deterioration early and have been recommended by the National Institute for Health and Clinical Excellence. In this review, we discuss recently developed and validated risk scores for use on the general inpatient wards. In addition, we compare newly developed systems with more established risk scores such as the Modified Early Warning Score and the criteria used in the Medical Early Response Intervention and Therapy (MERIT) trial in our database of > 59,000 ward admissions. In general we found the single-parameter systems, such as the MERIT criteria, to have the lowest predictive accuracy for adverse events, whereas the aggregate weighted scoring systems had the highest. The Cardiac Arrest Risk Triage (CART) score was best for predicting cardiac arrest, ICU transfer, and a composite outcome (area under the receiver operating characteristic curve [AUC], 0.83, 0.77, and 0.78, respectively), whereas the Standardized Early Warning Score, VitalPAC Early Warning Score, and CART score were similar for predicting mortality (AUC, 0.88). Selection of a risk score for a hospital or health-care system should be guided by available variables, calculation method, and system resources. Once implemented, ensuring high levels of adherence and tying them to specific levels of interventions, such as activation of a rapid response team, are necessary to allow for the greatest potential to improve patient outcomes. PMID:23732586
Churpek, Matthew M; Yuen, Trevor C; Edelson, Dana P
Patients who suffer adverse events on the wards, such as cardiac arrest and death, often have vital sign abnormalities hours before the event. Early warning scores have been developed with the aim of identifying clinical deterioration early and have been recommended by the National Institute for Health and Clinical Excellence. In this review, we discuss recently developed and validated risk scores for use on the general inpatient wards. In addition, we compare newly developed systems with more established risk scores such as the Modified Early Warning Score and the criteria used in the Medical Early Response Intervention and Therapy (MERIT) trial in our database of > 59,000 ward admissions. In general we found the single-parameter systems, such as the MERIT criteria, to have the lowest predictive accuracy for adverse events, whereas the aggregate weighted scoring systems had the highest. The Cardiac Arrest Risk Triage (CART) score was best for predicting cardiac arrest, ICU transfer, and a composite outcome (area under the receiver operating characteristic curve [AUC], 0.83, 0.77, and 0.78, respectively), whereas the Standardized Early Warning Score, VitalPAC Early Warning Score, and CART score were similar for predicting mortality (AUC, 0.88). Selection of a risk score for a hospital or health-care system should be guided by available variables, calculation method, and system resources. Once implemented, ensuring high levels of adherence and tying them to specific levels of interventions, such as activation of a rapid response team, are necessary to allow for the greatest potential to improve patient outcomes.
Virtanen, Marianna; Pentti, Jaana; Vahtera, Jussi; Ferrie, Jane E; Stansfeld, Stephen A; Helenius, Hans; Elovainio, Marko; Honkonen, Teija; Terho, Kirsi; Oksanen, Tuula; Kivimäki, Mika
This report assessed whether hospital ward overcrowding predicts antidepressant use among hospital staff. The extent of hospital ward overcrowding was determined using administrative records of monthly bed occupancy rates between 2000 and 2004 in 203 somatic illness wards in 16 Finnish hospitals providing specialized health care. Information on job contracts for personnel was obtained from the employers' registers. Comprehensive daily data on purchased antidepressant prescriptions (World Health Organization's Anatomical Therapeutic Chemical classification code N06A) for nurses (N=6,699) and physicians (N=641) was derived from national registers. Cox proportional hazards models were used to examine the association between bed occupancy rate and subsequent antidepressant treatment. Monthly bed occupancy rates were used as a time-dependent exposure that could change in value over the course of observation. Hazard ratios were adjusted for sex, age, occupation, type and length of employment contract, hospital district, specialty, and calendar year. Exposure over 6 months to an average bed occupancy rate over 10% in excess of the recommended limit was associated with new antidepressant treatment. This association followed a dose-response pattern, with increasing bed occupancy associated with an increasing likelihood of antidepressant use. There was no evidence of reverse causality; antidepressant treatment among employees did not predict subsequent excess bed occupancy. The increased risk of antidepressant use observed in this study suggests that overcrowding in hospital wards may have an adverse effect on the mental health of staff.
Lubis, A H; Sinuhaji, A B; Sutanto, A H; Yosodiharjo, A
A retrospective study had been conducted on hospitalized infants and children in the Pediatric ward of Dr. Pirngadi Hospital, Medan from January 1, 1987 through December 31, 1988. The purpose is to assess the incidence and clinical manifestations of intussusception. During the same period, there were 6484 infants and children hospitalized, 39 (0.6%) with intussusception, consisting of 23 (58.9%) males and (41.1%) females. Most of the cases (53.85%) were in age group of 4-6 months. Thirty four patients (87.12%) were wellnourished, and 5 patients (12.82%) undernourished. The major symptoms of intussusception were bloody diarrhoea (87.17%), vomiting (82.05%) and abdominal distention (66.41%). Successful reposition with barium enema occurred in 1 (20%) out of 5 patients. The major symptoms of intussusception were bloody diarrhoea (87.17%), vomiting. Surgical intervention was performed in 22 patients (56.41%). The result was as follows: discharged in good condition in 15 (68.18%) and deaths occurred in the remaining cases (7 cases = 31.82%). Of those 7 cases who died after operation, 2 cases were hospitalized in less than 2 days, 3 cases in less than 3 days and the remaining 2 cases in more than 3 days, after the symptoms developed.
: Editor's note: From its first issue in 1900 through to the present day, AJN has unparalleled archives detailing nurses' work and lives over more than a century. These articles not only chronicle nursing's growth as a profession within the context of the events of the day, but they also reveal prevailing societal attitudes about women, health care, and human rights. Today's nursing school curricula rarely include nursing's history, but it's a history worth knowing. To this end, From the AJN Archives highlights articles selected to fit today's topics and times.This month's article, from the July 1906 issue, suggests that there was controversy surrounding the type of furniture used in pediatric wards. Author Marienne Wheeler of Babies' Hospital in New York City (now known as New York-Presbyterian Morgan Stanley Children's Hospital) pointed out that brass beds were expensive and required constant upkeep by nursing staff, while plain iron beds, "white enameled," were cheaper and more easily kept clean. (To read the complete article from our archives, go to http://bit.ly/2cQvYOG.)Today, unburdened by the upkeep of cribs, neonatal ICU nurses at the Hospital of the University of Pennsylvania developed a program to standardize safe sleep practices for infants. See "An Evidence-Based Infant Safe Sleep Program to Reduce Sudden Unexplained Infant Deaths" in this issue.
A psychiatric investigation was carried out on patients aged 65-80 years who were admitted to the medical wards of six general hospitals in an industrial urban area of West Germany. In all, 626 patients were screened for cognitive and affective disorder using a short standardized interview, and at the second stage all those with abnormal responses, as well as a subsample of the apparently normal patients, were examined in greater detail. After correction for inaccuracies of screening, the frequency of psychiatric illness in this patient population was estimated as 30.2%, made up of 9.1% with organic brain syndromes and 21.1% with functional mental disorders. Comparison with field-study data for the same background population showed that the hospital patients were at increased risk for mental disturbance. At follow up after one year, outcome in terms of mortality, admission to long-term care and dependency on others was worst for patients with organic mental disorder, even after matching for age and initial severity of physical impairment. Functional mental illness was also associated with a relatively poor outcome in terms of dependency. The mental status of elderly medical patients appears to be important for the prognosis. PMID:3560118
Chojnowski, Janusz; Załuska, Maria
The world literature is reporting economic destabilisation of psychiatric wards in general hospitals related to the new rules of financing (managed care). The aim of this paper is to analyse the literature on psychiatric wards in general hospitals, and to know the opinions of psychiatrists employed in these wards in Poland regarding organisational model and the stability of these wards. The 18-items Likert-type questionnaire was send to 83 psychiatric wards in Poland and published on the website psychiatria.pl. 50 psychiatrists from psychiatric wards in general hospitals in 11 provinces had responded. The prevailing number of respondents positively assessed: the organisational model of the ward, implications for therapy arising from its location in the general hospital and the relationships with colleges of other specialties. However, they assessed negatively: the working conditions, stability of employment, the mode of treating the psychiatrists by the management of the hospital, and the interest of the authorities in these wards. The majority of respondents (72%) prefer to work in integrated stationary/ambulatory services, and postulates (86% of respondents) that the psychiatric wards in general hospitals should be guaranteed permanent status in the mental health system. The psychiatrists employed in the psychiatric wards in general hospitals in Poland evaluate this organisational model positively. However, the destabilisation of economic foundations of these wards reported in the world literature was also reflected in the results of a survey conducted in Poland. There is a need to develop standards for the organisation and financing departments of psychiatry in general hospitals providing them stable status in the healthcare system in Poland.
Gebhardt, R P; Schmidt-Michel, P O
A satellite ward is a psychiatric ward at a general hospital settled within the catchment area that is administered by a psychiatric hospital. The objective of the satellite model is to approach community treatment on the one hand and somatic medicine on the other hand, consequently diminishing the threshold for hospital treatment. This study investigated whether the diagnostic, psychopathologic and social reasons for admissions changed from this catchment area due to the lower threshold of a satellite ward. The results were controlled with another catchment area's admissions to the 30 km distant psychiatric hospital. The opening of the satellite ward was followed by an 81 % increase of admissions. In particular, admissions of patients with neuroses and personality disorders were more frequent. There was no change of the severity code of psychopathology at admission. From the catchment area of the satellite ward less patients were admitted involuntarily whereas more admissions happened due to social reasons and after patients' own decision.
Simoens, Steven; Kutten, Betty; Keirse, Emmanuel; Berghe, Paul Vanden; Beguin, Claire; Desmedt, Marianne; Deveugele, Myriam; Léonard, Christian; Paulus, Dominique; Menten, Johan
In addition to the effectiveness of hospital care models for terminal patients, policy makers and health care payers are concerned about their costs. This study aims to measure the hospital costs of treating terminal patients in Belgium from the health care payer perspective. Also, this study compares the costs of palliative and usual care in different types of hospital wards. A multicenter, retrospective cohort study compared costs of palliative care with usual care in acute hospital wards and with care in palliative care units. The study enrolled terminal patients from a representative sample of hospitals. Health care costs included fixed hospital costs and charges relating to medical fees, pharmacy and other charges. Data sources consisted of hospital accountancy data and invoice data. Six hospitals participated in the study, generating a total of 146 patients. The findings showed that palliative care in a palliative care unit was more expensive than palliative care in an acute ward due to higher staffing levels in palliative care units. Palliative care in an acute ward is cheaper than usual care in an acute ward. This study suggests that palliative care models in acute wards need to be supported because such care models appear to be less expensive than usual care and because such care models are likely to better reflect the needs of terminal patients. This finding emphasizes the importance of the timely recognition of the need for palliative care in terminal patients treated in acute wards.
Kivimäki, M; Voutilainen, P; Koskinen, P
This study investigated work motivation and job satisfaction at hospital wards with high and low levels of job enrichment. Primary nursing was assumed to represent a highly enriched job, whereas functional nursing represented a job with a low level of enrichment. Five surgical wards were divided into these two categories based on the structured interviews with head nurses. Work motivation and job satisfaction among ward personnel were assessed by a questionnaire. The ward personnel occupying highly enriched jobs reported significantly higher work motivation and satisfaction with the management than the personnel occupying jobs with a low level of enrichment.
Dumartin, Catherine; L'Hériteau, François; Péfau, Muriel; Bertrand, Xavier; Jarno, Pascal; Boussat, Sandrine; Angora, Pacôme; Lacavé, Ludivine; Saby, Karine; Savey, Anne; Nguyen, Florence; Carbonne, Anne; Rogues, Anne-Marie
Antibiotic use in French hospitals is among the highest in Europe. A study was carried out to describe antibiotic consumption for inpatients at hospital and at ward levels. Data were voluntarily collected retrospectively by 530 hospitals accounting for approximately 40 million patient-days (PD) on the following: antibacterials for systemic use [J01 class of the WHO Anatomical Therapeutic Chemical (ATC) classification, defined daily doses (DDD) system, 2007], rifampicin and oral imidazole derivatives, expressed in number of DDD and number of PD in 2007. Consumption was expressed in DDD/1000 PD. Median antibiotic use ranged from 60 DDD/1000 PD in long-term care (LTC) and psychiatric hospitals to 633 DDD/1000 PD in teaching hospitals. Penicillins and beta-lactamase inhibitors combinations were the most frequently used antibiotics, accounting for 26% of total use in cancer hospitals to 40% in LTC/psychiatric hospitals. Glycopeptides and carbapenems were mostly used in cancer and teaching hospitals. Level of consumption and pattern of use differed according to clinical ward from 60 DDD/1000 PD in psychiatric wards up to 1466 DDD/1000 PD in intensive care units (ICUs). In medicine, surgery, ICU and rehabilitation wards, fluoroquinolones accounted for 13%-19% of the total use. This multicentre survey provided detailed information on antibiotic use in a large sample of hospitals and wards, allowing relevant comparisons and benchmarking. Analysis of consumption at the ward level should help hospitals to target practice audits to improve antibiotic use.
Ellilä, H; Sourander, A; Välimäki, M; Piha, J
The aim of this study is to describe structural characteristics and staff resources of child psychiatric and adolescent psychiatric hospital wards in Finland. The target group of the survey consisted of 69 child and adolescent psychiatric hospital units in Finland. Information was obtained from 64 units (93%). Most of the wards were based on 24-h-a-day provision. There were only 7-day-treatment programmes including two family wards. When compared internationally, the numbers of units, beds and staff levels were high in Finland, with all members of staff qualified. The nurse-patient ratio and psychiatrist resources were rather satisfactory. However, in many units there was a lack of psychologists, social workers and occupational therapists. General recommendations and guidelines for staff resources in child and adolescent hospital treatment wards are warranted.
Adams, Ann; Bond, Senga
This paper explores relationships between grade mix, staff stability, care organization and nursing practice. The data were collected in the mid-1990s from a nationally representative sample of 100 acute hospital wards and 825 nurses. Analyses provides important insights for managers seeking to achieve the strategic aims set out in consecutive National Health Service (NHS) human resource management policies. Hypotheses about ward clinical grade mix were not well supported. Where there was rich grade mix, nurses reported better collaborative working with other disciplines and greater influence. However, it was expected that wards practising 'devolved' nursing would have a richer grade mix and that the latter would lead to more innovative practice and nurses experiencing greater job satisfaction. No evidence to support any of these hypotheses was found although the opposite scenario - a link between poor grade mix, unprogressive practice and perceived lower standards of care - was supported. Wards practising the 'devolved' system rely on adequate numbers of nurses rather than a rich grade mix, and do not necessarily provide a more stable, retentive work environment for nurses. By contrast, findings about staff stability were largely as expected. A strong link between staff stability and standards of professional nursing practice was found, indicating that staff stability is more important than a rich grade mix for achieving innovative, research-based practice. However, staff instability undermined cohesion with nurse colleagues, collaborative working with doctors, and nurses' ability to cope with the workload. Overall, both the papers demonstrate that staffing resources and prevailing ethos of care are more important predictors of care processes and job satisfaction than organizational systems. They identify the detrimental effects on nurses and their work of having few staff and a weak grade mix, and the importance of staff stability. Higher standards of nursing
Mirhoseini, Seyed Hamed; Nikaeen, Mahnaz; Khanahmad, Hossein; Hassanzadeh, Akbar
Background: Airborne transmission of pathogenic resistant bacteria is well recognized as an important route for the acquisition of a wide range of nosocomial infections in hospitals. The aim of this study was to determine the prevalence of airborne vancomycin and gentamicin (VM and GM) resistant bacteria in different wards of four educational hospitals. Materials and Methods: A total of 64 air samples were collected from operating theater (OT), Intensive Care Unit (ICU), surgery ward, and internal medicine ward of four educational hospitals in Isfahan, Iran. Airborne culturable bacteria were collected using all glass impingers. Samples were analyzed for the detection of VM- and GM-resistant bacteria. Results: The average level of bacteria ranged from 99 to 1079 CFU/m3. The highest level of airborne bacteria was observed in hospital 4 (628 CFU/m3) and the highest average concentration of GM- and VM-resistant airborne bacteria were found in hospital 3 (22 CFU/m3). The mean concentration of airborne bacteria was the lowest in OT wards and GM- and VM-resistant airborne bacteria were not detected in this ward of hospitals. The highest prevalence of antibiotic-resistant airborne bacteria was observed in ICU ward. There was a statistically significant difference for the prevalence of VM-resistant bacteria between hospital wards (P = 0.012). Conclusion: Our finding showed that the relatively high prevalence of VM- and GM-resistant airborne bacteria in ICUs could be a great concern from the point of view of patients' health. These results confirm the necessity of application of effective control measures which significantly decrease the exposure of high-risk patients to potentially airborne nosocomial infections. PMID:27656612
Sjetne, Ingeborg S; Helgeland, Jon; Stavem, Knut
The organization of nursing services could be important to the quality of patient care and staff satisfaction. However, there is no universally accepted nomenclature for this organization. The objective of the current study was to classify general hospital wards based on data describing organizational practice reported by the ward nurse managers, and then to compare this classification with the name used in the wards to identify the organizational model (self-identification). In a cross-sectional postal survey, 93 ward nurse managers in Norwegian hospitals responded to questions about nursing organization in their wards, and what they called their organizational models. K-means cluster analysis was used to classify the wards according to the pattern of activities attributed to the different nursing roles and discriminant analysis was used to interpret the solutions. Cross-tabulation was used to validate the solutions and to compare the classification obtained from the cluster analysis with that obtained by self-identification. The bootstrapping technique was used to assess the generalizability of the cluster solution. The cluster analyses produced two alternative solutions using two and three clusters, respectively. The three-cluster solution was considered to be the best representation of the organizational models: 32 team leader-dominated wards, 23 primary nurse-dominated wards and 38 wards with a hybrid or mixed organization. There was moderate correspondence between the three-cluster solution and the models obtained by self-identification. Cross-tabulation supported the empirical classification as being representative for variations in nursing service organization. Ninety-four per cent of the bootstrap replications showed the same pattern as the cluster solution in the study sample. A meaningful classification of wards was achieved through an empirical cluster solution; this was, however, only moderately consistent with the self-identification. This empirical
Santos, Lyvia de Jesus; Vieira, Maria Jésia
This article seeks to reflect on the professional activity of the psychologist in the hospital context by examining the role of psychologists working in hospitals and maternity wards in the State of Sergipe. It seeks to identify the specific role of these professionals in hospitals and maternity wards, as well as their motivating forces and the difficulties encountered. This work is part of a broader project that sought to study not only the activity per se, but also training aspects of these professionals. The sample was analyzed using a qualitative and quantitative approach for thematic analysis. Results revealed that the characterization of the role of psychologists has a focus on psychotherapeutic work with patients before and after surgery, as well as the caregivers and family members of critically ill patients in the following units: ICU, ICC, oncology, dialysis and surgical wards, offering support, especially at the pre- and post-surgery phase.
Sarkies, Mitchell N; Bowles, Kelly-Ann; Skinner, Elizabeth H; Haas, Romi; Mitchell, Deb; O'Brien, Lisa; May, Kerry; Ghaly, Marcelle; Ho, Melissa; Haines, Terry P
The aim of this study was to determine if the addition of daily ward interview data improves the capture of hospital quality and safety indicators compared with incident reporting systems alone. An additional aim was to determine the potential characteristics influencing under-reporting of hospital quality and safety indicators in incident reporting systems. A prospective, observational study was performed at two tertiary metropolitan public hospitals. Research assistants from allied health backgrounds met daily with the nurse in charge of the ward and discussed the occurrence of any falls, pressure injuries and rapid response medical team calls. Data were collected from four general medical wards, four surgical wards, an orthopaedic, neurosciences, plastics, respiratory, renal, sub-acute and acute medical assessment unit. An estimated total of 303 falls, 221 pressure injuries and 884 rapid response medical team calls occurred between 15 wards across two hospitals, over a period of 6 months. Hospital incident reporting systems underestimated falls by 30.0%, pressure injuries by 59.3% and rapid response medical team calls by 17.0%. The use of ward interview data collection in addition to hospital incident reporting systems improved data capture of falls by 23.8% (n = 72), pressure injuries by 21.7% (n = 48) and rapid response medical team calls by 12.7% (n = 112). Falls events were significantly less likely to be reported if they occurred on a Monday (P = 0.04) and pressure injuries significantly more likely to be reported if they occurred on a Wednesday (P = 0.01). Hospital quality and safety indicators (falls, pressure injuries and rapid response medical team calls) were under-reported in incident reporting systems, with variability in under-reporting between wards and the day of event occurrence. The use of ward interview data collection in addition to hospital incident reporting systems improved reporting of hospital quality and safety
Lasjerdi, Zohreh; Niyyati, Maryam; Lorenzo-Morales, Jacob; Haghighi, Ali; Taghipour, Niloofar
The present study was conducted to determine the occurrence of potentially pathogenic free-living amoeba in ophthalmology wards in reference hospitals in Iran. Since an increasing number of Acanthamoeba Keratitis cases after eye surgery and eye trauma have been recently observed in this country, it could be possible that the disinfection procedures undertaken in the clinical setting may not have a good hygiene and disinfection procedures, hence the aim of this study. Therefore, 42 dust and biofilm samples were collected from different areas of ophthalmology wards and checked for the presence of FLA using morphological criteria, PCR based analysis and DNA sequencing. Of the 42 samples from dust and biofilm sources, 18(42.86%) isolates were found to contain FLA and 12(92.3%) isolates belonged to Acanthamoeba T4 genotype. Isolation of the pathogenic genotype T4 from medical instruments, including slit lamp in corneal wards, may be a threat for patients undergoing eye surgery in these wards. Other FLA isolated in this study included Acanthamoeba genotype T5, Vahlkampfia sp, Naegleria australiensis, Vermamoeba vermiformis and Echinamoeba exudans. To our knowledge, this is the first report of the presence of potentially pathogenic FLA in ophthalmology wards in Iran. Improved disinfection methods and monitoring of hospitals ward are thus necessary in this area in order to minimize the risk of infection in patients.
Schorr, S G; Eickhoff, C; Feldt, S; Hohmann, C; Schulz, M
Clinical pharmacists play an important role in improving drug safety on hospital wards. However, little is known about the impact of pharmacy interns. The objective of our study was, therefore, to investigate the impact of hospital ward-based pharmacy interns on drug safety. This study was conducted as part of the project "P-STAT 2: Pharmacy interns on the ward" on 14 surgical wards in seven hospitals in Germany and a total of 27 pharmacy interns participated. All patients admitted to the participating wards from 1st June 2008 until 31st October 2008 and from 1st December 2008 till 30th April 2009 were included. The pharmacy interns were involved in medication reconciliation, and identifying, resolving, and preventing drug-related problems (DRPs) using the classification system APS-Doc. A total of 6,551 patients were included. Patients received on average (+/- SD) 4.4 +/- 3.9 drugs. The pharmacy interns detected a total of 4,085 DRPs and on average 0.6 +/- 1.2 DRPs per patient. Most frequently detected DRPs were potential drug-drug interactions (n = 591, 14%), missing drug strength, when different strengths were available (n = 373, 9%), and incomplete medication record (n = 296, 7%). The pharmacy interns conducted an intervention for 98% (n = 4,011) of all DRPs. According to their documentation, 74% of the DRPs (n = 3,038) were solved. Drugs which were most often related with DRPs were simvastatin, diclofenac, and ibuprofen. This is the very first study exploring the potential impact of pharmacy interns on drug safety on surgical wards in Europe. Pharmacy interns can play an important role to improve drug safety on hospital wards.
An ethnographic exploration was done in an orthopaedic ward of a government teaching hospital in Bangladesh to understand the nature of hospital culture in the context of Bangladeshi society at large. Life and work in the ward result in a culture that is simultaneously created by its inhabitants and the conditions in which they are situated. The study shows that biomedicine is a product of particular social conditions and that the hospital reflects features of its society. Behind the injuries and broken limbs in the ward are stories of violence, crime, and intolerance occurring in a society where masses of people fight over limited resources. In the ward people interact in an extremely hierarchical manner. The patients, who are mainly from poor economic backgrounds, remain at the bottom of the hierarchy. Doctors and other staff members are often professionally frustrated. Strikes related to hospital staff's various professional demands hamper the regular flow of work in the ward. Family members are engaged in nursing and provide various kinds of support to their hospitalized relatives. Patients give small bribes to ward boys and cleaners to obtain their day-to-day necessities. Patients joke with each other and mock senior doctors. Thus, they neutralize their powerlessness and drive away the monotony of their stay. Doctors develop 'indigenous' solutions to orthopaedic problems. Instead of using high-tech devices, they employ instruments made of bamboo, bricks, and razor blades. This study shows how medical practice takes shape in an understaffed, under-resourced and poorly financed hospital operating in a low-income country.
Metrizal; Sinuhaji, A B; Sutanto, A H
A retrospective study was done on infants with diarrhea who were hospitalized at the Pediatric ward of Dr. Pirngadi Hospital, Medan in a period of one year (January 1 to December 31, 1986). There were 3317 hospitalized patients and 1506 (45.40%) of them had diarrhea. Of these, 773 (51.32%) were in the age group of under 2 years. Thirty eight patients (4.91%) with infantile diarrhea died and prolonged diarrhea was found in 54 (6.98%) cases.
Gold, C A; Mayer, S A; Lennihan, L; Claassen, J; Willey, J Z
The aim of this study is to evaluate the characteristics of unplanned transfers of adult patients from hospital wards to a neurological intensive care unit (NICU). We retrospectively reviewed consecutive unplanned transfers from hospital wards to the NICU at our institution over a 3-year period. In-hospital mortality rates were compared between patients readmitted to the NICU ("bounce-back transfers") and patients admitted to hospital wards from sources other than the NICU who were then transferred to the NICU ("incident transfers"). We also measured clinical characteristics of transfers, including source of admission and indication for transfer. A total of 446 unplanned transfers from hospital wards to the NICU occurred, of which 39% were bounce-back transfers. The in-hospital mortality rate associated with all unplanned transfers to the NICU was 17% and did not differ significantly between bounce-back transfers and incident transfers. Transfers to the NICU within 24 h of admission to a floor service accounted for 32% of all transfers and were significantly more common for incident transfers than bounce-back transfers (39 vs. 21%, p = .0002). Of patients admitted via the emergency department who had subsequent incident transfers to the NICU, 50% were transferred within 24 h of admission. Unplanned transfers to an NICU were common and were associated with a high in-hospital mortality rate. Quality improvement projects should target the triage process and transitions of care to the hospital wards in order to decrease unplanned transfers of high-risk patients to the NICU.
Gajendragadkar, Parag R; Moualed, Daniel J; Nicolson, Phillip L R; Adjei, Felicia D; Cakebread, Holly E; Duehmke, Rudolf M; Martin, Claire A
To quantify the consumption of chocolates in a hospital ward environment. Multicentre, prospective, covert observational study. Four wards at three hospitals (where the authors worked) within the United Kingdom. Boxes of Quality Street (Nestlé) and Roses (Cadbury) on the ward and anyone eating these chocolates. Observers covertly placed two 350 g boxes of Quality Street and Roses chocolates on each ward (eight boxes were used in the study containing a total of 258 individual chocolates). These boxes were kept under continuous covert surveillance, with the time recorded when each chocolate was eaten. Median survival time of a chocolate. 191 out of 258 (74%) chocolates were observed being eaten. The mean total observation period was 254 minutes (95% confidence interval 179 to 329). The median survival time of a chocolate was 51 minutes (39 to 63). The model of chocolate consumption was non-linear, with an initial rapid rate of consumption that slowed with time. An exponential decay model best fitted these findings (model R(2)=0.844, P<0.001), with a survival half life (time taken for 50% of the chocolates to be eaten) of 99 minutes. The mean time taken to open a box of chocolates from first appearance on the ward was 12 minutes (95% confidence interval 0 to 24). Quality Street chocolates survived longer than Roses chocolates (hazard ratio for survival of Roses v Quality Street 0.70, 95% confidence interval 0.53 to 0.93, P=0.014). The highest percentages of chocolates were consumed by healthcare assistants (28%) and nurses (28%), followed by doctors (15%). From our observational study, chocolate survival in a hospital ward was relatively short, and was modelled well by an exponential decay model. Roses chocolates were preferentially consumed to Quality Street chocolates in a ward setting. Chocolates were consumed primarily by healthcare assistants and nurses, followed by doctors. Further practical studies are needed.
Moualed, Daniel J; Nicolson, Phillip L R; Adjei, Felicia D; Cakebread, Holly E; Duehmke, Rudolf M; Martin, Claire A
Objective To quantify the consumption of chocolates in a hospital ward environment. Design Multicentre, prospective, covert observational study. Setting Four wards at three hospitals (where the authors worked) within the United Kingdom. Participants Boxes of Quality Street (Nestlé) and Roses (Cadbury) on the ward and anyone eating these chocolates. Intervention Observers covertly placed two 350 g boxes of Quality Street and Roses chocolates on each ward (eight boxes were used in the study containing a total of 258 individual chocolates). These boxes were kept under continuous covert surveillance, with the time recorded when each chocolate was eaten. Main outcome measure Median survival time of a chocolate. Results 191 out of 258 (74%) chocolates were observed being eaten. The mean total observation period was 254 minutes (95% confidence interval 179 to 329). The median survival time of a chocolate was 51 minutes (39 to 63). The model of chocolate consumption was non-linear, with an initial rapid rate of consumption that slowed with time. An exponential decay model best fitted these findings (model R2=0.844, P<0.001), with a survival half life (time taken for 50% of the chocolates to be eaten) of 99 minutes. The mean time taken to open a box of chocolates from first appearance on the ward was 12 minutes (95% confidence interval 0 to 24). Quality Street chocolates survived longer than Roses chocolates (hazard ratio for survival of Roses v Quality Street 0.70, 95% confidence interval 0.53 to 0.93, P=0.014). The highest percentages of chocolates were consumed by healthcare assistants (28%) and nurses (28%), followed by doctors (15%). Conclusions From our observational study, chocolate survival in a hospital ward was relatively short, and was modelled well by an exponential decay model. Roses chocolates were preferentially consumed to Quality Street chocolates in a ward setting. Chocolates were consumed primarily by healthcare assistants and nurses, followed by doctors
Onatade, Raliat; Miller, Gavin; Sanghera, Inderjit
Background Several clinical pharmacy activities are common to UK hospitals. It is not clear whether these are provided at similar levels, and whether they take similar amounts of time to carry out. Objective To quantify and compare clinical pharmacist ward activities between different UK hospitals. Setting Seven acute hospitals in the Greater London area (UK). Methods A list of common ward activities was developed. On five consecutive days, pharmacists visiting hospital wards documented total time spent and how many of each activity they undertook. Results were analysed by hospital. The range and number of activities per 100 occupied bed days, and per 24 beds were compared. Main outcome measure Time spent on wards and numbers of each activity undertaken. Results Pharmacists logged a total of 2291 h carrying out 40,000 activities. 4250 changes to prescriptions were made or recommended. 5901 individual medication orders were annotated for clarity or safety. For every 24 beds visited, mean time spent was 230 min-seeing 6.2 new patients, carrying out 3.9 calculations and 1.3 patient consultations, checking and authorising 1.8 discharge prescriptions, and providing staff with information twice. Other activities varied significantly, not all could be explained by differences in hospital specialties or Information Technology systems. Conclusion This is the first detailed comparison of clinical pharmacy ward activities between different hospitals. There are some typical levels of activities carried out. Wide variations in other activities could not always be explained. Despite a large number of contacts, pharmacists reported very few consultation sessions with patients.
Parry, Sarah; Lloyd, Mike; Simpson, Jane
An interpretive phenomenological analysis sought to explore how people reporting moderate to high levels of dissociation experienced relationships with multidisciplinary hospital ward staff. Three superordinate themes were developed. First, the theme "multiple me and multiple them" explores the instability experienced by the participants as they managed their dissociative experiences alongside many inconsistencies. Second, "recognizing, meeting, or neglecting interpersonal and care needs" reflects on participants' needs within therapeutic relationships. Third, "between the needs of the internal system: navigating between 'better on my own' and 'someone to talk to'" discusses the confusion and understanding around dissociation and the importance of working with parts, not around them. Findings suggested that the current culture of some hospital wards directly influenced participants' distress, which could lead to further dissociation as a means of coping with perceived threats. Reflections on relational complexities and developing ward-based treatment are discussed.
Garattini, L; Giuliani, G; Pagano, E
Until recently Italian hospitals had no cost accounting or activity data collection systems, being formally required only to do financial book-keeping. The cost analysis method presented here might be used to set up detailed and complete hospital cost accounting, which would permit a better understanding of patterns of resource distribution among departments, better opportunities for cost saving and cost control for hospital managers and health authorities. The study first identified a framework within which to assess the annual cost related to a hospital ward, then calculated the mean bed day cost for each speciality. Cost data were collected over one year in 1996 from manually compiled records, at one local hospital in Northern Italy. Costs were estimated following a step-down allocation method. Wards requiring a major amount of resources per day of stay are intensive cardio-coronary unit (US$650.689), and ophthalmology (US$483.322). The less expensive ward is general medicine (US$148.645). The cost analysis method presented in this study might be used to set a detailed and complete hospital cost database, which is a necessary tool for hospital managers to realise cost control and cost recovery.
Koukia, E; Giannouli, E; Gonis, N; Douzenis, A
This research concerns the recording of safety measures in acute mental health wards of psychiatric hospitals in the greater area of Athens. The practices of control and testing on patients performed by nurses are also reported. The total sample consists of 14 acute inpatient psychiatric wards. The results indicated that important differences were noticed in the controls and prohibitions. Moreover, the main characteristic was the lack of protocols and measures of safety, a situation that burdened nursing practice. The lack of rules and strategies that would promote the safety of patient, professionals and therapeutic milieu, were brought into light by nurses' quotes.
Borek, Paulina; Chmielewski, Michał; Małgorzewicz, Sylwia; Dębska Ślizień, Alicja
Introduction: Malnutrition is a common problem among hospitalized patients. In chronic kidney disease, it affects up to 50% of the population. Undernourishment has an adverse effect on prognosis and prolongs convalescence. The aim of the study was to test the effectiveness of NRS (Nutrition Risk Screening) -2002 in the assessment of risk of malnutrition for patients hospitalized in nephrology wards. The aim was to develop clinical characteristics of malnourished patients and to assess the relationship between nutritional status and patient outcome. Methods: The analysis included 292 patients, consecutively admitted to nephrology wards. NRS-2002 was assessed in comparison to subjective global assessment. Associations with patient characteristics and outcome were evaluated. Results: Out of all the respondents, 119 patients (40%) suffered from malnutrition. The NRS-2002 showed a very strong relationship with Subjective Global Assessment (SGA) (p < 0.0001). Malnourished patients were older, were characterized by a significantly lower body mass index (BMI), and had a much longer hospitalization duration. In multiple regression analysis, the presence of malnutrition proved to be an independent predictor of the duration of hospital stay. CONCLUSIONS: Malnutrition is highly prevalent among patients hospitalized in nephrology wards, and it affects the length of hospitalization. Identification of malnourished patients and patients at serious risk of malnutrition progression allows the implementation of appropriate nutritional intervention. PMID:28300757
Borek, Paulina; Chmielewski, Michał; Małgorzewicz, Sylwia; Dębska Ślizień, Alicja
Malnutrition is a common problem among hospitalized patients. In chronic kidney disease, it affects up to 50% of the population. Undernourishment has an adverse effect on prognosis and prolongs convalescence. The aim of the study was to test the effectiveness of NRS (Nutrition Risk Screening) -2002 in the assessment of risk of malnutrition for patients hospitalized in nephrology wards. The aim was to develop clinical characteristics of malnourished patients and to assess the relationship between nutritional status and patient outcome. The analysis included 292 patients, consecutively admitted to nephrology wards. NRS-2002 was assessed in comparison to subjective global assessment. Associations with patient characteristics and outcome were evaluated. Out of all the respondents, 119 patients (40%) suffered from malnutrition. The NRS-2002 showed a very strong relationship with Subjective Global Assessment (SGA) (p < 0.0001). Malnourished patients were older, were characterized by a significantly lower body mass index (BMI), and had a much longer hospitalization duration. In multiple regression analysis, the presence of malnutrition proved to be an independent predictor of the duration of hospital stay. Malnutrition is highly prevalent among patients hospitalized in nephrology wards, and it affects the length of hospitalization. Identification of malnourished patients and patients at serious risk of malnutrition progression allows the implementation of appropriate nutritional intervention.
This study aimed to explore the effect of standardized teaching ward rounds in clinical nursing on preventing hospital-acquired infection. The experimental group comprised 120 nursing students from our hospital selected between June 2010 and June 2012. The control group consisted of 120 nursing students selected from May 2008 to May 2010. Traditional teaching ward rounds for nursing education were carried out with the control group, while a standardized teaching ward round was carried out with the experimental group. The comprehensive application of nursing abilities and skills, the mastering of situational infection knowledge, and patient satisfaction were compared between the two groups. The applied knowledge of nursing procedures and the pass rate on comprehensive skill tests were significantly higher in the experimental group than in the control group (P < 0.05). The rate of mastery of sterilization and hygiene procedures was also higher in the experimental group than in the control group (P < 0.05). The patient satisfaction rate with infection control procedures in the experimental group time period was 98.09%, which was significantly higher than patient satisfaction in the control group time period (93.05%, P < 0.05). Standardized teaching ward rounds for nursing education expanded the knowledge of the nursing staff in controlling hospital-acquired infection and enhanced the ability of comprehensive application and awareness of infection control procedures.
Sahandi, R; Noroozi, S; Roushan, G; Heaslip, V; Liu, Y
The evolution of patient monitoring on general hospital wards is discussed. Patients on general wards are monitored according to the severity of their conditions, which can be subjective at best. A report by the Commission for Healthcare Audit and Inspection in 2008 indicated dissatisfaction with patient monitoring. Commitment to providing quality health service by healthcare organizations encourages the implementation of other mechanisms for patient care. Remote patient monitoring (RPM), by supplementing the role of nurses, can improve efficiency and patient care on general wards. Developments in technology made it possible for wireless sensors to measure and transmit physiological data from patients to a control room for monitoring and recording. Two approaches in the application of wireless ZigBee sensor networks are discussed and their performances compared in a simulation environment. The role of RPM in early detection of deteriorating patients' conditions, reducing morbidity and mortality rates are also discussed.
Büter, K; Motzek, T; Dietz, B; Hofrichter, L; Junge, M; Kopf, D; von Lützau-Hohlbein, H; Traxler, S; Zieschang, T; Marquardt, G
Hospitals face great challenges in the necessity of providing care for the rising number of elderly patients with dementia. The adaptation of the spatial environment represents an important component to improve the care situation of patients with dementia. For more than 30 years research results from long-term care have provided evidence on the therapeutic effect of numerous architectural features on people with dementia. Due to specific medical and organizational requirements in hospitals, the transferability of these findings is, however, limited. An interdisciplinary workshop with experts from the fields of medicine, nursing, gerontology, self-help and architecture was conducted in July 2015. Based on existing research findings and experiences from pilot projects, the spatial requirements for dementia-friendly hospital wards were collated, suggested solutions were discussed from different perspectives and finally design recommendations were derived. The article gives a first comprehensive overview of architectural measures that are required for the design of dementia-friendly hospital wards. The recommendations provided range from architectural criteria, such as the size and spatial structure of hospital wards, to interior design elements, including orientation and navigation aids and the use of light and colors. Furthermore, information about the planning process are given.
Yoshizawa, Tomohiro; Nishino, Tomofumi; Mishima, Hajime; Ainoya, Takeshi; Yamazaki, Masashi
[Purpose] The convalescent rehabilitation ward (CRW) plays an important role for hip fracture patients in Japanese super-aged society. The purpose of this study is to clarify the usefulness of the CRW concomitant with acute wards in a single hospital. [Subjects and Methods] 110 hip fracture patients were evaluated; 63 patients were moved from acute wards to the CRW in the same hospital (Group C) and 47 patients were treated in acute wards only (Group A). Patient selection was determined by each attending doctor. The outcomes were examined from medical records. [Results] 90.5% of patients in the group C were discharged to home and 57.4% in the group A. 92.9% of patients in the group C had regained their ambulatory ability at discharge and 88.9% in the group A. The average total functional independence measure scores at discharge were 96.4 in the group C and 85.0 in the group A. The one-year mortality was 2.4% in the group C and 8.3% in the group A. [Conclusion] Using a CRW concomitant with acute wards in a single hospital could achieve a high home-discharge rate, good functional recovery, and low mortality in hip fracture patients.
Taheri, Leila; Kargar Jahromi, Marzieh; Hojat, Mohsen
Patient satisfaction is the most important indicator of high-quality health care and is used for the assessment and planning of health care. Also, Job satisfaction is an important factor on prediction and perception of organizational manner. The aim of this study is to identify and compare patient and staff satisfaction in general versus special wards. In order to identify the various indicators of satisfaction and dissatisfaction, a descriptive study (cross sectional) was done to assess patients' satisfaction with in-patient care at Jahrom University of Medical Science hospitals. The sample size was 600 patients that selected by sequential random sampling technique and are close to their discharge from the hospital. Patients were asked to indicate the scale point which best reflected their level of satisfaction with the treatment or service. Also we assess the staff satisfaction (sample size was 408 staffs) in general ward using a researcher made questionnaire. It should be noted that the participants were anonymous and there was no obligation to participation. We tried to set a secure and comfortable environment for filling out the questionnaire. Among 600 patients, 239 (n=38.67%) were men and 368 (61.33%) were female. Number of nurses was 408, of which 135 (33.08%) were men and 273 (66.92%) female. There was a significant correlation between working experience and professional factors of personnel. The mean total patient satisfaction in general and special wards is (2.75±.35, 3.03±.53) respectively. Differences of patient satisfaction in domains such respect, care and confidence in general wards versus special ward were statistically significant, but there was no difference in expect time of patients in these wards. Differences Between the mean patient and staff satisfaction in the general wards versus special wards were statistically significant using independent t-tests (p=.018, p=.029). Spearman test showed a statistically significant correlation between
Taheri, Leila; Jahromi, Marzieh Kargar; Hojat, Mohsen
Introduction and Aims: Patient satisfaction is the most important indicator of high-quality health care and is used for the assessment and planning of health care. Also, Job satisfaction is an important factor on prediction and perception of organizational manner. The aim of this study is to identify and compare patient and staff satisfaction in general versus special wards. Material and Method: In order to identify the various indicators of satisfaction and dissatisfaction, a descriptive study (cross sectional) was done to assess patients’ satisfaction with in-patient care at Jahrom University of Medical Science hospitals. The sample size was 600 patients that selected by sequential random sampling technique and are close to their discharge from the hospital. Patients were asked to indicate the scale point which best reflected their level of satisfaction with the treatment or service. Also we assess the staff satisfaction (sample size was 408 staffs) in general ward using a researcher made questionnaire. It should be noted that the participants were anonymous and there was no obligation to participation. We tried to set a secure and comfortable environment for filling out the questionnaire. Results: Among 600 patients, 239 (n = 38.67%) were men and 368 (61.33%) were female. Number of nurses was 408, of which 135 (33.08%) were men and 273 (66.92%) female. There was a significant correlation between working experience and professional factors of personnel. The mean total patient satisfaction in general and special wards is (2.75 ± .35, 3.03 ± .53) respectively. Differences of patient satisfaction in domains such respect, care and confidence in general wards versus special ward were statistically significant, but there was no difference in expect time of patients in these wards. Differences Between the mean patient and staff satisfaction in the general wards versus special wards were statistically significant using independent t-tests (p = .018, p = .029
Slack, R; Ferguson, B; Ryder, S
The objective of this paper is to investigate the relevance of access to hospital services in explaining utilization rates at a District Health Authority level in the UK. In order to test the hypothesis that access is important, it is necessary to develop a means of scoring access factors and then combining these scores with other more recognized influences on hospitalization rates e.g. deprivation measures. Acknowledging that hospitalization rates are not merely products of a population's socio-economic characteristics, the effect of accessibility to hospital services for the resident population is investigated through the derivation of an access score using both private and public transport from electoral ward of residence. Deprivation and accessibility to services were both found to be significant factors in determining hospitalization rates at electoral ward level. The chosen supply variable--number of GPs--was not found to be significant in any of the models developed using linear regression techniques. To conclude, it appears that access plays an important role in determining hospitalization rates within a given population. If high hospitalization rates are accepted as an indicator of effectively met demand then policy makers may have to consider increasing the accessibility of hospital services.
Fillary, Julie; Chaplin, Hema; Jones, Gill; Thompson, Angela; Holme, Anita; Wilson, Patricia
English NHS inpatient surveys consistently identify that noise at night in hospitals and its impact on patients' sleep is a persisting problem that needs addressing. To identify how noise at night in hospital affects patients on general wards and the range of interventions aimed at reducing the problem, a systematic mapping of the literature was undertaken. All primary studies and relevant literature published January 2003-July 2013 were included. Key issues identified in the literature included noise levels and causes, impact on patient experience, and lack of staff awareness. Interventions to reduce noise were targeted at staff education, behaviour modification, care organisation and environmental solutions. The scoping suggested that when compared with specialist units, there is little evidence on effective interventions reducing disturbance from night-time noise on general wards. The available evidence suggests a whole systems approach should be adopted to aid quality sleep and promote recovery.
Walker, A Sarah; Eyre, David W; Wyllie, David H; Dingle, Kate E; Harding, Rosalind M; O'Connor, Lily; Griffiths, David; Vaughan, Ali; Finney, John; Wilcox, Mark H; Crook, Derrick W; Peto, Tim E A
Clostridium difficile infection (CDI) is a leading cause of antibiotic-associated diarrhoea and is endemic in hospitals, hindering the identification of sources and routes of transmission based on shared time and space alone. This may compromise rational control despite costly prevention strategies. This study aimed to investigate ward-based transmission of C. difficile, by subdividing outbreaks into distinct lineages defined by multi-locus sequence typing (MLST). All C. difficile toxin enzyme-immunoassay-positive and culture-positive samples over 2.5 y from a geographically defined population of ~600,000 persons underwent MLST. Sequence types (STs) were combined with admission and ward movement data from an integrated comprehensive healthcare system incorporating three hospitals (1,700 beds) providing all acute care for the defined geographical population. Networks of cases and potential transmission events were constructed for each ST. Potential infection sources for each case and transmission timescales were defined by prior ward-based contact with other cases sharing the same ST. From 1 September 2007 to 31 March 2010, there were means of 102 tests and 9.4 CDIs per 10,000 overnight stays in inpatients, and 238 tests and 15.7 CDIs per month in outpatients/primary care. In total, 1,276 C. difficile isolates of 69 STs were studied. From MLST, no more than 25% of cases could be linked to a potential ward-based inpatient source, ranging from 37% in renal/transplant, 29% in haematology/oncology, and 28% in acute/elderly medicine to 6% in specialist surgery. Most of the putative transmissions identified occurred shortly (≤ 1 wk) after the onset of symptoms (141/218, 65%), with few >8 wk (21/218, 10%). Most incubation periods were ≤ 4 wk (132/218, 61%), with few >12 wk (28/218, 13%). Allowing for persistent ward contamination following ward discharge of a CDI case did not increase the proportion of linked cases after allowing for random meeting of matched controls
Chen, Hong; Zhao, Shangping; Feng, Ling
To construct a Decision support system of nursing human resources allocation in general wards based on Hospital information system (HIS). Time series prediction model and Information technical method were used based on data of HIS in West China Hospital, Sichuan University (Chengdu, P.R. China). This study completed the function design and system implementation of the nursing human resources allocation decision support system. The system would help nursing managers choose the optimal scheme and make scientific decisions in combination with "the actual" situation but more empirical studies are needed.
Nasution, F R; Panggabean, G; Loebis, M S; Siregar, Z
In a period of 1 year (1 January-31 December 1988) a retrospective study on patients admitted to the Pediatric ward of Tembakau Deli Hospital, Medan, was done. This hospital is a referral hospital for patients from hospitals of Dept. of Plantation in North Sumatera and Aceh. During year 1988, there were 1339 infants and children hospitalized at the Pediatric ward Tembakau Deli, Medan. Of these patients, 183 had gastroenteritis; it was most frequently found in the age group of 0-13 months (46.4%). The patients consisted of 53.55% males and 46.45% females. Most of the patients i.e. 140 (76.51%), had good nutrition. Malnutrition were found in 31 patients where 16.94% among them were moderate malnutrition, and 12 patients (6.55%) had malnutrition. The total mortality rate of gastroenteritis in this study was 2.18% which was usually associated with severe complications while pure gastroenteritis showed no (0%) mortality.
Jamaazghandi, Alireza; Emadzadeh, Ali; Vakili, Vida; Bazaz, Seyed Mojtaba Mousavi
Bedside teaching is a patient-based teaching method in medical education. The present study has been conducted with the aim of investigating the quality of bedside teaching in the internal wards of Qaem and Imam Reza Educational Hospitals. This study follows a mixed qualitative-quantitative approach using checklists on educational clinical rounds in Imam Reza and Qaem Hospitals in Mashhad. In the first stage consisting of qualitative study, the parts related to the quality of bedside teaching were recognized and a checklist was designed in three domains of patient comfort (8 questions), targeted teaching (14 questions) and group dynamics (8 questions), and its reliability and validity were verified. In the next step, data were collected and then analyzed using SPSS 16 software through statistical techniques of independent t-test, one-way ANOVA and variance analysis. In total, 113 educational rounds were investigated in this study. Among them, 59 (52.2%) and 54 (47.8%) educational rounds have been investigated in Imam Reza and Qaem Hospitals, respectively. The average total score of bedside teaching was 180.8 out of 300 in the internal wards of both Imam Reza and Qaem Hospitals. The results of this study showed that generally the quality of bedside teaching in Imam Reza and Qaem Hospitals of Mashhad is low according to the qualitative standards considered in this study. Holding educational workshops along with more familiarity of the professors with effective bedside teaching strategies could be effective in improving the quality of educational rounds.
Khan, Anjum; O'Grady, Sharon; Muller, Matthew Paul
Although scabies outbreaks in hospitals are frequent, the optimal approach to management of these outbreaks has not yet been defined. We describe a hospital scabies outbreak that was successfully controlled without ward closure. An outbreak of scabies at a teaching hospital and subsequent control measures were investigated. Outcomes included the number of cases affecting patients and staff, number of patients and staff requiring prophylaxis, duration of the outbreak, and cost of the outbreak. Outcomes were compared with those in a similar outbreak occurring at the same hospital 20 years earlier and with other published descriptions of hospital scabies outbreaks. In January 2010, a patient who had undergone renal transplantation was admitted 3 times to St. Michael's Hospital, but a diagnosis of scabies was not considered until the final admission. Widespread exposure of patients and staff on 2 wards prompted the establishment of an outbreak management team. Initial interventions focused on isolation and treatment of the index case and on contact tracing to identify and treat secondary cases and to offer prophylaxis to direct contacts. Five symptomatic staff members and 2 patient cases were quickly identified, an outbreak was declared, and mass simultaneous prophylaxis was initiated on the 2 involved wards. A single case occurred 2 weeks after the mass prophylaxis program in a staff member who had not received the prophylaxis. Six weeks after the onset of symptoms, the end of the outbreak was declared. No additional cases have been reported up to the time of publication. The total cost of the outbreak was $20,000. Early recognition of crusted scabies is essential to prevent outbreaks. Once an outbreak occurs, prompt control of the index patient and rapid tracing of contacts to identify secondary cases are necessary. When prolonged exposure to a case of crusted scabies results in multiple secondary cases, institution of simultaneous mass prophylaxis is the most
Stone, Geren S; Tarus, Titus; Shikanga, Mainard; Biwott, Benson; Ngetich, Thomas; Andale, Thomas; Cheriro, Betsy; Aruasa, Wilson
Observational data in the United States suggests that those without health insurance have a higher mortality and worse health outcomes. A linkage between insurance coverage and outcomes in hospitalized patients has yet to be demonstrated in resource-poor settings. To determine whether uninsured patients admitted to the public medical wards at a Kenyan referral hospital have any difference in in-hospital mortality rates compared to patients with insurance, we performed a retrospective observational study of all inpatients discharged from the public medical wards at Moi Teaching and Referral Hospital in Eldoret, Kenya, over a 3-month study period from October through December 2012. The primary outcome of interest was in-hospital death, and the primary explanatory variable of interest was health insurance status. During the study period, 201 (21.3%) of 956 patients discharged had insurance. The National Hospital Insurance Fund was the only insurance scheme noted. Overall, 211 patients (22.1%) died. The proportion who died was greater among the uninsured compared to the insured (24.7% vs. 11.4%, Chi-square = 15.6, p<0.001). This equates to an absolute risk reduction of 13.3% (95% CI 7.9-18.7%) and a relative risk reduction of 53.8% (95% CI 30.8-69.2%) of in-hospital mortality with insurance. After adjusting for comorbid illness, employment status, age, HIV status, and gender, the association between insurance status and mortality remained statistically significant (adjusted odds ratio (AOR) = 0.40, 95% CI 0.24-0.66) and similar in magnitude to the association between HIV status and mortality (AOR = 2.45, 95% CI 1.56-3.86). Among adult patients hospitalized in a public referral hospital in Kenya, insurance coverage was associated with decreased in-hospital mortality. This association was comparable to the relationship between HIV and mortality. Extension of insurance coverage may yield substantial benefits for population health.
Yaslianifard, Somayeh; Mobarez, Ashraf Mohabati; Fatolahzadeh, Bahram; Feizabadi, Mohammad Mehdi
Nosocomial infection caused by non-Enterobacteriaceae gram negative bacteria (GNB-NE) is increasing in intensive care units (ICU). The objective of this study was to determine whether potable water in ICU wards at Tehran hospitals is contaminated with L. pneomophila, P. aeroginosa and Acinetobacter spp. A total of 52 water samples from shower bath and taps water in seven hospitals of Tehran were collected. The water sample concentrated by filtering through millipore cellulose filters and cultured on BCYE agar and tryptic soya agar media. The presence of Legionella pneumophila was confirmed by real time PCR assay using primers-probe designed for the mip gene. Legionella pneumophila, Pseudomonas aeroginosa and Acinetobacter were isolated from 5 (9.6%), 6 (11.4%) and 1 (1.8%) of the hospital water systems, respectively. This study demonstrated the presence of Legionella, Pseudomonas and Acinetobacter in water system in ICU wards of different hospitals in Tehran. Hot water from shower heads could be a potential source of infection for Legionella pneumophila. Water was also proved to contain Pseudomonas aeruginonsa, the main GNB-NE causing nosocomila pneumonia at Tehran hospitals. Care should be taken concerning cleanliness and decontamination of water supplies at ICUs for pathogenic organisms.
Sadsad, Rosemarie; Sintchenko, Vitali; McDonnell, Geoff D.; Gilbert, Gwendolyn L.
Methicillin-resistant Staphylococcus aureus (MRSA) is a major cause of preventable nosocomial infections and is endemic in hospitals worldwide. The effectiveness of infection control policies varies significantly across hospital settings. The impact of the hospital context towards the rate of nosocomial MRSA infections and the success of infection control is understudied. We conducted a modelling study to evaluate several infection control policies in surgical, intensive care, and medical ward specialties, each with distinct ward conditions and policies, of a tertiary public hospital in Sydney, Australia. We reconfirm hand hygiene as the most successful policy and find it to be necessary for the success of other policies. Active screening for MRSA, patient isolation in single-bed rooms, and additional staffing were found to be less effective. Across these ward specialties, MRSA transmission risk varied by 13% and reductions in the prevalence and nosocomial incidence rate of MRSA due to infection control policies varied by up to 45%. Different levels of infection control were required to reduce and control nosocomial MRSA infections for each ward specialty. Infection control policies and policy targets should be specific for the ward and context of the hospital. The model we developed is generic and can be calibrated to represent different ward settings and pathogens transmitted between patients indirectly through health care workers. This can aid the timely and cost effective design of synergistic and context specific infection control policies. PMID:24340085
Gizaw, Zemichael; Gebrehiwot, Mulat; Yenew, Chalachew
The air inhaled by people is abundantly populated with microorganisms which also are called bioaerosols. Bioaerosols is a colloidal suspension, formed by liquid droplets and particles of solid matter in the air, whose components contain or have attached to them viruses, fungal spores and conidia, bacterial endospores, plant pollen and fragments of plant tissues. They account for 5-34 % of indoor air pollution. A cross-sectional study was conducted to assess the bacteriological concentration and to identify specific species of bacteria in the indoor air of Gondar University teaching hospital. Air samples were taken from 14 randomly selected wards. Bacterial measurements were made by passive air sampling technique i.e., the settle plate method. In each ward five Petri dishes were exposed for 30 and 60 min in the morning and afternoon. Bacteria were collected on nutrient agar and blood agar media. Both quantitative and qualitative analyses were conducted. The quantitative analysis was mainly conducted to determine bacterial load or number of bacteria in the indoor air. Bacterial load was enumerated as colony forming units. Qualitative analysis was conducted to identify specific species of bacteria. For this study we have selected Staphylococcus aureus and Streptococcus which had high public health concern. Mannitol test was used to isolate Staphylococcus aureus, whereas Bacitracin test was conducted to isolate Streptococcus pyogene. The result of this study indicated that the highest bacterial load which was 1468 CFU/m(3) has been recorded at 2:00 PM in Ward C at 60 min exposure time and the lowest bacterial concentration (i.e., 480 CFU/m(3)) was recorded at 8:00 AM in physiotherapy ward. Based on the result bacterial concentration of indoor air of Gondar University teaching hospital was found between 480 and 1468 CFU/m(3). The result of one way ANOVA showed that the highest mean bacterial concentration (1271.00 CFU/m(3)) was found in Medical ward and the
Anderson, D J; Webster, C S
To discuss a potentially powerful approach to safer medication administration on the hospital ward, based on principles of safety developed in other high-risk industries, and consistent with recent national reports on safety in health care released in the United Kingdom (UK) and United States of America (USA). To discuss why punitive approaches to safety on the hospital ward and in the nursing literature do not work. Drug administration error on the hospital ward is an ever-present problem and its occurrence is too frequent. Administering medication is probably the highest-risk task a nurse can perform, and accidents can lead to devastating consequences for the patient and for the nurse's career. Drug errors in nursing are often dealt with by unsystematic, punitive, and ineffective means, with little knowledge of the factors influencing error generation. Typically, individual nurses are simply blamed for their carelessness. By focusing on the individual, the complete set of contributing factors cannot be known. Instead, vain attempts will be made to change human behaviour - one of the most change-resistant aspects of any system. A punitive, person-centred approach therefore, severely hampers effective improvements in safety. By contrast, in other high-risk industries, such as aviation and nuclear power, the systems-centred approach to error reduction is routine. Accidents or errors are only the tip of the incident iceberg. Through effective, nonpunitive incident reporting, which includes reports of near-misses and system problems in addition to actual accidents, the systems-approach allows the complete set of contributing factors underlying an accident to be understood and addressed. Feedback to participants and targeted improvement in the workplace is also important to demonstrate that incident data are being used appropriately, and to maintain high levels of on-going reporting and enthusiasm for the scheme. Drug administration error is a serious problem, which
van den Oetelaar, W F J M; van Stel, H F; van Rhenen, W; Stellato, R K; Grolman, W
Introduction Hospitals pursue different goals at the same time: excellent service to their patients, good quality care, operational excellence, retaining employees. This requires a good balance between patient needs and nursing staff. One way to ensure a proper fit between patient needs and nursing staff is to work with a workload management method. In our view, a nursing workload management method needs to have the following characteristics: easy to interpret; limited additional registration; applicable to different types of hospital wards; supported by nurses; covers all activities of nurses and suitable for prospective planning of nursing staff. At present, no such method is available. Methods/analysis The research follows several steps to come to a workload management method for staff nurses. First, a list of patient characteristics relevant to care time will be composed by performing a Delphi study among staff nurses. Next, a time study of nurses’ activities will be carried out. The 2 can be combined to estimate care time per patient group and estimate the time nurses spend on non-patient-related activities. These 2 estimates can be combined and compared with available nursing resources: this gives an estimate of nurses’ workload. The research will take place in an academic hospital in the Netherlands. 6 surgical wards will be included, capacity 15–30 beds. Ethical considerations The study protocol was submitted to the Medical Ethical Review Board of the University Medical Center (UMC) Utrecht and received a positive advice, protocol number 14-165/C. Discussion This method will be developed in close cooperation with staff nurses and ward management. The strong involvement of the end users will contribute to a broader support of the results. The method we will develop may also be useful for planning purposes; this is a strong advantage compared with existing methods, which tend to focus on retrospective analysis. PMID:28186931
van Loon, Kim; van Zaane, Bas; Bosch, Els J; Kalkman, Cor J; Peelen, Linda M
Failure to recognize acute deterioration in hospitalized patients may contribute to cardiopulmonary arrest, unscheduled intensive care unit admission and increased mortality. In this systematic review we aimed to determine whether continuous non-invasive respiratory monitoring improves early diagnosis of patient deterioration and reduces critical incidents on hospital wards. Studies were retrieved from Medline, Embase, CINAHL, and the Cochrane library, searched from 1970 till October 25, 2014. Electronic databases were searched using keywords and corresponding synonyms 'ward', 'continuous', 'monitoring' and 'respiration'. Pediatric, fetal and animal studies were excluded. Since no validated tool is currently available for diagnostic or intervention studies with continuous monitoring, methodological quality was assessed with a modified tool based on modified STARD, CONSORT, and TREND statements. Six intervention and five diagnostic studies were included, evaluating the use of eight different devices for continuous respiratory monitoring. Quantitative data synthesis was not possible because intervention, study design and outcomes differed considerably between studies. Outcomes estimates for the intervention studies ranged from RR 0.14 (0.03, 0.64) for cardiopulmonary resuscitation to RR 1.00 (0.41, 2.35) for unplanned ICU admission after introduction of continuous respiratory monitoring. The methodological quality of most studies was moderate, e.g. 'before-after' designs, incomplete reporting of primary outcomes, and incomplete clinical implementation of the monitoring system. Based on the findings of this systematic review, implementation of routine continuous non-invasive respiratory monitoring on general hospital wards cannot yet be advocated as results are inconclusive, and methodological quality of the studies needs improvement. Future research in this area should focus on technology explicitly suitable for low care settings and tailored alarm and treatment
Tigabu, Bereket Molla; Daba, Daniel; Habte, Belete
Objective: The increasing number of available drugs and drug users, as well as more complex drug regimens led to more side effects and drug interactions and complicates follow-up. The objective of this study was to assess drug-related problems (DRPs) and associated factors in hospitalized patients. Methods: A hospital-based cross-sectional study design was employed. The study was conducted in Jimma University Specialized Hospital, Jimma, located in the south west of Addis Ababa. All patients who were admitted to the medical ward from February 2011 to March 2011 were included in the study. Data on sociodemographic variables, past medical history, drug history, current diagnosis, current medications, vital signs, and relevant laboratory data were collected using semi-structured questionnaire and data collection forms which were filling through patient interview and card review. Data were analyzed using SPSS version 16 for windows. Descriptive statistics, cross-tabs, Chi-square, and logistic regression were utilized. Findings: Out of 257 study participants, 189 (73.5%) had DRPs and a total of 316 DRPs were identified. From the six classes of DRPs studied, 103 (32.6%) cases related to untreated indication or need additional drug therapy, and 49 (15.5%) cases related to high medication dosage. Unnecessary drug therapy in 49 (15.5%) cases, low medication dosage in 44 (13.9%) cases, and ineffective drug therapy in 42 (13.3%) cases were the other classes of problems identified. Noncompliance in 31 (9.8%) cases was the least prevalent DRP. Independent factors which predicted the occurrence of DRPs in the study population were sex, age, polypharmacy, and clinically significant potential drug-drug interactions. The prevalence of DRPs was substantially high (73.5%). Conclusion: Drug-related problems are common among medical ward patients. Indication-related problems, untreated indication and unnecessary drug therapy were the most common types of DRPs among patients of our
Dutta, S; Biswas, R; Lahiri, A
A study was conducted in a non-paying gynaecological ward of the district hospital, South 24 Parganas, West Bengal to assess different bed efficiency indicators. Total 331 patients were admitted in 23 study beds (12 OPD beds and 11 emergency beds) during an observation period of six months. Overall average number of admissions were 14.4 and average length of stay 14.7days. Bed turnover rate was 13.8 and was higher for emergency beds (22.1) compared to OPD beds (9). Bed occupancy rate was 61.3% with significant difference between OPD beds (57.5%) and emergency beds (65.4%).
Stelfox, Henry T; Leigh, Jeanna Parsons; Dodek, Peter M; Turgeon, Alexis F; Forster, Alan J; Lamontagne, Francois; Fowler, Rob A; Soo, Andrea; Bagshaw, Sean M
To provide a 360-degree description of ICU-to-ward transfers. Prospective cohort study of 451 adults transferred from a medical-surgical ICU to a hospital ward in 10 Canadian hospitals July 2014-January 2016. Transfer processes documented in the medical record. Patient (or delegate) and provider (ICU/ward physician/nurse) perspectives solicited by survey 24-72 h after transfer. Medical records (100%) and survey responses (ICU physicians-80%, ICU nurses-80%, ward physicians-46%, ward nurses-64%, patients-74%) were available for most transfers. The median time from initiation to completion of transfer was 25 h (IQR 6-52). ICU physicians and nurses reported communicating with counterparts via telephone (78 and 75%) when transfer was requested (82 and 24%) or accepted (31 and 59%) and providing more elements of clinical information than ward physicians (mean 4.7 vs. 3.9, p < 0.001) and nurses (5.0 vs. 4.4, p < 0.001) reported receiving. Patients were more likely to report satisfaction with the transfer when they received more information (OR 1.32, 95% CI 1.18-1.48), had their questions addressed (OR 3.96, 95% CI 1.33-11.84), met the ward physician prior to transfer (OR 4.61, 95% CI 2.90-7.33), and were assessed by a nurse within 1 h of ward arrival (OR 4.70, 95% CI 2.29-9.66). Recommendations for improvement included having a documented care plan travel with the patient (all stakeholders), standardized face-to-face handover (physicians), avoiding transfers at shift change (nurses) and informing patients about pending transfers in advance (patients). ICU-to-ward transfers are characterized by failures of patient flow and communication; experienced differently by patients, ICU/ward physicians and nurses, with distinct suggestions for improvement.
Landau, Simha F; Bendalak, Yehudit
This study analyzes violence against personnel in the emergency wards of all 25 general hospitals in Israel using a self-report questionnaire (N=2,356). Informed by the routine activity theory, the hypotheses related to the major concepts of this approach: exposure, target suitability, guarding and proximity to offenders. A General Exposure to Violence Index (GEVI) was constructed, based on the participants' reports about type and frequency of their victimization to violence during the preceding year. The multiple regression analysis for explaining the GEVI was composed of 15 independent variables relating to participants' professional and personal characteristics as well as to structural features of hospitals. As predicted, higher exposure to violence was related to security or nursing staff and positions of authority; high weekly workload; working in a profession other than that of training; inability of coping with verbal violence; having no access to an emergency button, and working in settings restricting the number of accompanying persons to one only. Unexpectedly, previous training in coping with violence was related to higher victimization. Younger age, male gender and being of European/American origin (mainly from the former Soviet Union) was also related to higher risk of victimization. The results support the utility of the routine activities approach in explaining differences in emergency ward personnel victimization. The findings also indicate, however, the need to add domain-specific contextual analyses to this approach to reach a fuller understanding of the behaviors under discussion. Implications of the finding to coping with violence against emergency ward personnel are discussed, and suggestions are put forward for further study in this field.
Afekouh, H; Baune, P; Abbas, R; De Falvelly, D; Guermah, F; Haber, N
We aimed to identify the indications for antibiotic prescriptions made to patients hospitalized in the rehabilitation ward of a geriatric hospital. Our final objective was to assess those prescriptions. Medical experts performed a prospective study of all antibiotic treatments prescribed in the rehabilitation ward over a 4-month period based on Gyssens' algorithm and on the local guidelines for anti-infective drugs. Treatments were considered appropriate when the indication, choice of agent, duration, and dose were approved by the experts. They were however considered unnecessary when the indication was incorrect, and they were deemed inappropriate when the experts approved the indication but considered that treatment modalities were not optimal. We also reviewed the prescription re-evaluation made 48 to 72hours after treatment initiation. We reviewed 142 prescriptions. Treatments had mainly been prescribed for respiratory tract infections (81 infections), urinary tract infections (41), skin infections (15), or abdominal infections (8). A total of 27 prescriptions (19%) were considered unnecessary mainly because a urinary tract infection diagnosis had been wrongly made (21 prescriptions). Half of the prescriptions were considered inappropriate: 38 prescriptions had an inappropriate spectrum of activity and 32 had an inadequate treatment duration. A total of 67 prescriptions (47.2%) had been reassessed 48-72hours after treatment initiation. Overall, 25 prescriptions (17.6%) were considered appropriate and were reassessed 48-72hours after treatment initiation. We now have a better understanding of antibiotic prescription in a rehabilitation ward context. We identified several points that need to be improved: update and improvement of the local guidelines, better training for prescribers, and creation of a supporting document for the reassessment of the prescriptions 48-72hours after treatment initiation. Copyright © 2015 Elsevier Masson SAS. All rights reserved.
Abbasinazari, Mohammad; Hajhossein Talasaz, Azita; Eshraghi, Azadeh; Sahraei, Zahra
Any suboptimum treatment in the management of patients can lead to medication errors (MEs) that may increase morbidity and mortality in hospitalized individuals. By establishing well-designed patient care activities within the managed care setting, clinical pharmacists can cooperate with other health care professionals to provide quality care and maximize safety. The aim of this study was to evaluate the frequency and prevention of MEs by clinical pharmacists. This was a cross-sectional interventional study conducted in internal wards of a teaching hospital during a two-month period. During this period, patient records, and physician orders were reviewed by clinical pharmacists. Any prescription error identified was documented. Incorrect drug selection, dose, dosage form, frequency, or route of administration all were considered as medication errors. Then, the clinical pharmacist discuss about findings with the clinical fellows to change faulty orders. The frequency and types of MEs in different wards that were detected and prevented by clinical pharmacists was documented. During the study period, in 132 patients, 262 errors were detected (1.98 per each). Wrong frequency 71 (27%), forget to order 37 (14.1%), wrong selection 33 (12.5%), drug interactions 26 (9.9%), forget to discontinue 25 (9.5%) and inappropriate dose adjustment in renal impairment 25 (9.5%) were the most types of errors. Cardiovascular medications were the class with the highest detected errors (31.6%) followed by gastrointestinal agents (15.6%). Medication errors are common problems in medical wards that their frequency can be restricted by the intervention of clinical pharmacists.
mm »•’(. oc oc CO c CD l*»r—^ TECHNICAL REPORT TR75-118 AMEL SIMULATED SOLAR HEAT TESTS OF M.U.S.T. AIR-INFLATABLE, DOUBLE-WALL HOSPITAL ...8217^/ 2. OOVT ACCESSION NO SIMULATED^OLAR HEAT TESTS OF M.U.S.T. AIR- INFLATABLE, DOUBLE-WALL HOSPITAL WARD SHELTERS. - .^L . 31 f / AUTHOR 1250...for Building Technology conducted solar heat load tests on five sections of M.U.S.T. air-inflatable, double-wall hospital ward shelters. The purpose
Muşat, Simona Nicoleta; Ioniţa, Diana; Paceonea, Mirela; Chiriac, Nona Delia; Stoicescu, Ileana Paula; Mihălţan, F D
Identifying and promoting new management techniques for the descentralized pneumology hospitals or wards was one of the most ambitious objectives of the project "Quality in the pneumology medical services through continuous medical education and organizational flexibility", financed by the Human Resourses Development Sectorial Operational Programme 2007-2013 (ID 58451). The "Medium term Strategy on the specific management of the pneumology hospitals or wards after the descentralization of the sanitary system" presented in the article was written by the project's experts and discussed with pneumology managers and local authorities representatives. This Strategy application depends on the colaboration of the pneumology hospitals with professional associations, and local and central authorities.
Chan, H-T; White, P; Sheorey, H; Cocks, J; Waters, M-J
This study assessed the efficacy of a 'dry' hydrogen peroxide vapour decontamination in an Australian hospital via a two-armed study. The in vivo arm examined the baseline bacterial counts in high-touch zones within wards and evaluated the efficacy of cleaning with a neutral detergent followed by either hydrogen peroxide vapour decontamination, or a manual terminal clean with bleach or Det-Sol 500. The in vitro arm examined the efficacy of hydrogen peroxide vapour decontamination on a variety of different surfaces commonly found in the wards of an Australian hospital, deliberately seeded with a known concentration of vancomycin-resistant enterococci (VRE). All bacterial counts were evaluated by a protocol of contact plate method. In the in vivo arm, 33.3% of the high-touch areas assessed had aerobic bacterial count below the detection limit (i.e. no bacteria recoverable) post hydrogen peroxide decontamination, and in all circumstances the highest microbial density was ≤3 cfu/cm(2), while in the in vitro arm there was at least a reduction in bacterial load by a factor of 10 at all surfaces investigated. These results showed that dry hydrogen peroxide vapour room decontamination is highly effective on a range of surfaces, although the cleanliness data obtained by these methods cannot be easily compared among the different surfaces as recovery of organisms is affected by the nature of the surface.
Hasan, Md. Farhad; Himika, Taasnim Ahmed; Molla, Md. Mamun
In this paper, a very popular alternative computational technique, the Lattice Boltzmann Method (LBM) has been used for Large-Eddy Simulation (LES) of airflow and heat transfer in general ward of hospital. Different Reynolds numbers have been used to study the airflow pattern. In LES, Smagorinsky turbulence model has been considered and a discussion has been conducted in brief. A code validation has been performed comparing the present results with benchmark results for lid-driven cavity problem and the results are found to agree very well. LBM is demonstrated through simulation in forced convection inside hospital ward with six beds with a partition in the middle, which acted like a wall. Changes in average rate of heat transfer in terms of average Nusselt numbers have also been recorded in tabular format and necessary comparison has been showed. It was found that partition narrowed the path for airflow and once the air overcame this barrier, it got free space and turbulence appeared. For higher turbulence, the average rate of heat transfer increased and patients near the turbulence zone released maximum heat and felt more comfortable.
Jacobsohn, Vanessa; DeArman, Maria; Moran, Patrick; Cross, Jennette; Dietz, Deidre; Allen, Rebekah; Bachofer, Sally; Dow-Velarde, Lily; Kaufman, Arthur
Although the need for physician participation in critiquing and setting health policies is great, physician participation in health policy activities is low. Many barriers hamper physician involvement, from limited time to ignorance of their potential roles, to minimal exposure to the issue during medical education. University of New Mexico School of Medicine family medicine residents and students on ward teams were trained to ask specific questions on rounds that framed individual patient encounters as windows into broader community health and policy issues. Teams selected problems on which to intervene, with the intent of influencing hospital policies to improve health care and outcomes. Ten projects were completed in six months, four of which are presented. Resident and student accomplishments included (1) identifying a free drug formulary at the Health Care for the Homeless pharmacy to reduce readmission rates of discharged homeless patients, (2) expanding hospital outpatient pharmacy hours to reduce preventable emergency room visits for medications, (3) expanding the hospital social service workforce to address the overwhelming need to discharge indigent patients needing extended care, and (4) certifying residents and faculty to provide outpatient buprenorphine treatment as a harm-reduction intervention for opiate-addicted patients, thereby reducing preventable hospitalizations for overdose or for medical complications from illicit opiate use. Hospital health policy is made more accessible to learners if issues that generate policy discussions emerge from their daily learning environment, if learners can intervene to improve those policies within a limited timeframe, and if faculty mentors are available to guide their interventions.
Ghassemi, A; Farhangi, H; Badiee, Z; Banihashem, A; Mosaddegh, MR
Background Infections in critical care unit are high, and they are serious hospital problems. Infections acquired during the hospital stay are generally called nosocomial infections, initially known as infections arising after 48 h of hospital admission. The mostfrequent nosocomial infections (urinary, respiratory, gastroenteritis and blood stream infection) were common in patients at hospital.The aim was to study, the current status of nosocomial infection, rate of infection among hospitalized children at hematology-oncology ward of Dr. Sheikh children’s hospital, Mashhad, Iran. Materials and Methods Data were collected from 200 patient's records presented with symptoms of nosocomial infection at hematology-oncology ward of Dr. Sheikh children’s hospital from March 2014 to September 2014. Descriptive statistics using percentage was calculated. Results Incidence of nosocomial infections inpatients athematology-oncology ward was 31% (62/200). Of which 69.35% (43/62) blood stream infection being the most frequent; followed by 30.64% (19/62) was urinary tract infection (UTI), and the most common blood culture isolate was been Staphylococcus epidermidis 18 (41.86%), andour study showed that large numbers ofnosocomial UTIs causing by Gram‑negative bacteria. Conclusion This study showed blood stream infection and UTI are the common nosocomial infections among patients athematology-oncology ward. Early recognition of infections and short term use of invasive devices along with proper infection control procedures can significantly decrease the incidence of nosocomial infections in patients. PMID:26985350
van Loon, Kim; van Zaane, Bas; Bosch, Els J.; Kalkman, Cor J.; Peelen, Linda M.
Background Failure to recognize acute deterioration in hospitalized patients may contribute to cardiopulmonary arrest, unscheduled intensive care unit admission and increased mortality. Purpose In this systematic review we aimed to determine whether continuous non-invasive respiratory monitoring improves early diagnosis of patient deterioration and reduces critical incidents on hospital wards. Data Sources Studies were retrieved from Medline, Embase, CINAHL, and the Cochrane library, searched from 1970 till October 25, 2014. Study Selection Electronic databases were searched using keywords and corresponding synonyms ‘ward’, ‘continuous’, ‘monitoring’ and ‘respiration’. Pediatric, fetal and animal studies were excluded. Data Extraction Since no validated tool is currently available for diagnostic or intervention studies with continuous monitoring, methodological quality was assessed with a modified tool based on modified STARD, CONSORT, and TREND statements. Data Synthesis Six intervention and five diagnostic studies were included, evaluating the use of eight different devices for continuous respiratory monitoring. Quantitative data synthesis was not possible because intervention, study design and outcomes differed considerably between studies. Outcomes estimates for the intervention studies ranged from RR 0.14 (0.03, 0.64) for cardiopulmonary resuscitation to RR 1.00 (0.41, 2.35) for unplanned ICU admission after introduction of continuous respiratory monitoring, Limitations The methodological quality of most studies was moderate, e.g. ‘before-after’ designs, incomplete reporting of primary outcomes, and incomplete clinical implementation of the monitoring system. Conclusions Based on the findings of this systematic review, implementation of routine continuous non-invasive respiratory monitoring on general hospital wards cannot yet be advocated as results are inconclusive, and methodological quality of the studies needs improvement. Future
Illingworth, E; Taborn, E; Fielding, D; Cheesbrough, J; Diggle, P J; Orr, D
The standard approach for norovirus control in hospitals in the UK, as outlined by the Health Protection Agency guidance and implemented previously by Lancashire Teaching Hospitals, involves the early closure of affected wards. However, this has a major impact on bed-days lost and cancelled admissions. In 2008, a new strategy was introduced in the study hospital, key elements of which included closure of affected ward bays (rather than wards), installation of bay doors, enhanced cleaning, a rapid in-house molecular test and an enlarged infection control team. The impact of these changes was assessed by comparing two norovirus seasons (2007-08 and 2009-10) before and after implementation of the new strategy, expressing the contrast between seasons as a ratio (r) of expected counts in the two seasons. There was a significant decrease in the ratio of confirmed hospital outbreaks to community outbreaks (r = 0.317, P = 0.025), the number of days of restricted admissions on hospital wards per outbreak (r = 0.742, P = 0.041), and the number of hospital bed-days lost per outbreak (r = 0.344, P <0.001). However, there was no significant change in the number of patients affected per hospital outbreak (r = 1.080, P = 0.517), or the number of hospital staff affected per outbreak (r = 0.651, P = 0.105). Closure of entire wards during norovirus outbreaks is not always necessary. The changes implemented at the study hospital resulted in a significant reduction in the number of bed-days lost per outbreak, and this, together with a reduction in outbreak frequency, resulted in considerable cost savings.
Goldstein, Lee H; Elias, Mazen; Ron-Avraham, Gilat; Biniaurishvili, Ben Zion; Madjar, Magali; Kamargash, Irena; Braunstein, Rony; Berkovitch, Matitiahu; Golik, Ahuva
What is already known about this subject In general, use of herbal remedies and supplements is constantly rising in the western population and this may be potentially dangerous due to adverse effects and drug–herb interactions. All information up to now has been derived from the general population or outpatients. There are no publications on the rate of consumption of herbals in inpatients, or the awareness of the medical team of this fact. What this study adds Approximately 25% of patients hospitalized in internal medicine wards consume some kind of herbal or dietary supplement.Consumption is associated with higher income, nonsmoking and benign prostatic hypertrophy.The medical team was aware of the consumption in only 23% of the cases, and all drug–herbal interactions which we discovered were missed by the medical team. Aims Herbal remedies may have adverse effects and potentially serious interactions with some commonly prescribed conventional medications. Little is known about consumption of herbal remedies and dietary supplements by hospitalized patients. The aim was to evaluate the rate of consumption and characterize the patients hospitalized in internal medicine departments who consume herbal remedies and dietary supplements. Also, to assess the medical teams' awareness and assess the percentage of patients with possible drug–herb interactions. Methods Patients hospitalized in the medical wards of two hospitals in Israel were interviewed about their use of herbal remedies or dietary supplements. The medical records were searched for evidence that the medical team had knowledge of the use of herbal remedies or dietary supplements. Results Two hundred and ninety-nine hospitalized medical patients were interviewed. Of the participants, 26.8% were herbal or dietary supplement consumers (HC). On multivariate analysis the only variates associated with herbal or dietary supplement consumption were the hospital [odds ratio (OR) 2.97, 95% confidence interval
Saillour-Glénisson, F; Domecq, S; Kret, M; Sibe, M; Dumond, J P; Michel, P
Although many organizational culture questionnaires have been developed, there is a lack of any validated multidimensional questionnaire assessing organizational culture at hospital ward level and adapted to health care context. Facing the lack of an appropriate tool, a multidisciplinary team designed and validated a dimensional organizational culture questionnaire for healthcare settings to be administered at ward level. A database of organizational culture items and themes was created after extensive literature review. Items were regrouped into dimensions and subdimensions (classification validated by experts). Pre-test and face validation was conducted with 15 health care professionals. In a stratified cluster random sample of hospitals, the psychometric validation was conducted in three phases on a sample of 859 healthcare professionals from 36 multidisciplinary medicine services: 1) the exploratory phase included a description of responses' saturation levels, factor and correlations analyses and an internal consistency analysis (Cronbach's alpha coefficient); 2) confirmatory phase used the Structural Equation Modeling (SEM); 3) reproducibility was studied by a test-retest. The overall response rate was 80 %; the completion average was 97 %. The metrological results were: a global Cronbach's alpha coefficient of 0.93, higher than 0.70 for 12 sub-dimensions; all Dillon-Goldstein's rho coefficients higher than 0.70; an excellent quality of external model with a Goodness of Fitness (GoF) criterion of 0.99. Seventy percent of the items had a reproducibility ranging from moderate (Intra-Class Coefficient between 50 and 70 % for 25 items) to good (ICC higher than 70 % for 33 items). COMEt (Contexte Organisationnel et Managérial en Etablissement de Santé) questionnaire is a validated multidimensional organizational culture questionnaire made of 6 dimensions, 21 sub-dimensions and 83 items. It is the first dimensional organizational culture questionnaire
Asgari Dastjerdi, Hoori; Khorasani, Elahe; Yarmohammadian, Mohammad Hossein; Ahmadzade, Mahdiye Sadat
Abstract: Background: Medical errors are one of the greatest problems in any healthcare systems. The best way to prevent such problems is errors identification and their roots. Failure Mode and Effects Analysis (FMEA) technique is a prospective risk analysis method. This study is a review of risk analysis using FMEA technique in different hospital wards and departments. Methods: This paper has systematically investigated the available databases. After selecting inclusion and exclusion criteria, the related studies were found. This selection was made in two steps. First, the abstracts and titles were investigated by the researchers and, after omitting papers which did not meet the inclusion criteria, 22 papers were finally selected and the text was thoroughly examined. At the end, the results were obtained. Results: The examined papers had focused mostly on the process and had been conducted in the pediatric wards and radiology departments, and most participants were nursing staffs. Many of these papers attempted to express almost all the steps of model implementation; and after implementing the strategies and interventions, the Risk Priority Number (RPN) was calculated to determine the degree of the technique’s effect. However, these papers have paid less attention to the identification of risk effects. Conclusions: The study revealed that a small number of studies had failed to show the FMEA technique effects. In general, however, most of the studies recommended this technique and had considered it a useful and efficient method in reducing the number of risks and improving service quality. PMID:28039688
Sengke, M. M. C.; Atmodiwirjo, P.
This paper reports an on-going project that explores the use of digital application to study human field of view. The focus of discussion is to study the patients’ visual experience, in relation to the arrangement of interior elements in patients’ ward. The physical qualities of the environment can influence the healing process of the patient. Typical layout of interior elements often fails to provide visual stimulus that could support the healing process of the. This study explores the experience of seeing by simulating the hospital ward setting into 3D model using isovist analysis. Isovist is used to represent the experience of seeing by the patient from particular point of view and also to represent the object and surfaces that are being seen. Isovist has a function to show us the boundary of the visible areas, which can reveal which elements can and cannot seen by the patient. Isovist provides a way to understand the experience of seeing and being seen by visualizing the visibility area through three dimensional modelling. This study suggests the possibility to study human field of view to support the design of architecture for health.
Benzel, R A; Lipman, T O
Records of 103 consecutive admissions to a general medical ward over 4 months in a Veterans Administration Medical Center were reviewed. Assessment was made of nutritional status and potential need for supplemental vitamin therapy based upon predetermined criteria. Thirty-five of the 103 patients received one or more vitamin supplements. No patient received unnecessary vitamins as defined by our criteria. However, 48 patients had indications for vitamin supplementation, but did not receive any. Analysis of data by indication for vitamin therapy revealed 125 indications for vitamin therapy in 83 patients. Of the 125 indications 54 were treated appropriately, but there were no vitamin prescriptions in 71 indicated instances. We conclude that indicated vitamin supplementation may be underutilized in hospitalized general medical patients.
Hor, J Y
A cross-sectional study was conducted to examine the use of prescription drugs among elderly patients (> or = 60 years old) admitted to medical wards in Hospital Kuala Lumpur, Malaysia. A total of 204 elderly (101 men and 103 women) were interviewed. Eighty two percent of the elderly were taking at least one prescription drug, with 39.2% taking > or = 5 drugs. Prescription drugs commonly used were antihypertensives (54.4%), antidiabetics (40.2%), drugs used in haemostasis (36.8%), nitrates (33.3%) and diuretics (32.4%). Factors associated with increased use of prescription drugs were: more number of chronic diseases, self-rated health status as poor, low Barthel score, and Chinese women.
Hasley, Peggy B.; Arnold, Robert M.
No previous studies have described how faculty give summative evaluations to learners on the medical wards. The aim of this study was to describe summative evaluations on the medical wards. Participants were students, house staff and faculty at the University of Pittsburgh. Ward rotation evaluative sessions were tape recorded. Feedback was…
Hasley, Peggy B.; Arnold, Robert M.
No previous studies have described how faculty give summative evaluations to learners on the medical wards. The aim of this study was to describe summative evaluations on the medical wards. Participants were students, house staff and faculty at the University of Pittsburgh. Ward rotation evaluative sessions were tape recorded. Feedback was…
Giraldo, Nubia Amparo; Aguilar, Nora Luz; Restrepo, Beatriz Elena; Vanegas, Marcela; Alzate, Sandra; Martínez, Mónica; Gamboa, Sonia Patricia; Castaño, Eliana; Barbosa, Janeth; Román, Juliana; Serna, Ángela María; Hoyos, Gloria Marcela
Introduction: Nutritional support generates complications that must be detected and treated on time. Objective: To estimate the incidence of some complications of nutritional support in patients admitted to general hospital wards who received nutritional support in six high-complexity institutions. Methods: Prospective, descriptive and multicentric study in patients with nutritional support; the variables studied were medical diagnosis, nutritional condition, nutritional support duration, approach, kind of formula, and eight complications. Results: A total of 277 patients were evaluated; 83% received enteral nutrition and 17% received parenteral nutrition. Some 69.3% presented risk of malnourishment or severe malnourishment at admittance. About 35.4% of those receiving enteral nutrition and 39.6% of the ones who received parenteral nutrition had complications; no significant difference per support was found (p= 0.363). For the enteral nutrition, the most significant complication was the removal of the catheter (14%), followed by diarrhea (8.3%); an association between the duration of the enteral support with diarrhea, constipation and removal of the catheter was found (p < 0.05). For parenteral nutrition, hyperglycemia was the complication of highest incidence (22.9%), followed by hypophosphatemia (12.5%); all complications were associated with the duration of the support (p < 0.05). Nutritional support was suspended in 24.2% of the patients. Conclusions: Complications with nutritional support in hospital-ward patients were frequent, with the removal of the catheter and hyperglycemia showing the highest incidence. Duration of the support was the variable that revealed an association with complications. Strict application of protocols could decrease the risk for complications and boost nutritional support benefits. PMID:24893056
Ayalew, Mohammed Biset; Megersa, Teshome Nedi; Mengistu, Yewondwossen Taddese
Objective: This study was aimed to determine the prevalence of drug-related problems (DRPs), identify the most common drugs, and drug classes involved in DRPs as well as associated factors with the occurrence of DRPs. Methods: A prospective cross-sectional study was conducted on 225 patients admitted to medical wards of Tikur Anbessa Specialized Hospital, Addis Ababa from March to June 2014. Data regarding patient characteristics, medications, diagnosis, length of hospitalization, investigation, and laboratory results were collected using data abstraction forms through review of patients’ medical card and medication charts. Identified DRPs were recorded and classified using DRP registration forms. The possible intervention measures for the identified DRPs were proposed and communicated to either the physician or the patient. Data were entered into Epi Info 7 and analyzed using SPSS version 21 (IBM Corp. Released 2012, Armonk, NY: IBM Corp). Findings: DRPs were found in 52% of study subjects. A drug-drug interaction (48% of all DRPs) was the most common DRP followed by adverse drug reaction (23%). Anti-infectives and gastrointestinal medicines were commonly involved in DRPs. Drugs with the highest drug risk ratio were gentamycin, warfarin, nifedipine, and cimetidine. The number of drugs taken by the patient per day is an important risk factor for DRPs. Conclusion: DRPs are common among medical ward patients. Polypharmacy has a significant association with the occurrence of DRP. Drugs such as gentamycin, warfarin, nifedipine, and cimetidine have the highest probability of causing DRP. So, patients who are taking either of these drugs or polypharmacy should be closely assessed for identification and timely correction of DRPs. PMID:26645029
Smoleń, Ewa; Ksykiewicz-Dorota, Anna
Working time is a non-renewable and important element in the management of an organization. The implementation of changes in the structure of working time may be facilitated by the insight into activities undertaken by employees during work. Such an approach plays an important role since the effective use of time improves the quality of care, prevents timewasting and optimizes the use of the full potential of employees, including nurses. The objective of the study was to determine the structure of working time of pediatric nurses in hospital wards of 2 referential levels. The study was conducted in 2 wards (2nd and 3rd levels of reference) in the Regional Specialist Children's Hospital in Olsztyn. The research method involved the measurement of working time, as well as continuous and snap-shot observation techniques. Standardized research instruments were used in the study; 8 continuous observations and 2333 snap-shot observations were carried out. In the structure of working time of pediatric nurses indirect nursing-related activities predominated (52.2%). Direct nursing made 28.7% of the working time. The nurses devoted the smallest amount of time to coordination and organization - 8%. The percentage of time associated with non-duty activities and breaks at work was 11.1%. In direct nursing activities associated with diagnosing (9%) and treatment (11.7%) prevailed. In indirect nursing activities pertaining to documentation of activities related to direct nursing made 24.6%. Pediatric nurses devote insufficient amount of time to direct nursing. Activities associated with documentation of activities related to direct nursing, preparation for direct nursing, as well as treatment and diagnosing predominate in the working time structure of nurses. Med Pr 2017;68(1):95-103.
Background In 2006, Burkina Faso set up a policy to subsidize the cost of obstetric and neonatal emergency care. This policy has undoubtedly increased attendance at all levels of the health pyramid. The aim of this study was to measure the capacity of referral hospitals’ maternity services to cope with the demand for health services after the implementation of this policy. Methods This study was conducted in three referral health centres (CMAs, CHRs, and CHUs). The CHU Yalgado Ouédraogo (tertiary level) and the CMA in Sector 30 (primary level) were selected as health facilities in the capital, along with the Kaya CHR (secondary level). At each health facility, the study included official maternity ward staff only. We combined the two occupational categories (nurses and midwives) because they perform the same activities in these health facilities. We used the WISN method recommended by WHO to assess the availability of nurses and midwives. Results Nurses and midwives represented 38% of staff at the University Hospital, 65% in the CHR and 80% in the CMA. The number of nurses and midwives needed for carrying out the activities in the maternity ward in the University Hospital and the CMA is greater than the current workforce, with WISN ratio of 0.68 and 0.79 respectively. In the CHR, the current workforce is greater than the number required (WISN ratio = 2). This medical centre is known for performing a high number curative and preventive activities compared to the Kaya CHR. Like the CHU, the delivery room is a very busy unit. This activity requires more time and more staff compared to other activities. Conclusion This study showed a shortage of nurses and midwives in two health facilities in Ouagadougou, which confirms that there is considerable demand. At the Kaya CHR, there is currently enough staff to handle the workload in the maternity ward, which may indicate a need to expand the analysis to other health facilities to determine whether a redistribution of
Rafiei, Malihe; Ghadami, Ahmad; Irajpour, Alireza; Feizi, Avat
Application of a reliable and authentic behavioral tool for measuring patients' pain, hospitalized in intensive care units who are not able to establish relationship, is needed severely. Therefore, this study is conducted with the aim of validating Critical Care Pain Observation Tool (CPOT) in patients hospitalized in surgical wards. CPOT was first translated into Persian and was psychometrically measured in terms of content. It should be noted that the content validity of CPOT was approved by panel of specialists. In addition, validity of this tool was confirmed with high internal cluster correlation (nonpainful procedure (0.997) and painful procedure (0.726). The diagnostic validity was supported with the increased CPOT score during position change and its constancy during the measurement of blood pressure (P < 0.001). Despite higher NRS scores than CPOT, CPOT criterion validity was confirmed due to the correlation between the scores obtained by these two tools (P < 0.001). CPOT is a valid and reliable tool to study pain in patients hospitalized in intensive care units.
Background Computer keyboards and mice are potential reservoirs of nosocomial pathogens, but routine disinfection for non-water-proof computer devices is a problem. With better hand hygiene compliance of health-care workers (HCWs), the impact of these potential sources of contamination on clinical infection needs to be clarified. Methods This study was conducted in a 1600-bed medical center of southern Taiwan with 47 wards and 282 computers. With education and monitoring program of hand hygiene for HCWs, the average compliance rate was 74% before our surveillance. We investigated the association of methicillin-resistant Staphylococcus aureus (MRSA), Pseudomonas aeruginosa and Acinetobacter baumannii, three leading hospital-acquired pathogens, from ward computer keyboards, mice and from clinical isolates in non-outbreak period by pulsed field gel electrophoresis and antibiogram. Results Our results revealed a 17.4% (49/282) contamination rate of these computer devices by S. aureus, Acinetobacter spp. or Pseudomonas spp. The contamination rates of MRSA and A. baumannii in the ward computers were 1.1% and 4.3%, respectively. No P. aeruginosa was isolated. All isolates from computers and clinical specimens at the same ward showed different pulsotypes. However, A. baumannii isolates on two ward computers had the same pulsotype. Conclusion With good hand hygiene compliance, we found relatively low contamination rates of MRSA, P. aeruginosa and A. baumannii on ward computer interface, and without further contribution to nosocomial infection. Our results suggested no necessity of routine culture surveillance in non-outbreak situation. PMID:19796381
Lu, Po-Liang; Siu, L K; Chen, Tun-Chieh; Ma, Ling; Chiang, Wen-Gin; Chen, Yen-Hsu; Lin, Sheng-Fung; Chen, Tyen-Po
Computer keyboards and mice are potential reservoirs of nosocomial pathogens, but routine disinfection for non-water-proof computer devices is a problem. With better hand hygiene compliance of health-care workers (HCWs), the impact of these potential sources of contamination on clinical infection needs to be clarified. This study was conducted in a 1600-bed medical center of southern Taiwan with 47 wards and 282 computers. With education and monitoring program of hand hygiene for HCWs, the average compliance rate was 74% before our surveillance. We investigated the association of methicillin-resistant Staphylococcus aureus (MRSA), Pseudomonas aeruginosa and Acinetobacter baumannii, three leading hospital-acquired pathogens, from ward computer keyboards, mice and from clinical isolates in non-outbreak period by pulsed field gel electrophoresis and antibiogram. Our results revealed a 17.4% (49/282) contamination rate of these computer devices by S. aureus, Acinetobacter spp. or Pseudomonas spp. The contamination rates of MRSA and A. baumannii in the ward computers were 1.1% and 4.3%, respectively. No P. aeruginosa was isolated. All isolates from computers and clinical specimens at the same ward showed different pulsotypes. However, A. baumannii isolates on two ward computers had the same pulsotype. With good hand hygiene compliance, we found relatively low contamination rates of MRSA, P. aeruginosa and A. baumannii on ward computer interface, and without further contribution to nosocomial infection. Our results suggested no necessity of routine culture surveillance in non-outbreak situation.
Innes, Anthea; Kelly, Fiona; Scerri, Charles; Abela, Stephen
To ascertain the experiences, attitudes and knowledge of staff working in two Maltese hospital wards and the observed experiences of people with dementia living there. To examine the impact of recommendations made in October 2011 for improving the psychosocial and physical environments of the wards 1 year later. There is an increasing policy recognition of the need for a better trained and educated dementia care workforce and of ensuring that the environmental design of care settings meets the needs of people with dementia. At both time points, three established and validated data-collection methods evaluated (i) staff/patient interaction and patient experience, (ii) the extent to which the wards met dementia friendly principles and (iii) staff views about their work environment and their perceptions about their practice. Sixteen (five male and 11 female) patients with dementia and 69 staff in the two wards participated in the study. We noted small but important changes; however, the physical and psychosocial environments of the wards did not always align to current recommendations for dementia care, with staff perceptions of care delivery not always reflecting the observed experiences of care of those living with dementia. Comparing staff questionnaire data with observational methods offered a unique opportunity to understand multiple perspectives in a complex hospital setting. Incorporating these perspectives into staff and management feedback allowed for recommendations that recognised both patient-centred values and staff constraints. © 2016 John Wiley & Sons Ltd.
Background Antibiotic consumption in hospitals is commonly measured using the accumulated amount of drugs delivered from the pharmacy to ward held stocks. The reliability of this method, particularly the impact of the length of the registration periods, has not been evaluated and such evaluation was aim of the study. Methods During 26 weeks, we performed a weekly ward stock count of use of broad-spectrum antibiotics - that is second- and third-generation cephalosporins, carbapenems, and quinolones - in five hospital wards and compared the data with corresponding pharmacy sales figures during the same period. Defined daily doses (DDDs) for antibiotics were used as measurement units (WHO ATC/DDD classification). Consumption figures obtained with the two methods for different registration intervals were compared by use of intraclass correlation analysis and Bland-Altman statistics. Results Broad-spectrum antibiotics accounted for a quarter to one-fifth of all systemic antibiotics (ATC group J01) used in the hospital and varied between wards, from 12.8 DDDs per 100 bed days in a urological ward to 24.5 DDDs in a pulmonary diseases ward. For the entire study period of 26 weeks, the pharmacy and ward defined daily doses figures for all broad-spectrum antibiotics differed only by 0.2%; however, for single wards deviations varied from -4.3% to 6.9%. The intraclass correlation coefficient, pharmacy versus ward data, increased from 0.78 to 0.94 for parenteral broad-spectrum antibiotics with increasing registration periods (1-4 weeks), whereas the corresponding figures for oral broad-spectrum antibiotics (ciprofloxacin) were from 0.46 to 0.74. For all broad-spectrum antibiotics and for parenteral antibiotics, limits of agreement between the two methods showed, according to Bland-Altman statistics, a deviation of ± 5% or less from average mean DDDs at 3- and 4-weeks registration intervals. Corresponding deviation for oral antibiotics was ± 21% at a 4-weeks interval
Haug, Jon B; Myhr, Randi; Reikvam, Asmund
Antibiotic consumption in hospitals is commonly measured using the accumulated amount of drugs delivered from the pharmacy to ward held stocks. The reliability of this method, particularly the impact of the length of the registration periods, has not been evaluated and such evaluation was aim of the study. During 26 weeks, we performed a weekly ward stock count of use of broad-spectrum antibiotics--that is second- and third-generation cephalosporins, carbapenems, and quinolones--in five hospital wards and compared the data with corresponding pharmacy sales figures during the same period. Defined daily doses (DDDs) for antibiotics were used as measurement units (WHO ATC/DDD classification). Consumption figures obtained with the two methods for different registration intervals were compared by use of intraclass correlation analysis and Bland-Altman statistics. Broad-spectrum antibiotics accounted for a quarter to one-fifth of all systemic antibiotics (ATC group J01) used in the hospital and varied between wards, from 12.8 DDDs per 100 bed days in a urological ward to 24.5 DDDs in a pulmonary diseases ward. For the entire study period of 26 weeks, the pharmacy and ward defined daily doses figures for all broad-spectrum antibiotics differed only by 0.2%; however, for single wards deviations varied from -4.3% to 6.9%. The intraclass correlation coefficient, pharmacy versus ward data, increased from 0.78 to 0.94 for parenteral broad-spectrum antibiotics with increasing registration periods (1-4 weeks), whereas the corresponding figures for oral broad-spectrum antibiotics (ciprofloxacin) were from 0.46 to 0.74. For all broad-spectrum antibiotics and for parenteral antibiotics, limits of agreement between the two methods showed, according to Bland-Altman statistics, a deviation of ± 5% or less from average mean DDDs at 3- and 4-weeks registration intervals. Corresponding deviation for oral antibiotics was ± 21% at a 4-weeks interval. There is a need for caution in
Khan, Qasim; Ismail, Mohammad; Haider, Iqbal; Haq, Inam Ul; Noor, Sidra
Prolonged QT interval may lead to a lethal form of arrhythmia, torsades de pointes (TdP), which is associated with cardiovascular mortality. Therefore, we aimed to identify prevalence of QT interval prolongation, compare clinical characteristics of patients with normal and prolonged QT interval, and identify predictors of QT interval prolongation. A prospective observational study was conducted in cardiology wards of two teaching hospitals in Pakistan. Bazett's correction formula was used for the calculation of QTc interval. Prevalence of QT prolongation and pro-QTc scores were calculated. Comparative analysis was performed with respect to various clinical characteristics by applying t test and chi-square test. Odds ratios were calculated using regression analysis. Among 417 patients, 44.6% were found having prolonged QT interval, of which, 17.3% presented with an abnormally high QTc interval (> 500 ms). Significant difference was recorded between the groups (normal vs. prolonged) with respect to age, all prescribed medications, QT drugs, number of risk factors, QT-DDIs (QT-prolonging drug-drug interactions), gender, and diuretics use. Multivariate logistic regression analysis showed significant results for various predictors such as male gender (p = 0.03), various age categories 41-50 years (p = 0.04), 51-60 years (p = 0.01), and > 60 years (p < 0.001), and diuretics (p = 0.008). A substantial number of patients in cardiology wards presented with QT prolongation. Proper considerations are needed in order to minimize the associated risk particularly in patients with abnormally high QT prolongation, old age, polypharmacy, one or more QT-prolonging drugs, and high pro-QTc scores.
Yamani, Nikoo; Moosavi, Seyed Ali; Alizadeh, Maryam; Khorvash, Fariborz; Ghiasi, Mojdeh
In educational hospitals, in addition to providing care, emergency medicine department plays an important role in providing education and increasing the quality of care and education. This study was an endeavor to evaluate the performance of emergency medicine department in different areas such as education, service provision and interaction with other departments. This was a descriptive cross-sectional study performed as a 360-degree evaluation. The stakeholders taking part in this evaluation included residents, interns, attendants, administrators, nurses, and patients. Particular questionnaires for each group was developed based on the data achieved in the focus groups. Structured interviews were used to collect data from patients. Patients' medical files were investigated in order to extract performance indices of emergency medicine department. Data was analyzed using descriptive statistics, chi-square, and t-tests by SPSS. Based on the achieved data, patients' waiting time for the first visit of the emergency physician was 13.18 minutes in average. The mean of outpatients' waiting time (29.82 minutes) was higher than that of patients requiring hospitalization. In most cases (79%), similar first and final diagnoses were made. In addition, 93.5% of patients hospitalized in the emergency ward were highly satisfied with services received from the specialists while 6.5%were averagely satisfied. The highest performance scores to the emergency medicine department were given by the interns with the mean of 4.24 out of 5 performance. The results of the emergency department evaluation by different groups as well as indices showing the performance of this department revealed its overall performance in educational, clinical, and interactional areas as good. The findings of this study can be applied in Alzahra Hospital to promote the positive points and amend the negative points.
Scerri, Anthony; Innes, Anthea; Scerri, Charles
To explore the quality dementia care in two geriatric hospital wards using appreciative inquiry with formal care workers and family members of inpatients with dementia. Care models such as person-centred and relationship-centred care have been developed to explain what 'quality' dementia care should be. However, their usefulness and relevance to clinicians has been questioned. Using an exploratory qualitative design within an appreciative inquiry framework, 33 care workers working in a geriatric hospital and 10 family members of patients with dementia were interviewed. Open-ended questions were asked to encourage care workers to narrate positive care experiences when the care was perceived to be at its best and to identify what made these experiences possible. Interviews were audio-taped and transcribed whilst data were analysed thematically using a qualitative data analysis software to assist in data management. Positive care experiences can be understood within five care processes, namely building a relationship between the 'extended' dementia care triad, providing 'quality time' and 'care in time', going the 'extra mile', attending to the psychosocial needs and attending to the physical needs with a 'human touch'. Factors facilitating these positive care experiences included personal attributes of care workers, and organisational, environmental and contextual factors. This study provides an alternative and pragmatic approach to understanding quality dementia care and complements the body of knowledge on factors influencing dementia care practices in hospitals. By understanding the components of quality dementia care and how these can be achieved from different stakeholders, it is possible to develop strategies aimed at improving the care offered to patients with dementia in hospitals. © 2015 John Wiley & Sons Ltd.
Di Lorenzo, Rosaria; Cabri, Giulio; Carretti, Eleonora; Galli, Giacomo; Giambalvo, Nina; Rioli, Giulia; Saraceni, Serena; Spiga, Giulia; Del Giovane, Cinzia; Ferri, Paola
Purpose To investigate the perception of dignity among patients hospitalized in a psychiatric setting using the Patient Dignity Inventory (PDI), which had been first validated in oncologic field among terminally ill patients. Patients and methods After having modified two items, we administered the Italian version of PDI to all patients hospitalized in a public psychiatric ward (Service of Psychiatric Diagnosis and Treatment of a northern Italian town), who provided their consent and completed it at discharge, from October 21, 2015 to May 31, 2016. We excluded minors and patients with moderate/severe dementia, with poor knowledge of Italian language, who completed PDI in previous hospitalizations and/or were hospitalized for <72 hours. We collected the demographic and clinical variables of our sample (n=135). We statistically analyzed PDI scores, performing Cronbach’s alpha coefficient and principal factor analysis, followed by orthogonal and oblique rotation. We concomitantly administered to our sample other scales (Hamilton Rating Scales for Depression and Anxiety, Global Assessment of Functioning and Health of the Nation Outcome Scales) to analyze the PDI concurrent validity. Results With a response rate of 93%, we obtained a mean PDI score of 48.27 (±19.59 SD) with excellent internal consistency (Cronbach’s alpha coefficient =0.93). The factorial analysis showed the following three factors with eigenvalue >1 (Kaiser’s criterion), which explained >80% of total variance with good internal consistency: 1) “Loss of self-identity and social role”, 2) “Anxiety and uncertainty for future” and 3) “Loss of personal autonomy”. The PDI and the three-factor scores were statistically significantly positively correlated with the Hamilton Scales for Depression and Anxiety but not with other scale scores. Conclusion Our preliminary research suggests that PDI can be a reliable tool to assess patients’ dignity perception in a psychiatric setting, until now
Pasaribu, S; Lubis, M; Arsyad, F; Barus, N; Sutanto, A H
In 1983, 2869 infants and children were hospitalized in the pediatric ward of the Dr. Pirngadi Hospital Mecan. Of these, 1317 (46.2%) were gastroenteritis cases; 635 of these patients (48.2%) were those ages 0-1 year. The highest prevalence is found among this group. The months of July and August accounted for the majority of gastroenteritis cases, 15.6% in the 1st and 14.2% in the 2nd. This condition held true for all age groups. Mild, moderate, and severe dehydration were encountered in 4.3%, 35.7%, and 60.6% of the cases. The over 3 year olds had the highest number of severe dehydration cases; 76.5% of all patients in the same age group. Most of these cases occurred in July; 71.2% in that month. A significant inverse correlation between age and diarrhea duration was evident--the younger the age, the longer the duration of diarrhea (p0.01). Administration of oral electrolyte solution did not significantly alter the duration of diarrhea. The overall mortality rate was 13%. The highest age specific fatality rate was found among those ages 0-1 (20.3%). Mortality for those children older than 3 was 1.8%.
Kamal, Faiza; Fazal, Muhammad Irfan; Cheema, Muhammad Arshad
Nutritional assessment, as a method to identify malnourishment, has long been documented as an essential component of patient management which predicts adverse outcomes. The objective of the study was to find out the frequency of malnutrition and its association with the frequency of complications and deaths postoperatively. This study included all patients who were operated upon in a general surgical unit of Mayo Hospital, Lahore from June to August, 2013. Evaluation of 280 patients showed that 112 (40%) of the patients were malnourished, 90 (32%) were at risk of being malnourished and remaining 78 (28%) of the patients had normal nutritional status, according to the Subjective Global Assessment. Thirteen percent (13%) malnourished and 2 (3%) of the normally nourished patients died within 30 days of operation (p=0.001). Incidence of complications in malnourished patients was 23 (20.53%) as compared to normally nourished patients (5.12%, p=0.006). Malnutrition is very common in patients admitted to surgery wards of our hospitals. It adversely effects the outcome of surgical operations by increasing complications and mortality.
Barus, S T; Rani, R; Lubis, N U; Hamid, E D; Tarigan, S
A retrospective study on severe malnutrition concerning children hospitalized at the Pediatric ward of Dr. Pirngadi Hospital, Medan from January 1 to December 31, 1988 was conducted. Patients less than five years old were included in this study. The purpose of this study was to know the incidence of severe malnutrition, its symptoms and signs, the immunization status, feeding pattern and socio-economic factors. Out of the 3370 hospitalized patients, 2453 (72.78%) were children under five years old. Of these, 312 (12%) suffered from severe malnutrition. It consisted of marasmus 131 (41.9%), marasmic kwashiorkor 94 (30.1%) and kwashiorkor 87 (27.8%). The highest incidence was found in the age group of 0-2 years (58%). Clinical manifestation of marasmus were old man face (131 or 100%), muscular hypotrophy (118 or 71.9%) and decreased subcutaneous fat (116 or 71.1%) in marasmic kwashiorkor children 46 or 50% had their hair easily picked out, 45 or 46.3% showed hyperpigmentation and 48 or 52% had pretibial edema in the kwashiorkor group 29 or 63% had moon face, 52 or 60.4% showed crazy pavement dermatosis, 77 or 51.3% had hepatomegaly and 87 or 48% pretebial edema. Moon face was seen in 29 (63%), crazy Pavement Dermatosis in 52 (60.4%), hepatomegaly in 77 (51.3%), and pretebial edema in 87 (48%) of kwashiorkor cases. The accompanying diseases were mostly diarrhea (95%) and bronchopneumonia (22%). Immunization status showed that BCG comprised 50.6%, while DPT III and OPV III in 13.7% and 10.5% respectively and measles only 0.64%. More than half (59.6%) of them were breast-fed up to 6 months.(ABSTRACT TRUNCATED AT 250 WORDS)
Shabbir, Asad; Wali, Gorav; Steuer, Alan
Prolonged hospital stay not only increases financial stress on the National Health Service but also exposes patients to an unnecessarily high risk of adverse ward events. Each day accumulates approximately £225 in bed costs with additional risks of venousthromboembolism, hospital acquired infections, prescription errors, and falls. Despite being medically fit for discharge (MFFD), patients awaiting care packages with prolonged length of stay (LoS) have poorer outcomes and experience increased rates of mortality as a result. A six cycle prospective audit was carried out to investigate if four simple ward based initiatives could optimise patient flow through a medical ward and reduce LoS of inpatients awaiting social packages and placement. The four daily initiatives were: A morning board round between nurses and doctors to prioritise new or sick patients for early review.A post ward round meeting between the multidisciplinary team to expedite rehabilitation and plan discharges early.An evening board round to highlight which patients needed discharge paperwork for the next day to alleviate the wait for pharmacy.A ‘computer on wheels’ on ward rounds so investigations could be ordered and reviewed at the bedside allowing more time to address patient concerns. A control month in August 2013 and five intervention cycles were completed between September 2013 and January 2014. Prior to intervention, mean time taken for patients to be discharged with a package of care, once declared MFFD, was 25 days. With intervention this value dropped to 1 day. The total LoS fell from 46 days to 16 days. It was also found that the time taken from admission to MFFD status was reduced from 21 days to 15 days. In conclusion this data shows that with four simple modifications to ward behaviour unnecessary inpatient stay can be significantly reduced. PMID:26734432
Shabbir, Asad; Wali, Gorav; Steuer, Alan
Prolonged hospital stay not only increases financial stress on the National Health Service but also exposes patients to an unnecessarily high risk of adverse ward events. Each day accumulates approximately £225 in bed costs with additional risks of venousthromboembolism, hospital acquired infections, prescription errors, and falls. Despite being medically fit for discharge (MFFD), patients awaiting care packages with prolonged length of stay (LoS) have poorer outcomes and experience increased rates of mortality as a result. A six cycle prospective audit was carried out to investigate if four simple ward based initiatives could optimise patient flow through a medical ward and reduce LoS of inpatients awaiting social packages and placement. The four daily initiatives were: A morning board round between nurses and doctors to prioritise new or sick patients for early review.A post ward round meeting between the multidisciplinary team to expedite rehabilitation and plan discharges early.An evening board round to highlight which patients needed discharge paperwork for the next day to alleviate the wait for pharmacy.A 'computer on wheels' on ward rounds so investigations could be ordered and reviewed at the bedside allowing more time to address patient concerns. A control month in August 2013 and five intervention cycles were completed between September 2013 and January 2014. Prior to intervention, mean time taken for patients to be discharged with a package of care, once declared MFFD, was 25 days. With intervention this value dropped to 1 day. The total LoS fell from 46 days to 16 days. It was also found that the time taken from admission to MFFD status was reduced from 21 days to 15 days. In conclusion this data shows that with four simple modifications to ward behaviour unnecessary inpatient stay can be significantly reduced.
Lim, Ji Young
The aim of this study was to analyze net income of a surgical nursing ward in a general hospital. Data collection and analysis was conducted using a performance-based costing and activity-based costing method. Direct nursing activities in the surgical ward were 68, indirect nursing activities were 10. The total cost volume of the surgical ward was calculated at won 119,913,334.5. The cost volume of the allocated medical department was won 91,588,200.3, and the ward consumed cost was won 28,325,134.2. The revenue of the surgical nursing ward was won 33,269,925.0. The expense of a surgical nursing ward was 28,325,134.2. Therefore, the net income of a surgical nursing ward was won 4,944,790.8. We suggest that to develop a more refined nursing cost calculation model, a standard nursing cost calculation system needs to be developed.
Phua, Jason; Kee, Adrian Chin-Leong; Tan, Adeline; Mukhopadhyay, Amartya; See, Kay Choong; Aung, Ngu Wah; Seah, Angeline S T; Lim, Tow Keang
Despite international differences in cultural perspectives on end-of-life issues, little is known of the care for the dying in the general wards of acute hospitals in Asia. We performed a retrospective medical chart review of all 683 adult patients who died without intensive care unit (ICU) admission in our Singaporean hospital in 2007. We first evaluated the prevalence of do-not-resuscitate (DNR) orders and orders for or against life-sustaining therapies; second, if such orders were discussed with the patients and/or family members; and third, the actual treatments provided before death. There were DNR orders for 66.2% of patients and neither commitment for DNR nor cardiopulmonary resuscitation (CPR) for 28.1%. Orders to limit life-sustaining therapies, including ICU admission, intubation, and vasopressors/inotropes were infrequent. Only 6.2% of the alert and conversant patients with DNR orders were involved in discussions on these orders. In contrast, such discussions with their family members occurred 82.9% of the time. Interventions in the last 24 hours of life included CPR (9.4%), intubation (6.4%), vasopressors/inotropes (14.8%), tube feeding (24.7%), and antibiotics (44.9%). Analgesia was provided in 29.1% of patients. There was a lack of commitment by doctors on orders for DNR/CPR and to limit life-sustaining therapies, infrequent discussions with patients on end-of-life decisions, and excessive burdensome interventions with inadequate palliative care for the dying. These findings may reflect certain Asian cultural biases. More work is required to improve our quality of end-of-life care.
Ward clerks are essential members of the healthcare team, providing administrative and organizational support to acute care units and clinics. This role influences such matters as nurses' direct patient-care time, timeliness of patient discharges, and patient safety. To support ward clerks in the varying responsibilities and complex scope of this role, a formal orientation and ongoing education program is imperative. Whereas corporate orientation informs new employees of overall organizational processes, a ward clerk-specific workplace education program prepares individuals for the demands of the position, ultimately supporting the healthcare team and patient safety.
Spicer, Kevin B; Green, Jennifer; Dhada, Barnesh
Hospital-acquired infections (HAIs) impact care and costs in hospitals across the globe. There are minimal data on HAIs in sub-Saharan Africa and data specific to paediatrics are especially limited. To describe the incidence of HAIs in the paediatric medical units at Grey's Hospital, a tertiary government hospital in KwaZulu-Natal, South Africa. The Infection Prevention and Control (IPC) team collects data on all laboratory-confirmed infections, including from paediatric patients in two medical units (52 beds), the paediatric intensive/high-care unit (PICU, 8 beds) and the neonatal intensive care unit (NICU, 23 beds). HAIs are defined as infections: (i) not present (active or incubating) at the time of admission, and (ii) with onset >48 h after hospital admission. Daily patient statistics allow calculation of infections per 100 admissions and infections per 1000 patient days. In the non-ICU setting, there were 7.1 and 7.0 HAIs per 100 admissions in 2013 and 2014, respectively. In the PICU, there were 20.4 and 15.3 HAIs per 100 admissions, while in the NICU there were 23.9 and 21.6 HAIs per 100 admissions in 2013 and 2014, respectively. In the non-ICU setting, there were 6.8 HAIs per 1000 patient days in both 2013 and 2014. In the PICU, there were 27.5 and 33.0 HAIs per 1000 patient days, while in the NICU, there were 20.3 and 21.5 HAIs per 1000 patient days in 2013 and 2014, respectively. HAIs in non-ICU paediatric wards were consistent with a number of point-prevalence studies performed outside Africa (e.g. Canada, Russia, U.K.). Rates of HAIs in the ICUs were higher than rates reported from the International Nosocomial Infection Control Consortium, and were substantially higher than rates reported in the United States. HAIs are serious and important, especially in ICUs, and may be relatively neglected in low- and middle-income settings. Improved surveillance will allow the development and evaluation of targeted interventions to improve care of patients.
AKBARI SARI, Ali; DOSHMANGHIR, Leila; NEGHAHBAN, Zahra; GHIASIPOUR, Maryam; BEHESHTIZAVAREH, Zeinab
Abstract Background This study aimed to estimate the rate of pressure ulcers in intensive care units (ICUs) and medical and surgical wards of Iranian hospitals and compare the performance of methods of medical record review as well as direct observation for their detection. Methods The research team visited 308 patients in medical and surgical wards of hospitals affiliated with Tehran University of Medical Sciences and a further 90 patients in their ICUs between March 2009 and April 2010. In addition 310 patient records were randomly selected from patients discharged from the ICUs between March 2009 and April 2010. And a further 600 patient records were randomly selected from the patients that were discharged from medical and surgical wards between March 2010 and April 2011. These 910 selected records were retrospectively reviewed to identify pressure ulcers. Data were collected by a structured checklist. Results In ICUs 24 of 90 patients (26.7%, 95% CI: 17.56 to 35.84) that were directly observed and 59 of 310 patients (19.0%, 95% CI: 14.63 to 23.37) that were studied by retrospective review of medical records had pressure ulcers. In medical and surgical wards, 5 of 308 patients (1.6%, 95% CI: 0.20 to 3.00) that were directly observed had pressure ulcers, but no pressure ulcer was detected by review of 600 medical records. Conclusion Pressure ulcers are significantly more frequent in ICUs than in medical and surgical wards and a significant proportion of pressure ulcers are not reported. PMID:26110149
Franck, Linda S; Wray, Jo; Gay, Caryl; Dearmun, Annette K; Lee, Kirsty; Cooper, Bruce A
The aim of this study was to identify predictors of parental post-traumatic stress symptoms following child hospitalization. In this prospective cohort study, a sample of 107 parents completed questionnaires during their child's hospitalization on pediatric (non-intensive care) wards and again three months after discharge. Eligible parents had a child expected to be hospitalized for three or more nights. Standardized questionnaires were used to assess parent distress during the child's hospitalization, parent coping strategies and resources, and symptoms of post-traumatic stress after the hospitalization. Correlations and multiple regressions were used to determine whether parent distress during hospitalization and coping strategies and resources predicted post-traumatic stress symptoms three months after the child's discharge, while controlling for relevant covariates. Three months after the child's hospital discharge, 32.7% of parents (n=35) reported some degree of post-traumatic stress symptoms, and 21.5% (n=23) had elevated (≥34) scores consistent with a probable diagnosis of post-traumatic stress disorder. In the multivariable model, parent anxiety and uncertainty during hospitalization and use of negative coping strategies, such as denial, venting and self-blame, were associated with higher post-traumatic stress symptoms scores at three months post-discharge, even after controlling for the child's health status. Parental anxiety and depression during hospitalization moderated the relationship between negative coping strategies and post-traumatic stress symptoms. More than one quarter of parents of children hospitalized on pediatric (non-intensive care) wards experienced significant post-traumatic stress symptoms after their child's discharge. Parents' hospital-related anxiety, uncertainty and use of negative coping strategies are potentially modifiable factors that most strongly influenced post-traumatic stress symptoms. Further research is urgently needed
Wang, Dalin; Ma, Linlin; Wu, Zhenyu; Li, Mingcheng; Li, Xiaohan; Zhang, Wei; Chen, Kun
The aim of this study was to investigate the prevalence and characteristics of imipenem-resistant Acinetobacter baumanni isolated from surgical wards in a university hospital, China. A total of 143 non-duplicate A. baumannii were isolated from 517 inpatients in surgery intensive care units (ICUs), burn wards, and general surgery wards. Of these, 102 isolates of A. baumannii (71.3%) were resistant to imipenem. Among imipenem-resistant isolates, all isolates were resistant to almost all antimicrobial agents except polymyxin E, all isolates were positive for blaOXA-23 and blaOXA-51 in addition to ISAba1, 52 (51%) were positive for blaOXA-58, 8 (7.8%) contained blaVIM-2, which co-harbored with blaOXA-58. Molecular typing revealed the presence of three clones among imipenem-resistant isolates. This study confirmed that A. baumannii strains harboring OXA or VIM type β-lactamases are widely distributed throughout the surgery wards. The data demonstrate that there was a high prevalence of imipenem-resistant A. baumannii infection in the region.
Pham Thanh, Duy; Tran Do Hoan, Nhu; Wick, Ryan R.; Ingle, Danielle J.; Hawkey, Jane; Edwards, David J.; Kenyon, Johanna J.; Phu Huong Lan, Nguyen; Campbell, James I.; Thwaites, Guy; Thi Khanh Nhu, Nguyen; Hall, Ruth M.; Fournier-Level, Alexandre; Baker, Stephen; Holt, Kathryn E.
We recently reported a dramatic increase in the prevalence of carbapenem-resistant Acinetobacter baumannii infections in the intensive care unit (ICU) of a Vietnamese hospital. This upsurge was associated with a specific oxa23-positive clone that was identified by multilocus VNTR analysis. Here, we used whole-genome sequence analysis to dissect the emergence of carbapenem-resistant A. baumannii causing ventilator-associated pneumonia (VAP) in the ICU during 2009–2012. To provide historical context and distinguish microevolution from strain introduction, we compared these genomes with those of A. baumannii asymptomatic carriage and VAP isolates from this same ICU collected during 2003–2007. We identified diverse lineages co-circulating over many years. Carbapenem resistance was associated with the presence of oxa23, oxa40, oxa58 and ndm1 genes in multiple lineages. The majority of resistant isolates were oxa23-positive global clone GC2; fine-scale phylogenomic analysis revealed five distinct GC2 sublineages within the ICU that had evolved locally via independent chromosomal insertions of oxa23 transposons. The increase in infections caused by carbapenem-resistant A. baumannii was associated with transposon-mediated transmission of a carbapenemase gene, rather than clonal expansion or spread of a carbapenemase-harbouring plasmid. Additionally, we found evidence of homologous recombination creating diversity within the local GC2 population, including several events resulting in replacement of the capsule locus. We identified likely donors of the imported capsule locus sequences amongst the A. baumannii isolated on the same ward, suggesting that diversification was largely facilitated via reassortment and sharing of genetic material within the localized A. baumannii population. PMID:28348846
Usman, Gulzar; Memon, Khalida Naz; Shaikh, Shazia
A good hospital management includes an effective allocative planning for beds in a hospital. Bed-occupancy rates and length of stay are the measures that reflect the functional ability of a hospital. A cross sectional study of two months' duration was carried out in eight medical and allied wards of Liaquat University Hospital (LUH) Jamshoro with objective to estimate the bed occupancy rate and the average length of stay of patients. Data was collected by filling a predesigned check list and bed occupancy rate and average length of stay were computed. Associations were analysed by using SPSS version 16. The p-value 50.05 Was taken as level of significance. One hundred & seven admissions were recorded against 235 available beds. Average bed occupancy rate was 51.33%. The 51.4% of the patients in medical wards except paediatrics ward were of the age >50 years; the mean age was 45 years and standard deviation +/-6.4 years. Mean age in paediatrics was 3.89 years and standard deviation of +/-0.8 years. 55.1% patients had infectious diseases. The 32.7% patients stayed in hospital for up to 3 days showing significant association between nature of diseases and duration of stay (p=0.03). There was male preponderance, i.e., 54.2% males against 45.8% females. Showing significant association between gender and length of stay (p=0.01). Bed occupancy rate and average stay in hospital were found within recommended range; more improvement may be brought by doing further research on this issue.
Verhofstede, Rebecca; Smets, Tinne; Cohen, Joachim; Eecloo, Kim; Costantini, Massimo; Van Den Noortgate, Nele; Deliens, Luc
To describe the nursing and medical interventions performed in the last 48 hours of life and the quality of dying of patients dying in acute geriatric hospital wards. Cross-sectional descriptive study between October 1, 2012 and September 30, 2013. Twenty-three acute geriatric wards in 13 hospitals in Flanders, Belgium. Patients hospitalized for more than 48 hours before dying in the participating wards. Structured after-death questionnaires, filled out by the nurse, the physician, and the family carer most involved in end-of-life care. Main outcome measures were several nursing and medical interventions reported to be performed in the last 48 hours of life and the quality of dying. Of 993 patients, we included 338 (mean age 85.7 years; 173 women). Almost 58% had dementia and nearly half were unable to communicate in the last 48 hours of their life. The most frequently continued or started nursing and medical interventions in the last 48 hours of life were measuring temperature (91.6%), repositioning (83.3%), washing (89.5%), oxygen therapy (49.7%), and intravenous fluids and nutrition (30%). Shortness of breath, lack of serenity, lack of peace, and lack of calm were symptoms reported most frequently by nurses and family carers. Many nursing and medical interventions are continued or started in the last hours of a patient's life, which may not always be in their best interests. Furthermore, patients dying in acute geriatric wards are often affected by several symptoms. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.
Haines, Terry P; Bell, Rebecca A R; Varghese, Paul N
To evaluate the efficacy of a policy to introduce low-low beds for the prevention of falls and fall injuries on wards that had not previously accessed low-low beds. This was a pragmatic, matched, cluster randomized trial with wards paired according to rate of falls. Intervention and control wards were observed for a 6-month period after implementation of the low-low beds on the intervention wards. Data from a 6-month period before this were also collected and included in analyses to ensure comparability between intervention and control group wards. Public hospitals located in Queensland, Australia. Patients of 18 public hospital wards. Provision of one low-low bed for every 12 on a hospital ward, with written guidance for identifying patients at greatest risk of falls. Falls and fall injuries in the hospital measured using a computerized incident reporting system. There were 10,937 admissions to control and intervention wards combined during the pre-intervention period. There was no significant difference in the rate of falls per 1,000 occupied bed days between intervention and control group wards after the introduction of the low-low beds (generalized estimating equation coefficient=0.23, 95% confidence interval=-0.18-0.65, P=.28). The rate of bed falls, falls resulting in injury, and falls resulting in fracture also did not differ between groups. Some difficulties were encountered in intervention group wards in using the low-low beds as directed. A policy for the introduction of low-low beds did not appear to reduce falls or falls with injury, although larger studies would be required to determine their effect on fall-related fractures.
Myotoku, Michiaki; Iwamoto, Chiaki; Tomida, Yumi; Murayama, Yoko; Irishio, Keiko; Nakanishi, Akiko; Shimomura, Kazunori; Ihara, Yuki; Shioishi, Tomoko; Inui, Toshiko; Yohiro, Chika; Miyamoto, Emi; Suemura, Natsuko; Kawaguchi, Syunichi
At the Municipal Ikeda Hospital, a system in which pharmacists stationed in one ward pharmacy dispense drugs to be administered by injection and injectable preparations delivered to patients' bedsides was introduced in April 2000. This system was aimed at minimizing risks related to injections. Initially, however, on holidays, nurses played the roles of pharmacists in terms of the injections, and there were concerns over a possible rise in the incidence of errors (adverse events/near-misses) related to injections on these days compared with weekdays. Later, when planning to introduce a new holiday work system in the ward pharmacy, we took into account such factors as the number of pharmacists needed on holidays, their duties on holidays and the influence on weekday pharmacy activity of compensatory days-off taken by such pharmacists. In May 2004, the new holiday work system was introduced in the ward pharmacy. Under the new system, 5 pharmacists work at the ward pharmacy on holidays. After this system was put into operation, the number of injections dispensed at the ward pharmacy averaged 230 per day, and 177 per holiday. To evaluate the validity of this system, we recently conducted a questionnaire survey of nurses at our hospital. The survey involved 139 nurses. Of these nurses, 69.1% responded that the number of incidents (adverse events/near-misses) related to dispensing injections on holidays had decreased. Furthermore, 65.4% of the nurses reported a decrease in incidents related to the delivery and administration of injectable preparations. More than half of the nurses answered that the new system had made it easier for them to collect information on medicines and helped them provide better nursing services. When the nurses were asked to make a general assessment of the new system, 90% rated the system as "good." The results of this survey indicate that keeping the ward pharmacy open on holidays contributes to the promotion of the proper use of medicines
The effect of an active on-ward participation of hospital pharmacists in Internal Medicine teams on preventable Adverse Drug Events in elderly inpatients: protocol of the WINGS study (Ward-oriented pharmacy in newly admitted geriatric seniors).
Klopotowska, Joanna E; Wierenga, Peter C; de Rooij, Sophia E; Stuijt, Clementine C; Arisz, Lambertus; Kuks, Paul F; Dijkgraaf, Marcel G; Lie-A-Huen, Loraine; Smorenburg, Susanne M
The potential of clinical interventions, aiming at reduction of preventable Adverse Drug Events (preventable ADEs) during hospital stay, have been studied extensively. Clinical Pharmacy is a well-established and effective service, usually consisting of full-time on-ward participation of clinical pharmacists in medical teams. Within the current Hospital Pharmacy organisation in the Netherlands, such on-ward service is less feasible and therefore not yet established. However, given the substantial incidence of preventable ADEs in Dutch hospitals found in recent studies, appears warranted. Therefore, "Ward-Oriented Pharmacy", an on-ward service tailored to the Dutch hospital setting, will be developed. This service will consist of multifaceted interventions implemented in the Internal Medicine wards by hospital pharmacists. The effect of this service on preventable ADEs in elderly inpatients will be measured. Elderly patients are at high risk for ADEs due to multi-morbidity, concomitant disabilities and polypharmacy. Most studies on the incidence and preventability of ADEs in elderly patients have been conducted in the outpatient setting or on admission to a hospital, and fewer in the inpatient setting. Moreover, recognition of ADEs by the treating physicians is challenging in elderly patients because their disease presentation is often atypical and complex. Detailed information about the performance of the treating physicians in ADE recognition is scarce. The design is a multi-centre, interrupted time series study. Patients of 65 years or older, consecutively admitted to Internal Medicine wards will be included. After a pre-measurement, a Ward-Oriented Pharmacy service will be introduced and the effect of this service will be assessed during a post-measurement. The primary outcome measures are the ADE prevalence on admission and ADE incidence during hospital stay. These outcomes will be assessed using structured retrospective chart review by an independent expert
Virtanen, Marianna; Vahtera, Jussi; Batty, G David; Tuisku, Katinka; Oksanen, Tuula; Elovainio, Marko; Ahola, Kirsi; Pentti, Jaana; Salo, Paula; Vartti, Anne-Marie; Kivimäki, Mika
This study examined whether indicators of poor health and health risk behaviors among hospital staff differ between the ward specialties. Across 21 hospitals in Finland, 8003 employees (mean age 42 years, 87% women, 86% nurses) working in internal medicine, surgery, obstetrics and gynecology, pediatrics, intensive care, and psychiatry responded to a baseline survey on health and health risk behaviors (response rate 70%). Responses were linked to records of sickness absence and medication over the following 12 months. Psychiatric staff had higher odds of smoking [odds ratio (OR) 2.58, 95% confidence interval (95% CI) 2.14-3.12], high alcohol use (OR 1.55, 95% CI 1.21-1.99), physical inactivity (OR 1.30, 95% CI 1.11-1.53), chronic physical disease (OR 1.19, 95% CI 1.04-1.36), current or past mental disorders (OR 1.81, 95% CI 1.50-2.17), and co-occurring poor health indicators (OR 2.65, 95% CI 2.08-3.37) as compared to those working in other specialties. They also had higher odds of sickness absence due to mental disorders (OR 1.40, 95% CI 1.02-1.92) and depression (OR 1.61, 95% CI 1.02-2.55) at follow-up after adjustment for baseline health and covariates. Personnel in surgery had the lowest probability of morbidity. No major differences between specialties were found in the use of psychotropic medication. The prevalence of hospital employees with an adverse health risk profile is higher in psychiatric wards than other specialties.
Ferreira, Meire Coelho; Batista, Anne Margareth; Marques, Leandro Silva; Ferreira, Fernanda de Oliveira; Medeiros-Filho, João Batista; Ramos-Jorge, Maria Letícia
The aim of study was to determine the occurrence of tooth injuries and associated factors among patients treated at a hospital emergency ward. A cross-sectional study was conducted involving the analysis of 790 patient charts. The independent variables were gender, place of residence and type of accident. The dependent variable was tooth injury (fractures, concussion, luxation and avulsion). Statistical analysis involved the chi-square test, Poisson analysis and logistic regression. Explanatory variables with a p-value < 0.20 in the bivariate analysis were incorporated into the multivariate model. A total of 681 (86.2 %) patients had tooth injury, among whom 159 (20.1 %) had tooth fractures. Tooth concussion was associated with residence in urban areas (PR = 1.635; 95 % CI: 1.199-2.230), the male gender (PR = 1.673; 95 % CI: 1.225-2.285), violence (PR = 1.940; 95 % CI: 1.263-2.982) and sports (PR = 1.863; 95 % CI: 1.287-2.696). The prevalence rate of tooth fracture was higher among individuals having suffered a motorcycle (PR = 1.597; 95 % CI: 1.295-1.968) or bicycle accident (PR = 1.484; 95 % CI: 1.245-1.769). Victims of bicycle accidents had a 42.6-fold greater chance of suffering luxation (95 % CI: 20.917-86.808) and a threefold greater chance of suffering avulsion (95 % CI: 1.620-5.848). Victims of motorcycle accidents had a 2.96-fold greater chance of suffering avulsion (95 % CI: 1.471-5.937). In the study, concussion was the most frequent type of tooth injury. Motorcycle and bicycle accidents were associated with tooth fractures, luxation and avulsion, whereas sports and violence were associated with dental concussion. The findings on tooth injuries can contribute to public health policies regarding the prevention and health promotion measures.
Recently, a home palliative care has been recommended for terminal stage cancer patients. However, a few clinics are available providing a home palliative care. As a result of that, there have been many cases of the terminal stage cancer patients who could not receive a peace of mind care and die peacefully at home. Home palliative care has been promoted in Shizuoka City by starting Shizuoka city regional cooperation conference of cancer management with a help from Shizuoka city medical association and the general hospital. It is important to have the knowledge and technique put into practice by clinics and home visiting nurses for a further improvement of the palliative care. In order to transfer patient smoothly, the palliative care team conference is held in the general ward and the homecare transition manual is used at the hospital. An application of homecare insurance, the visiting doctor and nurse are arranged in parallel to management of physical and psychological symptoms of the patient, the visiting doctor and nurse are arranged. Before a patient is discharged from the hospital, the meeting will be held among the ward staff, visiting nurse and the patient's family. We intervened 8 cases from April to July 2007. Six out of 8 cases were transferred to home, and 2 patients were died at home. The home care transition manual will be shared with other hospitals from now on.
Matsubara, Kazuo; Toyama, Akira; Satoh, Hiroshi; Suzuki, Hiroshi; Awaya, Toshio; Tasaki, Yoshikazu; Yasuoka, Toshiaki; Horiuchi, Ryuya
It is obvious that pharmacists play a critical role as risk managers in the healthcare system, especially in medication treatment. Hitherto, there is not a single multicenter-survey report describing the effectiveness of clinical pharmacists in preventing medical errors from occurring in the wards in Japan. Thus, we conducted a 1-month survey to elucidate the relationship between the number of errors and working hours of pharmacists in the ward, and verified whether the assignment of clinical pharmacists to the ward would prevent medical errors between October 1-31, 2009. Questionnaire items for the pharmacists at 42 national university hospitals and a medical institute included the total and the respective numbers of medication-related errors, beds and working hours of pharmacist in 2 internal medicine and 2 surgical departments in each hospital. Regardless of severity, errors were consecutively reported to the Medical Security and Safety Management Section in each hospital. The analysis of errors revealed that longer working hours of pharmacists in the ward resulted in less medication-related errors; this was especially significant in the internal medicine ward (where a variety of drugs were used) compared with the surgical ward. However, the nurse assignment mode (nurse/inpatients ratio: 1 : 7-10) did not influence the error frequency. The results of this survey strongly indicate that assignment of clinical pharmacists to the ward is critically essential in promoting medication safety and efficacy.
Brewer, Margo L; Stewart-Wynne, Edward G
Royal Perth Hospital, in partnership with Curtin University, established the first interprofessional student training ward in Australia, based on best practice from Europe. Evaluation of the student and client experience was undertaken. Feedback from all stakeholders was obtained regularly as a key element of the quality improvement process. An interprofessional practice program was established with six beds within a general medical ward. This provided the setting for 2- to 3-week clinical placements for students from medicine, nursing, physiotherapy, occupational therapy, social work, pharmacy, dietetics and medical imaging. Following an initial trial, the training ward began with 79 students completing a placement. An interprofessional capability framework focused on the delivery of high quality client care and effective teamwork underpins this learning experience. Quantitative outcome data showed not only an improvement in students' attitudes towards interprofessional collaboration but also acquisition of a high level of interprofessional practice capabilities. Qualitative outcome data from students and clients was overwhelmingly positive. Suggestions for improvement were identified. This innovative learning environment facilitated the development of the students' knowledge, skills and attitudes required for interprofessional, client centred collaborative practice. Staff reported a high level of compliance with clinical safety and quality.
Dharmadhikari, Ashwin S; Mphahlele, Matsie; Stoltz, Anton; Venter, Kobus; Mathebula, Rirhandzu; Masotla, Thabiso; Lubbe, Willem; Pagano, Marcello; First, Melvin; Jensen, Paul A; van der Walt, Martie; Nardell, Edward A
Drug-resistant tuberculosis transmission in hospitals threatens staff and patient health. Surgical face masks used by patients with tuberculosis (TB) are believed to reduce transmission but have not been rigorously tested. We sought to quantify the efficacy of surgical face masks when worn by patients with multidrug-resistant TB (MDR-TB). Over 3 months, 17 patients with pulmonary MDR-TB occupied an MDR-TB ward in South Africa and wore face masks on alternate days. Ward air was exhausted to two identical chambers, each housing 90 pathogen-free guinea pigs that breathed ward air either when patients wore surgical face masks (intervention group) or when patients did not wear masks (control group). Efficacy was based on differences in guinea pig infections in each chamber. Sixty-nine of 90 control guinea pigs (76.6%; 95% confidence interval [CI], 68-85%) became infected, compared with 36 of 90 intervention guinea pigs (40%; 95% CI, 31-51%), representing a 56% (95% CI, 33-70.5%) decreased risk of TB transmission when patients used masks. Surgical face masks on patients with MDR-TB significantly reduced transmission and offer an adjunct measure for reducing TB transmission from infectious patients.
Marwick, Charis A; Guthrie, Bruce; Pringle, Jan E C; Evans, Josie M M; Nathwani, Dilip; Donnan, Peter T; Davey, Peter G
Antibiotic administration to inpatients developing sepsis in general hospital wards was frequently delayed. We aimed to reproduce improvements in sepsis management reported in other settings. Ninewells Hospital, an 860-bed teaching hospital with quality improvement (QI) experience, in Scotland, UK. The intervention wards were 22 medical, surgical and orthopaedic inpatient wards. A multifaceted intervention, informed by baseline process data and questionnaires and interviews with junior doctors, evaluated using segmented regression analysis of interrupted time series (ITS) data. MEASURES FOR IMPROVEMENT: Primary outcome measure: antibiotic administration within 4 hours of sepsis onset. Secondary measures: antibiotics within 8 hours; mean and median time to antibiotics; medical review within 30 min for patients with a standardised early warning system score .4; blood cultures taken before antibiotic administration; blood lactate level measured. The intervention included printed and electronic clinical guidance, educational clinical team meetings including baseline performance data, audit and monthly feedback on performance. Performance against all study outcome measures improved postintervention but differences were small and ITS analysis did not attribute the observed changes to the intervention. Rigorous analysis of this carefully designed improvement intervention could not confirm significant effects. Statistical analysis of many such studies is inadequate, and there is insufficient reporting of negative studies. In light of recent evidence, involving senior clinical team members in verbal feedback and action planning may have made the intervention more effective. Our focus on rigorous intervention design and evaluation was at the expense of iterative refinement, which likely reduced the effect. This highlights the necessary, but challenging, requirement to invest in all three components for effective QI.
Fernández-Ruiz, Mario; Calvo, Beatriz; Vara, Rebeca; Villar, Rocío N; Aguado, José María
The prevalence and predisposing factors were determined for inappropriate urinary catheterization (UC) among inpatients in medical wards. A cross-sectional study was conducted including all patients aged ≥ 18 years admitted to medical wards in a 1300-bed tertiary-care centre, and who had a urinary catheter in place on the day of the survey. Of 380 patients observed, 46 (12.1%) had a urinary catheter in place. Twelve of them (26.1%) were inappropriately catheterized. The most common indication for inappropriate UC was urine output monitoring in a cooperative, non-critically ill patient. Inappropriateness was associated with increased age, poor functional status, urinary incontinence, dementia, and admission from a long-term care facility. Further educational efforts should be focused on improving catheterization prescribing practices by physicians. Copyright © 2012 Elsevier España, S.L. All rights reserved.
de Vries, Meike Godelieve; Brazil, Inti Angelo; Tonkin, Matthew; Bulten, Berend Hendrik
Within this study the relationship between patient characteristics (age, length of stay, risk, psychopathy) and individual perceived ward climate (n=83), and differences between staff's and patient perceptions of climate (n=185) was investigated within a high secure forensic hospital. Results show that therapeutic hold was rated higher among staff compared to patients, while patients held a more favorable view on patient cohesion and experienced safety. Furthermore, patient characteristics (age, risk and psychopathy) were found to be related with individual ratings of ward climate. The findings underline the importance of assessing ward climate among both patients and staff in clinical practice. Copyright © 2015 Elsevier Inc. All rights reserved.
Lewin, Simon; Reeves, Scott
Interprofessional teamwork is widely advocated in health and social care policies. However, the theoretical literature is rarely employed to help understand the nature of collaborative relations in action or to critique normative discourses of teamworking. This paper draws upon Goffman's (1963) theory of impression management, modified by Sinclair (1997), to explore how professionals 'present' themselves when interacting on hospital wards and also how they employ front stage and backstage settings in their collaborative work. The study was undertaken in the general medicine directorate of a large NHS teaching hospital in England. An ethnographic approach was used, including interviews with 49 different health and social care staff and participant observation of ward-based work. These observations focused on both verbal and non-verbal interprofessional interactions. Thematic analysis of the data was undertaken. The study findings suggest that doctor-nurse relationships were characterised by 'parallel working', with limited information sharing or effective joint working. Interprofessional working was based less on planned, 'front stage' activities, such as wards rounds, than on ad hoc backstage opportunistic strategies. These backstage interactions, including corridor conversations, allowed the appearance of collaborative 'teamwork' to be maintained as a form of impression management. These interactions also helped to overcome the limitations of planned front stage work. Our data also highlight the shifting 'ownership' of space by different professional groups and the ways in which front and backstage activities are structured by physical space. We argue that the use of Sinclair's model helps to illuminate the nature of collaborative interprofessional relations within an acute care setting. In such settings, the notion of teamwork, as a form of regular interaction and with a shared team identity, appears to have little relevance. This suggests that interventions to
Wang, Ching-Hsun; Li, Jin-Feng; Huang, Li-Yueh; Lin, Fu-Mei; Yang, Ya-Sung; Siu, L Kristopher; Chang, Feng-Yee; Lin, Jung-Chung
This study describes an outbreak caused by imipenem-resistant Acinetobacter baumannii (IRAB) involving 2 general wards at the Penghu branch of Tri-Service General Hospital. Clinical data obtained from the patients with IRAB during an outbreak from May 2014-October 2014 were reviewed. Microbiologic sampling from the environment and the hands of health care workers (HCWs) was performed. Clinical isolates from case patients were genotyped using pulsed-field gel electrophoresis (PFGE). During the outbreak period, 12 patients were colonized or infected with IRAB. The hospital room environments of the case patients were contaminated with IRAB. Hands of nurses and physicians were not colonized with IRAB, but the hands of 2 bedside caregivers of case patients were colonized with IRAB. The PFGE analysis revealed that at least 2 major genetically distinct strains disseminated between 2 different wards. After implementation of infection control measures with a cohort of nursing patients, hand hygiene education for caregivers who had not received instructions before the outbreak, and a critical value alert system to notify case patients, the outbreak was controlled successfully. This outbreak study highlights the importance of adherence to hand hygiene by all HCWs to prevent the dissemination of multidrug-resistant organisms. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
Sileshi, Alemayehu; Tenna, Admasu; Feyissa, Mamo; Shibeshi, Workineh
Ceftriaxone is one of the most commonly used antibiotics due to its high antibacterial potency, wide spectrum of activity and low potential for toxicity. However, the global trend shows misuse of this drug. The aim of this study was to evaluate prospectively the appropriateness of ceftriaxone use in medical and emergency wards of Tikur Anbessa Specialized Hospital. A prospective cross-sectional study was conducted by reviewing medication records of patients receiving ceftriaxone during hospitalization at Tikur Anbessa Specialized Hospital between February 1 and June 30, 2014. Drug use evaluation was conducted to determine whether ceftriaxone was being used appropriately based on six criteria namely indication for use, dose, frequency of administration, duration of treatment, drug-drug interaction, culture and sensitivity test. The evaluation was made as per the protocol developed from current treatment guidelines. The total of 314 records of patients receiving ceftriaxone was reviewed. The prescribing rate of ceftriaxone was found to be very high (58 % point prevalence). Ceftriaxone use was empiric in 274 (87.3 %) cases. The most common indication for ceftriaxone use was pneumonia; observed in 110 (35.0 %) cases. The most common daily dosage, frequency of administration and duration of treatment with ceftriaxone were 2 g (88.9 %), twice-daily (98.4 %) and 8-14 days (46.2 %), respectively. Inappropriate use of ceftriaxone was observed in most of cases (87.9 %), the greatest proportion of which was attributed to inappropriate frequency of administration (80.3 %), followed by absence of culture and sensitivity test (53.2 %). This study revealed that the inappropriate use of ceftriaxone was very high in the medical and emergency wards of Tikur Anbessa Specialized Hospital. This may lead to emergence of resistant pathogens which in turn lead to treatment failure and increased cost of therapy. Therefore, adherence to current evidence-based guidelines is
De Buyser, Stefanie L.; Petrovic, Mirko; Taes, Youri E.; Vetrano, Davide L.; Corsonello, Andrea; Volpato, Stefano; Onder, Graziano
Objectives Changes in physical performance during hospital stay have rarely been evaluated. In this study, we examined functional changes during hospital stay by assessing both physical performance and activities of daily living. Additionally, we investigated characteristics of older patients associated with meaningful in-hospital improvement in physical performance. Methods The CRiteria to assess appropriate Medication use among Elderly complex patients project recruited 1123 patients aged ≥65 years, consecutively admitted to geriatric or internal medicine acute care wards of seven Italian hospitals. We analyzed data from 639 participating participants with a Mini Mental State Examination score ≥18/30. Physical performance was assessed by walking speed and grip strength, and functional status by activities of daily living at hospital admission and at discharge. Meaningful improvement was defined as a measured change of at least 1 standard deviation. Multivariable logistic regression models predicting meaningful improvement, included age, gender, type of admission (through emergency room or elective), and physical performance at admission. Results Mean age of the study participants was 79 years (range 65–98), 52% were female. Overall, mean walking speed and grip strength performance improved during hospital stay (walking speed improvement: 0.04±0.20 m/s, p<0.001; grip strength improvement: 0.43±5.66 kg, p = 0.001), no significant change was observed in activities of daily living. Patients with poor physical performance at admission had higher odds for in-hospital improvement. Conclusion Overall, physical performance measurements show an improvement during hospital stay. The margin for meaningful functional improvement is larger in patients with poor physical function at admission. Nevertheless, most of these patients continue to have poor performance at discharge. PMID:24820733
Esposito, Silvano; Gioia, Renato; De Simone, Giuseppe; Noviello, Silvana; Lombardi, Domenico; Di Crescenzo, Vincenzo Giuseppe; Filippelli, Amelia; Rega, Maria Rosaria; Massari, Angelo; Elberti, Maria Giovanna; Grisi, Lucilla; Boccia, Giovanni; De Caro, Francesco; Leone, Sebastiano
Objectives Surgical infections represent an increasingly important problem for the National Health System. In this study we retrospectively evaluated the bacterial epidemiology and antimicrobial susceptibility of the microorganisms concerned as well as the utilization of antibiotics in the General and Emergency Surgery wards of a large teaching hospital in southern Italy in the period 2011–2013. Methods Data concerning non-duplicate bacterial isolates and antimicrobial susceptibility were retrieved from the Vitek 2 database. The pharmacy provided data about the consumption of antibiotics in the above reported wards. Chi-square or Fisher’s exact test were used. Results In all, 94 Gram-negative were isolated in 2011, 77 in 2012, and 125 in 2013, Escherichia coli, Acinetobacter baumannii and Pseudomonas aeruginosa always being the most frequently isolated microorganisms. A. baumannii showed high rates of resistance to carbapenems (with values of 100% in 2011 and 2012) and low rates of resistance to tigecycline, colistin and amikacin. In the same years, there were respectively 105, 93, and 165 Gram-positive isolated. The rate of MRSA isolates ranged from 66% to 75% during the study period. Conclusions Our results show no significant increase in antimicrobial resistance over the period in question, and a higher rate of both MRSA isolates and resistance to carbapenems in A. baumannii compared with other European data. PMID:26075047
Chiurco, Antonella; Montico, Marcella; Brovedani, Pierpaolo; Monasta, Lorenzo; Davanzo, Riccardo
Published evidence on the impact of the integration of International Board Certified Lactation Consultants (IBCLCs) for breastfeeding promotion is growing, but still relatively limited. Our study aims at evaluating the effects of adding an IBCLC for breastfeeding support in a mother and child hospital environment. We conducted a prospective study in the maternity ward of our maternal and child health Institute, recruiting 402 mothers of healthy term newborns soon after birth. The 18-month intervention of the IBCLC (Phase II) was preceded (Phase I) by data collection on breastfeeding rates and factors related to breastfeeding, both at hospital discharge and two weeks later. Data collection was replicated just before the end of the intervention (Phase III). In Phase III, a significantly higher percentage of mothers: (a) received help to breastfeed, and also received correct information on breastfeeding and community support, (b) started breastfeeding within two hours from delivery, (c) reported a good experience with the hospital staff. Moreover, the frequency of sore and/or cracked nipples was significantly lower in Phase III. However, no difference was found in exclusive breastfeeding rates at hospital discharge or at two weeks after birth. PMID:26308018
Thomazeau, Josephine; Huo Yung Kai, Samantha; Rolland, Yves; Sourdet, Sandrine; Saffon, Nicolas; Nourhashemi, Fati
As population grow older, chronic diseases are more prevalent. It leads to an increase of hospitalization for acute decompensation, sometimes iterative. Management of these patients is not always clear, and care provided is not always proportional to life expectancy. Making decisions in acute situations is not easy. This review aims to list and describe mortality scores within a year following hospitalization of patients of 65 years or older. Following keywords were searched in title and abstract of articles via an advanced search in PudMed, and by searching Mesh terms: "aged", "aged, 80 and over", "mortality", "prognosis", "hospitalized", "models, statistical", "acute geriatric ward", "frailty", "outcome". Studies published in English between 1985 and 2015 were selected. Last article was published in June 2015. Articles that described prognostic factors of mortality without a scoring system were excluded. Articles that focus either on patients in the Emergency Department and in Intensive Care Unit, or living in institution were excluded. Twenty-two scores are described in 17 articles. These scores use items that refer to functional status, comorbidities, cognitive status and frailty. Scores of mortality 3 or 6 months after hospitalization are not discriminative. Few of the 1-year mortality prognostic score are discriminative with AUC≥0.7. This review is not systematic. Practical use of these scores might help management of these patients, in order to initiate appropriate reflexion and palliative care if necessary. Copyright © 2016. Published by Elsevier Masson SAS.
Neeman, Marine; Dobrinas, Maria; Maurer, Sophie; Tagan, Damien; Sautebin, Annelore; Blanc, Anne-Laure; Widmer, Nicolas
Continuity of care between hospitals and community pharmacies needs to be improved to ensure medication safety. This study aimed to evaluate whether a set of pharmaceutical interventions to prepare hospital discharge facilitates the transition of care. This study took place in the internal medicine ward and in surrounding community pharmacies. The intervention group's patients underwent a set of pharmaceutical interventions during their hospital stay: medication reconciliation at admission, medication review, and discharge planning. The two groups were compared with regards to: number of community pharmacist interventions, time spent on discharge prescriptions, and number of treatment changes. Comparison between the groups showed a much lower (77% lower) number of community pharmacist interventions per discharge prescription in the intervention (n=54 patients) compared to the control group (n=64 patients): 6.9 versus 1.6 interventions, respectively (p<0.0001); less time working on discharge prescriptions; less interventions requiring a telephone call to a hospital physician. The number of medication changes at different steps was also significantly lower in the intervention group: 40% fewer (p<0.0001) changes between hospital admission and discharge, 66% fewer (p<0.0001) between hospital discharge and community pharmacy care, and 25% fewer (p=0.002) between community pharmacy care and care by a general practitioner. An intervention group underwent significantly fewer medication changes in subsequent steps in the transition of care after a set of interventions performed during their hospital stay. Community pharmacists had to perform fewer interventions on discharge prescriptions. Altogether, this improves continuity of care. Copyright © 2016 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
Stab, Nicole; Hacker, Winfried; Weigl, Matthias
Ward organization is a major determinant for nurses' well-being on the job. The majority of previous research on this relationship is based on single source methods, which have been criticized as skewed estimations mainly due to subjectivity of the ratings and due to common source bias. To investigate the association of ward organization characteristics and nurses' exhaustion by combining observation-based assessments with nurses' self-reports. Cross-sectional study on 25 wards of four hospitals and 245 nurses. Our multi-method approach to evaluate hospital ward organization consisted of on-site observations with a standardized assessment tool and of questionnaires to evaluate nurses' self-reports and exhaustion. After establishing the reliability of our measures, we applied multi-level regression analyses to determine associations between determinant and outcome variables. We found substantial convergence in ward organization between the observation-based assessments and nurses' self-reports, which supports the validity of our external assessments. Furthermore, two observation-based characteristics, namely participation and patient-focused care, were significantly associated with lower emotional exhaustion among the nurses. Our results suggest that observation-based assessments are a valid and feasible way to assess ward organization in hospitals. Nurses' self-reported as well as observation-based ratings on ward organization were associated with nurses' emotional exhaustion. This is of interest mainly for identifying alternative measures in evaluating nurses' work environments, to inform health promotion activities and to evaluate job redesign intervention. Copyright © 2016 Elsevier Ltd. All rights reserved.
Boubred, F; Herlenius, E; Andres, V; des Robert, C; Marchini, G
The consequences of early postpartum discharge (EPPD, within 2 days after birth) on newborn health remain debated. Early discharge has been associated with increased neonatal morbidity. However, neonatal re-hospitalization can be prevented by careful follow-up during the 1st week after birth. We compared the early neonatal hospitalization of term newborns over 2 years in two hospitals: Karolinska University Hospital in Stockholm (n=7300 births), which allowed early discharge from 6h after birth with specific neonatal follow-up, and Marseille University Hospital (AP-HM) (n=4385) where postpartum discharge was more conventional after 72 h. During the study period, the EPPD rate was 41% vs. 2% in Stockholm and Marseille, respectively (P<0.001). Hospital readmission was comparable (5.6‰ vs. 7‰, P=0.2). The leading cause associated with hospitalization was icterus in Stockholm (76% vs. 26%, P<0.001) and feeding difficulties in Marseille (17% vs. 48%, P<0.001). In conclusion, close neonatal follow-up during the 1st week of life associated with restricted maternal and neonatal eligibility criteria for EPPD are required to prevent early neonatal re-hospitalization. Copyright © 2016 Elsevier Masson SAS. All rights reserved.
Morioka, Ikuharu; Tabuchi, Yuna; Takahashi, Yuko; Oda, Yuriko; Nakai, Masami; Yanase, Aki; Watazu, Chiyoko
The purpose of this study was to clarify the contamination of mobile phones shared in hospital wards and its relationship with the consciousness and behavior of nurses about biological cleanliness. Samples from mobile phones were cultured to detect viable bacteria (n=110) and Staphylococcus aureus (n=54). A questionnaire survey was conducted on 110 nurses carrying mobile phones on the day of sampling. Viable bacteria were detected on 79.1% of the mobile phones, whereas S. aureus was detected on 68.6%. All the nurses were aware of hand washing with water or alcohol after regular work, but 33.6% of the nurses were not conscious of hand washing with water or alcohol after using a mobile phone. There was a significant positive relationship between the frequency of using mobile phones and the number of hand washings with water or alcohol. A significant negative relationship was found between the detection of viable bacteria and the number of hand washings with alcohol. The results of logistic regression analysis showed that the detection of viable bacteria was related significantly with the number of hand washings with alcohol (Odds ratio, 0.350; 95%CI, 0.143-0.857) and that the detection of S. aureus was related significantly with the frequency of using mobile phones (Odds ratio, 0.183; 95%CI, 0.036-0.933). It is important to be conscious of the fact that mobile phones shared in hospital wards are easily contaminated. Because hand washing with water or alcohol prevents the contamination of the mobile phones, nurses should take standard precautions after using mobile phones.
Hor, Su-Yin; Hooker, Claire; Iedema, Rick; Wyer, Mary; Gilbert, Gwendolyn L; Jorm, Christine; O'Sullivan, Matthew Vincent Neil
Hospital-acquired infections are the most common adverse event for inpatients worldwide. Efforts to prevent microbial cross-contamination currently focus on hand hygiene and use of personal protective equipment (PPE), with variable success. Better understanding is needed of infection prevention and control (IPC) in routine clinical practice. We report on an interventionist video-reflexive ethnography study that explored how healthcare workers performed IPC in three wards in two hospitals in New South Wales, Australia: an intensive care unit and two general surgical wards. We conducted 46 semistructured interviews, 24 weeks of fieldwork (observation and videoing) and 22 reflexive sessions with a total of 177 participants (medical, nursing, allied health, clerical and cleaning staff, and medical and nursing students). We performed a postintervention analysis, using a modified grounded theory approach, to account for the range of IPC practices identified by participants. We found that healthcare workers' routine IPC work goes beyond hand hygiene and PPE. It also involves, for instance, the distribution of team members during rounds, the choreography of performing aseptic procedures and moving 'from clean to dirty' when examining patients. We account for these practices as the logistical work of moving bodies and objects across boundaries, especially from contaminated to clean/vulnerable spaces, while restricting the movement of micro-organisms through cleaning, applying barriers and buffers, and trajectory planning. Attention to the logistics of moving people and objects around healthcare spaces, especially into vulnerable areas, allows for a more comprehensive approach to IPC through better contextualisation of hand hygiene and PPE protocols, better identification of transmission risks, and the design and promotion of a wider range of preventive strategies and solutions. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted
Background. Medical emergency teams (METs) or rapid response teams (RRTs) facilitate early intervention for clinically deteriorating hospitalized patients. In healthcare systems where financial resources and intensivist availability are limited, the establishment of such teams can prove challenging. Objectives. A low-cost, ward-based response system was implemented on a medical clinical teaching unit in a Montreal tertiary care hospital. A prospective before/after study was undertaken to examine the system's impact on time to intervention, code blue rates, and ICU transfer rates. Results. Ninety-five calls were placed for 82 patients. Median time from patient decompensation to intervention was 5 min (IQR 1–10), compared to 3.4 hours (IQR 0.6–12.4) before system implementation (p < 0.001). Total number of ICU admissions from the CTU was reduced from 4.8/1000 patient days (±2.2) before intervention to 3.3/1000 patient days (±1.4) after intervention (IRR: 0.82, p = 0.04 (CI 95%: 0.69–0.99)). CTU code blue rates decreased from 2.2/1000 patient days (±1.6) before intervention to 1.2/1000 patient days (±1.3) after intervention (IRR: 0.51, p = 0.02 (CI 95%: 0.30–0.89)). Conclusion. Our local ward-based response system achieved a significant reduction in the time of patient decompensation to initial intervention, in CTU code blue rates, and in CTU to ICU transfers without necessitating additional usage of financial or human resources. PMID:27830088
Hadley, Mary B; Blum, Lauren S; Mujaddid, Saraana; Parveen, Shahana; Nuremowla, Sadid; Haque, Mohammad Enamul; Ullah, Mohammad
In response to concerns that nurses spend less than 6% of their time on direct patient care, this study explored factors that influence nurses' behaviour in the provision of 'hands on' care in hospitals in Bangladesh. Through in-depth interviews with female nurses and patients and their co-workers in six hospitals, we identified conflicts between the inherited British model of nursing and Bangladeshi societal norms. This was most evident in the areas of night duty, contact with strangers, and involvement in 'dirty' work. The public was said to associate nursing activities with commercial sex work. As a consequence, their value on the 'bride market' decreases. To minimise the stigma associated with their profession, nurses in government hospitals distance themselves from patients, using nurse surrogates in the form of patients' relatives and hospital support workers to carry out their work. These adaptations are supported and sustained through unofficial activities developed over time within hospitals. In contrast nurses in NGO hospitals give more direct patient care themselves and do not rely on carers as much because of tight supervision and limited visitor hours. Initiatives undertaken to improve the quality of patient care, such as enlarging the nursing workforce or providing clinical instruction, which do not take into account the prevailing culture in hospitals and social conflicts faced by nurses, are unlikely to succeed. Fundamental decisions on how to care for the sick in Bangladesh are required. If the present nursing curriculum is followed, adequate supplies, supervision and accountability are prerequisites for its implementation.
Lubis, N U; Sinuhaji, A B; Sutanto, A H
A retrospective study was done on infants and children hospitalized from January 1, 1988 to December 31, 1988 at the Pediatric Ward of Dr. Pirngadi Hospital, Medan. In this period a total of 3370 patients had been hospitalized and 1356 (40.24%) had gastroenteritis of whom 96 patients (7.08%) died. The causes of death as the complications were encephalopathy in 27 patients (28.12%), bronchopneumonia in 32 (33.33%), shock in 27 (28.12%), sepsis in 6 (6.25%) and acidosis in 4 (4.17%). Fifty one (53.12%) of those 96 patients who died were in the age group of under one year. The age specific mortality rate was highest in the age group of 1 month (14.28%). Of those 1356 patients with gastroenteritis 566 (41.74%) were well nourished of whom 8 patients died (1.42%); mildly malnourished in 532 patients of whom 36 (6.77%) died; and severely malnourished in 258 patients of whom 52 (20.16%) died. As far as the duration of illness was concerned 43 patients (12.73%) who died had a history of illness at home of 1 day. Beside the complications of the disease it seemed that the nutritional factors might have interfered with the mortality of patients with gastroenteritis.
Kaye, Dan K; Nakimuli, Annettee; Kakaire, Othman; Osinde, Michael O; Mbalinda, Scovia N; Kakande, Nelson
Client satisfaction is a common outcome measure for quality of care and goal for quality improvement in healthcare. We assessed women's perceptions of the structure, process and outcome of intrapartum care in Mulago hospital, specifically, labor ward duty shift handovers. Data was collected through 40 in-depth interviews conducted on two occasions: during the time of hospitalization and within 4-6 months after childbirth. Participants were women who delivered at the hospital, of whom some had life-threatening obstetric complications. Data was analyzed by thematic analysis. Maternity duty handovers were associated with patient dissatisfaction, particularly the process of hand-over, the decision-making that follows handovers and failure of communication of information to patients and their caretakers. Consequently, duty handovers were perceived inadequate. They were described as gaps in the continuity of care, and contributed to poor quality of care, birth trauma and mothers' dissatisfaction with the childbirth experience. The handover process and practices should be standardized using protocols and checklists. Health workers need training on handover practices, team work and communication skills (so as to improve patient-health provider and provider-provider interaction.
Noble, Helen; Brown, Joan; Shields, Joanne; Fogarty, Damian; Maxwell, Alexander P
To review end-of-life care provided by renal healthcare professionals to hospital in-patients with chronic kidney disease, and their carers, over a 12-month period in Northern Ireland. Retrospective review of 100 patients. Mean age at death was 72 years (19-95) and 56% were male. Eighty three percent of patients had a 'Not For Attempted Resuscitation' order during their last admission and this was implemented in 42%. Less than 20% of all patients died in a hospital ward. No patients had an advanced care plan, although 42% had commenced the Liverpool Care Pathway for the Dying Patient. Patients suffered excessive end-of-life symptoms. In addition, there was limited documentation of carer involvement and carer needs were not formally assessed. End-of-life care for patients with advanced chronic renal disease can be enhanced. There is significant variation in the recording of discussions regarding impending death and little preparation. There is poor recording of the patients' wishes regarding death. Those with declining functional status, including those frequently admitted to hospital require holistic assessment regarding end-of-life needs. More effective communication between the patient, family and multi-professional team is required for patients who are dying and those caring for them. © 2014 European Dialysis and Transplant Nurses Association/European Renal Care Association.
Farsaei, Shadi; Ghorbani, Sajad; Adibi, Payman
Purpose: The dramatic increase in stress ulcer prophylaxis (SUP) prescribing patterns over the past several years has raised concerns regarding to their appropriate utilization. This prospective study attempted to evaluate the trend of adherence to stress ulcer prophylaxis from admission until discharge in non- Intensive care unit (ICU) setting. Additionally, we attempted to find those variables associated with appropriate SUP administration. Methods: Data collection was performed prospectively to evaluate 195 randomly selected adult patients who received SUP or had indication for that in non-ICU wards of one of the largest referral center in Iran, during 6 months. Adherence was studied according to widely accepted American Society of Health system Pharmacists (ASHP) guideline. Univariate and multivariate logistic regression was also performed to detect associations related to misuse of SUP. Results: We recognized total inappropriate use of SUP upon admission, during hospital stay and at discharge were somewhat identical at different time points (61%, 80% and 77.4% respectively). On the other hand, since small number of patients experienced SUP underutilization, unfortunately this was not possible to elucidate factors that may have effect on this flawed behavior. However, increasing age was identified to be significant variable in SUP overutilization. Conclusion: This prospective study highlighted inappropriate overutilization of SUP within non-critically ill patients and found factors which predicted this behavior. Adherence during hospital stay was also calculated for the first time in this study, which was related to SUP adherence upon hospital admission. PMID:28507939
This paper summarizes the opinions of experts who participated in designing the environment of a children's hospital and reports the results of a questionnaire survey conducted among hospital users. The grounded theory method was adopted to analyze 292 concepts, 79 open codes, 25 axial codes, and 4 selective codes; in addition, confirmatory factor analysis and reliability analysis were performed to identify elements for designing a healing environment in a children's hospital, and 21 elements from 4 dimensions, namely, emotions, space design, interpersonal interaction, and pleasant surroundings, were determined. Subsequently, this study examined the perceptions of 401 children at National Taiwan University Children's Hospital. The results revealed that, regarding the children's responses to the four dimensions and their overall perception, younger children accepted the healing environment to a significantly higher degree than did older children. The sex effect was significant for the space design dimension, and it was not significant for the other dimensions.
Background Infectious diseases are a common cause of increased morbidity and mortality in elderly patients. Bacteraemia in the elderly is a difficult diagnosis and a therapeutic challenge due to age-related vicissitudes and to their comorbidities. The main purpose of the study was to assess independent risk factors for in-hospital mortality among the elderly with bacteraemia admitted to an Internal Medicine Ward. Methods Overall, a cohort of 135 patients, 65 years of age and older, with bacteraemia were retrospectively studied. Data related to demographic information, comorbidities, clinical parameters on admission, source and type of infection, microorganism isolated in the blood culture, laboratory data and empirical antibiotic treatment was recorded from each patient. Multivariate logistic regression was performed to identify independent predictors of all-cause in-hospital mortality. Results Of these 135 patients, 45.9% were women. The most common infections in this group of patients were urinary tract infections (46.7%). The main microorganisms isolated in the blood cultures were Escherichia coli (14.9%), Methicillin-resistant Staphylococcus aureus (MRSA) (12.0%), non-MRSA (11.4%), Klebsiella pneumoniae (9.1%) and Enterococcus faecalis (8.0%). The in-hospital mortality was 22.2%. Independent prognostic factors associated with in-hospital mortality were age ≥ 85 years, chronic renal disease, bacteraemia of unknown focus and cognitive impairment at admission (OR, 2.812 [95% CI, 1.039-7.611; p = 0.042]; OR, 6.179 [95% CI, 1.840-20.748; p = 0.003]; OR, 8.673 [95% CI, 1.557-48.311; p = 0.014] and OR, 3.621 [95% CI, 1.226-10.695; p = 0.020], respectively). By multivariate analysis appropriate antibiotic therapy was not associated with lower odds of mortality. Conclusion Bacteraemia in the elderly has a high mortality rate. There are no set of signs or clinical features that can predict bacteraemia in the elderly. However, older age (≥ 85 years), chronic renal
Filippi, Veronique; Ronsmans, Carine; Gohou, Valerie; Goufodji, Sourou; Lardi, Mohamed; Sahel, Amina; Saizonou, Jacques; De Brouwere, Vincent
This study examines near-miss obstetric events in African hospitals as to the frequency, nature, and ratio of near miss to death and considers whether these could become useful indicators for monitoring the performance of obstetric services in Africa. Prospective or retrospective reviews of medical records were conducted in nine referral hospitals in three countries (Benin, Côte d'Ivoire, and Morocco). We calculated the incidence of near-miss obstetric events, near-miss cases, and maternal deaths related to hemorrhage, hypertensive diseases of pregnancy, dystocia, infections, and anemia and analyzed these according to hospital and timing relative to admission. The incidence of near-miss cases was varied, and in some hospitals extremely large: from 1% to almost a quarter of all deliveries were near misses. Near-miss cases were 15 times more common than deaths (ranging from a ratio of 9:1-108:1). Most of the women with near-miss events (NMEs) (83%) were already in a critical condition on arrival at the hospital (range 54-90%), and two in three were referred from another facility. The most frequent types of NMEs were hemorrhage and hypertensive diseases of pregnancy, but anemia was the leading cause in three first referral level hospitals in Benin and Côte d'Ivoire. Near-miss events due to infections were rare. Near-miss events are extremely common in some African hospitals, with a high proportion arriving in critical conditions. Near-miss events must be estimated separately for those already in a critical condition on arrival and those developing after admission; the first as a good indicator of the effectiveness of emergency referrals and the second as a potential tool for monitoring the performance of obstetric services.
Kumari, D N; Haji, T C; Keer, V; Hawkey, P M; Duncanson, V; Flower, E
The spread of methicillin-resistant Staphylococcus aureus (MRSA) in a hospital is thought to be mainly by direct contact. Environmental sources such as exhaust ducting systems have been increasingly recognized as a source for MRSA outbreaks in intensive therapy units. We describe an outbreak of MRSA related to ventilation grilles in an orthopaedic ward. Six patients and one nurse were involved in an outbreak with EMRSA-15 during March 1996. The index case was transferred from a large university hospital in Leeds. One of the patients had shared the same bay with the index case. The rest of the patients were in another bay of the same ward and had no direct contact with the index patient. An environmental source was suspected and the ventilation grilles in boys 1 and 2 were found to be harbouring EMRSA-15. The ventilation system at that time was working on an intermittent cycle from 4 p.m.-8 a.m. Daily shut-down of the system temporarily created a negative pressure, sucking air in from the ward environment into the ventilation system and probably contaminating the outlet grilles. It is likely that contaminated air was blown back into the ward when the ventilation system was started. The system was thoroughly cleaned, appropriate infection control measures were instituted and the ventilation system was put back on a continuous running cycle and the outbreak terminated. Six months after the outbreak no isolates of EMRSA-15 had been made on the ward.
Aldrin, Magne; Raastad, Ragnhild; Tvete, Ingunn Fride; Berild, Dag; Frigessi, Arnoldo; Leegaard, Truls; Monnet, Dominique L; Walberg, Mette; Müller, Fredrik
Association between previous antibiotic use and emergence of antibiotic resistance has been reported for several microorganisms. The relationship has been extensively studied, and although the causes of antibiotic resistance are multi-factorial, clear evidence of antibiotic use as a major risk factor exists. Most studies are carried out in countries with high consumption of antibiotics and corresponding high levels of antibiotic resistance, and currently, little is known whether and at what level the associations are detectable in a low antibiotic consumption environment. We conduct an ecological, retrospective study aimed at determining the impact of antibiotic consumption on antibiotic-resistant Pseudomonas aeruginosa in three hospitals in Norway, a country with low levels of antibiotic use. We construct a sophisticated statistical model to capture such low signals. To reduce noise, we conduct our study at hospital ward level. We propose a random effect Poisson or binomial regression model, with a reparametrisation that allows us to reduce the number of parameters. Inference is likelihood based. Through scenario simulation, we study the potential effects of reduced or increased antibiotic use. Results clearly indicate that the effects of consumption on resistance are present under conditions with relatively low use of antibiotic agents. This strengthens the recommendation on prudent use of antibiotics, even when consumption is relatively low. Copyright © 2012 John Wiley & Sons, Ltd.
Nzeako, B C; Al Daughari, H; Al Lamki, Z; Al Rawas, O
This study aims to determine what objects lying in the hospital environment or brought in from outside contribute to the introduction of bacteria associated with nosocomial infections. One hundred swab specimens collected from children's toys, sinks, door handles, telephone handsets and flowers brought into the hospital were plated on different culture media. Colonial growth on the media was purified and identified subsequently using standard bacteriological methods. Of the 100 samples cultured, 61 (61%) grew a range of bacteria including Pseudomonas aeruginosa (n=14, 23.0%), Acinetobacter spp. (n=13, 21.3%), Serratia spp. (n=9, 14.7%), Staphylococcus epidermidis (n=9, 14.7%), Stenotrophomonas maltophilia (n=4, 6.6%), Staphylococcus aureus (n=4, 6.6%), Enterobacter cloacae (n=3, 4.9%), Pantoea sp. (n=2, 3.3%), Chryseobacterium sp. (n=2, 3.3%) and Klebsiella pneumoniae (n=1, 1.6%). Although all the Serratia, Enterobacter, Klebsiella and Pantoea species isolates showed varying degrees of resistance to gentamicin, ceftriaxone, cefuroxime and cefotaxime, all were resistant to ampicillin. Chryseobacterium and Stenotrophomonas species isolates were resistant to amikacin, imipenem, gentamicin and ceftazidime, to which only three isolates of Pseudomonas species were resistant. All the staphylococcal isolates were susceptible to methicillin. Although there has been no major outbreak of a nosocomial infection in the hospital, it is strongly recommended that effective control measures (e.g., sampling the hospital water supply, disinfecting children's toys, use of appropriate hand washing and checking some of the disinfectants for presence of bacteria) are needed. These measures are necessary to ensure that the antibiotic-resistant strains identified in this study are not allowed to spread in the hospital.
Lau, Hong Sang; Florax, Christa; Porsius, Arijan J; de Boer, Anthonius
Aims Accurate recording of medication histories in hospital medical records (HMR) is important when patients are admitted to the hospital. Lack of registration of drugs can lead to unintended discontinuation of drugs and failure to detect drug related problems. We investigated the comprehensiveness of medication histories in HMR with regard to prescription drugs by comparing the registration of drugs in HMR with computerized pharmacy records obtained from the community pharmacy. Methods Patients admitted to the general ward of two acute care hospitals were included in the study after obtaining informed consent. We conducted an interview on drugs used just prior to hospitalization and extracted the medication history from the HMR. Pharmacy records were collected from the community pharmacists over a 1 year period before the admission. Drugs in the pharmacy records were defined as possibly used (PU-drugs) when they were dispensed before the admission date and had a theoretical enddate of 7 days before the admission date or later. If any PU-drug was not recorded in the HMR, we asked the patient whether they were using that drug or not. Results Data were obtained from 304 patients who had an average age of 71 (range 40–92) years. The total number of drugs according to the HMR was 1239, 43 of which were not used. When compared with the pharmacy records we found an extra 518 drugs that were not recorded in the HMR but were possibly in use. After verification with the patients, 410 of these were indeed in use bringing the total number of drugs in use to 1606. The type of drugs in use but not recorded in the HMR covered a broad spectrum and included many drugs considered to be important such as cardiovascular drugs (n = 67) and NSAIDs (n = 31). The percentages of patients with 0, 1, 2, 3, 4, 5–11 drugs not recorded in the HMR were 39, 28, 16, 8, 3.6 and 5.5, respectively. Of the 1606 drugs in use according to information from all sources, only 38 (2.4%) were not
Heslop, Liza; Weeding, Stephen; Dawson, Linda; Fisher, Julie; Howard, Andrew
mWard is a project whose purpose is to enhance existing clinical and administrative decision support and to consider mobile computers, connected via wireless network, for bringing clinical information to the point of care. The mWard project allowed a limited number of users to test and evaluate a selected range of mobile-wireless infrastructure and mobile health care computing devices at the neuroscience ward at Southern Health's Monash Medical Centre, Victoria, Australia. Before the project commenced, the ward had two PC's which were used as terminals by all ward-based staff and numerous multi-disciplinary staff who visited the ward each day. The first stage of the research, outlined in this paper, evaluates a selected range of mobile-wireless infrastructure.
Boulain, Thierry; Runge, Isabelle; Delorme, Nathalie; Bouju, Angèle; Valéry, Antoine
Background. To identify, upon emergency department (ED) admission, predictors of unexpected death or unplanned intensive care/high dependency units (ICU/HDU) admission during the first 15 days of hospitalization on regular wards. Methods. Prospective cohort study in a medical-surgical adult ED in a teaching hospital, including consecutive patients hospitalized on regular wards after ED visit, and identification of predictors by logistic regression and Cox proportional hazards model. Results. Among 4,619 included patients, 77 (1.67%) target events were observed: 32 unexpected deaths and 45 unplanned transfers to an ICU/HDU. We identified 9 predictors of the target event including the oxygen administration on the ED, unknown current medications, and use of psychoactive drug(s). All predictors put the patients at risk during the first 15 days of hospitalization. A logistic model for hospital mortality prediction (death of all causes) still comprised oxygen administration on the ED, unknown current medications, and the use of psychoactive drug(s) as risk factors. Conclusion. The “use of oxygen therapy on the ED,” the “current use of psychoactive drug(s)”, and the “lack of knowledge of current medications taken by the patients” were important predisposing factors to severe adverse events during the 15 days of hospitalization on regular wards following the ED visit. PMID:24624300
Panggabean, G; Faisal; Nasution, R; Loebis, M S; Siregar, Z
Six hundred and fifty seven hospitalized patients under five in Child Health Department Hospital Tembakau Deli Medan, from January 1988 until December 1988 had been investigated retrospectively. Severe PCM are found 12 (1.8%), consisting of 7 (58.3%) boys and 5 (41.7%) girls. Most cases were found at the age of 1-2 years (33.3%). Marasmus were found in 5 cases (41.7%), Marasmic kwashiorkor in 4 (54%), while Kwashiorkor in 3 cases (25%). Clinical features of the patients are as follow: hepatomegaly 7 (58.3%), anorexia 6 (50%), old man face 5 (41.7%), subcutaneous fat decrease 5 (41.7%), thinsparse easily pick hairs 5 (41.7%), muscle hypotrophy 5 (41.7%), edema of the lower extremity 4 (33.3%), crazy pavement dermatosis 2 (16.7%). All patients were hospitalized combined with other diseases as chronic diarrhea 6 (50%), bronchopneumonia 5 (41.7%) and ascariasis 4 (33.3%). Mortality in 1 patient.
Harde, Minal; Bhadade, Rakesh; Iyer, Hemlata; Jatale, Amol; Tiwatne, Sagar
Infection is a potentially serious complication of epidural analgesia and with an increase in its use in wards there is a necessity to demonstrate its safety. We aimed to compare the incidence of colonization of epidural catheters retained for short duration (for 48 h) postoperative analgesia in postanesthesia care unit and wards. It was a prospective observational study done in a tertiary care teaching public hospital over a period of 2 years and included 400 patients with 200 each belonged to two groups PACU and ward. We also studied epidural tip culture pattern, skin swab culture at the entry point of the catheter, their relation to each other and whether colonization is equivalent to infection. Data were analyzed using statistical software GraphPad. Overall positive tip culture was 6% (24), of them 7% (14) were from PACU and 5% (10) were from ward (P = 0.5285). Positive skin swab culture was 38% (150), of them 20% (80) were from PACU and 18% (70) were from ward (P = 0.3526). The relation between positive tip culture and positive skin swab culture in same patients is extremely significant showing a strong linear relationship (95% confidence interval = 0.1053-0.2289). The most common microorganism isolated was Staphylococcus epidermidis. No patient had signs of local or epidural infection. There is no difference in the incidence of epidural catheter tip culture and skin swab culture of patients from the general ward and PACU. Epidural analgesia can be administered safely for 48 h in general wards without added risk of infection. The presence of positive tip culture is not a predictor of epidural space infection, and colonization is not equivalent to infection; hence, routine culture is not needed. Bacterial migration from the skin along the epidural track is the most common mode of bacterial colonization; hence, strict asepsis is necessary.
Falcone, M; Tiseo, G; Tascini, C; Russo, A; Sozio, E; Raponi, G; Rosin, C; Pignatelli, P; Carfagna, P; Farcomeni, A; Luzzati, R; Violi, F; Menichetti, F; Venditti, M
An increasing prevalence of candidemia has been reported in Internal Medicine wards (IMWs). The aim of our study was to identify risk factors for candidemia among non-neutropenic patients hospitalized in IMWs. A multicenter case-control study was performed in three hospitals in Italy. Patients developing candidemia (cases) were compared to patients without candidemia (controls) matched by age, time of admission and duration of hospitalization. A logistic regression analysis identified risk factors for candidemia, and a new risk score was developed. Validation was performed on an external cohort of patients. Overall, 951 patients (317 cases of candidemia and 634 controls) were included in the derivation cohort, while 270 patients (90 patients with candidemia and 180 controls) constituted the validation cohort. Severe sepsis or septic shock, recent Clostridium difficile infection, diabetes mellitus, total parenteral nutrition, chronic obstructive pulmonary disease, concomitant intravenous glycopeptide therapy, presence of peripherally inserted central catheter, previous antibiotic therapy and immunosuppressive therapy were factors independently associated with candidemia. The new risk score showed good area under the curve (AUC) values in both derivation (AUC 0.973 95% CI 0.809-0.997, p<0.001) and validation cohort (0.867 95% CI 0.710-0.931, p<0.001). A threshold of 3 leads to a sensitivity of 87% and a specificity of 83%. Non-neutropenic patients admitted in IMWs have peculiar risk factors for candidemia. A new risk score with a good performance could facilitate the identification of candidates to early antifungal therapy. Copyright © 2017 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
Petrick, P; Kong, N C T; Nordiah, A J; Cheong, I K S; Tamil, M A
The clinical outcome of bacteraemic patients is influenced by many factors. It is vital to know one's own local hospital epidemiological data so as to provide optimal care to the affected patients. This was a prospective, observational study carried out in the said patient population over a period of four months in the year 2005. One hundred and ninety one patients presented with bacteraemia over the study period. Fifty-two (27%) of the patients died. Mechanical ventilation, inappropriate empirical antibiotic usage, Chinese ethnicity and low serum albumin levels independently affected prognosis. These factors should alert physicians to those patients who require more intensive monitoring and care.
Ahmad, Aftab; Weston, Philip J; Ahmad, Mahin; Sharma, Dushyant; Purewal, Tejpal
Objectives Misuse of investigations, medications and hospital beds is costing the National Health Service (NHS) billions of pounds with little evidence that approaches centred on reducing overuse are sustainable. Our previous study demonstrated that twice-daily consultant ward rounds reduce inpatient length of stay and suggested a reduction in overuse of investigations and medications. This study aims to assess the impact of daily consultant ward rounds on the use of investigations and medications and estimate the potential cost benefit. Settings The study was performed on two medical wards in a major city university teaching hospital in Liverpool, UK, receiving acute admissions from medical assessment and emergency departments. Participants and intervention The total number of patients admitted, investigations performed and pharmacy costs incurred were collected for 2 years before and following a change in the working practice of consultants from twice-weekly to twice-daily consultant ward rounds on the two medical wards. Outcome measures We performed a cost-benefit analysis to assess the net amount of money saved by reducing inappropriate investigations and pharmacy drug use following the intervention. Results Despite a 70% increase in patient throughput (p<0.01) the investigations and pharmacy, costs per patient reduced by 50% over a 12-month period (p<0.01) and were sustained for the next 12 months. The reduction in investigations and medication use did not have any effect on the readmission or mortality rate (p=NS), whereas, the length of stay was almost halved (p<0.01). Daily senior clinician input resulted in a net cost saving of £336 528 per year following the intervention. Conclusions Daily consultant input has a significant impact on reducing the inappropriate use of investigations and pharmacy costs saving the NHS more than £650K on the two wards over a 2-year period. PMID:25854972
Weeding, Stephen; Dawson, Linda
Most hospital-based staff can be considered to be mobile but many hospital information systems (HIS) are based on fixed desk top computers. Wireless networks allow HIS to be brought to the point of care using mobile devices such as laptops on trolleys thus providing data which can aid in clinical decision-making. The research objective of this project focusses on the collaborative design of a laptop solution for providing data at the point of care. The research approach was based on a combination of action research and design science. Action research techniques including participant observation and informal one-to-one discussions were used to obtain information that was used to evolve the trolley design as a design artefact while addressing usability limitations. This paper presents three versions of the trolley design and how they evolved based on the feedback provided to the researchers from clinical use. Also these results show that using iterative action research techniques (planning, action, evaluation and reflection) in collaborative research can provide productive outcomes addressing a specific design objective within an acute care setting.
Isaak, Valerie; Vashdi, Dana; Bar-Noy, Dor; Kostisky, Hava; Hirschmann, Shmuel; Grinshpoon, Alexander
This study examined the effectiveness of an intervention program to enhance unit safety climate and minimize employee risk of injury from patient violence. The intervention program, including a 3-day workshop, was offered to personnel on maximum security units of an Israeli psychiatric hospital. Safety climate was examined before and after the implementation of the intervention, and incidents of patient violence were investigated. Six months after the intervention, a significant improvement in employees' perceptions of management's commitment to safety as well as a marginally significant improvement in communication about safety issues were found. This study demonstrated that an intervention program to enhance safety climate was associated with a decrease in the number of aggressive incidents. The researchers concluded that this intervention program is likely to return a sense of safety to workers and reduce workplace violence.
Cooper, Jessie; Kierans, Ciara; Defres, Sylviane; Easton, Ava; Kneen, Rachel; Solomon, Tom
Herpes simplex virus (HSV) encephalitis is a life-threatening infection of the brain, which has significant physical, cognitive and social consequences for survivors. Despite increasing recognition of the long-term effects of encephalitis, research and policy remains largely focused on its acute management, meaning there is little understanding of the difficulties people face after discharge from acute care. This paper aims to chart the problems and challenges which people encounter when they return home after treatment for HSV encephalitis. The paper reports on data from 30 narrative interviews with 45 people affected by HSV encephalitis and their significant others. The study was conducted as part of the ENCEPH-UK programme grant on Understanding and Improving the Outcome of Encephalitis. The findings show the diverse challenges which are experienced by people after treatment for HSV encephalitis. We first chart how peoples' everyday lives are fragmented following their discharge from hospital. Second, we document the social consequences which result from the longer-term effects of encephalitis. Finally, we show how the above struggles are exacerbated by the lack of support systems for the post-acute effects of encephalitis, and describe how people are consequently forced to devise their own care routines and strategies for managing their problems. The paper argues that in order to improve long-term outcomes in encephalitis, it is vital that we develop pathways of support for the condition beyond the acute hospital setting. We conclude by making recommendations to enhance communication and care for the post-acute consequences of encephalitis, to ensure those affected are fully supported through the chronic effects of this devastating disease.
Fadeyibi, Idowu Olusegun; Raji, Muhibat Adeola; Ibrahim, Nasiru Akanmu; Ugburo, Andrew Omotayo; Ademiluyi, Samuel
Burns are characterized by the loss of varying proportions of the protective layers of the skin, depression of immune responses, and increased wound susceptibility to infection. Wound infection is a major cause of morbidity and mortality in burn cases. This study characterizes those factors that predispose burn wounds to infection and the bacteriology of the microorganisms in our environment. Prospective study of burns patients that were admitted and treated at the Lagos State University Teaching Hospital (LASUTH), Ikeja-Lagos, Nigeria between January 1 and May 31, 2010 was carried out. Information about the demographics, aetiology/mechanism of burns, interval between the time of injury and admission, microbial studies, and antibiotic therapy were collected and analyzed. A total of 74 patients consisting of 43 males and 31 females were seen. The ages range between one week and 95 ± 22.42 years. Wound infections were confirmed in 28 patients (infection rate of 37.84 per 100 patients). Delayed presentation at LASUTH and length of hospital stay were significantly related to the development of wound infection. Pseudomonas aeruginosa and Proteus mirabilis were the most common infective organisms occurring in 53.6 and 10.7 percentages respectively. The isolated organisms were resistant to the beta-lactam antibiotics and mostly sensitive to carbapenem and aztreonam preparations. Factors predisposing to invasive wound infections in our environment were highlighted and suggestions made on methods that could reduce the infections and thus reduce morbidity and mortality in burns. Copyright © 2012 Elsevier Ltd and ISBI. All rights reserved.
Singh, Inderpal; Okeke, Justin; Edwards, Chris
Falls in hospital account for almost two-fifths of the patient safety incidents reported to the National Reporting and Learning System in U.K. Studies have suggested an increased incidence of falls in single-bedded hospitals. To compare the outcome of in-patient falls occurring in units with 100% single rooms (SRs) and multi-bedded wards (M-BWs). SAMPLING DESIGN AND METHODS: An observational study. Retrospective standard incident reporting data (DATIX) on in-patient falls and associated injury were obtained from both sites over 18 months each. There was no change in demographics, size and characteristics of population except change in the geography of new hospitals. The total number of in-patient fall incidents reported over the 3 years was 1,749. The mean age of patients on M-BW and SR sites was 81.0 ± 2.4 (51.3% females) and 80.3 ± 10.3 (50.7% females), respectively. The mean incidence of falls/1,000 patient-bed days on M-BW and SR sites was 5.44 ± 4.76 and 15.82 ± 19.56, respectively (P < 0.01). Overall fracture incidence/1,000 patient-bed days on M-BW and SR sites was 0.07 ± 0.48 and 0.36 ± 1.52 (P < 0.01), respectively. The hip fracture incidence/1,000 patient-bed days on M-BW and SR sites was 0.04 ± 0.38 and 0.15 ± 1.00 (P < 0.01), respectively. One-year mortality from the date of first incident fall was lower in M-BWs (41.1%) compared with SRs (47.1%), but this is not significant (P = 0.12). This observational study shows a significantly increased incidence of falls and fracture in a hospital design with SRs compared with a multi-bedded facility. Consideration should be given to increased incidence of falls and falls-related injury in SRs when deciding on the percentage of single-room provision in new hospitals to admit frail older adults. © The Author 2015. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: email@example.com.
Rama, Mylapuram; Viswanathan, Gayathri; Acharya, Leelavathi D; Attur, R P; Reddy, P N; Raghavan, S V
Polypharmacy is common in drug prescriptions of chronic kidney disease patients. A study of the prescription patterns of drugs with potential interactions would be of interest to prevent drug related adverse events. A prospective observational study of six months (Dec 2009-May 2010) was carried out among the chronic kidney disease patients admitted to the nephrology ward of a South Indian tertiary care hospital. The pattern and rates of drug-drug interactions seen in the prescriptions of these patients was studied. Among the 205 prescriptions included, a total of 474 interactions were reported, making 2.7 interactions per prescription with incidence rates of 76.09%. Around 19.62% of interactions were of major severity. Most common interactions were found between ascorbic acid and cyanocobalamine (12.45%), clonidine and metoprolol (3.80%) respectively. Hypo or hypertension (31.65%), decreased drug efficacy (29.11%) and hypo or hyperglycemia (14.14%), were the most commonly reported clinical outcomes of the drug interactions. Cardiovascular drugs (calcium channel blockers and beta blockers; 52%) constitute the major class of drugs involved in interactions. As most of the interactions had a delayed onset, long term follow-up is essential to predict the clinically significant outcomes of these interactions. Hence, drug interactions are commonly seen in the prescriptions of chronic kidney disease patients which can lead to serious adverse events if not detected early. Need for collaboration with a clinical pharmacist and electronic surveillance, which are absent in developing countries like India, is emphatic.
Harris, Ruth; Sims, Sarah; Levenson, Ros; Gourlay, Stephen; Ross CBE, Fiona; Davies, Nigel; Brearley, Sally; Favato, Giampiero; Grant, Robert
Introduction Intentional rounding (IR) is a structured process whereby nurses in hospitals carry out regular checks, usually hourly, with individual patients using a standardised protocol to address issues of positioning, pain, personal needs and placement of items. The widespread implementation of IR across the UK has been driven by the recommendations of the Francis Inquiry although empirical evidence of its effectiveness is poor. This paper presents a protocol of a multimethod study using a realist evaluation approach to investigate the impact and effectiveness of IR in hospital wards on the organisation, delivery and experience of care from the perspective of patients, their family members and staff. Methods and analysis The study will be conducted in four phases. Phase 1: theory development using realist synthesis to generate hypotheses about what the mechanisms of IR may be, what particular groups may benefit most or least and what contextual factors might be important to its success or failure which will be tested in subsequent phases of the study. Phase 2: a national survey of all NHS acute trusts to explore how IR is implemented and supported across England. Phase 3: case studies to explore how IR is implemented ‘on the ground’, including individual interviews with patients, family members and staff, non-participant observation, retrieval of routinely collected patient outcomes and cost analysis. Phase 4: accumulative data analysis across the phases to scrutinise data for patterns of congruence and discordance and develop an overall evaluation of what aspects of IR work, for whom and in what circumstances. Ethics and dissemination The study has been approved by NHS South East Coast—Surrey Research Ethics Committee. Findings will be published in a wide range of outputs targeted at key audiences, including patient and carer organisations, nursing staff and healthcare managers. PMID:28069627
Harris, Ruth; Sims, Sarah; Levenson, Ros; Gourlay, Stephen; Ross Cbe, Fiona; Davies, Nigel; Brearley, Sally; Favato, Giampiero; Grant, Robert
Intentional rounding (IR) is a structured process whereby nurses in hospitals carry out regular checks, usually hourly, with individual patients using a standardised protocol to address issues of positioning, pain, personal needs and placement of items. The widespread implementation of IR across the UK has been driven by the recommendations of the Francis Inquiry although empirical evidence of its effectiveness is poor. This paper presents a protocol of a multimethod study using a realist evaluation approach to investigate the impact and effectiveness of IR in hospital wards on the organisation, delivery and experience of care from the perspective of patients, their family members and staff. The study will be conducted in four phases. Phase 1: theory development using realist synthesis to generate hypotheses about what the mechanisms of IR may be, what particular groups may benefit most or least and what contextual factors might be important to its success or failure which will be tested in subsequent phases of the study. Phase 2: a national survey of all NHS acute trusts to explore how IR is implemented and supported across England. Phase 3: case studies to explore how IR is implemented 'on the ground', including individual interviews with patients, family members and staff, non-participant observation, retrieval of routinely collected patient outcomes and cost analysis. Phase 4: accumulative data analysis across the phases to scrutinise data for patterns of congruence and discordance and develop an overall evaluation of what aspects of IR work, for whom and in what circumstances. The study has been approved by NHS South East Coast-Surrey Research Ethics Committee. Findings will be published in a wide range of outputs targeted at key audiences, including patient and carer organisations, nursing staff and healthcare managers. 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/.
Worby, Colin J.; Jeyaratnam, Dakshika; Robotham, Julie V.; Kypraios, Theodore; O'Neill, Philip D.; De Angelis, Daniela; French, Gary; Cooper, Ben S.
Infection control for hospital pathogens such as methicillin-resistant Staphylococcus aureus (MRSA) often takes the form of a package of interventions, including the use of patient isolation and decolonization treatment. Such interventions, though widely used, have generated controversy because of their significant resource implications and the lack of robust evidence with regard to their effectiveness at reducing transmission. The aim of this study was to estimate the effectiveness of isolation and decolonization measures in reducing MRSA transmission in hospital general wards. Prospectively collected MRSA surveillance data from 10 general wards at Guy's and St. Thomas' hospitals, London, United Kingdom, in 2006–2007 were used, comprising 14,035 patient episodes. Data were analyzed with a Markov chain Monte Carlo algorithm to model transmission dynamics. The combined effect of isolation and decolonization was estimated to reduce transmission by 64% (95% confidence interval: 37, 79). Undetected MRSA-positive patients were estimated to be the source of 75% (95% confidence interval: 67, 86) of total transmission events. Isolation measures combined with decolonization treatment were strongly associated with a reduction in MRSA transmission in hospital general wards. These findings provide support for active methods of MRSA control, but further research is needed to determine the relative importance of isolation and decolonization in preventing transmission. PMID:23592544
Worby, Colin J; Jeyaratnam, Dakshika; Robotham, Julie V; Kypraios, Theodore; O'Neill, Philip D; De Angelis, Daniela; French, Gary; Cooper, Ben S
Infection control for hospital pathogens such as methicillin-resistant Staphylococcus aureus (MRSA) often takes the form of a package of interventions, including the use of patient isolation and decolonization treatment. Such interventions, though widely used, have generated controversy because of their significant resource implications and the lack of robust evidence with regard to their effectiveness at reducing transmission. The aim of this study was to estimate the effectiveness of isolation and decolonization measures in reducing MRSA transmission in hospital general wards. Prospectively collected MRSA surveillance data from 10 general wards at Guy's and St. Thomas' hospitals, London, United Kingdom, in 2006-2007 were used, comprising 14,035 patient episodes. Data were analyzed with a Markov chain Monte Carlo algorithm to model transmission dynamics. The combined effect of isolation and decolonization was estimated to reduce transmission by 64% (95% confidence interval: 37, 79). Undetected MRSA-positive patients were estimated to be the source of 75% (95% confidence interval: 67, 86) of total transmission events. Isolation measures combined with decolonization treatment were strongly associated with a reduction in MRSA transmission in hospital general wards. These findings provide support for active methods of MRSA control, but further research is needed to determine the relative importance of isolation and decolonization in preventing transmission.
Malfait, S; Eeckloo, K; Van Daele, J; Van Hecke, A
Patient participation is an important subject for modern healthcare. In order to improve patient participation on a ward, the ward's culture regarding patient participation should first be measured. In this study a measurement tool for patient participation culture from the healthcare worker's perspective, the Patient Participation Culture Tool for healthcare workers (PaCT-HCW), was developed and psychometrically evaluated. The aim of this study was to develop and validate a tool that measures the healthcare worker-related factors of patient participation and information sharing and dialogue in patient participation from the healthcare worker's perspective in order to represent the patient participation culture on general and university hospital wards. A four-phased validation study was conducted: (1) defining the construct of the PaCT-HCW, (2) development of the PaCT-HCW, (3) content validation, and (4) psychometric evaluation. The Belgian Federal Government invited all Flemish general and university hospitals by e-mail to distribute the PaCT-HCW in their organization. Fifteen general hospitals took part in the study. Units for surgery, general medicine, medical rehabilitation, geriatric and maternal care were included. Intensive care-units, emergency room-units, psychiatric units and units with no admitted patients (e.g. radiology) were excluded. The respondents had to be caregivers, with hands-on patient contact, who worked on the same ward for more than six months. Nursing students and other healthcare workers with short-time internship on the ward were excluded. The tool was completed by 1329 respondents on 163 wards. The PaCT-HCW was psychometrically evaluated by use of an exploratory factor analysis and calculation of the internal consistency. A model containing eight components was developed through a literature review, individual interviews, and focus interviews. The developed model showed high sampling adequacy and the Bartlett's test of sphericity was
Smedberg, J; Bråthen, M; Waka, M S; Jacobsen, A F; Gjerdalen, G; Nordeng, H
There is a lack of knowledge about drug-related problems (DRPs) among pregnant and lactating women. The aim of this study was to determine the extent and type of DRPs among pregnant and lactating women in the maternity ward at two Norwegian hospitals. We also aimed to investigate which drugs were involved in the identified DRPs, and the outcome of solving the DRPs. Patient-reported treatment reviews were performed to assess the prevalence and type of DRPs among women at the two maternity wards. In all, 212 women were included in the study, of which 89 (42 %) had experienced at least one DRP (105 DRPs in total). "Need for additional drug" (49 cases, 46.7 %) was the most frequent. The most frequent drug group involved in DRPs was drugs acting on the respiratory system, and the most common intervention was raising awareness/providing confidence/giving information during the patient-reported treatment review. Over four out of ten women in the maternity wards have DRPs, and many have questions about drug use during pregnancy and lactation. Many of the DRPs could probably be avoided by providing patient-reported treatment reviews to pregnant women as a part of antenatal care. Multidisciplinary collaboration including physicians, midwifes, and pharmacists in antenatal care and in maternity ward could possibly prevent DRPs and thereby promote patient safety for pregnant and lactating women.
Chest pain is an important presentation in adult patients attending emergency departments (ED). The process of ruling out an acute coronary syndrome (ACS) conventionally requires a short in-patient stay. This places a significant burden on healthcare systems. Recent developments have encouraged us to explore the role of an ED observation ward in the management of these patients. We designed and implemented two proformas ('flowformas'). The first provides integrated guidance and documentation for the management of chest pain in the ED. In patients determined to be at low risk of short-term adverse outcomes the ACS rule-out process is now completed on the ED observation ward rather than on the cardio-respiratory admission ward. The second proforma is used before discharge to determine the likelihood of underlying coronary artery disease (CAD), thereby allowing risk-based follow-up arrangements to be made. We collected data on all patients admitted to EDU on the NSTEMI rule-out pathway over a 12-month period. Between Feb 2012 and Feb 2013, 816 patients fulfilling the criteria were admitted on the pathway. 67 patients (8%) required admission due to ACS. 15 patients were admitted on two, and one on three occasions. In conclusion, it is possible to deliver ACS rule-out on an emergency observation ward. This reduces healthcare costs and shortens hospital stay.
Chest pain is an important presentation in adult patients attending emergency departments (ED). The process of ruling out an acute coronary syndrome (ACS) conventionally requires a short in-patient stay. This places a significant burden on healthcare systems. Recent developments have encouraged us to explore the role of an ED observation ward in the management of these patients. We designed and implemented two proformas (‘flowformas’). The first provides integrated guidance and documentation for the management of chest pain in the ED. In patients determined to be at low risk of short-term adverse outcomes the ACS rule-out process is now completed on the ED observation ward rather than on the cardio-respiratory admission ward. The second proforma is used before discharge to determine the likelihood of underlying coronary artery disease (CAD), thereby allowing risk-based follow-up arrangements to be made. We collected data on all patients admitted to EDU on the NSTEMI rule-out pathway over a 12-month period. Between Feb 2012 and Feb 2013, 816 patients fulfilling the criteria were admitted on the pathway. 67 patients (8%) required admission due to ACS. 15 patients were admitted on two, and one on three occasions. In conclusion, it is possible to deliver ACS rule-out on an emergency observation ward. This reduces healthcare costs and shortens hospital stay. PMID:26734201
Ughasoro, M D; Ikefuna, A N; Emodi, I J; Ibeziako, S N; Nwose, S O
To determine the indications, practices and outcomes of transfusion on children. A descriptive retrospective study. Paediatric wards of University of Nigeria Teaching Hospital, Enugu, Nigeria. Children one month to 18 years that received blood transfusion. Indications for the transfusion, haemoglobin rise, vital signs, duration of transfusion and adverse events. The two hundred and thirty eight transfusions reviewed were given amongst 95 patients, at a ratio of 2.5 transfusions per patient. The indicators of the transfusion were: malignancy (31.7%), sepsis (15.1%), sickle cell anaemia (12.1%), malaria (10.0%), hyperbilirubinaemia (10.0%), HIV/AIDS (8.3%), nephrotic syndrome (7.2%) and malnutrition (5.4%). Whole blood (56.4%) and sedimented cells (36.3%) were the main types of blood transfused. About 96.4% were transfused appropriate volume of blood. The mean Haemoglobin concentration (Hb) increase was 3.1g/dl and 12.8% of the recipients recorded an Hb increase of 5g/dl. The mean duration of transfusion was 4.6 hours and 59.7% of the transfusions exceeded the recommended four hours. Pulse and respiratory rates returned to normal post transfusion in 26.1 and 21.8% of the recipients respectively. In 10% of the transfusions there were minor adverse events; chills/fever (5.1%), itching (3.4%), hypothermia (1.0%) and vomiting (0.5%). Blood transfusion in this tertiary institution is not common and mainly due to non-communicable diseases. The expected optimal rise in Hb and normalising of vitals sign are not always the case. The duration of most transfusions was unduly prolonged and transfusion-related adverse events are rare.
Oh, Ai Ling; Goh, Leh Min; Nik Azim, Nik Abdullah; Tee, Chee Sian; Shehab Phung, Chee Wei
The widespread and inappropriate use of broad-spectrum antibiotics in surgical prophylaxis has led to reduced treatment efficacy, increased healthcare costs, and antibiotic resistance. This study aimed to explore the adherence of antibiotic usage in surgical prophylaxis to the national antibiotic guideline and the incidences of surgical site infection (SSI). A three-month prospective observational study has been conducted in the surgical wards of Sarawak General Hospital (SGH) using a standardized surveillance form. Each patient was reviewed for up to 30 days post-operatively to determine the occurrence of SSI. A total of 87 patients were included within the study period. The majority of the cases were clean-contaminated wounds (60.9%). Most were hepatobiliary cases (37.9%), followed by colorectal cases (19.5%). The most preferred antibiotic used was cefoperazone (63.2%). The choices of antibiotics in 78.2% of the cases were consistent with the guideline. Around 80% of prophylactic antibiotics were given within one hour before operation and 27.6% were omitted from intraoperative re-dosing. Prophylactic antibiotics were discontinued within 24 hours post-operatively in 77% of the cases. Of those continued for > 24 hours, the majority (60%) were administered for unknown reasons. SSI was documented in 13.8% of the total cases studied. However, there was no significant association between choices of antibiotics and timing of surgical prophylaxis with SSI (p = 0.299 and p = 0.258 respectively). Overall guideline adherence rate was more than 70%. Areas of non-concordance to the guideline require further investigation.
Kahbazi, M; Dorreh, F; Najmi, A R; Arjomandzadegan, M
Dysentery is one of the children's common disease for which various infectious and non-infectious reasons have been explained for it. Since determination of the cause especially with age segregation helps the experimental treatment, this study has been executed to establish relative Of frequency of dysentery causes and its comparison below and above the age of six months. This descriptive, sectional study has been executed on 50 below-six-month-old patients and 50 above-six-month-old patients both diagnosed with dysentery, held in the infection ward of Amir Kabir Hospital in 2010-2011. Faeces samples were taken for culture of Shigella, Yersinia, Salmonella, and E. coli, and serum samples were also taken for antibody against the Campylobacter, Yersinia, and allergy to cow milk protein; then results were analysed with SPSS. In 60% of patients the cause could not be determined. In 12% of patients, faeces culture was positive, yet the positive faeces culture in two groups had no significant difference (p=0.053) 7% of antibody against Yersinia, and 14% against the Campylobacter was positive which was more significantly differed in above-six-month group than below-six-month group. Ten percent were allergic to the cow milk protein which was more significantly differed in above-six-month group than below-six-month group. In more than half of the cases the cause to dysentery could not be identified, but the infectious reasons for above-six-month were double the below-six-month group. Campylobacter, and cow milk allergy was more common in the six-month group, and the frequency of Shigella and other infections in both groups did not have a significant difference.
Stypułkowska-Misiurewicz, Hanna; Pancer, Katarzyna; Krogulska, Bozena; Matuszewska, Renata
The aim of the paper is to describe the criteria used for identification of first and so far the only one outbreak of hospital bacterial infections due to L. pneumophila. The infected persons were patients hospitalized at ophthalmic ward for more than 10 days. Four patients were found ill among 27 hospitalized (15%) at ophthalmic ward and 3 of them died (75%) in spite treatment in intensive care unit. The source of infection was found in the hospital hot water system. It was shown that L. pneumophila sg 1 and sg 2-14 were settled in the tanks and pipelines of hot water installations. The high number of L. pneumophila sg I and sg 2-14 colony forming units (> 10 000 cfu /100 ml) were found in the water specimens taken from the hospital water system, showing the high risk of Legionella infection for patients. Cleaning and disinfection of hot water system was repeated three times using composition every time modified as stronger mechanical, thermal and chemical methods. Complete elimination of Legionella from hot water system was achieved after cutting off deadlegs of water and replacement of both old hot water reservoirs with new ones. Collected experience served for preparation of guidelines for control and prevention of Legionella infections in hospital buildings, published on National Institute of Hygiene web site A month later Polish Ministry of Health published the Directives concerning the quality of drinking water to which the control of Legionella infection has been included.
Abdul Rahman, Hamzah; Jarrar, Mu'taman; Don, Mohammad Sobri
Nursing knowledge and skills are required to sustain quality of care and patient safety. The numbers of nurses with Bachelor degrees in Malaysia are very limited. This study aims to predict the impact of nurse level of education on quality of care and patient safety in the medical and surgical wards in Malaysian private hospitals. A cross-sectional survey by questionnaire was conducted. A total 652 nurses working in the medical and surgical wards in 12 private hospitals were participated in the study. Multistage stratified simple random sampling performed to invite nurses working in small size (less than 100 beds), medium size (100-199 beds) and large size (over than 200) hospitals to participate in the study. This allowed nurses from all shifts to participate in this study. Nurses with higher education were not significantly associated with both quality of care and patient safety. However, a total 355 (60.9%) of respondents participated in this study were working in teaching hospitals. Teaching hospitals offer training for all newly appointed staff. They also provide general orientation programs and training to outline the policies, procedures of the nurses' roles and responsibilities. This made the variances between the Bachelor and Diploma nurses not significantly associated with the outcomes of care. Nursing educational level was not associated with the outcomes of care in Malaysian private hospitals. However, training programs and the general nursing orientation programs for nurses in Malaysia can help to upgrade the Diploma-level nurses. Training programs can increase their self confidence, knowledge, critical thinking ability and improve their interpersonal skills. So, it can be concluded that better education and training for a medical and surgical wards' nurses is required for satisfying client expectations and sustaining the outcomes of patient care.
Gong, Yali; Shen, Xiaodong; Huang, Guangtao; Zhang, Cheng; Luo, Xiaoqiang; Yin, Supeng; Wang, Jing; Hu, Fuquan; Peng, Yizhi; Li, Ming
Acinetobacter baumannii is an important opportunistic pathogen that causes severe nosocomial infections, especially in intensive care units (ICUs). Over the past decades, an everincreasing number of hospital outbreaks caused by A. baumannii have been reported worldwide. However, little attention has been directed toward the relationship between A. baumannii isolates from the ward environment and patients in the burn ICU. In this study, 88 A. baumannii isolates (26 from the ward environment and 62 from patients) were collected from the burn ICU of the Southwest Hospital in Chongqing, China, from July through December 2013. Antimicrobial susceptibility testing results showed that drug resistance was more severe in isolates from patients than from the ward environment, with all of the patient isolates being fully resistant to 10 out of 19 antimicrobials tested. Isolations from both the ward environment and patients possessed the β-lactamase genes bla OXA-51, bla OXA-23, bla AmpC, bla VIM, and bla PER. Using pulsed-field gel electrophoresis (PFGE) and multi-locus sequence typing (MLST), these isolates could be clustered into 4 major PFGE types and 4 main sequence types (ST368, ST369, ST195, and ST191) among which, ST368 was the dominant genotype. Epidemiologic and molecular typing data also revealed that a small-scale outbreak of A. baumannii infection was underway in the burn ICU of our hospital during the sampling period. These results suggest that dissemination of β-lactamase genes in the burn ICU might be closely associated with the high-level resistance of A. baumannii, and the ICU environment places these patients at a high risk for nosocomial infection. Cross-contamination should be an important concern in clinical activities to reduce hospitalacquired infections caused by A. baumannii.
Noeker, M; Juckel, G
Model projects according to § 64b of the Social Code V in the context of the new remuneration system in psychiatry and psychosomatics, offer great possibilities to improve the treatment of people with mental illnesses. This article presents the model project of the University Hospital Bochum, which is essentially characterized by improved transition through the internal hospital sections so that patients can be quickly transferred from inpatient and daycare sections to high frequency outpatient sections with ward-independent therapies (SUL), including outreach home treatment. The SUL is also intended to facilitate preadmission crises, to significantly reduce duration of inpatient treatment and to maximize post-inpatient continuity of treatment.
Wood, Sally D; Coster, Samantha; Norman, Ian
To investigate possible factors related to patient monitoring to explain the higher mortality rates associated with after-hours transfers compared with daytime transfers from critical care units to the wards. International research suggests that patients transferred from critical care units after-hours have a higher mortality rate than transfers during daytime, although the reasons remain unknown. A prospective exploratory study. Twenty-nine patients transferred from a UK critical care unit to a ward within the same hospital after-hours for 10 weeks beginning April 2009 were compared with 29 transfers during daytime hours matched on potentially confounding characteristics. UK Critical Care Unit transfer guidelines have remained unchanged since data collection. Outcomes were as follows: (i) frequency of nursing observations; (ii) time periods from transfer to first medical review; (iii) time period from transfer to first clinical observations; (iv) frequency of transfer to an inappropriate ward; (v) delayed transfers from Critical Care Unit to ward. Using Wilcoxon's Rank test (two tail) to compare paired data from the matched groups, observations were recorded significantly less frequently within the first 12 hours for after-hours transfers. Time from transfer to first clinical observations was significantly longer for after-hour transfer patients. The delay from when the patient was ready for ward care and actual transfer was also longer for the after-hours transfer group. Surveillance differences, including time to the first set of observations and frequency of observations in the first 12 hours, are potential factors that may explain the differential mortality associated with after-hours transfers. © 2014 John Wiley & Sons Ltd.
Ramsay, Angus I G; Turner, Simon; Cavell, Gillian; Oborne, C Alice; Thomas, Rebecca E; Cookson, Graham; Fulop, Naomi J
Background Relatively little is known about how scorecards presenting performance indicators influence medication safety. We evaluated the effects of implementing a ward-level medication safety scorecard piloted in two English NHS hospitals and factors influencing these. Methods We used a mixed methods, controlled before and after design. At baseline, wards were audited on medication safety indicators; during the ‘feedback’ phase scorecard results were presented to intervention wards on a weekly basis over 7 weeks. We interviewed 49 staff, including clinicians and managers, about scorecard implementation. Results At baseline, 18.7% of patients (total n=630) had incomplete allergy documentation; 53.4% of patients (n=574) experienced a drug omission in the preceding 24 h; 22.5% of omitted doses were classified as ‘critical’; 22.1% of patients (n=482) either had ID wristbands not reflecting their allergy status or no ID wristband; and 45.3% of patients (n=237) had drugs that were either unlabelled or labelled for another patient in their drug lockers. The quantitative analysis found no significant improvement in intervention wards following scorecard feedback. Interviews suggested staff were interested in scorecard feedback and described process and culture changes. Factors influencing scorecard implementation included ‘normalisation’ of errors, study duration, ward leadership, capacity to engage and learning preferences. Discussion Presenting evidence-based performance indicators may potentially influence staff behaviour. Several practical and cultural factors may limit feedback effectiveness and should be considered when developing improvement interventions. Quality scorecards should be designed with care, attending to evidence of indicators’ effectiveness and how indicators and overall scorecard composition fit the intended audience. PMID:24029440
Ahmad, Aftab; Weston, Philip J; Ahmad, Mahin; Sharma, Dushyant; Purewal, Tejpal
Misuse of investigations, medications and hospital beds is costing the National Health Service (NHS) billions of pounds with little evidence that approaches centred on reducing overuse are sustainable. Our previous study demonstrated that twice-daily consultant ward rounds reduce inpatient length of stay and suggested a reduction in overuse of investigations and medications. This study aims to assess the impact of daily consultant ward rounds on the use of investigations and medications and estimate the potential cost benefit. The study was performed on two medical wards in a major city university teaching hospital in Liverpool, UK, receiving acute admissions from medical assessment and emergency departments. The total number of patients admitted, investigations performed and pharmacy costs incurred were collected for 2 years before and following a change in the working practice of consultants from twice-weekly to twice-daily consultant ward rounds on the two medical wards. We performed a cost-benefit analysis to assess the net amount of money saved by reducing inappropriate investigations and pharmacy drug use following the intervention. Despite a 70% increase in patient throughput (p<0.01) the investigations and pharmacy, costs per patient reduced by 50% over a 12-month period (p<0.01) and were sustained for the next 12 months. The reduction in investigations and medication use did not have any effect on the readmission or mortality rate (p=NS), whereas, the length of stay was almost halved (p<0.01). Daily senior clinician input resulted in a net cost saving of £336,528 per year following the intervention. Daily consultant input has a significant impact on reducing the inappropriate use of investigations and pharmacy costs saving the NHS more than £650K on the two wards over a 2-year period. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Kuntaman, K; Hadi, Usman; Setiawan, Firman; Koendori, Eko Budi; Rusli, Musofa; Santosaningsih, Dewi; Severin, Juliette; Verbrugh, Henri A
Epidemiological data of methicillin resistant Staphylococcus aureus (MRSA) carriage in Indonesian hospitals are still scarce. These data are required for health management of infectious diseases in order to control hospital MRSA. The carriage rate of MRSA in nose and throat of patients on admission to Dr Soetomo Hospital Surabaya, Indonesia was 8.1% of 643 patients, 5.4% from throat, 3.9% from nose and 1.2% from both sites. Prevalence of MRSA among patients admitted to surgical and non-surgical ward was not different (8.2% and 8.0%, respectively). Although MRSA prevalence in Indonesian hospitals is low compared to many other countries worldwide, appropriate health strategies will be needed to be implemented if this infection is to be controlled.
Andersen, Pia; Lindgaard, Anne-Mette; Prgomet, Mirela; Creswick, Nerida; Westbrook, Johanna I
Selecting the right mix of stationary and mobile computing devices is a significant challenge for system planners and implementers. There is very limited research evidence upon which to base such decisions. We aimed to investigate the relationships between clinician role, clinical task, and selection of a computer hardware device in hospital wards. Twenty-seven nurses and eight doctors were observed for a total of 80 hours as they used a range of computing devices to access a computerized provider order entry system on two wards at a major Sydney teaching hospital. Observers used a checklist to record the clinical tasks completed, devices used, and location of the activities. Field notes were also documented during observations. Semi-structured interviews were conducted after observation sessions. Assessment of the physical attributes of three devices-stationary PCs, computers on wheels (COWs) and tablet PCs-was made. Two types of COWs were available on the wards: generic COWs (laptops mounted on trolleys) and ergonomic COWs (an integrated computer and cart device). Heuristic evaluation of the user interfaces was also carried out. The majority (93.1%) of observed nursing tasks were conducted using generic COWs. Most nursing tasks were performed in patients' rooms (57%) or in the corridors (36%), with a small percentage at a patient's bedside (5%). Most nursing tasks related to the preparation and administration of drugs. Doctors on ward rounds conducted 57.3% of observed clinical tasks on generic COWs and 35.9% on tablet PCs. On rounds, 56% of doctors' tasks were performed in the corridors, 29% in patients' rooms, and 3% at the bedside. Doctors not on a ward round conducted 93.6% of tasks using stationary PCs, most often within the doctors' office. Nurses and doctors were observed performing workarounds, such as transcribing medication orders from the computer to paper. The choice of device was related to clinical role, nature of the clinical task, degree of
Andersen, Pia; Lindgaard, Anne-Mette; Prgomet, Mirela; Creswick, Nerida
Background Selecting the right mix of stationary and mobile computing devices is a significant challenge for system planners and implementers. There is very limited research evidence upon which to base such decisions. Objective We aimed to investigate the relationships between clinician role, clinical task, and selection of a computer hardware device in hospital wards. Methods Twenty-seven nurses and eight doctors were observed for a total of 80 hours as they used a range of computing devices to access a computerized provider order entry system on two wards at a major Sydney teaching hospital. Observers used a checklist to record the clinical tasks completed, devices used, and location of the activities. Field notes were also documented during observations. Semi-structured interviews were conducted after observation sessions. Assessment of the physical attributes of three devices—stationary PCs, computers on wheels (COWs) and tablet PCs—was made. Two types of COWs were available on the wards: generic COWs (laptops mounted on trolleys) and ergonomic COWs (an integrated computer and cart device). Heuristic evaluation of the user interfaces was also carried out. Results The majority (93.1%) of observed nursing tasks were conducted using generic COWs. Most nursing tasks were performed in patients’ rooms (57%) or in the corridors (36%), with a small percentage at a patient’s bedside (5%). Most nursing tasks related to the preparation and administration of drugs. Doctors on ward rounds conducted 57.3% of observed clinical tasks on generic COWs and 35.9% on tablet PCs. On rounds, 56% of doctors’ tasks were performed in the corridors, 29% in patients’ rooms, and 3% at the bedside. Doctors not on a ward round conducted 93.6% of tasks using stationary PCs, most often within the doctors’ office. Nurses and doctors were observed performing workarounds, such as transcribing medication orders from the computer to paper. Conclusions The choice of device was related
Parsons Leigh, Jeanna; Brown, Kyla; Buchner, Denise; Stelfox, Henry T
Introduction Effective communication during hospital transitions of patient care is fundamental to ensuring patient safety and continuity of quality care. This study will describe text-based communication included in patient medical records before, during and after patient transfer from the intensive care unit (ICU) to a hospital ward (n=10 days) by documenting (1) the structure and focus of physician progress notes within and between medical specialties, (2) the organisation of subjective and objective information, including the location and accessibility of patient data and whether/how this changes during the hospital stay and (3) missing, illegible and erroneous information. Methods This study is part of a larger mixed methods prospective observational study of ICU to hospital ward transfer practices in 10 ICUs across Canada. Medical records will be collected and photocopied for each consenting patient for a period of up to 10 consecutive days, including the final 2 days in the ICU, the day of transfer and the first 7 days on the ward (n=10 days). Textual analysis of medical record data will be completed by 2 independent reviewers to describe communication between stakeholders involved in ICU transfer. Ethics and dissemination Research ethics board approval has been obtained at all study sites, including the coordinating study centre (which covers 4 Calgary-based sites; UofC REB 13-0021) and 6 additional study sites (UofA Pro00050646; UBC PHC Hi4-01667; Sunnybrook 336-2014; QCH 20140345-01H; Sherbrooke 14-172; Laval 2015-2171). Findings from this study will inform the development of an evidence-based tool that will be used to systematically analyse the series of notes in a patient's medical record. PMID:27401367
The Authentic Leadership Questionnaire (ALQ) is a standardized research instrument for the evaluation of individual elements of leader's conduct which contribute to the authentic leadership. The application of this questionnaire in Polish conditions required to carry out the validation process. The aim of the study was to evaluate of validity and reliability of the Polish version of the American research instrument for the needs of evaluation of authenticity of leadership of the nursing management in Polish hospitals. The study covered 286 nurses (143 head nurses and 143 of their subordinates) employed in 45 hospitals in Poland. Theoretical validity of the instrument was evaluated using Fisher's transformation (r-Person correlation coefficient), while the criterion validity of the ALQ was evaluated using rho-Spearman correlation coefficient and the BOHIPSZO questionnaire. The reliability of the ALQ was assessed by means of the Cronbach-alpha coefficient. The ALQ questionnaire applied for the evaluation of authenticity of leadership of the nursing management in Polish hospital wards shows an acceptable theoretical and criterion validity and reliability (Cronbach-alpha coefficient 0.80). The Polish version of the ALQ is valid and reliable, and may be applied in studies concerning the evaluation of authenticity of leadership of the nursing management in Polish hospital wards.
The progress of the Productive Ward programme has been variable. This article outlines a study that investigated the experience of implementing the programme in different hospitals and the lessons that can be learnt.
Ho, Hanley J; Toh, Cheng Yen; Ang, Brenda; Krishnan, Prabha; Lin, Raymond T P; La, My-Van; Chow, Angela
Autochthonous infections with New Delhi metallo-β-lactamase-1 (NDM-1)-producing Enterobacteriaceae have been reported in Singapore since 2011, but occurrences of nosocomial transmission have not. We report an outbreak of NDM-1-producing Enterobacter cloacae among adults admitted to an acute hospital's general ward. On detecting the index case with a culture specimen positive for NDM-1-producing E cloacae, active case finding was conducted by screening all possible patient contacts. On-site ward assessment was performed, and electronic patient medical records were reviewed to conduct a case-control study to identify factors associated with colonization. Of 55 screened patient contacts, 3 further cases were detected, with isolates genetically related to the index case. None of these 4 cases was housed within the same cubicle. However, 3 were managed by the same medical team. Being managed by this team was positively associated with being a case (adjusted odds ratio = 15.64; 95% confidence interval, 0.91-270.27; P = .06) after adjusting for age, sex, Charlson comorbidity index score, and recent antibiotic use. Our report suggests nosocomial transmission of NDM-1-producing E cloacae occurred via health care staff. Improvements in infection control measures, especially pertaining to staff hand hygiene practices and ward staffing, are needed to reduce the spread of highly resistant pathogens, such as NDM-1-producing Enterobacteriaceae. Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
Shukla, Shikha; Basu, Srikanta; Moritz, Michael L
To evaluate maintenance intravenous fluid-prescribing practices and the incidence of hospital-acquired hyponatremia in children admitted to a general pediatric ward. This is a prospective observational study conducted over a 2-month period in children ages 2 months to 5 years who were admitted to a general pediatric ward and who were receiving maintenance intravenous fluids. The composition, rate, and duration of intravenous fluids were chosen at the discretion of the treating physician. Serum biochemistries were obtained at baseline and 24 h following admission. Patients who were at high risk for developing hyponatremia or hypernatremia or had underlying chronic diseases or were receiving medications associated with a disorder in sodium and water homeostasis were excluded. Intravenous fluid composition and the incidence of hyponatremia (sodium <135 mEq/L) were assessed. Fifty-six children were enrolled. All received hypotonic fluids; 87.5% received 0.18% sodium chloride (NaCl) and 14.3% received 0.45% NaCl. Forty percent of patients (17/42) with a serum sodium (SNa) less than 140 mEq/L experienced a fall in SNa with 12.5% of all patients (7/56) developing hospital-acquired or aggravated hyponatremia (126-134 mEq/L) with fall in SNa between 2 and 10 mEq/L. Administration of hypotonic fluids was a prevalent practice in children admitted to a general pediatric ward and is associated with acute hospital-acquired hyponatremia.
Kwak, Yee Gyung; Moon, Chisook; Kim, Eu Suk; Kim, Baek-Nam
Antibiotics are often administered to terminally ill patients until death, and antibiotic use contributes to the emergence of multidrug-resistant organisms (MDROs). We investigated antibiotic use and the isolation of MDROs among patients who died in general medical wards. All adult patients who died in the general internal medicine wards at four acute care hospitals between January and June 2013 were enrolled. For comparison with these deceased patients, the same number of surviving, discharged patients was selected from the same divisions of internal medicine subspecialties during the same period. During the study period, 303 deceased patients were enrolled; among them, 265 (87.5%) had do-not-resuscitate (DNR) orders in their medical records. Antibiotic use was more common in patients who died than in those who survived (87.5% vs. 65.7%, P<0.001). Among deceased patients with DNR orders, antibiotic use was continued in 59.6% of patients after obtaining their DNR orders. Deceased patients received more antibiotic therapy courses (two [interquartile range (IQR) 1-3] vs. one [IQR 0-2], P<0.001). Antibiotics were used for longer durations in deceased patients than in surviving patients (13 [IQR 5-23] vs. seven days [IQR 0-18], P<0.001). MDROs were also more common in deceased patients than in surviving patients (25.7% vs. 10.6%, P<0.001). Patients who died in the general medical wards of acute care hospitals were exposed to more antibiotics than patients who survived. In particular, antibiotic prescription was common even after obtaining DNR orders in patients who died. The isolation of MDROs during the hospital stay was more common in these patients who died. Strategies for judicious antibiotic use and appropriate infection control should be applied to these patient populations.
... Protections for Children Involved as Subjects in Research § 46.409 Wards. (a) Children who are wards of the..., camps, hospitals, institutions, or similar settings in which the majority of children involved as... require appointment of an advocate for each child who is a ward, in addition to any other...
... Protections for Children Involved as Subjects in Research § 46.409 Wards. (a) Children who are wards of the..., camps, hospitals, institutions, or similar settings in which the majority of children involved as... require appointment of an advocate for each child who is a ward, in addition to any other...
Foroughinia, Farzaneh; Tazarehie, Seyyed Ramtin; Petramfar, Peyman
Objective: Nowadays, the role of clinical pharmacists has become more prominent by more clinical pharmacists joining the health-care teams. This study was aimed to assess the role of a clinical pharmacist specialist in detecting and managing drug-related problems (DRPs) in the neurology ward of a tertiary care teaching hospital in Iran. Methods: This is a prospective cross-sectional study conducted on 123 hospitalized patients admitted to the neurology ward of a teaching hospital. The clinical pharmacist visited the patients and filled out the designed pharmacotherapy sheet for each patient. Then, the general pharmacist checked the patients' files and pharmacotherapy sheets and categorized DRPs using modified method of “The Pharmaceutical Care Network Europe classification, Version 5.01.” Findings: A total of 168 errors were found and 346 interventions were done by the clinical pharmacist during the study period. The most common form of errors in our study was “drug choice problems” (57.76%). The acceptance rate of interventions was 41.91% among physicians. Conclusion: The large number of interventions reported in several studies, as well as this study, revealed that clinical pharmacy services could contribute to a rationalization of drug therapy and may eventually lead to more medication safety. PMID:27843966
Dehghani, Behzad; Mottamedifar, Mohammad; Khoshkharam-Roodmajani, Hossein; Hassanzadeh, Amir; Zomorrodian, Kamyar; Rahimi, Amir
Background: Outer membrane proteins (OMPs) constitute the main structure and about half of the cell wall of Gram-negative bacteria. The OMPs of Escherichia coli (E. coli) play an important role in its drug resistance. Previous studies have shown that the OMPs of E. coli enhance its pathogenic effects by helping the bacterium to evade the immune defense and promote its adsorption to host cells. We sought to compare E. coli isolates collected from different hospital wards and to perform a primary investigation of the association between the serotypes and profiles of their OMPs. We also aimed to detect the diversity of the E. coli isolates from the hospitalized patients. Methods: A total of 115 isolates of E. coli were collected from patients hospitalized in Nemazee Hospital, Shiraz, Iran. After biochemical and serological tests, OMPs were extracted by using glass beads and N-Lauroylsarcosine sodium. OMP typing was done by 10% SDS-PAGE and Coomassie brilliant blue staining. In terms of the number of protein bands, OMP-I was detected with 2 bands, OMP-α with 3 bands, and OMP-β with1 band. Results: Of the 115 isolates, 103 were OMP-I and 12 were OMP-α; none of the isolates belonged to OMP-β. Our statistical analyses showed a relationship between OMP patterns and other factors, including hospital wards and source of samples. Serotyping showed that the majority of the isolates were O128. Conclusion: Our results demonstrated some similarities between the OMP band patterns of the analyzed groups of E. coli. Of all the OMPs in the isolates from the hospitalized and outpatient department patients, OmpA and OmpC were the most prevalent proteins in the outer membrane of the studied uropathogenic E. coli. PMID:27582589
Rahman, Hamzah Abdul; Jarrar, Mu’taman; Don, Mohammad Sobri
Background and Objective: Nursing knowledge and skills are required to sustain quality of care and patient safety. The number of nurses with Bachelor degrees in Malaysia is very limited. This study aims to predict the impact of nurse level of education on quality of care and patient safety in the medical and surgical wards in Malaysian private hospitals. Methodology: A cross-sectional survey by questionnaire was conducted. A total of 652 nurses working in the medical and surgical wards in 12 private hospitals participated in the study. Multistage stratified simple random sampling performed to invite nurses working in small size (less than 100 beds), medium size (100-199 beds) and large size (over than 200) hospitals to participate in the study. This allowed nurses from all shifts to participate in this study. Results: Nurses with higher education were not significantly associated with both quality of care and patient safety. However, a total 355 (60.9%) of respondents who participated in this study were working in teaching hospitals. Teaching hospitals offer training for all newly appointed staff. They also provide general orientation programs and training to outline the policies, procedures of the nurses’ roles and responsibilities. This made the variances between the Bachelor and Diploma nurses not significantly associated with the outcomes of care. Conclusions: Nursing educational level was not associated with the outcomes of care in Malaysian private hospitals. However, training programs and the general nursing orientation programs for nurses in Malaysia can help to upgrade the Diploma-level nurses. Training programs can increase their self confidence, knowledge, critical thinking ability and improve their interpersonal skills. So, it can be concluded that better education and training for a medical and surgical wards’ nurses is required for satisfying client expectations and sustaining the outcomes of patient care. PMID:26153190
Różańska, Anna; Chmielarczyk, Agnieszka; Romaniszyn, Dorota; Bulanda, Małgorzata; Walkowicz, Monika; Osuch, Piotr; Knych, Tadeusz
Despite the employment of sanitary regimes, contact transmission of the aetiological agents of hospital infections is still exceedingly common. The issue of microbe transmission becomes particularly important when facing multidrug-resistant microorganisms such as methicillin-resistant staphylococci. In the case of deficiencies in cleaning and disinfection procedures, hospital equipment made of copper alloys can play an important role, complementing traditional hospital hygiene procedures. The objective of this study was to characterize staphylococcal strains isolated from touch surfaces in Polish hospital wards in terms of their drug resistance, ability to form biofilm and susceptibility to antimicrobial activity of copper alloys. The materials for the study were 95 staphylococcal strains isolated from touch surfaces in 13 different hospital wards from Małopolska province (the south of Poland). Phenotypic and genotypic antibiotic resistance were checked for erythromycin, clindamycin, gentamycin, ciprofloxacin, trimethoprim/sulfamethoxazole and mupirocin. Biofilm formation ability for the tested strains was checked with the use of culture on Congo red agar. Susceptibility to copper, tin bronze, brass and new silver was tested using a modification of the Japanese standard. Over 67% of the analysed staphylococcal strains were methicillin-resistant (MR). Four strains were resistant to all of the tested antibiotics, and 14 were resistant to all except mupirocin. Strains classified as MR had significantly increased resistance to the remaining antibiotic groups. About one-third of the analysed strains revealed biofilm-forming ability. Among the majority of species, biofilm-forming and non-biofilm-forming strains were distributed evenly; in the case of S. haemolyticus only, negative strains accounted for 92.8%. Susceptibility to copper alloys was different between strains and rather lower than in the case of the SA strain selected for comparison. Coagulase
Klopotowska, Joanna E; Kuiper, Rob; van Kan, Hendrikus J; de Pont, Anne-Cornelie; Dijkgraaf, Marcel G; Lie-A-Huen, Loraine; Vroom, Margreeth B; Smorenburg, Susanne M
Patients admitted to an intensive care unit (ICU) are at high risk for prescribing errors and related adverse drug events (ADEs). An effective intervention to decrease this risk, based on studies conducted mainly in North America, is on-ward participation of a clinical pharmacist in an ICU team. As the Dutch Healthcare System is organized differently and the on-ward role of hospital pharmacists in Dutch ICU teams is not well established, we conducted an intervention study to investigate whether participation of a hospital pharmacist can also be an effective approach in reducing prescribing errors and related patient harm (preventable ADEs) in this specific setting. A prospective study compared a baseline period with an intervention period. During the intervention period, an ICU hospital pharmacist reviewed medication orders for patients admitted to the ICU, noted issues related to prescribing, formulated recommendations and discussed those during patient review meetings with the attending ICU physicians. Prescribing issues were scored as prescribing errors when consensus was reached between the ICU hospital pharmacist and ICU physicians. During the 8.5-month study period, medication orders for 1,173 patients were reviewed. The ICU hospital pharmacist made a total of 659 recommendations. During the intervention period, the rate of consensus between the ICU hospital pharmacist and ICU physicians was 74%. The incidence of prescribing errors during the intervention period was significantly lower than during the baseline period: 62.5 per 1,000 monitored patient-days versus 190.5 per 1,000 monitored patient-days, respectively (P < 0.001). Preventable ADEs (patient harm, National Coordinating Council for Medication Error Reporting and Prevention severity categories E and F) were reduced from 4.0 per 1,000 monitored patient-days during the baseline period to 1.0 per 1,000 monitored patient-days during the intervention period (P = 0.25). Per monitored patient-day, the
Chapman, Alan; Law, Shirley
Nursing a person with dementia in a ward setting can be stressful and a challenge for staff and patients alike. Healthcare assistants are identified as requiring a specific training program. They form part of the front-line workforce and yet have the least access to training but often most contact with patients. The program in this study focused on person-centered care and used six self-study workbooks. Experienced registered nurses are trained to be facilitators of 12 group discussions in the ward setting. The training program viewed the facilitator as playing a key role in empowering the healthcare assistant but also in promoting reflective practice. The outcomes to date have been positive and showed a development in confidence and competence of the healthcare assistants involved.
Ridolfo, Anna L; Rimoldi, Sara G; Pagani, Cristina; Marino, Andrea F; Piol, Anna; Rimoldi, Matteo; Olivieri, Pietro; Galli, Massimo; Dolcetti, Lucia; Gismondo, Maria R
Carbapenem-resistant Klebsiella pneumoniae (CRKP) is emerging as a public health problem worldwide. In Italy, a remarkable increase in CRKP cases has been reported since 2010. In this study, CRKP diffusion, distribution and in-hospital transmission trends were evaluated in a university hospital in Milan, Italy, from January 2012 to December 2013. Isolates from 63 newly detected CRKP-positive patients were genotyped, and possible transmission was determined by combining the molecular results with data concerning the patients' admission and in-hospital transfers. Most of the cases (90.4%) were from general medical and surgery wards, and the remaining 9.6% were from the intensive care unit. Fifteen of the 46 hospital-associated cases (32.6%) were attributable to in-hospital transmission. After the introduction of targeted and hospital-wide control measures, the transmission index significantly decreased from 0.65 to 0.13 (p=0.01). There was also a decrease in the overall nosocomial case incidence, from 0.37 to 0.17 per 1000 person-days (p=0.07). Our findings indicate that the spread of CRKP in Northern Italy hospitals may go far beyond high-risk settings (i.e., intensive care units) and that strict surveillance should be extended to general areas of care.
Whelan, Kevin; Hill, Lydia; Preedy, Victor R; Judd, Patricia A; Taylor, Moira A
In contrast to the intensive care unit, little is known of the percentage of formula delivered to patients receiving enteral tube feeding (ETF) on general wards or of the complications that affect its delivery. This study prospectively investigated the incidence of nasogastric extubation and diarrhea in patients starting ETF on general wards and examined their effect on formula delivery. In a prospective observational study, the volume of formula delivered to patients receiving ETF on general wards was compared with the volume prescribed. The incidence of nasogastric extubation and diarrhea was measured and its effect on formula delivery calculated. Twenty-eight patients were monitored for a total of 319 patient days. The mean +/- SD volume of formula prescribed was 1460 +/- 213 mL/d, whereas the mean volume delivered was only 1280 +/- 418 mL/d (P < 0.001), representing a mean percentage delivery of 88 +/- 25% of prescribed formula. Nasogastric extubation occurred in 17 of 28 patients (60%), affecting 53 of the 319 patient days (17%). The percentage of formula delivered on days when the nasogastric tube remained in situ was 96 +/- 12% and on days when nasogastric extubation occurred it was only 45 +/- 31% (P < 0.001). Diarrhea affected 39 of 319 patient days (12%) but there was no difference in formula delivery on days when diarrhea did or did not occur (78% versus 89%, P = 0.295). There was a significant, albeit small, negative correlation between the daily stool score and formula delivery (correlation coefficient -0.216, P < 0.001). Formula delivery is marginally suboptimal in patients receiving ETF on general wards. Nasogastric extubation is common and results in an inherent cessation of ETF until the nasogastric tube is replaced and is therefore a major factor impeding formula delivery. Diarrhea is also common but does not result in significant reductions in formula delivery.
Gruther, Wolfgang; Pieber, Karin; Steiner, Irene; Hein, Cornelia; Hiesmayr, Jörg Michael; Paternostro-Sluga, Tatjana
The aim of this study was to evaluate if an early rehabilitation program for survivors of critical illness improves functional recovery, reduces length of stay, and reduces hospital costs. This was a prospective randomized controlled trial. Fifty-three consecutive survivors of critical illness were included in the study. After discharge from the intensive care unit, the intervention group received an early rehabilitation program, and the standard-care group received physical therapy as ordered by the primary care team. Length of stay at the general ward after transfer from the intensive care unit was recorded. In addition, Early Rehabilitation Barthel Index, visual analog scale for pain, 3-minute walk test, Beck Depression Inventory, State-Trait Anxiety Inventory, and Medical Research Council scale were used. In the per-protocol analysis, length of stay at the general ward was a median 14 days (interquartile range [IQR], 12-20 days) in the early rehabilitation and 21 days [IQR, 13-34 days) in the standard-care group. This significant result could not be confirmed by the intention-to-treat analysis (16 days [IQR, 13-23 days] vs. 21 days [IQR, 13-34 days]). Secondary outcomes were similar between the groups. Hospital costs were lower in the intervention group. No adverse effects were detected. An early rehabilitation program in survivors of critical illness led to an earlier discharge from the hospital, improved functional recovery, and was also cost-effective and safe. Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES: Upon completion of this article, the reader should be able to (1) delineate the benefits of early rehabilitation on a general medicine ward after an intensive care unit stay, (2) recognize the safety of appropriately implemented early rehabilitation, and (3) incorporate early rehabilitation on the general medical ward as applicable. Advanced ACCREDITATION: The Association of Academic
Buyle, F M; Decruyenaere, J; De Waele, J; Tulkens, P M; Van Audenrode, T; Depuydt, P; Claeys, G; Robays, H; Vogelaers, D
Extended and continuous infusions with beta-lactam antibiotics have been suggested as a means of pharmacokinetic and pharmacodynamic optimisation of antimicrobial therapy. Vancomycin is also frequently administered in continuous infusion, although more for practical reasons. A survey was undertaken to investigate the recommendations by the local antibiotic management teams (AMTs) in Belgian acute hospitals concerning the administration (intermittent, extended or continuous infusion) and therapeutic drug monitoring of four beta-lactam antibiotics (ceftazidime, cefepime, piperacillin-tazobactam, meropenem) and vancomycin for adult patients with a normal kidney function. A structured questionnaire survey comprising three domains was developed and approved by the members of the Belgian Antibiotic Policy Coordination Committee (BAPCOC). The questionnaire was sent by e-mail to the official AMT correspondents of 105 Belgian hospitals, followed by two reminders. The response rate was 32 %, with 94 %, 59 %, 100 %, 100 % and 100 % of the participating Belgian hospitals using ceftazidime, cefepime, piperacillin-tazobactam, meropenem and vancomycin, respectively. Comparing intensive care unit (ICU) with non-ICU wards showed a higher implementation of extended or continuous infusions for ceftazidime (81 % vs. 41 %), cefepime (35 % vs. 10 %), piperacillin-tazobactam (38 % vs. 12 %), meropenem (68 % vs. 35 %) and vancomycin (79 % vs. 44 %) on the ICU wards. A majority of the hospitals recommended a loading dose prior to the first dose. For vancomycin, the loading dose and the trough target concentration were too low based on the current literature. This survey shows that extended and continuous infusions with beta-lactams and vancomycin are widely implemented in Belgian hospitals.
Westbrook, Johanna I; Ampt, Amanda; Kearney, Leanne; Rob, Marilyn I
To quantify time doctors in hospital wards spend on specific work tasks, and with health professionals and patients. Observational time and motion study. 400-bed teaching hospital in Sydney. 19 doctors (seven registrars, five residents, seven interns) in four wards were observed between 08:30 and 19:00 for a total of 151 hours between July and December 2006. Proportions of time in categories of work; proportions of tasks performed with health professionals and patients; proportions of tasks using specific information tools; rates of multitasking and interruptions. The greatest proportions of doctors' time were in professional communication (33%; 95% CI, 29%-38%); social activities, such as non-work communication and meal breaks (17%; 95% CI, 13%-21%), and indirect care, such as planning care (17%; 95% CI, 15%-19%). Multitasking involved 20% of time, and on average, doctors were interrupted every 21 minutes. Most tasks were completed with another doctor (56%; 95% CI, 55%-57%), while 24% (95% CI, 23%-25%) were undertaken alone and 15% (95% CI, 15%-16%) with a patient. Interns spent more time completing documentation and administrative tasks, and less time in direct care than residents and registrars. The time interns spent documenting (22%) was almost double the time they were engaged in direct patient care. Two-thirds of doctors' time was consumed by three work categories: professional communication, social activities and indirect care. Doctors on wards are interrupted at considerably lower rates than those in emergency and intensive care units. The results confirm interns' previously reported dissatisfaction with their level of administrative work and documentation.
Bhardwaj, A; Sivapathasundaram, N; Yusof, Mf; Minghat, Ah; Swe, Kmm; Sinha, Nk
Background :Accidental needle-stick injuries (NSIs) are a hazard for health-care workers and general public health. Orthopaedic surgeons may be more prone to NSIs due to the prevalence of bone spikes in the operative field and the use of sharp orthopaedic instruments such as drills, saws and wires. A hospital-based cross sectional study was conducted in the orthopedic wards of Melaka General Hospital. The prevalence of NSIs was 32 (20.9%) and majority of it occurred during assisting in operation theatre 13(37.4%). Among them six (18.8%) were specialist, 12(37.5%) medical officer, 10 (31.2%) house officer and four staff nurses (12.5%). Among the respondents 142 (92.8%) had been immunized against Hepatitis B and 148 (96.7%) participants had knowledge regarding universal precaution. The incidence of NSI among health care workers at orthopaedics ward was not any higher in comparison with the similar studies and it was found out that the prevalence was more in junior doctors compared with specialist and staff nurses and it was statistically significant. Needle sticks injury, health care workers, and standard precaution.
Shek, K; Patidar, R; Kohja, Z; Liu, S; Gawaziuk, J P; Gawthrop, M; Kumar, A; Logsetty, S
Surfaces in the patient environment may play a role in microbial transmission if they become colonized by bacteria. Patient privacy curtains are one such surface that may pose a high risk for transmission because they are high-contact surfaces, are infrequently cleaned, and healthcare workers are less likely to wash their hands after contacting inanimate objects such as curtains. To determine the amount and type of bacterial colonization of patient privacy curtains at a regional burns/plastic surgery unit. Privacy curtain contamination on the burns/plastic surgery ward was determined for two separate occasions six months apart: 23 curtains on August 2015 and 26 curtains on January 2016. Dey-Engley neutralizing agar (DENA) replicate organism detection and counting (RODAC) contact plates were used daily to sample curtains near the edge hem where they are most frequently touched. Microbial contamination was reported as cfu/cm(2) and the presence of meticillin-resistant Staphylococcus aureus (MRSA) was determined. Swabs were also taken of any open wounds and from tracheostomy sites on the ward. Curtain contamination in August 2015 was 0.7-4.7 cfu/cm(2) with 22% testing positive for MRSA, whereas contamination on January 2016 was 0.6-13.3 cfu/cm(2) with 31% of curtains testing positive for MRSA. Curtains on the burns/plastic surgery ward become colonized with significant quantities of bacteria. Future studies will need to address the rate of colonization and the clinical impact of this colonization to better inform cleaning protocols. Copyright © 2017 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.
Sakhnini, Ali; Saliba, Walid; Schwartz, Naama; Bisharat, Naiel
Limited information is available about clinical predictors of in-hospital mortality in acute unselected medical admissions. Such information could assist medical decision-making.To develop a clinical model for predicting in-hospital mortality in unselected acute medical admissions and to test the impact of secondary conditions on hospital mortality.This is an analysis of the medical records of patients admitted to internal medicine wards at one university-affiliated hospital. Data obtained from the years 2013 to 2014 were used as a derivation dataset for creating a prediction model, while data from 2015 was used as a validation dataset to test the performance of the model. For each admission, a set of clinical and epidemiological variables was obtained. The main diagnosis at hospitalization was recorded, and all additional or secondary conditions that coexisted at hospital admission or that developed during hospital stay were considered secondary conditions.The derivation and validation datasets included 7268 and 7843 patients, respectively. The in-hospital mortality rate averaged 7.2%. The following variables entered the final model; age, body mass index, mean arterial pressure on admission, prior admission within 3 months, background morbidity of heart failure and active malignancy, and chronic use of statins and antiplatelet agents. The c-statistic (ROC-AUC) of the prediction model was 80.5% without adjustment for main or secondary conditions, 84.5%, with adjustment for the main diagnosis, and 89.5% with adjustment for the main diagnosis and secondary conditions. The accuracy of the predictive model reached 81% on the validation dataset.A prediction model based on clinical data with adjustment for secondary conditions exhibited a high degree of prediction accuracy. We provide a proof of concept that there is an added value for incorporating secondary conditions while predicting probabilities of in-hospital mortality. Further improvement of the model performance
Powell, Natalie; Bruce, Christopher G; Redfern, Oliver
Ward rounds are a vital part of hospital medicine and junior doctors play a key role in their delivery. Despite the importance of ward rounds to patient care and experience, we believe that junior doctors may lack the training and skills to carry them out most effectively. We designed a simulation-based training session focusing on ward round skills themed to key patient safety issues and have delivered the training to over 100 learners (medical students and foundation year one doctors). Few learners had any prior training in ward rounds. The session was highly valued by all participants and surveys completed both before and after the session showed statistically significant improvements in confidence in leading and documenting ward rounds. In addition, 94% of final year medical students and 93% of doctors felt such training should be included in the undergraduate curriculum. We believe there is a current gap in training around ward round skills and would strongly encourage simulation-based ward round training to be developed for undergraduates. Further sessions following qualification may then consolidate and develop ward round skills adapted to the level of the doctor. © 2015 Royal College of Physicians.
Chen, Chien-Min; Ke, Yen-Liang
One-third of the acute stroke patients in Taiwan receive rehabilitation. It is imperative for clinicians who care for acute stroke patients undergoing inpatient rehabilitation to identify which medical factors could be the predictors of the total medical costs. The aim of this study was to identify the most important predictors of the total medical costs for first-time hemorrhagic stroke patients transferred to inpatient rehabilitation using a retrospective design. All data were retrospectively collected from July 2002 to June 2012 from a regional hospital in Taiwan. A stepwise multivariate linear regression analysis was used to identify the most important predictors for the total medical costs. The medical records of 237 patients (137 males and 100 females) were reviewed. The mean total medical cost per patient was United States dollar (USD) 5939.5 ± 3578.5.The following were the significant predictors for the total medical costs: impaired consciousness [coefficient (B), 1075.7; 95% confidence interval (CI) = 138.5-2012.9], dysphagia [coefficient (B), 1025.8; 95% CI = 193.9-1857.8], number of surgeries [coefficient (B), 796.4; 95% CI = 316.0-1276.7], pneumonia in the neurosurgery ward [coefficient (B), 2330.1; 95% CI = 1339.5-3320.7], symptomatic urinary tract infection (UTI) in the rehabilitation ward [coefficient (B), 1138.7; 95% CI = 221.6-2055.7], and rehabilitation ward stay [coefficient (B), 64.9; 95% CI = 31.2-98.7] (R(2) = 0.387). Our findings could help clinicians to understand that cost reduction may be achieved by minimizing complications (pneumonia and UTI) in these patients.
Blacklock, Alexander; Sesay, Andrew; Kamara, Abdul; Kamara, Mamud; Blacklock, Claire
In 2012, Sierra Leone suffered a nationwide cholera epidemic which affected the capital Freetown and also the provinces. This study aims to describe the characteristics and clinical management of patients admitted to cholera isolation wards of the main referral hospital in the Northern Province and compare management with standard guidelines. All available clinical records of patients from the cholera isolation wards were reviewed retrospectively. There was no active case finding. The following data were collected from the clinical records after patients had left the ward: date of admission, demographics, symptoms, dehydration status, diagnoses, tests and treatments given, length of stay, and outcomes. A total of 798 patients were admitted, of whom 443 (55.5%) were female. There were 18 deaths (2.3%). Assessment of dehydration status was recorded in 517 (64.8%) of clinical records. An alternative or additional diagnosis was made for 214 patients (26.8%). Intravenous (IV) fluids were prescribed to 767 patients (96.1%), including 95% of 141 patients who had documentation of being not severely dehydrated. A history of vomiting was documented in 92.1% of all patients. Oral rehydration solution (ORS) was given to 629 (78.8%) patients. Doxycycline was given to 380 (47.6%) patients, erythromycin to 34 (4.3%), and other antibiotics were used on 247 occasions. Zinc was given to 209 (26.2%). This retrospective study highlights the need for efforts to improve the quality of triage, adherence to clinical guidance, and record keeping. Data collection and analysis of clinical practices during an epidemic situation would enable faster identification of those areas requiring intervention and improvement.
Karimzadeh, Iman; Mirzaee, Mona; Sadeghimanesh, Niloofar; Sagheb, Mohammad Mahdi
Objective: The aim of the present study was to determine the pattern of antimicrobial resistance of Gram-positive bacteria during three consecutive years at the nephrology ward of Namazi Hospital in Shiraz, Southwest of Iran. Methods: During a 3-year period from 2013 to 2015, data of all biological samples of hospitalized patients at the adult nephrology ward of Namazi Hospital were sent to the central laboratory for identification of Gram-positive microorganisms and subsequently, their antimicrobial susceptibility testing by Kirby–Bauer disc diffusion method were analyzed in a retrospective manner. Findings: Coagulase-negative Staphylococci (CONS) (38.5%), Staphylococcus aureus (25.4%), and Enterococcus spp. (23.8%) were the most common isolated Gram-positive bacteria from all biological samples. All Enterococcus spp. isolates within the 3 years were resistant to oxacillin. The rate of vancomycin-resistant enterococci (VRE) increased from 40.63% in 2013 to 72.73% in 2015. Enterococcus spp. resistance rates to aminoglycosides during 3 years were above 85%. The frequencies of oxacillin-resistant S. aureus (ORSA) in 2013, 2014, and 2015 were 95.24%, 80.95%, and 36.36%, respectively. Two out of 11 (6.67%) S. aureus isolates were resistant to vancomycin. More than 90% of CONS were sensitive to vancomycin within the study period. The frequency of gentamicin-resistant CONS ranged from 40% to 57.14%. Conclusion: The rates of ORSA, VRE, and aminoglycoside-resistant CONS as well as Enterococcus spp. in our clinical setting were considerably high and concerning. These may be due to the failure or lack of infection control activities and antimicrobial selection pressure. PMID:27843959
Cahill, Helen; Jones, Aaron; Herkes, Robert; Cook, Kathy; Stirling, Anne; Halbert, Tanya; Yates, Amanda; Lal, Sean; Gardo, Alan; Donnelly, Roy; Gattas, David J
INTRODUCTION Local and national awareness of the need to improve the recognition and response to the clinical deterioration of hospital inpatients is high. The authors designed and implemented a programme to improve recognition of deteriorating patients in their hospital; a new observation chart for vital signs was one of the major elements. The aim of the study is to evaluate the impact of the new chart and associated education programme on the completeness of vital-sign recording in ward areas. METHODS The setting is a university-affiliated teaching hospital in Sydney, Australia. Three study periods, each lasting 14 days (preintervention, 2 weeks postintervention, 3 months postintervention), were carried out in three wards. The new observation chart was supported by an education programme. The primary outcome measures were the ascertainment rates of individual vital signs as a proportion of total observation sets. RESULTS Documentation of respiratory rate increased from 47.8% to 97.8% (p<0.001) and was sustained at 3 months postintervention (98.5%). Collection of a full set of vital signs also improved by a similar magnitude. Basic neurological observation for all patients was introduced in the new chart; the uptake of this was very good (93.1%). Ascertainment rates of blood pressure and oxygen saturation also increased by small but significant amounts from good baseline rates of 97% or higher. CONCLUSION The introduction of a new observation chart, and education regarding its use and importance, was associated with a major improvement in the recording of respiratory rate and other vital signs.
Verhofstede, Rebecca; Smets, Tinne; Cohen, Joachim; Costantini, Massimo; Van Den Noortgate, Nele; Deliens, Luc
To improve the quality of end-of-life care in geriatric hospital wards we developed the Care Programme for the Last Days of Life. It consists of 1) the Care Guide for the Last Days of Life, 2) supportive documentation and 3) an implementation guide. The aim of this study is (1) to determine the feasibility of implementing the Care Programme for the Last Days of Life in the acute geriatric hospital setting and (2) to explore the health care professionals' perceptions of the effects of the Care Programme on end-of-life care. A phase 2 mixed methods study according with the MRC framework was performed in the acute geriatric ward of Ghent University Hospital between 1 April and 30 September 2013. During the implementation process a mixed methods approach was used including observation, interviews and the use of a quantitative process evaluation tool. This tool measured the success of implementation using several indicators, such as whether a steering group was formed, whether and how much of the health care staff was informed and trained and how many patients were cared for according to the Care Guide for the Last Days of Life. The process evaluation tool showed that implementing the Care Programme for the Last Days of Life in the geriatric ward was successful and thus feasible; a steering group was formed consisting of two facilitators, health care staff of the geriatric ward were trained in using the Care Guide for the Last Days of Life which was subsequently introduced onto the ward and approximately 57% of all dying patients were cared for according to the Care Guide for the Last Days of Life. With regard to health care professionals' perceptions, nurses and physicians experienced the Care Guide for the Last Days of Life as improving the overall documentation of care, improving communication among health care staff and between health care staff and patient/family and improving the quality of end-of-life care. Barriers to implementing the Care Programme for the Last
Nonpharmacological Interventions Targeted at Delirium Risk Factors, Delivered by Trained Volunteers (Medical and Psychology Students), Reduced Need for Antipsychotic Medications and the Length of Hospital Stay in Aged Patients Admitted to an Acute Internal Medicine Ward: Pilot Study
Piotrowicz, Karolina; Rewiuk, Krzysztof; Halicka, Monika; Kalwak, Weronika; Rybak, Paulina
Purpose. Effectiveness of nonpharmacological multicomponent prevention delivered by trained volunteers (medical and psychology students), targeted at delirium risk factors in geriatric inpatients, was assessed at an internal medicine ward in Poland. Patients and Methods. Participants were recruited to intervention and control groups at the internal medicine ward (inclusion criteria: age ≥ 75, acute medical condition, basic orientation, and logical contact on admission; exclusion criteria: life expectancy < 24 hours, surgical hospitalization, isolation due to infectious disease, and discharge to other medical wards). Every day trained volunteers delivered a multicomponent standardized intervention targeted at risk factors of in-hospital complications to the intervention group. The control group, selected using a retrospective individual matching strategy (1 : 1 ratio, regarding age, gender, and time of hospitalization), received standard care. Outcome Measures. Hospitalization time, deaths, falls, delirium episodes, and antipsychotic prescriptions were assessed retrospectively from medical documentation. Results. 130 patients (38.4% males) participated in the study, with 65 in the intervention group. Antipsychotic medications were initiated less frequently in the intervention group compared to the control group. There was a trend towards a shorter hospitalization time and a not statistically significant decrease in deaths in the intervention group. Conclusion. Nonpharmacological multicomponent intervention targeted at delirium risk factors effectively reduced length of hospitalization and need for initiating antipsychotic treatment in elderly patients at the internal medicine ward. PMID:28164113
Nonpharmacological Interventions Targeted at Delirium Risk Factors, Delivered by Trained Volunteers (Medical and Psychology Students), Reduced Need for Antipsychotic Medications and the Length of Hospital Stay in Aged Patients Admitted to an Acute Internal Medicine Ward: Pilot Study.
Gorski, Stanislaw; Piotrowicz, Karolina; Rewiuk, Krzysztof; Halicka, Monika; Kalwak, Weronika; Rybak, Paulina; Grodzicki, Tomasz
Purpose. Effectiveness of nonpharmacological multicomponent prevention delivered by trained volunteers (medical and psychology students), targeted at delirium risk factors in geriatric inpatients, was assessed at an internal medicine ward in Poland. Patients and Methods. Participants were recruited to intervention and control groups at the internal medicine ward (inclusion criteria: age ≥ 75, acute medical condition, basic orientation, and logical contact on admission; exclusion criteria: life expectancy < 24 hours, surgical hospitalization, isolation due to infectious disease, and discharge to other medical wards). Every day trained volunteers delivered a multicomponent standardized intervention targeted at risk factors of in-hospital complications to the intervention group. The control group, selected using a retrospective individual matching strategy (1 : 1 ratio, regarding age, gender, and time of hospitalization), received standard care. Outcome Measures. Hospitalization time, deaths, falls, delirium episodes, and antipsychotic prescriptions were assessed retrospectively from medical documentation. Results. 130 patients (38.4% males) participated in the study, with 65 in the intervention group. Antipsychotic medications were initiated less frequently in the intervention group compared to the control group. There was a trend towards a shorter hospitalization time and a not statistically significant decrease in deaths in the intervention group. Conclusion. Nonpharmacological multicomponent intervention targeted at delirium risk factors effectively reduced length of hospitalization and need for initiating antipsychotic treatment in elderly patients at the internal medicine ward.
King, M-F; Noakes, C J; Sleigh, P A; Bale, S; Waters, L
This study quantifies the relationship between hand hygiene and the frequency with which healthcare workers (HCWs) touch surfaces in patient rooms. Surface contacts and hand hygiene were recorded in a single-bed UK hospital ward for six care types. Surface contacts often formed non-random patterns, but hygiene before or after patient contact depends significantly on care type (P=0.001). The likelihood of hygiene correlated with the number of surface contacts (95% confidence interval 1.1-5.8, P=0.002), but not with time spent in the room. This highlights that a potential subconscious need for hand hygiene may have developed in HCWs, which may support and help focus future hygiene education programmes. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.
Dailey, Natalie J. M.; Rao, Agam K.; Fleischauer, Aaron T.; Greenwald, Ian; Deyde, Varough M.; Moore, Zack S.; Anderson, Deverick J.; Duffy, Jonathan; Gubareva, Larisa V.; Sexton, Daniel J.; Fry, Alicia M.; Srinivasan, Arjun; Wolfe, Cameron R.
Background. Oseltamivir resistance among 2009 pandemic influenza A (H1N1) viruses (pH1N1) is rare. We investigated a cluster of oseltamivir-resistant pH1N1 infections in a hospital ward. Methods. We reviewed patient records and infection control measures and interviewed health care personnel (HCP) and visitors. Oseltamivir-resistant pH1N1 infections were found with real-time reverse-transcription polymerase chain reaction and pyrosequencing for the H275Y neuraminidase (NA) mutation. We compared hemagglutinin (HA) sequences from clinical samples from the outbreak with those of other surveillance viruses. Results. During the period 6–11 October 2009, 4 immunocompromised patients within a hematology-oncology ward exhibited symptoms of pH1N1 infection. The likely index patient became febrile 8 days after completing a course of oseltamivir; isolation was instituted 9 days after symptom onset. Three other case patients developed symptoms 1, 3, and 5 days after the index patient. Three case patients were located in adjacent rooms. HA and NA sequences from case patients were identical. Twelve HCP and 6 visitors reported influenza symptoms during the study period. No other pH1N1 isolates from the hospital or from throughout the state carried the H275Y mutation. Conclusions. Geographic proximity, temporal clustering, presence of H275Y mutation, and viral sequence homology confirmed nosocomial transmission of oseltamivir-resistant pH1N1. Diagnostic vigilance and prompt isolation may prevent nosocomial transmission of influenza. PMID:21343149
Hughes, Catherine; van Heugten, Kate; Keeling, Sally; Szekely, Francisc
How do people with cancer occupy places within the health system during their journey through palliative care? The answer to this question was explored by the authors as part of a wider ethnographic study of eight people’s journeys from referral to palliative care services to the end of life. This article reports on findings that have emerged from ongoing analysis that has been completed in the years proceeding data collection. An ethnographic research design was used to collect data about the participants and their family members over a three-year period. Data was collected using participant observation and semi-structured interviews. Over 380 transcripts based on field note entries and taped interviews were produced during the 1121 h of contact with participants and family members that made up the research period. Analysis of these texts identified two focal sites within Christchurch Hospital that were occupied by the participants. These were the Chemotherapy Suite and the Oncology Ward. Drawing on literature concerning previous anthropological analysis, research was conducted to understand how places affect people and how people affect places. The researchers have used a model outlined by the American ethnographer Miles Richardson to analyse two distinct sites within one hospital. As explained in Richardson’s article, whose title is used to model the title of this article, a sense of place becomes apparent when comparing and contrasting two sites within the same location. Richardson’s article is highly interpretative and relies not only on pre-existing theoretical frameworks but also on personal interpretation. The same approach has been used in the current article. Here, ethnographic methods require the researcher’s interpretation of how participants occupied these sites. Following this approach, the Chemotherapy Suite is presented as a place where medicine dominates illness, and appears as distinct from the Oncology Ward, where disease predominates and
Chisti, Mohammod J; Pietroni, Mark A C; Smith, Jonathan H; Bardhan, Pradip K; Salam, Mohammed A
To evaluate the clinical and laboratory predictors of death in hospitalized under-five children with diarrhoea. This is a prospective cohort study carried out in the Special Care Ward (SCW) of the Dhaka Hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), Dhaka, Bangladesh. All admitted diarrhoeal children of both sexes, aged 0-59 months, from September 2007 through December 2007 were enrolled. We compared and analysed factors among diarrhoeal children who died (n = 29) with those who survived (n = 229). In logistic regression analysis, after adjusting for potential confounders (infusion of intravenous fluid and immature PMN), absent peripheral pulse even after complete rehydration (OR 10.9, 95% CI 2.1-56.8; p < 0.01), severe malnutrition (OR 7.9, 95% CI 1.8-34.8; p < 0.01), hypoxaemia (OR 8.5, 95% CI 1.0-75.0; p = 0.05), radiological lobar pneumonia (OR 17.8, 95% CI 3.7-84.5; p < 0.01) and hypernatraemia (OR 15.8, 95% CI 3.0-81.8; p < 0.01) were independently associated with deaths among diarrhoeal children admitted to SCW. Thus, the absence of peripheral pulses even after full rehydration, severe malnutrition, hypoxaemia, lobar pneumonia and hypernatraemia are independent predictors of death among the under-five children with diarrhoea admitted to critical care ward of a resource-limited setting in Bangladesh. © 2011 The Author(s)/Acta Paediatrica © 2011 Foundation Acta Paediatrica.
Cartmell, E; Natalal, H; François, I; Ferreira, M H; Grahnquist, L
Malnutrition is the fourth commonest reason for hospital admission to the paediatric department of the Central Hospital, Maputo and has the second highest death rate (20 per cent). A study from 1995 into mortality at this paediatric department, suggested an increase in severe malnutrition. Recent studies have shown that the global burden of undernutrition in the world is declining; however, data for Eastern Africa shows a deterioration. The current study was aimed at describing and comparing the patients on the malnutrition ward, in 2001 and 1983. The study gathered indices of nutritional status and secondary diagnoses from the notes of all children (aged between 6 months and 5 years) discharged from the malnutrition ward for a period of l year (January-December 2001), and from data (collected in January-December 1983) for the malnutrition ward. Data was entered and analysed using Epi-Info 6 and SPSS statistics package. The ethics committee of the hospital approved the study. Data was collected for 558 children in 2001 and 833 in 1983. There was no gender difference, average age was 21.7 months in 2001 and 23.8 months in 1983 and the average hospital stay was 13.1 and 14.3 days, respectively. In 2001, 33 per cent had kwashiorkor, 26 per cent marasmus, and 28 per cent marasmic kwashiorkor. Three hundred and twenty children (82 per cent) were <2 Z-scores below the median weight-for-age and 252 children (65 per cent) were <3 Z-scores. Forty per cent had malaria, 65 per cent anaemia, 53 per cent bronchopneumonia, 14 per cent TB, 36 per cent diarrhoea, and 12 per cent HIV/AIDS. In 1983, 49 per cent had kwashiorkor, 17 per cent marasmus, and 11 per cent had marasmic kwashiorkor. A total of 494 children (81 per cent) were <2 Z-scores below the median weight-for-age and 335 children (55 per cent) were <3 Z-scores. Eighteen per cent had malaria, 37 per cent anaemia, 28 per cent bronchopneumonia, 6 per cent TB, 8 per cent diarrhoea, and 4.4 per cent measles/post-measles. A
Movva, Ramya; Jampani, Anusha; Nathani, Jyothsna; Pinnamaneni, Sri Harsha; Challa, Siva Reddy
The study is aimed to assess the incidence of drug-related problems (DRPs) and provide pharmacist interventions for identified DRPs. A prospective, observational study was conducted among 189 patients with cardiovascular disease who were aged 18 years or older and admitted to the general medicine in-patient ward. During the 6 months study period, the incidence of DRPs was identified using Pharmaceutical Care Network Europe Foundation classification system version 6.2. A total of 189 patients were screened for DRPs. Among them, 130 patients have at least one DRP. A total of 416 DRPs were identified (on average, 2.2 DRPs per each patient). Of the 416 DRPs, 125 (30.04%) interventions were accepted, 7 (1.68%) interventions were not accepted, while remaining (68.26%) accepted but no action taken. The results of the study indicate that incidence of DRPs is substantial and pharmacist-led interventions resulted in resolution of DRPs. This represents the need for the active role of the clinical pharmacist in the developing countries like India. PMID:26605161
Costantini, Massimo; Pellegrini, Fabio; Di Leo, Silvia; Beccaro, Monica; Rossi, Carla; Flego, Guia; Romoli, Vittoria; Giannotti, Michela; Morone, Paola; Ivaldi, Giovanni P; Cavallo, Laura; Fusco, Flavio; Higginson, Irene J
Hospital is the most common place of cancer death but concerns regarding the quality of end-of-life care remain. Preliminary assessment of the effectiveness of the Liverpool Care Pathway on the quality of end-of-life care provided to adult cancer patients during their last week of life in hospital. Uncontrolled before-after intervention cluster trial. The trial was performed within four hospital wards participating in the pilot implementation of the Italian version of the Liverpool Care Pathway programme. All cancer patients who died in the hospital wards 2-4 months before and after the implementation of the Italian version of Liverpool Care Pathway were identified. A total of 2 months after the patient's death, bereaved family members were interviewed using the Toolkit After-Death Family Interview (seven 0-100 scales assessing the quality of end-of-life care) and the Italian version of the Views of Informal Carers - Evaluation of Services (VOICES) (three items assessing pain, breathlessness and nausea-vomiting). An interview was obtained for 79 family members, 46 (73.0%) before and 33 (68.8%) after implementation of the Italian version of Liverpool Care Pathway. Following Italian version of Liverpool Care Pathway implementation, there was a significant improvement in the mean scores of four Toolkit scales: respect, kindness and dignity (+16.8; 95% confidence interval = 3.6-30.0; p = 0.015); family emotional support (+20.9; 95% confidence interval = 9.6-32.3; p < 0.001); family self-efficacy (+14.3; 95% confidence interval = 0.3-28.2; p = 0.049) and coordination of care (+14.3; 95% confidence interval = 4.2-24.3; p = 0.007). No significant improvement in symptom' control was observed. These results provide the first robust data collected from family members of a preliminary clinically significant improvement, in some aspects, of quality of care after the implementation of the Italian version of Liverpool Care Pathway programme. The poor effect for symptom control
Dylag, Stanisław; Kucharz, Eugeniusz Józef
Blood and its components are valuable medication that should be administered according to recommendation after consideration of expected benefits and adverse reactions to the patient. To analyze amount and form of blood components or whole blood transfused at gynecological-obstetrical wars of university hospital (UH) or regional hospital (RH). Age of the patients and clinical diagnosis were included into the analysis. Two gynecological-obstetrical wards were investigated. The appropriate data were obtained from the hospital documentation (there was no electronic data system). Amount and form of transfused blood components or whole blood, diagnosis at admission, patient's age and number of the treated patients were collected from the hospital transfusion book. The final clinical diagnosis, age of the patient, and transfusion details were obtained from the patient's medical records. The diagnoses were presented according to the ICD-10 classification. UH patients (29,759 patients) and 13,540 patients from RH from 1996 to 2002 were investigated. Blood and its components were used for transfusion in 1150 women (3.8%) treated in UH, and in 206 women (1.5%) hospitalized in RH. In years 1996-2002, there were transfused 2746 units of blood and its components, including: 371 units of whole blood (13.5%), 2073 units of red blood cells (75.5%), 281 units of fresh frozen plasma (10.2%) and 21 units of therapeutic platelet concentrate (0.8%) in RH there were transfused 527 units of blood and its components, including: 8 units of whole blood (1.5%), 450 units of red blood cells (85.4%), 63 units of fresh frozen plasma (12%), and 6 units of therapeutic platelet concentrate (1.1%). The age of patients in UH was between 14 and 92 years and in RH between 18 and 79 years. The rate of patients with the same diagnosis in whom the transfusion was made, was higher in University Hospital. There were no differences between the number of transfused blood and its components between the two
Office of Management and Budget (OMB) Circular A-110 provides standards for obtaining consistency and uniformity among Federal agencies in the administration of grants and agreements with institutions of higher education, hospitals, and other non-profit organizations. OMB issued Circular A-110 in 1976 and, except for a minor revision in February 1987, the Circular contains its original provisions. To update the Circular, OMB established an interagency task force to review the Circular. The task force solicited suggestions for changes to the Circular from university groups, non-profit organizations and other interested parties and compared, for consistency, the provisions of similar provisions applied to State and local governments. The revised Circular reflects the results of these efforts.
Shahar, Suzana; Wong, Sunfun; Wan, Chakpa'wanchik
Elderly people are known to be at a greater risk of malnutrition, particularly those having diseases or illnesses. A prospective study was undertaken on 92 hospitalised geriatric patients (45.6% males), aged 60 to 89 years old, admitted to surgical and medical wards at Hospital Universiti Kebangsaan Malaysia (HUKM). The study aimed to assess malnutrition at admission, day 3 and day 7 of hospitalisation, and its relation with length of stay in the wards. Malnutrition was assessed using anthropometrics and biochemical indicators. Although the majority of subjects had a normal Body Mass Index (BMI), 10.9% had Chronic Energy Deficiency (CED) and 38% were overweight. A total of 10% subjects had muscle wasting as assessed by Mid-upper Arm Circumference (MUAC). Biochemical tests indicated that women subjects were more likely to have hypoalbuminaemia (p <0.05) whilst, men were at risk of anaemia (p < 0.05). Throughout hospitalisation, there was a significant reduction in body weight, biceps skinfold thickness, calf circumference, MUAC, percentage of body fat and body mass index (BMI) in both males and females (p < 0.05 for all parameters). Biochemical tests on a sub sample of subjects indicated that 71.4% had hypoalbuminaemia and 39.6% were anaemic. Subjects diagnosed with cancer, had loss of appetite or had poor nutritional status as assessed by BMI or MUAC on admission were more likely to be hospitalised longer than or equal to 7 days (p < 0.05 for all parameters). Serum albumin levels at admission correlated positively with MUAC values both on admission (r = 0.608, p <0.01) and at clay seven of hospitalisation (r = 0.906, p < 0.05). There is a need to screen elderly patients at high risk of malnutrition at admission in order to reduce the length of stay and increase their health and nutritional status.
Namazi, Soha; Sagheb, Mohammad Mahdi; Hashempour, Mohammad Mahdi; Sadatsharifi, Arman
Background: The inappropriate use of aminoglycosides has harmful effects such as the development of resistant pathogens and the incidence of nephrotoxicity and ototoxicity. Therefore, drug utilization evaluation of these drugs may improve their usage remarkably. The aim of this study was to assess the usage pattern of amikacin in an internal medicine ward. Methods: This cross-sectional study was conducted in the Internal Medicine Ward of Nemazee Teaching Hospital, Shiraz, Iran, in 2011. The guideline for amikacin use was approved by the institutional Pharmacy and Therapeutics Committee, and the study criteria were developed to assess several parameters involved in amikacin therapy such as appropriateness of drug use, dosage, duration of therapy, toxicity monitoring, and serum concentration assay. Serum concentration was assayed using a Cobas Mira AutoAnalyzer. Clinical and paraclinical parameters such as glomerular filtration rate, culture, microbial sensitivity, white blood cell count, and fever were collected. Results: Sixty-three patients were evaluated. Fifty-seven percent of the patients needed dose readjustment; however, it was not performed for 89% of them. Culture between 48 and 72 hours after amikacin administration was not controlled for 79% of the patients. In 19% of the patients, optimum therapeutic effect was not achieved. The mean±SD of the trough and peak concentrations was 7.63±5.4 μg/mL and 15.67±7.79 μg/mL, respectively. Forty-five percent of the trough and 38% of the peak levels were within the therapeutic range. The overall adherence of amikacin usage to the guideline was only 48%. Conclusion: To achieve appropriate treatment and prevent toxic effects, we recommend that pharmacokinetic dosing methods, amikacin guideline, and serum monitoring be considered. PMID:27217603
Emodi, Ij; Ikefuna, An; Ujunwa, Fa; Chinawa, Jm
Non-communicable diseases are increasing worldwide due to rapidly changing lifestyles and socio-economic status. It is contributing significantly to the global burden of diseases. To determine the pattern of non-communicable diseases in children admitted into the Paediatrics ward in a tertiary health centre in Enugu. A review of admissions into the Paediatrics ward of the University of Nigeria Teaching Hospital Enugu, between January 1999 and December 2008 was done using the registry of admission and discharge. The age range of patients admitted during the period was 2 months to 18 years (mean 5.27 ± 5.42 years). There were 1173 (59.6%) males and 796 (40.4%) females. Disorders of the haematological system accounted for 514 (23.3%) of the non-communicable diseases among the admissions, malignancies accounted for 424 (19.2%) among the admissions, whereas the renal, central nervous, and cardiovascular systems were involved in 282 (12.8%), 274 (12.4%), and 241 (10.9%) patients, respectively. There were 274 (12.4%) deaths and 1667 (75.5%) discharges while 38 (1.7%) were discharged against medical advice. Data on 221(10.2%) of the patients were reported missing. Malignancies contributed to 75 (27.3%) of the deaths, haematological disorders accounted for 44 (16%) whereas renal disorders and nutritional disorders contributed to 43 (15.7%) and 41 (15%) of the deaths, respectively. Non-communicable diseases affect children in our environment and contribute to morbidity and mortality in children. Strategies to prevent these diseases should be encouraged in order to avert the challenges of double burden of the diseases in children.
Emodi, IJ; Ikefuna, AN; Ujunwa, FA; Chinawa, JM
Background: Non-communicable diseases are increasing worldwide due to rapidly changing lifestyles and socio-economic status. It is contributing significantly to the global burden of diseases. Objective: To determine the pattern of non-communicable diseases in children admitted into the Paediatrics ward in a tertiary health centre in Enugu. Materials and Methods: A review of admissions into the Paediatrics ward of the University of Nigeria Teaching Hospital Enugu, between January 1999 and December 2008 was done using the registry of admission and discharge. Results: The age range of patients admitted during the period was 2 months to 18 years (mean 5.27 ± 5.42 years). There were 1173 (59.6%) males and 796 (40.4%) females. Disorders of the haematological system accounted for 514 (23.3%) of the non-communicable diseases among the admissions, malignancies accounted for 424 (19.2%) among the admissions, whereas the renal, central nervous, and cardiovascular systems were involved in 282 (12.8%), 274 (12.4%), and 241 (10.9%) patients, respectively. There were 274 (12.4%) deaths and 1667 (75.5%) discharges while 38 (1.7%) were discharged against medical advice. Data on 221(10.2%) of the patients were reported missing. Malignancies contributed to 75 (27.3%) of the deaths, haematological disorders accounted for 44 (16%) whereas renal disorders and nutritional disorders contributed to 43 (15.7%) and 41 (15%) of the deaths, respectively. Conclusion: Non-communicable diseases affect children in our environment and contribute to morbidity and mortality in children. Strategies to prevent these diseases should be encouraged in order to avert the challenges of double burden of the diseases in children. PMID:25538370
Dolkart, Oleg; Amar, Eyal; Weisman, Daniela; Flaishon, Ron; Weinbroum, Avi A
The present study aimed to evaluate subjective reactions of post-surgery and anesthesia patients who stay in post-anesthesia care units (PACU) longer than necessary medically, due to administrative causes. We interviewed consenting postoperative patients during an 18-month period. All patients who remained in the PACU twice our obligatory PACU length of stay (> 4 hours) due to lack of an available bed in the appropriate hospital ward, were interviewed at the time of discharge. The study group consisted of those who remained > 4 hours after surgery and a control group of patients who were discharged within 4 hours. The questions were chosen from different sources, including generic and condition-specific questionnaires. A total of 67 patients stayed > 4 hours and 63 < 4 hours. The overall mean PACU length of stay for the former was 14.23 +/- 5.77 hours (range 1.5-30 hours). No significant differences were found between the groups in terms of age, gender, surgical time or postoperative pain visual analogue scale. Irritability due to lack of independence were statistically higher, and satisfaction rates were lower in patients who stayed > 12 hours compared to those who were discharged after 4-12 hours (P < 0.05). Overcrowded wards may lead to significant delays in discharge from the PACU. Prolonged stay in the PACU requires attention, both from the administrative and the medical standpoints, because it may irritate the patient. Patients' irate behavior may distract the medical staff from effectively performing their duties and interferes with optimal medical care in the PACU.
Karimzadeh, Iman; Heydari, Marziyeh; Ramzi, Mani; Sagheb, Mohammad Mahdi
Background Nephrotoxicity is the most clinically significant adverse reaction of amphotericin B. Different aspects of amphotericin B (AmB) nephrotoxicity have not been studied well in our population. Objectives The purpose of this study was to assess the frequency, time onset, and possible associated factors of AmB nephrotoxicity in hospitalized patients in hematology-oncology wards in the southwest of Iran. Patients and Methods A cross-sectional, observational study was performed over a period of 9 months at 2 hematology-oncology and 1 hematopoietic stem cell transplantation wards at Namazi Hospital. Patients aged 15 years or older with no documented history of acute kidney injury or chronic kidney disease who were scheduled to receive formulations of AmB intravenously for at least 1 week were included. The required demographic and clinical data of the patients were recorded. Urine urea, creatinine, sodium, potassium, and magnesium levels were measured at days 0, 3, 5, 7, 10, and 14 of the AmB treatment. AmB nephrotoxicity based on serum creatinine increase, renal potassium wasting, hypokalemia, and hypomagnesemia were determined. Results Among the 40 patients recruited for the study, 11 (27.5%) patients developed AmB nephrotoxicity with a mean ± standard deviation onset of 6.73 ± 2.36 days. In 5 patients, AmB nephrotoxicity resolved spontaneously without any intervention. According to the multivariate logistic regression model, none of the studied demographic, clinical, and paraclinical variables were significantly associated with AmB nephrotoxicity. The duration of hospitalization (P = 0.541) and the mortality rate (P = 0.723) were comparable between the patients with and without AmB nephrotoxicity. Hypokalemia and renal potassium wasting were identified in 45% and 27.5% of the patients during AmB treatment, respectively. Conclusions Nearly one-third (27.5%) of our cohort developed nephrotoxicity within the first week of AmB treatment. Hypokalemia and renal
Bonetti, Loris; Terzoni, Stefano; Lusignani, Maura; Negri, Marina; Froldi, Marco; Destrebecq, Anne
to determine and compare the prevalence of malnutrition in medical and surgical hospital units; to assess quality of nutritional care and patients' perception about quality of food and nutritional care. hospital malnutrition in older people leads to increased mortality, length of stay, risk of infections and pressure ulcers. Several studies show that malnutrition is often caused by hospitalization, and related to poor nutritional care. Few studies report data on surgical older patients. a cross-sectional, multicenter study was conducted in 12 hospitals in northern Italy. Malnutrition prevalence was determined according to the Mini Nutritional Assessment full version. Head nurses were interviewed in 80 units, through a validated questionnaire regarding quality of nutritional care. Semi-structured interviews were administered to a sample of patients, to investigate their perception about quality of food and nutritional care. 228 patients out of 1066 were malnourished (21.4%). Medical patients were at higher risk, so were women, patients aged 85 or more, with impaired autonomy, pressure ulcers or taking more than three drugs. The lack of personnel impacts on quality of care: in 55% of the units, no nutritional screening is performed; nutritional history is investigated in 48% only. No protocols for nutritional problems exist in 70% of the wards; hardly ever the intake is measured. Patients are mostly satisfied, even though they report that food has no taste and is not well presented. They remark the need for more personnel. prevalence was high, as found in other studies. Medical patients were at higher risk. Nutritional care was inadequate, and often no measures were adopted to prevent malnutrition. Staffing should be increased during meals. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
Caloro, Matteo; Pucci, Daniela; Calabrò, Giuseppa; de Pisa, Eleonora; Mancinelli, Iginia; Rosini, Enrico; Montebovi, Franco; De Filippis, Sergio; Telesforo, Carla Ludovica; Cuomo, Ilaria; Kotzalidis, Georgios D; Girardi, Paolo
The aim of this study was to identify hiccup cases among patients hospitalized in a psychiatric ward and focus on their treatment, so to establish intervention risk. We reviewed records of 354 consecutively admitted patients during the year 2013 to identify hiccup cases. Hiccup occurred in 7 patients on both aripiprazole and benzodiazepines and in one on delorazepam. No patient on aripiprazole alone developed hiccup. No patient on drugs other than aripiprazole or benzodiazepines developed hiccup. The symptom subsided in 3 cases upon discontinuing aripiprazole and in 5 cases after discontinuing the benzodiazepine (including the case on delorazepam alone); in 2 cases of persistent hiccup, the symptom resolved after adding the calcium channel blocker, pregabalin. All patients developing hiccup were male. There was a 70-fold increase in the risk for developing hiccup in the aripiprazole/benzodiazepine intake condition versus all other conditions, and it further increased if limiting to the male sex. The retrospective nature of the study was its limitation. Hospitalized psychiatric patients on both aripiprazole and benzodiazepines may be at significant risk of hiccup. This clinical awareness could lead to antipsychotic and/or benzodiazepine discontinuation or switch or to the addition of calcium channel blocker inhibitors.
Soelver, L; Oestergaard, B; Rydahl-Hansen, S; Wagner, L
Most cancer patients receiving life-prolonging or palliative treatment are offered non-specialist palliative services. There is a lack of knowledge about their problem profile. The aim of this article is to describe the incidence of patient-reported physical and emotional problems on admission and discharge from general hospital wards and health staff's reported intervention. A prospective study was undertaken over 12 months, where advanced cancer patients completed a patient questionnaire, EORTC QLQ C15-PAL, on admission (n= 97) and discharge (n= 46). The incidences of the problems were dichotomised in intensity categories. The average number of 'clinically relevant problems' on admission was 5 (SD 2) and on discharge 4 (SD 2). A Wilcoxon signed rank test showed significant change in mean score for six out of nine problem areas, but the majority of the patients did not move to the lower intensity category. The highest concurrence was between patient-reported problems and reported intervention for physical function, pain, constipation and loss of appetite. Palliative cancer patients' self-reported problem profile on admission and discharge from hospital has not previously been described and the results indicate a need to focus on improvements to palliative services and for a special service for pain and constipation that could prevent some admissions. © 2012 Blackwell Publishing Ltd.
McLaren, Emma; Maxwell-Armstrong, Charles
This study was undertaken to measure and analyse noise levels over a 24-h period on five general surgical wards. Noise levels were measured on three wards with four bays of six beds each (wards A, B and C), one ward of side-rooms only (ward D) and a surgical high dependency unit (ward E) of eight beds. Noise levels were measured for 15 min at 4-hourly intervals over a period of 24 h midweek. The maximum sound pressure level, baseline sound pressure level and the equivalent continuous level (LEq) were recorded. Peak levels and LEq were compared with World Health Organization (WHO) guidelines for community noise. Control measurements were taken elsewhere in the hospital and at a variety of public places for comparison. The highest peak noise level recorded was 95.6 dB on ward E, a level comparable to a heavy truck. This exceeded all control peak readings except that recorded at the bus stop. Peak readings frequently exceeded 80 dB during the day on all wards. Each ward had at least one measurement which exceeded the peak sound level of 82.5 dB recorded in the supermarket. The highest peak measurements on wards A, B, C and E also exceeded peak readings at the hospital main entrance (83.4 dB) and coffee shop (83.4 dB). Ward E had the highest mean peak reading during the day and at night - 83.45 dB and 81.0 dB, respectively. Ward D, the ward of side-rooms, had the lowest day-time mean LEq (55.9 dB). Analysis of the LEq results showed that readings on ward E were significantly higher than readings on wards A, B and C as a group (P = 0.001). LEq readings on ward E were also significantly higher than readings on ward D (P < 0.001). Day and night levels differ significantly, but least so on the high dependency unit. The WHO guidelines state that noise levels on wards should not exceed 30 dB LEq (day and night) and that peak noise levels at night should not exceed 40 dB. Our results exceed these guidelines at all times. It is likely that these findings will translate to
McLaren, Emma; Maxwell-Armstrong, Charles
INTRODUCTION This study was undertaken to measure and analyse noise levels over a 24-h period on five general surgical wards. PATIENTS AND METHODS Noise levels were measured on three wards with four bays of six beds each (wards A, B and C), one ward of side-rooms only (ward D) and a surgical high dependency unit (ward E) of eight beds. Noise levels were measured for 15 min at 4-hourly intervals over a period of 24 h midweek. The maximum sound pressure level, baseline sound pressure level and the equivalent continuous level (LEq) were recorded. Peak levels and LEq were compared with World Health Organization (WHO) guidelines for community noise. Control measurements were taken elsewhere in the hospital and at a variety of public places for comparison. RESULTS The highest peak noise level recorded was 95.6 dB on ward E, a level comparable to a heavy truck. This exceeded all control peak readings except that recorded at the bus stop. Peak readings frequently exceeded 80 dB during the day on all wards. Each ward had at least one measurement which exceeded the peak sound level of 82.5 dB recorded in the supermarket. The highest peak measurements on wards A, B, C and E also exceeded peak readings at the hospital main entrance (83.4 dB) and coffee shop (83.4 dB). Ward E had the highest mean peak reading during the day and at night – 83.45 dB and 81.0 dB, respectively. Ward D, the ward of side-rooms, had the lowest day-time mean LEq (55.9 dB). Analysis of the LEq results showed that readings on ward E were significantly higher than readings on wards A, B and C as a group (P = 0.001). LEq readings on ward E were also significantly higher than readings on ward D (P < 0.001). Day and night levels differ significantly, but least so on the high dependency unit. CONCLUSIONS The WHO guidelines state that noise levels on wards should not exceed 30 dB LEq (day and night) and that peak noise levels at night should not exceed 40 dB. Our results exceed these guidelines at all times
Cavalcante, F S; Schuenck, R P; Ferreira, D C; da Costa, C R; Nouér, S A; dos Santos, K R N
This study aimed to characterize meticillin-resistant Staphylococcus aureus (MRSA) lineages circulating in a Brazilian teaching hospital. MRSA isolates from nasal swabs were evaluated to assess antimicrobial susceptibility, staphylococcal cassette chromosome mec (SCCmec), Panton-Valentine leucocidin status, pulsed-field gel electrophoresis profile and multi-locus sequence type (MLST) analysis. Eighty-three MRSA isolates were analysed. SCCmec III (43.4%) and IV (49.4%) were predominant. ST1-IV (USA400) was more common in internal medicine (P = 0.002) whereas 'clone M' (SCCmec III) was more common in the medical and surgical intensive care unit (P = 0.004), and all isolates were ST5-IV (USA800) in dermatology (P < 0.001). These data improved the understanding of the MRSA epidemiology inside the hospital and helped to establish effective control measures.
Caudill, Lester; Lawson, Barry
As the battle continues against hospital-acquired infections and the concurrent rise in antibiotic resistance among many of the major causative pathogens, there is a dire need to conduct controlled experiments, in order to compare proposed control strategies. However, cost, time, and ethical considerations make this evaluation strategy either impractical or impossible to implement with living patients. This paper presents a multi-scale model that offers promise as the basis for a tool to simulate these (and other) controlled experiments. This is a "unified" model in two important ways: (i) It combines inter-host and in-host dynamics into a single model, and (ii) it links two very different modeling approaches - agent-based modeling and differential equations - into a single model. The potential of this model as an instrument to combat antibiotic resistance in hospitals is demonstrated with numerical examples.
Sampson, Elizabeth L; White, Nicola; Lord, Kathryn; Leurent, Baptiste; Vickerstaff, Victoria; Scott, Sharon; Jones, Louise
Pain is underdetected and undertreated in people with dementia. We aimed to investigate the prevalence of pain in people with dementia admitted to general hospitals and explore the association between pain and behavioural and psychiatric symptoms of dementia (BPSD). We conducted a longitudinal cohort study of 230 people, aged above 70, with dementia and unplanned medical admissions to 2 UK hospitals. Participants were assessed at baseline and every 4 days for self-reported pain (yes/no question and FACES scale) and observed pain (Pain Assessment in Advanced Dementia scale [PAINAD]) at movement and at rest, for agitation (Cohen-Mansfield Agitating Inventory [CMAI]) and BPSD (Behavioural Pathology in Alzheimer Disease Scale [BEHAVE-AD]). On admission, 27% of participants self-reported pain rising to 39% on at least 1 occasion during admission. Half of them were able to complete the FACES scale, this proportion decreasing with more severe dementia. Using the PAINAD, 19% had pain at rest and 57% had pain on movement on at least 1 occasion (in 16%, this was persistent throughout the admission). In controlled analyses, pain was not associated with CMAI scores but was strongly associated with total BEHAVE-AD scores, both when pain was assessed on movement (β = 0.20, 95% confidence interval [CI] = 0.07-0.32, P = 0.002) and at rest (β = 0.41, 95% CI = 0.14-0.69, P = 0.003). The association was the strongest for aggression and anxiety. Pain was common in people with dementia admitted to the acute hospital and associated with BPSD. Improved pain management may reduce distressing behaviours and improve the quality of hospital care for people with dementia.
Sampson, Elizabeth L.; White, Nicola; Lord, Kathryn; Leurent, Baptiste; Vickerstaff, Victoria; Scott, Sharon; Jones, Louise
Abstract Pain is underdetected and undertreated in people with dementia. We aimed to investigate the prevalence of pain in people with dementia admitted to general hospitals and explore the association between pain and behavioural and psychiatric symptoms of dementia (BPSD). We conducted a longitudinal cohort study of 230 people, aged above 70, with dementia and unplanned medical admissions to 2 UK hospitals. Participants were assessed at baseline and every 4 days for self-reported pain (yes/no question and FACES scale) and observed pain (Pain Assessment in Advanced Dementia scale [PAINAD]) at movement and at rest, for agitation (Cohen–Mansfield Agitating Inventory [CMAI]) and BPSD (Behavioural Pathology in Alzheimer Disease Scale [BEHAVE-AD]). On admission, 27% of participants self-reported pain rising to 39% on at least 1 occasion during admission. Half of them were able to complete the FACES scale, this proportion decreasing with more severe dementia. Using the PAINAD, 19% had pain at rest and 57% had pain on movement on at least 1 occasion (in 16%, this was persistent throughout the admission). In controlled analyses, pain was not associated with CMAI scores but was strongly associated with total BEHAVE-AD scores, both when pain was assessed on movement (β = 0.20, 95% confidence interval [CI] = 0.07-0.32, P = 0.002) and at rest (β = 0.41, 95% CI = 0.14-0.69, P = 0.003). The association was the strongest for aggression and anxiety. Pain was common in people with dementia admitted to the acute hospital and associated with BPSD. Improved pain management may reduce distressing behaviours and improve the quality of hospital care for people with dementia. PMID:25790457
Maslow, Joel N; Glaze, Thomas; Adams, Pamela; Lataillade, Max
Acinetobacter baumannii has emerged as an opportunistic pathogen among acutely ill patients, especially those with thermal injury. A prospective 8-month study was conducted to describe the clinical and molecular epidemiology of multidrug-resistant A. baumannii affecting a single hospital. Univariate analysis comparing SmaI macrorestriction patterns of A. baumannii generated by pulsed-field gel electrophoresis (PFGE) versus clinical and demographic risk factors. A total of 200 isolates from 76 patients were collected, of which 185 isolates from 76 patients were analyzed by PFGE. A total of 17 distinct PFGE clonal types were identified. One clonal type (strain A) represented 129 isolates from 49 patients. A group of related clonal types (strain A variants) were identified as 40 isolates from 20 patients. The only risk factor other than geographic location associated with the presence of strain A was prior treatment with antibiotics active against gram-negative bacteria (P = .0015). The two clonal types differed in antibiotic resistance profiles: 25% of strain A isolates, the dominant strain in the burn unit, were susceptible to at least one antibiotic tested. In contrast, approximately 80% of the other strain types were susceptible to at least one antibiotic and were cultured from patients admitted elsewhere in the hospital. No combination of antibiotics was observed to yield additive or synergistic activity. Clonally related strains of Acinetobacter that differ in susceptibility patterns may coexist within a single hospital, dependent on the selective pressure related to antibiotic exposure.
Yarmohammadian, Mohammad H; Tavakoli, Nahid; Shams, Assadollah; Hatampour, Farzaneh
People capacity maturity model (PCMM) is one of the models which focus on improving organizational human capabilities. The aim of this model's application is to increase people ability to attract, develop, motivate, organize and retain the talents needed to organizational continuous improvement. In this study, we used the PCMM for investigation of organizational maturity level in medical record departments of governmental hospitals and determination strengths and weaknesses of their staff capabilities. This is an applied research and cross sectional study in which data were collected by questionnaires to investigation of PCMM model needs in medical record staff of governmental hospitals at Isfahan, Iran. We used the questionnaire which has been extracted from PCMM model and approved its reliability with Cronbach's Alpha 0.96. Data collected by the questionnaire was analyzed based on the research objectives using SPSS software and in accordance with research questions descriptive statistics were used. Our findings showed that the mean score of medical record practitioners, skill and capability in governmental hospitals was 35 (62.5%) from maximum 56 (100%). There is no significant relevance between organizational maturity and medical record practitioners, attributes. Applying PCMM model is caused increasing staff and manager attention in identifying the weaknesses in the current activities and practices, so it will result in improvement and developing processes.
Yarmohammadian, Mohammad H.; Tavakoli, Nahid; Shams, Assadollah; Hatampour, Farzaneh
Context: People capacity maturity model (PCMM) is one of the models which focus on improving organizational human capabilities. Aims: The aim of this model's application is to increase people ability to attract, develop, motivate, organize and retain the talents needed to organizational continuous improvement. Settings and Design: In this study, we used the PCMM for investigation of organizational maturity level in medical record departments of governmental hospitals and determination strengths and weaknesses of their staff capabilities. Materials and Methods: This is an applied research and cross sectional study in which data were collected by questionnaires to investigation of PCMM model needs in medical record staff of governmental hospitals at Isfahan, Iran. We used the questionnaire which has been extracted from PCMM model and approved its reliability with Cronbach's Alpha 0.96. Statistical Analysis Used: Data collected by the questionnaire was analyzed based on the research objectives using SPSS software and in accordance with research questions descriptive statistics were used. Results: Our findings showed that the mean score of medical record practitioners, skill and capability in governmental hospitals was 35 (62.5%) from maximum 56 (100%). There is no significant relevance between organizational maturity and medical record practitioners, attributes. Conclusions: Applying PCMM model is caused increasing staff and manager attention in identifying the weaknesses in the current activities and practices, so it will result in improvement and developing processes. PMID:25077147
Dik, Jan-Willem H.; Hendrix, Ron; Friedrich, Alex W.; Luttjeboer, Jos; Nannan Panday, Prashant; Wilting, Kasper R.; Lo-Ten-Foe, Jerome R.; Postma, Maarten J.; Sinha, Bhanu
Background In order to stimulate appropriate antimicrobial use and thereby lower the chances of resistance development, an Antibiotic Stewardship Team (A-Team) has been implemented at the University Medical Center Groningen, the Netherlands. Focus of the A-Team was a pro-active day 2 case-audit, which was financially evaluated here to calculate the return on investment from a hospital perspective. Methods Effects were evaluated by comparing audited patients with a historic cohort with the same diagnosis-related groups. Based upon this evaluation a cost-minimization model was created that can be used to predict the financial effects of a day 2 case-audit. Sensitivity analyses were performed to deal with uncertainties. Finally, the model was used to financially evaluate the A-Team. Results One whole year including 114 patients was evaluated. Implementation costs were calculated to be €17,732, which represent total costs spent to implement this A-Team. For this specific patient group admitted to a urology ward and consulted on day 2 by the A-Team, the model estimated total savings of €60,306 after one year for this single department, leading to a return on investment of 5.9. Conclusions The implemented multi-disciplinary A-Team performing a day 2 case-audit in the hospital had a positive return on investment caused by a reduced length of stay due to a more appropriate antibiotic therapy. Based on the extensive data analysis, a model of this intervention could be constructed. This model could be used by other institutions, using their own data to estimate the effects of a day 2 case-audit in their hospital. PMID:25955494
Pasqualini, Leonella; Mencacci, Antonella; Leli, Christian; Montagna, Paolo; Cardaccia, Angela; Cenci, Elio; Montecarlo, Ines; Pirro, Matteo; di Filippo, Francesco; Cistaro, Emma; Schillaci, Giuseppe; Bistoni, Francesco; Mannarino, Elmo
Early identification of causative pathogen in sepsis patients is pivotal to improve clinical outcome. SeptiFast (SF), a commercially available system for molecular diagnosis of sepsis based on PCR, has been mostly used in patients hospitalized in hematology and intensive care units. We evaluated the diagnostic accuracy and clinical usefulness of SF, compared to blood culture (BC), in 391 patients with suspected sepsis, hospitalized in a department of internal medicine. A causative pathogen was identified in 85 patients (22%). Sixty pathogens were detected by SF and 57 by BC. No significant differences were found between the two methods in the rates of pathogen detection (P = 0.74), even after excluding 9 pathogens which were isolated by BC and were not included in the SF master list (P = 0.096). The combination of SF and BC significantly improved the diagnostic yield in comparison to BC alone (P < 0.001). Compared to BC, SF showed a significantly lower contamination rate (0 versus 19 cases; P < 0.001) with a higher specificity for pathogen identification (1.00, 95% confidence interval [CI] of 0.99 to 1.00, versus 0.94, 95% CI of 0.90 to 0.96; P = 0.005) and a higher positive predictive value (1.00, 95% CI of 1.00 to 0.92%, versus 0.75, 95% CI of 0.63 to 0.83; P = 0.005). In the subgroup of patients (n = 191) who had been receiving antibiotic treatment for ≥24 h, SF identified more pathogens (16 versus 6; P = 0.049) compared to BC. These results suggest that, in patients with suspected sepsis, hospitalized in an internal medicine ward, SF could be a highly valuable adjunct to conventional BC, particularly in patients under antibiotic treatment.
Dik, Jan-Willem H; Hendrix, Ron; Friedrich, Alex W; Luttjeboer, Jos; Panday, Prashant Nannan; Wilting, Kasper R; Lo-Ten-Foe, Jerome R; Postma, Maarten J; Sinha, Bhanu
In order to stimulate appropriate antimicrobial use and thereby lower the chances of resistance development, an Antibiotic Stewardship Team (A-Team) has been implemented at the University Medical Center Groningen, the Netherlands. Focus of the A-Team was a pro-active day 2 case-audit, which was financially evaluated here to calculate the return on investment from a hospital perspective. Effects were evaluated by comparing audited patients with a historic cohort with the same diagnosis-related groups. Based upon this evaluation a cost-minimization model was created that can be used to predict the financial effects of a day 2 case-audit. Sensitivity analyses were performed to deal with uncertainties. Finally, the model was used to financially evaluate the A-Team. One whole year including 114 patients was evaluated. Implementation costs were calculated to be €17,732, which represent total costs spent to implement this A-Team. For this specific patient group admitted to a urology ward and consulted on day 2 by the A-Team, the model estimated total savings of €60,306 after one year for this single department, leading to a return on investment of 5.9. The implemented multi-disciplinary A-Team performing a day 2 case-audit in the hospital had a positive return on investment caused by a reduced length of stay due to a more appropriate antibiotic therapy. Based on the extensive data analysis, a model of this intervention could be constructed. This model could be used by other institutions, using their own data to estimate the effects of a day 2 case-audit in their hospital.
Mauta, L; Vince, J; Ripa, P
We compared the temperatures recorded, in febrile children admitted to a children's ward at Port Moresby General Hospital, by a doctor and by a group of nurses using glass mercury thermometers (GMT) and liquid crystal thermometers (LCT, Nextemp and Traxit. The mean difference (with 95% confidence intervals) in temperatures between GMT and Nextemp were -0.12 degrees C (-0.16 degrees C to -0.08 degrees C) for the doctor and 0.12 degrees C (0.04-0.20 degrees C) for nurses. The mean difference in temperatures between GMT and Traxit were -0.05 degrees C (-0.09 degrees C to -0.01 degrees C) for the doctor and 0.19 degrees C (0.10-0.28 degrees C) for the nurses. A similar result was obtained when one of the Nextemp thermometers used in the initial study was compared with GMT on a small sample of patients by the doctor 8 months later. Limited evaluation showed nursing staff were in favour of using the LCTs. Nextemp and Traxit thermometers can be used interchangeably with GMT in this setting.
Gyebre, Y. M. C.; Ouedraogo, R. W.-L.; Elola, A.; Ouedraogo, B. P.; Sereme, M.; Ouattara, M.; Ouoba, K.
Objectives. The aim of this study was to analyze the epidemiological and clinical aspects of chronic otitis media and its therapeutic processes in our context. Patients and Methods. In a prospective study over a period of 1 year (March 2009–February 2010), 79 patients with chronic otitis media have been cared for in the otolaryngology ward of the University Hospital of Ouagadougou. Results. Chronic otitis media (COM) commonly occurs in the age group from 0 to 15 years (40.50%). Otorrhea was the main reason for consultation in 53 cases (67.10%); the most frequently encountered clinicopathological forms were simple COM (71%) followed by otitis media with effusion (24.30%). Intra-auricular instillations of traditional products (46.09%) were the dominant favoring factor. Treatment was essentially through medication in 59 cases with a stabilization of lesions. Endotemporal complications were noticed in 6 cases. Conclusion. The fight against chronic otitis media is carried out through preventive measures of education the of people. PMID:24066241
Wu, Robert; Lo, Vivian; Morra, Dante; Appel, Eva; Arany, Teri; Curiale, Beth; Ryan, Joanne; Quan, Sherman
There is increasing interest in the use of information and communication technologies to improve how clinicians communicate in hospital settings. We implemented a communication system with support for physician handover and secure messaging on 2 general internal medicine wards. We measured usage and surveyed physicians and nurses on perceptions of the system's effects on communication. Between May 2011 and August 2012, a clinical teaching team received, on average, 14.8 messages per day through the system. Messages were typically sent as urgent (69.1%) and requested a text reply (76.5%). For messages requesting a text reply, 8.6% did not receive a reply. For those messages that did receive a reply, the median response time was 2.3 minutes, and 84.5% of messages received a reply within 15 minutes. Of those who completed the survey, 95.3% were medical residents (82 of 86) and 81.7% were nurses (83 of 116). Medical trainees (82.8%) and nursing staff (78.3%) agreed or strongly agreed that the system helped to speed up their daily work tasks. Overall, 67.1% of the trainees and 73.2% of nurses agreed or strongly agreed that the system made them more accountable in their clinical roles. Only 35.8% of physicians and 26.3% of nurses agreed or strongly agreed that the system was useful for communicating complex issues. In summary, with a system designed to improve communication, we found that there was high uptake and that users perceived that the system improved efficiency and accountability but was not appropriate for communicating complex issues. © 2014 Society of Hospital Medicine.
Degree of bacterial contamination and antibiotic susceptibility pattern of isolates from housekeeping surfaces in operating rooms and surgical wards at Jimma University Specialized Hospital, south west Ethiopia.
Genet, Chalachew; Kibru, Gebre; Hemalatha, Kannan
The role of the hospital environment as a reservoir of potential pathogens has received increasing attention. There are several reports demonstrating contamination of a wide variety of environmental sites in operating rooms (ORs) and surgical wards (SWs) which lead to nosocomial spread. To determine the degree of bacterial contamination and antibiotic susceptibility pattern of isolates from floor and tabletop surfaces in ORs and SWs at Jimma University Specialized Hospital (JUSH). A cross sectional study was conducted on 144 floor and tabletop surfaces from October to January 2009/2010. Samples were investigated for identification of bacterial species following standard procedures and antimicrobial susceptibility tests were performed using disc diffusion technique. The data was analyzed using SPSS version 16 and compared with the proposed standard value. The mean aerobic colony counts (ACCs) for tabletop surfaces (34 CFU/cm2) and floors (19CFU/cm2) in SWs were significantly higher than the set ACC standard for hand contact surfaces (< 5 CFU/cm2) P < 0.00. The ACCs obtained from tabletop surfaces (6.2 CFU/cm2) and floors (10.1CFU/cm2) in ORs were also exceeding the standard. Over 55% of gram negative bacteria were identified from Critical Zone of ORs. Staphylococcus aureus was the must frequently isolated bacterium accounting 33.3% followed by Escherichia coli and Klebsiella spp each with 11.1%. Moreover, S. aureus showed 100% resistance to methicillin and multidrug resistant Enterobacteriaceae were also seen in more than 90 % of isolates. An increased bacterial contamination was measured in both ORs and SWs of the JUSH and the isolated bacteria were also resistant for most of the antibiotics used as a treatment options in the study area. Therefore, appropriate infection control measures needs to be taken to keep the contamination level within the proposed standard.
Liu, Yang; Li, Xiang-Yang; Wan, La-Gen; Jiang, Wei-Yan; Li, Fang-Qu; Yang, Jing-Hong
The present study was conducted to confirm the presence of Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae associated with a nosocomial outbreak in a Chinese pediatric hospital. From July 2009 to January 2011, 124 nonduplicated K. pneumoniae isolates were collected from specimens from patients of pediatric units in the hospital. Twelve of the 124 isolates possessed the bla(KPC-2) gene and showed 7 different pulsed-field gel electrophoresis (PFGE) patterns. Meanwhile, 16S rRNA methylase, acc(6')-Ib-cr, and several types of β-lactamases were also produced by the majority of the KPC-producing isolates. Class 1 integron-encoded intI1 integrase gene was subsequently found in all strains, and amplification, sequencing, and comparison of DNA between 5' conserved segment and 3' conserved segment region showed the presence of several known antibiotic resistance gene cassettes of various sizes. The conjugation and plasmid-curing experiments indicated some KPC-2-encoding genes were transmissible. In addition, conjugal cotransfer of multidrug-resistant phenotypes with KPC-positive phenotypes was observed in KPC-producing strains. Restriction endonuclease analysis and DNA hybridization with a KPC-specific probe showed that the bla(KPC-2) gene was carried by plasmid DNA from K. pneumoniae of PFGE pattern B. The overall results indicate that the emergence and outbreak of KPC-producing K. pneumoniae in our pediatric wards occurred in conjunction with plasmids coharboring 16S rRNA methylase and extended-spectrum β-lactamases.
Ordoñez, Ana Manuela; Madalozzo Schieferdecker, Maria Eliana; Cestonaro, Talita; Cardoso Neto, João; Ligocki Campos, Antônio Carlos
Objetivo: Vincular el estado nutricional (EN) con la evolución clínica y la duración de la estancia de los pacientes ingresados en las clínicas médicas de un hospital universitario. Métodos: Estudio observacional retrospectivo en el que los datos analíticos se obtuvieron de los pacientes ingresados durante el período de un año. Para la evaluación del EN se utilizaron: la valoración global subjetiva (VGS), el índice de masa corporal (IMC), el pliegue cutáneo triciptal (PCT), la circunferencia muscular del brazo (CMB) y el diagnostico del estado nutricional por la combinación de métodos (VGS, medidas de antropometría y bioquímicas). El análisis estadístico se realizó con el poder de confianza del 95% (p < 0,05). Para las categorías de comparación se utilizó chi-cuadrado. Para examinar la asociación entre la duración de la estancia y variables relacionadas con el EN se utilizaron Mann-Whitney y Kruskal-Wallis con comparaciones múltiples. Resultados: De los 396 sujetos estudiados 57,8% eran adultos. Ser mayor se asoció con la presencia de hipertensión arterial (p <0,001), diabetes mellitus (p = 0,003) y requerir cambios en la consistencia de la dieta (p = 0,003). Al final de la evaluación el 45,7% eran desnutridos. Presentar disminución de la ingesta de alimentos (p = 0,01), malnutrición según el SGA (p = 0,02) y la CMB (p = 0,03) se asoció con mortalidad. Estuvieron más tiempo hospitalizados los pacientes con nivel terciario de atención (p = 0,01), disminución de la ingestión de alimentos (p = 0,001), que murieron (p = 0,004), con un diagnóstico de desnutrición por VGS (p = 0,001) y por la combinación de métodos (p = 0,001). Conclusión: pacientes desnutridos según VGS y con disminución de la ingestión de alimentos al comienzo de la hospitalización se mantuvieron más tiempo en el hospital y tuvieron peores resultados clínicos (mayor número de muertes). El diagnóstico de la desnutrición por CMB también se relacion
Mohseni Saravi, Benyamin; Reza Zadeh, Esmaeil; Siamian, Hasan; Yahghoobian, Mahboobeh
Introduction: Since children neither comprehended nor contribute to the decision, discharge against medical advice is a challenge of health care systems in the world. Therefore, the current study was designed to determine the rate and causes of discharge against medical advice. Methods: This descriptive cross-sectional study was done by reviewing the medical records by census method. Data was analyzed using SPSS software and x2 statistics was used to determine the relationship between variables. The value of P<0.05 was considered significant. Results: Rate of discharged against medical advice was 108 (2.2%). Mean of age and length of stay were 2.8±4 (SD).3 years old and 3.7±5.4 (SD) days, respectively. Totally, 95 patients (88.7%) had health insurance and 65 (60.2%) patients lived in urban areas. History of psychiatric disease and addiction in 22 (20.6%) of the parents were negative. In addition, 100 (92.3%) patients admitted for medical treatment and the others for surgery. The relationship of the signatory with patients (72.3%) was father. Of 108 patients discharged against medical advice, 20 (12%) were readmitted. The relationship between the day of discharge and discharge against medical advice was significant (ρ =0/03). Conclusion: Rate of discharge against medical advice in Boo-ali hospital is the same as the other studies in the same range. The form which is used for this purpose did not have suitable data elements about description of consequence of such discharge, and it has not shown the real causes of discharge against medical advice. PMID:24554800
Understanding and evaluating the effects of implementing an electronic paediatric prescribing system on care provision and hospital work in paediatric hospital ward settings: a qualitatively driven mixed-method study protocol.
Farre, Albert; Cummins, Carole
Electronic prescribing systems can improve the quality and safety of healthcare services, but their implementation is not straightforward and may create unexpected change. However, the added complexity of paediatric prescribing (eg, dose calculations, dilutions, manipulations) may pose additional challenges. This study will aim to (1) understand the complex organisational reality of a paediatric hospital in which a new electronic paediatric prescribing (ePP) system will be introduced; (2) describe ePP-related change, over time, in paediatric hospital ward settings; (3) explore staff perspectives in relation to currently established practices and processes; and (4) assess the impact of ePP on care provision and hospital work from the perspective of paediatricians, paediatric nurses and managers. A qualitatively driven mixed-method approach will be adopted, including 3 inter-related substudies. The core component of the study will be qualitative (substudy 1): we will use ethnographic research methods, including non-participant observation in wards and informal conversational interviews with members of staff. In addition, the design will include 2 embedded supplementary components: a qualitative 1 (substudy 2) based on in-depth interviews and/or focus groups with paediatricians, paediatric nurses, paediatric pharmacists/pharmacy technicians and managers; and a quantitative 1 (substudy 3) in which a staff survey will be developed and administered before and after the ePP implementation. Analytic themes will be identified from ethnographic field notes and interview data. Survey data will be analysed using descriptive statistics and baseline and follow-up data compared to establish impact evaluation measures. A favourable ethical opinion has been obtained from a National Health Service (NHS) Research Ethics Committee (15/SS/0157). NHS research governance approval has been obtained at the relevant hospital site. The results of the study will be disseminated through
Glen, Peter; Earl, Naomi; Gooding, Felix; Lucas, Emily; Sangha, Nicole; Ramcharitar, Steve
Clinical documentation is an integral part of the healthcare professional's job. Good record keeping is essential for patient care, accurate recording of consultations and for effective communication within the multidisciplinary team. Within the surgical department at the Great Western Hospital, Swindon, the case notes were deemed to be bulky and cumbersome, inhibiting effective record keeping, potentially putting patients' at risk. The aim of this quality improvement project was therefore to improve the standard of documentation, the labelling of notes and the overall filing. A baseline audit was firstly undertaken assessing the notes within the busiest surgical ward. A number of variables were assessed, but notably, only 12% (4/33) of the case notes were found to be without loose pages. Furthermore, less than half of the pages with entries written within the last 72 hours contained adequate patient identifiers on them. When assessing these entries further, the designation of the writer was only recorded in one third (11/33) of the cases, whilst the printed name of the writer was only recorded in 65% (21/33) of the entries. This project ran over a 10 month period, using a plan, do study, act methodology. Initial focus was on simple education. Afterwards, single admission folders were introduced, to contain only information required for that admission, in an attempt to streamline the notes and ease the filing. This saw a global improvement across all data subsets, with a sustained improvement of over 80% compliance seen. An educational poster was also created and displayed in clinical areas, to remind users to label their notes with patient identifying stickers. This saw a 4-fold increase (16%-68%) in the labelling of notes. In conclusion, simple, cost effective measures in streamlining medical notes, improves the quality of documentation, facilitates the filing and ultimately improves patient care. PMID:26734440
Glen, Peter; Earl, Naomi; Gooding, Felix; Lucas, Emily; Sangha, Nicole; Ramcharitar, Steve
Clinical documentation is an integral part of the healthcare professional's job. Good record keeping is essential for patient care, accurate recording of consultations and for effective communication within the multidisciplinary team. Within the surgical department at the Great Western Hospital, Swindon, the case notes were deemed to be bulky and cumbersome, inhibiting effective record keeping, potentially putting patients' at risk. The aim of this quality improvement project was therefore to improve the standard of documentation, the labelling of notes and the overall filing. A baseline audit was firstly undertaken assessing the notes within the busiest surgical ward. A number of variables were assessed, but notably, only 12% (4/33) of the case notes were found to be without loose pages. Furthermore, less than half of the pages with entries written within the last 72 hours contained adequate patient identifiers on them. When assessing these entries further, the designation of the writer was only recorded in one third (11/33) of the cases, whilst the printed name of the writer was only recorded in 65% (21/33) of the entries. This project ran over a 10 month period, using a plan, do study, act methodology. Initial focus was on simple education. Afterwards, single admission folders were introduced, to contain only information required for that admission, in an attempt to streamline the notes and ease the filing. This saw a global improvement across all data subsets, with a sustained improvement of over 80% compliance seen. An educational poster was also created and displayed in clinical areas, to remind users to label their notes with patient identifying stickers. This saw a 4-fold increase (16%-68%) in the labelling of notes. In conclusion, simple, cost effective measures in streamlining medical notes, improves the quality of documentation, facilitates the filing and ultimately improves patient care.
Diallo, Dapa Aly; Baby, Mounirou; Dembélé, Abdoul Karim; Diallo, Yacouba Lazare; Cissoko, Lala N'Drainy Sidibé; Dicko, Mariam Soumaré; Dembélé, Mamadou; Cissoko, Yacouba
Data from developed countries place the malignant hemopathies among the most frequent cancers in children. The epidemiologic and prognostic aspects of these diseases are not well known in developing countries notably in Africa sub-Saharan countries because of lack of registry and clinical collaborative studies. Nevertheless, the good progress in the management of paediatric diseases that were a big concerns in former times authorize to think that in future, these countries will be engaged in programs to fit malignant diseases as major health problems in children. A good knowledge of epidemiologic aspects of these diseases must be therefore an important concern. This study describes epidemiologic and prognosis particularities of malignant hemopathies in children diagnosed in a last referral hospital ward, Bamako, Mali (West Africa) during height years. Fifty-nine cases of malignant hemopathies were diagnosed by January 1996 to December 2003 in 19 females and 40 males. Data were analysed retrospectively with SPSS 11.0. These children were aged from 4 to 15 years and the modal class of age was 6-10 years. The mean recruitment of cases per year was 7.37. Lymphomas were more frequent (70%) particularly the Burkitt lymphoma. The Hodgkin's lymphoma was not observed under 5 years of age but represents 24% of cases over this age and was more frequent in male. This study emphasizes the need to put in place strategies for a better understanding of epidemiological aspects of malignant hemopathies in children and for developing policies to improve management and prevention of cases in Mali.
Mittermayer-Vassallo, Kirstin; Banda, Kondwani; Molyneux, Elizabeth M
One of the most common malignancies in HIV-endemic, resource-poor countries is Kaposi sarcoma (KS). It is an AIDS-defining disease and as Malawi's incidence and prevalence of HIV is high, KS is now the most common cancer in adult male Malawians and the second most common in women and children. Most attention has focused on HIV-seropositive adults as their number far outweighs those of children. This audit concerns the presentation and outcome of HIV-seronegative children with KS who presented in a 12-year period (2002-2014) to The Queen Elizabeth Central Hospital. Twenty (10.5%) of the 191 children with KS presenting to the paediatric oncology ward during 2002-2014 were HIV-seronegative. They were usually younger than seropositive children and 62% had severe anaemia. The main presenting complaints in the HIV-seronegative group were woody oedema, commonly of a limb, and lymphadenopathy. Woody oedema was common in children with or without HIV infection. Seronegative children with KS were less likely to have oral KS than HIV infected children. Of 11 children who completed courses of chemotherapy, seven (63%) had complete cure sustained over a 1-year follow-up period. KS is potentially curable in this group of children. Chemotherapy regimens are equally effective in HIV-seropositive and HIV-seronegative children. The presentation of HIV-seronegative children with KS differs from adults and HIV-seropositive children. Further research is necessary to determine possible triggers for developing KS in HIV-seronegative children. © The Author(s) 2015.
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.
Chaberny, Iris F; Schwab, Frank; Ziesing, Stefan; Suerbaum, Sebastian; Gastmeier, Petra
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.
Walk into Brooke ward and it doesn't feel like a ward at all. There are bright-coloured bedspreads, cuddly toys everywhere, a 1930s ball gown hangs above one of the lockers. And of course, there's Emma, the ward cat - continually fussed over by nurses and residents alike.
The aim of the study was to gain an understanding of the environment and facilities that adolescents require in a purpose-built adolescent ward. People who are hospitalized have limited control over their care and environment. The experience of hospitalization is also considered a highly stressful event. It is essential that patients have an opportunity to participate in the planning and design of ward environments in order to reduce their stress and better accommodate their treatment needs. An interpretative qualitative design was used. Seven chronically ill adolescents were asked to design their own ward in order to obtain consumer input about what the perceived necessary facilities for adolescent wards. The adolescents provided clear information about the facilities that should be incorporated into an adolescent ward to maintain their privacy and independence. Further research needs to be conducted seeking consumer input, especially if it can enhance the stay of adolescent patients while they are hospitalized. Adolescent voice is more often than not represented by nurses, or other healthcare professionals in the patients' best interest. This practice acts on the assumption that the adult knows best and/or that adolescents are unable to articulate their own needs. Adolescent consumers contribute worthwhile recommendations to how a ward is run providing insight about their needs in the ward environment.
Ritt, Martin; Ritt, Julia Isabel; Sieber, Cornel Christian; Gaßmann, Karl-Günter
Background Studies evaluating and comparing the power of frailty, comorbidity, and disability instruments, together and in parallel, for predicting mortality are limited. Objective This study aimed to evaluate and compare the measures of frailty, comorbidity, and disability in predicting 1-year mortality in geriatric inpatients. Design Prospective cohort study. Patients and setting A total of 307 inpatients aged ≥65 years in geriatric wards of a general hospital participated in the study. Measurements The patients were evaluated in relation to different frailty, comorbidity, and disability instruments during their hospital stays. These included three frailty (the seven-category Clinical Frailty Scale [CFS-7], a 41-item frailty index [FI], and the FRAIL scale), two comorbidity (the Cumulative Illness Rating Scale for Geriatrics [CIRS-G] and the comorbidity domain of the FI [Comorbidity-D-FI]), and two disability instruments (disability in basic activities of daily living [ADL-Katz] and the instrumental and basic activities of daily living domains of the FI [IADL/ADL-D-FI]). The patients were followed-up over 1 year. Results Using FI, CIRS-G, Comorbidity-D-FI, and ADL-Katz, this study identified a patient group with a high (≥50%) 1-year mortality rate in all of the patients and the two patient subgroups (ie, patients aged 65–82 years and ≥83 years). The CFS-7, FI, FRAIL scale, CIRS-G, Comorbidity-D-FI, and IADL/ADL-D-FI (analyzed as full scales) revealed useful discriminative accuracy for 1-year mortality (ie, an area under the curve >0.7) in all the patients and the two patient subgroups (all P<0.001). Thereby, CFS-7 (in all patients and the two patient subgroups) and FI (in the subgroup of patients aged ≥83 years) showed greater discriminative accuracy for 1-year mortality compared to other instruments (all P<0.05). Conclusion All the different instruments emerged as suitable tools for risk stratification in geriatric inpatients. Among them, CFS-7, and in
McLeod, P J
To develop guidelines for conducting ward rounds, all trainees in the Department of Medicine residency program at Montreal General Hospital were asked to identify the clinical instructors who were most successful at conducting rounds. The nine instructors mentioned most often were asked to write a description of how they conducted ward rounds. The common characteristics were empathy to the needs of trainees, interest in being with and facilitating the learning of trainees at all levels, and accessibility. Implementation of the guidelines resulted in heightened awareness of the importance of the teaching function of clinical ward rounds as well as increased emphasis on making rounds useful and enjoyable. PMID:3955484
Khan, Qasim; Ismail, Mohammad; Haider, Iqbal; Khan, Fahadullah
Background QT prolongation and associated arrhythmias, torsades de pointes (TdP), are considerable negative outcomes of many antipsychotic and antidepressant agents frequently used by psychiatric patients. Objective To identify the prevalence, levels, and predictors of QT prolonging drug-drug interactions (QT-DDIs), and AZCERT (Arizona Center for Education and Research on Therapeutics) classification of drugs involved in QT-DDIs. Setting Psychiatry wards of three major tertiary care hospitals of Khyber-Pakhtunkhwa, Pakistan. Method This was a multicenter cross-sectional study. Micromedex DrugReax was used for identification of QT-DDIs. TdP risks were identified by the AZCERT classification. Multivariate logistic regression analysis was performed to identify predictors of QT-DDIs. Main outcome measure Prevalence of QT-DDIs (overall, age-wise and gender-wise) and their levels of severity and documentation; AZCERT classes of drugs involved in QT-DDIs; and odds ratios for predictors of QT-DDIs. Results Of 600 patients, 58.5% were female. Median age was 25 years (IQR = 20-35). Overall 51.7% patients had QT-DDIs. Of total 698 identified QT-DDIs, most were of major-severity (98.4%) and fair-documentation (93.7%). According to the AZCERT classification, 36.4% of the interacting drugs were included in list-1 (known risk of TdP), 26.9% in list-2 (possible risk of TdP) and 27.5% in list-3 (conditional risk of TdP). Drugs commonly involved in QT-DDI were olanzapine (n = 146), haloperidol (138), escitalopram (122), risperidone (91), zuclopenthixol (87), quetiapine (n80) and fluoxetine (74). In multivariate logistic regression analysis, QT-DDIs were significantly associated with 6-7 prescribed medications (p = 0.04) and >7 medications (p = 0.03). Similarly, there was significant association of occurrence of QT-DDIs with 2-3 QT drugs (p < 0.001) and >3 QT drugs (p < 0.001). Conclusion A considerable number of patients are exposed to QT-DDIs in psychiatry. There is a
Gniadek, Agnieszka; Krzyściak, Paweł; Twarużek, Magdalena; Macura, Anna B
The basic care requirement for patients with weakened immune systems is to create the environment where the risk of mycosis is reduced to a minimum. Between 2007 and 2013 air samples were collected from various wards of a number of hospitals in Kraków, Poland, by means of the collision method using MAS-100 Iso MH Microbial Air Sampler (Merck Millipore, Germany). The air mycobiota contained several species of fungi, and almost 1/3 of it was made up of the species of the Aspergillus genus. Sixty-one strains of species other than A. fumigatus were selected for the research purposes, namely: 28 strains of A. ochraceus, 22 strains of A. niger and 11 strains of A. flavus species. Selected fungi underwent a cytotoxicity evaluation with the application of the MTT colorimetric assay (3-(4,5-dimethylthiazol-2-yl)-2,5- diphenyltetrazolium bromide). The assay assesses cell viability by means of reducing the yellow tetrazolium salt to insoluble formazan. A semi-quantitative scale for cytotoxicity grading was adopted: low cytotoxic effect (+) with half maximal inhibitory concentration (IC50) for values ranging from 31.251 cm2/ml to 7.813 cm2/ml, medium cytotoxic effect (++) for values ranging from 3.906 cm2/ml to 0.977 cm2/ml and the high one (+++) for values ranging from 0.488 cm2/ml to 0.061 cm2/ml. The absence of cytotoxicity was determined when the IC50 values was at ≥ 50. For 48 samples the analyzed fungi displayed the cytotoxic effect with A. ochraceus in 26 out of 28 cases, with 11 strains displaying the high cytotoxic effect. The lowest cytotoxicity was displayed by fungi of A. niger in 13 out of 22 cases, and the major fungi of A. flavus species were toxic (9 out of 11 cases). A half of the fungi displayed the low cytotoxic effect. On the basis of the comparison of average cytotoxicity levels it was determined that there were
Verhofstede, Rebecca; Smets, Tinne; Cohen, Joachim; Costantini, Massimo; Van Den Noortgate, Nele; Deliens, Luc
The Care Programme for the Last Days of Life has been developed to improve the quality of end-of-life care in acute geriatric hospital wards. The programme is based on existing end-of-life care programmes but modeled to the acute geriatric care setting. There is a lack of evidence of the effectiveness of end-of-life care programmes and the effects that may be achieved in patients dying in an acute geriatric hospital setting are unknown. The aim of this paper is to describe the research protocol of a cluster randomized controlled trial to evaluate the effects of the Care Programme for the Last Days of Life. A cluster randomized controlled trial will be conducted. Ten hospitals with one or more acute geriatric wards will conduct a one-year baseline assessment during which care will be provided as usual. For each patient dying in the ward, a questionnaire will be filled in by a nurse, a physician and a family carer. At the end of the baseline assessment hospitals will be randomized to receive intervention (implementation of the Care Programme) or no intervention. Subsequently, the Care Programme will be implemented in the intervention hospitals over a six-month period. A one-year post-intervention assessment will be performed immediately after the baseline assessment in the control hospitals and after the implementation period in the intervention hospitals. Primary outcomes are symptom frequency and symptom burden of patients in the last 48 hours of life. This will be the first cluster randomized controlled trial to evaluate the effect of the Care Programme for the Last Days of Life for the acute geriatric hospital setting. The results will enable us to evaluate whether implementation of the Care Programme has positive effects on end-of-life care during the last days of life in this patient population and which components of the Care Programme contribute to improving the quality of end-of-life care. ClinicalTrials.gov Identifier: NCT01890239. Registered June 24th
4. FIRE BREAK BETWEEN PSYCHIATRIC WARD AND NEXT WARD TO THE SOUTH - Fort Randall, Neuro-Psychiatric Ward, Northeast of intersection of California Boulevard & Nurse Drive, Cold Bay, Aleutian Islands, AK
Methicillin-Resistant Staphylococcus aureus (MRSA) Contamination in Bedside Surfaces of a Hospital Ward and the Potential Effectiveness of Enhanced Disinfection with an Antimicrobial Polymer Surfactant
Yuen, John W. M.; Chung, Terence W. K.; Loke, Alice Y.
The aim in this study was to assess the effectiveness of a quaternary ammonium chloride (QAC) surfactant in reducing surface staphylococcal contamination in a routinely operating medical ward occupied by patients who had tested positive for methicillin-resistant Staphylococcus aureus (MRSA). The QAC being tested is an antibacterial film that is sprayed onto a surface and can remain active for up to 8 h. A field experimental study was designed with the QAC plus daily hypochlorite cleaning as the experimental group and hypochlorite cleaning alone as the control group. The method of swabbing on moistened surfaces was used for sampling. It was found that 83% and 77% of the bedside surfaces of MRSA-positive and MRSA-negative patients respectively were contaminated with staphylococci at 08:00 hours, and that the staphylococcal concentrations increased by 80% at 1200 h over a 4-hour period with routine ward and clinical activities. Irrespective of the MRSA status of the patients, high-touch surfaces around the bed-units within the studied medical ward were heavily contaminated (ranged 1 to 276 cfu/cm2 amongst the sites with positive culture) with staphylococcal bacteria including MRSA, despite the implementation of daily hypochlorite wiping. However, the contamination rate dropped significantly from 78% to 11% after the application of the QAC polymer. In the experimental group, the mean staphylococcal concentration of bedside surfaces was significantly (p < 0.0001) reduced from 4.4 ± 8.7 cfu/cm2 at 08:00 hours to 0.07 ± 0.26 cfu/cm2 at 12:00 hours by the QAC polymer. The results of this study support the view that, in addition to hypochlorite wiping, the tested QAC surfactant is a potential environmental decontamination strategy for preventing the transmission of clinically important pathogens in medical wards. PMID:25768241
Methicillin-resistant Staphylococcus aureus (MRSA) contamination in bedside surfaces of a hospital ward and the potential effectiveness of enhanced disinfection with an antimicrobial polymer surfactant.
Yuen, John W M; Chung, Terence W K; Loke, Alice Y
The aim in this study was to assess the effectiveness of a quaternary ammonium chloride (QAC) surfactant in reducing surface staphylococcal contamination in a routinely operating medical ward occupied by patients who had tested positive for methicillin-resistant Staphylococcus aureus (MRSA). The QAC being tested is an antibacterial film that is sprayed onto a surface and can remain active for up to 8 h. A field experimental study was designed with the QAC plus daily hypochlorite cleaning as the experimental group and hypochlorite cleaning alone as the control group. The method of swabbing on moistened surfaces was used for sampling. It was found that 83% and 77% of the bedside surfaces of MRSA-positive and MRSA-negative patients respectively were contaminated with staphylococci at 08:00 hours, and that the staphylococcal concentrations increased by 80% at 1200 h over a 4-hour period with routine ward and clinical activities. Irrespective of the MRSA status of the patients, high-touch surfaces around the bed-units within the studied medical ward were heavily contaminated (ranged 1 to 276 cfu/cm2 amongst the sites with positive culture) with staphylococcal bacteria including MRSA, despite the implementation of daily hypochlorite wiping. However, the contamination rate dropped significantly from 78% to 11% after the application of the QAC polymer. In the experimental group, the mean staphylococcal concentration of bedside surfaces was significantly (p<0.0001) reduced from 4.4±8.7 cfu/cm2 at 08:00 hours to 0.07±0.26 cfu/cm2 at 12:00 hours by the QAC polymer. The results of this study support the view that, in addition to hypochlorite wiping, the tested QAC surfactant is a potential environmental decontamination strategy for preventing the transmission of clinically important pathogens in medical wards.
Kazemi, Alireza; Ellenius, Johan; Pourasghar, Faramarz; Tofighi, Shahram; Salehi, Aref; Amanati, Ali; Fors, Uno G H
Medication dosing errors are frequent in neonatal wards. In an Iranian neonatal ward, a 7.5 months study was designed in three periods to compare the effect of Computerized Physician Order Entry (CPOE) without and with decision support functionalities in reducing non-intercepted medication dosing errors in antibiotics and anticonvulsants. Before intervention (Period 1), error rate was 53%, which did not significantly change after the implementation of CPOE without decision support (Period 2). However, errors were significantly reduced to 34% after that the decision support was added to the CPOE (Period 3; P < 0.001). Dose errors were more often intercepted than frequency errors. Over-dose was the most frequent type of medication errors and curtailed-interval was the least. Transcription errors did not reduce after the CPOE implementation. Physicians ignored alerts when they could not understand why they appeared. A suggestion is to add explanations about these reasons to increase physicians' compliance with the system's recommendations.
O'Hare, James A
The ward round has been a central activity of hospital life for hundreds of years. It is hardly mentioned in textbooks. The ward round is a parade through the hospital of professionals where most decision making concerning patient care is made. However the traditional format may be intimidating for patients and inadequate for communication. The round provides an opportunity for the multi-disciplinary team to listen to the patient's narrative and jointly interpret his concerns. From this unfolds diagnosis, management plans, prognosis formation and the opportunity to explore social, psychological, rehabilitation and placement issues. Physical examination of the patient at the bedside still remains important. It has been a tradition to discuss the patient at the bedside but sensitive matters especially of uncertainty may better be discussed elsewhere. The senior doctor as round leader must seek the input of nursing whose observations may be under-appreciated due to traditional professional hierarchy. Reductions in the working hours of junior doctors and shortened length of stay have reduced continuity of patient care. This increases the importance of senior staff in ensuring continuity of care and the need for the joint round as the focus of optimal decision making. The traditional round incorporates teaching but patient's right to privacy and their preferences must be respected. The quality and form of the clinical note is underreported but the electronic record is slow to being accepted. The traditional multi-disciplinary round is disappearing in some centres. This may be regrettable. The anatomy and optimal functioning of the ward round deserves scientific scrutiny and experimentation.
Fukuzaki, Toshiki; Tanihara, Hiroyuki
To demonstrate the actual state of job stress and burnout among nurses and care workers working in psychiatric wards by comparing them with those who serve in internal medicine wards. A survey was conducted of female ward nurses and care workers working at two psychiatric hospitals and two general hospitals in the Chugoku area using the brief job stress questionnaire and the Maslach burnout inventory-Japanese version. A total of 232 female nurses and care workers were analyzed, 125 from psychiatric wards and 107 from internal medicine wards. Job stressors of stress due to workplace environment, job control, skill utilization, job aptitude and worthwhileness of working life were significantly greater in psychiatric wards than in internal medicine wards. Stress of quantitative and qualitative workloads, however, was significantly lower in psychiatric wards than in internal medicine wards. For job stress reaction, vigor was significantly lower in psychiatric wards than in internal medicine wards. For burnout, psychiatric wards scored significantly higher in depersonalization and reduced personal accomplishment compared with internal medicine wards. Reviewing these results and their association with stress control policy in psychiatric wards, we suggest that three factors are important: maintaining working environment, enhancing conferences, and providing learning opportunities.
Brown, S C; Schoeman, C J; Bester, C J
The aim of this prospective observational study was to determine the presence of cardiac abnormalities in HIV infected versus uninfected children who were admitted to a general paediatric ward during a two-month period. HIV status was determined by antibody and p24 antigen testing. Clinical information, echocardiography and electrocardiography (ECG) were performed for all children. There were 90 HIV-infected and 118 uninfected children. The median age was 9.6 and 11.8 months for infected and uninfected children, respectively. Baseline left ventricular dysfunction, defined as a shortening fraction < or = 25%, was found in 13 (17%) of the HIV-infected children compared to 5 (8%) uninfected children (p < 0.05). Left ventricular end-diastolic enlargement above the 98th percentile for age was found in 24% of the infected and 20% of uninfected children. Pericardial effusions, although common, were sub-clinical and not different in the groups. ECG findings and resting heart rates were also similar. Left ventricular dysfunction was the most significant cardiac abnormality present in hospitalised HIV-infected children. Other abnormalities, although common, were mostly asymptomatic and found with the same frequency in uninfected children. Further studies are indicated.
Brighton, Lisa Jane; Koffman, Jonathan; Robinson, Vicky; Khan, Shaheen A; George, Rob; Burman, Rachel; Selman, Lucy Ellen
Over half of all deaths in Europe occur in hospital, a location associated with many complaints. Initiatives to improve inpatient end-of-life care are therefore a priority. In England, over 78,000 volunteers provide a potentially cost-effective resource to hospitals. Many work with people who are dying and their families, yet little is known about their training in end-of-life care. To explore hospital volunteers' end-of-life care training needs and learning preferences, and the acceptability of training evaluation methods. Qualitative focus groups. Volunteers from a large teaching hospital were purposively sampled. Five focus groups were conducted with 25 hospital volunteers (aged 19-80 years). Four themes emerged as follows: preparation for the volunteering role, training needs, training preferences and evaluation preferences. Many described encounters with patients with life-threatening illness and their families. Perceived training needs in end-of-life care included communication skills, grief and bereavement, spiritual diversity, common symptoms, and self-care. Volunteers valued learning from peers and end-of-life care specialists using interactive teaching methods including real-case examples and role plays. A chance to 'refresh' training at a later date was suggested to enhance learning. Evaluation through self-reports or observations were acceptable, but ratings by patients, families and staff were thought to be pragmatically unsuitable owing to sporadic contact with each. Gaps in end-of-life care training for hospital volunteers indicate scope to maximise on this resource. This evidence will inform development of training and evaluations which could better enable volunteers to make positive, cost-effective contributions to end-of-life care in hospitals.
Rosu, Grigore; Goguen, Joseph; Norvig, Peter (Technical Monitor)
Circular coinduction is a technique for behavioral reasoning that extends cobasis coinduction to specifications with circularities. Because behavioral satisfaction is not recursively enumerable, no algorithm can work for every behavioral statement. However. algorithms using circular coinduction can prove every practical behavioral result that we know. This paper proves the correctness of circular coinduction and some consequences.
Alam, Tahmina; Ahmed, Tahmeed; Sarmin, Monira; Shahrin, Lubaba; Afroze, Farzana; Sharifuzzaman; Akhter, Shamima; Shahunja, K M; Shahid, Abu Sadat Mohammad Sayeem Bin; Bardhan, Pradip Kumar; Chisti, Mohammod Jobayer
Children with diarrhea hospitalized for respiratory distress often have fatal outcome in resource-limited settings, although data are lacking on risk factors for death in such children. We sought to evaluate clinical predictors for death in such children. In this prospective cohort study, we enrolled under-5 children with diarrhea admitted with severe respiratory distress to the intensive care unit of Dhaka Hospital of International Centre for Diarhoeal Disease Research, Bangladesh, from September 2014 through September 2015. We compared clinical and laboratory characteristics between study children those who died (n = 29) and those who survived (n = 62). In logistic regression analysis, after adjusting for potential confounders, the independent predictors for death in children hospitalized for diarrhea and severe respiratory distress were severe sepsis and hypoglycemia (P < .05 for all). Thus, recognition of these simple parameters may help clinicians identify children with diarrhea at risk of deaths in order to initiate prompt management for the better outcome, especially in resource-poor settings.
Welch, J P; Sims, N; Ford-Carlton, P; Moon, J B; West, K; Honore, G; Colquitt, N
The article describes a study conducted on general surgical and thoracic surgical floors of a 1000-bed hospital to assess the impact of a new network for portable patient care devices. This network was developed to address the needs of hospital patients who need constant, multi-parameter, vital signs surveillance, but do not require intensive nursing care. Bedside wall jacks were linked to UNIX-based workstations using standard digital network hardware, creating a flexible system (for general care floors of the hospital) that allowed the number of monitored locations to increase and decrease as patient census and acuity levels varied. It also allowed the general care floors to provide immediate, centralized vital signs monitoring for patients who unexpectedly became unstable, and permitted portable monitors to travel with patients as they were transferred between hospital departments. A disk-based log within the workstation automatically collected performance data, including patient demographics, monitor alarms, and network status for analysis. The log has allowed the developers to evaluate the use and performance of the system.
Welch, J. P.; Sims, N.; Ford-Carlton, P.; Moon, J. B.; West, K.; Honore, G.; Colquitt, N.
The article describes a study conducted on general surgical and thoracic surgical floors of a 1000-bed hospital to assess the impact of a new network for portable patient care devices. This network was developed to address the needs of hospital patients who need constant, multi-parameter, vital signs surveillance, but do not require intensive nursing care. Bedside wall jacks were linked to UNIX-based workstations using standard digital network hardware, creating a flexible system (for general care floors of the hospital) that allowed the number of monitored locations to increase and decrease as patient census and acuity levels varied. It also allowed the general care floors to provide immediate, centralized vital signs monitoring for patients who unexpectedly became unstable, and permitted portable monitors to travel with patients as they were transferred between hospital departments. A disk-based log within the workstation automatically collected performance data, including patient demographics, monitor alarms, and network status for analysis. The log has allowed the developers to evaluate the use and performance of the system. PMID:1807720
Papoulias, Constantina; Csipke, Emese; Rose, Diana; McKellar, Susie; Wykes, Til
Hospital care is still an integral part of mental healthcare services. But the impact of ward design on treatment outcomes is unclear. To review the effects of ward design on patient outcomes and patient and staff well-being. A systematic review of literature was carried out on Medline, Embase and PsycINFO. Papers on psychogeriatric and child and adolescent wards were excluded as these necessitate specific safety features. Twenty-three papers were identified. No strong causal links between design and clinical outcomes were found. Private spaces and a homely environment may contribute to patient well-being. Different stakeholders may experience ward design in conflicting ways; design has a symbolic and social dimension for patients. Data on the impact of design on treatment outcomes are inconclusive. Rigorous randomised controlled trials, qualitative studies and novel methods are called for. Different stakeholders' responses to the ward as a symbolic environment merit further investigation. Royal College of Psychiatrists.
Double, D; MacPherson, R; Wong, T
A random sample of those admitted to acute psychiatric wards in Sheffield in 1985 was traced to establish whether or not the patients were homeless 5 years later. Contrary to expectations none were found to be homeless. Although the proportion of mentally ill amongst the homeless may be significantly high, the number discharged from psychiatric hospital, at least in Sheffield, living consistently 'on the streets' or staying regularly in night shelters seems small as a proportion of all discharges.
Double, D; MacPherson, R; Wong, T
A random sample of those admitted to acute psychiatric wards in Sheffield in 1985 was traced to establish whether or not the patients were homeless 5 years later. Contrary to expectations none were found to be homeless. Although the proportion of mentally ill amongst the homeless may be significantly high, the number discharged from psychiatric hospital, at least in Sheffield, living consistently 'on the streets' or staying regularly in night shelters seems small as a proportion of all discharges. PMID:8410893
Silvana, Salerno; Laura, Forcella; Ursula, Di Fabio; Irene, Figà Talamanca; Paolo, Boscolo
Patient's aggressive behavior is one of the major problem in the psychiatric ward. Here we present the preliminary results of a psychiatric ward case-study, of a public hospital in the Chieti province, in order to plan ergonomic improvement. We applied the Method of Organizational Congruencies in the psychiatric ward in order to study the relationship between organized hospital work and nurses wellbeing in a 24 hour shifts. We observed 58 main phases in the three work shifts. The technical actions are mainly those of any hospital wards (shift briefing, preparing and administering drugs, recording data on clinical charts, etc.). We found important differences mainly due to the nurses overcontrol activities on the patients behavior (preventing suicides or self destructive behavior), the occurrence of restraint procedure towards patients, the pollution due to patient's cigarette smoke. The fear of patient's self destructive behavior or other aggressive behaviour are the main cognitive and social aspects of this hospital ward. Nurses working in this psychiatric ward have to accept: locked doors, poor and polluted environment, restraint procedure with high risk of aggression and no availability of mental health care programs. A new interdisciplinary concept for ergonomics in psychiatry setting may represent a challenge for both nurses and patients and the community.
Lurkittikul, N.; Kittithreerapronchai, O.
The aging population and the introduction of Thailand universal healthcare have increased inpatients and outpatients to public hospitals, particularly to a hospital that provides special and comprehensive health services. Many inpatient wards have experienced large influx of inpatients as the hospitals have to admit all patients regardless their conditions. These overcrowding wards cause stress to medical staffs, block access between medical departments, hospital-acquired infections, and ineffective uses of resources. One way to manage such inundated inpatient is to select some patients whose conditions require less clinical attention or whose lengths of stay are predictable and short and, then, place them at an observation ward. This intermediate ward increases turnover of beds and reduces unnecessary paperwork as patients are considered to be outpatients. In this article, we studied inpatient data of a tertiary care hospital in which an observation ward was considered to alleviate the overcrowding problem at Internal Medicine Department. The analysis of data showed that the hospital can balance inpatient flow by managing a group of patients who is admitted because of treatments ordered by its special clinics. Having explored several alternatives, we suggested patient selection criteria and proposed a layout at an observation ward. The hospital should increase medical beds in a new building ward because the current observation ward can handle 27.3% of total short stay patients, while the observation ward is projected to handle 80% of total short stay patients.
Mousavi, Maryam; Khalili, Hossein; Dashti-Khavidaki, Simin
Intravenous fluid therapy remains an essential part of patients' care during hospitalization. There are only few studies that focused on fluid therapy in the hospitalized patients, and there is not any consensus statement about fluid therapy in patients who are hospitalized in medical wards. The aim of the present study was to assess intravenous fluid therapy status and related errors in the patients during the course of hospitalization in the infectious diseases wards of a referral teaching hospital. This study was conducted in the infectious diseases wards of Imam Khomeini Complex Hospital, Tehran, Iran. During a retrospective study, data related to intravenous fluid therapy were collected by two clinical pharmacists of infectious diseases from 2008 to 2010. Intravenous fluid therapy information including indication, type, volume and rate of fluid administration was recorded for each patient. An internal protocol for intravenous fluid therapy was designed based on literature review and available recommendations. The data related to patients' fluid therapy were compared with this protocol. The fluid therapy was considered appropriate if it was compatible with the protocol regarding indication of intravenous fluid therapy, type, electrolyte content and rate of fluid administration. Any mistake in the selection of fluid type, content, volume and rate of administration was considered as intravenous fluid therapy errors. Five hundred and ninety-six of medication errors were detected during the study period in the patients. Overall rate of fluid therapy errors was 1.3 numbers per patient during hospitalization. Errors in the rate of fluid administration (29.8%), incorrect fluid volume calculation (26.5%) and incorrect type of fluid selection (24.6%) were the most common types of errors. The patients' male sex, old age, baseline renal diseases, diabetes co-morbidity, and hospitalization due to endocarditis, HIV infection and sepsis are predisposing factors for the
Hospital Acquired Pneumonia Due to Achromobacter spp. in a Geriatric Ward in China: Clinical Characteristic, Genome Variability, Biofilm Production, Antibiotic Resistance and Integron in Isolated Strains
Liu, Chao; Pan, Fei; Guo, Jun; Yan, Weifeng; Jin, Yi; Liu, Changting; Qin, Long; Fang, Xiangqun
Background: Hospital-acquired pneumonia (HAP) due to Achromobacter has become a substantial concern in recent years. However, HAP due to Achromobacter in the elderly is rare. Methods: A retrospective analysis was performed on 15 elderly patients with HAP due to Achromobacter spp., in which the sequence types (STs), integrons, biofilm production and antibiotic resistance of the Achromobacter spp. were examined. Results: The mean age of the 15 elderly patients was 88.8 ± 5.4 years. All patients had at least three underlying diseases and catheters. Clinical outcomes improved in 10 of the 15 patients after antibiotic and/or mechanical ventilation treatment, but three patients had chronic infections lasting more than 1 year. The mortality rate was 33.3% (5/15). All strains were resistant to aminoglycosides, aztreonam, nitrofurantoin, and third- and fourth-generation cephalosporins (except ceftazidime and cefoperazone). Six new STs were detected. The most frequent ST was ST306. ST5 was identified in two separate buildings of the hospital. ST313 showed higher MIC in cephalosporins, quinolones and carbapenems, which should be more closely considered in clinical practice. All strains produced biofilm and had integron I and blaOXA-114-like. The main type was blaOXA-114q. The variable region of integron I was different among strains, and the resistance gene of the aminoglycosides was most commonly inserted in integron I. Additionally, blaPSE-1 was first reported in this isolate. Conclusion: Achromobacter spp. infection often occurs in severely ill elders with underlying diseases. The variable region of integrons differs, suggesting that Achromobacter spp. is a reservoir of various resistance genes. PMID:27242678
Hospital Acquired Pneumonia Due to Achromobacter spp. in a Geriatric Ward in China: Clinical Characteristic, Genome Variability, Biofilm Production, Antibiotic Resistance and Integron in Isolated Strains.
Liu, Chao; Pan, Fei; Guo, Jun; Yan, Weifeng; Jin, Yi; Liu, Changting; Qin, Long; Fang, Xiangqun
Hospital-acquired pneumonia (HAP) due to Achromobacter has become a substantial concern in recent years. However, HAP due to Achromobacter in the elderly is rare. A retrospective analysis was performed on 15 elderly patients with HAP due to Achromobacter spp., in which the sequence types (STs), integrons, biofilm production and antibiotic resistance of the Achromobacter spp. were examined. The mean age of the 15 elderly patients was 88.8 ± 5.4 years. All patients had at least three underlying diseases and catheters. Clinical outcomes improved in 10 of the 15 patients after antibiotic and/or mechanical ventilation treatment, but three patients had chronic infections lasting more than 1 year. The mortality rate was 33.3% (5/15). All strains were resistant to aminoglycosides, aztreonam, nitrofurantoin, and third- and fourth-generation cephalosporins (except ceftazidime and cefoperazone). Six new STs were detected. The most frequent ST was ST306. ST5 was identified in two separate buildings of the hospital. ST313 showed higher MIC in cephalosporins, quinolones and carbapenems, which should be more closely considered in clinical practice. All strains produced biofilm and had integron I and blaOXA-114-like . The main type was blaOXA-114q . The variable region of integron I was different among strains, and the resistance gene of the aminoglycosides was most commonly inserted in integron I. Additionally, blaPSE-1 was first reported in this isolate. Achromobacter spp. infection often occurs in severely ill elders with underlying diseases. The variable region of integrons differs, suggesting that Achromobacter spp. is a reservoir of various resistance genes.
[The assessment of exposure to and the activity of the manual lifting of patients in wards: methods, procedures, the exposure index (MAPO) and classification criteria. Movimientazione e Assistenza Pazienti Ospedalizzati (Lifting and Assistance to Hospitalized Patients)].
Menoni, O; Ricci, M G; Panciera, D; Occhipinti, E
Since a method for quantifying exposure to patient handling in hospital wards is lacking, the authors describe and propose a model for identifying the main risk factors in this type of occupational exposure: presence of disabled patients, staff engaged on manual handling of patients, structure of the working environment, equipment and aids for moving patients, training of workers according to the specific risk. For each factor a procedure for identification and assessment is proposed that is easily applicable in practice. The authors also propose a formula for the calculation of a condensed exposure index (MAPO Index), which brings together the various factors. The exposure index, which requires further, detailed study and validation, makes it possible, in practice, to plan the preventive and health measures according to a specific order of priority, thus complying with the requirements of Chapter V of Law 626/94. From a practical point of view, in the present state of knowledge, it can be stated that for MAPO Index values between 0 and 1.5, risk is deemed negligible, average for values between 1.51 and 5, and high for values exceeding 5.
1. Streetscape of north ends of Detention Wards, Building Nos. 9946-B (left) and 9945-B (middle). Walled-in courtyard adjoins Building No. 9944-B at extreme right edge. Steam plant is in distance. This photo makes a panorama with photo WA-202-10-2. - Madigan Hospital, Detention Wards, Bounded by Wilson & McKinley Avenues & Garfield & Lincoln Streets, Tacoma, Pierce County, WA
Dean, Linda; Black, Sharon
This paper reports on a study of experiences of young people aged 14 to 18 years who were nursed on acute adult hospital wards in NHS hospitals in England. In spite of British government guidelines, young people from 14 years of age continue to be admitted to adult wards in the UK. Although much has been written about the transition of the young person to adult services, there is little research about the experiences of young people who are nursed on adult wards. Hermeneutic phenomenology was used to explore the lived experiences of eight young people who had been nursed on adult wards between 2004 and 2010. Data were collected in 2010. In-depth interviews were recorded, transcribed and analysed using Colaizzi's framework ( Colaizzi, 1978 ). Themes explored included expectations of what the experience may be like, young people's first impressions of the ward environment, the feelings of the young person while in hospital, the attitudes of people towards them including, both staff and other patients, and future admissions and how they would cope with readmissions. Better provision needs to be made for young people including appropriately trained staff, adolescent-friendly environments and areas in adult wards that are dedicated to adolescents.
Mekango, Dejene Ermias; Alemayehu, Mussie; Gebregergs, Gebremedhin Berhe; Medhanyie, Araya Abrha; Goba, Gelila
In Ethiopia, 20,000 women die each year from complications related to pregnancy, childbirth and post-partum. For every woman that dies, 20 more experience injury, infection, disease, or disability. "Maternal near miss" (MNM), defined by the World Health Organization (WHO) as a woman who nearly dies, but survives a complication during pregnancy, childbirth or within 42 days of a termination, is a proxy indicator of maternal mortality and quality of obstetric care. In Ethiopia, few studies have examined MNM. This study aims to identify determinants of MNM among a small population of women in Tigray, Ethiopia. Unmatched case-control study was conducted in hospitals in Tigray Region, Northern Ethiopia, from January 30-March 30, 2016. The sample included 103 cases and 205 controls recruited from among women seeking obstetric care at six (6) public hospitals. Clients with life-threatening obstetric complications, including hemorrhage, hypertensive diseases of pregnancy, dystocia, infection, and anemia or clinical signs of severe anemia (in women without hemorrhage) were taken as cases and those with normal obstetric outcomes were controls. Cases were selected based on proportion to size allocation while systematic sampling was employed for controls. Binary and multiple variable logistic regression ("odds ratio") analyses were calculated at 95% CI. Roughly 90% of cases and controls were married and 25% experienced their first pregnancy before the age of 16 years. About two-thirds of controls and 45.6% of cases had gestational ages between 37-41 weeks. Among cases, severe obstetric hemorrhage (44.7%), hypertensive disorders (38.8%), dystocia (17.5%), sepsis (9.7%) and severe anemia (2.9%) were leading causes of MNM. Histories of chronic maternal medical problems like hypertension, diabetes were reported in 55.3% of cases and 33.2% of controls. Women with no formal education [AOR = 3.2;95%CI:1.24, 8.12], being less than 16 years of age at first pregnancy [AOR = 2.5;95%CI:1
Background Snake bite is a common problem in the North Central province of Sri Lanka. Common krait (Bungarus careuleus), Ceylon krait (Bungarus ceylonicus), Cobra (Naja naja), Russell’s viper (Daboia russelii), Saw-scaled viper (Echis carinatus) and Hump-nosed pit viper (Hypnale hypnale) are the six species of venomous land snakes in Sri Lanka. A significant number of adults and children are bitten by snakes every year. However, the majority of research studies done in Sri Lanka and other countries show adults bitten by snakes and studies describing children bitten by snakes are very sparse. Methods A descriptive cross sectional study was performed in the Teaching Hospital Anuradhapura in the North Central Province of Sri Lanka from May 2010 to 2011 May to describe the characteristics associated with cases of snake bite. Results There were 24 males and 20 females. The highest numbers of bites (48%) were in the range of ages 6-12 years. The majority of the bites occurred between 6 pm to 6 am (59%).The foot was the most common bitten site (48%). Out of all the venomous bites, the Hump-nosed pit viper (Hypnale hypnale) accounted for the highest number (44%) and Russell’s viper (Daboia ruselii) accounted for the second highest number (27%). A significant number of venomous bites occurred indoors while sleeping (22%). Antivenom serum was given to (39%) of venomous bites. Deaths occurred in (11%) of the venomous bites. Conclusions Hump-nosed pit viper (Hypnale hypnale) accounted for the highest number of venomous bites. Majority of the bites occurred between 6 pm and 6 am. Foot was the most common bitten site. A significant number of venomous bites occurred indoor while sleeping. Antivenom serum was given to a significant number of venomous bites. Educating the public on making their houses snake proof and using a torch when going out during night time will help in the prevention of getting bitten by snakes. PMID:25073710
Levett, Tom; Caldwell, Gordon
The post-take ward round (PTWR) provides formal consultant review of acutely unwell patients admitted to hospital, yet specialist medical registrars, the consultants of tomorrow, receive little to no formal training in this area. There is an expectation that 'on the job' experience will provide sufficient preparation for this important aspect of clinical leadership. We aimed to seek the opinions of medical registrars on the use of a structured considerative checklist and learning-by-example approach in PTWR leadership training, assessing whether this model influences current and future practice. This was studied through a questionnaire-based survey of medical registrars working in Worthing Hospital from 2009 to 2011. Eighteen of 25 registrars (72%) across a range of specialties returned questionnaires. Although a third of respondents had spent time considering how they conduct ward rounds, none had received formal training, with most feeling that ward round skills were acquired 'on the job' from observation and experience of those conducted by senior colleagues. Exposure to the considerative checklist changed thinking in 94 per cent and changed practice in 88 per cent. Common positive themes included enhanced pre-ward round preparation, the importance of inclusion and communication, and the need for structure (facilitated by physical or mental checklist). Seventeen of 18 participants felt that this training would influence their consultant practice. Trainees respond positively to participation in a structured PTWR using a considerative checklist as a model of good practice, leading to changes in their current and future practice, and could be considered as a training tool. © 2014 John Wiley & Sons Ltd.
Luzzati, Roberto; Merelli, Maria; Ansaldi, Filippo; Rosin, Chiara; Azzini, Annamaria; Cavinato, Silvia; Brugnaro, Pierluigi; Vedovelli, Claudio; Cattelan, Annamaria; Marina, Busetti; Gatti, Giuseppe; Concia, Ercole; Bassetti, Matteo
Risk factors for nosocomial candidemia, severity of sepsis, treatment, and outcome were compared between patients admitted to medicine wards and those to surgical and intensive care units (ICUs). Data were retrospectively collected from patients belonging to six referral hospitals in Italy between January 2011 and December 2013. Risk factors for 30-day mortality were evaluated in the whole patient population. A total of 686 patients (mean age 70 ± 15 years) with candidemia were included. 367 (53.5 %) patients were in medicine wards, and 319 in surgery and ICUs. Host-related risk factors for candidemia were more common in medicine patients whereas healthcare-related factors in surgery/ICU patients. These patients showed severe sepsis and septic shock more commonly (71.7 %) than medicine patients (59.9 %) (p 0.003). The latter underwent central venous catheter (CVC) removal and adequate antifungal therapy less frequently than surgery/ICU patients. 149 (40.6 %) patients died with candidemia in medicine wards and 69 (21.6 %) in other wards (p < 0.001). Overall, the 30-day mortality was 36.3 %. At multivariate analysis, independent risk factors for death were aging, higher Charlson score, severe sepsis and septic shock, and no antifungal therapy, while major surgery and CVC removal were associated with higher probability of survival. The burden of risk factors for candidemia was different between medicine patients and those in other wards. Despite the lower severity of candidemia in medicine patients, their mortality turned out to be higher than in surgery or ICU patients. Awareness of the best management of candidemia should be pursued, especially in medicine wards.
Fenton, Katherine; Phillips, Natasha
The Francis report has called for a strengthening of the ward sister's role. It recommends that sisters should operate in a supervisory capacity and should not be office bound. Effective ward leadership has been recognised as being vital to high-quality patient care and experience, resource management and interprofessional working. However, there is evidence that ward sisters are ill equipped to lead effectively and lack confidence in their ability to do so. University College London Hospitals Foundation Trust has recognised that the job has become almost impossible in increasingly large and complex organisations. Ward sisters spend less than 40% of their time on clinical leadership and the trust is undertaking a number of initiatives to support them in this role.
Lata, Stanisław; Janiszewski, Jacek
The thesis presents a short history and organization of an acute poisoning centre in the1995 functioning within the internal diseases department in a multi-profile provincial hospital. The data show the number of patients treated beetween 1995-2009 an the types of toxic substances that caused poisoning. The conclusions presented refer to the role of the centre to help people suffering from acute poisoning within the city of Tarnow.
Lee, Paul D.
Provides a period-long activity using battery powered cars rolling in a circular motion on a tile floor. Students measure the time and distance as the car moves to derive the equation for centripetal acceleration. (MVL)
Lee, Paul D.
Provides a period-long activity using battery powered cars rolling in a circular motion on a tile floor. Students measure the time and distance as the car moves to derive the equation for centripetal acceleration. (MVL)
Bate, J. G.
Current trends in ward flooring materials and cleaning methods are considered from the point of view of the hospital bacteriologist. Methods employed in an investigation into the bacteriological safety of a number of floor-cleaning machines are described, and some considerations governing the choice of vacuum cleaners for ward use are discussed. Images PMID:13687726
Vanjak, Dominique; Girault, Guillaume; Branger, Catherine; Rufat, Pierre; Valla, Dominique-Charles; Fantin, Bruno
During 2001, Clostridium difficile infection was observed in 23 patients hospitalized in a hepatology ward (attack rate, 0.9%). Since strain typing ruled out a clonal dissemination, we performed a case-control study. In addition to antibiotic use as a risk factor, the C. difficile infection rate was higher among patients with autoimmune hepatitis (P<.01).
Lantta, Tella; Anttila, Minna; Kontio, Raija; Adams, Clive E; Välimäki, Maritta
Patient violence against nurses in their work environments is a widespread global concern, particularly in the field of mental health care. A high prevalence of violent events impacts the well-being of nurses and may also impair overall ward climate. However, it has been proposed that nurses' use limited techniques to prevent patient violence, and, therefore, more comprehensive methods for dealing with patient violence are needed. There is still restricted understanding of the ward climate during the occurrence of a violent event as well as how these incidents could be more effectively prevented. This study aimed to explore nurses' experiences of violent events in psychiatric wards, give insight into ward climates and examine suggestions for violence prevention. This study employed a descriptive, exploratory design including focus groups (n = 5) and open-ended questions. The participants were registered and enrolled nurses (n = 22) working on three closed psychiatric in-patient wards in one Finnish hospital district. Focus groups were tape-recorded, transcribed and analyzed with inductive content analysis. Nurses' experiences of violent events included a variety of warning signs and high-risk situations which helped them to predict forthcoming violence. Patient-instigated violent events were described as complicated situations involving both nurses and patients. When the wards were overloaded with work or emotions, or if nurses had become cynical from dealing with such events, well-being of nurses was impaired and nursing care was complicated. Suggestions for violence prevention were identified, and included, for example, more skilled interaction between nurses and patients and an increase in contact between nurses and patients on the ward. This study revealed the complexity of violent events on psychiatric wards as well as the implications of these events on clinical practice development and training, administration and policy. A routine process is needed
Background Previous research on mental health care has shown considerable differences in use of seclusion, restraint and involuntary medication among different wards and geographical areas. This study investigates to what extent use of seclusion, restraint and involuntary medication for involuntary admitted patients in Norwegian acute psychiatric wards is associated with patient, staff and ward characteristics. The study includes data from 32 acute psychiatric wards. Methods Multilevel logistic regression using Stata was applied with data from 1016 involuntary admitted patients that were linked to data about wards. The sample comprised two hierarchical levels (patients and wards) and the dependent variables had two values (0 = no use and 1 = use). Coercive measures were defined as use of seclusion, restraint and involuntary depot medication during hospitalization. Results The total number of involuntary admitted patients was 1214 (35% of total sample). The percentage of patients who were exposed to coercive measures ranged from 0-88% across wards. Of the involuntary admitted patients, 424 (35%) had been secluded, 117 (10%) had been restrained and 113 (9%) had received involuntary depot medication at discharge. Data from 1016 patients could be linked in the multilevel analysis. There was a substantial between-ward variance in the use of coercive measures; however, this was influenced to some extent by compositional differences across wards, especially for the use of restraint. Conclusions The substantial between-ward variance, even when adjusting for patients' individual psychopathology, indicates that ward factors influence the use of seclusion, restraint and involuntary medication and that some wards have the potential for quality improvement. Hence, interventions to reduce the use of seclusion, restraint and involuntary medication should take into account organizational and environmental factors. PMID:20370928
Husum, Tonje Lossius; Bjørngaard, Johan Håkon; Finset, Arnstein; Ruud, Torleif
Previous research on mental health care has shown considerable differences in use of seclusion, restraint and involuntary medication among different wards and geographical areas. This study investigates to what extent use of seclusion, restraint and involuntary medication for involuntary admitted patients in Norwegian acute psychiatric wards is associated with patient, staff and ward characteristics. The study includes data from 32 acute psychiatric wards. Multilevel logistic regression using Stata was applied with data from 1016 involuntary admitted patients that were linked to data about wards. The sample comprised two hierarchical levels (patients and wards) and the dependent variables had two values (0 = no use and 1 = use). Coercive measures were defined as use of seclusion, restraint and involuntary depot medication during hospitalization. The total number of involuntary admitted patients was 1214 (35% of total sample). The percentage of patients who were exposed to coercive measures ranged from 0-88% across wards. Of the involuntary admitted patients, 424 (35%) had been secluded, 117 (10%) had been restrained and 113 (9%) had received involuntary depot medication at discharge. Data from 1016 patients could be linked in the multilevel analysis. There was a substantial between-ward variance in the use of coercive measures; however, this was influenced to some extent by compositional differences across wards, especially for the use of restraint. The substantial between-ward variance, even when adjusting for patients' individual psychopathology, indicates that ward factors influence the use of seclusion, restraint and involuntary medication and that some wards have the potential for quality improvement. Hence, interventions to reduce the use of seclusion, restraint and involuntary medication should take into account organizational and environmental factors.
Background Recent guidance advocates daily consultant-led ward rounds, conducted in the morning with the presence of senior nursing staff and minimising patients on outlying wards. These recommendations aim to improve patient management through timely investigations, treatment and discharge. This study sought to evaluate the current surgical ward round practices in England. Methods Information regarding timing and staffing levels of surgical ward rounds was collected prospectively over a one-week period. The location of each patient was also documented. Two surgical trainee research collaboratives coordinated data collection from 19 hospitals and 13 surgical subspecialties. Results Data from 471 ward rounds involving 5622 patient encounters was obtained. 367 (77.9%) ward rounds commenced before 9am. Of 422 weekday rounds, 190 (45%) were consultant-led compared with 33 of the 49 (67%) weekend rounds. 2474 (44%) patients were seen with a nurse present. 1518 patients (27%) were classified as outliers, with 361 ward rounds (67%) reporting at least one outlying patient. Conclusion Recommendations for daily consultant-led multi disciplinary ward rounds are poorly implemented in surgical practice, and patients continue to be managed on outlying wards. Although strategies may be employed to improve nursing attendance on ward rounds, substantial changes to workforce planning would be required to deliver daily consultant-led care. An increasing political focus on patient outcomes at weekends may prompt changes in these areas. PMID:24581228
Cooke, M; Higgins, J; Kidd, P
Introduction: Observation and assessment wards allow patients to be observed on a short-term basis and permit patient monitoring and/or treatment for an initial 24–48 hour period. They should permit concentration of emergency activity and resources in one area, and so improve efficiency and minimise disruption to other hospital services. These types of ward go under a variety of names, including observation, assessment, and admission wards. This review aims to evaluate the current literature and discuss assessment/admission ward functionality in terms of organisation, admission criteria, special patient care, and cost effectiveness. Methods: Search of the literature using the Medline and BIDS databases, combined with searches of web based resources. Critical assessment of the literature and the data therein is presented. Results: The advantages and disadvantages of the use of assessment/admission wards were assessed from the current literature. Most articles suggest that these wards improve patient satisfaction, are safe, decrease the length of stay, provide earlier senior involvement, reduce unnecessary admissions, and may be particularly useful in certain diagnostic groups. A number of studies summarise their organisational structure and have shown that strong management, staffing, organisation, size, and location are important factors for efficient running. There is wide variation in the recommended size of these wards. Observation wards may produce cost savings largely relating to the length of stay in such a unit. Conclusion: All types of assessment/admission wards seem to have advantages over traditional admission to a general hospital ward. A successful ward needs proactive management and organisation, senior staff involvement, and access to diagnostics and is dependent on a clear set of policies in terms of admission and care. Many diagnostic groups benefit from this type of unit, excluding those who will inevitably need longer admission. Vigorous
Churpek, Matthew M.; Yuen, Trevor C.; Huber, Michael T.; Park, Seo Young; Hall, Jesse B.
Background: Current rapid response team activation criteria were not statistically derived using ward vital signs, and the best vital sign predictors of cardiac arrest (CA) have not been determined. In addition, it is unknown when vital signs begin to accurately detect this event prior to CA. Methods: We conducted a nested case-control study of 88 patients experiencing CA on the wards of a university hospital between November 2008 and January 2011, matched 1:4 to 352 control subjects residing on the same ward at the same time as the case CA. Vital signs and Modified Early Warning Scores (MEWS) were compared on admission and during the 48 h preceding CA. Results: Case patients were older (64 ± 16 years vs 58 ± 18 years; P = .002) and more likely to have had a prior ICU admission than control subjects (41% vs 24%; P = .001), but had similar admission MEWS (2.2 ± 1.3 vs 2.0 ± 1.3; P = .28). In the 48 h preceding CA, maximum MEWS was the best predictor (area under the receiver operating characteristic curve [AUC] 0.77; 95% CI, 0.71-0.82), followed by maximum respiratory rate (AUC 0.72; 95% CI, 0.65-0.78), maximum heart rate (AUC 0.68; 95% CI, 0.61-0.74), maximum pulse pressure index (AUC 0.61; 95% CI, 0.54-0.68), and minimum diastolic BP (AUC 0.60; 95% CI, 0.53-0.67). By 48 h prior to CA, the MEWS was higher in cases (P = .005), with increasing disparity leading up to the event. Conclusions: The MEWS was significantly different between patients experiencing CA and control patients by 48 h prior to the event, but includes poor predictors of CA such as temperature and omits significant predictors such as diastolic BP and pulse pressure index. PMID:22052772
Westcott, D L; Deeny, J E; Strauss, J G
The attitudes of parents towards staying with their children in the medical emergency ward at the Red Cross War Memorial Children's Hospital, Cape Town, are reported on. A randomly selected sample of 80 parents or caretakers attending children in the ward were interviewed. The interviews were semi-structured and included open-ended questions. Data were recorded on interview schedules. Of the respondents, 96% wanted to stay with their acutely ill children, although 20% of these were anxious about the effect of this on events at home or at work. Based on the finding that mothers want to stay, even in view of difficulties regarding the situation at home and at work, improved facilities for parents should receive high priority. Recommendations arising from the study include the provision of more comfortable sleeping accommodation for parents, availability of refreshments on a 24-hour basis and provision of a regular supply of books and magazines to the ward.
Pathak, A; Pathak, N; Kak, V K
The success of a perfect ward round lies in the role of the consultant leading the 'round making group' (RMG) as well as the hallmark of effective questioning and participation of each member. Twelve senior consultants with more than 10 years' experience in neurosurgical practice at three different university hospitals were observed during round making by a participant observer. Observations were made on the group climate of the RMG, the leadership pattern and language expressed by the clinician conducting the round and the effectiveness in his performance as a leader during clinical discussions. The group climate showed evidence of good productivity and flexibility with 92% and 75% consultants, pleasantness of climate was above average with only 50% (6/12) and poor objectivity with 42% (5/12) consultants. Forty two percent of the consultants were not always very well comprehensible, while only 50% (6/12) spoke exactly fitting the occasion. Only 33% (4/12) of the consultants used humour effectively, while 42% (5/12) spoke unnecessarily in between discussion and were poor in introducing the problems of patient to the round making group. Ward round making in neurosurgical practice needs a holistic approach with motivation, planning, leadership skills and structured curriculum to fulfill its objectives.
Schalast, Norbert; Sieß, Julia
Objective Investigate inter-relations of objective conditions and a ward's social climate. Method Staff and patients on 104 wards filled in the short Essen Climate Evaluation Schema (EssenCES). Assessments were related to setting variables (like open vs. closed wards, forensic vs. general psychiatric wards, ward size, staffing). Results Setting variables and climate characteristics are strongly associated. Conclusions The EssenCES, originally catered for forensic settings, proved to be useful to characterize general psychiatric wards. A number of suggestions regarding relevant setting conditions are clearly confirmed (like staffing level; open vs. closed wards). Remarkably, staff experience a higher level of Safety on forensic than on general psychiatric wards. Patients' Cohesion and Therapeutic Hold are rated higher on general psychiatric wards. Heterogeneity of patients (vs. specialization of wards) is not positively related to climate characteristics; staff experiences less Safety on non-specialized wards.
Oliveira, Lia; Gomes, Cláudia; Bacelar Nicolau, Leonor; Ferreira, Luís; Ferreira, Rosário
The mutual relationship between sleep and disease is well known, becoming more relevant whenever the disease leads to hospitalization. We intend to describe patterns of environmental factors of some pediatric wards, and to verify if these are in line with those recommended. As a secondary aim, we characterize sleep quality during hospitalization. Five pediatric wards of a tertiary-level hospital were included. Light, sound, and temperature were measured and assessed through descriptive statistics. The following recommended values were considered: maximum light 100 Lux, maximum sound 45 dB, and optimal temperature 20-24 °C. A questionnaire was prepared to assess children's sleep, and it was completed by a caregiver. Light values were within the desirable limits for 86% of evaluated time. In all wards, the intensity of sound was much higher than desirable, being above 45 dB during 85% of evaluated time. The temperature was above 24 °C during 78% of total time. Based on 34 answered questionnaires (out of 50 distributed), almost half of the respondents believe that sleep quality and restlessness are worse at the hospital. Most children slept for a longer time at home. Eighteen children awoke more times at the hospital, and those awakenings were mostly attributed to noise. The sound and temperature were higher than recommended. The different values between these wards may be due to different levels of care, but this shows that there are no standard rules on this matter. A worse quality and shorter duration of sleep at hospital were reported. Comprehensive studies are necessary to evaluate the impact of environmental factors on disease recovery. Copyright © 2015 Elsevier B.V. All rights reserved.
Maurice, Andrew; Hann, Angus
There is a paucity of literature regarding medical student experiences of after hours hospital ward call. It was observed at our institution that medical students had minimal experience in ward call, yet were required to undertake such shifts as interns after graduation. We implemented a buddy system in which a medical student shadowed a general surgery resident for a ward call shift. Final year medical students were recruited from the local university at a tertiary teaching hospital after institutional approval. Each student attended a 4 hour evening shift on a general surgery ward with a supervising resident. A survey detailing attitudes and expectations of ward call was completed before and after the experience. Nine students enrolled in the project. Familiarity of expectations of what is required of an intern on a ward call shift improved significantly after the experience (3.1/5 to 4.1/5, p = 0.002). After hours work experience was reported as useful both before and after the study (4.5/5 to 4.7/5, p = 0.47). Students and doctors involved unanimously felt the experience was worthwhile. After hours ward call experience is useful for a final year medical student. More studies are required to further define the role of after hours ward call experiences during medical training.
... Secretary, Department of Education PROTECTION OF HUMAN SUBJECTS Additional ED Protections for Children Who Are Subjects in Research § 97.409 Wards. (a) Children who are wards of the State or any other agency..., or similar settings in which the majority of children involved as subjects are not wards. (b)...
... 34 Education 1 2013-07-01 2013-07-01 false Wards. 97.409 Section 97.409 Education Office of the Secretary, Department of Education PROTECTION OF HUMAN SUBJECTS Additional ED Protections for Children Who Are Subjects in Research § 97.409 Wards. (a) Children who are wards of the State or any other...
... 34 Education 1 2010-07-01 2010-07-01 false Wards. 97.409 Section 97.409 Education Office of the Secretary, Department of Education PROTECTION OF HUMAN SUBJECTS Additional ED Protections for Children Who Are Subjects in Research § 97.409 Wards. (a) Children who are wards of the State or any other...
... 34 Education 1 2014-07-01 2014-07-01 false Wards. 97.409 Section 97.409 Education Office of the Secretary, Department of Education PROTECTION OF HUMAN SUBJECTS Additional ED Protections for Children Who Are Subjects in Research § 97.409 Wards. (a) Children who are wards of the State or any other...
... act in, the best interest of the child for the duration of the child's participation in the clinical... 21 Food and Drugs 1 2011-04-01 2011-04-01 false Wards. 50.56 Section 50.56 Food and Drugs FOOD AND... Additional Safeguards for Children in Clinical Investigations § 50.56 Wards. (a) Children who are wards...
... Protections for Children Involved as Subjects in Research § 46.409 Wards. (a) Children who are wards of the state or any other agency, institution, or entity can be included in research approved under § 46.406 or § 46.407 only if such research is: (1) Related to their status as wards; or (2) Conducted in schools...
... Protections for Children Involved as Subjects in Research § 46.409 Wards. (a) Children who are wards of the state or any other agency, institution, or entity can be included in research approved under § 46.406 or § 46.407 only if such research is: (1) Related to their status as wards; or (2) Conducted in schools...
... Protections for Children Involved as Subjects in Research § 46.409 Wards. (a) Children who are wards of the state or any other agency, institution, or entity can be included in research approved under § 46.406 or § 46.407 only if such research is: (1) Related to their status as wards; or (2) Conducted in schools...
... 34 Education 1 2011-07-01 2011-07-01 false Wards. 97.409 Section 97.409 Education Office of the Secretary, Department of Education PROTECTION OF HUMAN SUBJECTS Additional ED Protections for Children Who Are Subjects in Research § 97.409 Wards. (a) Children who are wards of the State or any other agency...
... 21 Food and Drugs 1 2012-04-01 2012-04-01 false Wards. 50.56 Section 50.56 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL PROTECTION OF HUMAN SUBJECTS Additional Safeguards for Children in Clinical Investigations § 50.56 Wards. (a) Children who are wards of...
... 21 Food and Drugs 1 2014-04-01 2014-04-01 false Wards. 50.56 Section 50.56 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL PROTECTION OF HUMAN SUBJECTS Additional Safeguards for Children in Clinical Investigations § 50.56 Wards. (a) Children who are wards of...
... 21 Food and Drugs 1 2013-04-01 2013-04-01 false Wards. 50.56 Section 50.56 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL PROTECTION OF HUMAN SUBJECTS Additional Safeguards for Children in Clinical Investigations § 50.56 Wards. (a) Children who are wards of...
Townsend, Keith; Wilkinson, Adrian; Kellner, Ashlea
This paper aims to identify and explore key obstacles preventing ward managers from effectively performing the human resource management (HRM) responsibilities required in their role. In the context of increasing costs and the decentralisation of responsibility to ward level, the relevance of the ward manager role within the 'black box' between human resource management and firm performance is becoming increasingly pertinent. This paper presents an intensive case study including 37 interviews across all levels of a hospital where senior management attempted to shift to a high performance model of human resource management. The findings indicated that ward managers played a critical role in maintaining and improving employee performance, although they were restricted from effectively performing their responsibilities due to budget pressure and limited managerial skill development. Our findings support the contention that hospitals would benefit from focusing on the critical role of the ward manager as the central locus of influence in high performance human resource management (HPHRM) systems. Investment into high performance human resource management is discouraged if the hospital cannot adequately enable ward managers who are responsible for implementation. Introduction of managerial skills training to potential and existing ward managers is critical. © 2013 John Wiley & Sons Ltd.
Fernandez, Rafael; Bacelar, Nestor; Hernandez, Gonzalo; Tubau, Isabel; Baigorri, Francisco; Gili, Gisela; Artigas, Antonio
To determine the effect of discharge from the ICU with a tracheostomy tube on ward mortality and its relation to patient vulnerability. Retrospective single-center cohort study. Database (2003-2006) review of patients undergoing mechanical ventilation (MV) > 24 h and discharged from the ICU with or without tracheostomy tube in place and followed up to hospital discharge or death. We recorded clinical characteristics, complications, major ICU procedures, subjective prognosis at ICU discharge (Sabadell score), and hospital outcome. Factors associated with ward mortality were analyzed by multiple logistic regression. From 3,065 patients admitted to the ICU, 1,502 needed MV > 24 h. Only 936 patients (62%) survived the ICU and were transferred to the ward; of these, 130 (13.9%) had a tracheostomy tube in place. Ward mortality was higher in patients with a tracheostomy tube in place than in those without (26 vs. 7%, P < 0.001). Increased ward mortality among cannulated patients was seen only in those with intermediate Sabadell score (24 vs. 9% in score 1, P = 0.02, and 38 vs. 24% in score 2, P = 0.06), but not in the "good prognosis" (2 vs. 2%, score 0) and "expected to die in hospital" (80 vs. 75%, score 3) groups. Multivariate analysis found three factors associated with ward mortality: age, tracheostomy tube in place, and Sabadell score. Lack of tracheostomy decannulation in the ICU appears to be associated with ward mortality, but only in the group with a Sabadell score of 1.
Zadravecz, Frank J.; Winslow, Christopher; Howell, Michael D.; Edelson, Dana P.
Rationale: Tools that screen inpatients for sepsis use the systemic inflammatory response syndrome (SIRS) criteria and organ dysfunctions, but most studies of these criteria were performed in intensive care unit or emergency room populations. Objectives: To determine the incidence and prognostic value of SIRS and organ dysfunctions in a multicenter dataset of hospitalized ward patients. Methods: Hospitalized ward patients at five hospitals from November 2008 to January 2013 were included. SIRS and organ system dysfunctions were defined using 2001 International Consensus criteria. Patient characteristics and in-hospital mortality were compared among patients meeting two or more SIRS criteria and by the presence or absence of organ system dysfunction. Measurements and Main Results: A total of 269,951 patients were included in the study, after excluding 48 patients with missing discharge status. Forty-seven percent (n = 125,841) of the included patients met two or more SIRS criteria at least once during their ward stay. On ward admission, 39,105 (14.5%) patients met two or more SIRS criteria, and patients presenting with SIRS had higher in-hospital mortality than those without SIRS (4.3% vs. 1.2%; P < 0.001). Fourteen percent of patients (n = 36,767) had at least one organ dysfunction at ward admission, and those presenting with organ dysfunction had increased mortality compared with those without organ dysfunction (5.3% vs. 1.1%; P < 0.001). Conclusions: Almost half of patients hospitalized on the wards developed SIRS at least once during their ward stay. Our findings suggest that screening ward patients using SIRS criteria for identifying those with sepsis would be impractical. PMID:26158402
Office of Management and Budget (OMB) Circular A-110 provides standards for obtaining consistency and uniformity among Federal agencies in the administration of grants and agreements with institutions of higher education, hospitals, and other non-profit organizations. On September 13, 1994, the Department published a final rule which adopted the revised circular as it pertains to HUD. However, the September 13, 1994 rule contained, in subpart E, special provisions relating to the use of lump sum grants. Therefore, subpart E was treated as an interim rule, and the public was invited to submit comments on subpart E. This final rule addresses the public comments received on subpart E and makes final the provisions of subpart E.
Force, Jade; Thomas, Ian; Buckley, Frances
Learning in the clinical environment is an important feature of medical education. Ward-round teaching leads to relevant, applied and lasting learning of knowledge, skills and attitudes; however, on fast-paced ward rounds in specialties such as general surgery, the student experience is often suboptimal, and teaching can be overlooked. Clinical teaching fellows (CTFs) are postgraduate doctors ranging from foundation year-2 (FY2) level through to specialty trainees, who have elected to spend up to 2 years out of the programme to teach medical undergraduates. This article explores whether CTFs can successfully support the regular delivery of undergraduate medical teaching on the busy post-take surgical ward round (PTSWR). The CTFs at Raigmore Hospital, Inverness, planned and facilitated weekly, structured teaching sessions to accompany the PTSWR. This educational intervention was evaluated using pre- and post-intervention student questionnaires. The questionnaires focused on student enjoyment and depth of learning using Likert scales and free-text components. Students were also asked about barriers to learning on typical PTSWRs. The consultant surgeons leading on these rounds were issued separate questionnaires, to gauge their evaluation of CTF support. The main barrier to effective undergraduate ward round teaching was a lack of time on the part of clinical staff. Ward rounds accompanied by CTF support significantly increased student enjoyment (p < 0.0001) and perceived learning (p < 0.0001). Consultant surgeons were supportive of the teaching initiative. Support from CTFs on busy PTSWRs optimised student satisfaction, and was welcomed by clinical staff. CTF support could be widened to other busy ward rounds, e.g. acute medical takes, to enhance student learning and reduce the teaching burden on clinical faculty staff. © 2014 John Wiley & Sons Ltd.
Timmermans, Marijke J C; van Vught, Anneke J A H; Van den Berg, Michiel; Ponfoort, Erik D; Riemens, Frank; van Unen, Jacco; Wobbes, Theo; Wensing, Michel; Laurant, Miranda G H
Medical ward care has been increasingly reallocated from medical doctors (MDs) to physician assistants (PAs). Insight into their roles and tasks is limited. This study aims to provide insight into different organizational models of medical ward care, focusing on the position, tasks and responsibilities of the involved PAs and MDs. In this cross-sectional descriptive study 34 hospital wards were included. Characteristics of the organizational models were collected from the heads of departments. We documented provider continuity by examination of work schedules. MDs and PAs in charge for medical ward care (n = 179) were asked to complete a questionnaire to measure workload, supervision and tasks performed. We distinguished four different organizational models for ward care: medical specialists in charge of admitted patients (100% MS), medical residents in charge (100% MR), PAs in charge (100% PA), both MRs and PAs in charge (mixed PA/MR). The wards with PAs had the highest provider continuity. PAs spend relatively more time on direct patient care; MDs spend relatively more time on indirect patient care. PAs spend more hours on quality projects (P = 0.000), while MDs spend more time on scientific research (P = 0.030). Across different organizational models for medical ward care, we found variations in time per task, time per bed and provider continuity. Further research should focus on the impact of these differences on outcomes and efficiency of medical ward care. © 2015 John Wiley & Sons, Ltd.
Singh, Salil; Lipscomb, George; Padmakumar, Kadukkavil; Ramamoorthy, Radha; Ryan, Shirley; Bates, Vivien; Crompton, Sandra; Dermody, Emma; Moriarty, Kieran
For gastroenterology, The Royal College of Physicians reiterates the common practice of two to three consultant ward rounds per week. The Royal Bolton Hospital NHS Foundation Trust operated a 26-bed gastroenterology ward, covered by two consultants at any one time. A traditional system of two ward rounds per consultant per week operated, but as is commonplace, discharges peaked on ward round days. To determine whether daily consultant ward rounds would improve patient care, shorten length of stay and reduce inpatient mortality. A new way of working was implemented in December 2009 with a single consultant taking responsibility for all ward inpatients. Freed from all other direct clinical care commitments for their 2 weeks of ward cover, they conducted ward rounds each morning. A multidisciplinary team (MDT) meeting followed immediately. The afternoon was allocated to gastroenterology referrals and reviewing patients on the medical admissions unit. The changes had an immediate and dramatic effect on average length of stay, which was reduced from 11.5 to 8.9 days. The number of patients treated over 12 months increased by 37% from 739 to 1010. Moreover, the number of deaths decreased from 88 to 62, a reduction in percentage mortality from 11.2% to 6%. However, these major quality outcomes involved a reduction in consultant-delivered outpatient and endoscopy activity. This new method of working has both advantages and disadvantages. However, it has had a major impact on inpatient care and provides a compelling case for consultant gastroenterology expansion in the UK.
Westcott, Eliza; Broadhurst, Alicia; Crossley, Steven; Lee, Lloyd; Phan, Xuyen; Scharli, Rainer; Xu, Yan
A floor-washing robot has been acquired to assist physicists with decontamination of radioiodine therapy ward rooms after discharge of the patient at Sir Charles Gairdner Hospital. The effectiveness of the robot in decontaminating the ward has been evaluated. A controlled experiment was performed by deliberately contaminating a polyvinyl chloride flooring offcut with 131I followed by automated decontamination with the robot. The extent of fixed and removable contamination was assessed before and after decontamination by two methods: (1) direct Geiger-Mueller counting and (2) beta-counting wipe tests. Surface contamination was also assessed in situ on the ward by Geiger-Mueller counting and wipe testing. Contamination maps confirmed that contamination was removed rather than spread around by the robot. Wipe testing revealed that the robot was successful in clearing approximately 60-80% of removable contamination. The robotic floor-washing device was considered suitable to provide effective automated decontamination of the radioiodine ward. In addition, the robot affords other benefits: the time spent by the physicists decontaminating the room is greatly reduced offering financial and occupational safety and health benefits. The robot has also found utility in other decontamination applications in the healthcare environment.
Lehnbom, Elin C; Adams, Kristian; Day, Richard O; Westbrook, Johanna I; Baysari, Melissa T
Much clinical information is computerised and doctors' use of mobile devices such as iPad tablets to access this information is expanding rapidly. This study investigated the use of iPads during ward rounds and their usefulness in providing access to information during ward rounds. Ten teams of doctors at a large teaching hospital were given iPads for ten weeks and were observed on ward rounds for 77.3 hours as they interacted with 525 patients. Use of iPads and other information technology devices to access clinical information was recorded. The majority of clinical information was accessed using iPads (56.2%), followed by computers-on-wheels (35.8%), stationary PCs (7.9%) and smartphones (0.1%). Despite having read-only access on iPads, doctors were generally happy using iPads on ward rounds. These findings provide evidence of the value of iPads as a tool to access information at the point of care.
Koukia, Evmorfia; Giannouli, Eleni; Gonis, Nikolaos; Douzenis, Athanassios
Mental health nurses play a key role in maintaining the safety of patients, themselves, and others during hospitalization. The aim of the research was to evaluate the safety measures that are taken by mental health nurses to identify the security policies that exist in acute mental health wards. The Ward Safety and Security Rules Survey was used as a method of data collection. Descriptive analysis and content analysis were carried out in order to identify nurses' practices. The total sample consisted of 172 mental health nurses and nurses' assistants who worked in 14 acute inpatient psychiatric wards in three psychiatric hospitals in the greater area of Athens, Greece. The results show a minimum number of security features existing in the wards. Only one of the 14 wards had an intercom system. In only nine wards, there was a panic alarm in the office, and in eight, an emergency response telephone extension. A wide range of practices were noted concerning banned items and patient searches upon admission and return from leave. The results indicate the significant lack of protocols and specific safety rules to guide nurses' actions across psychiatric acute admission wards in Athens.
Nordeng, Hedvig; Eskild, Anne; Nesheim, Britt-Ingjerd
To investigate factors related to analgesic use after delivery, and especially whether rates of analgesic use were different in a midwife-managed maternity hotel as compared to conventional postnatal wards. One maternity hotel and two conventional postnatal wards at Ullevål University Hospital in Oslo, Norway. Data were obtained from hospital records for 804 women with vaginal deliveries. Postnatal analgesic use. Overall, approximately half the women used analgesics after vaginal delivery in both conventional postnatal wards and maternity hotel. The factors that were significantly associated with use of analgesics postnatally in multivariate analysis were multiparity, having a non-Western ethnicity, smoking in pregnancy, younger age, instrumental delivery, analgesic use during labour, maternal complications post partum, and duration of postnatal stay 4 days or more. The use of analgesics is determined by socio-demographic and obstetric factors rather than the organisation of the ward.
Gebhardt, R P; Schmidt-Michel, P O
A satellite ward is a psychiatric ward at a general hospital settled within a catchment area that is administered by a distant psychiatric hospital. The objective of the satellite model is to close the gap between patients and their community on the one hand and between psychiatry and general medicine on the other. The essential size of the satellite ward that enables it to take care for the patients in its catchment area is discussed controversially. This study investigated admission rates and number of beds needed in two catchment areas distant to the psychiatric hospital from 6 months before opening until 12 months after the opening of a satellite ward with 21 beds in one of the two catchment areas. We registered an 81% increase of admission rates in this catchment area (from 130 admissions in the half-year before the opening of the satellite ward to 235 admissions in the 2nd half-year after it) and a 41% increase in beds needed (from 28.8 beds in the half-year before opening to 40.7 beds in the 2nd half-year following). This increase was significant in comparison to the increase in the controlled catchment area. Thus, only 168 (71%) patients of the catchment area (but 82% of the patients with schizophrenia) were treated in the satellite ward. The remaining patients were treated in the parent house. A selective admission of severely ill patients into the parent house was not observed.
Farquharson, Barbara; Bell, Cheryl; Johnston, Derek; Jones, Martyn; Schofield, Pat; Allan, Julia; Ricketts, Ian; Morrison, Kenny; Johnston, Marie
To explore the frequency of different nursing tasks in medical and surgical wards. The time nurses spend on direct patient care is important for both patients and nurses. However, little is known about the time nurses spend on various nursing tasks. A real-time, repeated measures design conducted amongst 67 (n = 39 medical, n = 28 surgical) UK hospital nurses. Between September 2011 and August 2012 participants completed an electronic diary version of a classification of nursing tasks (WOMBAT) during shifts. A total of 961 real-time measures of nursing task were obtained. Direct patient care [median = 37.5%, interquartile range = 27.8], indirect care (median = 11.1%, interquartile range = 19.4) and medication (median = 11.1%, interquartile range = 18.8) were most commonly reported. Participants were interrupted in 62% of entries (interquartile range = 35), reported adequate time in 78% (interquartile range = 31) and adequate resources in 89% (interquartile range = 36). Ward-related tasks were significantly more frequent on medical wards than surgical wards but otherwise there were no significant differences. Nurses spend the highest proportion of time in direct patient care and majority of this on core nursing activities. Interruptions to tasks are common. Nurses tend to report adequate time/resources. The frequency of nursing tasks is similar in medical and surgical wards. Nurse managers should review the level of interruptions to nurses' work and ensure appropriate levels of supervision. © 2013 John Wiley & Sons Ltd.
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
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
Leung, Annie; Abitbol, Jeremie; Ramana-Kumar, Agnihotram V; Fadlallah, Bassam; Kessous, Roy; Cohen, Sabine; Lau, Susie; Salvador, Shannon; Gotlieb, Walter H
To analyze the changes in the composition of the gynecologic oncology inpatient ward following the implementation of a robotic surgery program and its impact on inpatient resource utilization and costs. Retrospective review of the medical charts of patients admitted onto the gynecologic oncology ward the year prior to and five years after the implementation of robotics. The following variables were collected: patient characteristics, hospitalization details (reason for admission and length of hospital stay), and resource utilization (number of hospitalization days, consultations, and imaging). Following the introduction of robotic surgery, there were more admissions for elective surgery yet these accounted for only 21% of the inpatient ward in terms of number of hospital days, compared to 36% prior to the robotic program. This coincided with a sharp increase in the overall number of patients operated on by a minimally invasive approach (15% to 76%, p<0.0001). The cost per surgical admission on the inpatient ward decreased by 59% ($9827 vs. $4058) in the robotics era. The robotics program contributed to a ward with higher proportion of patients with complex comorbidities (Charlson≥5: RR 1.06), Stage IV disease (RR 1.30), and recurrent disease (RR 1.99). Introduction of robotic surgery allowed for more patients to be treated surgically while simultaneously decreasing inpatient resource use. With more patients with non-surgical oncological issues and greater medical complexity, the gynecologic oncology ward functions more like a medical rather than surgical ward after the introduction of robotics, which has implications for hospital-wide resource planning. Copyright © 2017 Elsevier Inc. All rights reserved.
Alazzawi, Sulaiman; Silk, Zacharia; Saha, Urmila U; Auplish, Sunil; Masterson, Sean
This article present the results of an audit cycle which evaluated the quality of inpatient ward round documentation in a busy district general hospital before and after the implementation of a standardized proforma which was specifically designed for trauma and orthopaedic patients. In each cycle, 20 case notes were examined and the data analysed to examine three main areas: Diagnosis, management and/or discharge plan Objective assessments including neurovascular status, weight-bearing status, surgical wound review, observations, results of investigations and decision from the daily trauma meeting Logistics of the documentation such as legibility, date and time, name and grade of the doctor and contact number. This audit demonstrated that using a ward round proforma can significantly enhance the quality of documentation and improve communication between multidisciplinary team members.
Oyama, Yumiko; Yonekura, Yuki; Fukahori, Hiroki
To investigate the factors affecting nurse health-related quality of life (HRQOL) by considering the patient characteristics and ward characteristics. Nurse health-related quality of life is an important health outcome, and should be promoted for quality nursing care. This cross-sectional study was conducted on nurses who work in general acute care wards in three university hospitals in metropolitan Japan. Multilevel analysis was conducted to investigate possible factors related to nurse health-related quality of life. Nurses who worked at a ward had a significantly lower physical health score (β = -0.13, P < 0.01). These nurses had a higher ratio of patients who could not understand medical instructions, had cognitive disabilities, or required assistance with activities of daily living (ADL). The number of beds was the only factor significantly related to mental health status of nurses (β = 0.19, P < 0.05). Work conditions that sustain nurse health should take into account not only the number of nurses, but also patient characteristics. Further large-scale studies are needed in order to investigate the effect of hospital characteristics on nurse health-related quality of life. Increasing the number of nurses' aides and delegating assistance with ADL to them could support nurse health-related quality of life in the acute care setting. © 2014 John Wiley & Sons Ltd.
Lin, Jing; Fang, Xiaoqun; Wu, Suhong
To evaluate the management practice and process of a cataract surgery day ward. From January to December in 2012, a portion of the cataract patients were evaluated for the pattern of day ward management. Methods were as follows: 1) Establish the cataract day ward. 2) Enroll the patients who met the following criteria: voluntary, local residents or outsiders who stayed in a hotel near the hospital, accompanied by family, and who had simple senile cataract without any systemic major diseases. 3) Establish the hospitalization process. 4) Analyze the nursing process. After cataract day surgery, the patients were followed for 2 hours and completed a questionnaire about their needs and sentiments. A total of 3971 cases were observed in this study; 49 cases were switched to a normal pattern of hospitalization because of operative complications, 1 case had a strong desire to switch to a normal pattern of hospitalization because of ocular discomfort, 8 cases went back to the hospital for treatment because of ocular pain, and 52 cases called on the phone to seek help. Overall, 3820 cases(96.2%) returned on time the next day to visit the doctor. No patients showed severe postoperative complications and 98% expressed great satisfaction with the day ward process. Only 200 cases expressed great concern about not knowing how to deal with postoperative pain, the changes in condition outside the hospital, the therapeutic effects, and the problem of expense reimburse-ment. Day ward cataract surgery is an efficient and safe mode, and has the potential to relieve the demand for inpatient beds and to ensure timely treatment of the patients. In addition, it helps the patients enjoy health care at public expense, reserving reimbursement for those who need to be hospitalized. Nurses should pay more attention to systemic evaluation of the patients, health education, and psychological guidance, and keep in close communication with doctors, which is the key to ensure the safety of day ward
Randle, Jacqueline; Firth, Joseph; Vaughan, Natalie
To measure healthcare workers', children's and visitors' hand hygiene compliance in a paediatric oncology ward and a paediatric respiratory ward in an English hospital. Children are especially vulnerable to healthcare-associated infections, yet few studies have reported on hand hygiene compliance in paediatric clinical areas. This was an observational study. We measured hand hygiene compliance over an eight-hour period in two hospital wards using the 'five moments of hand hygiene' observation tool. We monitored a total of 407 hand hygiene opportunities. Overall opportunities for compliance were 74% for healthcare workers (n = 315) and children and visitors 23% (n = 92). Compliance was 84% for allied health professionals, 81% for doctors, 75% for nurses and 73% for ancillary and other staff. Hand hygiene compliance varied depending on which of the five moments of hygiene healthcare workers were undertaking (p < 0·001), with compliance before child contact 90% (140/155); after child contact 78% (89/114); after body fluid exposure 75% (3/4); and after surroundings contact 36% (15/42). For healthcare workers and visitors, there was no evidence of an association between time of day and their hand hygiene compliance, and for visitors to the oncology ward, hand hygiene compliance was higher (p < 0·05). Owing to the nature of the clinical environments, we are unable to draw conclusions about children's hand hygiene compliance; however, visitors' compliance was low. Among healthcare workers, levels of compliance were higher compared with previous reported estimates. Visitors had the lowest level of compliance yet owing to the nature of the clinical environments, nearly a quarter of care is delivered by them rather than healthcare workers, and so, this offers opportunities for specific future interventions aimed at families and carers. © 2012 Blackwell Publishing Ltd.
Nikendei, C; Huhn, D; Pittius, G; Trost, Y; Bugaj, T J; Koechel, A; Schultz, J-H
Ward rounds are an essential activity for interprofessional teams in hospital settings and represent complex tasks requiring not only medical knowledge but also communication skills, clinical technical skills, patient management skills and team-work skills. The present study aimed to analyse final year students', nurses' as well as physiotherapists' views on a simulation-based interprofessional ward round training. In two successive passes a total number of 29 final year students, nursing students and physiotherapy students (16 in the first run, 13 in the second) volunteered to participate in two standardized patient ward round scenarios: (1) patient with myocardial infarction, and (2) patient with poorly controlled diabetes. Views on the interprofessional ward round training were assessed using focus groups. Focus group based feedback contained two main categories (A) ward round training benefits and (B) difficulties. Positive aspects enfolded course preparation, setting of the training, the involvement of the participants during training and the positive learning atmosphere. Difficulties were seen in the flawed atmosphere and realization of ward rounds in the daily clinical setting with respect to inter-professional aspects, and course benefit for the different professional groups. The presented inter-professional ward round training represents a well received and valuable model of interprofessional learning. Further research should assess its effectiveness, processes of interprofessional interplay and transfer into clinical practice.
Nikendei, C.; Huhn, D.; Pittius, G.; Trost, Y.; Bugaj, T. J.; Koechel, A.; Schultz, J.-H.
Introduction: Ward rounds are an essential activity for interprofessional teams in hospital settings and represent complex tasks requiring not only medical knowledge but also communication skills, clinical technical skills, patient management skills and team-work skills. The present study aimed to analyse final year students’, nurses’ as well as physiotherapists’ views on a simulation-based interprofessional ward round training. Methods: In two successive passes a total number of 29 final year students, nursing students and physiotherapy students (16 in the first run, 13 in the second) volunteered to participate in two standardized patient ward round scenarios: (1) patient with myocardial infarction, and (2) patient with poorly controlled diabetes. Views on the interprofessional ward round training were assessed using focus groups. Results: Focus group based feedback contained two main categories (A) ward round training benefits and (B) difficulties. Positive aspects enfolded course preparation, setting of the training, the involvement of the participants during training and the positive learning atmosphere. Difficulties were seen in the flawed atmosphere and realization of ward rounds in the daily clinical setting with respect to inter-professional aspects, and course benefit for the different professional groups. Conclusion: The presented inter-professional ward round training represents a well received and valuable model of interprofessional learning. Further research should assess its effectiveness, processes of interprofessional interplay and transfer into clinical practice. PMID:27280125
Bowers, Len; Allan, Teresa; Simpson, Alan; Nijman, Henk; Warren, Jonathan
Adverse incidents (violence, self-harm and absconding) can cause significant harm to patients and staff, are difficult to predict, and are driving an increase in security measures and defensive practice. To explore the relationship between adverse incidents on acute psychiatric wards, admissions and nursing workforce variables. A retrospective analysis of officially collected data covering a period of 30 months on 14 acute wards at three hospitals. This data included 69 serious untoward incidents. Adverse incidents were more likely during and after weeks of high numbers of male admissions, during weeks when other incidents also occurred, and during weeks of high regular staff absence through leave and vacancy. It may be possible to predict adverse incidents. Careful staff management and deployment may reduce the risks.
Ruud, Torleif; Lindefors, Nils; Lindhardt, Anne
The aim of the paper is to provide an overview of some of the most important issues faced by acute inpatient facilities in three Scandinavian countries, including reflections and critical remarks for discussion in this field. Information was drawn from scientific articles and official reports published in recent years, as well as the authors' own knowledge of acute facilities in their home countries. Acute inpatient facilities, including General Hospital Psychiatric Units (GHPUs), in all Scandinavian countries have several issues and problems in common, which include the organisation and capacity of acute services, the assessment of dangerousness and suicidality, the use of coercion and efforts to reduce coercion, the need to define and improve the quality of acute services, and the necessity to improve collaboration and continuity between acute services and other services. Although the emphasis some of these issues receive can vary across the three countries, Scandinavian mental health professionals (and policy makers) have begun to systematically share their experiences in developing a growing spirit of collaboration. Despite the role of welfare state and the deployment of substantial resources in Scandinavian countries, mental health practitioners are struggling to implement best practices in acute wards, to develop differentiated forms of acute services, and to reach the right balance and coordination between acute services and other services.
This study compared two acute psychiatric ward nursing regimes, focusing on ward rules as a means of investigating the relationship between the flexibility/inflexibility of the regimes and patient outcomes. Previous studies identified an association between ward rules and patient aggression. A link between absconding and nurses' attitudes towards rule enforcement has also been explored. However, an in-depth exploration of ward rules from the perspective of nurses and patients had not been undertaken previously. The study aimed to discover the content of rules within acute psychiatric wards; to explore patients' responses to the rules; to evaluate the impact of rules and rule enforcement on nurse-patient relationships and on ward events; and to investigate the relationship between ward rules, ward atmosphere and ward design. The relevance of sociological theory emerged from the data analysis. During this process, the results were moved up to another conceptual level to represent the meaning of lived experience at the level of theory. For example, nurses' descriptions of their feelings in relation to rule enforcement were merged as role ambivalence. This concept was supported by examples from the transcripts. Other possible explanations for the data and the connections between them were checked by returning to each text unit in the cluster and ensuring that it fitted with the emergent theory. The design centred on a comparative interview study of 30 patients and 30 nurses within two acute psychiatric wards in different hospitals. Non-participant observations provided a context for the interview data. Measures of the Ward Atmosphere Scale, the Hospital-Hostel Practices Profile, ward incidents and levels of as required (PRN) medication were obtained. The analysis of the quantitative data was assisted by spss, and the qualitative analysis by QSR *NUDIST. Thematic and interpretative phenomenological methods were used in the analysis of the qualitative data. A series of
Davis, Jacqueline; Adams, John
The aim of this study was to explore the perceptions of nursing staff concerning the implementation of the 'Releasing Time to Care - the Productive Ward' programme in a specialist cardiothoracic hospital. The 'Releasing Time to Care - the Productive Ward' programme uses the 'lean' philosophy originally developed in the Japanese motor industry to improve the efficiency of hospital wards. Its aim is to increase the proportion of time that nurses are able to spend in direct patient care. This study used a descriptive qualitative method with a sample size of four nurses and two health-care support workers. Thematic analysis of the interview transcripts was undertaken using the procedure developed by Burnard. Thematic content analysis identified five major themes: starting to implement the programme, anxiety and defensiveness, the importance of leadership and communication, challenges, and learning and personal development. Overall, the programme had a positive impact on both the wards studied. Challenges that were identified included the need to sustain momentum once the initial enthusiasm had waned. This study highlighted the importance of key transformational leadership skills at ward manager level, such as the ability to inspire nurses to approach old problems in new ways, in the implementation of the 'Releasing Time to Care - the Productive Ward' programme. © 2011 Blackwell Publishing Ltd.
Hewart, Carol; Fethney, Loveday
There is much research concerning the psychological and physical effects of sleep deprivation on patients in healthcare systems, yet interrupted sleep on hospital wards at night remains a problem. Staff at Plymouth Hospitals NHS Trust, Devon, wanted to identify the factors that prevent patients from sleeping well at night. Two audits were carried out, between April and August 2015, to assess noise and light levels on wards at night, and to engage nurses in ways of reducing these. A number of recommendations were made based on the audit findings, many of which have been put into practice.
35. Basement, passage beneath main entrance porch, showing circular skylight opening, view to northwest - Portsmouth Naval Hospital, Hospital Building, Rixey Place, bounded by Williamson Drive, Holcomb Road, & The Circle, Portsmouth, Portsmouth, VA
Jiang, Hui; Li, Chen; Gu, Yan; Lu, Haiyan
To explore satisfaction and burnout of nurses working in neurology wards in Shanghai, China. A descriptive cross-sectional questionnaire survey. Three hundred and eighty-seven nurses from 23 neurology wards in 21 tertiary general hospitals were recruited using cluster sampling. The valid response rate was 94.83%. Nurse satisfaction with the salary/wages, the job and the nurse staffing level were 21.79%, 37.33%, and 40.87%. A high nurse burnout rate was found as: emotional exhaustion (EE) ≥ 27 (89.92%); depersonalization (DP) ≥ 10 (92.64%); and reduced personal accomplishment (PA)≤ 33 (79.29%). Most nurses in the neurology wards were dissatisfied and had high levels of burnout. Experienced, intermediate and senior nurses were at the highest risk for job turnover. Nurse administrators should take effective measures to increase nurse satisfaction and decrease burnout to retain experienced nurses and keep the stability of nursing workforce. © 2014 Association of Rehabilitation Nurses.
Morra, D.; Lo, V.; Quan, S.; Wu, R.
Summary Objective To describe the uses of institutional and personal smartphones on General Internal Medicine wards and highlight potential consequences from their use. Methods A mixed methods study consisting of both quantitative and qualitative research methods was conducted in General Internal Medicine wards across four academic teaching hospitals in Toronto, Ontario. Participants included medical students, residents, attending physicians and allied health professionals. Data collection consisted of work shadowing observations, semi-structured interviews and surveys. Results Personal smartphones were used for both clinical communication and non-work-related activities. Clinicians used their personal devices to communicate with their medical teams and with other medical specialties and healthcare professionals. Participants understood the risks associated with communicating confidential health information via their personal smartphones, but appear to favor efficiency over privacy issues. From survey responses, 9 of 23 residents (39%) reported using their personal cell phones to email or text patient information that may have contained patient identifiers. Although some residents were observed using their personal smartphones for non-work-related activities, personal use was infrequent and most residents did not engage in this activity. Conclusion Clinicians are using personal smartphones for work-related purposes on the wards. With the increasing popularity of smartphone devices, it is anticipated that an increasing number of clinicians will use their personal smartphones for clinical work. This trend poses risks to the secure transfer of confidential personal health information and may lead to increased distractions for clinicians. PMID:25298819
Andersen, Stig Ejdrup
The aim of this study was to determine the frequency of drug dispensing errors in a traditional ward stock system operated by nurses and to investigate the effect of potential contributing factors. This was a descriptive study conducted in a teaching hospital from January 2005 to June 2007. In five wards, samples of dispensed solid drugs were collected prospectively and compared with the prescriptions. Data were evaluated using multivariable logistic regression. Overall, 2173 samples were collected, 95.5% of which were correctly dispensed (95% CI 94.5-96.2). In total, 124 errors in 6715 opportunities for error were identified; error rate of 1.85 errors per 100 opportunities for error (95% CI 1.54-2.20). Omission of a dose was the predominant type of error while vitamins and minerals, drugs for acid-related diseases and antipsychotic drugs were the drugs most frequently affected by errors. Multivariable analysis showed that surgical and psychiatric settings were more susceptible to involvement in dispensing errors and that polypharmacy was a risk factor. In this ward stock system, dispensing errors are relatively common, they depend on speciality and are associated with polypharmacy. These results indicate that strategies to reduce dispensing errors should address polypharmacy and focus on high-risk units. This should, however, be substantiated by a future trial.
AMU ward rounds can be busy, and many consultants feel they are 'too busy to teach'. Yet the AMU is a rich learning environment. If we take the starting point that teaching is not the same as learning, how can consultants facilitate learning during a busy AMU ward round? Opportunistic teaching requires some planning but can easily be incorporated in to the business of the working day. Good educational practice requires some knowledge however. This article aims to give physicians some understanding and tips on teaching on the AMU ward round.
Shafipour, Vida; Mohammad, Eesa; Ahmadi, Fazlollah
An appropriate and effective nurse-patient communication is of the most important aspect of caring. The formation and continuation of such a relationship depends on various factors such as the conditions and context of communication and a mutual understanding between the two. A review of the literature shows that little research is carried out on identification of such barriers in hospital wards between the patients and the healthcare staff. The present study was therefore conducted to explore the experiences of nurses and patients on communication barriers in hospital cardiac surgery wards. This qualitative research was carried out using a content analysis method (Graneheim & Lundman, 2004). The participants were selected by a purposeful sampling and consist of 10 nurses and 11 patients from the cardiac surgery wards of three teaching hospitals in Tehran, Iran. Data was gathered by unstructured interviews. All interviews were audio-taped and transcribed verbatim. Findings were emerged in three main themes including job dissatisfaction (with the sub-themes of workload tension and decreased motivation), routine-centered care (with the sub-themes of habitual interventions, routinized and technical interventions, and objective supervision), and distrust in competency of nurses (with the sub-themes of cultural contrast, less responsible nurses, and their apathy towards the patients). Compared to other studies, our findings identified different types of communication barriers depending on the nursing settings. These findings can be used by the ward clinical nursing managers at cardiac surgery wards to improve the quality of nursing care.
Kim, Min Jeong; Kim, Byung Seup; Kwon, Jae Woo; Ahn, So-Eun; Lee, Seung Soon; Park, Hyoung Chul
Purpose Clostridium difficile colitis (CDC) is a nosocomial infection. We attempted to discover the risk factors for the development of CDC in patients admitted to our surgical ward. Methods We conducted a retrospective chart review of all patients admitted to our surgical ward between January 2010 and July 2011. CDC was confirmed when toxin A/B or toxin B polymerase chain reaction was detected in the stool and clinical symptoms, such as diarrhea, were present. We divided patients into the CDC and non-CDC groups, and compared the clinical features between the two groups. Results The rate of CDC occurrence was 0.4% (19/4,720 patients). Univariate analysis showed that colectomy (P < 0.001), hospital stays longer than 10 days (P < 0.001), aged over 55 years (P < 0.001) and transfer from medical ward (P = 0.009) were significant parameters for CDC. Multivariate analysis showed that colectomy (P < 0.001; odds ratio [OR], 8.405; 95% confidence interval [CI], 2.927 to 24.132) and hospital stays longer than 10 days (P = 0.035; OR, 10.253; 95% CI, 1.176 to 89.392) were high risk factors for CDC occurrence in the surgical ward. Conclusion The risk factors for CDC in a surgical ward could be colectomy and a long duration of hospitalization. Therefore, clinicians should consider the possibility of CDC when patients undergo colectomy, are admitted for a long time, and have postoperative diarrhea. PMID:22792529
Govranos, Melissa; Newton, Jennifer M
Health care systems demand that nurses are flexible skilful workers who maintain currency and competency in order to deliver safe effective patient centered care. Nurses must continually build best practice into their care and acquire lifelong learning. Often this learning is acquired within the work environment and is facilitated by the clinical nurse educator. Understanding clinical nurses' values and needs of continuing education is necessary to ensure appropriate education service delivery and thus enhance patient care. To explore clinical ward-based nurses' values and perceptions towards continuing education and what factors impact on continuing education in the ward. A case study approach was utilized. A major teaching hospital in Melbourne, Australia. A range of clinical nursing staff (n=23). Four focus groups and six semi-structured individual interviews were undertaken. Focus group interviews explored participants' values and perceptions on continuing education through a values clarification tool. Thematic analysis of interviews was undertaken to identify themes and cluster data. Three central themes: 'culture and attitudes', 'what is learning?' and 'being there-being seen', emerged reflecting staffs' values and perceptions of education and learning in the workplace. Multiple factors influence ward nurses' ability and motivation to incorporate lifelong learning into their practice. Despite variance in nurses' values and perceptions of CE in clinical environments, CE was perceived as important. Nurses yearned for changes to facilitate lifelong learning and cultivate a learning culture. Clinical nurse educators need to be cognizant of adult learners' characteristics such as values, beliefs, needs and potential barriers, to effectively facilitate support in a challenging and complex learning environment. Organizational support is essential so ward managers in conjunction with educational departments can promote and sustain continuing education, lifelong
Adatia, Safina; Law, Susan; Haggerty, Jeannie
For mothers who have just given birth, the postpartum hospital stay is meant to promote an environment where resting, healing and bonding can take place. New mothers, however, face many interruptions throughout the day including multiple visitors and noise caused by medical equipment, corridor conversations and intercom announcements. This paper argues that disruptions and noise on a maternity ward are detrimental to the healing process for new mothers and their newborns and healthcare decision-makers need to act to improve the environment for these patients. This paper also provides recommendations on how to reduce the noise levels, or at least control the noise on a maternity ward, through the implementation of a daily quiet time. Hospital disruptions and its negative health effects in particular for new mothers and their children are illustrated in this paper. Hospital noise and interruptions act as a stressor for both new mothers and staff, and can lead to sleep deprivation and detrimental cardiovascular health effects. Sleep deprivation is associated with a number of negative mental and physical health consequences such as decreased immune function, vascular dysfunction and increased sympathetic cardiovascular modulation. Sleep deprivation can also increase the risk of postpartum mental health disorders in new mothers. Some efforts have been made to reduce the disruptions experienced by these patients within a hospital setting. For example, the introduction of a daily quiet time is one way of controlling noise levels and interruptions, however, these have mostly been implemented in intensive care units. Noise and disruptions are a significant problem during postpartum hospital stay. Healthcare institutions are responsible for patient-centered care; a quiet time intervention promises to contribute to a safe, healing environment in hospitals.
Bowers, Len; James, Karen; Quirk, Alan; Simpson, Alan; Stewart, Duncan; Hodsoll, John
Acute psychiatric wards manage patients whose actions may threaten safety (conflict). Staff act to avert or minimise harm (containment). The Safewards model enabled the identification of ten interventions to reduce the frequency of both. To test the efficacy of these interventions. A pragmatic cluster randomised controlled trial with psychiatric hospitals and wards as the units of randomisation. The main outcomes were rates of conflict and containment. Staff and patients in 31 randomly chosen wards at 15 randomly chosen hospitals. For shifts with conflict or containment incidents, the experimental condition reduced the rate of conflict events by 15% (95% CI 5.7-23.7%) [corrected] relative to the control intervention. The rate of containment events for the experimental intervention was reduced by 23.2% (95% CI 9.9-35.5%). [corrected] Simple interventions aiming to improve staff relationships with patients can reduce the frequency of conflict and containment. IRSCTN38001825. Crown Copyright © 2015. Published by Elsevier Ltd. All rights reserved.
Ford, Helen; Cleland, Jennifer; Thomas, Ian
Distractions and interruptions on the ward pose substantial patient safety risks, but medical students receive little training on their management. Although there is some evidence that medical students can be taught how to manage distractions and interruptions in a simulated ward environment, the only model to date is based on individual feedback, which is resource-expensive, mitigating curricular integration. Our aim was to assess the educational utility of a cost-efficient approach to a patient safety-focused simulated ward round. Twenty-three of 55 final-year medical students took part in a cost-reduced simulated ward round. Costs were minimised by providing group rather than individualised feedback, thereby shortening the duration of each simulation and reducing the number of interruptions. The utility of the simulation was assessed via student evaluation and performance on a patient safety station of an objective structured clinical examination (OSCE). The direct costs of the simulation were more than 50 per cent lower per student compared with the original study, mostly as a result of a reduction in the time that faculty members took to give feedback. Students managed distractions better and received higher scores in the OSCE station than those who had not undergone the ward round. Group feedback was evaluated positively by most participants: 94 per cent of those who provided feedback agreed or strongly agreed that the simulation would make them a safer doctor and would improve their handling of distractions. Our aim was to assess the educational utility of a cost-efficient approach to a patient safety-focused simulated ward round DISCUSSION: The costs of a simulated ward round can be significantly reduced whilst maintaining educational utility. These findings should encourage medical schools to integrate ward simulation into curricula. © 2016 John Wiley & Sons Ltd.
Fujino, Mitsuku; Nojima, Yoshiko
The purpose of this study was to examine the experience of Japanese clinical nurses undertaking a ward rotation in a general hospital, and its effects on subsequent processes relating to: (i) perception of ward rotation; (ii) reactions to the ward transition process; and (iii) outcomes of ward rotation. In-depth interviews were conducted with 21 Japanese clinical nurses who had an average of 8.8 years (SD = 5.50) clinical experience. Findings indicated that participants experienced role overload, role incongruity and/or role underload, role overqualification, or role ambiguity in the new environment. These role stresses created critical emotional distress during the transition process. The high desire for career development facilitated the transition process, while lack of preparation inhibited the transition process. To facilitate smooth transition, well-prepared and structured supports based on reliable interpersonal relationships are necessary. The findings offer significant cues for effective ward rotation programs. The implication for nursing administrators is that appropriate ward rotations enhance confidence and promote effective role development in the new clinical setting.
Angelhoff, Charlotte; Edéll-Gustafsson, Ulla; Mörelius, Evalotte
To describe sleep quality and mood in parents accommodated with their sick child in a family-centred paediatric ward. Secondary aims were to compare mothers' and fathers' sleep quality and mood in the paediatric ward, and to compare the parents' sleep quality and mood between the paediatric ward and in a daily-life home setting after discharge. Frequent interruptions, ward noise, and anxiety affect parents' sleep quality and mood negatively when accommodated with their sick child in paediatric wards. Poor sleep quality and negative mood decreases the parents' ability to sustain attention and focus, and to care for their sick child. This was a prospective and descriptive study. Eighty-two parents (61 mothers and 21 fathers) with children (median age 6.25 years) admitted to six paediatric wards participated in the study. Uppsala Sleep Inventory, a sleep diary and The MACL were used to measure sleep quality and mood. The parents had a good sleep quality in the paediatric ward even though they had more nocturnal awakenings compared to home. Moreover, they were less alert, less interested, and had reduced concentration, and were more tired, dull and passive in the hospital than at home after discharge. Vital sign checks, noises made by the staff and medical treatment were given reasons influencing sleep. Poor sleep quality correlated with negative mood. Parents' sleep quality in family-centred paediatric care is good. However, the habitual sleep efficacy before admittance to the hospital is lower than expected and needs to be further investigated. The healthcare professionals should acknowledge parents' sleep and mood when they are accommodated with their sick child. Further should care at night be scheduled and sleep promoted for the parents in order to maintain health and well-being in the family. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
Background Hospital doctors face constantly increasing workloads. Besides caring for patients, their duties also comprise the education of future colleagues. The aim of this study was to objectively investigate whether the workload arising from increased patient care interferes with student supervision and is associated with more non-medical activities of final-year medical students. Methods A total of 54 final-year students were asked to keep a diary of their daily activities over a three-week period at the beginning of their internship in Internal Medicine. Students categorized their activities – both medical and non-medical - according to whether they had: (1) only watched, (2) assisted the ward resident, (3) performed the activity themselves under supervision of the ward resident, or (4) performed the activity without supervision. The activities reported on a particular day were matched with a ward specific workload-index derived from the hospital information system, including the number of patients treated on the corresponding ward on that day, a correction factor according to the patient comorbidity complexity level (PCCL), and the number of admissions and discharges. Both students and ward residents were blinded to the study question. Results A total of 32 diaries (59 %, 442 recorded working days) were handed back. Overall, the students reported 1.2 ± 1.3 supervised, 1.8 ±1.6 medical and 3.6 ± 1.7 non-medical activities per day. The more supervised activities were reported, the more the number of reported medical activities increased (p < .0001). No relationship between the ward specific workload and number of medical activities could be shown. Conclusions There was a significant association between ward doctors’ supervision of students and the number of medical activities performed by medical students. The workload had no significant effect on supervision or the number of medical or non-medical activities of final-year students. PMID
Teitelbaum, Alexander; Lahad, Amnon; Calfon, Nitza; Gun-Usishkin, Monica; Lubin, Gad; Tsur, Anat
To study the association between bed occupancy in psychiatric wards and rate of adverse incidents (AIs) including aggressive behavior and falls. This is a retrospective study analyzing bed occupancy and AIs' data in 4 closed wards in a state psychiatric hospital in Israel over a 20-month period. Ward-level daily records were extracted from the hospital's electronic admission-discharge and AI registries, creating a log of 609 days for each of the 4 wards. Relationships between gross and net bed occupancy and AIs rate were calculated, in general and for each ward and type of incidents. Average gross occupancy was 106±14.8% and net occupancy was 96.4±15.6%. Gross occupancy >100% was recorded in 51% of days. Net occupancy was higher on days with at least 1 incident than on no-incident days (98.6±14.8% vs. 95.7±15.7%, P<0.0001). AIs occurred in 18.6% of days in the lowest occupancy quadrant (up to 85% occupancy), compared with 26.7% of days in the highest occupancy quadrant (106% and above). Moreover, aggressive behavior-type incidents were significantly lower in the lowest occupancy quadrant days compared with the highest occupancy quadrant (8.3% vs. 14.1%, P<0.01). Evidence of a dose-response effect of bed occupancy on AIs rate was found. Overoccupancy is prevalent in psychiatric wards and is associated with an increased rate of aggressive AIs and falls. Policy makers should be convinced about the necessity to reduce overcrowding in psychiatric wards and to improve safety of inpatient facilities.
Butt, Irfan A.; Aslam, Bilal; Rasool, Muhammad H.; Shafiq, Humerah B.; Khurshid, Mohsin; Aslam, Muhammad A.
Objectives: To test various items in hospital environment as reservoirs of bacteria. Methods: This simple descriptive study was conducted between June and December 2014. Pediatric wards of 4 different hospitals of Faisalabad, Pakistan were selected and 8 different items per hospital were sampled (n=160). Poisson regression analysis was carried out with R software and using lme4 package. Results: There were no differences between the hospitals regarding total number of bacterial isolates or bacterial isolates per sample source or prevalent bacterial species. Utensile tables were significantly the least contaminated source when comparing all sample sources from all hospitals (p=0.05). When testing if the bacterial species differed significantly between sample sources, Escherichia coli (p=0.05) and Bacillus (p=0.04) were found significantly high on utensils, while Pseudomonas was found significantly less on curtains (p=0.03) and doors (p=0.02). Conclusion: Due to unhygienic practices in hospitals children are exposed to pathogens steers to life threatening infection. A good control strategy should be implemented to avoid health care-associated infection. PMID:27761569
New York City Board of Education, Brooklyn, NY. Bureau of Curriculum Development.
This guide for teachers, students, and adults illustrates how it is possible to use Ward's Island as an outdoor laboratory. It contains a guide to 30 kinds of trees on the island, along with clearly drawn maps and illustrations. The guide helps the user to locate these trees along two nature trails. A section called "Ward's Island…
Bandurska, Ewa; Zarzeczna-Baran, Marzena; Zielazny, Paweł
The aim of this study was to evaluate the quality of nursing care in psychiatric wards and compare it between hospitals of different types. Significant differences between hospitals were found in: personnel benevolence (p=0,006219) and response to patient needs (p=0,011446) as well as patients' sense of safety (p=0,020042). In both hospitals, patients were equally dissatisfied with the quality of information concerning treatment side effects (p=0,207804). In both hospitals patients were equally satisfied regarding the level of respect for their dignity and psychological support (p=0,176928). General patient perception of nursing care in psychiatry wards seems to be positive. Some tasks carried out by nurses in psychiatric care still require improvement, especially regarding providing information to patients. Copyright Â© 2016 Elsevier Inc. All rights reserved.
Berg, Robert A.; Sutton, Robert M.; Holubkov, Richard; Nicholson, Carol E.; Dean, J. Michael; Harrison, Rick; Heidemann, Sabrina; Meert, Kathleen; Newth, Christopher; Moler, Frank; Pollack, Murray; Dalton, Heidi; Doctor, Allan; Wessel, David; Berger, John; Shanley, Thomas; Carcillo, Joseph; Nadkarni, Vinay M.
Objective The aim of this study was to evaluate the relative frequency of pediatric in-hospital CPR events occurring in intensive care units (ICUs) compared to general wards. We hypothesized that the proportion of pediatric CPR provided in ICUs versus general wards has increased over the past decade and this shift is associated with improved resuscitation outcomes. Design Prospective, observational study. Setting Total of 315 hospitals in the American Heart Association’s Get With The Guidelines-Resuscitation (GTWG-R) database. Patients Total of 5,870 pediatric cardiopulmonary resuscitation (CPR) events between January 1, 2000 and September 14, 2010. CPR events were defined as external chest compressions >1minute. Measurements and Results The primary outcome was proportion of total ICU versus general ward CPR events over time evaluated by chi square test for trend. Secondary outcome included return of spontaneous circulation (ROSC) following the CPR event. Among 5870 pediatric CPR events, 5477 (93.3%) occurred in ICUs compared to 393 (6.7%) on inpatient wards. Over time, significantly more of these CPR events occurred in the ICU compared to the wards (test for trend: p<0.01), with a prominent shift noted between 2003 and 2004 (2000-2003: 87 - 91% vs. 2004-2010: 94 - 96%). In a multivariable model controlling for within center variability and other potential confounders, ROSC increased in 2004-2010 compared with 2000-2003 (RR 1.08, 95% confidence interval: 1.03-1.13). Conclusions In-hospital pediatric CPR is much more commonly provided in ICUs vs. Wards and the proportion has increased significantly over the past decade with concomitant increases in return of spontaneous circulation. PMID:23921270
Puvaneswaralingam, Shobitha; Ross, Daniella
Transferring patients from the ward of their specialty or consultant is described as boarding. 1 Boarding patients is becoming increasingly prevalent due to greater pressure on hospital capacity. This practice compromises patient safety through delayed investigations, prolonged hospital stays, and increased risk of hospital-acquired infections. 1 2 We evaluated how regularly boarded patients were reviewed, and how effectively information regarding their management was communicated from their primary specialty to ward staff. We aimed to improve the frequency of patient reviews by ensuring that each patient was reviewed every weekday and increase communication between primary specialty, and medical and nursing teams by 20% from baseline during the data collection period. The project was based in the Otolaryngology ward in Ninewells Hospital, Dundee, where there was a high prevalence of boarded patients. Baseline data showed a clear deficit in communication between the primary specialty and ward staff with only 31% of patient reviews being communicated to ward doctors. We designed and implemented a communication tool, in the form of a sticker, to be inserted into patients' medical notes for use by the primary specialty. Implementation of the sticker improved communication between teams as stickers were completed in 93% of instances. In 88% of patient reviews, the junior doctor was informed of the management plan, showing a large increase from baseline. Through PDSA cycles, we aimed to increase the sustainability and reliability of the sticker; however, we faced challenges with sustainability of sticker insertion. We aim to engage more stakeholders to raise awareness of the problem, brainstorm solutions together, and review the production and implementation of stickers with senior hospital management to discuss the potential use of this tool within practice. There is potentially a large scope for utilisation of this communication tool on a local level, which we hope
Puvaneswaralingam, Shobitha; Ross, Daniella
Transferring patients from the ward of their specialty or consultant is described as boarding. 1 Boarding patients is becoming increasingly prevalent due to greater pressure on hospital capacity. This practice compromises patient safety through delayed investigations, prolonged hospital stays, and increased risk of hospital-acquired infections. 1 2 We evaluated how regularly boarded patients were reviewed, and how effectively information regarding their management was communicated from their primary specialty to ward staff. We aimed to improve the frequency of patient reviews by ensuring that each patient was reviewed every weekday and increase communication between primary specialty, and medical and nursing teams by 20% from baseline during the data collection period. The project was based in the Otolaryngology ward in Ninewells Hospital, Dundee, where there was a high prevalence of boarded patients. Baseline data showed a clear deficit in communication between the primary specialty and ward staff with only 31% of patient reviews being communicated to ward doctors. We designed and implemented a communication tool, in the form of a sticker, to be inserted into patients' medical notes for use by the primary specialty. Implementation of the sticker improved communication between teams as stickers were completed in 93% of instances. In 88% of patient reviews, the junior doctor was informed of the management plan, showing a large increase from baseline. Through PDSA cycles, we aimed to increase the sustainability and reliability of the sticker; however, we faced challenges with sustainability of sticker insertion. We aim to engage more stakeholders to raise awareness of the problem, brainstorm solutions together, and review the production and implementation of stickers with senior hospital management to discuss the potential use of this tool within practice. There is potentially a large scope for utilisation of this communication tool on a local level, which we hope
Galvão, C M; Trevizan, M A; Sawada, N O; Fávero, N
The present study was oriented to the leadership theme focussing nurses inside surgical ward unities. As a theoretical reference, the authors used the Situational Leadership Model proposed by Hersey and Blanchard. This study aimed at analysing the correspondence between the opinions of nurses and auxiliary personnel about the leadership style exerted by nurses in the surgical ward unit regarding the six categories of the assistance activity that were studied. Authors noticed that nurses, from the two studied hospitals, adopted the directive leadership styles (E2/selling or E1/telling) with the auxiliary personnel.
Wölfel, Teresa; Beltermann, Esther; Lottspeich, Christian; Vietz, Elisa; Fischer, Martin R; Schmidmaier, Ralf
The medical ward round is a central but complex activity that is of relevance from the first day of work. However, difficulties for young doctors have been reported. Instruction of ward round competence in medical curricula is hampered by the lack of a standardized description of the procedure. This paper aims to identify and describe physicians' tasks and relevant competences for conducting a medical ward round on the first day of professional work. A review of recent literature revealed known important aspects of medical ward rounds. These were used for the development of a semi-structured interview schedule. Medical ward round experts working at different hospitals were interviewed. The sample consisted of 14 ward physicians (M = 8.82 years of work experience) and 12 nurses (M = 14.55 years of work experience) working in different specializations of internal medicine. All interviews were audiotaped, fully transcribed, and analyzed using an inductive-deductive coding scheme. Nine fields of competences with 18 related sub-competences and 62 observable tasks were identified as relevant for conducting a medical ward round. Over 70 % of the experts named communication, collaborative clinical reasoning and organization as essential competences. Deeper analysis further unveiled the importance of self-management, management of difficult situations, error management and teamwork. The study is the first to picture ward round competences and related tasks in detail and to define an EPA "Conducting an internal medicine ward round" based on systematic interprofessional expert interviews. It thus provides a basis for integration of ward round competences in the medical curricula in an evidence based manner and gives a framework for the development of instructional intervention studies and comparative studies in other medical fields.
Mantra, I B
The author examines circular migration in Indonesia, with primary focus on the 1970s. It is found that circular, or repeated return migration, generally occurs over short distances and for short periods and is more frequent than lifetime migration. The relationships between improvements in the national transport system, access to labor force opportunities in both the formal and informal sectors of the economy, and circular migration are discussed.
Andritsch, Elisabeth; Stöger, Herbert; Bauernhofer, Thomas; Andritsch, Hans; Kasparek, Anne-Katrin; Schaberl-Moser, Renate; Ploner, Ferdinand; Samonigg, Hellmut
Change affects all areas of healthcare organizations and none more so than each aspect of the oncology ward, beginning with the patient's room. It is there that the issues faced by the major players in healing environments - administrator, caregiver, family member, and, most importantly, the patient - come sharply into focus. Hospitals are building new facilities or renovating old ones in order to adapt to new environmental demands of patient care and security. Driven by ethical and professional responsibility, the oncological team headed by Professor Hellmut Samonigg of Graz Medical University Graz pursued a vision of designing a model oncology ward unique in Europe. Friedensreich Hundertwasser, the world-famous artist, was the creative force behind the design. The oncology ward became a place of healing, permeated with a colorful sense of life and harmonious holistic care. The successful outcome was confirmed by the extraordinarily positive feedback by patients, families, and healthcare staff.
Raybould, T. A.; Fedotov, V. A.; Papasimakis, N.; Kuprov, I.; Youngs, I. J.; Chen, W. T.; Tsai, D. P.; Zheludev, N. I.
We demonstrate that the induced toroidal dipole, represented by currents flowing on the surface of a torus, makes a distinct and indispensable contribution to circular dichroism. We show that toroidal circular dichroism supplements the well-known mechanism involving electric dipole and magnetic dipole transitions. We illustrate this with rigorous analysis of the experimentally measured polarization-sensitive transmission spectra of an artificial metamaterial, constructed from elements of toroidal symmetry. We argue that toroidal circular dichroism will be found in large biomolecules with elements of toroidal symmetry and should be taken into account in the interpretation of circular dichroism spectra of organics.
To determine the impact of a clinical pharmacist on detection and prevention of prescription errors at the nephrology ward of a referral hospital. Nephrology ward of a major referral hospital in Southern Iran. During a 4-month period, a clinical pharmacist was assigned to review medication order sheets and drug orders three times a week at the nephrology ward. Besides chart review, the clinical pharmacist participated in medical rounds once a week. The occurrence of prescribing errors, and related harm was determined on hospitalized patients in this ward during the 4 month period. When an error was detected, intervention was made after agreement of the attending physician. Number and types of prescribing errors, level of harm, and number of interventions were determined. Seventy six patient charts were reviewed during the 4-month period. A total of 818 medications were ordered in these patients. Eighty six prescribing errors were detected in 46 hospital admissions. The mean age of the patients was 47.7 +/- 17.2. Fifty five percent were male while 45% were female. Different types of prescribing errors and their frequencies were as follows: wrong frequency (37.2%), wrong drug selection (19.8%), overdose (12.8%), failure to discontinue (10.5%), failure to order (7 %), under- dose (3.5%), wrong time (3.5%), monitoring (3.5%), wrong route (1.2%), and drug interaction (1.2 %). The attending physician agreed to 96.5% of the prescription errors detected, and interventions were made. Although 89.5% of the detected errors caused no harm, 4(4.7%) of the errors increased the need for monitoring, 2 (2.3%) increased length of stay, and 2 (2.3%) led to permanent patient harm. presence of a clinical pharmacist at the nephrology ward helps in early detection of prescription errors, and therefore potential prevention of negative consequences due to drug administration.
Melis Tormos, Eloida
In patients who undergo cardiac surgery, particularly valvular surgery it is essential to carry out frequent anticoagulation controls during their hospital stay The author questions if it is viable to carry out these controls by means of a portable coagulation meter which, in principle, can provide advantages in patient care. To determine this viability the author evaluates the concordance between the measurements obtained with this device and measurements taken in a laboratory The author compared the INR (prothrombin time, Normalized International Ratio) in 106 pairs of simultaneous blood samples, from both veins and capillaries, taken from 60 patients receiving anticoagulation medicine hospitalized in the cardiac surgery ward at the La Fe Hospital after each underwent surgery The samples taken from veins were processed in a hemostasia laboratory while the capillary samples were processed with a portable coagulation meter, a Roche CoaguChek"S. The statistical analyses applied were Pearson coefficient, intraclass correlation coefficient (CCI) and the method for mean differences (MMD). Numbers for hemocytes and therapy combined with heparine were taken into account. The results showed, in the overall analysis of data, a very good degree of concordance, CCI = 0.939 (confidence interval, IC=95%, 0.902-0.961) and MMD numbers <10%. For hemocytes <32, the concordance decreases, CCI = 0.876 (IC 95% = 0.787-0.930). The author concludes that this coagulation meter is trustworthy therefore using it would improve care for a patient needing anti-coagulation treatment during his/her stay in the ward since using this meter helps to obtain immediate results and reduces the trauma when extracting blood samples, etc. Nonetheless, when dealing with patients having a low hemocyte level, it is more prudent to make use of laboratory results.
Cotter, Danielle; Turner, Michael J; McAuliffe, Fionnuala M; Higgins, Mary F
To study the educational value to medical students of a labour ward rotation. Qualitative research study was performed in two tertiary level obstetric hospitals attached to a large medical school in Dublin. Medical students attending a six-week rotation in Obstetrics and Gynaecology in University College Dublin were invited to participate. As part of this rotation, students spend one week as part of the clinical team working on the labour ward. Focus groups were held in order to identify common themes and experiences of medical students during this labour ward week. Grounded theory with thematic analysis was used. The main outcome measures were the educational experience and value of a labour ward rotation to medical students. Five distinct themes developed from the focus groups of 19 students. A high value was placed on patient centred bedside teaching. Midwives were identified as excellent teachers and facilitators of learning. There was a clear sense of teamwork and belonging by the students. However, students reported frustration with unclear learning objectives. Students identified extra pre-learning with pre-specified learning aims before the labour ward week as being important. Bedside teaching was highly valued as it advanced student's knowledge of obstetrics theory and improved communication skills. In general, medical students reported a positive experience from working in the labour word but there is scope for improvement. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.
Duffield, Christine; Roche, Michael; Twigg, Di; Williams, Anne; Clarke, Sean
To assess the impact of adding nursing support workers to ward staffing. Nurses' capacity to provide safe care is compromised by increased workloads and nursing shortages. Use of unregulated workers is an alternative to increasing the number of regulated nurses. The impact of adding nursing support workers on patient, nurse and system outcomes has not been systematically evaluated. A mixed longitudinal and cross-sectional design using administrative data sets and prospective data from a sample of wards. Payroll data will identify wards on which unregulated staff work. To assess the impact on nursing-sensitive outcomes, retrospective analysis of morbidity and mortality data of all patients admitted to Western Australia hospitals for over 24 hours across 4 years will be undertaken. For the cross-sectional study, a sample of 20 pairs of matched wards will be selected: 10 with unregulated workers added and 10 where they have not. From this sample the impact on patients will be assessed using the Patient Evaluation of Emotional Care during Hospitalisation survey. The impact on nurses will be assessed by a nurse survey used extensively which includes variables such as job satisfaction and intention to leave. The impact on system outcomes will be explored using work sampling of staff activities and the Practice Environment Scale. Interviews will determine nurses' experience of working with nursing support workers. The study aims to provide evidence about the impact of adding nursing support workers to ward staffing for patients, staff and the work environment. © 2016 John Wiley & Sons Ltd.
Burkholder, David; Hall, Stephanie F.; Burkholder, Jessica
This article investigated 71 counselor educators' perspectives and pedagogical practices related to "Ward v. Wilbanks" (2009) and the American Counseling Association (ACA) response to the case. The authors used qualitative content analysis to identify 6 themes from survey data: (a) views on gatekeeping and student training; (b)…
O'Nell, Robert M.
The University of Colorado's Ward Churchill is but the latest in a long line of professors whose volatile statements have created controversy for themselves and their universities. Specific personnel matters in the case have been meticulously addressed in Boulder, but several larger questions have been curiously neglected. One might well ask, for…
O'Nell, Robert M.
The University of Colorado's Ward Churchill is but the latest in a long line of professors whose volatile statements have created controversy for themselves and their universities. Specific personnel matters in the case have been meticulously addressed in Boulder, but several larger questions have been curiously neglected. One might well ask, for…
Burkholder, David; Hall, Stephanie F.; Burkholder, Jessica
This article investigated 71 counselor educators' perspectives and pedagogical practices related to "Ward v. Wilbanks" (2009) and the American Counseling Association (ACA) response to the case. The authors used qualitative content analysis to identify 6 themes from survey data: (a) views on gatekeeping and student training; (b)…
Harries, A D; Mvula, B
The pattern of adult medical deaths in Queen Elizabeth Central Hospital, Blantyre, Malawi was documented over a 12 month period between April 1992 and March 1993. Results were compared with mortality data collected from the same wards in the pre-AIDS era in 1973. Tuberculosis and AIDS together accounted for 49% of all medical deaths in 1992-93. Eighty-two per cent of deaths occurred in the age group 13-49 years; tuberculosis, AIDS, gastroenteritis, pneumonia, pyogenic meningitis and septicaemia were the most important causes of death in these young patients. These findings are very different to those observed in the same wards 20 years previously when tuberculosis was responsible for 13% of deaths and there were no deaths due to AIDS. The predicted upsurge in AIDS-related deaths in sub-Saharan Africa in the 1990s will have grave consequences not only for the health sector, but for the social and economic fabric of the countries concerned.
Lakshminarayana, Indumathy; Wall, David; Bindal, Taruna; Goodyear, Helen M
Leading a ward round is an essential skill for hospital consultants and senior trainees but is rarely assessed during training. To investigate the key attributes for ward round leadership and to use these results to develop a multisource feedback (MSF) tool to assess the ward round leadership skills of senior specialist trainees. A panel of experts comprising four senior paediatric consultants and two nurse managers were interviewed from May to August 2009. From analysis of the interview transcripts, 10 key themes emerged. A structured questionnaire based on the key themes was designed and sent electronically to paediatric consultants, nurses and trainees at a large university hospital (June-October 2010). 81 consultants, nurses and trainees responded to the survey. The internal consistency of this tool was high (Cronbach's α 0.95). Factor analysis showed that five factors accounted for 72% of variance. The five key areas for ward round leadership were communication skills, preparation and organisation, teaching and enthusiasm, team working and punctuality; communication was the most important key theme. A MSF tool for ward round leadership skills was developed with these areas as five domains. We believe that this tool will add to the current assessment tools available by providing feedback about ward round leadership skills. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
... assistant professor of medicine at the University of Chicago, said in a university news release. "After caring ... patients who were admitted to the University of Chicago Medicine from 2009 to 2013. The researchers focused ...
3. PSYCHIATRIC WARD IN 24' X 60' QUONSET HUT, VIEW OF SOUTH FACE - Fort Randall, Neuro-Psychiatric Ward, Northeast of intersection of California Boulevard & Nurse Drive, Cold Bay, Aleutian Islands, AK
2. Northwest circular bastion, seen from edge of southwest circular bastion wall. Metal roof beams extend up to form peak. World War II gun installation at right. - Fort Hamilton, Northwest Circular Bastion, Rose Island, Newport, Newport County, RI
Tapisiz, A; Polat, M; Kara, S S; Tezer, H; Simsek, H; Aktas, F
Since measles is a highly contagious respiratory infection with significant airborne transmission risk in hospitals, effective prevention measures are crucial. After a mother accompanying her child on a paediatric ward lacking a negative pressure room was diagnosed with measles, exposed persons without evidence of immunity (documentary evidence of receiving two doses of measles-mumps-rubella vaccine) were treated with vaccination or intravenous immunoglobulin (IVIG). The interruption of transmission with these treatments was evaluated. There were 44 children and 101 adults exposed to the index patient. Twenty-five children and 88 adults were considered immune, providing evidence of immunity. Nineteen children and 13 adults were either given vaccination or IVIG for post-exposure prophylaxis (PEP). There were no additional cases of measles after 3 weeks follow-up. We conclude that measles is highly preventable by adequate PEP with vaccination or IVIG in a healthcare setting that lacks the benefit of a negative pressure room.
Srulovici, Einav; Drach-Zahavy, Anat
Missed nursing care is considered an act of omission with potentially detrimental consequences for patients, nurses, and organizations. Although the theoretical conceptualization of missed nursing care specifies nurses' values, attitudes, and perceptions of their work environment as its core antecedents, empirical studies have mainly focused on nurses' socio-demographic and professional attributes. Furthermore, assessment of missed nursing care has been mainly based on same-source methods. This study aimed to test the joint effects of personal and ward accountability on missed nursing care, by using both focal (the nurse whose missed nursing care is examined) and incoming (the nurse responsible for the same patients at the subsequent shift) nurses' assessments of missed nursing care. A cross-sectional design, where nurses were nested in wards. A total of 172 focal and 123 incoming nurses from 32 nursing wards in eight hospitals. Missed nursing care was assessed with the 22-item MISSCARE survey using two sources: focal and incoming nurses. Personal and ward accountability were assessed by the focal nurse with two 19-item scales. Nurses' socio-demographics and ward and shift characteristics were also collected. Mixed linear models were used as the analysis strategy. Focal and incoming nurses reported occasional missed nursing care of the focal nurse (Mean=1.87, SD=0.71 and Mean=2.09, SD=0.84, respectively; r=0.55, p<0.01). Regarding the focal nurse's assessment of his/her own missed nursing care, findings showed that, above and beyond nurses' overload and personal socio-demographic characteristics, higher personal accountability was significantly associated with decreased missed care (β=-0.29, p<0.01), whereas ward accountability was not (β=-0.23, p>0.05). The interaction effect was significant (β=-0.31, p<0.05); the higher the ward accountability, the stronger the negative relationship between nurses' personal accountability and missed nursing care. Similar
... paragraph (b) of this section, ward of the State means a child who, as determined by the State where the child resides, is— (1) A foster child; (2) A ward of the State; or (3) In the custody of a public child welfare agency. (b) Exception. Ward of the State does not include a foster child who has a foster...
... paragraph (b) of this section, ward of the State means a child who, as determined by the State where the child resides, is— (1) A foster child; (2) A ward of the State; or (3) In the custody of a public child welfare agency. (b) Exception. Ward of the State does not include a foster child who has a foster...
... paragraph (b) of this section, ward of the State means a child who, as determined by the State where the child resides, is— (1) A foster child; (2) A ward of the State; or (3) In the custody of a public child welfare agency. (b) Exception. Ward of the State does not include a foster child who has a foster...
Papsdorf, I; Hannich, H; Tost, F
The daily ward round is the main opportunity for communicative interaction between physician and patient during a patient's hospital stay. We analysed to what extent the round was capable of fulfilling the patients' needs for information and emotional support, using the ophthalmologic ward of a university hospital as an example. For a period of 4 months in 2006, doctor-patient-interactions in an ophthalmologic ward round were recorded with a dictating machine. Fifty physician-patient interactions between 50 patients and five different physicians were selected according to uniform criteria. After the recordings were transcribed, the interactions were evaluated using formal quantitative speech analysis. We examined the patients' subjective perceptions by means of a standardised questionnaire. The average doctor-patient interaction lasted just under 4 min. The formal quantitative analysis of the effective verbal communication between physician and patient indicated an asymmetry to the advantage of the physician, who spoke 73% of the words (Chi 245.48 words). The patient remained rather incommunicative during the course of the conversation. Medical terms were used in only 0.53% of the direct doctor-patient dialogue. The ward round conversation was characterised by numerous personnel internal dialogues. During much of the rounds (46% of the time), the patients were unable to participate actively in the conversations. As a result, information could not reach the patients. Requests to speak were initiated 83% of the time by the physicians and only 33% of the time by the patients. Nevertheless, the patients indicated high (22%) and very high (66%) satisfaction with the ward rounds. In the future, the ophthalmologic ward round should satisfy the criteria of patient-centric conversation. Therefore, the informational value of the daily ward round must be increased, and organisational and structural changes must be made to promote direct conversation between the patient and
Kotlyar, Victor V; Kovalev, Alexey A
We discuss vector Hankel beams with circular polarization. These beams appear as a generalization of a spherical wave with an embedded optical vortex with topological charge n. Explicit analytical relations to describe all six projections of the E- and H-field are derived. The relations are shown to satisfy Maxwell's equations. Hankel beams with clockwise and anticlockwise circular polarization are shown to have peculiar features while propagating in free space. Relations for the Poynting vector projections and the angular momentum in the far field are also obtained. It is shown that a Hankel beam with clockwise circular polarization has radial divergence (ratio between the radial and longitudinal projections of the Poynting vector) similar to that of the spherical wave, while the beam with the anticlockwise circular polarization has greater radial dependence. At n = 0, the circularly polarized Hankel beam has non-zero spin angular momentum. At n = 1, power flow of the Hankel beam with anticlockwise polarization consists of two parts: right-handed helical flow near the optical axis and left-handed helical flow in periphery. At n ≥2, power flow is directed along the right-handed helix regardless of the direction of the circular polarization. Power flow along the optical axis is the same for the Hankel beams of both circular polarizations, if they have the same topological charge.
Hall, Joanna; Roopnarine, Sharmela; McLean, Jane
Where and how to care for children with infections, or those requiring protection, is a daily debate in many paediatric settings. The practice of placing patients into single rooms for infection control purposes is well documented but there is little guidance on when to remove patients from isolation rooms. Unless the appropriateness of isolation for each patient is evaluated daily, the availability of cubicles falls, resulting in potentially unnecessary transfers to other hospitals where such facilities are available. A new isolation policy was introduced to improve the availability of isolation rooms on paediatric wards in a large inner city teaching hospital with over 100 paediatric inpatient beds. A change management framework was used that included empowering organisational action and consolidating improvements. A number of strategies were introduced to prompt daily review of children in isolation, including clear criteria for isolation and nursing staff in the emergency department challenging the decision to admit a child into an isolation room. Introduction of the policy and subsequent audits have resulted in improved staff awareness, more effective use of isolation rooms and reduced transfers to other hospitals.
Pobrotyn, Piotr; Susło, Robert; Witczak, Izabela; Milczanowski, Piotr; Drobnik, Jarosław
Rheumatic diseases are becoming more and more common in Poland with the ageing of the population. Nearly 18% of the total hospital admissions in Poland result from rheumatic diseases, which was equivalent to 350 thousand cases in the year 2008. These diseases tend to last for many decades, decreasing both the quality of life and income of the patients as well as increasing the medical institutions' workload and society's financial burden. The aim of the study was to determine whether the medical care parameters in a rheumatic disease hospital ward show any significant differences among different patient age groups - especially such that would support taking them into account as a basis for adjusting the financial coverage level of medical services. Data on hospitalizations at the Rheumatic Diseases Ward of Wroclaw University Hospital in Wroclaw in the years 2009-2015 were analyzed, taking into account the age groups, number of hospital admissions, their duration and causes. Relevant statistical data analysis was performed. The study revealed that the number of old patients hospitalized at the rheumatic diseases ward increased over the last 6 years and that such statistically significant differences do exist: on average the old patients not only tend to stay much longer at the hospital, but also suffer from a different and more diverse spectrum of diseases in comparison to their younger counterparts. The detected differences in medical care parameters support the need for more individualized medical care and increased cost of the hospital stay in the case of older patients. Consequently, those factors justify the necessity to increase the value of medical services in the case of old patients, possibly also taking into account the variation between age subgroups.
Consider a circular segment (the smaller portion of a circle cut off by one of its chords) with chord length c and height h (the greatest distance from a point on the arc of the circle to the chord). Is there a simple formula involving c and h that can be used to closely approximate the area of this circular segment? Ancient Chinese and Egyptian…
Consider a circular segment (the smaller portion of a circle cut off by one of its chords) with chord length c and height h (the greatest distance from a point on the arc of the circle to the chord). Is there a simple formula involving c and h that can be used to closely approximate the area of this circular segment? Ancient Chinese and Egyptian…
Kagan, Ilya; Kigli-Shemesh, Ronit; Tabak, Nili; Abramowitz, Moshe Z; Margolin, Jacob
In August 2001, the Israeli Ministry of Health issued its Limitation of Smoking in Public Places Order, categorically forbidding smoking in hospitals. This forced the mental health system to cope with the issue of smoking inside psychiatric hospitals. The main problem was smoking by compulsorily hospitalized psychiatric patients in closed wards. An attempt by a psychiatric hospital to implement the tobacco smoking restraint instruction by banning the sale of cigarettes inside the hospital led to the development of a black market and cases of patient exploitation in return for cigarettes. This article surveys the literature dealing with smoking among psychiatric patients, the role of smoking in patients and the moral dilemmas of taking steps to prevent smoking in psychiatric hospitals. It addresses the need for public discussion on professional caregivers' dilemmas between their commitment to uphold the law and their duty to act as advocates for their patients' rights and welfare.
Sørlie, Venke; Torjuul, Kirsti; Ross, Anita; Kihlgren, Mona
To illuminate the experience of being a patient and cared for in an acute care ward. Patients may be the best source of information for assessing the quality of care in acute care wards. Studies often show that patients' satisfaction with their hospital stay is interpreted by managers and care providers as a measure for quality of care. Ten patients were interviewed as part of a comprehensive investigation by four researchers into the narratives of five enrolled nurses (study No. 1--published in Nursing Ethics 2004), five Registered Nurses (study No. 2 published in Nursing Ethics 2005) and 10 patients (study No. 3) about their experiences from an acute care ward at one university hospital in Sweden. A phenomenological hermeneutical method (inspired by the French philosopher Paul Ricoeur) was conducted in all three studies. The patients are very satisfied with their treatment and care. They also tell about factors that they do not consider as optimal, but which they explain as compromises, which must be accepted as a necessary part of their stay in the ward. This study demonstrates a close connection between patient satisfaction and vulnerability. It is important for all health care providers not to be complacent and satisfied when patients express their satisfaction with their treatment and care. This can result in losing the focus on the patients' vulnerability and existential thoughts and reflections which are difficult for them, and which need to be addressed. The findings can be seen as a challenge for the health care providers as well as the organization to provide quality of care to patients in acute care ward. When listening to the patients' voice it makes it easier to be aware of the content of their vulnerability.
Tornquist, Carmen Susana
The maternity ward of the University Hospital in Florianópolis, Santa Catarina, Brazil, attempts to follow World Health Organization guidelines for humanized childbirth care, including the encouragement of non-surgical delivery, breastfeeding, rooming-in, extended family visitation, and reduction of excessive technological intervention in the delivery process. The study focuses specifically on the choice of delivery procedure and on family presence during labor/childbirth, as well as women's experience with labor and breastfeeding.
Iadanza, Ernesto; Dori, Fabrizio
In this work is discussed an active RFId system to track and identify patients in a children's critical care ward. The technical solutions may be very different according to the patients type, age and cognitive conditions and according to the hospital shapes. The proposed system to track and identify patients has been developed taking into account all the constraints induced by the particular environment. The system is composed of five different hardware devices and a tracking software, purposely designed and realized.
Baysari, M T; Adams, K; Lehnbom, E C; Westbrook, J I; Day, R O
Previous work has examined the impact of technology on information sharing and communication between doctors and patients in general practice consultations, but very few studies have explored this in hospital settings. To assess if, and how, senior clinicians use an iPad to share information (e.g. patient test results) with patients during ward rounds and to explore patients' and doctors' experiences of information sharing events. Ten senior doctors were shadowed on ward rounds on general wards during interactions with 525 patients over 77.3 h, seven senior doctors were interviewed and 180 patients completed a short survey. Doctors reported that information sharing with patients is critical to the delivery of high-quality healthcare, but were not seen to use the iPad to share information with patients on ward rounds. Patients did not think the iPad had impacted on their engagement with doctors on rounds. Ward rounds were observed to follow set routines and patient interactions were brief. Although the iPad potentially creates new opportunities for information sharing and patient engagement, the ward round may not present the most appropriate context for this to be done. © 2014 The Authors; Internal Medicine Journal © 2014 Royal Australasian College of Physicians.
Sharma B, Gaurav; Evs, Maben; Ms, Kotian; B, Ganaraja
Psychological assessment for depression, anxiety and stress among ICU patients and the patients admitted to ward in a hospital in India. This aspect did not get much attention in India so far. Such studies were common in developed countries. Therefore we decided in this study, to analyse the psychological status responses from the hospitalised patients in Mangalore using a validated questionnaire. To assess and compare the depression, anxiety and stress Scores from the patients admitted in Intensive Care Unit (ICU) and those admitted to ward. Eighty patients admitted to hospital, 40 from ICU and 40 admitted to ward were recruited. They were explained the procedure and after taking an informed consent, they were administered Depression, Anxiety, Stress Scale (DASS) Questionnaire, which contains 42-item questionnaire which includes three self-report scales designed to measure the negative emotional states of depression, anxiety and stress. The responses were computed and tabulated. We analysed the responses with Student's t-test and Chi-square test, p<0.05 accepted as statistically significant. The results revealed significantly elevated stress, depression and anxiety among the ICU patients when compared to those in the ward (p<0.001). Above normal anxiety and stress levels were also seen in the ward patients, compared to the scores in normal range. 50% and 25% respectively showed mild and normal depression scores in ward patients, compared to 12% and 5% in those admitted to ICU. This trend was also true for Anxiety and stress scores. From the results we found that there were elevated depression, anxiety and stress levels among the patients and this was significantly higher in ICU patients. Various factors could influence the psychological wellbeing of the patients, including the hospital environment, care givers, presence of family members nearby apart from the seriousness of illness, apprehensions about possibility of death. Such studies were rare among Indian
Sharma B, Gaurav; EVS, Maben; MS, Kotian
Background: Psychological assessment for depression, anxiety and stress among ICU patients and the patients admitted to ward in a hospital in India. This aspect did not get much attention in India so far. Such studies were common in developed countries. Therefore we decided in this study, to analyse the psychological status responses from the hospitalised patients in Mangalore using a validated questionnaire. Aim: To assess and compare the depression, anxiety and stress Scores from the patients admitted in Intensive Care Unit (ICU) and those admitted to ward. Materials and Methods: Eighty patients admitted to hospital, 40 from ICU and 40 admitted to ward were recruited. They were explained the procedure and after taking an informed consent, they were administered Depression, Anxiety, Stress Scale (DASS) Questionnaire, which contains 42-item questionnaire which includes three self-report scales designed to measure the negative emotional states of depression, anxiety and stress. The responses were computed and tabulated. We analysed the responses with Student’s t-test and Chi-square test, p<0.05 accepted as statistically significant. Results: The results revealed significantly elevated stress, depression and anxiety among the ICU patients when compared to those in the ward (p<0.001). Above normal anxiety and stress levels were also seen in the ward patients, compared to the scores in normal range. 50% and 25% respectively showed mild and normal depression scores in ward patients, compared to 12% and 5% in those admitted to ICU. This trend was also true for Anxiety and stress scores. Conclusion: From the results we found that there were elevated depression, anxiety and stress levels among the patients and this was significantly higher in ICU patients. Various factors could influence the psychological wellbeing of the patients, including the hospital environment, care givers, presence of family members nearby apart from the seriousness of illness, apprehensions about
Fügener, Andreas; Edenharter, Guenther Michael; Kiefer, Paskal; Mayr, Ulrike; Schiele, Julian; Steiner, Fabian; Kolisch, Rainer; Blobner, Manfred
With increasing organizational and financial pressure on hospitals, each individual surgical treatment has to be reviewed and planned thoroughly. Apart from the expensive operating room facilities, proper staffing and planning of downstream units, like the wards or the intensive care units (ICUs), should be considered as well. In this article, we outline the relationship between a master surgery schedule (MSS), i.e., the assignment of surgical blocks to medical specialties, and the bed demand in the downstream units using an analytical model. By using historical data retrieved from the clinical information system and a patient flow model, we applied a recently developed algorithm for predicting bed demand based on the MSSs for patients of 3 surgical subspecialties of a hospital. Simulations with 3 different MSSs were performed. The impact on the required amount of beds in the downstream units was analyzed. We show the potential improvements of the current MSS considering 2 main goals: leveling workload among days and reduction of weekend utilization. We discuss 2 different MSSs, one decreasing the weekend ICU utilization by 20% and the other one reducing maximum ward bed demand by 7%. A test with 12 months of real-life data validates the results. The application of the algorithm provides detailed insights for the hospital into the impact of MSS designs on the bed demand in downstream units. It allowed creating MSSs that avoid peaks in bed demand and high weekend occupancy levels in the ICU and the ward.
Baum, Alexander; Kagan, Ilya
The aim of this study was to investigate: (a) the association between socio-demographic variables, job satisfaction and intent to leave among hospital psychiatric nurses, and (b) the differences in the above between psychiatric nurses working on closed and open wards. After receiving ethical approval, a convenience sample of 52 (70% of total nursing staff) was drawn from psychiatric nurses in a large Israeli psychiatric hospital (95% response rate). The sample completed anonymously a self-administered structured questionnaire. A negative correlation was found between job satisfaction and intent to leave and between age, all categories of seniority, and intent to leave. Closed-ward nurses reported a higher intent to leave psychiatric nursing. Nurses under 35 reported a significantly higher intent to leave psychiatric nursing than nurses over 35. Job satisfaction was significantly higher among full-time nurses than part-time. Psychiatric hospitals need to pay attention to all factors associated with workers' readiness to leave. Given the widespread shortage of nurses, it is especially important that they address the relatively low job satisfaction of both younger and part-time nurses, and the particular stresses that closed-ward nurses work under. Copyright © 2015 Elsevier Inc. All rights reserved.
Fernández-Durán, J J
Johnson and Wehrly (1978, Journal of the American Statistical Association 73, 602-606) and Wehrly and Johnson (1980, Biometrika 67, 255-256) show one way to construct the joint distribution of a circular and a linear random variable, or the joint distribution of a pair of circular random variables from their marginal distributions and the density of a circular random variable, which in this article is referred to as joining circular density. To construct flexible models, it is necessary that the joining circular density be able to present multimodality and/or skewness in order to model different dependence patterns. Fernández-Durán (2004, Biometrics 60, 499-503) constructed circular distributions based on nonnegative trigonometric sums that can present multimodality and/or skewness. Furthermore, they can be conveniently used as a model for circular-linear or circular-circular joint distributions. In the current work, joint distributions for circular-linear and circular-circular data constructed from circular distributions based on nonnegative trigonometric sums are presented and applied to two data sets, one for circular-linear data related to the air pollution patterns in Mexico City and the other for circular-circular data related to the pair of dihedral angles between consecutive amino acids in a protein.
Paganini, J M
The objective of this research was to study the relationship between structural characteristics of hospitals (number and types of personnel, size of hospital units, and specialization of services) and health care outcomes, as measured by in-hospital mortality and average weight gain (AWG) in children under 1 year diagnosed with acute diarrheal disease (ADD). The study was carried out at 14 nonprofit acute-care hospitals located in greater Buenos Aires. The units of analysis were 23 pediatric wards (1,718 beds). The study population included 3,434 ADD cases (15.6% of total ward discharges). Various generalized linear models were used in the analysis, and the findings were adjusted according to the patients' age, severity of illness, and nutritional status. The acuteness of the disease investigated was verified. Of the study patients, 80.4% were 6 months old or younger and 40.1% suffered from some nutritional deficiency. According to an analysis of 32% of the cases, age was inversely associated with severity of illness, grade I nutritional deficiency, and in-hospital mortality, and directly associated with AWG. The adjusted case-fatality rates for the wards studied were different. Analysis of the relationship between the structural variables and the outcomes revealed that the number of nurses was inversely related to in-hospital mortality, while ward specialization and professional experience were directly related to AWG. These associations were statistically significant. There was a direct, statistically significant relationship between number of hospital staff and in-hospital mortality. Structural variables measuring the physicians' commitment to the institution, ward size, and hospital size were not found to be related to the outcomes. These findings can provide useful support for decision-making about hospital resource allocation, as well as about hospital organization and management. There is a need for more in-depth study of the relationship between the
Tran, Truyen; Luo, Wei; Phung, Dinh; Venkatesh, Svetha
Background: Modeling patient flow is crucial in understanding resource demand and prioritization. We study patient outflow from an open ward in an Australian hospital, where currently bed allocation is carried out by a manager relying on past experiences and looking at demand. Automatic methods that provide a reasonable estimate of total next-day discharges can aid in efficient bed management. The challenges in building such methods lie in dealing with large amounts of discharge noise introduced by the nonlinear nature of hospital procedures, and the nonavailability of real-time clinical information in wards. Objective Our study investigates different models to forecast the total number of next-day discharges from an open ward having no real-time clinical data. Methods We compared 5 popular regression algorithms to model total next-day discharges: (1) autoregressive integrated moving average (ARIMA), (2) the autoregressive moving average with exogenous variables (ARMAX), (3) k-nearest neighbor regression, (4) random forest regression, and (5) support vector regression. Although the autoregressive integrated moving average model relied on past 3-month discharges, nearest neighbor forecasting used median of similar discharges in the past in estimating next-day discharge. In addition, the ARMAX model used the day of the week and number of patients currently in ward as exogenous variables. For the random forest and support vector regression models, we designed a predictor set of 20 patient features and 88 ward-level features. Results Our data consisted of 12,141 patient visits over 1826 days. Forecasting quality was measured using mean forecast error, mean absolute error, symmetric mean absolute percentage error, and root mean square error. When compared with a moving average prediction model, all 5 models demonstrated superior performance with the random forests achieving 22.7% improvement in mean absolute error, for all days in the year 2014. Conclusions In the
Brau, Charles A.; Kurnit, Norman A.; Cooper, Richard K.
A high efficiency, free electron laser utilizing a circular relativistic electron beam accelerator and a circular whispering mode optical waveguide for guiding optical energy in a circular path in the circular relativistic electron beam accelerator such that the circular relativistic electron beam and the optical energy are spatially contiguous in a resonant condition for free electron laser operation. Both a betatron and synchrotron are disclosed for use in the present invention. A free electron laser wiggler is disposed around the circular relativistic electron beam accelerator for generating a periodic magnetic field to transform energy from the circular relativistic electron beam to optical energy.
Phillips, P S; Golagani, A K; Malik, A; Payne, F B
Methicillin-resistant Staphyloccocus aureus (MRSA) infection has received much attention in both the medical and non-medical press. However, it is not widely encountered on ENT wards, given the profile of short-stay, relatively well patients, although its impact seems to be increasing. We wished to explore the knowledge and attitudes towards MRSA on general surgical and ENT wards, and see if there were any significant differences between specialties, or between doctors and nurses. A 13-item questionnaire with a Likert scale response with six knowledge questions and seven attitude questions was prepared. It was completed anonymously by all nursing and medical staffs on the ENT and general surgical wards of a large District General Hospital. ENT doctors displayed the lowest knowledge and attitude scores; however, this only attained significance in terms of the knowledge of the difference between infection and colonization. Overall, nurses displayed significantly more positive attitudes towards MRSA patients than doctors, but knowledge scores were not significantly different between professions. The study suggests a lack of knowledge about and preponderance of negative attitudes towards MRSA amongst ENT doctors. The difference between colonization and infection is not well understood. Reasons for this may include the relative rarity of MRSA cases on ENT wards.
Lavoie-Tremblay, Mélanie; Feeley, Nancy; Lavigne, Geneviève L; Genest, Christine; Robins, Stéphanie; Fréchette, Julie
There is some research on the impact of open-ward unit design on the health of babies and the stress experienced by parents and nurses in neonatal intensive care units. However, few studies have explored the factors associated with nurse stress and work satisfaction among nurses practicing in open-ward neonatal intensive care units. The purpose of this study was to examine what factors are associated with nurse stress and work satisfaction among nurses practicing in an open-ward neonatal intensive care unit. A cross-sectional correlational design was used in this study. Participants were nurses employed in a 34-bed open-ward neonatal intensive care unit in a major university-affiliated hospital in Montréal, Quebec, Canada. A total of 94 nurses were eligible, and 86 completed questionnaires (91% response rate). Descriptive statistics were computed to describe the participants' characteristics. To identify factors associated with nurse stress and work satisfaction, correlational analysis and multiple regression analyses were performed with the Nurse Stress Scale and the Global Work Satisfaction scores as the dependent variables. Different factors predict neonatal intensive care unit nurses' stress and job satisfaction, including support, family-centered care, performance obstacles, work schedule, education, and employment status. In order to provide neonatal intensive care units nurses with a supportive environment, managers can provide direct social support to nurses and influence the culture around teamwork.
Bowers, Len; Simpson, Alan; Eyres, Sophie; Nijman, Henk; Hall, Cerdic; Grange, Angela; Phillips, Louise
Serious untoward incidents, or sentinel events (suicide, homicide, suicide attempt, serious assault, and absconding of high-risk patients) occur from time to time in association with acute psychiatric inpatient wards. The aim of this study was to discover the impact of serious untoward incidents on inpatient wards. Doctors, nurses, and occupational therapists at three hospitals were interviewed about these events and their impact on their wards. Staff reported feelings of shock, depression, demoralization, upset, loss, and grief, followed by ruminations, guilt, and anxiety. Levels of containment increased, as did the focus on risk assessment. Processing of the emotional impact was hindered by the pace of ward life, a lack of external support, and management investigations. Patient responses were largely ignored. A few staff responded negatively, hindering service improvements. Much more attention needs to be given to the needs of the patient group following incidents. Substantial planning, organization, and investment are required to properly prepare for such events and manage their outcome. Without this planning and action, acute inpatient work has the capacity to be damaging to staff.
Bowers, Len; Nijman, Henk; Allan, Teresa; Simpson, Alan; Warren, Jonathan; Turner, Lynny
Reports of violence and injuries to staff and patients in acute psychiatric inpatient settings have led to the development and implementation of training courses in the Prevention and Management of Violence and Aggression (PMVA). The purpose of this study was to explore the relationship between PMVA training of acute psychiatric ward nursing staff and officially reported violent incident rates. A retrospective analysis was conducted of training records (312 course attendances) and violent incident rates (684 incidents) over two-and-a-half years on 14 acute admission psychiatric wards (5,384 admissions) at three inner-city hospitals in the United Kingdom as part of the Tompkins Acute Ward Study. A positive association was found between training and rates of violent incidents. There was weak evidence that increased rates of aggressive incidents prompted course attendance, no evidence that course attendance reduced violence, and some evidence that attendance of briefer update courses triggered small short-term rises in rates of physical aggression. Course attendance was associated with a rise in physical and verbal aggression while staff were away from the ward. The failure to find a drop in incident rates after training, coupled with the small increases in incidents detected, raises concerns about the training course's efficacy as a preventive strategy. Alternatively, the results are consistent with a threshold effect, indicating that once adequate numbers of staff have been trained, further training keeps incidents at a low rate.
Kuang, Ling-Han; Jiang, Yong-Mei; Hu, Zheng-Qiang; Mu, Li-Yuan; Su, Min; Zhou, Wei
To investigate the species and percentage changes of pathogens in blood cultures from the pediatric hematology ward, and to analyze the drug resistance of main pathogens and the risk factors for positive blood culture (sepsis). A retrospective analysis was performed to analyze the species and drug sensitivity of the pathogens isolated from 2358 blood cultures from the pediatric hematology ward of the West China Second University Hospital between 2008 and 2011, as well as the related clinical data. A total of 110 strains of pathogens were isolated, with Escherichia coli (16 strains), Pseudomonas aeruginosa (12 strains) and Staphylococcus epidermidis (8 strains) being the most common ones. From 2008 to 2011, the percentage of Gram-positive bacteria decreased, while the percentage of Gram-negative bacteria increased. The detection rates of methicillin-resistant coagulase-negative Staphylococci and methicillin-resistant Staphylococcus aureus were 69% and 43% respectively, but both were sensitive to vancomycin. The detection rates of extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli and ESBL-producing Klebsiella pneumoniae were 69% and 62% respectively, but both were sensitive to imipenem and meropenem. Malignant tumor was a risk factor for positive blood culture (OR=3.564, P<0.05). A wide range of pathogens are responsible for bloodstream infection in the pediatric hematology ward and the percentages of bacteria are changing; these pathogens have a high drug resistance rate. Malignant tumor is a risk factor for positive blood culture in the pediatric hematology ward.
Tantawi, Sami G.
A multi-port waveguide is provided having a rectangular waveguide that includes a Y-shape structure with first top arm having a first rectangular waveguide port, a second top arm with second rectangular waveguide port, and a base arm with a third rectangular waveguide port for supporting a TE.sub.10 mode and a TE.sub.20 mode, where the end of the third rectangular waveguide port includes rounded edges that are parallel to a z-axis of the waveguide, a circular waveguide having a circular waveguide port for supporting a left hand and a right hand circular polarization TE.sub.11 mode and is coupled to a base arm broad wall, and a matching feature disposed on the base arm broad wall opposite of the circular waveguide for terminating the third rectangular waveguide port, where the first rectangular waveguide port, the second rectangular waveguide port and the circular waveguide port are capable of supporting 4-modes of operation.
Harper, D R
Data relating to the cost of caring for individual patients were collected for all patients in a general surgical ward over a six-month period. From this the cost per patient was calculated for various diseases and was found to be related to duration of stay. Postoperative morbidity was important in determining cost. A system that calculates cost by means of units based on the use of resources rather than by cash cost accounting is probably the most suitable for a clinician who has to monitor resources. PMID:435707
Ahmad, Muayyad M; Al-Daken, Laila Ismae'l; Ahmad, Huthaifa M
The purpose of this study was to examine the quality of life (QoL) for patients in medical-surgical wards in Jordanian hospitals. A cross-sectional design was performed. The data were collected between January and April 2011 through individual interviews (n = 746) using the Medical Outcome Study 36-item Short-Form (MOS-SF-36) and Charlson's Co-morbidity Index (CCI). The private and public hospitals in the three largest cities in Jordan were represented. The MANOVA test was used to examine the health status based on patients' co-morbidity level. The results showed that QoL for patients with severe co-morbidity has been affected negatively in many aspects more than both patients with no co-morbidity and patients with mild co-morbidity. However, although it is difficult to change the demographic characteristics, it is possible to improve the health status of patients with multiple co-morbidities, which will result in having a better QoL.
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Zadravecz, Frank J.; Tien, Linda; Robertson-Dick, Brian J.; Yuen, Trevor C.; Twu, Nicole M.; Churpek, Matthew M.; Edelson, Dana P.
Background Altered mental status is a significant predictor of mortality in inpatients. Several scales exist to characterize mental status, including the AVPU (Alert, responds to Voice, responds to Pain, Unresponsive) scale, which is used in many early warning scores in the general ward setting. The use of the Glasgow Coma Scale (GCS) and Richmond Agitation Sedation Scale (RASS) is not well established in this population. Objective To compare the accuracies of AVPU, GCS, and RASS for predicting inpatient mortality Design Retrospective cohort study Setting Single urban academic medical center Participants Adult inpatients on the general wards Measurements Nurses recorded GCS and RASS on consecutive adult hospitalizations. AVPU was extracted from the eye subscale of the GCS. We compared the accuracies of each scale for predicting in-hospital mortality within 24 hours of a mental status observation using area under the receiver operating characteristic curves (AUC). Results 295,974 paired observations of GCS and RASS were obtained from 26,873 admissions; 417 (1.6%) resulted in in-hospital death. GCS and RASS more accurately predicted mortality than AVPU (AUC 0.80 and 0.82, respectively vs. 0.73; p<0.001 for both comparisons). Simultaneous use of GCS and RASS produced an AUC of 0.85 (95% CI: 0.82-0.87; p<0.001 when compared to all three scales). Conclusions In ward patients, both GCS and RASS were significantly more accurate predictors of mortality than AVPU. In addition, combining GCS and RASS was more accurate than any scale alone. Routine tracking of GCS and/or RASS on general wards may improve accuracy of detecting clinical deterioration. PMID:26374471
Pini, Gabriella; Donato, Rosa; Faggi, Elisabetta; Fanci, Rosa
The control of microbial air contamination in hospital wards has assumed great importance particularly for those hospital infections where an airborne infection route is hypothesised, such as aspergillosis. Invasive aspergillosis represents one of the most serious complications in immunocompromised patients. For some authors there is a direct association between this pathology and the concentrations of Aspergillus conidia in the air; in addition, reports of aspergillosis concurring during building construction have been frequent. In this study, two haematology wards were monitored for about 2 years in order to make both a qualitative and quantitative evaluation of fungal burden in the air, also in relation to major construction and demolition work taking place in the same building. Air samples were taken from the hospital rooms of neutropenic patients, in the corridors of their ward and outside the building. Total fungal concentration resulted higher outside (mean 572 Colony Forming Units/m3 of air), lower in the corridors (147 CFU/m3) and even lower in the rooms (50 CFU/m3). In all the samples we found the development of at least one fungal colony. Cladosporium was the most frequently isolated genus (57%), in contrast to Aspergillus spp. (2%). The average concentration of Cladosporium spp. was 24 CFU/m3 in the rooms, 78 CFU/m3 in the corridors and 318 CFU/m3 outside. The average concentration of Aspergillus spp. was 1.2 CFU/m3 in the rooms, 3.5 CFU/m3 in the corridors, 5.6 CFU/m3 outside. Our observations show low concentrations of Aspergillus fumigatus and A. flavus in all the environments examined and particularly in the rooms (0.09 and 0.10 CFU/m3 respectively); this observation could explain the absence of cases of invasive aspergillosis during the period of air monitoring in the two haematology wards.
In this article the role of the ward manager in promoting patient safety is explored. The background to the development of the patient safety agenda is briefly discussed and the relationship between quality and safety is illustrated. The pivotal importance of the role of the ward manager in delivering services to patients is underlined and literature on patient safety is examined to identify what a ward manager can do to make care safer. Possible actions of the ward manager to improve safety discussed in the literature are structured around the Leadership Framework. This framework identifies seven domains for the leadership of service delivery. Ward managers use their personal qualities, and network and work within teams, while managing performance and facilitating innovation, change and measurement for improvement. The challenge of promoting patient safety for ward managers is briefly explored and recommendations for further research are made.
Gao, Nan; Zhang, Yuchao; Xie, Changqing
We introduce circular Fibonacci gratings (CFGs) that combine the concept of circular gratings and Fibonacci structures. Theoretical analysis shows that the diffraction pattern of CFGs is composed of fractal distributions of impulse rings. Numerical simulations are performed with two-dimensional fast Fourier transform to reveal the fractal behavior of the diffraction rings. Experimental results are also presented and agree well with the numerical results. The fractal nature of the diffraction field should be of great theoretical interest, and shows potential to be further developed into practical applications, such as in laser measurement with wideband illumination.
Sharma, Deepak; Murki, Srinivas; Oleti, Tejo Pratap
The aim of this study was to compare growth outcome and cost effectiveness of "Kangaroo ward care" (KWC) with "Intermediate intensive care" (IIC) in stable infants with birth weight 1000 g to <1100 g. In this secondary analysis, we included 79 infants, with birth weight 1000 g to <1100 g. Thirty-eight were randomized to KWC and 41 to IIC group once the infant reached a weight of 1150 g. Infants in the KWC group were shifted to Kangaroo ward immediately after randomization and in the IIC group received IIC care till they attained a weight of 1250 g before shifting to Kangaroo Ward. After shifting to Kangaroo ward, infants in the IIC group received equivalent care to KWC group infants. There was significant better weight gain post-randomization during hospital stay and better length gain till 40 weeks of gestational age in intervention arm. There was reduction of post-randomization hospital stay by 2 d in the KWC group. The infants in the KWC group were shifted 6 d earlier to Kangaroo ward from IIC when compared with the IIC group. The cost-effective analysis that used "top-down" and "bottom-up" accounting method showed significant reduction of hospital and parents expenditure in the KWC group (p < .001) with saving of 570 USD per patient in the KWC group. Early shifting of infants to Kangaroo ward with birth weight 1000 g to <1100 g leads to better growth and is cost effective (CTRI/2014/05/004625). Clinical trial registry of India CTRI/2014/05/004625.
Dancer, Stephanie J; White, Liza; Robertson, Chris
Ten hand-touch sites were screened weekly on two surgical wards over two consecutive six-month periods. The results were analysed using hygiene standards, which specify (i) an aerobic colony count (ACC) > 2.5 cfu/cm(2), and (ii) presence of coagulase-positive staphylococci, as hygiene failures. Sites most often failing the standards were beds and hoist (64%: 33 of 52 weeks), bedside lockers (62%: 32 of 52) and overbed tables (44%: 23 of 52). Methicillin-susceptible/resistant Staphylococcus aureus (MSSA/MRSA) were more often recovered from lockers, overbed tables and beds. Recovery of MSSA/MRSA at any site was significantly associated with an ACC > 2.5 cfu/cm(2) from that site (p = 0.001; OR: 3.35 [95% CI 1.79, 6.28]). In addition, total ACC's > 2.5 cfu/cm(2) each week were significantly associated with weekly bed occupancies > 95% (p = 0.0004; OR: 2.94 [95% CI 1.44, 6.02]). Higher microbial growth levels from hand-touch sites reflect weekly bed occupancies and indicate a risk for both resistant and susceptible S. aureus. These organisms are more likely to be recovered from near-patient sites on the ward.
Spencer, Caroline; Al-Sadoon, Tara; Hemmings, Laura; Jackson, Karen; Mulligan, Paul
Moving from the staff nurse to ward sister role involves acquiring a range of skills to lead and motivate a team and ensure standards of care are high. Recognising new ward sisters' need for support, a trust developed a training programme to enable them to develop the necessary skills and provide mutual support. This article discusses the development of the programme and offers the reflections of three ward sisters who participated in it.
Suwanwela, Nijasri Charnnarong; Eusattasak, Nattapong; Phanthumchinda, Kammant; Piravej, Krisna; Locharoenkul, Chaichon
infarction, urinary tract infection, pneumonia, and pressure sore were also observed. The length of hospital stay of the patients admitted in 2001 and 2003 was 11.26 and 8.09 days, respectively. Combination of organized acute stroke unit and short-term ward with early supported discharge reduces the mortality and complications of ischemic stroke patients during admission as well as the length of stay when compared to the general medical ward. The present study reassures that the combination is useful for hospitals in developing countries, which have limited number of beds in their stroke units.
Churpek, Matthew M.; Yuen, Trevor C.; Park, Seo Young; Meltzer, David O.; Hall, Jesse B.; Edelson, Dana P.
Objective Rapid response team (RRT) activation criteria were created using expert opinion and have demonstrated variable accuracy in previous studies. We developed a cardiac arrest risk triage (CART) score to predict cardiac arrest (CA) and compared it to the Modified Early Warning Score (MEWS), a commonly cited RRT activation criterion. Design A retrospective cohort study. Setting An academic medical center in the United States. Patients All patients hospitalized from November 2008 to January 2011 who had documented ward vital signs were included in the study. These patients were divided into three cohorts: patients who suffered a CA on the wards, patients who had a ward to intensive care unit (ICU) transfer, and patients who had neither of these outcomes (controls). Interventions None. Measurements and Main Results Ward vital signs from admission until discharge, ICU transfer, or ward CA were extracted from the medical record. Multivariate logistic regression was used to predict CA, and the CART score was calculated using the regression coefficients. The model was validated by comparing its accuracy for detecting ICU transfer to the MEWS. Each patient’s maximum score prior to CA, ICU transfer, or discharge was used to compare the areas under the receiver operating characteristic curves (AUC) between the two models. Eighty-eight CA patients, 2820 ICU transfers, and 44519 controls were included in the study. The CART score more accurately predicted CA than the MEWS (AUC 0.84 vs. 0.76;P=0.001). At a specificity of 89.9%, the CART score had a sensitivity of 53.4% compared to 47.7% for the MEWS. The CART score also predicted ICU transfer better than the MEWS (AUC 0.71 vs. 0.67;P<0.001). Conclusions The CART score is simpler and more accurately detected CA and ICU transfer than the MEWS. Implementation of this tool may decrease RRT resource utilization and provide a better opportunity to improve patient outcomes than the MEWS. PMID:22584764
Kouh, Minjoon; Holz, Danielle; Kawam, Alae; Lamont, Mary
The advent of new sensor technologies can provide new ways of exploring fundamental physics. In this paper, we show how a Wiimote, which is a handheld remote controller for the Nintendo Wii video game system with an accelerometer, can be used to study the dynamics of circular motion with a very simple setup such as an old record player or a…
Kouh, Minjoon; Holz, Danielle; Kawam, Alae; Lamont, Mary
The advent of new sensor technologies can provide new ways of exploring fundamental physics. In this paper, we show how a Wiimote, which is a handheld remote controller for the Nintendo Wii video game system with an accelerometer, can be used to study the dynamics of circular motion with a very simple setup such as an old record player or a…
Library of Congress, Washington, DC. Copyright Office.
This circular answers some of the questions that are frequently asked about copyright, a form of protection provided by the laws of the United States to authors of "original works of authorship" including library, dramatic musical, artistic, and certain other intellectual works. The Copyright Act of 1976 (title 17 of the United States…
Kouh, Minjoon; Holz, Danielle; Kawam, Alae; Lamont, Mary
The advent of new sensor technologies can provide new ways of exploring fundamental physics. In this paper, we show how a Wiimote, which is a handheld remote controller for the Nintendo Wii video game system with an accelerometer, can be used to study the dynamics of circular motion with a very simple setup such as an old record player or a bicycle wheel.
Nazareth, Juliana Vieira; de Souza, Kleyde Ventura; Beinner, Mark Anthony; Barra, Juliana Silva; Brüggemann, Odaléa Maria; Pimenta, Adriano Marçal
To compare two care models of high-risk pregnant women--a House for Pregnant Women, staffed by nurse-midwives, versus a traditional care model in a hospital maternity ward. This was across-sectional study conducted in two reference maternity hospitals for high-risk pregnancies, in Belo Horizonte, Minas Gerais, Brazil. The sample consisted of 312 high-risk pregnant women consecutively admitted from January 1st to December 31(st), 2010, either to the House for Pregnant Women (n=247), or the hospital maternity ward (n=65). Gestational ages varied from 22 weeks to 36 weeks and six days. We measured individual, demographic, obstetric, labour and delivery variables, and newborn characteristics. For data analysis, we used descriptive, bivariate and multivariate statistics using Poisson regression, with a 5% significance level. At the conventional hospital maternity ward, more women had six or more antenatal exams, greater frequencies of diagnosis related to blood pressure, and a greater number of women underwent either a C-section or a vaginal delivery with an episiotomy and analgesia. At the House for Pregnant Women, the majority of the hospitalizations were related to preterm labour and premature rupture of membranes. There were no statistical differences in the newborn characteristics. The House for Pregnant Women care model, utilizing midwives was less interventionist, yet with results as favorable as in a conventional maternity hospital setting. Copyright © 2017 Elsevier Ltd. All rights reserved.
ABSTRACT Circular DNAs are extra-chromosomal fragments that become circularized by genomic recombination events. We have recently shown that yeast LTR elements generate circular DNAs through recombination events between their flanking long terminal repeats (LTRs). Similarly, circular DNAs can be generated by recombination between LTRs residing at different genomic loci, in which case the circular DNA will contain the intervening sequence. In yeast, this can result in gene copy number variations when circles contain genes and origins of replication. Here, I speculate on the potential and implications of circular DNAs generated through recombination between human transposable elements. PMID:28090380
Pitkänen, Anneli; Hätönen, Heli; Kuosmanen, Lauri; Välimäki, Maritta
People with mental disorders suffer from impaired quality of life (QoL). In psychiatric hospital wards nurses are in a close relationship with patients and have good opportunities to support patients' QoL. Still, relatively little is known about patients' perceptions related to nursing interventions by which nurses can support the QoL of patients with severe mental illness. To explore patients' perceptions of nursing interventions in supporting patients' QoL in acute psychiatric inpatient settings. Explorative descriptive study design. The study was conducted in seven acute 24-h psychiatric wards of general hospitals in Southern Finland. Thirty-five inpatients diagnosed with schizophrenia, schizotypal disorder or delusional disorder. The data were generated through semi-structured interviews and processed by means of qualitative content analysis. Five main categories of patients' perceptions of nursing interventions were identified to support QoL from patients' descriptions: empowering interventions, social interventions, activating interventions, security interventions and interventions to support physical health. Impaired QoL of patients with severe mental illness can be supported in acute psychiatric wards through nursing interventions. However, we are not sure how effective these interventions are. Thus, research on the effectiveness of nursing interventions to support patients' QoL is needed.
Negri, Monica; Martignoni, Alessandra; Baccheschi, Jordan; Santilli, Giovanna; Marchesi, Eugenia
Precocious admission to specifically "dedicated" wards proved to improve reduction of mortality and degree of residual disability in patients with stroke, even if their inhomogeneous distribution gets most patients admitted to wards of Internal Medicine. We purposed to evaluate the importance of this problem, to check adhesion to the national guidelines and to show the main problems in management of patients with stroke in the Operative Unit of Internal Medicine, Vascular and Metabolic Diseases of the IRCCS S. Matteo Hospital of Pavia. 143 patients with stroke were admitted in 2001, 126 were ischemic, 17 hemorragic; the mean age was of 73. The most frequent risk factors were hypertension, diabetes, smoke and atrial fibrillation. 59% of patients were admitted within 6 hours from onset of symptoms. Within the ischemic subtypes, 17.5% were atherotrombothic, 16.7% cardioembolic, 23.8% lacunar and 42% with undetermined etiology. Lacunar syndromes were the most part. 80% of patients underwent computed tomography, 50% underwent epiaortic Doppler sonography, 38% echocardiography. 61% of ischemic subtypes underwent acute antiplatelet treatment. Complications were prevalent in oldest patients. Mortality of inpatients was 17%, influenced by age, hypertension, severe sensorial compromission at admission, cardioembolism and complications. This study proved leak of adhesion to national guidelines which brought to inadequate accuracy in diagnosis and difficulty in making correct and coherent therapeutic choices. At least in great hospitals, "dedicated" areas in wards of Internal Medicine with selected, trained and motivated staff should be desirable.
Quirk, Alan; Lelliott, Paul; Seale, Clive
In Asylums, Goffman [1961. Asylums. London: Penguin] identified some permeable features of the old mental hospitals but presented them as exceptions to the rule and focused on their impermeable aspects. We argue that this emphasis is no longer valid and offer an alternative ideal type that better represents the reality of everyday life in contemporary 'bricks and mortar' psychiatric institutions. We call this the "permeable institution". The research involved participant observation of between 3 and 4 months and interviews with patients, patient advocates and staff on 3 psychiatric wards. Evidence for permeability includes that ward membership is temporary and changes rapidly (patients tend to have very short stays and staff turnover is high); patients maintain contact with the outside world during their stay; and institutional identities are blurred to the point where visitors or new patients can easily mistake staff and patients for one another. Permeability has both positive consequences (e.g., reduced risk of institutionalism), and negative consequences (e.g., unwanted people coming into hospital to cause trouble, and illicit drug use among patients). Staff employ various methods to regulate their ward's permeability, within certain parameters. The metaphor of the total/closed institution remains valuable, but it fails to capture the highly permeable nature of the psychiatric institutions we studied. Analysts may therefore find the permeable institution a more helpful reference point or ideal type against which to examine and compare empirical cases. Perhaps most helpful is to conceptualise a continuum of institutional permeability with total and permeable institutions at each extreme.
Donohue, Lynne A; Endacott, Ruth
The majority of hospitals in the United Kingdom (UK) use some form of track and trigger scoring system, such as early warning scores, to identify deteriorating patients; however, response by the multi-professional team is not always timely and problems with recognition of deterioration persist. To examine ward nurse and critical care outreach staff perceptions of the management of patients who deteriorate in acute wards. A qualitative design was used with critical incident (CI) technique employed to structure data collection. Semi-structured interviews were undertaken with nurses who had managed a patient who was referred to the outreach team (n=11) and members of the outreach team (n=3). Registered nurses in this study looked at trends when assessing their patients visually. However, early warning scoring was not a key component of patient assessment and was used more commonly to quantify deterioration once the patient's changing condition had been recognised. Findings demonstrated some tensions in team communication. The results of this study suggest that clinicians need a better understanding of the value of track and trigger scoring systems in identifying trends in the patient's condition. Further, our data suggest that steps need to be taken in acute hospital wards to improve team members' understanding of each others' roles and capabilities. Copyright (c) 2009 Elsevier Ltd. All rights reserved.
Allender, Steven; Scarborough, Peter; Keegan, Thomas; Rayner, Mike
The aims of this study were to assess whether deprivation inequality at small area level in England is associated with coronary heart disease (CHD) mortality rates and to assess whether this provides evidence of an association between area-level and individual-level risk. Mortality rates for all wards in England were calculated using all CHD deaths between 2001 and 2006. Ward-level deprivation was measured using the Carstairs Index. Deprivation inequality within local authorities (LAs) was measured by the IQR of deprivation for wards within the LA. Relative deprivation for wards was measured as the modulus of the difference between deprivation for the ward and average deprivation for all neighbouring wards. Deprivation inequality within LAs was positively associated with CHD mortality rates per 100000 (eg, all men β; 95% CI=2.7; 1.1 to 4.3) after adjustment for absolute deprivation (p<0.001 for all models). Relative deprivation for wards was positively associated with CHD mortality rates per 100000 (eg, all men 1.4; 0.7 to 2.1) after adjustment for absolute deprivation (p<0.001 for all models). Subgroup analyses showed that relative deprivation was independently associated with CHD mortality rates in both affluent and deprived wards. Rich wards surrounded by poor areas have higher CHD mortality rates than rich wards surrounded by rich areas, and poor wards surrounded by rich areas have worse CHD mortality rates than poor wards surrounded by poor areas. Local deprivation inequality has a similar adverse impact on both rich and poor areas, supporting the hypothesis that income inequality of an area has an impact on individual-level health outcomes.