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Sample records for circular hospital wards

  1. Dealing with Scabies in a Hospital Ward.

    PubMed

    Clavagnier, Isabelle

    2015-01-01

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

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

    PubMed

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

    2015-06-01

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

  3. Control of infection in hospital wards.

    PubMed

    Blowers, R

    1961-01-01

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

  4. Rethinking hospital general ward ventilation design using computational fluid dynamics.

    PubMed

    Yam, R; Yuen, P L; Yung, R; Choy, T

    2011-01-01

    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.

  5. Identifying Patients With Sepsis on the Hospital Wards.

    PubMed

    Bhattacharjee, Poushali; Edelson, Dana P; Churpek, Matthew M

    2017-04-01

    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.

  6. [Old picture postcards depicting hospital wards--puzzling similarities].

    PubMed

    Schretlen, Ignace

    2013-01-01

    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.

  7. Thermal comfort of patients in hospital ward areas.

    PubMed Central

    Smith, R. M.; Rae, A.

    1977-01-01

    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

  8. The Ventilation, Heating and Lighting of Hospital Wards

    PubMed Central

    Watt, James

    1933-01-01

    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

  9. Delirium in elderly patients hospitalized in internal medicine wards.

    PubMed

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

    2014-06-01

    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.

  10. The Economical Furnishing and Equipment of Children's Hospitals or Wards.

    PubMed

    2016-11-01

    : 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.

  11. [Reasons for Hospital Treatment of Psychiatric Patients before and after the Opening of a Satellite Ward].

    PubMed

    Gebhardt, R P; Schmidt-Michel, P O

    2002-04-01

    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.

  12. Characteristics and staff resources of child and adolescent psychiatric hospital wards in Finland.

    PubMed

    Ellilä, H; Sourander, A; Välimäki, M; Piha, J

    2005-04-01

    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.

  13. Occurrence of airborne vancomycin- and gentamicin-resistant bacteria in various hospital wards in Isfahan, Iran

    PubMed Central

    Mirhoseini, Seyed Hamed; Nikaeen, Mahnaz; Khanahmad, Hossein; Hassanzadeh, Akbar

    2016-01-01

    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

  14. Staffing in acute hospital wards: part 2. Relationships between grade mix, staff stability and features of ward organizational environment.

    PubMed

    Adams, Ann; Bond, Senga

    2003-09-01

    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

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

    PubMed

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

    2014-04-01

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

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

    PubMed

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

    2015-09-01

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

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

    PubMed

    Zaman, Shahaduz

    2004-11-01

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

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

    PubMed

    Brunt, David

    2008-03-01

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

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

    PubMed Central

    Moualed, Daniel J; Nicolson, Phillip L R; Adjei, Felicia D; Cakebread, Holly E; Duehmke, Rudolf M; Martin, Claire A

    2013-01-01

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

  20. Potential hazard from spray cleaning of floors in hospital wards.

    PubMed

    Medcraft, J W; Hawkins, J M; Fletcher, B N; Dadswell, J V

    1987-03-01

    The potential hazard from using contaminated spray cleaning fluid to clean hospital floors was investigated. Eight of 10 sprays in daily hospital use failed the 'in-use' test of Kelsey & Maures. Contamination was due to Gram-negative bacilli, mainly Pseudomonas spp. An experiment showed that freshly diluted cleaning fluid in a new spray container became contaminated in 6 days, although the route of contamination of the fluid is not clear. Air samples and samples from bedding collected during spray cleaning with contaminated fluid showed the presence of Pseudomonas spp. Use of freshly diluted cleaning fluid and daily cleaning of spray containers is recommended.

  1. Analysis of Outcomes of the NRS 2002 in Patients Hospitalized in Nephrology Wards

    PubMed Central

    Borek, Paulina; Chmielewski, Michał; Małgorzewicz, Sylwia; Dębska Ślizień, Alicja

    2017-01-01

    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

  2. Investigating the prevention of hospital-acquired infection through standardized teaching ward rounds in clinical nursing.

    PubMed

    Zhang, R

    2015-04-22

    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.

  3. Analysis of hospitalization rates by electoral ward: relationship to accessibility and deprivation data.

    PubMed

    Slack, R; Ferguson, B; Ryder, S

    1997-02-01

    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.

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

    PubMed

    Totman, Jonathan; Mann, Farhana; Johnson, Sonia

    2010-01-01

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

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

    PubMed

    Vahidi, Maryam; Hosseinzadeh, Mina

    2014-12-01

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

  6. Characteristics of human metapneumovirus infection prevailing in hospital wards housing patients with severe disabilities.

    PubMed

    Matsuda, Shunji; Nakamura, Masako; Hirano, Eiko; Kiyota, Naoko; Omura, Tamaki; Suzuki, Yumi; Noda, Masahiro; Kimura, Hirokazu

    2013-01-01

    Epidemics of infectious diseases often occur at long-term inpatient facilities for patients with severe motor and intellectual disabilities. However, the pathogens causing these infections remain unknown in approximately half of such epidemics. Two epidemics of respiratory tract infection occurred in 2 wards in the National Hospital Organization Ehime Hospital (prevalence 1, 34 infected out of 59 inpatients in the A ward in September 2011; prevalence 2, 8 infected out of 58 inpatients in the B ward in June 2012). Human metapneumovirus (HMPV) was detected from the nasal (and some pharyngeal) swabs from 17 patients. Based on phylogenetic analysis of viral genomes, the virus was grouped in subgroup A2 (prevalence 1) and B2 (prevalence 2). We considered that the viruses had spread through the 2 wards. The average duration of high fever in the 42 patients was 6.8 days, with the majority of fevers exceeding 38℃ (79%) and being accompanied by a productive cough. Ten out of 17 patients (59%) in whom HMPV was detected had decreased lymphocyte and increased monocyte counts in the blood. Eleven cases (65%) had elevated-C reactive protein levels and fever protraction as well as images of bronchitis or pneumonia on chest radiographs approximately 1 week after onset. Anti-HMPV antibody in the blood was positive in 95% of patients (151 of 159 inpatients), indicating no relation between HMPV infection and antibody titer but revealing recurrent infections. In view of the fever protraction and frequent co-occurrence of bronchitis and pneumonia at long-term inpatient facilities for immunocompromised patients such as the ones in this study, the prevalence of HMPV must be carefully monitored, and preventive measures and early-stage treatments are required.

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

    PubMed Central

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

    2013-01-01

    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

  8. Effectiveness of hospital-wide methicillin-resistant Staphylococcus aureus (MRSA) infection control policies differs by ward specialty.

    PubMed

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

    2013-01-01

    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.

  9. Balancing nurses' workload in hospital wards: study protocol of developing a method to manage workload

    PubMed Central

    van den Oetelaar, W F J M; van Stel, H F; van Rhenen, W; Stellato, R K; Grolman, W

    2016-01-01

    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

  10. [Medium-term strategy for the specific management of pneumology hospitals and wards after the decentralization of the sanitary system].

    PubMed

    Muşat, Simona Nicoleta; Ioniţa, Diana; Paceonea, Mirela; Chiriac, Nona Delia; Stoicescu, Ileana Paula; Mihălţan, F D

    2011-01-01

    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.

  11. Personnel exposure to violence in hospital emergency wards: a routine activity approach.

    PubMed

    Landau, Simha F; Bendalak, Yehudit

    2008-01-01

    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.

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

    PubMed

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

    2011-10-01

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

  13. Large-eddy simulation of airflow and heat transfer in a general ward of hospital

    NASA Astrophysics Data System (ADS)

    Hasan, Md. Farhad; Himika, Taasnim Ahmed; Molla, Md. Mamun

    2016-07-01

    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.

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed

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

    2011-09-01

    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.

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

    PubMed Central

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

    2015-01-01

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

  17. Using Isovist Application to Explore Visibility Area of Hospital Inpatient Ward

    NASA Astrophysics Data System (ADS)

    Sengke, M. M. C.; Atmodiwirjo, P.

    2017-03-01

    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.

  18. Evaluating the application of failure mode and effects analysis technique in hospital wards: a systematic review

    PubMed Central

    Asgari Dastjerdi, Hoori; Khorasani, Elahe; Yarmohammadian, Mohammad Hossein; Ahmadzade, Mahdiye Sadat

    2017-01-01

    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

  19. [Treatment of Anorexia Nervosa Patients in General Hospitals with Psychiatric Wards Current Situation and Establishment of a Treatment System].

    PubMed

    Wada, Yoshihisa

    2015-01-01

    Patients with anorexia nervosa (AN) exhibit physical and psychiatric symptoms, in addition to their behavioral problems, and often require admission to a general hospital with a psychiatric ward. There are only a few general hospitals with psychiatric wards available, and patients with AN tend to be concentrated in a small number of such institutions. Thus, it is difficult to provide adequate support for the treatment of patients with AN. In Kyoto, the number of general hospitals with a psychiatric ward is small. Patients with AN tend to be treated at the two university hospitals. However, our University Hospital cannot accept all patients with AN, especially the emergency admissions. Therefore, with respect to the inpatient treatment of AN, we established a cooperation agreement with other psychiatric hospitals. We are planning to divide the inpatient treatment of AN between our university hospital and other psychiatric hospitals, depending on the stage of AN and the severity of the patients' physical condition. With respect to the treatment of AN, it is necessary to establish a treatment system with each hospital playing a role.

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed Central

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

    2012-01-01

    Introduction: Nutritional support generates complications that must be detected and treated on time. Objective: To estimate the incidence of some complications of nutritional support in patients admitted to general hospital wards who received nutritional support in six high-complexity institutions. Methods: Prospective, descriptive and multicentric study in patients with nutritional support; the variables studied were medical diagnosis, nutritional condition, nutritional support duration, approach, kind of formula, and eight complications. Results: A total of 277 patients were evaluated; 83% received enteral nutrition and 17% received parenteral nutrition. Some 69.3% presented risk of malnourishment or severe malnourishment at admittance. About 35.4% of those receiving enteral nutrition and 39.6% of the ones who received parenteral nutrition had complications; no significant difference per support was found (p= 0.363). For the enteral nutrition, the most significant complication was the removal of the catheter (14%), followed by diarrhea (8.3%); an association between the duration of the enteral support with diarrhea, constipation and removal of the catheter was found (p < 0.05). For parenteral nutrition, hyperglycemia was the complication of highest incidence (22.9%), followed by hypophosphatemia (12.5%); all complications were associated with the duration of the support (p < 0.05). Nutritional support was suspended in 24.2% of the patients. Conclusions: Complications with nutritional support in hospital-ward patients were frequent, with the removal of the catheter and hyperglycemia showing the highest incidence. Duration of the support was the variable that revealed an association with complications. Strict application of protocols could decrease the risk for complications and boost nutritional support benefits. PMID:24893056

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

    PubMed Central

    2014-01-01

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

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

    ERIC Educational Resources Information Center

    Hasley, Peggy B.; Arnold, Robert M.

    2009-01-01

    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…

  4. A preliminary study of Patient Dignity Inventory validation among patients hospitalized in an acute psychiatric ward

    PubMed Central

    Di Lorenzo, Rosaria; Cabri, Giulio; Carretti, Eleonora; Galli, Giacomo; Giambalvo, Nina; Rioli, Giulia; Saraceni, Serena; Spiga, Giulia; Del Giovane, Cinzia; Ferri, Paola

    2017-01-01

    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

  5. Nutritional Status of Patients Admitted in a General Surgical Ward at a Tertiary Hospital of Punjab.

    PubMed

    Kamal, Faiza; Fazal, Muhammad Irfan; Cheema, Muhammad Arshad

    2016-04-01

    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.

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

    PubMed Central

    Shabbir, Asad; Wali, Gorav; Steuer, Alan

    2015-01-01

    Prolonged hospital stay not only increases financial stress on the National Health Service but also exposes patients to an unnecessarily high risk of adverse ward events. Each day accumulates approximately £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

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

    PubMed

    Shabbir, Asad; Wali, Gorav; Steuer, Alan

    2015-01-01

    Prolonged hospital stay not only increases financial stress on the National Health Service but also exposes patients to an unnecessarily high risk of adverse ward events. Each day accumulates approximately £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.

  8. Implications of design on infection prevention and control practice in a novel hospital unit: the Medical Ward of the 21st Century.

    PubMed

    VanSteelandt, Amanda; Conly, John; Ghali, William; Mather, Charles

    2015-01-01

    The physical design of hospital wards is associated with transmission of pathogenic organisms and hospital-acquired infections. A novel hospital unit, the Medical Ward of the 21st Century (W21C), optimizes features for infection prevention and control practices. Ethnographic research on the W21C versus conventional hospital wards examined the experiential and behavioural elements of the different designs. Three recurring themes emerged regarding the design features on the W21C and included visual cues, 'having a place for things', and less sharing of spaces and materials. Observational data of healthcare worker practices demonstrated significantly higher compliance with hand hygiene opportunities on the W21C compared with older hospital units. These findings suggest how the physical design of a hospital ward may enhance infection prevention and control practices.

  9. Rate of Pressure Ulcers in Intensive Units and General Wards of Iranian Hospitals and Methods for Their Detection

    PubMed Central

    AKBARI SARI, Ali; DOSHMANGHIR, Leila; NEGHAHBAN, Zahra; GHIASIPOUR, Maryam; BEHESHTIZAVAREH, Zeinab

    2014-01-01

    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

  10. The Importance of a Role-Specific, In-Hospital Ward Clerk Education Program.

    PubMed

    Kennedy, Maggie

    2016-01-01

    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.

  11. Identification and characteristics of imipenem-resistant Acinetobacter baumannii in surgical wards in a Chinese university hospital.

    PubMed

    Wang, Dalin; Ma, Linlin; Wu, Zhenyu; Li, Mingcheng; Li, Xiaohan; Zhang, Wei; Chen, Kun

    2015-03-01

    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.

  12. Repeated local emergence of carbapenem-resistant Acinetobacter baumannii in a single hospital ward

    PubMed Central

    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.

    2016-01-01

    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

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

    PubMed

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

    2006-10-01

    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

  14. [The home palliative care transition manual for the regional cooperation from the general ward at Shizuoka Red Cross Hospital].

    PubMed

    Shiraishi, Ko

    2007-12-01

    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.

  15. [Longer working hours of pharmacists in the ward resulted in lower medication-related errors--survey of national university hospitals in Japan].

    PubMed

    Matsubara, Kazuo; Toyama, Akira; Satoh, Hiroshi; Suzuki, Hiroshi; Awaya, Toshio; Tasaki, Yoshikazu; Yasuoka, Toshiaki; Horiuchi, Ryuya

    2011-04-01

    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.

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

    PubMed

    Brewer, Margo L; Stewart-Wynne, Edward G

    2013-11-01

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

  17. Enacting 'team' and 'teamwork': using Goffman's theory of impression management to illuminate interprofessional practice on hospital wards.

    PubMed

    Lewin, Simon; Reeves, Scott

    2011-05-01

    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

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

    PubMed Central

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

    2014-01-01

    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

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed Central

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

    2015-01-01

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

  1. Impact of a Local Low-Cost Ward-Based Response System in a Canadian Tertiary Care Hospital

    PubMed Central

    2016-01-01

    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

  2. [Hospital readmission after postpartum discharge of term newborns in two maternity wards in Stockholm and Marseille].

    PubMed

    Boubred, F; Herlenius, E; Andres, V; des Robert, C; Marchini, G

    2016-03-01

    The consequences of early postpartum discharge (EPPD, within 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.

  3. Why Bangladeshi nurses avoid 'nursing': social and structural factors on hospital wards in Bangladesh.

    PubMed

    Hadley, Mary B; Blum, Lauren S; Mujaddid, Saraana; Parveen, Shahana; Nuremowla, Sadid; Haque, Mohammad Enamul; Ullah, Mohammad

    2007-03-01

    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.

  4. Predictors of in-hospital mortality in elderly patients with bacteraemia admitted to an Internal Medicine ward

    PubMed Central

    2011-01-01

    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

  5. Kids' Perceptions toward Children's Ward Healing Environments: A Case Study of Taiwan University Children's Hospital

    PubMed Central

    Lin, Yi-Ling

    2016-01-01

    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.

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

    PubMed

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

    1998-06-01

    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.

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

    PubMed Central

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

    2014-01-01

    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

  8. Implementation issues for mobile-wireless infrastructure and mobile health care computing devices for a hospital ward setting.

    PubMed

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

    2010-08-01

    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.

  9. A comparative study of epidural catheter colonization and infection in Intensive Care Unit and wards in a Tertiary Care Public Hospital.

    PubMed

    Harde, Minal; Bhadade, Rakesh; Iyer, Hemlata; Jatale, Amol; Tiwatne, Sagar

    2016-02-01

    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.

  10. Outcome of bacteraemia in patients admitted to the adult medical wards of the UKM hospital.

    PubMed

    Petrick, P; Kong, N C T; Nordiah, A J; Cheong, I K S; Tamil, M A

    2007-10-01

    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.

  11. Laptops on trolleys: lessons from a mobile-wireless hospital ward.

    PubMed

    Weeding, Stephen; Dawson, Linda

    2012-12-01

    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.

  12. Assessment of Drug-Drug Interactions among Renal Failure Patients of Nephrology Ward in a South Indian Tertiary Care Hospital.

    PubMed

    Rama, Mylapuram; Viswanathan, Gayathri; Acharya, Leelavathi D; Attur, R P; Reddy, P N; Raghavan, S V

    2012-01-01

    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.

  13. What aspects of intentional rounding work in hospital wards, for whom and in what circumstances? A realist evaluation protocol

    PubMed Central

    Harris, Ruth; Sims, Sarah; Levenson, Ros; Gourlay, Stephen; Ross CBE, Fiona; Davies, Nigel; Brearley, Sally; Favato, Giampiero; Grant, Robert

    2017-01-01

    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

  14. [Outbreak of hospital acquired Legionnaires' disease in patients of ophthalmic ward. Nosocomial Legionella infections for the first time observed in Poland].

    PubMed

    Stypułkowska-Misiurewicz, Hanna; Pancer, Katarzyna; Krogulska, Bozena; Matuszewska, Renata

    2007-01-01

    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.

  15. Epidemiology and resistance features of Acinetobacter baumannii isolates from the ward environment and patients in the burn ICU of a Chinese hospital.

    PubMed

    Gong, Yali; Shen, Xiaodong; Huang, Guangtao; Zhang, Cheng; Luo, Xiaoqiang; Yin, Supeng; Wang, Jing; Hu, Fuquan; Peng, Yizhi; Li, Ming

    2016-08-01

    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.

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

    PubMed Central

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

    2014-01-01

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

  17. PREVALENCE OF METHICILLIN RESISTANT STAPHYLOCOCCUS AUREUS FROM NOSE AND THROAT OF PATIENTS ON ADMISSION TO MEDICAL WARDS OF DR SOETOMO HOSPITAL, SURABAYA, INDONESIA.

    PubMed

    Kuntaman, K; Hadi, Usman; Setiawan, Firman; Koendori, Eko Budi; Rusli, Musofa; Santosaningsih, Dewi; Severin, Juliette; Verbrugh, Henri A

    2016-01-01

    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.

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

    PubMed Central

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

    2009-01-01

    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

  19. Protocol to describe the analysis of text-based communication in medical records for patients discharged from intensive care to hospital ward

    PubMed Central

    Parsons Leigh, Jeanna; Brown, Kyla; Buchner, Denise; Stelfox, Henry T

    2016-01-01

    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

  20. Progress of the Productive Ward.

    PubMed

    Robert, Glenn

    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.

  1. Detecting and managing drug-related problems in the neurology ward of a tertiary care teaching hospital in Iran: A clinical pharmacist's intervention

    PubMed Central

    Foroughinia, Farzaneh; Tazarehie, Seyyed Ramtin; Petramfar, Peyman

    2016-01-01

    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

  2. 45 CFR 46.409 - Wards.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... Protections for Children Involved as Subjects in Research § 46.409 Wards. (a) Children who are wards of the..., 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...

  3. 45 CFR 46.409 - Wards.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 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...

  4. Diffusion and transmission of carbapenem-resistant Klebsiella pneumoniae in the medical and surgical wards of a university hospital in Milan, Italy.

    PubMed

    Ridolfo, Anna L; Rimoldi, Sara G; Pagani, Cristina; Marino, Andrea F; Piol, Anna; Rimoldi, Matteo; Olivieri, Pietro; Galli, Massimo; Dolcetti, Lucia; Gismondo, Maria R

    2016-01-01

    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.

  5. Bridging the gap: an innovative dementia learning program for healthcare assistants in hospital wards using facilitator-led discussions.

    PubMed

    Chapman, Alan; Law, Shirley

    2009-04-01

    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.

  6. Antimicrobial resistance pattern of Gram-positive bacteria during three consecutive years at the nephrology ward of a tertiary referral hospital in Shiraz, Southwest Iran

    PubMed Central

    Karimzadeh, Iman; Mirzaee, Mona; Sadeghimanesh, Niloofar; Sagheb, Mohammad Mahdi

    2016-01-01

    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

  7. Introduction of a new observation chart and education programme is associated with higher rates of vital-sign ascertainment in hospital wards.

    PubMed

    Cahill, Helen; Jones, Aaron; Herkes, Robert; Cook, Kathy; Stirling, Anne; Halbert, Tanya; Yates, Amanda; Lal, Sean; Gardo, Alan; Donnelly, Roy; Gattas, David J

    2011-09-01

    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.

  8. 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

    PubMed Central

    Piotrowicz, Karolina; Rewiuk, Krzysztof; Halicka, Monika; Kalwak, Weronika; Rybak, Paulina

    2017-01-01

    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

  9. 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.

    PubMed

    Gorski, Stanislaw; Piotrowicz, Karolina; Rewiuk, Krzysztof; Halicka, Monika; Kalwak, Weronika; Rybak, Paulina; Grodzicki, Tomasz

    2017-01-01

    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.

  10. A prospective study of incidence of medication-related problems in general medicine ward of a tertiary care hospital

    PubMed Central

    Movva, Ramya; Jampani, Anusha; Nathani, Jyothsna; Pinnamaneni, Sri Harsha; Challa, Siva Reddy

    2015-01-01

    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

  11. Usage Pattern and Serum Level Measurement of Amikacin in the Internal Medicine Ward of the Largest Referral Hospital in the South of Iran: A Pharmacoepidemiological Study

    PubMed Central

    Namazi, Soha; Sagheb, Mohammad Mahdi; Hashempour, Mohammad Mahdi; Sadatsharifi, Arman

    2016-01-01

    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

  12. A Prospective Study on Malnutrition and Duration of Hospitalisation among Hospitalised Geriatric Patients Admitted to Surgical and Medical Wards of Hospital Universiti Kebangsaan Malaysia.

    PubMed

    Shahar, Suzana; Wong, Sunfun; Wan, Chakpa'wanchik

    2002-03-01

    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.

  13. Frequency and Associated Factors of Amphotericin B Nephrotoxicity in Hospitalized Patients in Hematology-Oncology Wards in the Southwest of Iran

    PubMed Central

    Karimzadeh, Iman; Heydari, Marziyeh; Ramzi, Mani; Sagheb, Mohammad Mahdi

    2016-01-01

    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

  14. A unified inter-host and in-host model of antibiotic resistance and infection spread in a hospital ward.

    PubMed

    Caudill, Lester; Lawson, Barry

    2017-03-30

    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.

  15. Meticillin-resistant Staphylococcus aureus: spread of specific lineages among patients in different wards at a Brazilian teaching hospital.

    PubMed

    Cavalcante, F S; Schuenck, R P; Ferreira, D C; da Costa, C R; Nouér, S A; dos Santos, K R N

    2014-02-01

    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.

  16. Pain, agitation, and behavioural problems in people with dementia admitted to general hospital wards: a longitudinal cohort study

    PubMed Central

    Sampson, Elizabeth L.; White, Nicola; Lord, Kathryn; Leurent, Baptiste; Vickerstaff, Victoria; Scott, Sharon; Jones, Louise

    2015-01-01

    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

  17. Pain, agitation, and behavioural problems in people with dementia admitted to general hospital wards: a longitudinal cohort study.

    PubMed

    Sampson, Elizabeth L; White, Nicola; Lord, Kathryn; Leurent, Baptiste; Vickerstaff, Victoria; Scott, Sharon; Jones, Louise

    2015-04-01

    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.

  18. Evaluation of organizational maturity based on people capacity maturity model in medical record wards of Iranian hospitals

    PubMed Central

    Yarmohammadian, Mohammad H.; Tavakoli, Nahid; Shams, Assadollah; Hatampour, Farzaneh

    2014-01-01

    Context: People capacity maturity model (PCMM) is one of the models which focus on improving organizational human capabilities. Aims: The aim of this model's application is to increase people ability to attract, develop, motivate, organize and retain the talents needed to organizational continuous improvement. Settings and Design: In this study, we used the PCMM for investigation of organizational maturity level in medical record departments of governmental hospitals and determination strengths and weaknesses of their staff capabilities. Materials and Methods: This is an applied research and cross sectional study in which data were collected by questionnaires to investigation of PCMM model needs in medical record staff of governmental hospitals at Isfahan, Iran. We used the questionnaire which has been extracted from PCMM model and approved its reliability with Cronbach's Alpha 0.96. Statistical Analysis Used: Data collected by the questionnaire was analyzed based on the research objectives using SPSS software and in accordance with research questions descriptive statistics were used. Results: Our findings showed that the mean score of medical record practitioners, skill and capability in governmental hospitals was 35 (62.5%) from maximum 56 (100%). There is no significant relevance between organizational maturity and medical record practitioners, attributes. Conclusions: Applying PCMM model is caused increasing staff and manager attention in identifying the weaknesses in the current activities and practices, so it will result in improvement and developing processes. PMID:25077147

  19. Diagnostic performance of a multiple real-time PCR assay in patients with suspected sepsis hospitalized in an internal medicine ward.

    PubMed

    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

    2012-04-01

    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.

  20. Cost-Minimization Model of a Multidisciplinary Antibiotic Stewardship Team Based on a Successful Implementation on a Urology Ward of an Academic Hospital

    PubMed Central

    Dik, Jan-Willem H.; Hendrix, Ron; Friedrich, Alex W.; Luttjeboer, Jos; Nannan Panday, Prashant; Wilting, Kasper R.; Lo-Ten-Foe, Jerome R.; Postma, Maarten J.; Sinha, Bhanu

    2015-01-01

    Background In order to stimulate appropriate antimicrobial use and thereby lower the chances of resistance development, an Antibiotic Stewardship Team (A-Team) has been implemented at the University Medical Center Groningen, the Netherlands. Focus of the A-Team was a pro-active day 2 case-audit, which was financially evaluated here to calculate the return on investment from a hospital perspective. Methods Effects were evaluated by comparing audited patients with a historic cohort with the same diagnosis-related groups. Based upon this evaluation a cost-minimization model was created that can be used to predict the financial effects of a day 2 case-audit. Sensitivity analyses were performed to deal with uncertainties. Finally, the model was used to financially evaluate the A-Team. Results One whole year including 114 patients was evaluated. Implementation costs were calculated to be €17,732, which represent total costs spent to implement this A-Team. For this specific patient group admitted to a urology ward and consulted on day 2 by the A-Team, the model estimated total savings of €60,306 after one year for this single department, leading to a return on investment of 5.9. Conclusions The implemented multi-disciplinary A-Team performing a day 2 case-audit in the hospital had a positive return on investment caused by a reduced length of stay due to a more appropriate antibiotic therapy. Based on the extensive data analysis, a model of this intervention could be constructed. This model could be used by other institutions, using their own data to estimate the effects of a day 2 case-audit in their hospital. PMID:25955494

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

    PubMed Central

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

    2013-01-01

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

  2. Comparison of the use of liquid crystal thermometers with glass mercury thermometers in febrile children in a children's ward at Port Moresby General Hospital, Papua New Guinea.

    PubMed

    Mauta, L; Vince, J; Ripa, P

    2009-12-01

    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.

  3. Molecular characterization of the bla(KPC-2) gene in clinical isolates of carbapenem-resistant Klebsiella pneumoniae from the pediatric wards of a Chinese hospital.

    PubMed

    Liu, Yang; Li, Xiang-Yang; Wan, La-Gen; Jiang, Wei-Yan; Li, Fang-Qu; Yang, Jing-Hong

    2012-10-01

    The present study was conducted to confirm the presence of Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae associated with a nosocomial outbreak in a Chinese pediatric hospital. From July 2009 to January 2011, 124 nonduplicated K. pneumoniae isolates were collected from specimens from patients of pediatric units in the hospital. Twelve of the 124 isolates possessed the bla(KPC-2) gene and showed 7 different pulsed-field gel electrophoresis (PFGE) patterns. Meanwhile, 16S rRNA methylase, acc(6')-Ib-cr, and several types of 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.

  4. Uniform administrative requirements for grants and agreements with institutions of higher education, hospitals and other non-profit organizations--OMB. Final revision to OMB circular A-110.

    PubMed

    1993-11-29

    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.

  5. Nutritional status influences the length of stay and clinical outcomes in patients hospitalized in internal medicine wards.

    PubMed

    Ordoñez, Ana Manuela; Madalozzo Schieferdecker, Maria Eliana; Cestonaro, Talita; Cardoso Neto, João; Ligocki Campos, Antônio Carlos

    2013-01-01

    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

  6. Discharge Against Medical Advice in the Pediatric Wards in Boo-ali Sina Hospital, Sari, Iran 2010

    PubMed Central

    Mohseni Saravi, Benyamin; Reza Zadeh, Esmaeil; Siamian, Hasan; Yahghoobian, Mahboobeh

    2013-01-01

    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

  7. [The malignant hemopathies in children: epidemiologic aspects in the Haematology and Medical Oncology Ward of Point G Hospital, Bamako, Mali (1996-2003)].

    PubMed

    Diallo, Dapa Aly; Baby, Mounirou; Dembélé, Abdoul Karim; Diallo, Yacouba Lazare; Cissoko, Lala N'Drainy Sidibé; Dicko, Mariam Soumaré; Dembélé, Mamadou; Cissoko, Yacouba

    2008-01-01

    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.

  8. Simple interventions can greatly improve clinical documentation: a quality improvement project of record keeping on the surgical wards at a district general hospital

    PubMed Central

    Glen, Peter; Earl, Naomi; Gooding, Felix; Lucas, Emily; Sangha, Nicole; Ramcharitar, Steve

    2015-01-01

    Clinical documentation is an integral part of the healthcare professional's job. Good record keeping is essential for patient care, accurate recording of consultations and for effective communication within the multidisciplinary team. Within the surgical department at the Great Western Hospital, Swindon, the case notes were deemed to be bulky and cumbersome, inhibiting effective record keeping, potentially putting patients' at risk. The aim of this quality improvement project was therefore to improve the standard of documentation, the labelling of notes and the overall filing. A baseline audit was firstly undertaken assessing the notes within the busiest surgical ward. A number of variables were assessed, but notably, only 12% (4/33) of the case notes were found to be without loose pages. Furthermore, less than half of the pages with entries written within the last 72 hours contained adequate patient identifiers on them. When assessing these entries further, the designation of the writer was only recorded in one third (11/33) of the cases, whilst the printed name of the writer was only recorded in 65% (21/33) of the entries. This project ran over a 10 month period, using a plan, do study, act methodology. Initial focus was on simple education. Afterwards, single admission folders were introduced, to contain only information required for that admission, in an attempt to streamline the notes and ease the filing. This saw a global improvement across all data subsets, with a sustained improvement of over 80% compliance seen. An educational poster was also created and displayed in clinical areas, to remind users to label their notes with patient identifying stickers. This saw a 4-fold increase (16%-68%) in the labelling of notes. In conclusion, simple, cost effective measures in streamlining medical notes, improves the quality of documentation, facilitates the filing and ultimately improves patient care. PMID:26734440

  9. Comparing the predictive accuracy of frailty, comorbidity, and disability for mortality: a 1-year follow-up in patients hospitalized in geriatric wards

    PubMed Central

    Ritt, Martin; Ritt, Julia Isabel; Sieber, Cornel Christian; Gaßmann, Karl-Günter

    2017-01-01

    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

  10. A ward without patients.

    PubMed

    1988-01-02

    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.

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed

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

    2015-03-11

    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.

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

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

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

  14. Anatomy of the ward round.

    PubMed

    O'Hare, James A

    2008-07-01

    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.

  15. A flexible system for vital signs monitoring in hospital general care wards based on the integration of UNIX-based workstations, standard networks and portable vital signs monitors.

    PubMed

    Welch, J P; Sims, N; Ford-Carlton, P; Moon, J B; West, K; Honore, G; Colquitt, N

    1991-01-01

    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.

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

    NASA Astrophysics Data System (ADS)

    Lurkittikul, N.; Kittithreerapronchai, O.

    2014-06-01

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

  17. Tracing patients from acute psychiatric wards.

    PubMed Central

    Double, D; MacPherson, R; Wong, T

    1993-01-01

    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

  18. 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

    PubMed Central

    Liu, Chao; Pan, Fei; Guo, Jun; Yan, Weifeng; Jin, Yi; Liu, Changting; Qin, Long; Fang, Xiangqun

    2016-01-01

    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

  19. [The assessment of exposure to and the activity of the manual lifting of patients in wards: methods, procedures, the exposure index (MAPO) and classification criteria. Movimientazione e Assistenza Pazienti Ospedalizzati (Lifting and Assistance to Hospitalized Patients)].

    PubMed

    Menoni, O; Ricci, M G; Panciera, D; Occhipinti, E

    1999-01-01

    Since a method for quantifying exposure to patient handling in hospital wards is lacking, the authors describe and propose a model for identifying the main risk factors in this type of occupational exposure: presence of disabled patients, staff engaged on manual handling of patients, structure of the working environment, equipment and aids for moving patients, training of workers according to the specific risk. For each factor a procedure for identification and assessment is proposed that is easily applicable in practice. The authors also propose a formula for the calculation of a condensed exposure index (MAPO Index), which brings together the various factors. The exposure index, which requires further, detailed study and validation, makes it possible, in practice, to plan the preventive and health measures according to a specific order of priority, thus complying with the requirements of Chapter V of Law 626/94. From a practical point of view, in the present state of knowledge, it can be stated that for MAPO Index values between 0 and 1.5, risk is deemed negligible, average for values between 1.51 and 5, and high for values exceeding 5.

  20. Joint geriatric and psychiatric wards: a review of the literature.

    PubMed

    George, Jim; Adamson, John; Woodford, Henry

    2011-09-01

    Joint geriatric/psychiatric wards are a potential solution to improving care of older patients with both psychiatric and medical illnesses in acute hospitals. A literature search using Medline, PsycINFO, Embase and CINAHL between 1980 and 2010 was carried out for information about joint wards for older people. Thirteen relevant papers were identified. These wards share common characteristics and there is evidence that they may reduce length of stay and be cost-effective, but there are no high-quality randomised controlled trials. Further research is needed, particularly regarding cost-effectiveness.

  1. 1. Streetscape of north ends of Detention Wards, Building Nos. ...

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

    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

  2. Exploring the experiences of young people nursed on adult wards.

    PubMed

    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.

  3. A cross-sectional study to determine the prevalence of calcium metabolic disorder in malignant childhood cancers in patients admitted to the pediatric ward of Vali-Asr Hospital.

    PubMed

    Moayeri, Heshmat; Oloomi, Zohreh; Sambo, Saudatu A

    2011-01-01

    Calcium metabolic disorders, such as hypercalcemia is a potentially life-threatening disorder especially when coupled with an already compromised condition. The aim of this study was to determine the prevalence of metabolic calcium disorders in childhood cancers of patients admitted to the pediatric ward of Vali-Asr Hospital from the year 2001-2008. The study was carried out by reviewing hospital records of these patients from the hospital archives. Range of age was between 1 and 18 years. Inclusion criteria for the study population were the presence of total serum calcium evaluated at least once; and for the hypercalcemia subgroup, at least two occasions of elevated calcium levels. The prevalence of hypercalcemia and other metabolic abnormalities of phosphorus, alkaline phosphatase, urea and creatinine; the prevalence of parameters such as age, gender, type and duration of cancer were determined within these groups. Median of elevated calcium levels was also determined to classify hypercalcemia into moderate and severe hypercalcemia. Median was 11.7 mg/dl, therefore, severe hypercalcemia was ≥11.7 mg/dl and moderate hypercalcemia, a range between the upper limit of normal, 10.8 and 10.2 mg/dl for the child and adolescent respectively, and 11.7 mg/dl. Relationship between hypercalcemia and the other metabolic disorders and parameters were analyzed by the SPSS V.17 program. The population of study consisted of 148 cases. Hypercalcemia was found in 8 (5.4%) patients. Half of the cases were associated with severe hypercalcemia and acute lymphoblastic leukemia (ALL). Out of 148 cases, there were 92 (62%) boys and 56 (38%) girls. Mean and median ages were 10.9 and 11 years respectively. Mean duration of cancer was 12.8 and median 6 months. There were 57 (38.5%) cases of leukemia and 91 (61.5%) cases of solid tumors. The most common cancers were ALL, 44 cases (29.7%) followed by brain tumors, 19 cases (12.8%); non-Hodgkin's lymphoma, 16 cases (10.8%); 13 cases of acute

  4. Circular Coinduction

    NASA Technical Reports Server (NTRS)

    Rosu, Grigore; Goguen, Joseph; Norvig, Peter (Technical Monitor)

    2001-01-01

    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.

  5. Developing skills in clinical leadership for ward sisters.

    PubMed

    Fenton, Katherine; Phillips, Natasha

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

  6. [Poison cases and types of poisons based on data obtained of patients hospitalized from 1995-2009 with acute poisoning in the second internal ward in a multi-profile provincial hospital in Tarnow].

    PubMed

    Lata, Stanisław; Janiszewski, Jacek

    2010-01-01

    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.

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

    PubMed Central

    Bate, J. G.

    1961-01-01

    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

  8. Risk factors for Clostridium difficile infection in a hepatology ward.

    PubMed

    Vanjak, Dominique; Girault, Guillaume; Branger, Catherine; Rufat, Pierre; Valla, Dominique-Charles; Fantin, Bruno

    2007-02-01

    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).

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

    PubMed Central

    2010-01-01

    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

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

    PubMed Central

    2014-01-01

    Background Recent guidance advocates daily consultant-led ward rounds, conducted in the morning with the presence of senior nursing staff and minimising patients on outlying wards. These recommendations aim to improve patient management through timely investigations, treatment and discharge. This study sought to evaluate the current surgical ward round practices in England. Methods Information regarding timing and staffing levels of surgical ward rounds was collected prospectively over a one-week period. The location of each patient was also documented. Two surgical trainee research collaboratives coordinated data collection from 19 hospitals and 13 surgical subspecialties. Results Data from 471 ward rounds involving 5622 patient encounters was obtained. 367 (77.9%) ward rounds commenced before 9am. Of 422 weekday rounds, 190 (45%) were consultant-led compared with 33 of the 49 (67%) weekend rounds. 2474 (44%) patients were seen with a nurse present. 1518 patients (27%) were classified as outliers, with 361 ward rounds (67%) reporting at least one outlying patient. Conclusion Recommendations for daily consultant-led multi disciplinary ward rounds are poorly implemented in surgical practice, and patients continue to be managed on outlying wards. Although strategies may be employed to improve nursing attendance on ward rounds, substantial changes to workforce planning would be required to deliver daily consultant-led care. An increasing political focus on patient outcomes at weekends may prompt changes in these areas. PMID:24581228

  11. Use of emergency observation and assessment wards: a systematic literature review

    PubMed Central

    Cooke, M; Higgins, J; Kidd, P

    2003-01-01

    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

  12. Predicting Cardiac Arrest on the Wards

    PubMed Central

    Churpek, Matthew M.; Yuen, Trevor C.; Huber, Michael T.; Park, Seo Young; Hall, Jesse B.

    2012-01-01

    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

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

    PubMed

    Maurice, Andrew; Hann, Angus

    2015-01-01

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

  14. [Interrelations of Objective Conditions on Psychiatric Wards and Ward Climate Characteristics].

    PubMed

    Schalast, Norbert; Sieß, Julia

    2017-04-03

    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.

  15. Incidence and Prognostic Value of the Systemic Inflammatory Response Syndrome and Organ Dysfunctions in Ward Patients

    PubMed Central

    Zadravecz, Frank J.; Winslow, Christopher; Howell, Michael D.; Edelson, Dana P.

    2015-01-01

    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

  16. 21 CFR 50.56 - Wards.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... act in, the best interest of the child for the duration of the child's participation in the clinical... 21 Food and Drugs 1 2013-04-01 2013-04-01 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...

  17. 21 CFR 50.56 - Wards.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... act in, the best interest of the child for the duration of the child's participation in the clinical... 21 Food and Drugs 1 2014-04-01 2014-04-01 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...

  18. 21 CFR 50.56 - Wards.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... act in, the best interest of the child for the duration of the child's participation in the clinical... 21 Food and Drugs 1 2012-04-01 2012-04-01 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...

  19. 21 CFR 50.56 - Wards.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 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...

  20. 34 CFR 97.409 - Wards.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 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...

  1. 34 CFR 97.409 - Wards.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 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...

  2. 34 CFR 97.409 - Wards.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 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...

  3. 34 CFR 97.409 - Wards.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 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...

  4. 34 CFR 97.409 - Wards.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 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)...

  5. Circular Motion.

    ERIC Educational Resources Information Center

    Lee, Paul D.

    1995-01-01

    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)

  6. Security rules and banned items in psychiatric acute admission wards in Athens, Greece.

    PubMed

    Koukia, Evmorfia; Giannouli, Eleni; Gonis, Nikolaos; Douzenis, Athanassios

    2010-12-01

    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.

  7. Uniform administrative requirements for grants and agreements with institutions of higher education, hospitals and other non-profit organizations--OMB Circular A-110 (revised)--HUD. Final rule.

    PubMed

    1995-06-20

    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.

  8. [An acute psychiatric ward moves into the community. An empirical test of the satellite model].

    PubMed

    Gebhardt, R P; Schmidt-Michel, P O

    2002-11-01

    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.

  9. Ward identities for Hall transport

    NASA Astrophysics Data System (ADS)

    Hoyos, Carlos; Kim, Bom Soo; Oz, Yaron

    2014-10-01

    We derive quantum field theory Ward identities based on linear area preserving and conformal transformations in 2+1 dimensions. The identities relate Hall viscosities, Hall conductivities and the angular momentum. They apply both for relativistic and non relativistic systems, at zero and at finite temperature. We consider systems with or without translation invariance, and introduce an external magnetic field and viscous drag terms. A special case of the identities yields the well known relation between the Hall conductivity and half the angular momentum density.

  10. Students' Perceptions on an Interprofessional Ward Round Training – A Qualitative Pilot Study

    PubMed Central

    Nikendei, C.; Huhn, D.; Pittius, G.; Trost, Y.; Bugaj, T. J.; Koechel, A.; Schultz, J.-H.

    2016-01-01

    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

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

    PubMed

    Alexander, J

    2006-10-01

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

  12. Improving patients' sleep: reducing light and noise levels on wards at night.

    PubMed

    Hewart, Carol; Fethney, Loveday

    2016-02-01

    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.

  13. Risk factors for the development of Clostridium difficile colitis in a surgical ward

    PubMed Central

    Kim, Min Jeong; Kim, Byung Seup; Kwon, Jae Woo; Ahn, So-Eun; Lee, Seung Soon; Park, Hyoung Chul

    2012-01-01

    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

  14. Characteristics of aggression among psychiatric inpatients by ward type in Japan: Using the Staff Observation Aggression Scale - Revised (SOAS-R).

    PubMed

    Sato, Makiko; Noda, Toshie; Sugiyama, Naoya; Yoshihama, Fumihiro; Miyake, Michi; Ito, Hiroto

    2016-07-22

    Aggressive behaviour by psychiatric patients is a serious issue in clinical practice, and adequate management of such behaviour is required, with careful evaluation of the factors causing the aggression. To examine the characteristics of aggressive incidents by ward type, a cross-sectional descriptive study was conducted for 6 months between April 2012 and June 2013 using the Staff Observation Aggression Scale - Revised, Japanese version (SOAS-R) in 30 wards across 20 Japanese psychiatric hospitals. Participating wards were categorized into three types based on the Japanese medical reimbursement system: emergency psychiatric, acute psychiatric, and standard wards (common in Japan, mostly treating non-acute patients). On analyzing the 443 incidents reported, results showed significant differences in SOAS-R responses by ward type. In acute and emergency psychiatric wards, staff members were the most common target of aggression. In acute psychiatric wards, staff requiring patients to take medication was the most common provocation, and verbal aggression was the most commonly used means. In emergency psychiatric wards, victims felt threatened. In contrast, in standard wards, both the target and provocation of aggression were most commonly other patients, hands were used, victims reported experiencing physical pain, and seclusion was applied to stop their behaviour. These findings suggest that ward environment was an important factor influencing aggressive behaviour. Ensuring the quality and safety of psychiatric care requires understanding the characteristics of incidents that staff are likely to encounter in each ward type, as well as implementing efforts to deal with the incidents adequately and improve the treatment environment.

  15. Distribution of various pathogenic bacteria from pediatric ward settings

    PubMed Central

    Butt, Irfan A.; Aslam, Bilal; Rasool, Muhammad H.; Shafiq, Humerah B.; Khurshid, Mohsin; Aslam, Muhammad A.

    2016-01-01

    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

  16. 35. Basement, passage beneath main entrance porch, showing circular skylight ...

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

    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

  17. Ratio of Pediatric ICU versus Ward Cardiopulmonary Resuscitation Events is Increasing

    PubMed Central

    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.

    2013-01-01

    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

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

    ERIC Educational Resources Information Center

    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…

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

    PubMed

    Galvão, C M; Trevizan, M A; Sawada, N O; Fávero, N

    1997-04-01

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

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

    PubMed

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

    2013-06-01

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

  1. On Hospital Wards, Patient Crises May Have 'Domino Effect'

    MedlinePlus

    ... 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 ...

  2. Limits of Freedom: The Ward Churchill Case

    ERIC Educational Resources Information Center

    O'Nell, Robert M.

    2006-01-01

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

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

    ERIC Educational Resources Information Center

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

    2014-01-01

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

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

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

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

  5. Prevention of measles spread on a paediatric ward.

    PubMed

    Tapisiz, A; Polat, M; Kara, S S; Tezer, H; Simsek, H; Aktas, F

    2015-03-01

    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.

  6. 34 CFR 303.37 - Ward of the State.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 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...

  7. 34 CFR 303.37 - Ward of the State.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 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...

  8. 34 CFR 303.37 - Ward of the State.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 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...

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

    PubMed

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

    2004-09-01

    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.

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

    PubMed

    Iadanza, Ernesto; Dori, Fabrizio

    2009-01-01

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

  11. Psychological Evaluation of Patients in Critical Care/Intensive Care Unit and Patients Admitted in Wards

    PubMed Central

    Sharma B, Gaurav; EVS, Maben; MS, Kotian

    2014-01-01

    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

  12. Forecasting Daily Patient Outflow From a Ward Having No Real-Time Clinical Data

    PubMed Central

    Tran, Truyen; Luo, Wei; Phung, Dinh; Venkatesh, Svetha

    2016-01-01

    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

  13. Neonatal Intensive Care Unit Nurses Working in an Open Ward: Stress and Work Satisfaction.

    PubMed

    Lavoie-Tremblay, Mélanie; Feeley, Nancy; Lavigne, Geneviève L; Genest, Christine; Robins, Stéphanie; Fréchette, Julie

    2016-01-01

    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.

  14. Serious untoward incidents and their aftermath in acute inpatient psychiatry: the Tompkins Acute Ward study.

    PubMed

    Bowers, Len; Simpson, Alan; Eyres, Sophie; Nijman, Henk; Hall, Cerdic; Grange, Angela; Phillips, Louise

    2006-12-01

    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.

  15. Quality of Life for Patients in Medical-Surgical Wards.

    PubMed

    Ahmad, Muayyad M; Al-Daken, Laila Ismae'l; Ahmad, Huthaifa M

    2015-08-01

    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.

  16. Two years of a fungal aerobiocontamination survey in a Florentine haematology ward.

    PubMed

    Pini, Gabriella; Donato, Rosa; Faggi, Elisabetta; Fanci, Rosa

    2004-01-01

    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.

  17. Comparison of mental status scales for predicting mortality on the general wards

    PubMed Central

    Zadravecz, Frank J.; Tien, Linda; Robertson-Dick, Brian J.; Yuen, Trevor C.; Twu, Nicole M.; Churpek, Matthew M.; Edelson, Dana P.

    2016-01-01

    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

  18. [Circular migration in Indonesia].

    PubMed

    Mantra, I B

    1979-12-01

    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.

  19. Toroidal circular dichroism

    NASA Astrophysics Data System (ADS)

    Raybould, T. A.; Fedotov, V. A.; Papasimakis, N.; Kuprov, I.; Youngs, I. J.; Chen, W. T.; Tsai, D. P.; Zheludev, N. I.

    2016-07-01

    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.

  20. Derivation of a cardiac arrest prediction model using ward vital signs

    PubMed Central

    Churpek, Matthew M.; Yuen, Trevor C.; Park, Seo Young; Meltzer, David O.; Hall, Jesse B.; Edelson, Dana P.

    2012-01-01

    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

  1. The transition from staff nurse to ward leader.

    PubMed

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

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

  2. Monitoring environmental cleanliness on two surgical wards.

    PubMed

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

    2008-10-01

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

  3. Aggression in psychiatry wards: a systematic review.

    PubMed

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

    2011-08-30

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

  4. Pressure ulcers in palliative ward patients: hyponatremia and low blood pressure as indicators of risk

    PubMed Central

    Sternal, Danuta; Wilczyński, Krzysztof; Szewieczek, Jan

    2017-01-01

    Background Prevention strategies for pressure ulcer formation remain critical in patients with an advanced illness. We analyzed factors associated with the development of pressure ulcers in patients hospitalized in a palliative care ward setting. Patients and methods This study was a retrospective analysis of 329 consecutive patients with a mean age (± standard deviation) of 70.4±11.8 years (range: 30–96 years, median 70.0 years; 55.3% women), who were admitted to the Palliative Care Department between July 2012 and May 2014. Results Patients were hospitalized for mean of 24.8±31.4 days (1–310 days, median 14 days). A total of 256 patients (77.8%) died in the ward and 73 patients (22.2%) were discharged. Two hundred and six patients (62.6%) did not develop pressure ulcers during their stay in the ward, 84 patients (25.5%) were admitted with pressure ulcers, and 39 patients (11.9%) developed pressure ulcers in the ward. Four factors assessed at admission appear to predict the development of pressure ulcers in the multivariate logistic regression model: Waterlow score (odds ratio [OR] =1.140, 95% confidence interval [CI] =1.057–1.229, P=0.001), transfer from other hospital wards (OR =2.938, 95% CI =1.339–6.448, P=0.007), hemoglobin level (OR =0.814, 95% CI =0.693–0.956, P=0.012), and systolic blood pressure (OR =0.976, 95% CI =0.955–0.997, P=0.023). Five other factors assessed during hospitalization appear to be associated with pressure ulcer development: mean evening body temperature (OR =3.830, 95% CI =1.729–8.486, P=0.001), mean Waterlow score (OR =1.194, 95% CI =1.092–1.306, P<0.001), the lowest recorded sodium concentration (OR =0.880, 95% CI =0.814–0.951, P=0.001), mean systolic blood pressure (OR =0.956, 95% CI =0.929–0.984, P=0.003), and the lowest recorded hemoglobin level (OR =0.803, 95% CI =0.672–0.960, P=0.016). Conclusion Hyponatremia and low blood pressure may contribute to the formation of pressure ulcers in patients with an

  5. Pharmacists as fiscal auditors save hospital millions of dollars.

    PubMed

    Corchnoy, B

    1987-11-01

    Pharmacist expertise in medical terminology and knowledge of medical procedures performed in a teaching community hospital plus the ability to communicate well and arbitrate helps a fiscal department of a hospital to ward off third-party challenges of hospital billings, thus creating loss avoidance, reduction of accounts receivable by over $5,000,000, and increased hospital revenue of approximately 2%.

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

    PubMed Central

    Zhang, Ju; Ye, Wenqin; Fan, Fan

    2015-01-01

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

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

    PubMed Central

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

    2014-01-01

    Background: The door-to-needle-time (DNT) is considered a standard time for scheduling thrombolysis for acute ST-segment elevation of myocardial infarction and this time can be reduced by minimizing the delay in starting thrombolytic treatment once the patient has reached to the hospital. This study was carried out on a sample of Iranian patients with acute myocardial infarction to determine the DNT in those after changing schedule of thrombolysis during 8 years from emergency to coronary care unit (CCU). Methods: A descriptive cross-sectional study was carried out on all consecutive patients with a confirmed diagnosis of acute myocardial infarction admitted to the emergency ward of Ekbatan Hospital in Hamadan, Iran, within 2011 and had an indication of fibrinolytic therapy, which 47 patients were finally indicated to receive streptokinase in the part of CCU. Results: The mean time interval between arrival at the hospital and electrocardiogram (ECG) assessment was 6.30 min, taking ECG and patient's admission was 21.6 min and transferring the patient from admission to CCU ward was 31.9. The time between transferring the patients to CCU ward and fibrinolytic administration order and the time between its ordering and infusion was 31.2 min and 14.0 min respectively. In sum, the DNT was estimated 84.48 ± 53.00 min ranged 30-325 min that was significantly more than standard DNT (P <0.01). Furthermore, DNT mean in this study is significantly more than a study conducted 8 years ago in the same hospital (P <0.01). Conclusions: The DNT is higher than the standard level and higher than the estimated level in the past. This shows that DNT was longer after transferring to CCU. PMID:24829715

  8. 34 CFR 300.45 - Ward of the State.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... welfare agency. (b) Exception. Ward of the State does not include a foster child who has a foster parent... REHABILITATIVE SERVICES, DEPARTMENT OF EDUCATION ASSISTANCE TO STATES FOR THE EDUCATION OF CHILDREN WITH... paragraph (b) of this section, ward of the State means a child who, as determined by the State where...

  9. 34 CFR 300.45 - Ward of the State.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... welfare agency. (b) Exception. Ward of the State does not include a foster child who has a foster parent... REHABILITATIVE SERVICES, DEPARTMENT OF EDUCATION ASSISTANCE TO STATES FOR THE EDUCATION OF CHILDREN WITH... paragraph (b) of this section, ward of the State means a child who, as determined by the State where...

  10. 34 CFR 300.45 - Ward of the State.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... welfare agency. (b) Exception. Ward of the State does not include a foster child who has a foster parent... REHABILITATIVE SERVICES, DEPARTMENT OF EDUCATION ASSISTANCE TO STATES FOR THE EDUCATION OF CHILDREN WITH... paragraph (b) of this section, ward of the State means a child who, as determined by the State where...

  11. 34 CFR 300.45 - Ward of the State.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... welfare agency. (b) Exception. Ward of the State does not include a foster child who has a foster parent... REHABILITATIVE SERVICES, DEPARTMENT OF EDUCATION ASSISTANCE TO STATES FOR THE EDUCATION OF CHILDREN WITH... paragraph (b) of this section, ward of the State means a child who, as determined by the State where...

  12. 25 CFR 117.23 - Transactions between guardian and ward.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 117.23 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR FINANCIAL ACTIVITIES DEPOSIT AND... COMPETENCY § 117.23 Transactions between guardian and ward. Business dealings between the guardian and his ward involving the sale or purchase of any property, real or personal, by the guardian to or from...

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

    PubMed Central

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

    2014-01-01

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

  14. Squaring a Circular Segment

    ERIC Educational Resources Information Center

    Gordon, Russell

    2008-01-01

    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…

  15. Disposal of Hospital Wastes Containing Pathogenic Organisms

    DTIC Science & Technology

    1979-09-01

    wastes from wards where pathogers may be generated or where exposure to pathogens may occur (the mental health ward, for example, is excluded); and...hospital solid waste. 5.2 M•Wicipal Solid Warte The pathogers identified in municipal solid waste in Table 5-1 were isolated frola municipal solid waste...parasites are retained by filtering. A sufficiently thick layer of the proper soil would pro- tect the groundwater from bacterial and viral contamination

  16. 1. VIEW OF HOSPITAL COMPLEX FROM MOVIE THEATER, SHOWING SOUTHEAST ...

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

    1. VIEW OF HOSPITAL COMPLEX FROM MOVIE THEATER, SHOWING SOUTHEAST SECTION OF COMPLEX - Fort Randall, Neuro-Psychiatric Ward, Northeast of intersection of California Boulevard & Nurse Drive, Cold Bay, Aleutian Islands, AK

  17. Detection of Common Respiratory Viruses and Mycoplasma pneumoniae in Patient-Occupied Rooms in Pediatric Wards

    PubMed Central

    Wan, Gwo-Hwa; Huang, Chung-Guei; Chung, Fen-Fang; Lin, Tzou-Yien; Tsao, Kuo-Chien; Huang, Yhu-Chering

    2016-01-01

    Abstract Few studies have assessed viral contamination in the rooms of hospital wards. This cross-sectional study evaluated the air and objects in patient-occupied rooms in pediatric wards for the presence of common respiratory viruses and Mycoplasma pneumoniae. Air samplers were placed at a short (60–80 cm) and long (320 cm) distance from the head of the beds of 58 pediatric patients, who were subsequently confirmed to be infected with enterovirus (n = 17), respiratory syncytial virus (RSV) (n = 13), influenza A virus (n = 13), adenovirus (n = 9), or M pneumoniae (n = 6). Swab samples were collected from the surfaces of 5 different types of objects in the patients’ rooms. All air and swab samples were analyzed via real-time quantitative polymerase chain reaction assay for the presence of the above pathogens. All pathogens except enterovirus were detected in the air, on the objects, or in both locations in the patients’ rooms. The detection rates of influenza A virus, adenovirus, and M pneumoniae for the long distance air sampling were 15%, 67%, and 17%, respectively. Both adenovirus and M pneumoniae were detected at very high rates, with high concentrations, on all sampled objects. The respiratory pathogens RSV, influenza A virus, adenovirus, and M pneumoniae were detected in the air and/or on the objects in the pediatric ward rooms. Appropriate infection control measures should be strictly implemented when caring for such patients. PMID:27057827

  18. Team climate and attitudes toward information and communication technology among nurses on acute psychiatric wards.

    PubMed

    Koivunen, Marita; Anttila, Minna; Kuosmanen, Lauri; Katajisto, Jouko; Välimäki, Maritta

    2015-01-01

    Objectives: To describe the association of team climate with attitudes toward information and communication technology among nursing staff working on acute psychiatric wards. Background: Implementation of ICT applications in nursing practice brings new operating models to work environments, which may affect experienced team climate on hospital wards. Method: Descriptive survey was used as a study design. Team climate was measured by the Finnish modification of the Team Climate Inventory, and attitudes toward ICT by Burkes' questionnaire. The nursing staff (N = 181, n = 146) on nine acute psychiatric wards participated in the study. Results: It is not self-evident that experienced team climate associates with attitudes toward ICT, but there are some positive relationships between perceived team climate and ICT attitudes. The study showed that nurses' motivation to use ICT had statistically significant connections with experienced team climate, participative safety (p = 0.021), support for innovation (p = 0.042) and task orientation (p = 0.042). Conclusion: The results suggest that asserting team climate and supporting innovative operations may lead to more positive attitudes toward ICT. It is, in particular, possible to influence nurses' motivation to use ICT. More attention should be paid to psychosocial factors such as group education and co-operation at work when ICT applications are implemented in nursing.

  19. An ethnographic study of classifying and accounting for risk at the sharp end of medical wards.

    PubMed

    Dixon-Woods, Mary; Suokas, Anu; Pitchforth, Emma; Tarrant, Carolyn

    2009-08-01

    An understanding of how staff identify, classify, narrativise and orient to patient safety risks is important in understanding responses to efforts to effect change. We report an ethnographic study of four medical wards in the UK, in hospitals that were participating in the Health Foundation's Safer Patients Initiative, an organisation-wide patient safety programme. Data analysis of observations and 49 interviews with staff was based on the constant comparative method. We found that staff engaged routinely in practices of determining what gets to count as a risk, how such risks should properly be managed, and how to account for what they do. Staff practices and reasoning in relation to risk emerged through their practical engagement in the everyday work of the wards, but were also shaped by social imperatives. Risks, in the environment we studied, were not simply risks to patient safety; when things went wrong, professional identity was at risk too. Staff oriented to risks in the context of busy and complex ward environments, which influenced how they accounted for risk. Reasoning about risk was influenced by judgements about which values should be promoted when caring for patients, by social norms, by risk-spreading logics, and by perceptions of the extent to which particular behaviours and actions were coupled to outcomes and were blameworthy. These ways of identifying, evaluating and addressing risks are likely to be highly influential in staff responses to efforts to effect change, and highlight the challenges in designing and implementing patient safety interventions.

  20. Vaccine cold-chain status in the Elim health ward of Gazankulu.

    PubMed

    De Swardt, R; Ijsselmuiden, C B; Edginton, M E

    1987-09-05

    The vaccine cold-chain is a fundamental component of any immunisation programme. This study used chemical-based temperature indicators to monitor the cold-chain constantly in the Elim Hospital health ward of Gazankulu. It was found that the cold-chain was adequately maintained at the hospital, but that as vaccine travelled towards the periphery severe breaks in the cold-chain occurred. Eighteen per cent of vaccines at the Elim Hospital store and up to 90% at the periphery were potentially exposed to temperatures high enough and for a sufficient length of time to have affected their potency. More emphasis needs to be placed on maintaining the cold-chain if we are to reach to EPI's goal of immunisation for all children by the year 1990.

  1. Acute bacterial skin and skin structure infections in internal medicine wards: old and new drugs.

    PubMed

    Falcone, Marco; Concia, Ercole; Giusti, Massimo; Mazzone, Antonino; Santini, Claudio; Stefani, Stefania; Violi, Francesco

    2016-08-01

    Skin and soft tissue infections (SSTIs) are a common cause of hospital admission among elderly patients, and traditionally have been divided into complicated and uncomplicated SSTIs. In 2010, the FDA provided a new classification of these infections, and a new category of disease, named acute bacterial skin and skin structure infections (ABSSSIs), has been proposed as an independent clinical entity. ABSSSIs include three entities: cellulitis and erysipelas, wound infections, and major cutaneous abscesses This paper revises the epidemiology of SSTIs and ABSSSIs with regard to etiologies, diagnostic techniques, and clinical presentation in the hospital settings. Particular attention is owed to frail patients with multiple comorbidities and underlying significant disease states, hospitalized on internal medicine wards or residing in nursing homes, who appear to be at increased risk of infection due to multi-drug resistant pathogens and treatment failures. Management of ABSSSIs and SSTIs, including evaluation of the hemodynamic state, surgical intervention and treatment with appropriate antibiotic therapy are extensively discussed.

  2. Circular free-electron laser

    DOEpatents

    Brau, Charles A.; Kurnit, Norman A.; Cooper, Richard K.

    1984-01-01

    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.

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

    PubMed Central

    2014-01-01

    Background Continuous positive airway pressure (CPAP) is commonly used to relieve respiratory distress in infants with bronchiolitis, but has mostly been studied in an intensive care setting. Our prime aim was to evaluate the feasibility of CPAP for infants with bronchiolitis in a general paediatric ward, and secondary to assess capillary PCO2 (cPCO2) levels before and during treatment. Methods From May 1st 2008 to April 30th 2012, infants with bronchiolitis at Stavanger University Hospital were treated with CPAP in a general paediatric ward, but could be referred to an intensive care unit (ICU) when needed, according to in-house guidelines. Levels of cPCO2 were prospectively registered before the start of CPAP and at approximately 4, 12, 24 and 48 hours of treatment as long as CPAP was given. We had a continuous updating program for the nurses and physicians caring for the infants with CPAP. The study was population based. Results 672 infants (3.4%) were hospitalized with bronchiolitis. CPAP was initiated in 53 infants (0.3%; 7.9% of infants with bronchiolitis), and was well tolerated in all but three infants. 46 infants were included in the study, the majority of these (n = 33) were treated in the general ward only. These infants had lower cPCO2 before treatment (8.0; 7.7, 8.6)(median; quartiles) than those treated at the ICU (n = 13) (9.3;8.5, 9.9) (p < 0.001). The level of cPCO2 was significantly reduced after 4 h in both groups; 1.1 kPa (paediatric ward) (p < 0.001) and 1.3 kPa (ICU) (p = 0.002). Two infants on the ICU did not respond to CPAP (increasing cPCO2 and severe apnoe) and were given mechanical ventilation, otherwise no side effects were observed in either group treated with CPAP. Conclusion Treatment with CPAP for infants with bronchiolitis may be feasible in a general paediatric ward, providing sufficient staffing and training, and the possibility of referral to an ICU when needed. PMID:24886569

  4. Economic evaluation of hospital at home versus hospital care: cost minimisation analysis of data from randomised controlled trial

    PubMed Central

    Jones, Jeremy; Wilson, Andrew; Parker, Hilda; Wynn, Alison; Jagger, Carol; Spiers, Nicky; Parker, Gillian

    1999-01-01

    Objectives To compare the costs of admission to a hospital at home scheme with those of acute hospital admission. Design Cost minimisation analysis within a pragmatic randomised controlled trial. Setting Hospital at home scheme in Leicester and the city's three acute hospitals. Participants 199 consecutive patients assessed as being suitable for admission to hospital at home for acute care during the 18 month trial period (median age 84 years). Intervention Hospital at home or hospital inpatient care. Main outcome measures Costs to NHS, social services, patients, and families during the initial episode of treatment and the three months after admission. Results Mean (median) costs per episode (including any transfer from hospital at home to hospital) were similar when analysed by intention to treat—hospital at home £2569 (£1655), hospital ward £2881 (£2031), bootstrap mean difference −305 (95% confidence interval −1112 to 448). When analysis was restricted to those who accepted their allocated place of care, hospital at home was significantly cheaper—hospital at home £2557 (£1710), hospital ward £3660 (£2903), bootstrap mean difference −1071 (−1843 to −246). At three months the cost differences were sustained. Costs with all cases included were hospital at home £3671 (£2491), hospital ward £3877 (£3405), bootstrap mean difference −210 (−1025 to 635). When only those accepting allocated care were included the costs were hospital at home £3698 (£2493), hospital ward £4761 (£3940), bootstrap mean difference −1063 (−2044 to −163); P=0.009. About 25% of the costs for episodes of hospital at home were incurred through transfer to hospital. Costs per day of care were higher in the hospital at home arm (mean £207 v £134 in the hospital arm, excluding refusers, P<0.001). Conclusions Hospital at home can deliver care at similar or lower cost than an equivalent admission to an acute hospital. PMID:10591720

  5. Isolation of Trichosporon in a hematology ward.

    PubMed

    Pini, Gabriella; Faggi, Elisabetta; Donato, Rosa; Fanci, Rosa

    2005-01-01

    During mycologic monitoring of the air in a hematology ward, we found massive air contamination caused by Trichosporon asahii, both in the room where neutropenic patients were staying and the corridor immediately outside the room. This fungal species had never been isolated in previous samplings. The urine culture taken from one of the patients in this room, whose urinary catheter had been removed immediately prior to air sampling, resulted positive for T. asahii. Both macroscopic and microscopic morphologic observation was insufficient for confirming the hypothesis of a close relationship between the strains isolated from the patient, from the air in the room and corridor. Therefore, we used genomic typing with random amplified polymorphic DNA (RAPD). The five primers used, (GTG)(5), (GACA)(4), M13, OPE01, RC08, produced different patterns of polymerase chain reaction (PCR) products; the genomic profiles obtained with the same primer, however, resulted perfectly superimposable for all the strains. This result led us to conclude that the massive air contamination caused by T. asahii can have effectively been determined by the removal of the urinary catheter from the patient who presented an asymptomatic infection caused by this microorganism.

  6. Compact waveguide circular polarizer

    SciTech Connect

    Tantawi, Sami G.

    2016-08-16

    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.

  7. Circular Fibonacci gratings.

    PubMed

    Gao, Nan; Zhang, Yuchao; Xie, Changqing

    2011-11-01

    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.

  8. INTERIOR OF WARD ROOM WITH RUDDER QUADRANT AND SHAFT LOCATED ...

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

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

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

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

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

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

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

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

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

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

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

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

    ERIC Educational Resources Information Center

    Tanner, Laurel N.; Tanner, Daniel

    1987-01-01

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

  13. 1. VIEW OF DETENTION WARD AREA, LOOKING NORTHWEST FROM Y ...

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

    1. VIEW OF DETENTION WARD AREA, LOOKING NORTHWEST FROM Y STREET - Fort McCoy, Building No. T-1065, Northeast of Intersection of South Ninth Avenue & South "Y" Street, Block 10, Sparta, Monroe County, WI

  14. Three Bridge Fryer's Ford Bridge, Nimrod Bridge, and Ward's ...

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

    Three Bridge - Fryer's Ford Bridge, Nimrod Bridge, and Ward's Crossing Bridge - Fryer's Ford Bridge, Spanning East Fork of Point Remove Creek at Fryer Bridge Road (CR 67), Solgohachia, Conway County, AR

  15. 1. Oblique view of east portion of Portsmouth Naval Hospital ...

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

    1. Oblique view of east portion of Portsmouth Naval Hospital Complex showing in middle ground, from left to right, Medical Ward A (HABS No. VA01287-G), Medical Ward B (HABS No. VA-1287-H), Medical Ward C (HABS No. VA-1287-I, Portsmouth Naval Hospital Building (HABS No. VA-1287-A), Hospital Point; and in foreground, from left to right, gardener's tool shed (HABS No. VA-1287-C), Service Building (HABS No. VA01287-D), garage (HABS No. VA-1287-F), Medical Officer's Quarters C (HABS No. VA-1287-B), and Medical Officer's Quarters B (HAQBS No. VA-1287-E), view to north from roof of 1960 high-rise hospital - Portsmouth Naval Hospital, Bounded by Elizabeth River, Crawford Street, Portsmouth General Hospital, Parkview Avenue, & Scotts Creek, Portsmouth, Portsmouth, VA

  16. Electronic Printed Ward Round Proformas: Freeing Up Doctors' Time

    PubMed Central

    Fernandes, Darren; Eneje, Philip

    2017-01-01

    The role of a junior doctor involves preparing for the morning ward round. At a time when there are gaps on rotas and doctors' time is more stretched, this can be a source of significant delay and thus a loss of working time. We therefore looked at ways in which we could make the ward round a more efficient place by introducing specific electronic, printed ward round proformas. We used the average time taken to write proformas per patient and the average time taken per patient on the ward round. This would then enable us to make fair comparisons with future changes that were made using the plan, do, study, and act principles of quality improvement. Our baseline measurement found that the average time taken to write up the proforma for each patient was 1 minute 9 seconds and that the average time taken per patient on the ward round was 8 minutes 30 seconds. With the changes we made during our 3 PDSA cycles and the implementation of an electronic, printed ward round proforma, we found that we were able to reduce the average time spent per patient on the ward round to 6 minutes 32 seconds, an improvement of 1 min 58 seconds per patient. The project has thus enabled us to reduce the time taken per patient during the ward round. This improved efficiency will enable patients to be identified earlier for discharge. It will also aid in freeing up the time of junior doctors, allowing them to complete discharge letters sooner, order investigations earlier and enable them to complete their allocated tasks within contracted hours. PMID:28352467

  17. Electronic Printed Ward Round Proformas: Freeing Up Doctors' Time.

    PubMed

    Fernandes, Darren; Eneje, Philip

    2017-01-01

    The role of a junior doctor involves preparing for the morning ward round. At a time when there are gaps on rotas and doctors' time is more stretched, this can be a source of significant delay and thus a loss of working time. We therefore looked at ways in which we could make the ward round a more efficient place by introducing specific electronic, printed ward round proformas. We used the average time taken to write proformas per patient and the average time taken per patient on the ward round. This would then enable us to make fair comparisons with future changes that were made using the plan, do, study, and act principles of quality improvement. Our baseline measurement found that the average time taken to write up the proforma for each patient was 1 minute 9 seconds and that the average time taken per patient on the ward round was 8 minutes 30 seconds. With the changes we made during our 3 PDSA cycles and the implementation of an electronic, printed ward round proforma, we found that we were able to reduce the average time spent per patient on the ward round to 6 minutes 32 seconds, an improvement of 1 min 58 seconds per patient. The project has thus enabled us to reduce the time taken per patient during the ward round. This improved efficiency will enable patients to be identified earlier for discharge. It will also aid in freeing up the time of junior doctors, allowing them to complete discharge letters sooner, order investigations earlier and enable them to complete their allocated tasks within contracted hours.

  18. Strongly Lacunary Ward Continuity in 2-Normed Spaces

    PubMed Central

    Çakalli, Hüseyin; Ersan, Sibel

    2014-01-01

    A function f defined on a subset E of a 2-normed space X is strongly lacunary ward continuous if it preserves strongly lacunary quasi-Cauchy sequences of points in E; that is, (f(xk)) is a strongly lacunary quasi-Cauchy sequence whenever (xk) is strongly lacunary quasi-Cauchy. In this paper, not only strongly lacunary ward continuity, but also some other kinds of continuities are investigated in 2-normed spaces. PMID:25050397

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

    PubMed

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

    2015-08-01

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

  20. Cruelty in Maternity Wards: Fifty Years Later

    PubMed Central

    Goer, Henci

    2010-01-01

    Fifty years have passed since a scandal broke over inhumane treatment of laboring women in U.S. hospitals, yet first-person and eyewitness reports document that medical care providers continue to subject childbearing women to verbal and physical abuse and even to what would constitute sexual assault in any other context. Women frequently are denied their right to make informed decisions about care and may be punished for attempting to assert their right to refusal. Mistreatment is not uncommon and persists because of factors inherent to hospital social culture. Concerted action on the part of all stakeholders will be required to bring about systemic reform. PMID:21629381

  1. Prevalence of workplace violence in psychiatric wards, Tehran, Iran.

    PubMed

    Khoshknab, Masoud Fallahi; Tamizi, Zahra; Ghazanfari, Nahid; Mehrabani, Golnoush

    2012-07-15

    Workplace violence is still a problem that nurses may be exposed to in clinical wards. A psychiatric ward is among the most probable one confronting this violence. This study determined the workplace violence in psychiatric wards in Tehran, Iran. Nurses working in Razi Psychiatric Center, Tehran, Iran were enrolled using the International Workplace Violence questionnaire. Among 385 nurses of this ward, 200 subjects completed the questionnaire using a simple random sampling method with a response rate of 91.5%. The prevalence of workplace violence was 71% including mental (93.4%) and physical violence (71.6%). Verbal and sexual violence occurred in 19.1 and 5.5% of subjects, respectively. The 62.3% of the nurses did not report violence because they considered it useless (55.3%) or did not believe to be important (42.1%). The 61.2% believed to the necessity of training courses while 72.7% had completed these courses and 59.6% believed to a reporting system. The need to security guard (56.8%), taking security actions in wards (67.8%) and training of staffs (68.9%) were the most important preventive measures reported to be effective for workplace violence. It seems that training courses, establishing rules to prevent workplace violence, reporting systems, compensating losses from violence, increasing the security at workplace, increasing the number of nurses and providing especial guiding protocols against any workplace violence would promote the wards to control the workplace violence against nurses.

  2. Absconding: reducing failure to return in adult mental health wards

    PubMed Central

    Bailey, Jill; Page, Bethan; Ndimande, Nokuthula; Connell, Julie; Vincent, Charles

    2016-01-01

    Failing to return from leave from acute psychiatric wards can have a range of negative consequences for patients, relatives and staff. This study used quality improvement methodology to improve the processes around patient leave and time away from the ward. The aim of this study was to improve rates of on-time return from leave by detained and informal patients by 50%. Following a baseline period, four interventions were implemented and refined using PDSA cycles. The main outcome measure was the proportion of periods of leave where the patient returned on time. Late return was defined as failure to return to the ward within 10 minutes of the agreed time. At baseline, the rate for on-time return was 56.0%; this increased to 87.1% post-intervention, a statistically significant increase of 55.5%. SPC charts show that the interventions were associated with improvements. The improvements have been sustained and the interventions are fully embedded into daily practice. The project was refined to local context and trialled on six additional wards: four of the six wards have successfully implemented the interventions and have on-time return rates of over 90%. This project produced a marked and sustained improvement in patients returning on-time from leave, facilitating a more open discussion between staff and patients about the purpose and value of periods away from the ward. Quality improvement approaches can be effectively applied in mental health settings. PMID:27933157

  3. Multicenter Comparison of Machine Learning Methods and Conventional Regression for Predicting Clinical Deterioration on the Wards

    PubMed Central

    Churpek, Matthew M; Yuen, Trevor C; Winslow, Christopher; Meltzer, David O; Kattan, Michael W; Edelson, Dana P

    2016-01-01

    OBJECTIVE Machine learning methods are flexible prediction algorithms that may be more accurate than conventional regression. We compared the accuracy of different techniques for detecting clinical deterioration on the wards in a large, multicenter database. DESIGN Observational cohort study. SETTING Five hospitals, from November 2008 until January 2013. PATIENTS Hospitalized ward patients INTERVENTIONS None MEASUREMENTS AND MAIN RESULTS Demographic variables, laboratory values, and vital signs were utilized in a discrete-time survival analysis framework to predict the combined outcome of cardiac arrest, intensive care unit transfer, or death. Two logistic regression models (one using linear predictor terms and a second utilizing restricted cubic splines) were compared to several different machine learning methods. The models were derived in the first 60% of the data by date and then validated in the next 40%. For model derivation, each event time window was matched to a non-event window. All models were compared to each other and to the Modified Early Warning score (MEWS), a commonly cited early warning score, using the area under the receiver operating characteristic curve (AUC). A total of 269,999 patients were admitted, and 424 cardiac arrests, 13,188 intensive care unit transfers, and 2,840 deaths occurred in the study. In the validation dataset, the random forest model was the most accurate model (AUC 0.80 [95% CI 0.80–0.80]). The logistic regression model with spline predictors was more accurate than the model utilizing linear predictors (AUC 0.77 vs 0.74; p<0.01), and all models were more accurate than the MEWS (AUC 0.70 [95% CI 0.70–0.70]). CONCLUSIONS In this multicenter study, we found that several machine learning methods more accurately predicted clinical deterioration than logistic regression. Use of detection algorithms derived from these techniques may result in improved identification of critically ill patients on the wards. PMID:26771782

  4. Evaluating performance of the operational managers of obstetrics and gynecology service providing wards

    PubMed Central

    Parvaresh, Zahra; Kazemi, Ashraf; Ehsanpour, Soheila; Sajadi, Haniye Sadat

    2016-01-01

    Background: The goal of hospitals, as the most important health care providing centers, is to improve the health level of the society. Achieving this goal is directly related with performance of the managers. This study was conducted to evaluate the performance of operational managers of obstetrics and gynecology service providing wards from the point of view of the staff at educational hospitals of Isfahan University of Medical Sciences in 2015. Materials and Methods: In this descriptive study, target population comprised all supervisors and the staff working at obstetrics and gynecology and maternity wards. Data were collected through a researcher-made questionnaire after evaluation of its reliability and validity using questions on managerial performance (planning, organizing, leadership, and control dimensions) and demographic characteristics of the managers and staff. Data were analyzed using independent t-test, one sample t-test, Spearman and Pearson coefficient tests, and one-way analysis of variance. Results: The total mean score of staff's point of view toward performance of managers’ performance was significantly higher than the average level (P < 0.001, t = 13.2). In addition, mean scores of managerial performance in planning (P < 0.001, t = 14.93), organizing (P < 0.001, t = 11.64), leadership (P < 0.001, t = 11.16), and control (P < 0.001, t = 13.75) dimensions were significantly higher than the moderate level. Conclusions: With respect to the fact that maintaining and improving the health of mothers and neonates depends on the management and managers’ performance in obstetrics and gynecology service providing wards, more than moderate managers’ performance need to be improved. It is recommended that higher-level managers pay special attention to the empowerment of managerial skills among operational managers. PMID:28194206

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

    ERIC Educational Resources Information Center

    Technomics, Inc., McLean, VA.

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

  6. [Problems with pregnancy, delivery and puerperium in teenage girls hospitalized in a city hospital].

    PubMed

    Kukulski, P; Kwaśniewski, S; Szymański, J

    1993-08-01

    At the paper the problems of girls hospitalized at the Gynaecological and Obstetrician ward of the hospital situated on the border of city agglomeration were described. The data regards as pregnancy, delivery and puerperium and they were collected in last two years.

  7. Wiimote Experiments: Circular Motion

    ERIC Educational Resources Information Center

    Kouh, Minjoon; Holz, Danielle; Kawam, Alae; Lamont, Mary

    2013-01-01

    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…

  8. Wiimote Experiments: Circular Motion

    NASA Astrophysics Data System (ADS)

    Kouh, Minjoon; Holz, Danielle; Kawam, Alae; Lamont, Mary

    2013-03-01

    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.

  9. Copyright Basics. Circular 1.

    ERIC Educational Resources Information Center

    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…

  10. Transposable elements and circular DNAs

    PubMed Central

    2016-01-01

    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

  11. Using Gamification Combined with Indoor Location to Improve Nurses' Hand Hygiene Compliance in an ICU Ward.

    PubMed

    Lapão, Luís Velez; Marques, Rita; Gregório, João; Pinheiro, Fernando; Póvoa, Pedro; Mira da Silva, Miguel

    2016-01-01

    Healthcare acquired infections are among the biggest unsolved problems in healthcare, implying an increasing number of deaths, extra-days of hospital stay and hospital costs. Performing hand hygiene is a simple and inexpensive prevention measure, but healthcare workers compliance with it is still far from optimal. Recognized hurdles are lack of time, forgetfulness, wrong technique and lack of motivation. This study aims at exploring gamification to promote nurses' HH compliance self-awareness and action. Real-time data collected from an indoor location system will provide feedback information to a group of nurses working in an ICU ward. In this paper both the research's motivation and methods is presented, along with the first round of results and its discussion.

  12. Hospital clowning: a paediatrician's view.

    PubMed

    van Venrooij, Lennard T; Barnhoorn, Pieter C

    2017-02-01

    This study investigates the current position of hospital clowns from the perspective of paediatricians and paediatric residents. A total of 14 attending paediatricians and paediatric residents participated in two focus group sessions. Data were analysed using Atlas.ti 5.0. In general, physicians reported positive experiences regarding the interaction between hospital clowns and paediatric patients on the ward. Physicians were more interested in research on children's perception of hospital clowns than in research on the clinical efficacy of hospital clowning. No direct collaboration between physicians and hospital clowns was reported. However, physicians proposed conditions which may streamline their encounters with hospital clowns such as clear communication prior to hospital clown visits, and the condition that visits do not impede medical interventions.

  13. [Comment on “Ward Off?”] Ward Valley Report deserves better coverage

    NASA Astrophysics Data System (ADS)

    Thompson, George A.

    Eos, Transactions, AGU, which is bannered as “The Newspaper of the Geophysical Sciences,” carried an “In Brief” article in the issue of May 23 that does a serious disservice to the geophysical sciences. It was written in a flip editorial style that questioned the usefulness of the Ward Valley report (Secretary Babbitt found it useful enough to act decisively) and the integrity of the NAS/NRC committee members who wrote it.The 17 committee members, most of whom are AGU members, studied the issues as a public service at the request of the NAS in response to Babbitt's request. They documented the evidence and conclusions thoroughly in a report of over 200 pages. Surely, scientific input is needed for decisions about complex issues in our society.

  14. Circular inferences in schizophrenia.

    PubMed

    Jardri, Renaud; Denève, Sophie

    2013-11-01

    A considerable number of recent experimental and computational studies suggest that subtle impairments of excitatory to inhibitory balance or regulation are involved in many neurological and psychiatric conditions. The current paper aims to relate, specifically and quantitatively, excitatory to inhibitory imbalance with psychotic symptoms in schizophrenia. Considering that the brain constructs hierarchical causal models of the external world, we show that the failure to maintain the excitatory to inhibitory balance results in hallucinations as well as in the formation and subsequent consolidation of delusional beliefs. Indeed, the consequence of excitatory to inhibitory imbalance in a hierarchical neural network is equated to a pathological form of causal inference called 'circular belief propagation'. In circular belief propagation, bottom-up sensory information and top-down predictions are reverberated, i.e. prior beliefs are misinterpreted as sensory observations and vice versa. As a result, these predictions are counted multiple times. Circular inference explains the emergence of erroneous percepts, the patient's overconfidence when facing probabilistic choices, the learning of 'unshakable' causal relationships between unrelated events and a paradoxical immunity to perceptual illusions, which are all known to be associated with schizophrenia.

  15. Generalising Ward's Method for Use with Manhattan Distances.

    PubMed

    Strauss, Trudie; von Maltitz, Michael Johan

    2017-01-01

    The claim that Ward's linkage algorithm in hierarchical clustering is limited to use with Euclidean distances is investigated. In this paper, Ward's clustering algorithm is generalised to use with l1 norm or Manhattan distances. We argue that the generalisation of Ward's linkage method to incorporate Manhattan distances is theoretically sound and provide an example of where this method outperforms the method using Euclidean distances. As an application, we perform statistical analyses on languages using methods normally applied to biology and genetic classification. We aim to quantify differences in character traits between languages and use a statistical language signature based on relative bi-gram (sequence of two letters) frequencies to calculate a distance matrix between 32 Indo-European languages. We then use Ward's method of hierarchical clustering to classify the languages, using the Euclidean distance and the Manhattan distance. Results obtained from using the different distance metrics are compared to show that the Ward's algorithm characteristic of minimising intra-cluster variation and maximising inter-cluster variation is not violated when using the Manhattan metric.

  16. Methods of Transposition of Nurses between Wards

    NASA Astrophysics Data System (ADS)

    Miyazaki, Shigeji; Masuda, Masakazu

    In this paper, a computer-implemented method for automating the transposition of a hospital’s nursing staff is proposed. The model is applied to the real case example ‘O’ hospital, which performs a transposition of its nursing staff once a year. Results are compared with real data obtained from this hospital’s current manual transposition system. The proposed method not only significantly reduces the time taken to construct the transposition, thereby significantly reducing management labor costs, but also is demonstrated to increase nurses’ levels of satisfaction with the process.

  17. 78 FR 14620 - Joint Development: Proposed Circular

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-03-06

    ... Federal Transit Administration Joint Development: Proposed Circular AGENCY: Federal Transit Administration... the form of a circular, on joint development. This circular provides guidance to recipients of Federal... joint development. This circular: (1) Defines the term ``joint development''; ] (2) explains how...

  18. Generalized On-Shell Ward Identities in String Theory

    NASA Astrophysics Data System (ADS)

    Lee, J.

    1994-02-01

    It is demonstrated that an infinite set of string-tree level on shell Ward identities, which are valid to all σ-model loop orders, can be systematically constructed without referring to the string field thoery. As examples, bosonic massive scattering amplitudes are calculated explicitly up to the second massive excited states. Ward identities satisfied by these amplitudes are derived by using zero-norm states in the spectrum. In particulalr the inter-particle Ward identity generated by the D2 otimes D2' zero-norm state at the second massive level is demonstrated. The four physical propagating states of this mass level are then shown to form a large gauge multiplet. This result justifies our previous consideration on higher inter-spin symmetry from the generalized worldsheet σ-model point of view.

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

    PubMed

    Wilson, Rachel

    2015-01-01

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

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

    PubMed Central

    Wilson, Rachel

    2015-01-01

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

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

    PubMed Central

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

    2012-01-01

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

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

    PubMed Central

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

    2013-01-01

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

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

    PubMed

    Bowers, L

    2014-08-01

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

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

    PubMed

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

    2014-01-01

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

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

    PubMed

    Liu, Wei; Manias, Elizabeth; Gerdtz, Marie

    2014-09-01

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

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

    PubMed

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

    2012-08-01

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

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

    PubMed

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

    2005-07-01

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

  8. Salmonella isolation from hospital areas.

    PubMed Central

    Harvey, R. W.; Price, T. H.; Joynson, D. H.

    1979-01-01

    Evidence of the presence of salmonellas in a paediatric ward, a special care baby unit, a maternity unit and a hospital kitchen was obtained by culture of sewer swabs, faeces and food samples. The survey was designed to cause as little administrative interference as possible. The technical aspects of the survey did not strain laboratory facilities. Minimal secondary spread of salmonella infection was experienced. PMID:390044

  9. [Pericarditis in a general hospital].

    PubMed

    Faintuch, J J; Friedmann, A A

    1996-01-01

    The authors studied 57 patients with pericarditis in the Ward of Internal Medicine of the University of São Paulo from January 1993 through May 1995. A comparison was made with the results of a similar study performed in the same hospital in 1989. Increasing frequency of pericarditis was verified. Tuberculosis, formerly the most frequent etiologic agent, decreased while neoplastic diseases became more common.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

  10. 'Real life' clinical learning on an interprofessional training ward.

    PubMed

    Freeth, D; Reeves, S; Goreham, C; Parker, P; Haynes, S; Pearson, S

    2001-07-01

    This paper describes the multi-method evaluation of an interprofessional training ward placement for medical, nursing, occupational therapy and physiotherapy students. Unique in the UK, and an extension of pioneering work in Sweden (Wahlström et al. 1997, Wahlstroöm & Sandén 1998), this interprofessional clinical placement allowed senior pre-qualifying students, under the supervision of practitioners, to plan and deliver interprofessional care for a group of orthopaedic and rheumatology patients. This responsibility enabled students to develop both their profession-specific skills in a real-world setting and the quality of their interprofessional teamwork. Student teams were supported by facilitators who led reflective sessions and acted as a resource for the students' problem-based learning. The training ward was evaluated by a multi-method approach, incorporating interviews, observations and questionnaires with students, patients and clinical staff. The evaluation findings have been grouped into a number of themes which offer an insight into the varying perspectives of training ward students, patients and staff. This paper pays particular attention to the nursing perspective of the interprofessional training ward pilot.

  11. Influence of Parental Encouragement towards Health Care of Their Wards

    ERIC Educational Resources Information Center

    Sophia, R. Grace; Veliappan, A.

    2015-01-01

    The purpose of the present study is to explore how parents are encouraging towards health care of their wards. A "Survey Method" was used in the present study. A standardized "Agarwal Parental Encouragement Scale (APES)" was used to collect information from the students. The sample consists of thousand and ninety five higher…

  12. 34 CFR 300.45 - Ward of the State.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 34 Education 2 2010-07-01 2010-07-01 false Ward of the State. 300.45 Section 300.45 Education Regulations of the Offices of the Department of Education (Continued) OFFICE OF SPECIAL EDUCATION AND REHABILITATIVE SERVICES, DEPARTMENT OF EDUCATION ASSISTANCE TO STATES FOR THE EDUCATION OF CHILDREN...

  13. Improving the quality of patient handover on a surgical ward.

    PubMed

    Bradley, Alison

    2014-01-01

    The European Working Time Directive means safe patient hand over is imperative. It is the responsibility of every doctor and an issue of patient safety and clinical governance [1]. The aims of this project were to improve the quality of patient handover between combined assessment unit (CAU) and surgical ward FY1 doctors. The Royal College of Surgeons England (RCSEng) guidelines on surgical patient handover [1] were used as the standard. Data was collected throughout November 2013. A handover tool was then introduced and attached to the front of patient notes when a patient was transferred from CAU to the surgical ward. The doctor handing over the patient and the ward doctor receiving the handover signed this document. Policy was also changed so that handover should take place once the patient had received senior review on the CAU and was deemed appropriate for transfer to the surgical ward. Data from the handover tool was collated and checked against the list of surgical admission for February 2014. The number of patients handed over improved from 15 % to 45%. The quality of patient handover also improved. 0 patient handovers in November 2013 included all of the information recommended by the RCSEng guidelines. 100% of the patient handovers in February 2014 contained all the recommended information. Introduction of a handover tool and formalisation of timing of patient handover helped to improve quality and number of patients being handed over. Further work needs to be done to improve safe handover of surgical patients, particularly out of hours.

  14. Selected determinants of the quality of hospital care. II. Managing a therapeutic team.

    PubMed

    Sierpińska, Lidia; Ksykiewicz-Dorota, Anna

    2002-01-01

    The effects of teamwork depend to a large extent on the organizational skills of the manager. In health care units a physician/ward head is responsible for coordinating the work of a therapeutic team. The study was undertaken to discover to what extent doctors and nurses are aware that the ward head manages the work of the therapeutic team, and how they evaluate the skills of their managers. The study covered 161 doctors and 339 nurses from 4 hospitals with accreditation and 17 health units which did not possess the Quality Certificate. The study was conducted by the method of a diagnostic survey, and the technique was a questionnaire form. The results of the survey showed that charge nurses in hospitals with accreditation and ward heads in hospitals without the Quality Certificate significantly more often perceived the effectiveness of managing a therapeutic team by a ward head/manager of a clinic in positive terms. A greater number of negative evaluations were expressed by charge nurses in hospitals without accreditation and ward head nurses in hospitals with the Quality Certificate. It was confirmed that doctors and nurses from hospitals with accreditation significantly more frequently perceived the ward head as the manager of the therapeutic team, compared to the staff of hospitals without the Quality Certificate.

  15. Patient and organisational variables associated with pressure ulcer prevalence in hospital settings: a multilevel analysis

    PubMed Central

    Bredesen, Ida Marie; Bjøro, Karen; Gunningberg, Lena; Hofoss, Dag

    2015-01-01

    Objectives To investigate the association of ward-level differences in the odds of hospital-acquired pressure ulcers (HAPUs) with selected ward organisational variables and patient risk factors. Design Multilevel approach to data from 2 cross-sectional studies. Settings 4 hospitals in Norway were studied. Participants 1056 patients at 84 somatic wards. Primary outcome measure HAPU. Results Significant variance in the odds of HAPUs was found across wards. A regression model using only organisational variables left a significant variance in the odds of HAPUs across wards but patient variables eliminated the across-ward variance. In the model including organisational and patient variables, significant ward-level HAPU variables were ward type (rehabilitation vs surgery/internal medicine: OR 0.17 (95% CI 0.04 to 0.66)), use of preventive measures (yes vs no: OR 2.02 (95% CI 1.12 to 3.64)) and ward patient safety culture (OR 0.97 (95% CI 0.96 to 0.99)). Significant patient-level predictors were age >70 vs <70 (OR 2.70 (95% CI 1.54 to 4.74)), Braden scale total score (OR 0.73 (95% CI 0.67 to 0.80)) and overweight (body mass index 25–29.99 kg/m2) (OR 0.32 (95% CI 0.17 to 0.62)). Conclusions The fact that the odds of HAPU varied across wards, and that across-ward variance was reduced when the selected ward-level variables entered the explanatory model, indicates that the HAPU problem may be reduced by ward-level organisation of care improvements, that is, by improving the patient safety culture and implementation of preventive measures. Some wards may prevent pressure ulcers better than other wards. The fact that ward-level variation was eliminated when patient-level HAPU variables were included in the model indicates that even wards with the best HAPU prevention will be challenged by an influx of high-risk patients. PMID:26316647

  16. The Abuse of Status Offenders in Private Hospitals.

    ERIC Educational Resources Information Center

    Robin, Michael

    1982-01-01

    Although status offenders (young people defined as incorrigible, runaways, or truants) have often been abused previously, their placement in hospital psychiatric wards constitutes further abuse. Insecure, insufficiently trained hospital staffers are one of the major problems that perpetuates the cycle of provocation and punishment in…

  17. Extended Outbreak of Cryptosporidiosis in a Pediatric Hospital, China

    PubMed Central

    Wang, Lin; Duan, Liping; Gomez-Puerta, Luis A.; Zhang, Longxian; Zhao, Xukun; Hu, Jingjing; Zhang, Nan; Xiao, Lihua

    2012-01-01

    Four Cryptosporidium spp. and 6 C. hominis subtypes were isolated from 102 of 6,284 patients in 3 pediatric hospitals in People’s Republic of China. A cryptosporidiosis outbreak was identified retrospectively. The outbreak lasted >1 year and affected 51.4% of patients in 1 hospital ward, where 2 C. hominis subtypes with different virulence were found. PMID:22305484

  18. CIRCULAR CAVITY SLOT ANTENNA

    DOEpatents

    Kerley, P.L.

    1959-01-01

    A small-size antenna having a doughnut-shaped field pattern and which can act both as an antenna and a resonant circuit is described. The antenna is of the slotted type and comprises a resonant cavity with a center hole. A circular slot is provided in one wall of the cavity concentric with the hole and a radio frequency source is connected across the slot. The pattern and loading of the antenna are adjusted by varying the position and shape of a center element slidably disposed within the hole and projecting from the slotted side of the resonant cavity. The disclosed structure may also be used to propagate the oscillator signal down a transniission line by replacing the center element with one leg of the transmission line in a spaced relation from the walls of the cavity.

  19. Personal Digital Assistant in an orthopaedic wireless ward: the HandHealth project.

    PubMed

    Tassani, Simone; Baruffaldi, Fabio; Testi, Debora; Cacciari, Cinzia; Accarisi, Serena; Viceconti, Marco

    2007-04-01

    Personal Digital Assistant devices are becoming a frequently used device for the bedside care of the patient. Ways of application are many, but limitations are also numerous. Input device and monitor resolution are limited by the device size. Moreover, the choice of specific programs and the amount of storable data are limited by the quantity of memory. During HandHealth project a system was developed using a different point of view. Personal Digital Assistant is only a means to access data and use functionalities that are stored in a remote server. Using that system patient ward note can be showed and collected on the handheld device but saved directly on the Hospital Information System. Medical images can be showed on the device display, but also transferred to a high-resolution monitor. Large amount of data can be dictated and translated by remote continuous speech recognition.

  20. Effectiveness of a pressure-relieving mattress in an acute stroke ward.

    PubMed

    Gleeson, Deborah

    2016-11-10

    Between the 10 May and 18 July 2016, St Helens and Knowsley Teaching Hospitals NHS Trust conducted a small, non-controlled evaluation set out to assess the performance of the Apex Pro-care Auto pressure-relieving mattress in an acute stroke ward. Seven patients, assessed as being at medium-to-high risk of developing a pressure ulcer (PU), were recruited into the evaluation; the mean age was 73.1 years. Three patients were bed bound and four had restricted mobility. The average length of time spent on the mattress was 31 days. At the end of the evaluation, none of the patients had developed a PU while using the mattress. These results indicate that, when combined with a robust PU prevention plan inclusive of repositioning, this pressure-relieving mattress is effective in preventing pressure ulceration.

  1. Paediatric early warning scores on a children's ward: a quality improvement initiative.

    PubMed

    Ennis, Linda

    2014-09-01

    The aim of this quality improvement initiative was to incorporate a paediatric early warning score (PEWS) and track and trigger system in the routine care of children in an acute general children's ward at a regional hospital in the Republic of Ireland. In the absence of a nationally recommended specific PEWS strategy, a local plan was developed. The experience of structuring and implementing the PEWS and track and trigger system is presented in this article. Data from the first year of use were collected to evaluate the clinical utility and effectiveness of this system. In the busy acute children's service, the PEWS initiative was found to benefit processes of early detection, prompt referral and timely, appropriate management of children at potential risk of clinical deterioration. Nursing staff were empowered and supported to communicate concerns immediately and to seek rapid medical review, according to an agreed PEWS escalation plan. Outcomes were significantly improved.

  2. Circularly Polarized MHOHG with Bichromatic Circularly Polarized Laser Pulses

    NASA Astrophysics Data System (ADS)

    Bandrauk, Andre D.; Mauger, Francois; Uzer, Turgay

    2016-05-01

    Circularly polarized MHOHG-Molecular High Order Harmonic Generation is shown to occur efficiently with intense ultrashort bichromatic circularly polarized pulses due to frequent electron-parent -ion recollision with co-or counter-rotating incident circular pulses as predicted in 1995. We show in this context that molecules offer a very robust and efficient frameworkfor the production of circularly polarized harmonics for the generation of single circularly polarized ``attosecond'' pulses. The efficiency of such new MHOHG is shown to depend on the compatibility of the symmetry of the molecular medium with the net electric field generated by the combination of the laser pulses.Using a time-dependent symmetry analysis with concrete examples such as H 2 + vs H 3 + we show how all the features(harmonic order and ∧ polarization) of MHOHG can be explained and predicted.

  3. [PEG tube placement in German geriatric wards - a retrospective data-base analysis].

    PubMed

    Wirth, R; Volkert, D; Bauer, J M; Schulz, R J; Borchelt, M; Fleischhauer, C; Steinhagen-Thiessen, E; Sieber, C C

    2007-02-01

    The placement of a percutaneous endoscopic gastrostomy (PEG) is a safe and widely accepted method of artificial enteral nutrition. In Germany, PEG placement is performed approximately 140,000 times a year, about 65% of them in elderly patients. Yet indications for PEG placement in the elderly, as well as the health and functional status of these patients are unexplored in Germany. To draw conclusions about the indication for PEG placement, the health status and the further development of patients undergoing PEG in acute geriatric wards, we performed an analysis of the 2004 annual data set of the German Gemidas database. The Gemidas database is an instrument of voluntary quality assurance, where the treatment data of patients in German geriatric hospital units are registered. Data of 40 acute geriatric hospital units with 27,775 patients and 393 PEG tube placements were analyzed. According to the database items, we received information about the incidence of PEG placement, nutrition-relevant treatment diagnosis, patients age, functional and mental status, length of hospital stay, where patients were admitted from and discharged to and the hospital mortality of geriatric patients with and without PEG placement. In 1.4% of all treatment cases, a PEG was inserted. PEG placement was mainly performed in patients with the treatment diagnosis stroke (65.1%) and dysphagia (64.1%). The functional status of patients with PEG tube placement was very poor, with an Barthel Index of 8.2 (+/- 14.6) points at admission. Due to the severity of the disease and in concordance with existing data the overall hospital mortality of patients undergoing PEG placement was 17.6%, which is higher than in patients without PEG placement (4.3%). In all 27 775 analyzed geriatric patients, a diagnosis related to malnutrition was coded in only 7.0%, although sufficient data show a prevalence of about 50% in elderly hospital patients.

  4. Frequency, types, and direct related costs of medication errors in an academic nephrology ward in Iran.

    PubMed

    Gharekhani, Afshin; Kanani, Negin; Khalili, Hossein; Dashti-Khavidaki, Simin

    2014-09-01

    Medication errors are ongoing problems among hospitalized patients especially those with multiple co-morbidities and polypharmacy such as patients with renal diseases. This study evaluated the frequency, types and direct related cost of medication errors in nephrology ward and the role played by clinical pharmacists. During this study, clinical pharmacists detected, managed, and recorded the medication errors. Prescribing errors including inappropriate drug, dose, or treatment durations were gathered. To assess transcription errors, the equivalence of nursery charts and physician's orders were evaluated. Administration errors were assessed by observing drugs' preparation, storage, and administration by nurses. The changes in medications costs after implementing clinical pharmacists' interventions were compared with the calculated medications costs if the medication errors were continued up to patients' discharge time. More than 85% of patients experienced medication error. The rate of medication errors was 3.5 errors per patient and 0.18 errors per ordered medication. More than 95% of medication errors occurred at prescription nodes. Most common prescribing errors were omission (26.9%) or unauthorized drugs (18.3%) and low drug dosage or frequency (17.3%). Most of the medication errors happened on cardiovascular drugs (24%) followed by vitamins and electrolytes (22.1%) and antimicrobials (18.5%). The number of medication errors was correlated with the number of ordered medications and length of hospital stay. Clinical pharmacists' interventions decreased patients' direct medication costs by 4.3%. About 22% of medication errors led to patients' harm. In conclusion, clinical pharmacists' contributions in nephrology wards were of value to prevent medication errors and to reduce medications cost.

  5. Adverse Drug Reactions in a Tertiary Care Emergency Medicine Ward - Prevalence, Preventability and Reporting

    PubMed Central

    Rydberg, Diana M.; Holm, Lennart; Engqvist, Ida; Fryckstedt, Jessica; Lindh, Jonatan D.; Stiller, Carl-Olav; Asker-Hagelberg, Charlotte

    2016-01-01

    Purpose To identify the prevalence and preventability of adverse drug reactions (ADRs) in an emergency ward setting in a tertiary hospital in Sweden and to what extent the detected ADRs were reported to the Medical Product Agency (MPA). Methods In this prospective cross sectional observational study, 706 patients admitted to one of the Emergency Wards, at the Karolinska University Hospital in Solna, Stockholm during September 2008 –September 2009, were included. The electronic patient records were reviewed for patients’ demographic parameters, prevalence of possible ADRs and assessment of their preventability. In addition, the extent of formal and required ADR reporting to national registers was studied. Results Approximately 40 percent of the patient population had at least one possible ADR (n = 284). In the multivariable regression model, age and number of drugs were significantly associated with risk of presenting with an ADR (p<0.01 and p<0.001, respectively). Sex was not identified as a significant predictor of ADRs (p = 0.27). The most common ADRs were cardiovascular, followed by electrolyte disturbances, and hemorrhage. In 18 percent of the patient population ADRs were the reason for admission or had contributed to admission and 24% of these ADRs were assessed as preventable. The under-reporting of ADRs to the MPA was 99%. Conclusions ADRs are common in Emergency Medicine in tertiary care in Sweden, but under-reporting of ADRs is substantial. The most frequent ADRs are caused by cardiovascular drugs, and significantly associated with age and number of drugs. However, only a minority of the detected serious ADRs contributing to admission could have been avoided by increased risk awareness. PMID:27622270

  6. The Therapeutic Relationship in the Shadow: Nurses' Experiences of Barriers to the Nurse-Patient Relationship in the Psychiatric Ward.

    PubMed

    Pazargadi, Mehrnoosh; Fereidooni Moghadam, Malek; Fallahi Khoshknab, Masoud; Alijani Renani, Houshang; Molazem, Zahra

    2015-07-01

    The therapeutic relationship is widely accepted as the basic core and essence of the psychiatric nurse's role and is thus essential for providing quality mental health care. A detailed and clear perception of the issues that facilitate or obstruct this relationship is therefore important. The purpose of this study was to gain insights into the experiences of nurses working in psychiatry wards, of the barriers to the nurse-patient relationship. A qualitative content-analysis study was undertaken using a purpose-based sampling approach with the participation of 15 nurses employed in psychiatric wards in hospitals located in South Iran. Semi-structured interviews provided the source of data, and an inductive content-analysis approach was used for data analysis. The main concept extracted from the study was identified as 'the therapeutic relationship in the shadow', which captured the sense that this critical relationship is mostly unseen in the daily practice of the nurses interviewed. Factors that functioned as barriers to this relationship were classified into three main categories: nurse-related, patient-related and organization-related. The results of this study revealed that, despite the widely claimed importance of the nurse-patient relationship in psychiatric settings, this relationship is powerfully influenced by individual and organizational factors that have not been considered adequately in previous research. It is strongly recommended that greater consideration of these factors be given to care planning in psychiatric wards.

  7. Can measuring environmental cleanliness using ATP aid in the monitoring of wards with periods of increased incidence of Clostridium difficile?

    PubMed Central

    Hardy, Katherine; Abbott, Gill; Bashford, Sarah; Bucior, Helen; Codd, Jane; Holland, Madelaine; Reynolds, Mandy; Simms, Avril

    2013-01-01

    Management of periods of increased incidence of Clostridium difficile (PIIs) on a ward have become multi-factorial and involve isolation of patients, typing of the isolates, antibiotic audit and a weekly environmental audit completed until three consecutive weekly passes are obtained. The aim of this study was to establish if monitoring the environment using adenosine triphosphate (ATP) could aid in reducing the length of time the wards remained on the weekly environmental audit. Secondly, it was to establish if certain pieces of equipment had continually high ATP scores requiring wider interventions. The study took place across three hospital sites covered by one infection control team over a 22 month period. There were three study periods, with the only difference being that ATP monitoring was conducted during period B. There was a difference in the length of time the wards remained on the audit between the first period and the ATP period; however this decrease was sustained in the third period when ATP monitoring ceased. There was an increase in the percentage of sites achieving a pass with ATP week on week. ATP monitoring provided the staff with non-subjective results and immediate feedback that facilitated discussions about cleaning regimes. ATP monitoring was a useful adjunct to environmental audits.

  8. Sarcopenia predicts readmission and mortality in elderly patients in acute care wards: a prospective study

    PubMed Central

    Hu, Xiaoyi; Wang, Haozhong; Zhang, Lei; Hao, Qiukui; Dong, Birong

    2016-01-01

    Abstract Background The aim of this study is to assess the prevalence of sarcopenia and investigate the associations between sarcopenia and long‐term mortality and readmission in a population of elderly inpatients in acute care wards. Methods We conducted a prospective observational study in the acute care wards of a teaching hospital in western China. The muscle mass was estimated according to a previously validated anthropometric equation. Handgrip strength was measured with a handheld dynamometer, and physical performance was measured via a 4 m walking test. Sarcopenia was defined according to the recommended diagnostic algorithm of the Asia Working Group for Sarcopenia. The survival status and readmission information were obtained via telephone interviews at 12, 24, and 36 months during the 3 year follow‐up period following the baseline investigation. Results Two hundred and eighty‐eight participants (mean age: 81.1 ± 6.6 years) were included. Forty‐nine participants (17.0%) were identified as having sarcopenia. This condition was similar in men and women (16.9% vs. 17.5%, respectively, P = 0.915). During the 3 year follow‐up period, 49 men (22.7%) and 9 women (16.4%) died (P = 0.307). The mortality of sarcopenic participants was significantly increased compared with non‐sarcopenic participants (40.8% vs. 17.1%, respectively, P < 0.001). After adjusting for age, sex and other confounders, sarcopenia was an independent predictor of 3 year mortality (adjusted hazard ratio: 2.49; 95% confidential interval: 1.25–4.95) and readmission (adjusted hazard ratio: 1.81; 95% confidential interval: 1.17–2.80). Conclusions Sarcopenia, which is evaluated by a combination of anthropometric measures, gait speed, and handgrip strength, is valuable to predict hospital readmission and long‐term mortality in elderly patients in acute care wards. PMID:27896949

  9. 75 FR 81269 - Ward Transformer Superfund Site Raleigh, Wake County, NC; Notice of Settlements

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-12-27

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

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

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-03-06

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

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

    ERIC Educational Resources Information Center

    Behrens, Donna

    2010-01-01

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

  12. National survey of hospital patients.

    PubMed Central

    Bruster, S.; Jarman, B.; Bosanquet, N.; Weston, D.; Erens, R.; Delbanco, T. L.

    1994-01-01

    OBJECTIVE--To survey patients' opinions of their experiences in hospital in order to produce data that can help managers and doctors to identify and solve problems. DESIGN--Random sample of 36 NHS hospitals, stratified by size of hospital (number of beds), area (north, midlands, south east, south west), and type of hospital (teaching or non-teaching, trust or directly managed). From each hospital a random sample of, on average, 143 patients was interviewed at home or the place of discharge two to four weeks after discharge by means of a structured questionnaire about their treatment in hospital. SUBJECTS--5150 randomly chosen NHS patients recently discharged from acute hospitals in England. Subjects had been patients on medical and surgical wards apart from paediatric, maternity, psychiatric, and geriatric wards. MAIN OUTCOME MEASURES--Patients' responses to direct questions about preadmission procedures, admission, communication with staff, physical care, tests and operations, help from staff, pain management, and discharge planning. Patients' responses to general questions about their degree of satisfaction in hospitals. RESULTS--Problems were reported by patients, particularly with regard to communication with staff (56% (2824/5020) had not been given written or printed information); pain management (33% (1042/3162) of those suffering pain were in pain all or most of the time); and discharge planning (70% (3599/5124) had not been told about warning signs and 62% (3177/5119) had not been told when to resume normal activities). Hospitals failed to reach the standards of the Patient's Charter--for example, in explaining the treatment proposed and giving patients the option of not taking part in student training. Answers to questions about patient satisfaction were, however, highly positive but of little use to managers. CONCLUSIONS--This survey has highlighted several problems with treatment in NHS hospitals. Asking patients direct questions about what happened

  13. Circular chemiresistors for microchemical sensors

    DOEpatents

    Ho, Clifford K.

    2007-03-13

    A circular chemiresistor for use in microchemical sensors. A pair of electrodes is fabricated on an electrically insulating substrate. The pattern of electrodes is arranged in a circle-filling geometry, such as a concentric, dual-track spiral design, or a circular interdigitated design. A drop of a chemically sensitive polymer (i.e., chemiresistive ink) is deposited on the insulating substrate on the electrodes, which spreads out into a thin, circular disk contacting the pair of electrodes. This circularly-shaped electrode geometry maximizes the contact area between the pair of electrodes and the polymer deposit, which provides a lower and more stable baseline resistance than with linear-trace designs. The circularly-shaped electrode pattern also serves to minimize batch-to-batch variations in the baseline resistance due to non-uniform distributions of conductive particles in the chemiresistive polymer film.

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

    PubMed

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

    2016-01-01

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

  15. An outbreak of HBV and HCV infection in a paediatric oncology ward: epidemiological investigations and prevention of further spread.

    PubMed

    Dumpis, Uga; Kovalova, Zanna; Jansons, Juris; Cupane, Liene; Sominskaya, Irina; Michailova, Marija; Karayiannis, Peter; Gardovska, Dace; Viazov, Sergey; Ross, Stefan; Roggendorf, Michael; Pumpens, Paul

    2003-03-01

    Hospital-acquired hepatitis B (HBV) and C virus (HCV) infections continue to occur despite increased awareness of this problem among the medical community. One hundred six patients were infected in a haematology oncology ward for children, over the time period 1996 to 2000. Serum samples from 45 such patients and 3 from infected medical personnel were used for nucleic acid amplification. HBV core, as well as HCV core and hypervariable region 1 (HVR1) nucleotide sequences, were analysed by phylogenetic tree analysis, in order to characterise the epidemiological pattern of viral transmission on the ward. Samples from 32 patients were positive for HBV-DNA or HCV-RNA by PCR. Ten patients were positive for both markers. Seventeen out of twenty-three HCV core gene sequences were found to be evolutionarily related and clustered separately from other local sequences in the phylogenetic tree, indicating nosocomial transmission. This was confirmed by analysis of HVR1 gene sequences. One nurse and one physician from the ward were HCV RNA positive, but their HCV sequences were not related evolutionarily to those of the patient cluster. Fifteen out of nineteen HBV core gene sequences were also clustered together and were positioned separately in the relevant tree. Epidemiological investigation excluded a common source infection and indicated that spread of infection was most likely due to inappropriate infection control measures on the ward. No obvious risk factors for transmission were identified during the retrospective survey in patients with related sequences, except use of multidose vials for saline and poor staff compliance with routine hand hygiene procedures. The preventive measures that were introduced reduced the incidence of infection significantly. No new cases of HBV infection and only three anti-HCV seroconversions occurred over a period of 19 months. The introduction and maintenance of strict prevention measures over a 2 year period, combined with HBV vaccination

  16. Ward-based clinical teaching in gynaecology: principles and practice.

    PubMed

    Mukhopadhyay, S; Smith, S

    2010-01-01

    Clinical teaching on the wards remains a prime method of educational instruction. Despite changes in modern educational climate and patient expectations, its value is still irrefutable. There is evidence to suggest that such teaching is beneficial to students and patients alike. This paper describes the planning and delivery steps of a ward-based teaching session with 'pregnancy of unknown location' as an example. The organisation, following-up and feedback after the session are also mentioned. We have discussed the models applicable to clinical teaching and explored ways how the 'microskill' technique could be potentially used in such a situation. The paper also focuses on the use of clinical reasoning processes. Finally, the six domains of knowledge necessary to become a good preceptor have been applied to the session. A good teaching exercise is moored to sound pedagogical principles. Its success relies on mutual trust and understanding between the teacher and the taught.

  17. Nuclear spin circular dichroism

    SciTech Connect

    Vaara, Juha; Rizzo, Antonio; Kauczor, Joanna; Norman, Patrick; Coriani, Sonia

    2014-04-07

    Recent years have witnessed a growing interest in magneto-optic spectroscopy techniques that use nuclear magnetization as the source of the magnetic field. Here we present a formulation of magnetic circular dichroism (CD) due to magnetically polarized nuclei, nuclear spin-induced CD (NSCD), in molecules. The NSCD ellipticity and nuclear spin-induced optical rotation (NSOR) angle correspond to the real and imaginary parts, respectively, of (complex) quadratic response functions involving the dynamic second-order interaction of the electron system with the linearly polarized light beam, as well as the static magnetic hyperfine interaction. Using the complex polarization propagator framework, NSCD and NSOR signals are obtained at frequencies in the vicinity of optical excitations. Hartree-Fock and density-functional theory calculations on relatively small model systems, ethene, benzene, and 1,4-benzoquinone, demonstrate the feasibility of the method for obtaining relatively strong nuclear spin-induced ellipticity and optical rotation signals. Comparison of the proton and carbon-13 signals of ethanol reveals that these resonant phenomena facilitate chemical resolution between non-equivalent nuclei in magneto-optic spectra.

  18. Boxer blurring the lines in Ward Valley debate

    SciTech Connect

    Newman, P.

    1994-04-05

    This article concerns the controversy over the siting of Ward Valley, a proposed low-level nuclear waste depository in California. The author contends that certain politicians and environmental groups have misrepresented the facts in their opposition to the site. In particular, an accusation about withholding information about the amount of Pu-239 to be stored at the site is false, since that information is available in the public record. Other misrepresentations are presented and discussed.

  19. Ward identities and high energy scattering amplitudes in string theory

    NASA Astrophysics Data System (ADS)

    Chan, Chuan-Tsung; Ho, Pei-Ming; Lee, Jen-Chi

    2005-02-01

    High-energy limit α→∞ of stringy Ward identities derived from the decoupling of two types of zero-norm states in the old covariant first quantized (OCFQ) spectrum of open bosonic string are used to check the consistency of saddle point calculations of high energy scattering amplitudes of Gross and Mende and Gross and Manes. Some inconsistencies of their saddle point calculations are found even for the string-tree scattering amplitudes of the excited string states. We discuss and calculate the missing terms of the calculation by those authors to recover the stringy Ward identities. In addition, based on the tree-level stringy Ward identities, we give the proof of a general formula, which was proposed previously, of all high energy four-point string-tree amplitudes of arbitrary particles in the string spectrum. In this formula all such scattering amplitudes are expressed in terms of those of tachyons as conjectured by Gross. The formula is extremely simple which manifestly demonstrates the universal high energy behavior of the interactions among all string states.

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

    PubMed Central

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

    2015-01-01

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

  1. Spatial patterns in electoral wards with high lymphoma incidence in Yorkshire health region.

    PubMed

    Barnes, N; Cartwright, R A; O'Brien, C; Roberts, B; Richards, I D; Bird, C C

    1987-08-01

    The possibilities of clustering between those electoral wards which display higher than expected incidences of cases of the lymphomas occurring between 1978 and 1982 are examined. Clusters are defined as being those wards with cases in excess (at a probability of less than 10%) which are geographically adjacent to each other. A separate analysis extends the definition of cluster to include high incidence wards that are adjacent or separated by one other ward. The results indicate that many high incidence lymphoma wards do occur close together and when computer simulations are used to compute expected results, many of the observed results are shown to be highly improbable both in the overall number of clustering wards and in the largest number of wards comprising a 'cluster'.

  2. Circular Scan Streak Tube Development

    NASA Technical Reports Server (NTRS)

    Nevin, S.

    1980-01-01

    A streak tube having circular scan was designed, built and tested. Continuous circular scan, easily derived from out of phase sine waves applied to the conventional deflection plates, permits the timing of pulses traveling long baselines. At the tube's output a circular array of 720 elements is scanned to provide 30 to 40 picosecond resolution. Initial difficulties with electron bombarded silicon arrays were circumvented by using microchannel plates within the streak tube to provide the needed electronic amplification and digital sensitivity and coupling the 720 element arrays to the electron beam by means of a phosphor on a fiber optics. Two ceramic body tubes with S-20 photocathodes were tested and delivered.

  3. Digitalizing the Circular Economy

    NASA Astrophysics Data System (ADS)

    Reuter, Markus A.

    2016-12-01

    Metallurgy is a key enabler of a circular economy (CE), its digitalization is the metallurgical Internet of Things (m-IoT). In short: Metallurgy is at the heart of a CE, as metals all have strong intrinsic recycling potentials. Process metallurgy, as a key enabler for a CE, will help much to deliver its goals. The first-principles models of process engineering help quantify the resource efficiency (RE) of the CE system, connecting all stakeholders via digitalization. This provides well-argued and first-principles environmental information to empower a tax paying consumer society, policy, legislators, and environmentalists. It provides the details of capital expenditure and operational expenditure estimates. Through this path, the opportunities and limits of a CE, recycling, and its technology can be estimated. The true boundaries of sustainability can be determined in addition to the techno-economic evaluation of RE. The integration of metallurgical reactor technology and systems digitally, not only on one site but linking different sites globally via hardware, is the basis for describing CE systems as dynamic feedback control loops, i.e., the m-IoT. It is the linkage of the global carrier metallurgical processing system infrastructure that maximizes the recovery of all minor and technology elements in its associated refining metallurgical infrastructure. This will be illustrated through the following: (1) System optimization models for multimetal metallurgical processing. These map large-scale m-IoT systems linked to computer-aided design tools of the original equipment manufacturers and then establish a recycling index through the quantification of RE. (2) Reactor optimization and industrial system solutions to realize the "CE (within a) Corporation—CEC," realizing the CE of society. (3) Real-time measurement of ore and scrap properties in intelligent plant structures, linked to the modeling, simulation, and optimization of industrial extractive process

  4. Towards future circular colliders

    NASA Astrophysics Data System (ADS)

    Benedikt, Michael; Zimmermann, Frank

    2016-09-01

    The Large Hadron Collider (LHC) at the European Organization for Nuclear Research (CERN) presently provides proton-proton collisions at a center-of-mass (c.m.) energy of 13 TeV. The LHC design was started more than 30 years ago, and its physics program will extend through the second half of the 2030's. The global Future Circular Collider (FCC) study is now preparing for a post-LHC project. The FCC study focuses on the design of a 100-TeV hadron collider (FCC-hh) in a new ˜100 km tunnel. It also includes the design of a high-luminosity electron-positron collider (FCCee) as a potential intermediate step, and a lepton-hadron collider option (FCC-he). The scope of the FCC study comprises accelerators, technology, infrastructure, detectors, physics, concepts for worldwide data services, international governance models, and implementation scenarios. Among the FCC core technologies figure 16-T dipole magnets, based on Nb3 S n superconductor, for the FCC-hh hadron collider, and a highly-efficient superconducting radiofrequency system for the FCC-ee lepton collider. Following the FCC concept, the Institute of High Energy Physics (IHEP) in Beijing has initiated a parallel design study for an e + e - Higgs factory in China (CEPC), which is to be succeeded by a high-energy hadron collider (SPPC). At present a tunnel circumference of 54 km and a hadron collider c.m. energy of about 70 TeV are being considered. After a brief look at the LHC, this article reports the motivation and the present status of the FCC study, some of the primary design challenges and R&D subjects, as well as the emerging global collaboration.

  5. Beam Rounders for Circular Colliders

    SciTech Connect

    A. Burov; S. Nagaitsev; Ya. Derbenev

    2001-07-01

    By means of linear optics, an arbitrary uncoupled beam can be locally transformed into a round (rotation-invariant) state and then back. This provides an efficient way to round beams in the interaction region of circular colliders.

  6. Beam rounders for circular colliders

    SciTech Connect

    A. Burov and S. Nagaitsev

    2002-12-10

    By means of linear optics, an arbitrary uncoupled beam can be locally transformed into a round (rotation-invariant) state and then back. This provides an efficient way to round beams in the interaction region of circular colliders.

  7. Beach vortices near circular topography

    NASA Astrophysics Data System (ADS)

    Hinds, A. K.; Johnson, E. R.; McDonald, N. R.

    2016-10-01

    Finite-area monopolar vortices which propagate around topography without change in shape are computed for circular seamounts and wells including the limiting cases of each: islands and infinitely deep wells. The time-dependent behaviour of vortex pairs propagating toward circular topography is also examined. Trajectories of point-vortex pairs exterior to the topography are found and compared to trajectories of vortex patches computed using contour dynamics.

  8. The effect of information provision on reduction of errors in intravenous drug preparation and administration by nurses in ICU and surgical wards.

    PubMed

    Abbasinazari, Mohammad; Zareh-Toranposhti, Samaneh; Hassani, Abdollah; Sistanizad, Mohammad; Azizian, Homa; Panahi, Yunes

    2012-01-01

    Malpractice in preparation and administration of intravenous (IV) medications has been reported frequently. Inadequate knowledge of nurses has been reported as a cause of such errors. We aimed to evaluate the role of nurses' education via installation of wall posters and giving informative pamphlets in reducing the errors in preparation and administration of intravenous drugs in 2 wards (ICU and surgery) of a teaching hospital in Tehran, Iran. A trained observer stationed in 2 wards in different work shifts. He recorded the nurses' practice regarding the preparation and administration of IV drugs and scored them before and after the education process. 400 observations were evaluated. Of them, 200 were related to before education and 200 were related to after education. On a 0-10 quality scale, mean ± SD scores of before and after education were determined. Mean ± SD scores of before and after education at the 2 wards were 4.51 (± 1.24) and 6.15 (± 1.23) respectively. There was a significant difference between the scores before and after intervention in ICU (P<0.001), surgery (P<0.001), and total two wards (P<0.001). Nurses' education by using wall poster and informative pamphlets regarding the correct preparation and administration of IV drugs can reduce the number of errors.

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

    PubMed

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

    2014-08-01

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

  10. Interprofessional learning at work: what spatial theory can tell us about workplace learning in an acute care ward.

    PubMed

    Gregory, Linda Rosemary; Hopwood, Nick; Boud, David

    2014-05-01

    It is widely recognized that every workplace potentially provides a rich source of learning. Studies focusing on health care contexts have shown that social interaction within and between professions is crucial in enabling professionals to learn through work, address problems and cope with challenges of clinical practice. While hospital environments are beginning to be understood in spatial terms, the links between space and interprofessional learning at work have not been explored. This paper draws on Lefebvre's tri-partite theoretical framework of perceived, conceived and lived space to enrich understandings of interprofessional learning on an acute care ward in an Australian teaching hospital. Qualitative analysis was undertaken using data from observations of Registered Nurses at work and semi-structured interviews linked to observed events. The paper focuses on a ward round, the medical workroom and the Registrar's room, comparing and contrasting the intended (conceived), practiced (perceived) and pedagogically experienced (lived) spatial dimensions. The paper concludes that spatial theory has much to offer understandings of interprofessional learning in work, and the features of work environments and daily practices that produce spaces that enable or constrain learning.

  11. Standardising the organisation of clinical equipment on surgical wards at North Bristol NHS Trust: a quality improvement initiative

    PubMed Central

    Ward, Joseph; Spencer, Robin; Soo, Eleanor; finucane, katherine

    2015-01-01

    Poorly organised clinical equipment can waste significant amounts of time otherwise available for direct patient care. As a group of foundation year one doctors, we identified the organisation of clinical equipment across surgical wards at North Bristol NHS Trust to be poor with stocks often low and items frequently difficult to locate. Time-motion studies (n=80) were confirmatory demonstrating that the mean time to collect equipment necessary for venepuncture, cannulation, arterial blood gases, or blood cultures ranged from 121 to 174 seconds between different areas. By applying a plan-do-study-act (PDSA) methodology, surveying peers as well as working with nursing staff and senior managers, we were able to purchase and implement clinical equipment trolleys on 10 surgical wards across the trust to reduce the time-taken to locate clinical equipment to between 38 to 45 seconds (p=0.01). We feel the key factors for the success of our initiative were strong multidisciplinary engagement and a simple uniform idea. Clinical equipment trolleys organised in a standardised manner have now been rolled out hospital-wide in the new Southmead Hospital Brunel building. PMID:26734373

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

    PubMed

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

    2013-01-01

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

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

    PubMed Central

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

    2016-01-01

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

  14. Five-year review of absconding in three acute psychiatric inpatient wards in Australia.

    PubMed

    Gerace, Adam; Oster, Candice; Mosel, Krista; O'Kane, Deb; Ash, David; Muir-Cochrane, Eimear

    2015-02-01

    Absconding, where patients under an involuntary mental health order leave hospital without permission, can result in patient harm and emotional and professional implications for nursing staff. However, Australian data to drive nursing interventions remain sparse. The purpose of this retrospective study was to investigate absconding in three acute care wards from January 2006 to June 2010, in order to determine absconding rates, compare patients who did and did not abscond, and to examine incidents. The absconding rate was 17.22 incidents per 100 involuntary admissions (12.09% of patients), with no significant change over time. Being male, young, diagnosed with a schizophrenia or substance-use disorder, and having a longer hospital stay were predictive of absconding. Aboriginal and Torres Strait Islander patients had higher odds of absconding than Caucasian Australians. Over 25% of absconding patients did so multiple times. Patients absconded early in admission. More incidents occurred earlier in the year, during summer and autumn, and later in the week, and few incidents occurred early in the morning. Almost 60% of incidents lasted ≤24 hours. Formulation of prospective interventions considering population demographic factors and person-specific concerns are required for evidence-based nursing management of the risks of absconding and effective incident handling when they do occur.

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

    PubMed

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

    2013-05-01

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

  16. Nosocomial Outbreak of Drug-Resistant Streptococcus pneumoniae Serotype 9V in an Adult Respiratory Medicine Ward

    PubMed Central

    Khan-Orakzai, Zareena; Kapatai, Georgia; Bloch, Susannah; Singleton, Julie; Atkin, Sara; Shah, Victoria; Hatcher, James; Samarasinghe, Dunisha; Sheppard, Carmen

    2016-01-01

    ABSTRACT Streptococcus pneumoniae infections arising in hospitalized patients are often assumed to be sporadic and linked to community acquisition. Here, whole-genome sequencing was used to demonstrate nosocomial acquisition of antimicrobial-resistant sequence type 156 (ST156) serotype 9V S. pneumoniae in 3 respiratory patients that resulted in two bacteremias and one lower respiratory tract infection. Two of the cases arose in patients who had recently been discharged from the hospital and were readmitted from the community. Nosocomial spread was suspected solely because of the highly unusual resistance pattern and case presentations within 24 h of one another. The outbreak highlights the potential for rapid transmission and the short incubation period in the respiratory ward setting. PMID:27974539

  17. A standardised storage solution for venepuncture/cannulation equipment could save an NHS hospital the equivalent of a whole junior doctor

    PubMed Central

    Lindley, Steven; Robertson, Ian

    2014-01-01

    Junior doctors, nursing staff, and phlebotomists spend a large proportion of their time taking blood samples and siting (venous) cannulae. Approximately 350 blood samples are taken daily across 25 wards at the Royal United Hospital Bath NHS Trust. There is no standard storage solution for venepuncture or cannulation equipment. On-call junior doctors cover most of the hospital's wards. Time is wasted locating essential equipment on unfamiliar wards and nurses are frequently interrupted to assist. These delays can compromise patient safety in emergencies as well as contributing to a source of daily inefficiency. Junior doctors were timed collecting equipment needed for venepuncture and cannulation on unfamiliar wards. Initial results suggested large variation between timings on different wards. The medical admissions unit (MAU), which organises items for venepuncture and cannulation on a single trolley, was 4 times quicker than the mean of all other wards. MAU mean time 21.0s vs. Non-standardised wards mean time 103.0s (p<0.0001). Estimates suggest approximately 47 hours per week (the equivalent of a fulltime doctor) could be saved by implementing a standard trust-wide storage solution. We set out to introduce the MAU trolley format to all adult inpatient wards. All ward managers agreed to implement the trolley. 18 wards (72% of adult inpatient wards) already possessed the ‘MAU style’ trolley, which we standardised using an easy-to-follow inventory and laminated draw inlays. Feedback was very positive from doctors and ward staff alike. We repeated timings to validate the change and successfully presented a business case to senior management for a further 10 trolleys (£3623.78) for full adult inpatient ward coverage. As junior doctors, we identified a common problem, tested solutions, and made early simple affordable changes. Initial work helped us present a compelling case for patient safety and efficiency improvements, releasing money to implement modest trust

  18. Hospital sector choice and support for public hospital care in New Zealand: Results from a labeled discrete choice survey.

    PubMed

    Brown, Paul; Panattoni, Laura; Cameron, Linda; Knox, Stephanie; Ashton, Toni; Tenbensel, Tim; Windsor, John

    2015-09-01

    This study uses a discrete choice experiment (DCE) to measure patients' preferences for public and private hospital care in New Zealand. A labeled DCE was administered to 583 members of the general public, with the choice between a public and private hospital for a non-urgent surgery. The results suggest that cost of surgery, waiting times for surgery, option to select a surgeon, convenience, and conditions of the hospital ward are important considerations for patients. The most important determinant of hospital choice was whether it was a public or private hospital, with respondents far more likely to choose a public hospital than a private hospital. The results have implications for government policy toward using private hospitals to clear waiting lists in public hospitals, with these results suggesting the public might not be indifferent to policies that treat private hospitals as substitutes for public hospitals.

  19. Lifshitz anomalies, Ward identities and split dimensional regularization

    NASA Astrophysics Data System (ADS)

    Arav, Igal; Oz, Yaron; Raviv-Moshe, Avia

    2017-03-01

    We analyze the structure of the stress-energy tensor correlation functions in Lifshitz field theories and construct the corresponding anomalous Ward identities. We develop a framework for calculating the anomaly coefficients that employs a split dimensional regularization and the pole residues. We demonstrate the procedure by calculating the free scalar Lifshitz scale anomalies in 2 + 1 spacetime dimensions. We find that the analysis of the regularization dependent trivial terms requires a curved spacetime description without a foliation structure. We discuss potential ambiguities in Lifshitz scale anomaly definitions.

  20. Built environment and wellbeing in Italian psychiatric wards.

    PubMed

    Plantamura, Francesca; Capolongo, Stefano; Oberti, Ilaria

    2015-01-01

    The healthcare built environment has effects on patient's wellbeing. These effects are even heavier on sensitive patient such as psychiatric ones. Therefore the environment design can be a key factor in promoting the patients' well-being and the care process. This paper investigates how this vision is influencing the design of psychiatric facilities in the Italian context, known for its radical innovation of mental health services due to Law 180 (1978). The article identifies the current built environment issues of the psychiatric ward, the design indications available and the possible future actions to meet the needs of users and to improve wellbeing and care process.

  1. Connecting with Suicidal Patients in Psychiatric Wards: Therapist Challenges.

    PubMed

    Hagen, Julia; Hjelmeland, Heidi; Knizek, Birthe Loa

    2017-01-27

    In this qualitative interview study, we investigated how therapists experience and view treatment and care for suicidal patients in psychiatric wards. The focus is on aspects that may contribute toward shaping and possibly constraining therapists' connections with suicidal individuals. We conducted semi-structured interviews of four psychiatrists and four psychologists, and analyzed the data by means of thematic analysis. The findings suggest that high emphasis on diagnostics and standardized suicide risk assessments, limited direct care of suicidal patients, and fragmented mental health services may challenge therapists' connections with suicidal patients.

  2. ["Cold turkey" detoxification of drug, narcotic and chemical addicts conducted at the Occupational Diseases and Toxicology Ward of the Polish Center of Occupational Medicine in Poznan in 1986-1996].

    PubMed

    Mańkowski, W; Sikorski, M

    1997-01-01

    In this paper we have discussed the method of the "pure" detoxification (without the use of any psychotropics) of patients addicted to drugs, narcotics and chemicals treated at the Occupational Diseases & Toxicology Ward of the WCMP in Poznań. The material includes 152 cases of addicted patients who were treated in the Ward in the period from 1986 till 1996. Our research proved that the applied method is safe for the patients. We also found that addicts sharing hospital room with general medicine, not addicted patients, experience a positive effects in the process of treatment and resocialization.

  3. Circular codes, symmetries and transformations.

    PubMed

    Fimmel, Elena; Giannerini, Simone; Gonzalez, Diego Luis; Strüngmann, Lutz

    2015-06-01

    Circular codes, putative remnants of primeval comma-free codes, have gained considerable attention in the last years. In fact they represent a second kind of genetic code potentially involved in detecting and maintaining the normal reading frame in protein coding sequences. The discovering of an universal code across species suggested many theoretical and experimental questions. However, there is a key aspect that relates circular codes to symmetries and transformations that remains to a large extent unexplored. In this article we aim at addressing the issue by studying the symmetries and transformations that connect different circular codes. The main result is that the class of 216 C3 maximal self-complementary codes can be partitioned into 27 equivalence classes defined by a particular set of transformations. We show that such transformations can be put in a group theoretic framework with an intuitive geometric interpretation. More general mathematical results about symmetry transformations which are valid for any kind of circular codes are also presented. Our results pave the way to the study of the biological consequences of the mathematical structure behind circular codes and contribute to shed light on the evolutionary steps that led to the observed symmetries of present codes.

  4. [Obstetric analgesia in Norwegian hospitals].

    PubMed

    Dahl, V; Hagen, I E; Raeder, J C

    1998-04-30

    We report the results of a questionnaire sent to anaesthetists and midwives on the use of obstetric analgesia and anaesthesia in Norwegian hospitals in 1996. 95% of the 49 hospitals involved responded to the questionnaire, representing a total of 56,884 births. The use of epidural analgesia in labour varied from 0 to 25% in the different hospitals with a mean value of 15%. Epidural analgesia was much more widely used in university and regional hospitals than in local hospitals (p < 0.001). Five of the local hospitals did not offer epidural analgesia during labour at all. The combination of low-dose local anaesthetic and an opioid (either sufentanil or fentanyl) had not been introduced in nine of the hospitals (20%). The optimal use of epidural analgesia to relieve labour pain was judged to be more frequent by the anaesthetists than by the midwives (19% versus 11%, p < 0.01). In response to what factors limited the frequency of epidural analgesia, the anaesthetists specified factors related to the attitude of the midwife, and the midwives specified factors related to the anaesthetist. Only five of the hospitals provided written information on the various analgesic methods that could be employed during labour. The majority of midwives considered the analgesic methods employed on their maternity ward to be good or excellent. The frequency of Caesarean section was 12%; spinal anaesthesia was used in 55%, epidural anaesthesia in 17%, and general anaesthesia in 28% of the cases.

  5. Circular piezoelectric bender laser tuners

    NASA Technical Reports Server (NTRS)

    Mcelroy, J. H.; Thompson, P. E.; Walker, H. E.; Johnson, E. H.; Radecki, D. J.; Reynolds, R. S.

    1972-01-01

    The circular piezoelectric bender laser tuner to replace conventional laser tuners when mirror diameters up to 0.50 inch are sufficient is described. The circular piezoelectric bender laser tuner offers much higher displacements per applied volt and permits laser control circuits to be fabricated using standard operational amplifiers, rather than the expensive high-voltage amplifiers required by conventional tuners. The cost of the device is more than one order of magnitude lower than conventional tuners and the device is very rugged with all mechanical resonances easily designed to be greater than 3kHz. In addition to its use as a laser frequency tuner, the circular bender tuner should find many applications in interferometers and similar devices.

  6. Photoelectron circular dichroism of isopropanolamine

    NASA Astrophysics Data System (ADS)

    Catone, D.; Turchini, S.; Contini, G.; Prosperi, T.; Stener, M.; Decleva, P.; Zema, N.

    2017-01-01

    Spectroscopies based on circular polarized light are sensitive to the electronic and structural properties of chiral molecules. Photoelectron circular dichroism (PECD) is a powerful technique that combines the chiral sensitivity of the circular polarized light and the electronic information obtained by photoelectron spectroscopy. An experimental and theoretical PECD study of the outer valence and C 1s core states of 1-amino-2-propanol in the gas phase is presented. The experimental dichroic dispersions in the photoelectron kinetic energy are compared with theoretical calculations employing a multicentric basis set of B-spline functions and a Kohn-Sham Hamiltonian. In order to understand analogies and differences in the dichroism of structural isomers bearing the same functional groups, a comparison with previous PECD study of valence band of 2-amino-1-propanol is carried out.

  7. How Can Ward Teaching Be Made More Systematic?

    PubMed

    2016-09-01

    : 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 June 1926 issue, offers ideas "by which we hope to make ward experiences of more value to the student." Author Mina A. McKay originally presented this material at a meeting of the Massachusetts State League of Nursing Education. She calls for more comprehensive morning and evening reports ("not just a mere reading of… orders"), the use of student experience records, ward clinics ("the type of bedside talk which supplements class room lectures"), and case reports presented by the students themselves. Efforts to improve clinical nursing education are ongoing, and in "'Flipping' the Classroom" in this month's AJN, Diane M. Billings describes a relatively new way of translating clinical concepts into practice.

  8. Upgrading the Ward Beecher Planetarium for the 21st Century

    NASA Astrophysics Data System (ADS)

    Durrell, P. R.; Young, W.; Pirko, R.; Shanks, S. L.; Neiheisel, J.; Dean, M. E.; Kotel, R.; Schaefer, S.; Morlan, R.; Wilson, A.; Feldmeier, J. J.

    2005-12-01

    We report on recent progress and future public outreach plans in light of a significant upgrade of the Ward Beecher Planetarium at Youngstown State University. Over a period of 40 years, the facility has been a first-rate 150 seat planetarium and introductory astronomy classroom, and in its history has seen over 50 000 undergraduate students and over 750 000 visits from people in the surrounding area and beyond. Through a recent generous donation from the Ward Beecher Foundation, we have added the SciDome full-dome visualization system, and soon will be replacing our Spitz A3P planetarium star projector. These upgrades, in addition to new digital video projectors and a complete overhaul of our roof-top observatory, are being done in order to further enhance both the education of YSU students and our ability to continue numerous public outreach programs, including full-dome digital planetarium shows, public observing, shows for both elementary and high school students, and home-schooling programs.

  9. Door locking and exit security measures on acute psychiatric admission wards.

    PubMed

    Nijman, H; Bowers, L; Haglund, K; Muir-Cochrane, E; Simpson, A; Van Der Merwe, M

    2011-09-01

    Locking the exit doors of psychiatric wards is believed to reduce the risk of patients absconding. The aims of the study were to investigate both the prevalence of door locking and other exit security measures on UK admission wards, as well as whether door locking appears to be effective in keeping inpatients in. A cross-sectional survey on 136 acute psychiatric wards in the UK was conducted, in which a range of data on patients, staff, and conflict and containment events, including door locking and absconding, were collected from shift to shift during a period of 6 months. About one-third of the participating wards (30%) operated with their ward exit door permanently locked, whereas another third (34%) never locked the ward door. Univariate analyses suggested little association between exit security measures and absconding. A more robust multilevel statistical analysis, however, did indicate a reduction of about 30% of absconding rates when the ward door was locked the entire shift. Although locking the ward door does seem to reduce absconding to a certain extent, it far from completely prevents it. As it may be unrealistic to strive for a 100% absconding-proof ward, alternative measures for door locking to prevent absconding are discussed.

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

    PubMed

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

    2015-01-01

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

  11. Ribotyping provides efficient differentiation of nosocomial Serratia marcescens isolates in a pediatric hospital.

    PubMed Central

    Bingen, E H; Mariani-Kurkdjian, P; Lambert-Zechovsky, N Y; Desjardins, P; Denamur, E; Aujard, Y; Vilmer, E; Elion, J

    1992-01-01

    Ribotyping with a nonradioactive probing system was used for the epidemiological evaluation of 15 Serratia marcescens nosocomial strains isolated from the stools of 12 children with no apparent illness in five different hospital wards over a 20-day period. Our results indicate that the occurrence of S. marcescens colonization was the result of the spread of a single epidemiological strain in the hematology ward, the oncology ward, and the gastroenterology ward and in two neonates in the neonatology ward, suggesting cross-contamination between the patients in these four wards. This isolate was genotypically unrelated to the bacterial strain found in the three other patients in the neonatology ward. Interestingly, one patient in the neonatology ward harbored these two genotypically different strains. Finally, the patient in the intensive care unit was colonized with a different strain. We find ribotyping to be a more reliable technique than biochemical typing. The results of ribotyping are more easily interpreted than are those of total DNA analysis, with an equivalent degree of discrimination. Images PMID:1354222

  12. Paired circularly polarized heterodyne ellipsometer

    SciTech Connect

    Yu, C.-J.; Lin, C.-E.; Yu, L.-P.; Chou, C

    2009-02-01

    We develop a paired circularly polarized heterodyne ellipsometer (PCPHE), in which a heterodyne interferometer based on a two-frequency circularly polarized laser beam is set up. It belongs to an amplitude-sensitive ellipsometer that is able to provide not only a wider dynamic range of polarization modulation frequency but also a higher detection sensitivity than that of a conventional photometric ellipsometer. A real-time and precise measurement of ellipsometric parameters, which demonstrated an accuracy of less than 1 nm on thickness measurement of SiO2 thin film deposited on silicon substrate, can be applied with the PCPHE.

  13. Maximal dinucleotide and trinucleotide circular codes.

    PubMed

    Michel, Christian J; Pellegrini, Marco; Pirillo, Giuseppe

    2016-01-21

    We determine here the number and the list of maximal dinucleotide and trinucleotide circular codes. We prove that there is no maximal dinucleotide circular code having strictly less than 6 elements (maximum size of dinucleotide circular codes). On the other hand, a computer calculus shows that there are maximal trinucleotide circular codes with less than 20 elements (maximum size of trinucleotide circular codes). More precisely, there are maximal trinucleotide circular codes with 14, 15, 16, 17, 18 and 19 elements and no maximal trinucleotide circular code having less than 14 elements. We give the same information for the maximal self-complementary dinucleotide and trinucleotide circular codes. The amino acid distribution of maximal trinucleotide circular codes is also determined.

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

    PubMed

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

    2013-05-01

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

  15. Delayed Recognition of Deterioration of Patients in General Wards Is Mostly Caused by Human Related Monitoring Failures: A Root Cause Analysis of Unplanned ICU Admissions

    PubMed Central

    Driesen, Babiche E. J. M.; Merten, Hanneke; Ludikhuize, Jeroen; van der Spoel, Johannes I.; Kramer, Mark H. H.; Nanayakkara, Prabath W. B.

    2016-01-01

    Background An unplanned ICU admission of an inpatient is a serious adverse event (SAE). So far, no in depth-study has been performed to systematically analyse the root causes of unplanned ICU-admissions. The primary aim of this study was to identify the healthcare worker-, organisational-, technical,- disease- and patient- related causes that contribute to acute unplanned ICU admissions from general wards using a Root-Cause Analysis Tool called PRISMA-medical. Although a Track and Trigger System (MEWS) was introduced in our hospital a few years ago, it was implemented without a clear protocol. Therefore, the secondary aim was to assess the adherence to a Track and Trigger system to identify deterioration on general hospital wards in patients eventually transferred to the ICU. Methods Retrospective observational study in 49 consecutive adult patients acutely admitted to the Intensive Care Unit from a general nursing ward. 1. PRISMA-analysis on root causes of unplanned ICU admissions 2. Assessment of protocol adherence to the early warning score system. Results Out of 49 cases, 156 root causes were identified. The most frequent root causes were healthcare worker related (46%), which were mainly failures in monitoring the patient. They were followed by disease-related (45%), patient-related causes (7, 5%), and organisational root causes (3%). In only 40% of the patients vital parameters were monitored as was instructed by the doctor. 477 vital parameter sets were found in the 48 hours before ICU admission, in only 1% a correct MEWS was explicitly documented in the record. Conclusions This in-depth analysis demonstrates that almost half of the unplanned ICU admissions from the general ward had healthcare worker related root causes, mostly due to monitoring failures in clinically deteriorating patients. In order to reduce unplanned ICU admissions, improving the monitoring of patients is therefore warranted. PMID:27537689

  16. Anxiety and depressive disorders in an emergency department ward of a general hospital: a control study

    PubMed Central

    Marchesi, C; Brusamonti, E; Borghi, C; Giannini, A; Di, R; Minneo, F; Quarantelli, C; Maggini, C

    2004-01-01

    Objective: In this study anxiety and depressive disorders were evaluated in patients admitted to an emergency department (ED) or to a medical department (MD). Methods: The General Health Questionnaire-30 (GHQ-30) was administered to screen all patients (n = 719) consecutively admitted to an ED (n = 556) and to MD (n = 163) in a 120 day period. All GHQ-30 positive (score>4) underwent the Mini International Neuropsychiatric Interview, a structured interview to diagnose mental disorders according to DSM-IV criteria. Results: Subjects positive to GHQ-30 were 264 (47%) in ED and 88 (54%) in MD. A mental disorder was diagnosed in 233 ED patients (42%) and in 77 MD patients (47%) (p = 0.70). The most frequent disorders were anxiety disorders in ED patients (18.1%) and depressive disorders in MD patients (21%) (p = 0.04). Conclusions: Anxious patients more frequently seek attention at ED, whereas patients with depressive disorders are more often observed in medical units. The improvement of quality of care, the waste of healthcare resources through unnecessary medical care, and the well known efficacy of appropriate treatments in patients with anxiety and depressive disorders make the diagnosis of these patients particularly important. PMID:14988342

  17. Facilitating the transition from physiology to hospital wards through an interdisciplinary case study of septic shock

    PubMed Central

    2014-01-01

    Background In order to develop clinical reasoning, medical students must be able to integrate knowledge across traditional subject boundaries and multiple disciplines. At least two dimensions of integration have been identified: horizontal integration, bringing together different disciplines in considering a topic; and vertical integration, bridging basic science and clinical practice. Much attention has been focused on curriculum overhauls, but our approach is to facilitate horizontal and vertical integration on a smaller scale through an interdisciplinary case study discussion and then to assess its utility. Methods An interdisciplinary case study discussion about a critically ill patient was implemented at the end of an organ system-based, basic sciences module at New York University School of Medicine. Three clinical specialists—a cardiologist, a pulmonologist, and a nephrologist—jointly led a discussion about a complex patient in the intensive care unit with multiple medical problems secondary to septic shock. The discussion emphasized the physiologic underpinnings behind the patient’s presentation and the physiologic considerations across the various systems in determining proper treatment. The discussion also highlighted the interdependence between the cardiovascular, respiratory, and renal systems, which were initially presented in separate units. After the session students were given a brief, anonymous three-question free-response questionnaire in which they were asked to evaluate and freely comment on the exercise. Results Students not only took away physiological principles but also gained an appreciation for various thematic lessons for bringing basic science to the bedside, especially horizontal and vertical integration. The response of the participants was overwhelmingly positive with many indicating that the exercise integrated the material across organ systems, and strengthened their appreciation of the role of physiology in understanding disease presentations and guiding appropriate therapy. Conclusions Horizontal and vertical integration can be presented effectively through a single-session case study, with complex patient cases involving multiple organ systems providing students opportunities to integrate their knowledge across organ systems while emphasizing the importance of physiology in clinical reasoning. Furthermore, having several clinicians from different specialties discuss the case together can reinforce the matter of integration across multiple organ systems and disciplines in students’ minds. PMID:24725336

  18. Accelerator Science: Circular vs. Linear

    ScienceCinema

    Lincoln, Don

    2016-12-14

    Particle accelerator are scientific instruments that allow scientists to collide particles together at incredible energies to study the secrets of the universe. However, there are many manners in which particle accelerators can be constructed. In this video, Fermilab’s Dr. Don Lincoln explains the pros and cons of circular and linear accelerators.

  19. Accelerator Science: Circular vs. Linear

    SciTech Connect

    Lincoln, Don

    2016-11-10

    Particle accelerator are scientific instruments that allow scientists to collide particles together at incredible energies to study the secrets of the universe. However, there are many manners in which particle accelerators can be constructed. In this video, Fermilab’s Dr. Don Lincoln explains the pros and cons of circular and linear accelerators.

  20. Class IIc or Circular Bacteriocins

    NASA Astrophysics Data System (ADS)

    Martin-Visscher, Leah A.; van Belkum, Marco J.; Vederas, John C.

    The circular bacteriocins produced by Gram-positive bacteria represent a diverse class of antimicrobial peptides. These bacteriocins display enhanced stability compared to linear bacteriocins, which arises from their characteristic circular backbone. Currently, eight unique circular bacteriocins have been identified, and analysis of their gene clusters indicates that they likely utilize complex mechanisms for maturation and secretion, as well as for immunity. These bacteriocins target the cytoplasmic membrane of sensitive cells, leading to pore formation that results in loss of ions, dissipation of membrane potential, and ultimately, cell death. Structural studies suggest that despite variation in their sequences, most of these bacteriocins likely adopt a common three-dimensional architecture, consisting of four or five tightly packed helices encompassing a hydrophobic core. There are many mysteries surrounding the biosynthesis of these peptides, particularly in regard to the mechanism by which they are cyclized. Elucidation of such a mechanism may provide exciting new approaches to the bioengineering of new, stable, and antimicrobially active circular peptides.

  1. Stress Analysis of Circular Frames

    NASA Technical Reports Server (NTRS)

    Fahlbusch, H; Wegner, W

    1941-01-01

    The stresses in circular frames of constant bending stiffnesses, as encountered in thin-wall shells, are investigated from the point of view of finite depth of sectional area of frame. The solution is carried out for four fundamental load conditions. The method is illustrated on a worked out example.

  2. Eight years' experience with a weekday gynaecological ward.

    PubMed

    Bevan, J; Newton, J

    1979-07-21

    Between 1971 and 1978, 9651 patients were admitted to a gynaecological ward in use five days a week. 39.5% of patients were admitted as "day cases", the rest as "overnight stay" patients. Patients can choose between local or general anaesthesia and between day care or overnight stay. The procedures carried out were termination of pregnancy (41.3%), laparoscopy (14.1%), minor gynaecological procedures (41.2%), and urological procedures (3.4%). Despite an 80% increase in work load during these 8 years the waiting list, which fell by 62% in the first year, has been maintained at that level. The advantages of having such a unit in a modern gynaecological service are discussed.

  3. 4WARD: A European Perspective towards the Future Internet

    NASA Astrophysics Data System (ADS)

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

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

  4. Major Concerns of Hospitalized School-Age Children and Their Parents in Hong Kong.

    ERIC Educational Resources Information Center

    Lian, Ming-Gon John; Chan, Hiu Nam Helena

    2003-01-01

    A study identified major concerns of 23 hospitalized children (grades PreK-9) and their parents, including the interruption of the child's pace of academic study, his/her health condition and fears of medical treatment and therapy, his/her loneliness in the ward, and time management problems. Recommendations for hospital schoolteachers are…

  5. Controlled Confrontation: The Ward Grievance Procedure of the California Youth Authority. An Exemplary Project.

    ERIC Educational Resources Information Center

    National Inst. of Law Enforcement and Criminal Justice (Dept. of Justice/LEAA), Washington, DC.

    The Ward Grievance Procedure of the California Youth Authority is one of 17 programs that earned the National Institute's "Exemplary" label. This brochure provides the requisite practical information for those who wish to test or consider testing the ward grievance procedure. The program was developed as a way of dealing with the questions raised…

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

    ERIC Educational Resources Information Center

    Library Journal, 2004

    2004-01-01

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

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

    ERIC Educational Resources Information Center

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

    2013-01-01

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

  8. The Educational Value Of Post-Take Ward Rounds For Senior Trainees

    PubMed Central

    Parry, David; El-Mileik, Hanan

    2016-01-01

    Background The educational value of post-take ward rounds (PTWRs) is an under-researched area of postgraduate medical education. Objective We investigated perceptions of this activity amongst higher specialty trainees. Methods The project was conducted in a large district general hospital in London, UK. Quantitative and qualitative data were collected to establish opinions of the PTWR amongst higher specialty trainees in medicine. Eighteen senior trainees were eligible to participate. Of these, 14 (78%) responded to our questionnaire and 4 were selected by purposive sampling to participate in semi-structured interviews. Results Most trainees felt that the focus of PTWRs was service provision with little time devoted to teaching (79% of respondents) and that feedback was rarely provided (71% of respondents). Trainees commented on learning opportunities available on PTWRs, as well as consultant behaviour they considered valuable. The main barriers to teaching and learning were time pressures, workload, interruptions, management (rather than patient assessment) focus, lack of follow-up of cases and feedback. The data included useful suggestions for improving the educational value of PTWRs. Conclusions PTWRs are currently a wasted educational opportunity. Radical change to organisation and practice will be necessary to address this. There will be resource implications. PMID:27601766

  9. Psychiatric nursing as 'different' care: experience of Iranian mental health nurses in inpatient psychiatric wards.

    PubMed

    Zarea, K; Nikbakht-Nasrabadi, A; Abbaszadeh, A; Mohammadpour, A

    2013-03-01

    Patients with mental illness require unique and specific care. The purpose of this study was to explore the experiences of nurses, who provide such care for mentally ill people, within the context of Iranian culture. This hermeneutic phenomenological study was carried out in a university-affiliated hospital in an urban area of Iran. We interviewed 10 mental health nurses to capture in detail their experiences in psychiatric units, and the approach developed by Diekelmann et al. was employed to analyse the data. Four themes and five sub-themes were identified: 'being engaged with patients' (sub-themes: 'struggle for monitor/control', 'safety/security concerns', 'supporting physiological and emotional needs'), 'being competent', 'altruistic care' and 'facing difficulties and challenges' (sub-themes: 'socio-cultural' and 'organizational challenges'). The results provide valuable insights and greater understanding of the professional experiences of psychiatric nurses in Iran, and indicate the need for a stable and responsible organizational structure for those nurses who are expected to manage patient care in psychiatric wards.

  10. Patterns of antipsychotics' prescription in Portuguese acute psychiatric wards: A cross-sectional study.

    PubMed

    Campos Mendes, João; Azeredo-Lopes, Sofia; Cardoso, Graça

    2016-12-30

    This study aimed to establish the prescribing patterns of antipsychotics in acute psychiatric wards across Portugal, to determine the prevalence of polypharmacy and "high-doses" treatment, and to identify possible predictors. Twelve acute psychiatric inpatient units and 272 patients were included. The majority (87.5%) was treated with antipsychotics regardless of diagnosis, and 41.6% had at least two antipsychotics prescribed in combination. Age, use of depot antipsychotics, and antipsychotic "high-doses" were significant predictors of antipsychotic polypharmacy. Excluding 'as required' prescriptions, 13.8% of the patients were prescribed "high-doses" of antipsychotics. When antipsychotics 'as required' prescriptions were considered, 49.2% of the patients were on antipsychotic "high-doses". Age, use of depot antipsychotics, previous psychiatric hospitalization and involuntary admission were significant predictors of antipsychotic "high-doses". These results show that in Portugal the antipsychotics prescribing practices in psychiatric inpatient units diverge from those that are universally recommended, entailing important clinical and economic implications. It seems advisable to optimize the prescription of these drugs, in order to prevent adverse effects and improve the quality of the services provided.

  11. Laughter in a psychiatric ward. Somatic, emotional, social, and clinical influences on schizophrenic patients.

    PubMed

    Gelkopf, M; Kreitler, S; Sigal, M

    1993-05-01

    The study was designed to explore the potential therapeutic effects of humor on hospitalized schizophrenics. For this purpose, in the first stage, we conducted a review of findings in regard to physical health, emotions, psychiatric state, and social behavior. In the second stage, we carried out an experiment with 34 resident patients in two chronic schizophrenic wards who were exposed to 70 movies during 3 months. The experimental group was exposed to humorous movies only, and the control group to different kinds of movies. Before and after the exposure to films for 3 months, both groups were tested on different health, emotional, social, and clinical measures using the Cognitive Orientation of Health Questionnaire, the Shalvata Symptom Rating Scale, blood pressure, heart rate, Perceived Verbal and Motor Aggression (rated by nurses), the Multiple Affect Adjective Check List, the Social Support Questionnaire 6, and the Brief Psychiatric Rating Scale (BPRS; rated by psychiatrists). Covariance analyses yielded significant reductions in Perceived Verbal Hostility, BPRS scales (total score, anxiety/depression), and significant increases in BPRS (activation) and degree of staff support experienced by the patients. The results indicate that the effects of exposure to humor may be mediated by the effects on the staff of the incidental exposure to humorous films.

  12. Unsolicited post-prescription antibiotic review in surgical and medical wards: factors associated with counselling and physicians' compliance.

    PubMed

    Lesprit, P; Landelle, C; Brun-Buisson, C

    2013-02-01

    The purpose of this investigation was to describe the impact of an early review of antibiotic prescriptions in a hospital using unsolicited infectious disease physician (IDP) counselling, identify areas for improvement and examine factors associated with physicians' non-compliance. The prescriptions of 15 selected antibiotics from surgical or medical wards were screened daily and reviewed between days 3 and 5 by a single IDP during an 8-month period to identify those likely needing counselling. Improved antibiotic use was sought by encouraging ward physicians to withdraw or de-escalate therapy, promoting oral switch or reducing the duration of therapy whenever appropriate. Variables potentially associated with IDP counselling and physicians' non-compliance were tested using bivariate analysis and then entered in a logistic regression model. Among 857 prescriptions analysed, 54.6 % prompted unsolicited counselling, mostly for stopping therapy (18.8 %), reducing its duration (18.0 %) or de-escalation (13.0 %). Variables independently associated with IDP counselling included antibiotic combination (adjusted odds ratio [aOR], 5.27 [95 % confidence interval (CI), 1.80-15.45]; p = 0.002), non-clinically documented infection (aOR, 4.98 [95 % CI, 2.81-8.82]; p < 0.001) and microbiologically documented infection (aOR, 2.04 [95 % CI, 1.51-2.75]; p < 0.001). The physicians' compliance rate was 77.3 %. Variables independently associated with physicians' non-compliance to the IDP recommendation were the surgical speciality of the ward physician (aOR, 1.91 [95 % CI, 1.17-3.12]; p = 0.009) and advice to reduce the duration of therapy (aOR, 1.88 [95 % CI, 1.12-3.15]; p = 0.017). An unsolicited post-prescription antibiotic review can be successfully implemented with a high rate of physicians' compliance. Areas for targeting improvement measures include prescriptions in surgical wards and shortening the duration of therapy.

  13. 77 FR 42077 - Environmental Justice: Final Circular

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-07-17

    ... TRANSPORTATION Federal Transit Administration Environmental Justice: Final Circular AGENCY: Federal Transit... (hereinafter ``EJ Circular'') on incorporating environmental justice principles into plans, projects, and... recipients of FTA funds on how to fully engage environmental justice populations in the public...

  14. An Analysis of a Program to Identify and Quantify Standards of Performance for U.S. Army Hospital Food Services for the Purpose of Quality Assurance

    DTIC Science & Technology

    1982-08-01

    the wards. 3. Silas B. Hays Army Cormnunity Hospital is located at Fort Ord, California. The hospital has 169 operating beds . A number of specialties... Hospital is a 238 bed hospital located at Fort Leonard Wood, Missouri. The majority of patients seen are basic trainees with relatively minor injuries...home of the Army Command and General Staff College and the Army Detention Facility. The hospital is a 46 bed hospital averaging about 34 occupied beds

  15. [Possibilities for rehabilitation in a county hospital].

    PubMed

    Mohr, P

    1981-01-01

    A county hospital with an infirmary surely offers the possibilities for rehabilitation as much as any other institution. Due to its manageable size, the county hospital can probably guarantee deeper personal care. The following possibilities are discussed: activating care, mental stimulation in a reality orientation program, dance and music therapy, plus the opening of the infirmary outwards, which remains a very important aspect. The rehabilitation in a county hospital can be guaranteed only by the complete cooperation between hospital internal and external medicine. An outpatient ward such as the day- and night-clinic is also a useful institution. In the future, the employment of volunteers in and outside the hospital will be of greater importance. Already now, greater efforts should be made on behalf of continued training and greater social prestige for these volunteers.

  16. [Medical clowns at hospitals and their effect on hospitalized children].

    PubMed

    Bornstein, Yossi

    2008-01-01

    Healing by the use of humor has become popular over the last few years and it is used not only in alternative medicine but also in conventional medicine in hospitals all over the world, particularly in the USA and Europe. This practice has been well implemented in pediatric wards. It is easier to make a child laugh than an adult. In the framework of healing by humor, use is made of a medical clown who is in fact a person who has undergone special training in acting and clowning, combined with medical knowledge and an understanding of patient behavior. Some medical clowns come from the world of entertainment, and are actors, clowns, and magicians. Some have a paramedical or medical background. Medical research demonstrates that medical clowns and humor have a positive effect on patients. The implementation of medical clowning has been increasing throughout the world from year to year and has, slowly but surely, started a movement to integrate it into formal frameworks in both pediatric and adult wards in hospitals. However, there is still a necessity to conduct larger, well controlled clinical trials regarding the influence of the different programs. Maybe the growing awareness in the world will fill the void that demands resources of both personnel and budgets, both of which are often missing from health budgets.

  17. Use of novel psychoactive substances by inpatients on general adult psychiatric wards

    PubMed Central

    Stanley, Jack L; Mogford, Daniel V; Lawrence, Rebecca J; Lawrie, Stephen M

    2016-01-01

    Objectives Non-illicit alternatives to controlled drugs, known as novel psychoactive substances (NPS), have recently risen to prominence. They are readily available, with uncertain pharmacology and no widely available assay. Given that psychiatric patients are at risk of comorbid substance abuse, we hypothesised that NPS use would be present in the psychiatric population, and sought to determine its prevalence and investigate the characteristics of those who use these drugs with a retrospective review of discharge letters. Setting General adult inpatient wards of a psychiatric hospital in a Scottish city. Participants All adult inpatients (18–65) discharged from general psychiatric wards between 1 July 2014 and 31 December 2014. Of the 483 admissions identified, 46 were admissions for maintenance electroconvulsive therapy (ECT) and were excluded. Of the remaining 437 admissions, 49 discharge letters were unobtainable, leaving 388 admissions to analyse. Primary outcome measure The mention, or lack thereof, of NPS use in discharge letters was our planned primary outcome measure and was also the primary outcome measure we used in our analysis. Results NPS use was identified in 22.2% of admissions, contributing to psychiatric symptoms in 59.3%. In comparison to non-users, NPS users were younger (p<0.01), male and more likely to have a forensic history ((p<0.001) for both). The diagnosis of drug-induced psychosis was significantly more likely in NPS users (p<0.001, OR 18.7, 95% CI 8.1 to 43.0) and the diagnosis of depression was significantly less likely (p<0.005, OR 0.133, CI 0.031 to 0.558). Use of cannabis was significantly more likely in NPS users (p<0.001, OR 4.2, CI 2.5 to 7.1), as was substitute opiate prescribing (p<0.001, OR 3.7, CI 1.8 to 7.4). Conclusions NPS use was prevalent among young, male psychiatric inpatients, in particular those with drug-induced psychosis and often occurred alongside illicit drug use. PMID:27165643

  18. Circular on planned parenthood, 1987.

    PubMed

    1987-01-01

    In 1987 fourteen units of the Government of Henan issued a Circular stating that: "Planned parenthood must be publicized deep into the grass roots and among the people, and importance must be attached to results." The Circular stresses: "In the propaganda drive, it is necessary to successfully grasp three key links: 1. It is necessary to disseminate intensively the important directive on population problems that is contained in the report of the 13th CPC National Congress and the seriousness of the population situation of our country and province so that the cadres and the masses can understand the relationship between population control and the achievement of the strategic target of the three big steps, understand the reason for carrying out planned parenthood, understand that the one-child policy is still advocated, and conscientiously carry out planned parenthood. 2. It is essential to succeed in propagating knowledge of contraception, sterilization, childbirth, and child care and in conducting ideological education for those who undergo operations and for their family members. 3. It is imperative to visit those who have undergone operations and to help them solve practically their difficulties in making a living." The Circular concludes by demanding that under the unified leadership of party committees and governments at all levels, the propaganda drive be carried out by relying on the efforts of all of society. In conjunction with their own work, departments, including the propaganda, education, public health, and cultural departments, must carry out propaganda and education for planned parenthood.

  19. A novel replicating circular DNAzyme

    PubMed Central

    Chen, Fei; Wang, Ruijian; Li, Zhe; Liu, Bin; Wang, Xiaoping; Sun, Yanhong; Hao, Dongyun; Zhang, Jin

    2004-01-01

    10–23 DNAzyme has the potential to suppress gene expressions through sequence-specific mRNA cleavage. However, the dependence on exogenous delivery limits its applications. The objective of this work is to establish a replicating DNAzyme in bacteria using a single-stranded DNA vector. By cloning the 10–23 DNAzyme into the M13mp18 vector, we constructed two circular DNAzymes, C-Dz7 and C-Dz482, targeting the β-lactamase mRNA. These circular DNAzymes showed in vitro catalytic efficiencies (kcat/KM) of 7.82 × 106 and 1.36 × 107 M–1·min–1, respectively. Their dependence on divalent metal ions is similar to that found with linear 10–23 DNAzyme. Importantly, the circular DNAzymes were not only capable of replicating in bacteria but also exhibited high activities in inhibiting β-lactamase and bacterial growth. This study thus provides a novel strategy to produce replicating DNAzymes which may find widespread applications. PMID:15115797

  20. Malnutrition among hospitalized patients in King Khalid University Hospital, Riyadh.

    PubMed

    Bani, I A; Al-Kanhal, M A

    1998-09-01

    The present study was undertaken to determine the incidence of malnutrition among hospitalized patients. A cross-sectional study of patients were evaluated for findings suggestive of protein calorie malnutrition (PCM). Hundred and sixty patients admitted to the medical and surgical wards over a period of five months were studied. Anthropometrics and biochemical measurements were used. Nutrition status was calculated based on some nutrition parameters weight for height, midarm, circumference, serum albumin and total lymphocyte count. Anthropometric measurements, weight for height and midarm circumference reflected malnutrition (PCM) of 33.8% and 30% respectively. The overall prevalence of obesity was 21%. A higher proportion (23.9%) of medical cases were found to be obese compared to surgical cases (19.7%). If malnutrition can be documented on hospital admission, attempts can be made to reverse malnutrition in the high risk patients.

  1. Which patients are most at risk of methicillin resistant Staphylococcus aureus: a review of admissions to a regional maxillofacial ward between 2001 and 2005.

    PubMed

    Rogers, Simon N; Proczek, Katarzyna; Sen, Rachel A; Hughes, Julie; Banks, Paul; Lowe, Derek

    2008-09-01

    This study aimed to identify all Staphylococcus aureus (MRSA) cases on a Regional Maxillofacial ward, to estimate incidence and to ascertain who were most at risk. The study also explored clinical and demographic factors associated with MRSA in a subset of consecutive patients managed by primary surgery for previously untreated oral and oropharyngeal squamous cell carcinoma (OOSCC) over the same time period. Patients admitted from 1st April 2001 to 31st March 2006 to the Regional Maxillofacial Unit ward, Liverpool were identified by a retrospective review of the hospital MRSA database and there were 10109 patient admissions. MRSA (1.1%) occurred in 115 patient episodes involving 97 patients. There were 84 patients having a single episode and 13 more than one. There were no cases of mortality due to MRSA. Of the MFU patients 73 were oncology and 7 trauma. In the oncology group the commonest primary sites were wound (41) and sputum (11). Of new patients admitted for definitive treatment for OOSCC, 14% had MRSA and the two main risk factors were stage of cancer (P<0.001) and free flap (P<0.001). The risk of MRSA infection on our maxillofacial ward is low though MRSA infection is more prevalent among oncology patients particularly those requiring free tissue transfer. Careful adherence to infection prevention and control precautions is essential and practical methods to reduce MRSA need further evaluation.

  2. A study of the efficacy and cost-effectiveness of MRSA screening and monitoring on surgical wards using a new, rapid molecular test (EMMS)

    PubMed Central

    Hardy, Katherine J; Szczepura, Ala; Davies, Ruth; Bradbury, Andrew; Stallard, Nigel; Gossain, Savita; Walley, Paul; Hawkey, Peter M

    2007-01-01

    Background MRSA is a significant contributor to prolonged hospital stay, poor clinical outcome and increased healthcare costs amongst surgical patients. A PCR test has been developed for rapid detection of MRSA in nasal swabs. The aims of this study are (1) to estimate the effectiveness of screening using this rapid PCR tests vs culture in reducing MRSA cross-infection rates; (2) to compare the cost of each testing strategy, including subsequent health care costs; and (3) to model different policies for the early identification and control of MRSA infection in surgical patients. Methods/Design The study is a prospective two-period cross-over study set in 7 surgical wards covering different surgical specialities. A total of 10,000 patients > 18 years will be tested over 16 months. The only difference between the two study periods is the method used for the detection of MRSA in each ward (rapid v conventional culture), with all other infection control practices remaining consistent between the arms. The study has been designed to complement routine practice in the NHS. Outcomes are MRSA cross-infection rates (primary outcome) and need for antibiotic therapy and MRSA-related morbidity. Parallel economic and modelling studies are being conducted to aid in the interpretation of the results and to evaluate the cost-effectiveness of the rapid PCR screening strategy. Discussion This paper highlights the design, methods and operational aspects of a study evaluating rapid MRSA screening in the surgical ward setting. PMID:17915008

  3. Investigation into the acceptability of door locking to staff, patients, and visitors on acute psychiatric wards.

    PubMed

    Muir-Cochrane, Eimear; van der Merwe, Marie; Nijman, Henk; Haglund, Kristina; Simpson, Alan; Bowers, Len

    2012-02-01

    There is disagreement among psychiatric professionals about whether the doors of acute psychiatric wards should be kept locked to prevent patients from leaving and harming themselves or others. This study explored patient, staff, and visitor perceptions about the acceptability of locking the ward door on acute psychiatric inpatient wards. Interviews were conducted with 14 registered nurses, 15 patients, and six visitors from three different acute wards. Findings revealed commonalities across all groups, with general agreement that locking the door reduced absconding. Staff expressed feelings of guilt, embarrassment, and fear of being blamed when a patient absconded. Staff also reported that open wards created anxious vigilance to prevent an abscond and increased workload in allocating staff to watch the door, whereas staff on partially-locked doors also perceived an increased workload in letting people in and out of the ward. Patients had mixed feelings about the status of the door, expressing depression, a sense of stigma, and low self-esteem when the door was locked. The issue of balancing safety and security on acute psychiatric wards against the autonomy of patients is not easily resolved, and requires focused research to develop innovative nursing practices.

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

    PubMed

    Xie, Hui; Kang, Jian

    2012-01-01

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

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

    PubMed Central

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

    1994-01-01

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

  6. Norovirus - hospital

    MedlinePlus

    Gastroenteritis - norovirus; Colitis - norovirus; Hospital acquired infection - norovirus ... fluids ( dehydration ). Anyone can become infected with norovirus. Hospital patients who are very old, very young, or ...

  7. Low birthweight in electoral wards: a useful health and social indicator at local level.

    PubMed

    Wynn, M; Wynn, A

    2000-01-01

    Greater use of electoral ward data is recommended for the guidance of allocation of resources to reduce low birthweight rates and for the monitoring of the health of communities. Ward data on low birthweight can be used for correlation studies to show the many associations of social, economic and health factors with low birthweight and with each other. A recent government report shows a substantial increase in the prevalence of disability since 1985 which is partly a consequence of an increase in low birthweight and of a deterioration in the nutritional status of an important minority of poor families who are concentrated in inner city wards.

  8. Irreversible rapid changes of magnetic field associated with the 2012 October 23 circular near-limb X1.8 Flare

    NASA Astrophysics Data System (ADS)

    Ye, Dan-Dan; Liu, Chang; Wang, Haimin

    2016-06-01

    It has been found that photospheric magnetic fields can change in accordance with restructuring of the three-dimensional magnetic field following solar eruptions. Previous studies mainly use vector magnetic field data taken for events near the disk center. In this paper, we analyze the magnetic field evolution associated with the 2012 October 23 X1.8 flare in NOAA AR 11598 that is close to the solar limb, using both the 45 s cadence line-of-sight and 12 min cadence vector magnetograms from the Helioseismic and Magnetic Imager on board Solar Dynamics Observatory. This flare is classified as a circular-ribbon flare with spine-fan type magnetic topology containing a null point. In the line-of-sight magnetograms, there are two apparent polarity inversion lines (PILs). The PIL closer to the limb is affected more by the projection effect. Between these two PILs there lie positive polarity magnetic fields, which are surrounded by negative polarity fields outside the PILs. We find that after the flare, both the apparent limb-ward and disk-ward negative fluxes decrease, while the positive flux in-between increases. We also find that the horizontal magnetic fields have a significant increase along the disk-ward PIL, but in the surrounding area, they decrease. Synthesizing the observed field changes, we conclude that the magnetic fields collapse toward the surface above the disk-ward PIL as depicted in the coronal implosion scenario, while the peripheral field turns to a more vertical configuration after the flare. We also suggest that this event is an asymmetric circular-ribbon flare: a flux rope is likely present above the disk-ward PIL. Its eruption causes instability of the entire fan-spine structure and the implosion near that PIL.

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

    PubMed Central

    Yeo, Jing Ming

    2016-01-01

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

  10. Molecular analysis of Malassezia species isolated from hospitalized neonates.

    PubMed

    Zomorodain, Kamiar; Mirhendi, Hossein; Tarazooie, Bita; Kordbacheh, Parivash; Zeraati, Hojjat; Nayeri, Fatemeh

    2008-01-01

    Malassezia species are a part of the skin microflora of neonates. Under certain circumstances, they can cause diseases ranging from simple pustulosis to lifethreatening fungemia in newborn infants. Little information is available about the epidemiology of Malassezia species in neonates. In the present study, we successfully isolated Malassezia yeasts from 68.7% of hospitalized neonates. Using the polymerase chain reaction-restriction fragment length polymorphism method (PCR-RFPL), M. furfur (88.06%) was identified as the most isolated species, followed in frequency by M. globosa (10.48%), M. obtusa (0.73%), and M. slooffiae (0.73%). Among the variables studied, only a longer stay in the ward resulted in a higher colonization rate. Using multiple logistic regression, only the type of hospital and ward had some effects on the colonization rate. Our results supported the hypothesis that neonates acquire Malassezia flora through direct contact with their mothers or hospital personnel.

  11. Do wheelchairs spread pathogenic bacteria within hospital walls?

    PubMed

    Peretz, Avi; Koiefman, Anna; Dinisman, Eleonora; Brodsky, Diana; Labay, Kozitta

    2014-02-01

    Transmission of nosocomial pathogens has been linked to transient colonization of health care workers, medical devices and other constituents of patients' environment. In this paper we present our findings concerning the presence of pathogenic bacteria on wheelchairs, and the possibility that wheelchairs constitute a reservoir of these bacteria and a means of spreading them. In this work we examined four wheelchairs, each from a different location: the internal medicine ward, the emergency department, the general surgery ward and wheelchair stockpile of the transportation unit of the hospital. The samples were collected and cultured on different media. Bacterial identification and antimicrobial sensitivity testing were carried out using accepted practices in the microbiology laboratory. We found that wheelchairs are contaminated with several pathogenic bacteria, among them antibiotic-resistant strains such as MRSA, Pseudomonas aeruginosa, Acinetobacter baumanni etc. Since there is no specific guideline protocol that deals with disinfection and cleaning frequency of wheelchairs in hospitals, we suggest each hospital to write one.

  12. Improving the hospital environment for people with dementia.

    PubMed

    Bray, Jennifer; Evans, Simon; Bruce, Mary; Carter, Christine; Brooker, Dawn; Milosevic, Sarah; Thompson, Rachel; Longden, Jane; Robinson, Jennifer

    2015-11-01

    This article is the third in a series presenting examples of the positive work achieved by trusts who participated in the Royal College of Nursing's development programme to improve dementia care in acute hospitals. The hospital environment is often disorientating for people with dementia and can be particularly distressing when a patient is admitted in an emergency. Subsequent ward moves can also be disruptive and confusing, especially if they take place out of hours. Two NHS trusts aimed to improve the experience for patients with dementia by addressing the physical environment along with practical aspects of care provision at different stages in the hospital journey. The Queen Elizabeth Hospital King's Lynn NHS Foundation Trust in Norfolk enhanced its emergency department environment by redesigning four bays and an observation area to be dementia-friendly. The hospital has supported these changes by providing dementia awareness training for all staff in these areas. Walsall Healthcare NHS Trust focused on minimising ward moves by implementing procedures to identify patients who should not be moved. Since introducing the new process, adherence has been good and there have been fewer ward moves.

  13. Unlocking an acute psychiatric ward: the impact on unauthorised absences, assaults and seclusions.

    PubMed

    Beaglehole, Ben; Beveridge, John; Campbell-Trotter, Warren; Frampton, Chris

    2017-04-01

    Aims and method The acute psychiatric in-patient service in Christchurch, New Zealand, recently changed from two locked and two unlocked wards to four open wards. This provided the opportunity to evaluate whether shifting to an unlocked environment was associated with higher rates of adverse events, including unauthorised absences, violent incidents and seclusion. We compared long-term adverse event data before and after ward configuration change. Results Rates of unauthorised absences increased by 58% after the change in ward configuration (P = 0.005), but seclusion hours dropped by 53% (P = 0.001). A small increase in violent incidents was recorded but this was not statistically significant. Clinical implications Although unauthorised absences increased, the absence of statistically significant changes for violent incidents and a reduction in seclusion hours suggest that the change to a less restrictive environment may have some positive effects.

  14. Unlocking an acute psychiatric ward: the impact on unauthorised absences, assaults and seclusions

    PubMed Central

    Beaglehole, Ben; Beveridge, John; Campbell-Trotter, Warren; Frampton, Chris

    2017-01-01

    Aims and method The acute psychiatric in-patient service in Christchurch, New Zealand, recently changed from two locked and two unlocked wards to four open wards. This provided the opportunity to evaluate whether shifting to an unlocked environment was associated with higher rates of adverse events, including unauthorised absences, violent incidents and seclusion. We compared long-term adverse event data before and after ward configuration change. Results Rates of unauthorised absences increased by 58% after the change in ward configuration (P = 0.005), but seclusion hours dropped by 53% (P = 0.001). A small increase in violent incidents was recorded but this was not statistically significant. Clinical implications Although unauthorised absences increased, the absence of statistically significant changes for violent incidents and a reduction in seclusion hours suggest that the change to a less restrictive environment may have some positive effects.

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

    MedlinePlus

    ... Navigation Bar Home Current Issue Past Issues The Mind-Body Connection How to Fight Stress and Ward Off ... the question, Dr. Sternberg suggests meditation to rest body and mind. "Evidence shows that meditation bolsters immune function by ...

  16. Iranian nurses' experiences of aggression in psychiatric wards: a qualitative study.

    PubMed

    Moghadam, Malek Fereidooni; Pazargadi, Mehrnoosh; Khoshknab, Masoud Fallahi

    2013-10-01

    Aggression from psychiatric patients is a constant problem for care providers that causes major problems in the therapeutic environment, and may have negative effects on the quality of care. Since recognition of aggression with regard to cultural background leads to better control of aggression in the psychiatric wards, this study has been done to clarify Iranian nurses' experiences of aggression in psychiatric wards. A qualitative content analysis study was conducted to explore experiences of nurses. Data analysis revealed four themes: (1) Damage resulting from aggression, (2) Aggression catalysts, (3) Contagious nature of aggression, and (4) Various control strategies. There are various causes for in-patients' aggression, and nurses use various approaches to control it. These approaches are influenced by personnel, facilities, and ward environment. Identifying these factors and strategies can contribute to better management of aggression and, thus, better quality of care in psychiatric wards.

  17. Nurses' attire in a special hospital: perceptions of patients and staff.

    PubMed

    Brennan, W; Scully, W; Tarbuck, P; Young, C

    Nurses' uniforms have been the subject of ongoing debate in many areas. Following the Ashworth Hospital inquiry, two wards at the hospital piloted the wearing of casual clothes by nurses. Patients and nurses in these wards completed questionnaires to evaluate the effects of the change. The results showed that the patients felt casual clothes helped remove a 'them and us' distinction and enhanced nurse/patient relationships. Nurses found casual clothes to be more comfortable and practical. Although concern was expressed that, without uniform, nurses might not be readily identifiable in an emergency situation, the change to casual clothing was generally viewed positively by both patients and nurses.

  18. Dinucleotide circular codes and bijective transformations.

    PubMed

    Fimmel, Elena; Giannerini, Simone; Gonzalez, Diego Luis; Strüngmann, Lutz

    2015-12-07

    The presence of circular codes in mRNA coding sequences is postulated to be involved in informational mechanisms aimed at detecting and maintaining the normal reading frame during protein synthesis. Most of the recent research is focused on trinucleotide circular codes. However, also dinucleotide circular codes are important since dinucleotides are ubiquitous in genomes and associated to important biological functions. In this work we adopt the group theoretic approach used for trinucleotide codes in Fimmel et al. (2015) to study dinucleotide circular codes and highlight their symmetry properties. Moreover, we characterize such codes in terms of n-circularity and provide a graph representation that allows to visualize them geometrically. The results establish a theoretical framework for the study of the biological implications of dinucleotide circular codes in genomic sequences.

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

    PubMed Central

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

    1993-01-01

    OBJECTIVE--To determine whether the seeming excess of childhood leukaemia and lymphoma identified in Seascale, Cumbria, UK, remains unusual when put into a wider context. DESIGN--Analysis of cancer incidence by geographical area. SETTING--The north of England including the Northern and North Western Regional Health Authority regions and the Southport and South Sefton districts of the Mersey Regional Health Authority. SUBJECTS--Altogether 6686 cases of malignant disease in people under 25 years old. MEASUREMENTS AND MAIN RESULTS--Cases of cancer diagnosed before their 25th birthday between January 1968 and December 1985 identified from three regional cancer registries were allocated to a census ward on the basis of 'usual place of residence'. Population data were derived from the 1971 and 1981 censuses, and the cancer incidence was calculated for each ward. Of the 6686 cases, there were 1035 cases of acute lymphoblastic leukaemia and 361 of non-Hodgkins lymphoma. Wards were ranked by cancer incidence and Poisson probability, using different population bases. Seascale ward is the most highly ranked ward for acute lymphoblastic leukaemia for the time periods 1968-85 or 1968-76. It is not the most highly ranked for non-Hodgkins lymphoma. However, combining acute lymphoblastic leukaemia and non-Hodgkins lymphoma incidence gives an even more extreme position for Seascale. The most extreme Poisson probability for any of the analyses was that for brain tumours in the electoral ward of Ashton St Michael, Tameside (p = 0.000009). CONCLUSION--The incidence of acute lymphoblastic leukaemia and non-Hodgkins lymphoma in the Seascale ward remains high when put into a wider context. For other cancers there are wards with even more extreme Poisson probability values. PMID:8326267

  20. The Determination of TV Viewing Patterns in a Mental Hospital and Comment on Therapeutic Applications of This "Constant Companion."

    ERIC Educational Resources Information Center

    Jeffers, Dennis W.; And Others

    In view of recent studies of media use in mental hospitals showing that television is the predominant mass medium and one with great potential for therapy, a study was conducted to determine the patterns of television viewing in this environment. A total of 1,204 observations were made in five lounges on two wards of a mental hospital.…

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

    PubMed

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

    1999-01-01

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

  2. Realistic evaluation of Situation Awareness for Everyone (SAFE) on paediatric wards: study protocol

    PubMed Central

    Deighton, J; Edbrooke-Childs, J; Stapley, E; Sevdalis, N; Hayes, J; Gondek, D; Sharples, E; Lachman, P

    2016-01-01

    Introduction Evidence suggests that health outcomes for hospitalised children in the UK are worse than other countries in Europe, with an estimated 1500 preventable deaths in hospital each year. It is presumed that some of these deaths are due to unanticipated deterioration, which could have been prevented by earlier intervention, for example, sepsis. The Situation Awareness For Everyone (SAFE) intervention aims to redirect the ‘clinical gaze’ to encompass a range of prospective indicators of risk or deterioration, including clinical indicators and staff concerns, so that professionals can review relevant information for any given situation. Implementing the routine use of huddles is central to increasing situation awareness in SAFE. Methods and analysis In this article, we describe the realistic evaluation framework within which we are evaluating the SAFE programme. Multiple methods and data sources are used to help provide a comprehensive understanding of what mechanisms for change are triggered by an intervention and how they have an impact on the existing social processes sustaining the behaviour or circumstances that are being targeted for change. Ethics and dissemination Ethics approval was obtained from London—Dulwich Research Ethics Committee (14/LO/0875). It is anticipated that the findings will enable us to understand what the important elements of SAFE and the huddle are, the processes by which they might be effective and—given the short timeframes of the project—initial effects of the intervention on outcomes. The present research will add to the extant literature by providing the first evidence of implementation of SAFE and huddles in paediatric wards in the UK. PMID:28039297

  3. Interprofessional Collaboration on an Internal Medicine Ward: Role Perceptions and Expectations among Nurses and Residents

    PubMed Central

    Muller-Juge, Virginie; Cullati, Stéphane; Blondon, Katherine S.; Hudelson, Patricia; Maître, Fabienne; Vu, Nu V.; Savoldelli, Georges L.; Nendaz, Mathieu R.

    2013-01-01

    Background Effective interprofessional collaboration requires that team members share common perceptions and expectations of each other's roles. Objective Describe and compare residents’ and nurses’ perceptions and expectations of their own and each other’s professional roles in the context of an Internal Medicine ward. Methods A convenience sample of 14 residents and 14 nurses volunteers from the General Internal Medicine Division at the University Hospitals of Geneva, Switzerland, were interviewed to explore their perceptions and expectations of residents’ and nurses’ professional roles, for their own and the other profession. Interviews were analysed using thematic content analysis. The same respondents also filled a questionnaire asking their own intended actions and the expected actions from the other professional in response to 11 clinical scenarios. Results Three main themes emerged from the interviews: patient management, clinical reasoning and decision-making processes, and roles in the team. Nurses and residents shared general perceptions about patient management. However, there was a lack of shared perceptions and expectations regarding nurses’ autonomy in patient management, nurses’ participation in the decision-making process, professional interdependence, and residents’ implication in teamwork. Results from the clinical scenarios showed that nurses’ intended actions differed from residents’ expectations mainly regarding autonomy in patient management. Correlation between residents’ expectations and nurses’ intended actions was 0.56 (p = 0.08), while correlation between nurses’ expectations and residents’ intended actions was 0.80 (p<0.001). Conclusions There are discordant perceptions and unmet expectations among nurses and residents about each other’s roles, including several aspects related to the decision-making process. Interprofessional education should foster a shared vision of each other’s roles and clarify

  4. Prospective study analyzing risk factors and characteristics of healthcare-associated infections in a Urology ward

    PubMed Central

    Sopeña-Sutil, Raquel; Benítez-Sala, Raúl; Lara-Isla, Alba; Alonso-Isa, Manuel; Gil-Moradillo, Javier; Justo-Quintas, Juan; García-Rojo, Esther; González-Padilla, Daniel Antonio; Passas-Martínez, Juan Bautista; Tejido-Sánchez, Ángel

    2017-01-01

    Purpose Healthcare-associated infections (HAIs) in urological patients have special features due to specific risk factors. Our objective was to evaluate the characteristics and risk factors for HAIs in patients hospitalized in a Urology ward. Materials and Methods We evaluated prospectively, from 2012 to 2015, the incidence, types and risk factor for HAIs, microbiological and resistance patterns. Results The incidence of HAIs was 6.3%. The most common types were urinary infections (70.5%) and surgical site infections (22.1%). Univariate analysis showed an increased risk of HAIs among patients with American Society of Anesthesiologists physical status classification system III–IV (odds ratio [OR], 1.39; p<0.001), immunosuppression (OR, 1.80; p=0.013), previous urinary infection (OR, 4.46; p<0,001), and urinary catheter before admission (OR, 1.74; p<0.001). The surgical procedures with the highest incidence of HAIs were radical cystectomy (54.2%) and renal surgery (8.7%). The most frequently isolated microorganisms were Escherichia coli (25.1%), Enterococcus spp. (17.5%), Klebsiella spp. (13.5%) and Pseudomonas aeruginosa (12.3%). Enterococcus sp was the most common microorganism after radical cystectomy and in surgical site infections, E. coli showed resistance rates of 53.5% for fluoroquinolones, 9.3% for amikacin. The percentage of extended-spectrum betalactamase producing E. coli was 24.7%. Klebsiella spp. showed resistance rates of 47.8% for fluoroquinolones, 7.1% for amikacin and 4.3% for carbapenems. Enterococcus spp showed resistance rates of 1.7% for vancomycin and; P. aeruginosa of 33.3% for carbapenems and 26.2% for amikacin. Conclusions Comorbidities, previous urinary infections, and urinary catheter are risk factors for HAIs. The microorganisms most commonly isolated were E. coli, Enterococcus and P. aeruginosa. Prospective monitoring may decrease the incidence of infections. PMID:28097270

  5. Aggression in Psychiatric Wards: Effect of the Use of a Structured Risk Assessment.

    PubMed

    Hvidhjelm, Jacob; Sestoft, Dorte; Skovgaard, Lene Theil; Rasmussen, Kirsten; Almvik, Roger; Bue Bjorner, Jakob

    2016-12-01

    Health care workers are often exposed to violence and aggression in psychiatric settings. Short-term risk assessments, such as the Brøset Violence Checklist (BVC), are strong predictors of such aggression and may enable staff to take preventive measures against aggression. This study evaluated whether the routine use of the BVC could reduce the frequency of patient aggression. We conducted a study with a semi-random regression discontinuity design in 15 psychiatric wards. Baseline aggression risk was assessed using the Aggression Observation Short Form (AOS) over three months. The BVC was implemented in seven intervention wards, and the risk of aggressive incidents over three months of follow-up was compared with the risk in eight control wards. The analysis was conducted at the ward level because each ward was allocated to the intervention and control groups. At baseline, the risk of aggression varied between wards, from one aggressive incident per patient per 1,000 shifts to 147 aggressive incidents per patient per 1,000 shifts. The regression discontinuity analysis found a 45% reduction in the risk of aggression (Odds Ratio (OR) = 0.55, 95% confidence interval: 0.21-1.43). The study did not find a significant reduction in the risk of aggression after implementing a systematic short-term risk assessment with the BVC. Although our findings suggest that use of the BVC may reduce the risk of aggression, the results need to be confirmed in studies with more statistical power.

  6. Occurrence of Medication Errors and Comparison of Manual and Computerized Prescription Systems in Public Sector Hospitals in Lahore, Pakistan

    PubMed Central

    Riaz, Muhammad Kashif; Hashmi, Furqan Khurshid; Bukhari, Nadeem Irfan; Riaz, Mohammad; Hussain, Khalid

    2014-01-01

    The knowledge of medication errors is an essential prerequisite for better healthcare delivery. The present study investigated prescribing errors in prescriptions from outpatient departments (OPDs) and emergency wards of two public sector hospitals in Lahore, Pakistan. A manual prescription system was followed in Hospital A. Hospital B was running a semi-computerised prescription system in the OPD and a fully computerised prescription system in the emergency ward. A total of 510 prescriptions from both departments of these two hospitals were evaluated for patient characteristics, demographics and medication errors. The data was analysed using a chi square test for comparison of errors between both the hospitals. The medical departments in OPDs of both hospitals were the highest prescribers at 45%–60%. The age group receiving the most treatment in emergency wards of both the hospitals was 21–30 years (21%–24%). A trend of omitting patient addresses and diagnoses was observed in almost all prescriptions from both of the hospitals. Nevertheless, patient information such as name, age, gender and legibility of the prescriber’s signature were found in almost 100% of the electronic-prescriptions. In addition, no prescribing error was found pertaining to drug concentrations, quantity and rate of administration in e-prescriptions. The total prescribing errors in the OPD and emergency ward of Hospital A were found to be 44% and 60%, respectively. In hospital B, the OPD had 39% medication errors and the emergency department had 73.5% errors; this unexpected difference between the emergency ward and OPD of hospital B was mainly due to the inclusion of 69.4% omissions of route of administration in the prescriptions. The incidence of prescription overdose was approximately 7%–19% in the manual system and approximately 8% in semi and fully electronic system. The omission of information and incomplete information are contributors of prescribing errors in both manual and

  7. Occurrence of medication errors and comparison of manual and computerized prescription systems in public sector hospitals in Lahore, Pakistan.

    PubMed

    Riaz, Muhammad Kashif; Hashmi, Furqan Khurshid; Bukhari, Nadeem Irfan; Riaz, Mohammad; Hussain, Khalid

    2014-01-01

    The knowledge of medication errors is an essential prerequisite for better healthcare delivery. The present study investigated prescribing errors in prescriptions from outpatient departments (OPDs) and emergency wards of two public sector hospitals in Lahore, Pakistan. A manual prescription system was followed in Hospital A. Hospital B was running a semi-computerised prescription system in the OPD and a fully computerised prescription system in the emergency ward. A total of 510 prescriptions from both departments of these two hospitals were evaluated for patient characteristics, demographics and medication errors. The data was analysed using a chi square test for comparison of errors between both the hospitals. The medical departments in OPDs of both hospitals were the highest prescribers at 45%-60%. The age group receiving the most treatment in emergency wards of both the hospitals was 21-30 years (21%-24%). A trend of omitting patient addresses and diagnoses was observed in almost all prescriptions from both of the hospitals. Nevertheless, patient information such as name, age, gender and legibility of the prescriber's signature were found in almost 100% of the electronic-prescriptions. In addition, no prescribing error was found pertaining to drug concentrations, quantity and rate of administration in e-prescriptions. The total prescribing errors in the OPD and emergency ward of Hospital A were found to be 44% and 60%, respectively. In hospital B, the OPD had 39% medication errors and the emergency department had 73.5% errors; this unexpected difference between the emergency ward and OPD of hospital B was mainly due to the inclusion of 69.4% omissions of route of administration in the prescriptions. The incidence of prescription overdose was approximately 7%-19% in the manual system and approximately 8% in semi and fully electronic system. The omission of information and incomplete information are contributors of prescribing errors in both manual and electronic

  8. Circular permutant GFP insertion folding reporters

    SciTech Connect

    Waldo, Geoffrey S.; Cabantous, Stephanie

    2013-04-16

    Provided are methods of assaying and improving protein folding using circular permutants of fluorescent proteins, including circular permutants of GFP variants and combinations thereof. The invention further provides various nucleic acid molecules and vectors incorporating such nucleic acid molecules, comprising polynucleotides encoding fluorescent protein circular permutants derived from superfolder GFP, which polynucleotides include an internal cloning site into which a heterologous polynucleotide may be inserted in-frame with the circular permutant coding sequence, and which when expressed are capable of reporting on the degree to which a polypeptide encoded by such an inserted heterologous polynucleotide is correctly folded by correlation with the degree of fluorescence exhibited.

  9. Circular permutant GFP insertion folding reporters

    DOEpatents

    Waldo, Geoffrey S.; Cabantous, Stephanie

    2008-06-24

    Provided are methods of assaying and improving protein folding using circular permutants of fluorescent proteins, including circular permutants of GFP variants and combinations thereof. The invention further provides various nucleic acid molecules and vectors incorporating such nucleic acid molecules, comprising polynucleotides encoding fluorescent protein circular permutants derived from superfolder GFP, which polynucleotides include an internal cloning site into which a heterologous polynucleotide may be inserted in-frame with the circular permutant coding sequence, and which when expressed are capable of reporting on the degree to which a polypeptide encoded by such an inserted heterologous polynucleotide is correctly folded by correlation with the degree of fluorescence exhibited.

  10. Circular permutant GFP insertion folding reporters

    DOEpatents

    Waldo, Geoffrey S; Cabantous, Stephanie

    2013-02-12

    Provided are methods of assaying and improving protein folding using circular permutants of fluorescent proteins, including circular permutants of GFP variants and combinations thereof. The invention further provides various nucleic acid molecules and vectors incorporating such nucleic acid molecules, comprising polynucleotides encoding fluorescent protein circular permutants derived from superfolder GFP, which polynucleotides include an internal cloning site into which a heterologous polynucleotide may be inserted in-frame with the circular permutant coding sequence, and which when expressed are capable of reporting on the degree to which a polypeptide encoded by such an inserted heterologous polynucleotide is correctly folded by correlation with the degree of fluorescence exhibited.

  11. Circular permutant GFP insertion folding reporters

    DOEpatents

    Waldo, Geoffrey S.; Cabantous, Stephanie

    2011-06-14

    Provided are methods of assaying and improving protein folding using circular permutants of fluorescent proteins, including circular permutants of GFP variants and combinations thereof. The invention further provides various nucleic acid molecules and vectors incorporating such nucleic acid molecules, comprising polynucleotides encoding fluorescent protein circular permutants derived from superfolder GFP, which polynucleotides include an internal cloning site into which a heterologous polynucleotide may be inserted in-frame with the circular permutant coding sequence, and which when expressed are capable of reporting on the degree to which a polypeptide encoded by such an inserted heterologous polynucleotide is correctly folded by correlation with the degree of fluorescence exhibited.

  12. A national survey of inpatient medication systems in English NHS hospitals

    PubMed Central

    2014-01-01

    Background Systems and processes for prescribing, supplying and administering inpatient medications can have substantial impact on medication administration errors (MAEs). However, little is known about the medication systems and processes currently used within the English National Health Service (NHS). This presents a challenge for developing NHS-wide interventions to increase medication safety. We therefore conducted a cross-sectional postal census of medication systems and processes in English NHS hospitals to address this knowledge gap. Methods The chief pharmacist at each of all 165 acute NHS trusts was invited to complete a questionnaire for medical and surgical wards in their main hospital (July 2011). We report here the findings relating to medication systems and processes, based on 18 closed questions plus one open question about local medication safety initiatives. Non-respondents were posted another questionnaire (August 2011), and then emailed (October 2011). Results One hundred (61% of NHS trusts) questionnaires were returned. Most hospitals used paper-based prescribing on the majority of medical and surgical inpatient wards (87% of hospitals), patient bedside medication lockers (92%), patients’ own drugs (89%) and ‘one-stop dispensing’ medication labelled with administration instructions for use at discharge as well as during the inpatient stay (85%). Less prevalent were the use of ward pharmacy technicians (62% of hospitals) or pharmacists (58%) to order medications on the majority of wards. Only 65% of hospitals used drug trolleys; 50% used patient-specific inpatient supplies on the majority of wards. Only one hospital had a pharmacy open 24 hours, but all had access to an on-call pharmacist. None reported use of unit-dose dispensing; 7% used an electronic drug cabinet in some ward areas. Overall, 85% of hospitals had a double-checking policy for intravenous medication and 58% for other specified drugs. “Do not disturb” tabards

  13. Cancer Ward Staff Group: An Intervention Designed to Prevent Disaster.

    ERIC Educational Resources Information Center

    Barber, William H.

    1985-01-01

    Describes a case study illustrating organizational and system contingencies for introducing and maintaining a support group for oncology nursing staff in a large general hospital culture. Criteria for long-run survivability of innovation in a work system are applied to a group structured like that described by Balint for training physicians in…

  14. 76 FR 62148 - Title VI; Proposed Circular, Environmental Justice; Proposed Circular

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-10-06

    ... Federal Transit Administration Title VI; Proposed Circular, Environmental Justice; Proposed Circular AGENCY: Federal Transit Administration (FTA), DOT. ACTION: Notice; correction. SUMMARY: This notice... program questions, Amber Ontiveros, Office of Civil Rights, Federal Transit Administration, 1200...

  15. Improving capacity and consent to treatment recording in psychiatric inpatient wards: A multi-centre quality improvement project

    PubMed Central

    Li, Ching; Stellman, Judith; Patel, Nitisha; Dalton, Florence

    2016-01-01

    Assessment of mental capacity provides an ethical and legal framework for care which values patients' autonomy whilst recognising the instances where it is appropriate to act in patients' best interests. Existing medical literature indicates that mental capacity is poorly documented in psychiatric inpatient settings. The aim of the project was to examine the frequency of capacity and consent to treatment documentation with a view to creating changes in practice by raising awareness about the importance of assessing and documenting mental capacity. A multi-centre quality improvement project was conducted in September 2014 across all general adult psychiatric inpatient wards in the North Central London Training Scheme. The frequency of documentation of capacity and consent to treatment for all adult psychiatric inpatient wards across North Central London was measured. Electronic patient notes were audited retrospectively to ascertain whether capacity and consent to treatment on admission, and within the preceding seven days of data collection, was recorded. Data was collected across three successive time points during a 12 month period following the implementation of changes. A total of 232 patients were included in the baseline measurements. The results highlighted a deficiency in the recording of capacity and consent to treatment for adult psychiatric inpatients. The results showed that, of the patients audited, 49.8% had their capacity and consent to treatment assessed on admission, 61.9% had a capacity assessment in the previous 7 days and 60.5% had consent recorded in the previous 7 days. These findings were presented at local hospital teaching sessions at each of the audited sites. These sessions also gave teaching on mental capacity. Audit cycle 1 was conducted 6 months later, this included 213 patients and showed a 30% improvement in the frequency of documentation across all measures. The results showed that 77% of patients audited had their capacity and

  16. Improving capacity and consent to treatment recording in psychiatric inpatient wards: A multi-centre quality improvement project.

    PubMed

    Li, Ching; Stellman, Judith; Patel, Nitisha; Dalton, Florence

    2016-01-01

    Assessment of mental capacity provides an ethical and legal framework for care which values patients' autonomy whilst recognising the instances where it is appropriate to act in patients' best interests. Existing medical literature indicates that mental capacity is poorly documented in psychiatric inpatient settings. The aim of the project was to examine the frequency of capacity and consent to treatment documentation with a view to creating changes in practice by raising awareness about the importance of assessing and documenting mental capacity. A multi-centre quality improvement project was conducted in September 2014 across all general adult psychiatric inpatient wards in the North Central London Training Scheme. The frequency of documentation of capacity and consent to treatment for all adult psychiatric inpatient wards across North Central London was measured. Electronic patient notes were audited retrospectively to ascertain whether capacity and consent to treatment on admission, and within the preceding seven days of data collection, was recorded. Data was collected across three successive time points during a 12 month period following the implementation of changes. A total of 232 patients were included in the baseline measurements. The results highlighted a deficiency in the recording of capacity and consent to treatment for adult psychiatric inpatients. The results showed that, of the patients audited, 49.8% had their capacity and consent to treatment assessed on admission, 61.9% had a capacity assessment in the previous 7 days and 60.5% had consent recorded in the previous 7 days. These findings were presented at local hospital teaching sessions at each of the audited sites. These sessions also gave teaching on mental capacity. Audit cycle 1 was conducted 6 months later, this included 213 patients and showed a 30% improvement in the frequency of documentation across all measures. The results showed that 77% of patients audited had their capacity and

  17. A study of medication errors in a tertiary care hospital

    PubMed Central

    Patel, Nrupal; Desai, Mira; Shah, Samdih; Patel, Prakruti; Gandhi, Anuradha

    2016-01-01

    Objective: To determine the nature and types of medication errors (MEs), to evaluate occurrence of drug-drug interactions (DDIs), and assess rationality of prescription orders in a tertiary care teaching hospital. Materials and Methods: A prospective, observational study was conducted in General Medicine and Pediatric ward of Civil Hospital, Ahmedabad during October 2012 to January 2014. MEs were categorized as prescription error, dispensing error, and administration error (AE). The case records and treatment charts were reviewed. The investigator also accompanied the staff nurse during the ward rounds and interviewed patients or care taker to gather information, if necessary. DDIs were assessed by Medscape Drug Interaction Checker software (version 4.4). Rationality of prescriptions was assessed using Phadke's criteria. Results: A total of 1109 patients (511 in Medicine and 598 in Pediatric ward) were included during the study period. Total number of MEs was 403 (36%) of which, 195 (38%) were in Medicine and 208 (35%) were in Pediatric wards. The most common ME was PEs 262 (65%) followed by AEs 126 (31%). A potential significant DDIs were observed in 191 (17%) and serious DDIs in 48 (4%) prescriptions. Majority of prescriptions were semirational 555 (53%) followed by irrational 317 (30%), while 170 (17%) prescriptions were rational. Conclusion: There is a need to establish ME reporting system to reduce its incidence and improve patient care and safety. PMID:27843792

  18. Tests on Stiffened Circular Cylinders

    NASA Technical Reports Server (NTRS)

    Holt, Marshall

    1941-01-01

    Compressive tests were made of two series of stiffened circular cylindrical shells under axial load. All the shells were 16 inches in diameter by 24 inches in length and were made of aluminum-alloy sheet curved to the proper radius and welded with one longitudinal weld. The ratios of diameter to thickness of shell wall in the two series of specimens were 258 and 572. Strains were measured with Huggenberger tensometers at a number of gage lines on the stiffeners and shell. The results of these tests indicate that a spacing of circumferential stiffeners equal to 0.67 times the radius is too great to strengthen the shell wall appreciably. The results are not inclusive enough to show the optimum in stiffeners. Plain cylinders without stiffeners developed ultimate strengths approximately half as great as the buckling strengths computed by the equation resulting from the classical theory and slightly greater than those computed by Donnell's large deflection theory.

  19. Pattern of antibiotic prescription and resistance profile of common bacterial isolates in the internal medicine wards of a tertiary referral centre in Nigeria.

    PubMed

    Iliyasu, Garba; Dayyab, Farouq M; Bolaji, Tiamiyu A; Habib, Zaiyad G; Takwashe, Isa M; Habib, Abdulrazaq G

    2015-06-01

    Indiscriminate and excessive use of antibiotics is the major driver to the development of bacterial resistance, which is now a global challenge. Information regarding antibiotic use in Nigerian hospitals is lacking. This study examined the pattern of antibiotic prescription in a tertiary hospital in Nigeria. In a retrospective survey, case records of patients who were admitted into the medical wards over a 6-month period were reviewed. A pre-formed questionnaire was administered that sought information such as sociodemographic data, drug data, basis of prescription and other relevant information on all patients who received antibiotics. Data were analysed using SPSS for Windows v.16. Of 412 patients admitted into the internal medicine ward during the study period, 202 (49.0%) received antibiotics, of whom 125 (61.9%) received more than one antibiotic. Overall there were 334 antibiotic prescriptions. Community-acquired pneumonia (67/202; 33.2%) was the leading cause of antibiotic prescription, and ceftriaxone (132/334; 39.5%) was the most commonly prescribed antibiotic. The parenteral route was the commonest route of administration (270/334; 80.8%) and most of the prescriptions were empirical (323/334; 96.7%). Antimicrobial resistance among common bacterial isolates was noted. Inappropriate antibiotic prescription is common. There was frequent use of third-generation cephalosporins as empirical therapy, with de-escalation in only a handful of cases. This highlights the need for introduction of antibiotic guidelines.

  20. Effects of sharing information on drug administration errors in pediatric wards: a pre–post intervention study

    PubMed Central

    Chua, Siew-Siang; Choo, Sim-Mei; Sulaiman, Che Zuraini; Omar, Asma; Thong, Meow-Keong

    2017-01-01

    Background and purpose Drug administration errors are more likely to reach the patient than other medication errors. The main aim of this study was to determine whether the sharing of information on drug administration errors among health care providers would reduce such problems. Patients and methods This study involved direct, undisguised observations of drug administrations in two pediatric wards of a major teaching hospital in Kuala Lumpur, Malaysia. This study consisted of two phases: Phase 1 (pre-intervention) and Phase 2 (post-intervention). Data were collected by two observers over a 40-day period in both Phase 1 and Phase 2 of the study. Both observers were pharmacy graduates: Observer 1 just completed her undergraduate pharmacy degree, whereas Observer 2 was doing her one-year internship as a provisionally registered pharmacist in the hospital under study. A drug administration error was defined as a discrepancy between the drug regimen received by the patient and that intended by the prescriber and also drug administration procedures that did not follow standard hospital policies and procedures. Results from Phase 1 of the study were analyzed, presented and discussed with the ward staff before commencement of data collection in Phase 2. Results A total of 1,284 and 1,401 doses of drugs were administered in Phase 1 and Phase 2, respectively. The rate of drug administration errors reduced significantly from Phase 1 to Phase 2 (44.3% versus 28.6%, respectively; P<0.001). Logistic regression analysis showed that the adjusted odds of drug administration errors in Phase 1 of the study were almost three times that in Phase 2 (P<0.001). The most common types of errors were incorrect administration technique and incorrect drug preparation. Nasogastric and intravenous routes of drug administration contributed significantly to the rate of drug administration errors. Conclusion This study showed that sharing of the types of errors that had occurred was significantly

  1. Inpatient Opioid Withdrawal Management of Street Children and Adolescents Admitted to Child and Adolescent Psychiatric Ward: A Preliminary Case Series

    PubMed Central

    Firouzkouhi Moghadam, Mahboubeh; Hashemian, Seyed-Sepehr; Pishjoo, Masoud; Ghasemi, Sanaz; Hajebi, Ahmad; Noroozi, Alireza

    2016-01-01

    Background About 10 million children worldwide live or work on the street. International reports estimate the prevalence of substance use among street children to be between 25% - 90%, which is who were referredntal disorders and high-risk behaviors. Objectives The objective of this study was to report the outcomes of assisted withdrawal of opioid-dependent vulnerable children and adolescents who were referred to child and adolescent psychiatric ward of Ali Ebne Abitaleb hospital, an academic hospital in Zahedan city. Methods Clinical chart abstractions were performed on a convenience sample of 40 serial opioid-dependent street children and adolescents (mean age: 11.14 ± 3.6 years) who were referred to child and adolescent psychiatric ward of Ali Ebne Abitaleb treatment and research center from November 2014 to May 2015. The demographic data, drug use history, comorbid physical and psychiatric conditions, symptomatology of opioid withdrawal syndrome, pharmacotherapies and psychosocial services, length of hospital stay, and any adverse events were extracted from the patients’ files using a checklist developed by the authors. Results Twenty-four (60%) patients were male, and 16 (40%) were female. The main drug used by all patients was opioids. Heroin Kerack (which has a street name of crystal in southeast Iran) was the most common (75%) drug of use, followed by opium (10%) and opium residue (7.5%). None of the participants self-reported using injected drugs. The high rate of a lack of eligibility for guardianship was documented among parents (87.5%) mainly due to their use of illegal drugs. Musculoskeletal pain and diarrhea were the most common withdrawal symptoms of the patients upon admission. The mean length of stay was 10.8 (± 7.30) days, and no significant adverse events were reported during the symptomatic treatment of opioid withdrawal syndrome. Conclusions To our knowledge, this is the first study to report on the safety and feasibility of inpatient

  2. Drug Utilization on Neonatal Wards: A Systematic Review of Observational Studies

    PubMed Central

    Rosli, Rosliana; Dali, Ahmad Fauzi; Abd Aziz, Noorizan; Abdullah, Amir Heberd; Ming, Long Chiau; Manan, Mohamed Mansor

    2017-01-01

    Despite limited evidence on safety and efficacy of drug use in neonates, drugs are extensively used in this age group. However, the availability of information on drug consumption in neonates, especially inpatient neonates, is limited. This paper systematically reviews published studies on drug utilization in hospitalized neonates. A systematic literature review was carried out to identify observational studies published from inception of databases used till August 2016. Four search engines, namely Medline, CINAHL, Embase, and PubMed, were used. Publications written in English that described drug utilization in neonatal wards were selected. Assessment of the data was based on the category of the study design, the objective of study and the method used in reporting drug consumption. A total of 20 drug utilization studies were identified, 12 of which focused on all drug classes, while the other eight evaluated antimicrobials. Studies were reported in Europe (n = 7), the United States (n = 6), India (n = 5), Brazil (n = 1), and Iran (n = 1). Substantial variance with regard to study types (study design and methods), data source, and sample size were found among the selected studies. Of the studies included, 45% were cross-sectional or retrospective, 40% were prospective studies, and the remaining 15% were point prevalence surveys. More than 70% of the studies were descriptive studies, describing drug consumption patterns. Fifteen per cent of the descriptive studies evaluated changes in drug utilization patterns in neonates. Volume of units was the most prevalent method used for reporting all drug categories. The ATC/DDD system for reporting drug use was only seen in studies evaluating antimicrobials. The most commonly reported drugs across all studies are anti-infectives for systemic use, followed by drugs for the cardiovascular system, the nervous system and the respiratory system. Ampicillin and gentamicin were the most prescribed antimicrobials in hospitalized

  3. Drug Utilization on Neonatal Wards: A Systematic Review of Observational Studies.

    PubMed

    Rosli, Rosliana; Dali, Ahmad Fauzi; Abd Aziz, Noorizan; Abdullah, Amir Heberd; Ming, Long Chiau; Manan, Mohamed Mansor

    2017-01-01

    Despite limited evidence on safety and efficacy of drug use in neonates, drugs are extensively used in this age group. However, the availability of information on drug consumption in neonates, especially inpatient neonates, is limited. This paper systematically reviews published studies on drug utilization in hospitalized neonates. A systematic literature review was carried out to identify observational studies published from inception of databases used till August 2016. Four search engines, namely Medline, CINAHL, Embase, and PubMed, were used. Publications written in English that described drug utilization in neonatal wards were selected. Assessment of the data was based on the category of the study design, the objective of study and the method used in reporting drug consumption. A total of 20 drug utilization studies were identified, 12 of which focused on all drug classes, while the other eight evaluated antimicrobials. Studies were reported in Europe (n = 7), the United States (n = 6), India (n = 5), Brazil (n = 1), and Iran (n = 1). Substantial variance with regard to study types (study design and methods), data source, and sample size were found among the selected studies. Of the studies included, 45% were cross-sectional or retrospective, 40% were prospective studies, and the remaining 15% were point prevalence surveys. More than 70% of the studies were descriptive studies, describing drug consumption patterns. Fifteen per cent of the descriptive studies evaluated changes in drug utilization patterns in neonates. Volume of units was the most prevalent method used for reporting all drug categories. The ATC/DDD system for reporting drug use was only seen in studies evaluating antimicrobials. The most commonly reported drugs across all studies are anti-infectives for systemic use, followed by drugs for the cardiovascular system, the nervous system and the respiratory system. Ampicillin and gentamicin were the most prescribed antimicrobials in hospitalized

  4. Home management of hematological patients requiring hospital admission.

    PubMed

    Isaia, Gianluca; Tibaldi, Vittoria; Astengo, Marco; Ladetto, Marco; Marinello, Renata; Bo, Mario; Michelis, Giuliana; Ruatta, Fiorella; Ricauda, Nicoletta Aimonino

    2010-01-01

    The hospital-at-home service (HHS) could be considered as an alternative to the traditional ward for elderly patients. We aimed at evaluating the home management of elderly people requiring transfusions. The ever-increasing demand on acute hospital services requires alternative methods of delivering all aspects of health care. HHS demonstrated to be as efficacious as a traditional ward for elderly and functionally compromised patients. The method was a retrospective descriptive study enrolling patients needing an hospital admission from 1st January 2007 to 31st December 2007 and reporting an hematological discharge's diagnosis as primary or secondary diagnosis. A total of 54 patients were evaluated in this study. Of them, 34 (62.9%) needed a hemocomponent transfusion for a total volume of 112 blood units and 49 platelet pools. Patients requiring at least one blood or platelet transfusion were more functionally compromised and presented a higher level of acute physiology and chronic health evaluation, compared to the non-transfused ones. The conclusion was that hematological subjects mainly the frail ones and functionally highly compromised with acute illnesses could be treated at home as an alternative of the traditional medical ward. This could be the starting point for future studies that will be able to increase the power of hospital-at-home service for this type of patients.

  5. Creation operators for Cartesian and circular beams.

    PubMed

    Siguenza-Torres, Anibal; Gutiérrez-Vega, Julio C

    2016-05-01

    Creation operators of fractional order, to derive the general Cartesian beams and circular beams from the lowest-order Gaussian beam, are introduced and discussed. Finding the creation operator for these general cases is a way to find the creation operator of all the special cases of Cartesian and circular beams.

  6. A Random Walk on a Circular Path

    ERIC Educational Resources Information Center

    Ching, W.-K.; Lee, M. S.

    2005-01-01

    This short note introduces an interesting random walk on a circular path with cards of numbers. By using high school probability theory, it is proved that under some assumptions on the number of cards, the probability that a walker will return to a fixed position will tend to one as the length of the circular path tends to infinity.

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

    PubMed Central

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

    2015-01-01

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

  8. Understanding hospitality.

    PubMed

    Patten, C S

    1994-03-01

    Bridging patient/"customer" issues and business aspects can be aided through developing a specific nursing basis for hospitality. The ancient practice of hospitality has evolved into three distinct levels: public, personal and therapeutic. Understanding these levels is helpful in integrating various dimensions of guest relations programs in hospitals into a more comprehensive vision. Hospitality issues must become a greater part of today's nursing management.

  9. Circular motion in NUT space-time

    NASA Astrophysics Data System (ADS)

    Jefremov, Paul I.; Perlick, Volker

    2016-12-01

    We consider circular motion in the NUT (Newman-Unti-Tamburino) space-time. Among other things, we determine the location of circular time-like geodesic orbits, in particular of the innermost stable circular orbit (ISCO) and of the marginally bound circular orbit. Moreover, we discuss the von Zeipel cylinders with respect to the stationary observers and with respect to the zero angular momentum observers (ZAMOs). We also investigate the relation of von Zeipel cylinders to inertial forces, in particular in the ultra-relativistic limit. Finally, we generalise the construction of thick accretion tori (‘Polish doughnuts’) which are well known on the Schwarzschild or Kerr background to the case of the NUT metric. We argue that, in principle, an NUT source could be distinguished from a Schwarzschild or Kerr source by observing the features of circular matter flows in its neighbourhood.

  10. Report: The assessment of hospital waste management:a case study in Tehran.

    PubMed

    Arab, Mohammad; Baghbani, Rouhollah Askari; Tajvar, Maryam; Pourreza, Abolghasem; Omrani, Ghasemali; Mahmoudi, Mahmoud

    2008-06-01

    Hospital waste management is an important process that must be dealt with diligently. The management of hazardous waste material requires specific knowledge and regulations and it must be carried out by specialists in the field. In this cross-sectional study, we assessed the main stages of hospital waste management including separation, containment, removal and disposal of waste materials in public hospitals affiliated with Tehran University of Medical Sciences (TUMS). We selected 108 units of six hospitals (three general hospitals and three subspecialty hospitals) from those hospitals supervised by TUMS using the cluster sampling method. The measurement was conducted through a questionnaire and direct observation by researchers. Association analysis was done by statistical tests; Fisher exact test and chi-squared using SPSS software. According to the results obtained by the questionnaire, most of the studied wards scored moderately in terms of quality of their performance in all stages of waste management. About one-fifth of the wards were suffering from poor management of their medical waste and only a minority of wards obtained good scores for managing their waste materials. The findings also revealed significant associations between temporary waste storage and collection and the level of education of the managers (P = 0.040, P = 0.050, respectively). In summary, the study indicated a moderate management in all processes of separation, collection, containment, removal and disposal of waste materials in hospitals with several observed problems in the process.

  11. [Incorporation of the hospital into modern technology].

    PubMed

    Foucault, M

    1978-01-01

    This address traces the emergence of the hospital in the 18th century as a facility for combating disease and tending to the sick. Reference is made to the reports of Tenon and Howard on hospitals in several European countries, which instead of considering the hospital as a mere architectural object make recommendations based on the numbers of beds of an institution, its usable space, the dimensions of wards, mortaility rates, etc.; the result is a new functional concept of the medical and physical organization of the hospital. The author delves into the characteristics of the hospital and medical practice in the Middle Ages, the 17th and 18th centuries, and since the middle of the 18th. He brings out the direct relationship of hospital organization to the economic regulations that emerged with mercantilism. He stresses the importance of man for social and military development on the one hand, and, on the other hand, to the application of a technology that could be described as political: the discipline. He is of the view that the introduction of disciplinary mechanisms in the confused environment of the hospital permitted its "medicalization" and the development of the medical-therapeutic hospital.

  12. An integrated hospital information system in Geneva.

    PubMed

    Scherrer, J R; Baud, R H; Hochstrasser, D; Ratib, O

    1990-01-01

    Since the initial design phase from 1971 to 1973, the DIOGENE hospital information system at the University Hospital of Geneva has been treated as a whole and has retained its architectural unity, despite the need for modification and extension over the years. In addition to having a centralized patient database with the mechanisms for data protection and recovery of a transaction-oriented system, the DIOGENE system has a centralized pool of operators who provide support and training to the users; a separate network of remote printers that provides a telex service between the hospital buildings, offices, medical departments, and wards; and a three-component structure that avoids barriers between administrative and medical applications. In 1973, after a 2-year design period, the project was approved and funded. The DIOGENE system has led to more efficient sharing of costly resources, more rapid performance of administrative tasks, and more comprehensive collection of information about the institution and its patients.

  13. The introduction of generic workers into the ward team: an exploratory study.

    PubMed

    Anderson, L

    1997-03-01

    This study arose from a quantitative study that defined the role and resources required for the introduction of generic workers into the ward team. A month's trial was conducted to explore the staff attitudes and perceptions associated with such an introduction, thereby identifying potential problems and benefits that may influence successful introduction into the ward team. A small convenient sample that included trained, untrained and domestic staff was used. The methodological strategies in the study were semi-structured interviews, pre- and post-trial, and non-participant observations during the trial. The data obtained were transcribed and analysed using 'thematic content analysis' and 'within method triangulation'. The findings indicated positive support for the introduction of such workers and the transfer of responsibility from a central domestic team to the ward manager. The ward environment improved and nursing staff were freed from non-nursing activity, leaving more time for patient care. Recommendations to facilitate the smooth introduction of these workers are stated within the study and are now in place within the Trust. The introduction of these workers has been agreed and a staggered roll out of the project is underway in all wards across the Trust.

  14. Predictors of suicide in the patient population admitted to a locked-door psychiatric acute ward

    PubMed Central

    Fosse, Roar; Ryberg, Wenche; Carlsson, Merete Kvalsvik; Hammer, Jan

    2017-01-01

    Objective No prior study appears to have focused on predictors of suicide in the general patient population admitted to psychiatric acute wards. We used a case-control design to investigate the association between suicide risk factors assessed systematically at admission to a locked-door psychiatric acute ward in Norway and subsequent death by suicide. Method From 2008 to 2013, patients were routinely assessed for suicide risk upon admission to the acute ward with a 17-item check list based on recommendations from the Norwegian Directorate of Health and Social Affairs. Among 1976 patients admitted to the ward, 40 patients, 22 men and 18 women, completed suicide within December 2014. Results Compared to a matched control group (n = 120), after correction for multiple tests, suicide completers scored significantly higher on two items on the check list: presence of suicidal thoughts and wishing to be dead. An additional four items were significant in non-corrected tests: previous suicide attempts, continuity of suicidal thoughts, having a suicide plan, and feelings of hopelessness, indifference, and/or aggression. A brief scale based on these six items was the only variable associated with suicide in multivariate regression analysis, but its predictive value was poor. Conclusion Suicide specific ideations may be the most central risk markers for suicide in the general patient population admitted to psychiatric acute wards. However, a low predictive value may question the utility of assessing suicide risk. PMID:28301590

  15. Revival of circular variable filters

    NASA Astrophysics Data System (ADS)

    Cabib, Dario; Lavi, Moshe; Orr, Henry

    2010-10-01

    Up to about a decade or more ago Circular Variable Filters (CVF) were a commercial optical component useful in the visible and infrared wavelength ranges and were being produced and sold by the US company Optical Coating Laboratory, Inc. The CVF was used as a monochromator and its advantage was in its ease of use for spectroscopy especially in remote sensing applications. Based on the idea of multilayer interference coating with linearly varying thickness on the circumference of a rotating wheel, it worked as a continuously variable center-wavelength narrowbandpass filter with 1-2% spectral resolution. One spin of the wheel placed on the optical path of a light beam provided a full scan in the wavelength range and allowed a detector to record a full spectrum in that range. Since then this component was discontinued and companies used old remaining stocks from previous production batches. CI is now reconstructing the technology to be able to produce the CVF again and is building new radiometers for new applications based on it. In this paper we review the history of the CVF and its use by CI and we provide some details on the characteristics of the CVF as planned and as preliminarily tested.

  16. Circular on family planning, 1988.

    PubMed

    1988-01-01

    This Hubei, China, Circular, issued near the end of 1988, provides the following: "The population growth situation in our country is grim. Since 1986, the natural population growth rate has risen continuously. To draw the prompt attention of the whole party and the entire people to the issue of our population, all localities must seriously unfold the activities of publicizing family planning (FP) this winter and next spring, in coordination with education in current affairs. It is necessary to publicize FP in an all-around way and with accuracy, and the activities of publicizing must be carried out effectively in a solid and deep-going way. In the rural areas, stress must be placed on areas where FP work is not carried out well and where there is a prevailing tendency toward early marriage, early child-bearing, and extra-budgetary births. In cities, publicity and education must be conducted especially among the transient population, individual households, and jobless households. During the period of publicity, large-scale street-corner publicity activities must be carried out in cities and towns so as to create strong public opinion and to combine the endeavor to publicize current affairs and policies with the effort to popularize knowledge about contraception and birth-control, to execute measures of contraception and birth control, and to establish FP associations in the countryside."

  17. Emerging Functions of Circular RNAs

    PubMed Central

    Cortés-López, Mariela; Miura, Pedro

    2016-01-01

    Many thousands of Circular RNAs (circRNAs) have recently been identified in metazoan genomes by transcriptome-wide sequencing. Most circRNAs are generated by back-splicing events from exons of protein-coding genes. A great deal of progress has recently been made in understanding the genome-wide expression patterns, biogenesis, and regulation of circRNAs. To date, however, few functions of circRNAs have been identified. CircRNAs are preferentially expressed in neural tissues and some are found at synapses, suggesting possible functions in the nervous system. Several circRNAs have been shown to function as microRNA “sponges” to counteract microRNA mediated repression of mRNA. New functions for circRNAs are arising, including protein sequestration, transcriptional regulation, and potential functions in cancer. Here, we highlight the recent progress made in understanding the biogenesis and regulation of circRNAs, discuss newly uncovered circRNA functions, and explain the methodological approaches that could reveal more exciting and unexpected roles for these RNAs. PMID:28018143

  18. Porphyria or Catatonia: Diagnostic Dilemma on the Medical Wards.

    PubMed

    Kurkjian, Natalie; Tucker, Phebe

    2016-01-01

    A 24-year-old Caucasian female, DD, was admitted to the medical service at an academic hospital with symptoms of weakness in bilateral lower extremities, falls, headaches, and altered mental status. Psychiatry was consulted to evaluate for psychiatric causes of her symptoms. This case presented a diagnostic challenge as the patient's identified symptoms changed almost daily, depending on what practitioner or medical service she encountered. In this study, we discuss the differential diagnoses, tests and treatments the patient received, with a review of literature helping differentiate between diagnostic parameters.

  19. Design in mind: eliciting service user and frontline staff perspectives on psychiatric ward design through participatory methods

    PubMed Central

    Csipke, Emese; Papoulias, Constantina; Vitoratou, Silia; Williams, Paul; Rose, Diana; Wykes, Til

    2016-01-01

    Abstract Background: Psychiatric ward design may make an important contribution to patient outcomes and well-being. However, research is hampered by an inability to assess its effects robustly. This paper reports on a study which deployed innovative methods to capture service user and staff perceptions of ward design. Method: User generated measures of the impact of ward design were developed and tested on four acute adult wards using participatory methodology. Additionally, inpatients took photographs to illustrate their experience of the space in two wards. Data were compared across wards. Results: Satisfactory reliability indices emerged based on both service user and staff responses. Black and minority ethnic (BME) service users and those with a psychosis spectrum diagnosis have more positive views of the ward layout and fixtures. Staff members have more positive views than service users, while priorities of staff and service users differ. Inpatient photographs prioritise hygiene, privacy and control and address symbolic aspects of the ward environment. Conclusions: Participatory and visual methodologies can provide robust tools for an evaluation of the impact of psychiatric ward design on users. PMID:26886239

  20. Applying the Integrated Practice Unit Concept to a Modified Virtual Ward Model of Care for Patients at Highest Risk of Readmission: A Randomized Controlled Trial

    PubMed Central

    Ng, Matthew Joo Ming; Balasubramaniam, Kanchana; Towle, Rachel Marie

    2017-01-01

    Background Emerging evidence from the virtual ward care model showed that multidisciplinary case management are inadequate to reduce readmissions or death for high risk patients. There is consensus that interventions should encompass both pre-hospital discharge and post-discharge transitional care to be effective. Integrated practice units (IPU) had been proposed as an approach of restructuring the organization and work processes of multidisciplinary teams to achieve value in healthcare. Our primary objective is to evaluate if the novel application of the IPU concept to organize a modified virtual ward model incorporating pre-hospital discharge transitional care can reduce readmissions of patients at highest risk for readmission. Methods We conducted an open label, assessor blinded randomized controlled trial on patients with one or more unscheduled readmissions in the prior 90 days and LACE score ≥ 10. 840 patients were randomized in 1:1 ratio and blocks of 6 to the intervention program (n = 420) or control (n = 420). Allocation concealment was effected via an off-site telephone service maintained by a hospital administrator. Intervention patients received discharge planning, medication reconciliation, coaching on self-management of chronic diseases using standardized action plans and an individualized care plan complete with written discharge instructions, appointments schedule, medication changes and the contact information of the outpatient VW nurse before discharge. At discharge, care is handed over to the outpatient VW team. Patients were closely monitored in the VW for three months that included a telephone review within 72 hours of discharge, home assessment, regular telephone reviews to identify early complications and early review clinics for patients who destabilize. The VW meet daily to discuss new patients and review care plans for patients. Control patients received standard hospital care that included a standardized patient copy of the hospital

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

    PubMed

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

    2016-01-01

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

  2. Acceptance of the 2009 Henry Baldwin Ward Medal: The accidental parasitologist

    USGS Publications Warehouse

    Lafferty, Kevin D.

    2009-01-01

    Members of the Society, President Conn, colleagues, friends, and particularly students, the Ward Medal recipient, from Clarke Read onward, traditionally recounts how their career was shaped. A decade ago, in a crumbling Kona hotel, the ASP's own tattooed lady, Janine Caira, opened her Ward Medal address with: “To all future Ward Medalists, many of whom I trust are sitting in the audience out there today, I say: savor the moment! You have no idea how much easier it is to be sitting out there where you are than standing up here where I am” (Caira 1998). I certainly didn't imagine that Janine was delivering her advice to me and it is presumptuous to imagine my story is a template for shaping a career. As the title of my talk indicates, it was an accident.

  3. Psychiatric Nursing in Integrated Wards Accommodating Both Female and Male Patients: A Historic Pioneering Reform Initiative Implemented by the Institute of Psychiatry, a Unit of the Federal University of Rio De Janeiro, Brazil.

    PubMed

    Bandeira, Paloma Mello; Haddad P Souza, Cynthia; da Silva Guimarães, Juliana C; de Almeida Filho, Antonio José; de Almeida Peres, Maria Angélica

    2015-01-01

    The purpose of this research is to analyze aspects of the sexuality of people with mental disorders, an issue that influenced nursing care in the mixed nursing wards of the Institute of Psychiatry at the Federal University of Rio de Janeiro between 1996-2002. A qualitative Historical Social Study methodology used written and oral texts that were analyzed drawing on Michel Foucault's ideas about sexuality. Results of the study indicate that a rupture occurred in the distribution model according to gender at the Psychiatric Hospitalization Unit. This, in turn, influenced nursing care. From this study, we conclude that accommodating patients in mixed wards better facilitates the psychosocial rehabilitation process and changes nursing teams' conceptions about the sexuality of people with mental disorders.

  4. Prevalence and Characteristics of Surgical Site Infections Caused by Gram-negative Rod-shaped Bacteria from the Family Enterobacteriacae and Gram-positive Cocci from the Genus Staphylococcus in Patients who Underwent Surgical Procedures on Selected Surgical Wards.

    PubMed

    Tomaszewska-Kowalska, Małgorzata; Kołomecki, Krzysztof; Wieloch-Torzecka, Maria

    2016-10-01

    Surgical site infections on surgical wards are the most common cause of postoperative complications. Prevalence of surgical site infections depends on the surgical specialization. Analysis of the causes of surgical site infections allows to conclude that microorganisms from the patient's own microbiota - Gram-negative rod-shaped bacteria from the family Enterobacteriacae and from the patient's skin microbiota - Gram-positive cocci - Staphylococcus are the most common agents inducing surgical site infections. The aim of the study was to assess prevalence and characteristics of surgical site infections caused by Gram-negative rod-shaped bacteria from the family Eneterobacteriacae and Gram-positive cocci from the genus Staphylococcus in patients who underwent surgical procedures at the Regional Specialist Hospital named after M. Copernika in Łódź on selected surgical wards.

  5. The Hospital as Predictor of Children's and Adolescents' Length of Stay

    ERIC Educational Resources Information Center

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

    2006-01-01

    Objective: To predict psychiatric hospital length of stay (LOS) for a sample of Illinois Department of Children and Family Services wards across 4 fiscal years. Method: A prospective design was implemented using the Children's Severity of Psychiatric Illness scale, a reliable and valid measure of psychiatric severity, risk factors, youth…

  6. The Paradox of Nursing Terminal Patients in a Belgian General Hospital.

    ERIC Educational Resources Information Center

    Timmermans, Stefan

    1993-01-01

    Analyzed how nurses deal with terminal and dying patients in two inpatient wards in Belgian general hospital. Observed that nurses often felt dissatisfied with their terminal caregiving. Suggests terminal care include specific physical, social, religious, and psychological services, given to terminal patient and family, to obtain as high a level…

  7. Social Relations and Innovation: Changing the State of Play in Hospitals.

    ERIC Educational Resources Information Center

    Hall, David J.

    Data on the process and impact of introducing play therapy in children's hospitals in England and Wales are presented in this book. The effects of the introduction of play therapy on children's behaviors in children's wards and on the relationships between parents, doctors, nurses, ancillary staff, and playleaders are described. The responsiveness…

  8. Effects of locality based community hospital care on independence in older people needing rehabilitation: randomised controlled trial

    PubMed Central

    Green, John; Young, John; Forster, Anne; Mallinder, Karen; Bogle, Sue; Lowson, Karin; Small, Neil

    2005-01-01

    Objective To determine the effects on independence in older people needing rehabilitation in a locality based community hospital compared with care on a ward for elderly people in a district general hospital. Design Randomised controlled trial. Setting Care in a community hospital and district general hospital in Bradford, England. Participants 220 patients needing rehabilitation after an acute illness that required hospital admission. Interventions Patients were randomly allocated to a locality based community hospital or to remain within a department for the care of elderly people in a district general hospital. Main outcome measures Primary outcomes were Nottingham extended activities of daily living scale and general health questionnaire 28 (carer). Secondary outcomes were activities of daily living (Barthel index), Nottingham health profile, hospital anxiety and depression scale, mortality, destination after discharge, satisfaction with services, carer strain index, and carer's satisfaction with services. Results The median length of stay was 15 days for both the community hospital and the district general hospital groups (interquartile range: community hospital 9-25 days; district general hospital 9-24 days). Independence at six months was greater in the community hospital group (adjusted mean difference 5.30, 95% confidence interval 0.64 to 9.96). Results for the secondary outcome measures, including care satisfaction and measures of carer burden, were similar for both groups. Conclusions Care in a locality based community hospital is associated with greater independence for older people than care in wards for elderly people in a district general hospital. PMID:15994660

  9. Sepsis Prevalence and Outcome on the General Wards and Emergency Departments in Wales: Results of a Multi-Centre, Observational, Point Prevalence Study

    PubMed Central

    Ellis, Gemma; Morgan, Paul; Kopczynska, Maja; Dhadda, Amrit; Mann, Charlotte; Donoghue, Danielle; Rollason, Sarah; Brownlow, Emma; Hill, Francesca; Carr, Grace; Turley, Hannah; Hassall, James; Lloyd, James; Davies, Llywela; Atkinson, Michael; Jones, Molly; Jones, Nerys; Martin, Rhodri; Ibrahim, Yousef; Hall, Judith E.

    2016-01-01

    Data on sepsis prevalence on the general wards is lacking on the UK and in the developed world. We conducted a multicentre, prospective, observational study of the prevalence of patients with sepsis or severe sepsis on the general wards and Emergency Departments (ED) in Wales. During the 24-hour study period all patients with NEWS≥3 were screened for presence of 2 or more SIRS criteria. To be eligible for inclusion, patients had to have a high clinical suspicion of an infection, together with a systemic inflammatory response (sepsis) and evidence of acute organ dysfunction and/or shock (severe sepsis). There were 5317 in-patients in the 24-hour study period. Data were returned on 1198 digital data collection forms on patients with NEWS≥3 of which 87 were removed, leaving 1111 for analysis. 146 patients had sepsis and 144 patients had severe sepsis. Combined prevalence of sepsis and severe sepsis was 5.5% amongst all in-patients. Patients with sepsis had significantly higher NEWS scores (3 IQR 3–4 for non-sepsis and 4 IQR 3–6 for sepsis patients, respectively). Common organ dysfunctions in severe sepsis were hypoxia (47%), hypoperfusion (40%) and acute kidney injury (25%). Mortality at 90 days was 31% with a median (IQR) hospital free stay of 78 (36–85) days. Screening for sepsis, referral to Critical Care and completion of Sepsis 6 bundle was low: 26%, 16% and 12% in the sepsis group. Multivariable logistic regression analysis identified higher National Early Warning Score, diabetes, COPD, heart failure, malignancy and current or previous smoking habits as independent variables suggesting the diagnosis of sepsis. We observed that sepsis is more prevalent in the general ward and ED than previously suggested before and that screening and effective treatment for sepsis and severe sepsis is far from being operationalized in this environment, leading to high 90 days mortality. PMID:27907062

  10. Undetected Bacillus pseudo-outbreak after renovation work in a teaching hospital.

    PubMed

    Ohsaki, Yoshinobu; Koyano, Shin; Tachibana, Mineji; Shibukawa, Kiyoko; Kuroki, Masako; Yoshida, Itsuro; Ito, Yoshihisa

    2007-06-01

    A 602-bed capacity hospital underwent complete renovation from 1999 to 2004. In April 2005, the Infection Control Team was informed of the occurrence of three consecutive cases of Bacillus cereus bacteremia in a ward for patients with hematologic malignancies. A retrospective analysis of patients with Bacillus isolates was initiated. We found more Bacillus cereus isolates from blood samples in 2004 compare to the preceding years. Swab samples were collected in the particular ward from the surface of a working desk, filter unit of the air-conditioners, entrance of air inlet ducts, exit of the air outlet ducts and three-way valves of the particular ward under the consideration of iatrogenic contamination. Towels and gowns used in the ward were examined. Dens dust was noted in the filter of the air-conditioner and inlets/outlets of the air-ventilation system of the ward. Bacillus cereus was isolated from the dust, and from cleaned towels and gowns. PFGE fingerprinting differed among four patients' sample. We considered the present case as an undetected Bacillus cereus pseudo-outbreak that lasted for about one year after the renovation work of the hospital. We also considered that filters of the HVAC-system and towels and gowns were probable sources of the outbreak.

  11. Care practices of older people with dementia in the surgical ward: A questionnaire survey

    PubMed Central

    Hynninen, Nina; Saarnio, Reetta; Elo, Satu

    2016-01-01

    Objectives: The objective of this study was to describe the care practices of nursing staff caring older people with dementia in a surgical ward. Methods: The data were collected from nursing staff (n = 191) working in surgical wards in one district area in Finland during October to November 2015. Data were collected using a structured questionnaire and analyzed statistically. The instrument consists of a total number of 141 items and four dimensions. The dimensions were as follows: background information (12 of items), specific characteristics of older people with dementia in a surgical ward (24 of items), specific characteristics of their care in a surgical ward (66 of items) and use of physical restraints and alternative models for use of restraints for people with dementia (39 of items). Results: The questions which measure the nursing staff’s own assessment of care practices when caring for people with dementia in surgical wards were selected: counseling people with dementia, reaction when a surgical patient with dementia displays challenging behavior and use of alternative approach instead of physical restraints. Most commonly the nursing staff pay attention to patient’s state of alertness before counseling older people with dementia. Instead of using restraints, nursing staff gave painkillers for the patient and tried to draw patients’ attention elsewhere. The nursing staff with longer work experience estimate that they can handle the patients’ challenging behavior. They react by doing nothing more often than others. They pretend not to hear, see or notice anything. Conclusion: The findings of this study can be applied in nursing practice and in future studies focusing on the care practices among older people with dementia in acute care environment. The results can be used while developing patient treatments process in surgical ward to meet future needs. PMID:27895915

  12. Controlled trial of chemical disinfection of urinary drainage bags. Reduction in hospital-acquired catheter-associated infection.

    PubMed

    Holliman, R; Seal, D V; Archer, H; Doman, S

    1987-11-01

    A controlled, prospective trial was conducted on an orthopaedic ward to test the use of peroxide disinfection of drainage bags as the only measure taken to affect the rate of hospital-acquired, catheter-associated urinary tract infection (UTI). A significant reduction (P less than 0.05) in the number of patients with catheter-associated UTI occurred with the use of bag disinfectant when compared with patients in whom this technique was not used. We consider this technique to be suitable for the management of catheterised patients on general hospital wards to reduce catheter-associated UTI and environmental spread of their bacteria.

  13. Bacterial pathogens isolated from cockroaches trapped from paediatric wards in peninsular Malaysia.

    PubMed

    Oothuman, P; Jeffery, J; Aziz, A H; Abu Bakar, E; Jegathesan, M

    1989-01-01

    A survey was conducted in 4 paediatric wards in Malaysia to determine the distribution of various species of cockroaches and to examine their gut contents for bacteria. Cockroaches were trapped from food dispensing areas (kitchens), store rooms, cupboards and open wards. 104 cockroaches were caught, consisting of Periplaneta americana (67.3%), Blattella germanica (26%), P. brunnea (4.8%), and Supella longipalpa (1.9%). Bacteria were isolated from all cockroaches except 3 P. americana. Many bacterial species were identified, including the pathogenic and potentially pathogenic species Shigella boydii, S. dysenteriae, Salmonella typhimurium, Klebseilla oxytoca, K. ozaena and Serratia marcescens.

  14. Molecular surveillance and population structure analysis of methicillin-susceptible and methicillin-resistant Staphylococcus aureus in high-risk wards.

    PubMed

    Sergi, Simona; Donnarumma, Francesca; Mastromei, Giorgio; Goti, Emanuele; Nicoletti, Pierluigi; Pecile, Patrizia; Cecconi, Daniela; Mannino, Roberta; Fanci, Rosa; Bosi, Alberto; Bartolozzi, Benedetta; Casalone, Enrico

    2009-10-01

    In this study we report the results of analysis of 253 isolates of Staphylococcus aureus (132 methicillin [meticillin]-resistant S. aureus [MRSA] isolates and 121 methicillin-susceptible S. aureus [MSSA] isolates) from 209 patients admitted to 18 high-risk wards of six hospitals located in Florence, Italy, over an 8-month period during which a program of epidemiological surveillance of hospital-acquired infections was conducted. The majority (69%) of the 87 reported S. aureus infections were caused by MRSA. No outbreak events have been reported. All the isolates were typed by amplified fragment length polymorphism (AFLP), and AFLP profiles were analyzed in order to define similarity groups. The discriminatory power of AFLP is very high with MSSA (Simpson index of diversity [D], 95.9%), whereas its resolution capability with MRSA (D, 44.7%) is hampered by the well-known high clonality of these populations (the main MRSA group accounted for 74% of the MRSA isolates). Combining AFLP, improved by visual inspection of polymorphisms, with multiplex PCR greatly increases MRSA resolution (D, 85.5%), resolving the MRSA population to a level that is one of the highest reported in the literature. Widespread and sporadic clones of MSSA and MRSA were identified, and their diffusion in the different hospitals and wards over the surveillance period was studied. The understanding of MSSA and MRSA population structures should be the starting point for the design of a more rational surveillance program for S. aureus species, maximizing benefits and reducing the cost of infection control strategies.

  15. Hand contamination during routine care in medical wards: the role of hand hygiene compliance.

    PubMed

    Monistrol, Olga; López, M Liboria; Riera, Montserrat; Font, Roser; Nicolás, Carme; Escobar, Miguel Angel; Freixas, Núria; Garau, Javier; Calbo, Esther

    2013-04-01

    The hands of healthcare workers (HCWs) are the most common vehicle for the transmission of micro-organisms from patient to patient and within the healthcare environment. The aim of this study was to evaluate the impact of a multimodal campaign on the type and amount of resident and transient flora and the presence of potential risk factors for hand contamination during routine care. A before-after (PRE and POST periods) interventional study was carried out in medical wards of a tertiary care hospital. Eighty-nine samples were analysed. Samples were cultured immediately before patient contact using a glove-juice method. Data collected included socio-demographic and risk factors for hand contamination. Flora was measured as log10 c.f.u. ml(-1) and evaluated by comparing median values in the PRE and POST periods. Transient flora was isolated from the hands of 67.4 and 46.1 % of HCWs in the PRE and POST periods, respectively (P<0.001). Enterobacteriaceae, Pseudomonas spp. and meticillin-sensitive Staphylococcus aureus were the predominant contaminants. Resident flora was isolated from 92.1 % of HCWs in the PRE period and from 70.8 % in the POST period (P<0.001). The meticillin-resistant coagulase-negative staphylococci log10 c.f.u. count ml(-1) decreased from 1.96 ± 1.2 to 0.89 ± 1.2 (mean ± s d; P<0.001), and the global flora count decreased from 2.77 ± 1.1 to 1.56 ± 1.4 (P<0.001). In the POST period, the wearing of fewer rings (P<0.001), shorter fingernail length (P = 0.008), a shorter time since recent hand hygiene (HH) (P = 0.007) and an increased use of alcohol-based hand rub instead of soap (P<0.001) were documented. The HH multimodal strategy reduced the number of risk factors and the level of HCW hand contamination.

  16. The pain-free ward: myth or reality.

    PubMed

    Morton, Neil S

    2012-06-01

    Over the last 25 years, pediatric care has changed dramatically with increased survival after premature birth, more complex care, better outcomes, and reduced mortality. There is a better understanding of how pain pathways and receptor systems develop and also how to assess pain at different stages of development. The myth that children do not feel pain has been comprehensively dispelled. Safe analgesic dose regimens for neonates, infants, and children have been developed based upon a better understanding of developmental pharmacokinetics and pharmacodynamics. It is a myth that pain in children cannot be prevented or treated safely and effectively because of the risks of adverse effects and addiction. Large-scale prospective audits have clarified the safety profile and risk-benefit balance for different techniques. There is now a substantial evidence base supporting many techniques of postoperative and procedural pain management for all age-groups of children. Guidelines based upon systematic review of this evidence have been published and updated, but the real challenge is in implementation of accurate pain assessment and safe, effective pain management comprehensively to all children whatever the procedure, clinical setting, developmental stage of the child, or comorbidities. In developed countries, these are core topics in the education of all doctors and nurses who care for children, and they are integrated into clinical practice by acute pediatric pain teams for most hospitals. However, it is disappointing that many country's healthcare systems do not give pediatric pain management a priority and in many parts of the world there are no analgesics available. So pain-free healthcare is sadly lacking in many hospitals. My hope is that the current knowledge can be used more effectively to relieve the unnecessary suffering of children in the 21st century.

  17. Polarisation vision: beetles see circularly polarised light.

    PubMed

    Warrant, Eric J

    2010-07-27

    It has long been known that the iridescent cuticle of many scarab beetles reflects circularly polarised light. It now turns out that scarabs can also see this light, potentially using it as a covert visual signal.

  18. Depth perception through circular movements of dots.

    PubMed

    Ito, Hiroyuki

    2010-01-01

    Elements that move with velocity gradients have been shown to give the impression of depth. In this study, it was found that dots in circular motion around a line of sight give a depth impression corresponding to the gradients of the angular velocities of circular motion on a screen. The results of two experiments show that depth perception through circular motion is as effective as that through expansion or spiral motion, but less effective than that through lateral motion parallax when the local speed distributions on the screen are matched. The present depth effect shows that expansion-contraction, spiral, and circular motions are a continuum in terms of producing depth effects; they differ from lateral motion parallax.

  19. 17 CFR 230.253 - Offering circular.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    .... Repetition of information should be avoided; cross-referencing of information within the document is... COMPLETENESS OF ANY OFFERING CIRCULAR OR OTHER SELLING LITERATURE. THESE SECURITIES ARE OFFERED PURSUANT TO...

  20. 17 CFR 230.253 - Offering circular.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    .... Repetition of information should be avoided; cross-referencing of information within the document is... COMPLETENESS OF ANY OFFERING CIRCULAR OR OTHER SELLING LITERATURE. THESE SECURITIES ARE OFFERED PURSUANT TO...

  1. 17 CFR 230.253 - Offering circular.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    .... Repetition of information should be avoided; cross-referencing of information within the document is... COMPLETENESS OF ANY OFFERING CIRCULAR OR OTHER SELLING LITERATURE. THESE SECURITIES ARE OFFERED PURSUANT TO...

  2. 17 CFR 230.253 - Offering circular.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    .... Repetition of information should be avoided; cross-referencing of information within the document is... COMPLETENESS OF ANY OFFERING CIRCULAR OR OTHER SELLING LITERATURE. THESE SECURITIES ARE OFFERED PURSUANT TO...

  3. 17 CFR 230.253 - Offering circular.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    .... Repetition of information should be avoided; cross-referencing of information within the document is... COMPLETENESS OF ANY OFFERING CIRCULAR OR OTHER SELLING LITERATURE. THESE SECURITIES ARE OFFERED PURSUANT TO...

  4. Making A Circular-Harmonic Filter

    NASA Technical Reports Server (NTRS)

    Cheng, Yeou Yen

    1989-01-01

    Optical image-correlating system made rotationally invariant. Experiment shows circular-harmonic filter generated optically. Hologram made by phase-shifted-double-exposure procedure. Filter used in optical image-recognition system based on correlation between target (image to be recognized) and matched spatial filter. In addition to usual invariance under translation of target, circular harmonic filter invariant under rotation of target; peak intensity of illumination at origin of correlation plane does not vary when target rotated about optical axis.

  5. CIRCULAR RIBBON FLARES AND HOMOLOGOUS JETS

    SciTech Connect

    Wang Haimin; Liu Chang

    2012-12-01

    Solar flare emissions in the chromosphere often appear as elongated ribbons on both sides of the magnetic polarity inversion line (PIL), which has been regarded as evidence of a typical configuration of magnetic reconnection. However, flares having a circular ribbon have rarely been reported, although it is expected in the fan-spine magnetic topology involving reconnection at a three-dimensional (3D) coronal null point. We present five circular ribbon flares with associated surges, using high-resolution and high-cadence H{alpha} blue wing observations obtained from the recently digitized films of Big Bear Solar Observatory. In all the events, a central parasitic magnetic field is encompassed by the opposite polarity, forming a circular PIL traced by filament material. Consequently, a flare kernel at the center is surrounded by a circular flare ribbon. The four homologous jet-related flares on 1991 March 17 and 18 are of particular interest, as (1) the circular ribbons brighten sequentially, with cospatial surges, rather than simultaneously, (2) the central flare kernels show an intriguing 'round-trip' motion and become elongated, and (3) remote brightenings occur at a region with the same magnetic polarity as the central parasitic field and are co-temporal with a separate phase of flare emissions. In another flare on 1991 February 25, the circular flare emission and surge activity occur successively, and the event could be associated with magnetic flux cancellation across the circular PIL. We discuss the implications of these observations combining circular flare ribbons, homologous jets, and remote brightenings for understanding the dynamics of 3D magnetic restructuring.

  6. Designing Hospital for better Infection Control: an Experience.

    PubMed

    Rao, Skm

    2004-01-01

    The physical design of hospital is an essential component of a hospital's infection control strategy, incorporating infection control issues to minimise the risk of infection transmission. Hospital design therefore, needs to consider the separation of dirty and clean areas, adequate ventilation, lighting and storage facilities and design of patient accommodation areas, including adequate number of wash hand basins and single bed facilities. A 250 bed general hospital was planned keeping in view structural and design elements necessary for success of a good infection control programme. Various National and International Standards like BSI recommendations, JCAHO, IC Standards, DHSS, ASHRAE, AIA and OSHA were studied and compared with our planning parameters. Planning of ward unit, ICU, Operation theatre and Isolation wards were especially reviewed in the light of recent knowledge available in the field of hospital acquired infection and modifications were carried out. Need for effective identification of potential infections, risks in the design of a hospital were stressed. Engineering controls required to reduce the concentration of infectious droplet nuclei in the air and prevention of transmission of disease were highlighted.

  7. Circular Data Images for Directional Data

    NASA Technical Reports Server (NTRS)

    Morpet, William J.

    2004-01-01

    Directional data includes vectors, points on a unit sphere, axis orientation, angular direction, and circular or periodic data. The theoretical statistics for circular data (random points on a unit circle) or spherical data (random points on a unit sphere) are a recent development. An overview of existing graphical methods for the display of directional data is given. Cross-over occurs when periodic data are measured on a scale for the measurement of linear variables. For example, if angle is represented by a linear color gradient changing uniformly from dark blue at -180 degrees to bright red at +180 degrees, the color image will be discontinuous at +180 degrees and -180 degrees, which are the same location. The resultant color would depend on the direction of approach to the cross-over point. A new graphical method for imaging directional data is described, which affords high resolution without color discontinuity from "cross-over". It is called the circular data image. The circular data image uses a circular color scale in which colors repeat periodically. Some examples of the circular data image include direction of earth winds on a global scale, rocket motor internal flow, earth global magnetic field direction, and rocket motor nozzle vector direction vs. time.

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

    PubMed

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

    2013-01-01

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

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

    PubMed Central

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

    2013-01-01

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

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

    PubMed Central

    2013-01-01

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

  11. Factors associated with recovery of Acinetobacter baumannii in a combat support hospital.

    PubMed

    Griffith, Matthew E; Gonzalez, Russell S; Holcomb, John B; Hospenthal, Duane R; Wortmann, Glenn W; Murray, Clinton K

    2008-07-01

    A retrospective review of hospital records for Acinetobacter baumannii infection at a US Army combat support hospital revealed a monthly infection rate ranging from 20.5 to 0 cases per 1,000 patients admitted. The rate correlated with the mean census of host-nation patients in the intensive care unit, the mean census of host-nation patients on the wards, and length of stay in the intensive care unit.

  12. A Study of Perinatal Services at Walson Army Hospital, Fort Dix, New Jersey

    DTIC Science & Technology

    1980-08-01

    patients would also be hospitalized on the ward. With an estimated gynecological surgery workload of sixty cases per month and an average length of stay of...1/1/77-12/31/77 Number of Admissions 1,224 717 Total Hospital Days 5,396 3,124 Average Length of Stay 4.4 4.4 Average Daily Patient Load 14.8 8.6

  13. SARS in Three Categories of Hospital Workers, Hong Kong

    PubMed Central

    Yang, Xilin; Leung, Ping-Chung; Chan, Louis; Wong, Eliza; Fong, Carmen; Tsui, Hi-Yi

    2004-01-01

    We analyzed attack rates for severe acute respiratory syndrome (SARS) in three categories of hospital workers (nurses, nonmedical support staff, and other technical or medical staff) in all public hospitals in Hong Kong that had admitted SARS patients. Of 16 such hospitals, 14 had cases. The overall attack rate was 1.20%. Nonmedical support staff had the highest attack rate (2.73%). The odds ratios of group nonmedical support staff versus those of nurses and of nonmedical support staff versus other technical or medical staff were 2.30 (p < 0.001) and 9.78 (p < 0.001), respectively. The number of affected staff and attack rates were significantly correlated with the number of SARS patients admitted (r = 0.914 and 0.686, respectively). Affected patients were concentrated in three hospitals and in the earlier phase of the epidemic. Cleaning and clerical staff on hospital wards were at a much higher risk. PMID:15496240

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

    PubMed

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

    2007-02-01

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

  15. The relationships among personality, social support, and resilience of abused nurses at emergency rooms and psychiatric wards in Taiwan.

    PubMed

    Hsieh, Hsiu-Fen; Chang, Shu-Chen; Wang, Hsiu-Hung

    2017-01-01

    The aim of the authors in this study was to identify factors associated with resilience that helped abused nurses face and cope with violent events. The data for this cross-sectional study were collected from June 2013 to December 2013; 272 participants were recruited from emergency rooms and psychiatric wards in four hospitals in central Taiwan. Among these participants, 230 (84.6%) met the inclusion criterion and completed all questionnaires; 69 (30%) of them reported having experienced only verbal violence; 46 (20%) reported having experienced only physical violence, and 115 (50%) reported having experienced a combination of verbal and physical violence. The following were positively associated with resilience score: having a college education or greater (exp((β)()) = 1.045, p = .018), extraversion (exp((β)()) = 1.012 per unit increase in the score, p < .001), family support (exp((β)()) = 1.004 per unit increase in the score, p = .031), peer support (exp((β)()) = 1.008 per unit increase in the score, p = .006), and lower level of neuroticism (exp((β)()) = 0.983 per unit increase in the score, p < .001); 43.6% of the variance in resilience was explained by the variables assessed. Adequate support and advanced education are important for abused nurses to enhance their resilience.

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

    NASA Astrophysics Data System (ADS)

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

    1993-06-01

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

  17. Circular DH/8 D/87 on maternity or adoption leave for and authorized absences by career and non-career employees of the establishments referred to in Section 2 of Law No. 86-33 of 9 January 1986 laying down regulations applicable to staff in the public service in the hospital sector, 7 October 1987.

    PubMed

    1988-01-01

    This Circular is addressed by the Minister of Social Affairs and Employment of France to the regional and departmental authorities responsible for health and social affairs and repeals various earlier Circulars on the same subject. It describes a group of measures within the framework of government policy, relating to, among other things: reducing pregnancy-related risks by associating the occupational physician with measures to protect pregnant women, in particular, concerning the fitness of a pregnant woman for her occupation; entitling pregnant women to a leave of absence from the date of declaration of pregnancy in the case of pregnancies with pathological evolution; and improving the arrangements for leave of absence for pregnancy and birth which was hitherto conditional on obtaining the favorable opinion of the occupational physician, in particular with regard to according flexible working hours during pregnancy and leave of absence for prenatal examinations. It is also recalled, in connection with leave of absence, that administrations having appropriate facilities for baby-minding must enable the mother to breast feed her infant, allowing her leave of absence for this purpose for one hour per day, to be taken at two times during the day.

  18. Evaluation of Mental Workload among ICU Ward's Nurses

    PubMed Central

    Mohammadi, Mohsen; Mazloumi, Adel; Kazemi, Zeinab; Zeraati, Hojat

    2015-01-01

    Background: High level of workload has been identified among stressors of nurses in intensive care units (ICUs). The present study investigated nursing workload and identified its influencing perfor­mance obstacles in ICUs. Methods: This cross-sectional study was conducted, in 2013, on 81 nurses working in ICUs in Imam Khomeini Hospital in Tehran, Iran. NASA-TLX was applied for assessment of workload. Moreover, ICUs Performance Obstacles Questionnaire was used to identify performance obstacles associated with ICU nursing. Results: Physical demand (mean=84.17) was perceived as the most important dimensions of workload by nurses. The most critical performance obstacles affecting workload included: difficulty in finding a place to sit down, hectic workplace, disorganized workplace, poor-conditioned equipment, waiting for using a piece of equipment, spending much time seeking for supplies in the central stock, poor quality of medical materials, delay in getting medications, unpredicted problems, disorganized central stock, outpatient surgery, spending much time dealing with family needs, late, inadequate, and useless help from nurse assistants, and ineffective morning rounds (P-value<0.05). Conclusion: Various performance obstacles are correlated with nurses' workload, affirms the significance of nursing work system characteristics. Interventions are recommended based on the results of this study in the work settings of nurses in ICUs. PMID:26933647

  19. Missed Opportunities for Nutritional Rehabilitation in Children Admitted to Surgical Wards

    PubMed Central

    Dave, Pooja; Nimbalkar, Somashekhar; Phatak, Ajay; Desai, Rajendra; Srivastava, Shirish

    2016-01-01

    Background. Malnutrition in children has serious health and economic consequences. We studied documentation of malnutrition, actual prevalence, and treatment given in children admitted to surgical wards. Methods. Retrospective study of 154 patients aged <5 yrs admitted to general surgical, orthopedic, and otorhinolaryngology wards. Records were evaluated for completeness of data, way of documentation, and data quality. Descriptive analysis was done. If malnutrition was not identified and/or proper action was not taken, it was defined as a “missed opportunity.” Results. Of 154 records audited, 100 (64.94%) were males, 108 (70.13%) were from general surgery ward, and 78 (50.65%) were residing in suburban area. The mean (SD) age of the study population was 2.32 (1.16) years whereas mean (SD) duration of stay was 5.84 (6.29) days. Weight and height were mentioned in 116 (75.32%) and 8 (5.19%) records, respectively, mostly by nonsurgical personnel. Documentation and treatment of malnutrition were poor. Out of 106 apparently correct weight records, 19 (17.93%) children were severely undernourished and 30 (28.30%) were moderately undernourished whereas 20 (18.87%) children were not undernourished but required nutritional attention. Conclusion. There is poor documentation of nutritional indicators of children admitted to surgical wards. From data that was available, it is apparent that malnutrition is at high levels. “Identification” and hence management of malnutrition need more attention. PMID:27429836

  20. Staff attitude changes after environmental changes on a ward for psychogeriatric patients.

    PubMed

    Ingstad, P J; Götestam, K G

    1987-01-01

    On a ward for chronic elderly patients, mostly senile demented patients, several environmental changes were performed to improve the patients' behaviors. Before and after these changes, the staff (N = 12) were asked about their attitudes in relation to different issues, according to a semantic differential scheme. The semantic differential scheme consisted (apart from six distractor pairs) of the following semantic pairs: (a) negative-positive, (b) valueless-valuable, (c) bad-good, (d) onesided-manysided, (e) unimportant-important, and (f) stupid-smart. The object sentences tested with this semantic differential scheme were (1) cleaning the ward, (2) the patients' meals, (3) dressing the patients, and (4) social interaction with patients. The results showed significant positive changes in staff attitudes towards the patients in the three last object sentences. These also corresponded to the interventions made in the environmental program, whereas "cleaning the ward" was not really changed during the program. It is concluded that improvements in patient behaviors on the ward has important positive effects also on the staff attitudes.

  1. 42 CFR 70.7 - Responsibility with respect to minors, wards, and patients.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... patients. 70.7 Section 70.7 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES..., and patients. A parent, guardian, physician, nurse, or other such person shall not transport, or procure or furnish transportation for any minor child or ward, patient or other such person who is in...

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

    ERIC Educational Resources Information Center

    Schmidt, Peter

    2009-01-01

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

  3. Missed Opportunities for Nutritional Rehabilitation in Children Admitted to Surgical Wards.

    PubMed

    Dave, Pooja; Nimbalkar, Somashekhar; Phatak, Ajay; Desai, Rajendra; Srivastava, Shirish

    2016-01-01

    Background. Malnutrition in children has serious health and economic consequences. We studied documentation of malnutrition, actual prevalence, and treatment given in children admitted to surgical wards. Methods. Retrospective study of 154 patients aged <5 yrs admitted to general surgical, orthopedic, and otorhinolaryngology wards. Records were evaluated for completeness of data, way of documentation, and data quality. Descriptive analysis was done. If malnutrition was not identified and/or proper action was not taken, it was defined as a "missed opportunity." Results. Of 154 records audited, 100 (64.94%) were males, 108 (70.13%) were from general surgery ward, and 78 (50.65%) were residing in suburban area. The mean (SD) age of the study population was 2.32 (1.16) years whereas mean (SD) duration of stay was 5.84 (6.29) days. Weight and height were mentioned in 116 (75.32%) and 8 (5.19%) records, respectively, mostly by nonsurgical personnel. Documentation and treatment of malnutrition were poor. Out of 106 apparently correct weight records, 19 (17.93%) children were severely undernourished and 30 (28.30%) were moderately undernourished whereas 20 (18.87%) children were not undernourished but required nutritional attention. Conclusion. There is poor documentation of nutritional indicators of children admitted to surgical wards. From data that was available, it is apparent that malnutrition is at high levels. "Identification" and hence management of malnutrition need more attention.

  4. Differences Between Ward's and UPGMA Methods of Cluster Analysis: Implications for School Psychology.

    ERIC Educational Resources Information Center

    Hale, Robert L.; Dougherty, Donna

    1988-01-01

    Compared the efficacy of two methods of cluster analysis, the unweighted pair-groups method using arithmetic averages (UPGMA) and Ward's method, for students grouped on intelligence, achievement, and social adjustment by both clustering methods. Found UPGMA more efficacious based on output, on cophenetic correlation coefficients generated by each…

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

    ERIC Educational Resources Information Center

    Byrd, Jodi A.

    2007-01-01

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

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

    ERIC Educational Resources Information Center

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

    2015-01-01

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

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

    NASA Technical Reports Server (NTRS)

    1973-01-01

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

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

    PubMed Central

    2011-01-01

    Background Good morale among staff on inpatient psychiatric wards is an important requirement for the maintenance of strong therapeutic alliances and positive patient experiences, and for the successful implementation of initiatives to improve care. More understanding is needed of mechanisms underlying good and poor morale. Method We conducted individual and group interviews with staff of a full range of disciplines and levels of seniority on seven NHS in-patient wards of varying types in England. Results Inpatient staff feel sustained in their potentially stressful roles by mutual loyalty and trust within cohesive ward teams. Clear roles, supportive ward managers and well designed organisational procedures and structures maintain good morale. Perceived threats to good morale include staffing levels that are insufficient for staff to feel safe and able to spend time with patients, the high risk of violence, and lack of voice in the wider organisation. Conclusions Increasing employee voice, designing jobs so as to maximise autonomy within clear and well-structured operational protocols, promoting greater staff-patient contact and improving responses to violence may contribute more to inpatient staff morale than formal support mechanisms. PMID:21510852

  9. How hospitalized children and parents perceive nurses and hospital amenities: A qualitative descriptive study in Poland.

    PubMed

    Marcinowicz, Ludmiła; Abramowicz, Paweł; Zarzycka, Danuta; Abramowicz, Magdalena; Konstantynowicz, Jerzy

    2016-03-01

    A qualitative descriptive design using an interview guide approach was adopted to investigate the patient-nurse relationship and paediatric ward amenities from the perspective of parents and hospitalised children in Poland. The study included 26 parents or caregivers of hospitalised children (between 13 months and 15 years old) and 22 children (from 10 to 16 years old). Qualitative content analysis was used to analyse the recorded verbal data. Data from patients' transcripts were coded and classified in terms of topics on the patient-nurse relationship and hospital care. We identified five main topics. 1. Nurse qualities; 2. Nurse verbal behaviour; 3. Nurse tone of voice and non-verbal behaviour; 4. Hospital amenities; 5. Parents' expectations towards nurses. Our study contributes to increased understanding of parents' and children's experiences of paediatric hospital care.

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

    PubMed Central

    2010-01-01

    Background Ward rounds form an integral part of Internal Medicine teaching. This study aimed to determine the trainees' opinions regarding various aspects of their ward rounds, including how well they cover their learning needs, how they would like the rounds to be conducted, and differences of opinion between medical students and postgraduates. Methods A cross-sectional study was conducted on a total of 134 trainees in Internal Medicine, comprising medical students, interns, residents and fellows, who were asked to fill in a structured, self-designed questionnaire. Most of the responses required a rating on a scale of 1-5 (1 being highly unsatisfactory and 5 being highly satisfactory). Results Teaching of clinical skills and bedside teaching received the lowest overall mean score (Mean ± SD 2.48 ± 1.02 and 2.49 ± 1.12 respectively). They were rated much lower by postgraduates as compared to students (p < 0.001). All respondents felt that management of patients was the aspect best covered by the current ward rounds (Mean ± SD 3.71 ± 0.72). For their desired ward rounds, management of patients received the highest score (Mean ± SD 4.64 ± 0.55), followed by bedside examinations (Mean ± SD 4.60 ± 0.61) and clinical skills teaching (Mean ± SD 4.50 ± 0.68). The postgraduates desired a lot more focus on communication skills, counselling and medical ethics as compared to students, whose primary focus was teaching of bedside examination and management. A majority of the respondents (87%) preferred bedside rounds over conference room rounds. Even though the duration of rounds was found to be adequate, a majority of the trainees (68%) felt there was a lack of individual attention during ward rounds. Conclusions This study highlights important areas where ward rounds need improvement in order to maximize their benefit to the learners. There is a need to modify the current state of ward rounds in order to address the needs and expectations of trainees. PMID:20618929

  11. 5 CFR 1310.5 - List of current circulars.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 5 Administrative Personnel 3 2010-01-01 2010-01-01 false List of current circulars. 1310.5 Section 1310.5 Administrative Personnel OFFICE OF MANAGEMENT AND BUDGET OMB DIRECTIVES OMB CIRCULARS § 1310.5 List of current circulars. The following list includes all circulars in effect as of December 1,...

  12. 5 CFR 1310.3 - Availability of circulars.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 5 Administrative Personnel 3 2010-01-01 2010-01-01 false Availability of circulars. 1310.3 Section 1310.3 Administrative Personnel OFFICE OF MANAGEMENT AND BUDGET OMB DIRECTIVES OMB CIRCULARS § 1310.3 Availability of circulars. Copies of individual circulars are available at OMB's Internet home page; you...

  13. 5 CFR 1310.3 - Availability of circulars.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 5 Administrative Personnel 3 2013-01-01 2013-01-01 false Availability of circulars. 1310.3 Section 1310.3 Administrative Personnel OFFICE OF MANAGEMENT AND BUDGET OMB DIRECTIVES OMB CIRCULARS § 1310.3 Availability of circulars. Copies of individual circulars are available at OMB's Internet home page; you...

  14. 24 CFR 574.605 - Applicability of OMB circulars.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 24 Housing and Urban Development 3 2011-04-01 2010-04-01 true Applicability of OMB circulars. 574... of 24 CFR part 85 (codified pursuant to OMB Circular No. A-102) and OMB Circular No. A-87 apply with... acceptance and use of funds under the program by private non-profit entities. (Copies of OMB Circulars may...

  15. Use of a fluorescent marker for assessing hospital bathroom cleanliness.

    PubMed

    Fattorini, Mattia; Ceriale, Emma; Nante, Nicola; Lenzi, Daniele; Manzi, Pietro; Basagni, Claudia; Messina, Gabriele

    2016-09-01

    A fluorescent marker was used to assess the efficacy of daily cleaning in hospital en suite bathrooms. We applied the marker on 218 surfaces and we assigned a score according how completely the mark had been removed. We found significant statistical differences among different surfaces and wards (P < .05). Microbiologic contamination and marker removal score did not seem to be correlated. Differences in cleanliness may indicate discrepancies in cleaning procedures. Fluorescent marker proved to be a practical and effective method and it could be adopted as a first-level control system to assess hospital cleanliness.

  16. A STUDY OF PROBLEM DRINKERS IN A GENERAL HOSPITAL

    PubMed Central

    Babu, R. Sateesh; Sengupta, S.N.

    1997-01-01

    349 new admissions in the wards of Medicine, General Surgery & Orthopedics in a general hospital were screened with MAST & AUDIT for problem use of alcohol. Problem drinking was present in 14.6% of the inpatients. The severity and the need for additional treatment were measured with Addiction Severity Index (ASI). Majority of the patients had problems in more than one ar?a. Nevertheless, only one fourth of the patients were referred for psychiatric treatment. The findings indicate the need to develop services towards the recognition and referrals of the problem drinkers in general hospitals PMID:21584037

  17. [Drug supply chain safety in hospitals: current data and experience of the Grenoble university hospital].

    PubMed

    Bedouch, P; Baudrant, M; Detavernier, M; Rey, C; Brudieu, E; Foroni, L; Allenet, B; Calop, J

    2009-01-01

    Drug supply chain safety has become a priority for public health which implies a collective process. This process associates all health professionals including the pharmacist who plays a major role. The objective of this present paper is to describe the several approaches proven effective in the reduction of drug-related problem in hospital, illustrated by the Grenoble University Hospital experience. The pharmacist gets involved first in the general strategy of hospital drug supply chain, second by his direct implication in clinical activities. The general strategy of drug supply chain combines risk management, coordination of the Pharmacy and Therapeutics Committee, selection and purchase of drugs and organisation of drug supply chain. Computer management of drug supply chain is a major evolution. Nominative drug delivering has to be a prior objective and its implementation modalities have to be defined: centralized or decentralized in wards, manual or automated. Also, new technologies allow the automation of overall drug distribution from central pharmacy and the implementation of automated drug dispensing systems into wards. The development of centralised drug preparation allows a safe compounding of high risk drugs, like cytotoxic drugs. The pharmacist should develop his clinical activities with patients and other health care professionals in order to optimise clinical decisions (medication review, drug order analysis) and patients follow-up (therapeutic monitoring, patient education, discharge consultation).

  18. Characteristics of psychiatric hospitalizations with multiple mechanical restraint episodes versus hospitalization with a single mechanical restraint episode.

    PubMed

    Guzman-Parra, Jose; Guzik, Justyna; Garcia-Sanchez, Juan A; Pino-Benitez, Isabel; Aguilera-Serrano, Carlos; Mayoral-Cleries, Fermin

    2016-10-30

    We investigated the characteristics of multiple episodes of mechanical restraint versus a single episode in a psychiatric ward of a public general hospital. The following characteristics were associated with multiple restraints: young age, length of hospital stay, not being readmitted within 30 days from previous discharge, and admission in the previous year before the implementation of an intervention program to reduce mechanical restraint. The study suggests that both organizational factors and patients' disturbed behaviour are associated with the risk of being mechanically restrained several times.

  19. Bright circularly polarized soft X-ray high harmonics for X-ray magnetic circular dichroism.

    PubMed

    Fan, Tingting; Grychtol, Patrik; Knut, Ronny; Hernández-García, Carlos; Hickstein, Daniel D; Zusin, Dmitriy; Gentry, Christian; Dollar, Franklin J; Mancuso, Christopher A; Hogle, Craig W; Kfir, Ofer; Legut, Dominik; Carva, Karel; Ellis, Jennifer L; Dorney, Kevin M; Chen, Cong; Shpyrko, Oleg G; Fullerton, Eric E; Cohen, Oren; Oppeneer, Peter M; Milošević, Dejan B; Becker, Andreas; Jaroń-Becker, Agnieszka A; Popmintchev, Tenio; Murnane, Margaret M; Kapteyn, Henry C

    2015-11-17

    We demonstrate, to our knowledge, the first bright circularly polarized high-harmonic beams in the soft X-ray region of the electromagnetic spectrum, and use them to implement X-ray magnetic circular dichroism measurements in a tabletop-scale setup. Using counterrotating circularly polarized laser fields at 1.3 and 0.79 µm, we generate circularly polarized harmonics with photon energies exceeding 160 eV. The harmonic spectra emerge as a sequence of closely spaced pairs of left and right circularly polarized peaks, with energies determined by conservation of energy and spin angular momentum. We explain the single-atom and macroscopic physics by identifying the dominant electron quantum trajectories and optimal phase-matching conditions. The first advanced phase-matched propagation simulations for circularly polarized harmonics reveal the influence of the finite phase-matching temporal window on the spectrum, as well as the unique polarization-shaped attosecond pulse train. Finally, we use, to our knowledge, the first tabletop X-ray magnetic circular dichroism measurements at the N4,5 absorption edges of Gd to validate the high degree of circularity, brightness, and stability of this light source. These results demonstrate the feasibility of manipulating the polarization, spectrum, and temporal shape of high harmonics in the soft X-ray region by manipulating the driving laser waveform.

  20. Bright circularly polarized soft X-ray high harmonics for X-ray magnetic circular dichroism

    PubMed Central

    Fan, Tingting; Grychtol, Patrik; Knut, Ronny; Hernández-García, Carlos; Hickstein, Daniel D.; Zusin, Dmitriy; Gentry, Christian; Dollar, Franklin J.; Mancuso, Christopher A.; Hogle, Craig W.; Kfir, Ofer; Legut, Dominik; Carva, Karel; Ellis, Jennifer L.; Dorney, Kevin M.; Chen, Cong; Shpyrko, Oleg G.; Fullerton, Eric E.; Cohen, Oren; Oppeneer, Peter M.; Milošević, Dejan B.; Becker, Andreas; Jaroń-Becker, Agnieszka A.; Popmintchev, Tenio; Murnane, Margaret M.; Kapteyn, Henry C.

    2015-01-01

    We demonstrate, to our knowledge, the first bright circularly polarized high-harmonic beams in the soft X-ray region of the electromagnetic spectrum, and use them to implement X-ray magnetic circular dichroism measurements in a tabletop-scale setup. Using counterrotating circularly polarized laser fields at 1.3 and 0.79 µm, we generate circularly polarized harmonics with photon energies exceeding 160 eV. The harmonic spectra emerge as a sequence of closely spaced pairs of left and right circularly polarized peaks, with energies determined by conservation of energy and spin angular momentum. We explain the single-atom and macroscopic physics by identifying the dominant electron quantum trajectories and optimal phase-matching conditions. The first advanced phase-matched propagation simulations for circularly polarized harmonics reveal the influence of the finite phase-matching temporal window on the spectrum, as well as the unique polarization-shaped attosecond pulse train. Finally, we use, to our knowledge, the first tabletop X-ray magnetic circular dichroism measurements at the N4,5 absorption edges of Gd to validate the high degree of circularity, brightness, and stability of this light source. These results demonstrate the feasibility of manipulating the polarization, spectrum, and temporal shape of high harmonics in the soft X-ray region by manipulating the driving laser waveform. PMID:26534992

  1. A broadband, circular-polarization selective surface

    NASA Astrophysics Data System (ADS)

    Momeni Hasan Abadi, Seyed Mohamad Amin; Behdad, Nader

    2016-06-01

    We introduce a new technique for designing wideband circular-polarization selective surfaces (CPSSs) based on anisotropic miniaturized element frequency selective surfaces. The proposed structure is a combination of two linear-to-circular polarization converters sandwiching a linear polarizer. This CPSS consists of a number of metallic layers separated from each other by thin dielectric substrates. The metallic layers are in the form of two-dimensional arrays of subwavelength capacitive patches and inductive wire grids with asymmetric dimensions and a wire grid polarizer with sub-wavelength period. The proposed device is designed to offer a wideband circular-polarization selection capability allowing waves with left-hand circular polarization to pass through while rejecting those having right-hand circular polarization. A synthesis procedure is developed that can be used to design the proposed CPSS based on its desired band of operation. Using this procedure, a prototype of the proposed CPSS operating in the 12-18 GHz is designed. Full-wave electromagnetic simulations are used to predict the response of this structure. These simulation results confirm the validity of the proposed design concept and synthesis procedure and show that proposed CPSS operates within a fractional bandwidth of 40% with a co-polarization transmission discrimination of more than 15 dB. Furthermore, the proposed design is shown to be capable of providing an extremely wide field of view of ±60°.

  2. Environmental issues elimination through circular economy

    NASA Astrophysics Data System (ADS)

    Špirková, M.; Pokorná, E.; Šujanová, J.; Samáková, J.

    2016-04-01

    Environmental efforts of European Union are currently going towards circular economy. Tools like Extended Producer Responsibility and Eco-design were established. The circular economy deals with resources availability issue on one hand and waste management on the other hand. There are few pioneering companies all over the world with some kind of circular economy practice. Generally the concept is not very wide-spread. The paper aims to evaluate possibility of transition towards circular economy in Slovak industrial companies. They need to have an active approach to material treatment of their products after usage stage. Innovation is another important pre-condition for the transition. Main problem of current cradle to grave system is landfilling of valuable materials after one cycle of usage. Their potential value for next manufacturing cycles is lost. Companies may do not see connection between waste management and material resource prices and volatility of supplies. Municipalities are responsible for municipal waste collection and treatment in Slovakia. The circular economy operates by cradle to cradle principle. Company manages material flow until the material comes back to the beginning of manufacturing process by itself or by another partners. Stable material supplies with quite low costs are provided this way. It is necessary to deal with environmental problems in phase of product design. Questionnaire survey results show on one hand low involvement of industrial companies in waste management area, however on the other hand they are open to environmental innovations in future.

  3. Circular and Elliptic Submerged Impinging Water Jets

    NASA Astrophysics Data System (ADS)

    Claudey, Eric; Benedicto, Olivier; Ravier, Emmanuel; Gutmark, Ephraim

    1999-11-01

    Experiments and CFD have been performed to study circular and elliptic jets in a submerged water jet facility. The tests included discharge coefficient measurement to evaluate pressure losses encountered in noncircular nozzles compared to circular ones. Three-dimensional pressure mappings on the impingement surface and PIV measurement of the jet mean and turbulent velocity have been performed at different compound impingement angles relative to the impingement surface and at different stand-off distances. The objective was to investigate the effect of the non-circular geometry on the flow field and on the impact region. The tests were performed in a close loop system in which the water was pumped through the nozzles into a clear Plexiglas tank. The Reynolds numbers were typically in the range of 250000. Discharge coefficients of the elliptic nozzle was somewhat lower than that of the circular jet but spreading rate and turbulence level were higher. Pressure mapping showed that the nozzle exit geometry had an effect on the pressure distribution in the impact region and that high-pressure zones were generated at specific impact points. PIV measurements showed that for a same total exit area, the elliptic jets affected a surface area that is 8the equivalent circular. The turbulence level in the elliptic jet tripled due to the nozzle design. Results of the CFD model were in good agreement with the experimental data.

  4. Hospital marketing.

    PubMed

    Carter, Tony

    2003-01-01

    This article looks at a prescribed academic framework for various criteria that serve as a checklist for marketing performance that can be applied to hospital marketing organizations. These guidelines are drawn from some of Dr. Noel Capon of Columbia University's book Marketing Management in the 21st Century and applied to actual practices of hospital marketing organizations. In many ways this checklist can act as a "marketing" balanced scorecard to verify performance effectiveness and develop opportunities for innovation.

  5. Hospital philanthropy.

    PubMed

    Smith, Dean G; Clement, Jan P

    2013-01-01

    It remains an open question whether hospital spending on fundraising efforts to garner philanthropy is a good use of funds. Research and industry reports provide conflicting results. We describe the accounting and data challenges in analysis of hospital philanthropy, which include measurement of donations, measurement of fundraising expenses, and finding the relationships among organizations where these cash flows occur. With these challenges, finding conflicting results is not a surprise.

  6. Prolonged clonal spreading and dynamic changes in antimicrobial resistance of Escherichia coli ST68 among patients who stayed in a respiratory care ward.

    PubMed

    Chen, Chih-Ming; Ke, Se-Chin; Li, Chia-Ru; Chiou, Chien-Shun; Chang, Chao-Chin

    2014-11-01

    From 2007 to 2009, we collected a total of 83 bacteraemic isolates of Escherichia coli with reduced susceptibility or resistance to third-generation cephalosporins (TGCs). Isolates were genotyped by PFGE and multilocus sequence typing (MLST). The PFGE patterns revealed two highly correlated clusters (cluster E: nine isolates; cluster G: 22 isolates) associated with this prolonged clonal spreading. Compared with cluster E isolates, cluster G isolates were significantly more likely to harbour aac(6')-Ib-cr (P<0.05), and most of these isolates were isolated during a later year than cluster E isolates (P<0.05). By MLST analysis, 94% of cluster E and G isolates (29/31) were ST68. Although no time or space clustering could be identified by the conventional hospital-acquired infection monitoring system, E. coli cases caused by cluster E and G isolates were significantly associated with having stayed in our hospital's respiratory care ward (P<0.05). Isolates obtained from patients who had stayed in the respiratory care ward had a significantly higher rate of aac(6')-Ib-cr and blaCTX-M-14 positivity, and were more likely to belong to ST68/S68-like (all P<0.05). To our knowledge, this is the first report of prolonged clonal spreading caused by E. coli ST68 associated with a stay in a long-term care facility. Using epidemiological investigations and PFGE and MLST analyses, we have identified long-term clonal spreading caused by E. coli ST68, with extra antimicrobial-resistance genes possibly acquired during the prolonged spreading period.

  7. 6-PACK programme to decrease fall injuries in acute hospitals: cluster randomised controlled trial

    PubMed Central

    Morello, Renata T; Wolfe, Rory; Brand, Caroline A; Haines, Terry P; Hill, Keith D; Brauer, Sandra G; Botti, Mari; Cumming, Robert G; Livingston, Patricia M; Sherrington, Catherine; Zavarsek, Silva; Lindley, Richard I; Kamar, Jeannette

    2016-01-01

    Objective To evaluate the effect of the 6-PACK programme on falls and fall injuries in acute wards. Design Cluster randomised controlled trial. Setting Six Australian hospitals. Participants All patients admitted to 24 acute wards during the trial period. Interventions Participating wards were randomly assigned to receive either the nurse led 6-PACK programme or usual care over 12 months. The 6-PACK programme included a fall risk tool and individualised use of one or more of six interventions: “falls alert” sign, supervision of patients in the bathroom, ensuring patients’ walking aids are within reach, a toileting regimen, use of a low-low bed, and use of a bed/chair alarm. Main outcome measures The co-primary outcomes were falls and fall injuries per 1000 occupied bed days. Results During the trial, 46 245 admissions to 16 medical and eight surgical wards occurred. As many people were admitted more than once, this represented 31 411 individual patients. Patients’ characteristics and length of stay were similar for intervention and control wards. Use of 6-PACK programme components was higher on intervention wards than on control wards (incidence rate ratio 3.05, 95% confidence interval 2.14 to 4.34; P<0.001). In all, 1831 falls and 613 fall injuries occurred, and the rates of falls (incidence rate ratio 1.04, 0.78 to 1.37; P=0.796) and fall injuries (0.96, 0.72 to 1.27; P=0.766) were similar in intervention and control wards. Conclusions Positive changes in falls prevention practice occurred following the introduction of the 6-PACK programme. However, no difference was seen in falls or fall injuries between groups. High quality evidence showing the effectiveness of falls prevention interventions in acute wards remains absent. Novel solutions to the problem of in-hospital falls are urgently needed. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12611000332921. PMID:26813674

  8. Experimental evidence for circular inference in schizophrenia

    NASA Astrophysics Data System (ADS)

    Jardri, Renaud; Duverne, Sandrine; Litvinova, Alexandra S.; Denève, Sophie

    2017-01-01

    Schizophrenia (SCZ) is a complex mental disorder that may result in some combination of hallucinations, delusions and disorganized thinking. Here SCZ patients and healthy controls (CTLs) report their level of confidence on a forced-choice task that manipulated the strength of sensory evidence and prior information. Neither group's responses can be explained by simple Bayesian inference. Rather, individual responses are best captured by a model with different degrees of circular inference. Circular inference refers to a corruption of sensory data by prior information and vice versa, leading us to `see what we expect' (through descending loops), to `expect what we see' (through ascending loops) or both. Ascending loops are stronger for SCZ than CTLs and correlate with the severity of positive symptoms. Descending loops correlate with the severity of negative symptoms. Both loops correlate with disorganized symptoms. The findings suggest that circular inference might mediate the clinical manifestations of SCZ.

  9. Nanophotonic control of circular dipole emission

    NASA Astrophysics Data System (ADS)

    Le Feber, B.; Rotenberg, N.; Kuipers, L.

    2015-04-01

    Controlling photon emission by single emitters with nanostructures is crucial for scalable on-chip information processing. Nowadays, nanoresonators can affect the lifetime of linear dipole emitters, while nanoantennas can steer the emission direction. Expanding this control to the emission of orbital angular momentum-changing transitions would enable a future coupling between solid state and photonic qubits. As these transitions are associated with circular dipoles, such control requires knowledge of the interaction of a complex dipole with optical eigenstates containing local helicity. We experimentally map the coupling of classical, circular dipoles to photonic modes in a photonic crystal waveguide. We show that, depending on the combination of the local helicity of the mode and the dipole helicity, circular dipoles can couple to left- or rightwards propagating modes with a near-unity directionality. The experimental maps are in excellent agreement with calculations. Our measurements, therefore, demonstrate the possibility of coupling the spin to photonic pathway.

  10. Experimental evidence for circular inference in schizophrenia

    PubMed Central

    Jardri, Renaud; Duverne, Sandrine; Litvinova, Alexandra S; Denève, Sophie

    2017-01-01

    Schizophrenia (SCZ) is a complex mental disorder that may result in some combination of hallucinations, delusions and disorganized thinking. Here SCZ patients and healthy controls (CTLs) report their level of confidence on a forced-choice task that manipulated the strength of sensory evidence and prior information. Neither group's responses can be explained by simple Bayesian inference. Rather, individual responses are best captured by a model with different degrees of circular inference. Circular inference refers to a corruption of sensory data by prior information and vice versa, leading us to ‘see what we expect' (through descending loops), to ‘expect what we see' (through ascending loops) or both. Ascending loops are stronger for SCZ than CTLs and correlate with the severity of positive symptoms. Descending loops correlate with the severity of negative symptoms. Both loops correlate with disorganized symptoms. The findings suggest that circular inference might mediate the clinical manifestations of SCZ. PMID:28139642

  11. Circular bacteriocins: biosynthesis and mode of action.

    PubMed

    Gabrielsen, Christina; Brede, Dag A; Nes, Ingolf F; Diep, Dzung B

    2014-11-01

    Circular bacteriocins are a group of N-to-C-terminally linked antimicrobial peptides, produced by Gram-positive bacteria of the phylum Firmicutes. Circular bacteriocins generally exhibit broad-spectrum antimicrobial activity, including against common food-borne pathogens, such as Clostridium and Listeria spp. These peptides are further known for their high pH and thermal stability, as well as for resistance to many proteolytic enzymes, properties which make this group of bacteriocins highly promising for potential industrial applications and their biosynthesis of particular interest as a possible model system for the synthesis of highly stable bioactive peptides. In this review, we summarize the current knowledge on this group of bacteriocins, with emphasis on the recent progress in understanding circular bacteriocin genetics, biosynthesis, and mode of action; in addition, we highlight the current challenges and future perspectives for the application of these peptides.

  12. Structure and genetics of circular bacteriocins.

    PubMed

    van Belkum, Marco J; Martin-Visscher, Leah A; Vederas, John C

    2011-08-01

    Circular bacteriocins are antimicrobial peptides produced by a variety of Gram-positive bacteria. They are part of a growing family of ribosomally synthesized peptides with a head-to-tail cyclization of their backbone that are found in mammals, plants, fungi and bacteria and are exceptionally stable. These bacteriocins permeabilize the membrane of sensitive bacteria, causing loss of ions and dissipation of the membrane potential. Most circular bacteriocins probably adopt a common 3D structure consisting of four or five α-helices encompassing a hydrophobic core. This review compares the various structures, as well as the gene clusters that encode circular bacteriocins, and discusses the biogenesis of this unique class of bacteriocins.

  13. Circular Bacteriocins: Biosynthesis and Mode of Action

    PubMed Central

    Brede, Dag A.; Nes, Ingolf F.; Diep, Dzung B.

    2014-01-01

    Circular bacteriocins are a group of N-to-C-terminally linked antimicrobial peptides, produced by Gram-positive bacteria of the phylum Firmicutes. Circular bacteriocins generally exhibit broad-spectrum antimicrobial activity, including against common food-borne pathogens, such as Clostridium and Listeria spp. These peptides are further known for their high pH and thermal stability, as well as for resistance to many proteolytic enzymes, properties which make this group of bacteriocins highly promising for potential industrial applications and their biosynthesis of particular interest as a possible model system for the synthesis of highly stable bioactive peptides. In this review, we summarize the current knowledge on this group of bacteriocins, with emphasis on the recent progress in understanding circular bacteriocin genetics, biosynthesis, and mode of action; in addition, we highlight the current challenges and future perspectives for the application of these peptides. PMID:25172850

  14. Charged Particle Optics in Circular Higgs Factory

    SciTech Connect

    Cai, Yunhai

    2015-02-26

    Similar to a super B-factory, a circular Higgs factory will require strong focusing systems near the interaction points and a low-emittance lattice in arcs to achieve a factory luminosity. At electron beam energy of 120 GeV, beamstrahlung effects during the collision pose an additional challenge to the collider design. In particular, a large momentum acceptance at 2 percent level is necessary to retain an adequate beam lifetime. This turns out to be the most challenging aspect in the design of circular Higgs factory. In this paper, an example will be provided to illustrate the beam dynamics in circular Higgs factory, emphasizing on the chromatic optics. Basic optical modules and advanced analysis will be presented. Most important, we will show that 2% momentum aperture is achievable

  15. Circularly Polarized Luminescence from Simple Organic Molecules.

    PubMed

    Sánchez-Carnerero, Esther M; Agarrabeitia, Antonia R; Moreno, Florencio; Maroto, Beatriz L; Muller, Gilles; Ortiz, María J; de la Moya, Santiago

    2015-09-21

    This article aims to show the identity of "circularly polarized luminescent active simple organic molecules" as a new concept in organic chemistry due to the potential interest of these molecules, as availed by the exponentially growing number of research articles related to them. In particular, it describes and highlights the interest and difficulty in developing chiral simple (small and non-aggregated) organic molecules able to emit left- or right-circularly polarized light efficiently, the efforts realized up to now to reach this challenging objective, and the most significant milestones achieved to date. General guidelines for the preparation of these interesting molecules are also presented.

  16. Practical circular-polarization-maintaining optical fiber.

    PubMed

    Huang, H C

    1997-09-20

    The author describes a new idea for making circular-polarization-maintaining optical fiber with an existing fabrication technique. The method simply requires one to spin at a constant rate a special preform consisting of only one off-axis stress-applying element in addition to the on-axis core. Measurements taken with such a fiber specimen verify the existence of circular eigenmodes, the ease of joining or splicing two fiber segments, the tolerance to macrobending with a small radius, etc. Good agreement exists between the experimental data and the theoretical analysis. Prospective applications are discussed.

  17. Rotatable non-circular forebody flow controller

    NASA Technical Reports Server (NTRS)

    Moskovitz, Cary A. (Inventor)

    1991-01-01

    The invention is a rotatable, non-circular forebody flow controller. The apparatus comprises a small geometric device located at a nose of a forebody of an aircraft and a non-circular cross-sectional area that extends toward the apex of the aircraft. The device is symmetrical about a reference plane and preferably attaches to an axle which in turn attaches to a rotating motor. The motor rotates the device about an axis of rotation. Preferably, a control unit connected to an aircraft flight control computer signals to the rotating motor the proper rotational positioning of the geometric device.

  18. Nosocomial Cholera Outbreak in a Mental Hospital: Challenges and Lessons Learnt from Butabika National Referral Mental Hospital, Uganda.

    PubMed

    Bwire, Godfrey; Malimbo, Mugagga; Kagirita, Atek; Makumbi, Issa; Mintz, Eric; Mengel, Martin A; Orach, Christopher Garimoi

    2015-09-01

    During the last four decades, Uganda has experienced repeated cholera outbreaks in communities; no cholera outbreaks have been reported in Ugandan health facilities. In October 2008, a unique cholera outbreak was confirmed in Butabika National Mental Referral Hospital (BNMRH), Uganda. This article describes actions taken to control the outbreak, challenges, and lessons learnt. We reviewed patient and hospital reports for clinical symptoms and signs, treatment and outcome, patient mental diagnosis, and challenges noted during management of patients and contacts. Out of 114 BNMRH patients on two affected wards, 18 cholera cases and five deaths were documented for an attack rate of 15.8% and a case fatality rate of 28%. Wards and surroundings were intensively disinfected and 96 contacts (psychiatric patients) in the affected wards received chemoprophylaxis with oral ciprofloxacin 500 mg twice daily until November 5, 2008. We documented a nosocomial cholera outbreak in BNMRH with a high case fatality of 28% compared with the national average of 2.4% for cholera outbreaks in communities. To avoid cholera outbreaks and potentially high mortality among patients in mental institutions, procedures for prompt diagnosis, treatment, disinfection, and prophylaxis are needed and preemptive use of oral cholera vaccines should be considered.

  19. Suffer the little children. The influence of nurses and parents in the evolution of open visiting in children's wards 1940-1970.

    PubMed

    Bradley, S

    2001-01-01

    Major changes have occurred in children's hospital care in the UK since the 1940s, many provoking intense debate amongst professionals and public. A dynamic tension between the views of nurses and parents appears to have influenced significantly the process of change--but not always to the benefit of the child. The 'vexed question' of parental visiting is one example. Open visiting of hospitalised children is now indisputable--50 years ago however the issue was fiercely debated. Parents could visit weekly, sometimes not at all. Contemporary research into early separation of child and mother introduced new insights into the needs of children. The Government responded by urging hospitals to institute regular visiting for children--a subsequent Report, 'The Welfare of Children in Hospital', recommended daily, open visiting. Progress was slow however: whilst there is evidence nurses tried new policies, it is also clear that certain arguments were repeatedly postulated against open visiting. Through the pressure of dissatisfied parents and sympathetic professionals change was eventually achieved, though not without great effort. It is difficult now to understand why change in such a crucial area was so delayed. This paper presents material from the archives of the Association of British Paediatric Nurses, the pressure group Action for Sick Children and contemporary journal papers, exploring the influence of paediatric nurses and parents in the evolution of open visiting in children's wards in the UK, in the period 1940-1970.

  20. Management of hospitalized type 2 diabetes mellitus patients

    PubMed Central

    Marín-Peñalver, Juan José; Martín-Timón, Iciar

    2016-01-01

    Abstract Both hyperglycemia and hypoglycemia in hospitalized patients are associated with adverse outcomes including increased rates of infection, longer hospital length of stay, and even death. Clinical trials in patients with type 2 diabetes mellitus proved that by improving glycemic control, we can reduce all of them. Insulin is the preferred treatment for glycemic control in most cases, but alternative treatment options that can normalize blood glucose levels without hypoglycemia are being sought. Moreover, hospitalized patients are particularly vulnerable to severe, prolonged hypoglycemia since they may be unable to sense or respond to the early warning signs and symptoms of low blood glucose. Finally, nutritional support, corticosteroid therapy, and surgery increase the risk of hyperglycemia that leads to an increased risk of morbidity and mortality. We review the management of type 2 diabetes mellitus patients who are admitted to the general medical wards of the hospital for a procedure of intercurrent illness. PMID:28191539