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Sample records for patient treatment room

  1. Patients' Experience of Winter Depression and Light Room Treatment

    PubMed Central

    2017-01-01

    Background. There is a need for more knowledge on the effects of light room treatment in patients with seasonal affective disorder and to explore patients' subjective experience of the disease and the treatment. Methods. This was a descriptive and explorative study applying qualitative content analysis. A purposeful sample of 18 psychiatric outpatients with a major depressive disorder with a seasonal pattern and a pretreatment score ≥12 on the 9-item Montgomery-Åsberg Depression self-rating scale was included (10 women and 8 men, aged 24–65 years). All patients had completed light room treatment (≥7/10 consecutive weekdays). Data was collected two weeks after treatment using a semistructured interview guide. Results. Patients described a clear seasonal pattern and a profound struggle to adapt to seasonal changes during the winter, including deterioration in sleep, daily rhythms, energy level, mood, activity, and cognitive functioning. Everyday life was affected with reduced work capacity, social withdrawal, and disturbed relations with family and friends. The light room treatment resulted in a radical and rapid improvement in all the major symptoms with only mild and transient side effects. Discussion. The results indicate that light room treatment is essential for some patients' ability to cope with seasonal affective disorder. PMID:28293623

  2. SU-E-T-387: Achieving Optimal Patient Setup Imaging and Treatment Workflow Configurations in Multi-Room Proton Centers

    SciTech Connect

    Zhang, H; Prado, K; Langen, K; Yi, B; Mehta, M; Regine, W; D'Souza, W

    2014-06-01

    Purpose: To simulate patient flow in proton treatment center under uncertainty and to explore the feasibility of treatment preparation rooms to improve patient throughput and cyclotron utilization. Methods: Three center layout scenarios were modeled: (S1: In-Tx room imaging) patient setup and imaging (planar/volumetric) performed in treatment room, (S2: Patient setup in preparation room) each treatment room was assigned with preparation room(s) that was equipped with lasers only for patient setup and gross patient alignment, and (S3: Patient setup and imaging in preparation room) preparation room(s) was equipped with laser and volumetric imaging for patient setup, gross and fine patient alignment. A 'snap' imaging was performed in treatment room. For each scenario, the number of treatment rooms and the number of preparation rooms serving each treatment room were varied. We examined our results (average of 100 16-hour (two shifts) working days) by evaluating patient throughput and cyclotron utilization. Results: When the number of treatment rooms increased ([from, to]) [1, 5], daily patient throughput increased [32, 161], [29, 184] and [27, 184] and cyclotron utilization increased [13%, 85%], [12%, 98%], and [11%, 98%] for scenarios S1, S2 and S3 respectively. However, both measures plateaued after 4 rooms. With the preparation rooms, the throughput and the cyclotron utilization increased by 14% and 15%, respectively. Three preparation rooms were optimal to serve 1-3 treatment rooms and two preparation rooms were optimal to serve 4 or 5 treatment rooms. Conclusion: Patient preparation rooms for patient setup may increase throughput and decrease the need for additional treatment rooms (cost effective). Optimal number of preparation rooms serving each gantry room varies as a function of treatment rooms and patient setup scenarios. A 5th treatment room may not be justified by throughput or utilization.

  3. [Single-patient rooms].

    PubMed

    Jensen, Elisabeth Brøgger

    2009-05-18

    The Danish government has allocated funding to achieve the goal of replacing 50% of all existing hospital buildings by new facilities. Facing such a building boom, the debate for and against single-patient rooms is in progress. A review of the literature shows that single-patient rooms have a direct impact on patient safety. Patient Safety Leadership Walkrounds and failure modes and effects analysis can be used for identifying risks before designing single rooms in future hospitals. The acuity adaptability model needs to be revised.

  4. Monte Carlo study of neutron-ambient dose equivalent to patient in treatment room.

    PubMed

    Mohammadi, A; Afarideh, H; Abbasi Davani, F; Ghergherehchi, M; Arbabi, A

    2016-12-01

    This paper presents an analytical method for the calculation of the neutron ambient dose equivalent H* (10) regarding patients, whereby the different concrete types that are used in the surrounding walls of the treatment room are considered. This work has been performed according to a detailed simulation of the Varian 2300C/D linear accelerator head that is operated at 18MV, and silver activation counter as a neutron detector, for which the Monte Carlo MCNPX 2.6 code is used, with and without the treatment room walls. The results show that, when compared to the neutrons that leak from the LINAC, both the scattered and thermal neutrons are the major factors that comprise the out-of field neutron dose. The scattering factors for the limonite-steel, magnetite-steel, and ordinary concretes have been calculated as 0.91±0.09, 1.08±0.10, and 0.371±0.01, respectively, while the corresponding thermal factors are 34.22±3.84, 23.44±1.62, and 52.28±1.99, respectively (both the scattering and thermal factors are for the isocenter region); moreover, the treatment room is composed of magnetite-steel and limonite-steel concretes, so the neutron doses to the patient are 1.79 times and 1.62 times greater than that from an ordinary concrete composition. The results also confirm that the scattering and thermal factors do not depend on the details of the chosen linear accelerator head model. It is anticipated that the results of the present work will be of great interest to the manufacturers of medical linear accelerators.

  5. [Interdisciplinary treatment of severely injured patients in the trauma resuscitation room].

    PubMed

    Wurmb, Thomas; Müller, Thorben; Jansen, Hendrik; Ruchholtz, Steffen; Roewer, Norbert; Kühne, Christian A

    2010-06-01

    The trauma resuscitation room in emergency departments is an important link between preclinical treatment and clinical management of patients with multiple trauma. For the trauma team (Trauma Surgery, Anaesthesiology, Radiology) to respond adequately, a high degree of training and standardisation is required. With arrival of the patient, the trauma team starts with priority orientated resuscitation. After life-threatening problems have been resolved, the diagnostic work is started with plain films of the chest and the pelvis and FAST. Additional plain films are made depending on further suspected injuries. Reassessment of the patient is done and necessary emergency interventions are performed before the patient is transferred to the radiology department for organ focused computed tomography. CT has gained importance in the early diagnostic phase of trauma care. The development of Multislice Helical Computed Tomography (MSCT) has led to substantial refinement in the diagnostic work-up. For many institutions it has become an essential part of the imaging of the traumatized patient. Delayed and insufficient medical interventions have a high impact on negative patient outcome. Anticipating and dealing with critical situations might reduce preventable errors in the treatment process and can be achieved by implementation of an algorithm-based structured workflow. In that context some elements of quality management are well established in clinical practice. In the presented paper we describe the effort that needs to be done to provide optimal care for multiple trauma patients after admission to a designed trauma centre.

  6. Compliance with adjuvant treatment guidelines in endometrial cancer: room for improvement in high risk patients.

    PubMed

    Eggink, F A; Mom, C H; Boll, D; Ezendam, N P M; Kruitwagen, R F P M; Pijnenborg, J M A; van der Aa, M A; Nijman, H W

    2017-08-01

    Compliance of physicians with guidelines has emerged as an important indicator for quality of care. We evaluated compliance of physicians with adjuvant therapy guidelines for endometrial cancer patients in the Netherlands in a population-based cohort over a period of 10years. Data from all patients diagnosed with endometrial cancer between 2005 and 2014, without residual tumor after surgical treatment, were extracted from the Netherlands Cancer Registry (N=14,564). FIGO stage, grade, tumor type and age were used to stratify patients into risk groups. Possible changes in compliance over time and impact of compliance on survival were assessed. Patients were stratified into low/low-intermediate (52%), high-intermediate (21%) and high (20%) risk groups. Overall compliance with adjuvant therapy guidelines was 85%. Compliance was highest in patients with low/low-intermediate risk (98%, no adjuvant therapy indicated). The lowest compliance was determined in patients with high risk (61%, external beam radiotherapy with/without chemotherapy indicated). Within this group compliance decreased from 64% in 2005-2009 to 57% in 2010-2014. In high risk patients with FIGO stage III serous disease compliance was 55% (chemotherapy with/without radiotherapy indicated) and increased from 41% in 2005-2009 to 66% in 2010-2014. While compliance of physicians with adjuvant therapy guidelines is excellent in patients with low and low-intermediate risk, there is room for improvement in high risk endometrial cancer patients. Eagerly awaited results of ongoing randomized clinical trials may provide more definitive guidance regarding adjuvant therapy for high risk endometrial cancer patients. Copyright © 2017 Elsevier Inc. All rights reserved.

  7. Self-Medication: Initial Treatments Used by Patients Seen in an Ophthalmologic Emergency Room

    PubMed Central

    Carvalho, Regina Souza; Kara-José, Newton; Temporini, Edméa Rita; Kara-Junior, Newton; Noma-Campos, Regina

    2009-01-01

    OJECTIVE This study seeks to identify practices of self-medication in the treatment of ocular emergencies. We examine patients’ use of both homemade preparations and manufactured products before seeking specialized care. MATERIALS AND METHODS We conducted a cross-sectional analytic survey of consecutive patients seen in the ophthalmology emergency room of a teaching hospital. RESULTS The sample included 561 subjects, 51.3% males and 48.7% females, with a mean age of 39.8 years. Prior to seeking emergency care, 40.5% reported self-medicating; 29.4% used a homemade preparation (13.9% referred to an industrialized product like boric acid as a homemade preparation), and 11.1% used a manufactured product. The most frequently used products included a boric acid solution (53.3%), a normal saline solution (35.7%), herbal infusions (6.1%) and breast milk (4.8%). Viral conjunctivitis was the most frequent diagnosis (24.4%), followed by the presence of a corneal foreign body (7.4%). No significant differences were found in the self-treatment of ocular injuries according to gender (p = 0.95), level of education (p = 0.21) or age (p = 0.14). In addition, self-medication practices were not related to the medically judged severity of the condition. CONCLUSION Patients often attempt to treat conditions that require ophthalmologic emergency care by self-medicating with homemade or manufactured products. The most widely used products include boric acid, normal saline, leaf infusions and breast milk. This behavior occurs independently of educational level, gender, age or the nature of the ocular condition. Self-medication is a culturally driven practice that is used even in cases of acute ocular injuries. PMID:19690656

  8. Introduction of a treatment algorithm can improve the early management of emergency patients in the resuscitation room.

    PubMed

    Bernhard, Michael; Becker, Torben K; Nowe, Tim; Mohorovicic, Marko; Sikinger, Marcus; Brenner, Thorsten; Richter, Goetz M; Radeleff, Boris; Meeder, Peter-Jürgen; Büchler, Markus W; Böttiger, Bernd W; Martin, Eike; Gries, André

    2007-06-01

    Successful management of emergency patients with multiple trauma in the hospital resuscitation room depends on the immediate diagnosis and rapid treatment of the most life-threatening injuries. In order to reduce the time spent in the resuscitation room, an in-hospital algorithm was developed in an interdisciplinary team approach with respect to local structures. The aim of the study was to analyse whether this algorithm affects the interval between hospital admission and the completion of diagnostic procedures and the start of life-saving interventions. Moreover, in-hospital mortality was investigated before and after the algorithm was introduced. In this prospective study, all consecutive trauma patients in the resuscitation room were investigated before (group I, 01/04-10/04) and after (group II, 01/05-11/05) introduction of the algorithm. The times between hospital admission and the end of the diagnostic procedures (ultrasound [sono], chest X-ray [CF], and cranial computed tomography [CCT]), and between hospital admission and the start of life-saving interventions were registered and in-hospital mortality analysed. In the study period, 170 patients in group I and 199 patients in group II were investigated. Injury severity score (ISS) were comparable between the two groups. The intervals between admission and completion of diagnostic procedures were significantly lower after the algorithm was introduced (mean+/-S.D.): sono (11 +/- 10 min versus 7 +/- 6 min, p < 0.05), CF (21 +/- 12 min versus 12 +/- 9 min, p < 0.01), and CCT (55 +/- 27 min versus 32 +/- 14 min, p < 0.01). Moreover, the interval to the start of life-saving interventions was significantly shorter (126 +/- 90 min versus 51 +/- 20 min, p < 0.01). After introducing the algorithm, in-hospital mortality was reduced significantly from 33.3% to 16.7% (p < 0.05) in the most severely injured patients (ISS>or=25). The introduction of an algorithm for early management of emergency patients significantly

  9. RADIATION DOSIMETRY IN THE BNCT PATIENT TREATMENT ROOM AT THE BMRR.

    SciTech Connect

    HOLDEN, N.E.; RECINIELLO, R.N.; HU, J.-P.

    2005-05-08

    The Medical Research Reactor at the Brookhaven National Laboratory (BMRR) was a heterogeneous, tank type, light water cooled and moderated, graphite reflected reactor, which was operated on demand at a power level up to 3 mega-watts (MW) for medical and biological research [1]. The reactor first went critical on March 15, 1959, with 17 fresh fuel elements (2.52 kg uranium-235 in a total of 2.7 kg uranium) in the center core. The BMRR had two treatment rooms on opposite sides of the core. It had a predominately thermal neutron beam in the Thermal Neutron Irradiation Facility (TNE) on the west side of the core. By early 1990, a redesigned beam line had a predominately epithermal neutron beam in the Epithermal Neutron Irradiation Facility (ENIF) on the east side of the core [2]. The ENP was approximately 11 feet by 21 feet in size with its focal point consisting of a bismuth plate mounted in the wall adjacent to the reactor shield about 36 inches above the floor. The beam originated at a shutter constructed of 0.75 inch steel filled with concrete and weighing {approx}21 tons. Access to the ENIF was through a pair of hand operated steel shielding doors, each 42 inches wide, 84 inches high and 5 inches thick. The inner door had a 4-inch thick layer of paraffin on the side facing the reactor. The doors 5000 pounds weighed each. Additional shielding material had been added to the entire beam port at reactor wall within the ENIF. The shielding material consisted of 2-inch thick polyethylene sheets, which were impregnated with 95%-enriched {sup 6}Li in lithium carbonate (Li{sub 2}CO{sub 3}). The shielding sheets around the port face were designed to allow the insertion of a variety of different beam collimators.

  10. Design of patient rooms and automatic radioiodine-131 waste water management system for a thyroid cancer treatment ward: 'Suandok Model'.

    PubMed

    Vilasdechanon, N; Ua-Apisitwong, S; Chatnampet, K; Ekmahachai, M; Vilasdechanon, J

    2014-09-01

    The great benefit of (131)I radionuclide treatment for differentiated thyroid cancer (DTC) was acknowledged by the long survival rate. The main requirements for (131)I therapy in hospital were treatment facilities and a radiation safety plan that assured radiation protection and safety to patient, hospital worker, public, and environment. To introduce the concepts and methods of radiation safety design for a patient's room in a (131)I treatment ward and a system of radioactive waste water management in hospital. The design was based on principles of external and internal radiation protection for unsealed source and radioactive waste management. Planning for treatment facilities was concluded from clinical evidence, physical and physiological information for (131)I, radiation safety criteria, hospital resources and budget. The three phases of the working process were: construction, software development, and radiation safety assessment. The (131)I treatment facility and automatic radioactive waste water management system was completely implemented in 2009. The radiation waste water management system known as the 'Suandok Model' was highly recommended by the national regulator to hospitals who desire to provide (131)I treatment for thyroid cancer. In 2011, the Nuclear Medicine Division, Chiang Mai University was rewarded by the national authority for a very good radiation practice in development of safe working conditions and environment. The Suandok Model was a facility design that fulfilled requirements for the safe use of high radiation (131)I doses for thyroid cancer treatment in hospital. The facility presented in this study may not be suitable for all hospitals but the design concepts could be applied according to an individual hospital context and resources. People who use or gain benefit from radiation applications have to emphasise the responsibility to control and monitor radiation effects on individuals, communities and the environment.

  11. Noise control considerations for patient rooms

    NASA Astrophysics Data System (ADS)

    Davenny, Benjamin

    2005-09-01

    The patient room envelope is a path between outside noise sources and the patient receiver. Within the patient room there are several sources including televisions, clinical monitor alarms, medical pumps, etc. Noise control in patient rooms relies on a combination of the sound transmission loss of the patient room envelope and the level of background sound at the patient's head. Guidelines published by the American Society of Heating, Refrigerating, and Air-Conditioning Engineers (ASHRAE), American Institute of Architects (AIA), and the U.S. Department of Defense for background noise and sound transmission loss in patient rooms will be discussed. Appropriate levels, spectra, and temporal characteristics of background sound at the patient head location may be helpful in raising the threshold of annoying sounds. Various means of personal hearing protection for patients will be discussed. Sound-pressure levels in patient rooms reported in previous literature will also be discussed.

  12. Evaluation of the disruptive behaviors among treatment teams and its reflection on the therapy process of patients in the operating room: The impact of personal conflicts

    PubMed Central

    Maddineshat, Maryam; Hashemi, Mitra; Tabatabaeichehr, Mahbubeh

    2017-01-01

    INTRODUCTION: Understanding the development and distribution of disruptive behaviour among members of a health-care team is critical to the safety and quality of patient care in high-risk environments such as operating rooms. The present study identified disruptive behaviour and its effect on the treatment of patients in the operating room environment. SUBJECTS AND METHODS: This cross-sectional study used the convenience sampling method to select 144 operating room physicians and nurses (91 women and 53 men). The study was conducted in the operating rooms of four academic hospitals with different specialties in North Khorasan province in Iran from December 2013 to September 2014. The data were collected using a translated, modified, and validated questionnaire to investigate the prevalence and consequences of disruptive behaviour, the response of the health care system to the behaviour, factors affecting the creation of conflict and the spread of disruptive behaviour. Statistical analysis of the data was performed using SPSS 18. RESULTS: Disruptive behaviour was reported by 82.95% physicians and nurses. On average, 39% of physicians and 21% of operating room nurses exhibited disruptive behaviour. Disruptive behaviour is associated with psychological and clinical consequences. Factors such as fear of retaliation (8%), lack of change (43.8%), lack of security (18.1%) and attitude of the organization (14.6%) are significant reasons for the failure to report these behaviours. CONCLUSIONS: The findings suggest that disruptive behaviour occurs and affects treatment and workflow of treatment teams in the operating room. Interpersonal conflict contributes to the growth of such behaviour; thus, more research should focus on this subject in the future. PMID:28852659

  13. Evaluation of the disruptive behaviors among treatment teams and its reflection on the therapy process of patients in the operating room: The impact of personal conflicts.

    PubMed

    Maddineshat, Maryam; Hashemi, Mitra; Tabatabaeichehr, Mahbubeh

    2017-01-01

    Understanding the development and distribution of disruptive behaviour among members of a health-care team is critical to the safety and quality of patient care in high-risk environments such as operating rooms. The present study identified disruptive behaviour and its effect on the treatment of patients in the operating room environment. This cross-sectional study used the convenience sampling method to select 144 operating room physicians and nurses (91 women and 53 men). The study was conducted in the operating rooms of four academic hospitals with different specialties in North Khorasan province in Iran from December 2013 to September 2014. The data were collected using a translated, modified, and validated questionnaire to investigate the prevalence and consequences of disruptive behaviour, the response of the health care system to the behaviour, factors affecting the creation of conflict and the spread of disruptive behaviour. Statistical analysis of the data was performed using SPSS 18. Disruptive behaviour was reported by 82.95% physicians and nurses. On average, 39% of physicians and 21% of operating room nurses exhibited disruptive behaviour. Disruptive behaviour is associated with psychological and clinical consequences. Factors such as fear of retaliation (8%), lack of change (43.8%), lack of security (18.1%) and attitude of the organization (14.6%) are significant reasons for the failure to report these behaviours. The findings suggest that disruptive behaviour occurs and affects treatment and workflow of treatment teams in the operating room. Interpersonal conflict contributes to the growth of such behaviour; thus, more research should focus on this subject in the future.

  14. Evaluation of a PBL strategy in clinical supervision of nursing students: patient-centred training in student-dedicated treatment rooms.

    PubMed

    Staun, Margaretha; Bergström, Berit; Wadensten, Barbro

    2010-10-01

    The present study aimed at investigating staff members' and nursing students' perception of and satisfaction with an intervention involving patient-centred training in student-dedicated treatment rooms during clinical supervision. It is well known that clinical education is important and that the clinical learning environment influences the development of nursing students' ability to solve clinical problems. In the present study, an intervention using a problem-based learning (PBL) strategy was introduced and evaluated in clinical education. The PBL strategy is called 'Patient-centred training in student-dedicated treatment rooms'. Descriptive; both quantitative and qualitative methods were used. A questionnaire and focus group interviews were used. Most participants found the PBL strategy to be highly satisfactory, both for staff and for students. The students seemed to feel that their time in clinical education had been used efficiently. Integration of theory and practice during clinical training has been emphasized as a necessary component, and the new strategy, which involves a method of promoting students' reflection, represents one way of facilitating such integration, in that it may bridge the gap between theory and practice. More extensive and more specific research is need in the future. Copyright © 2009 Elsevier Ltd. All rights reserved.

  15. Qualities of Inpatient Hospital Rooms: Patients' Perspectives.

    PubMed

    Devlin, Ann Sloan; Andrade, Cláudia Campos; Carvalho, Diana

    2016-04-01

    The aim of this qualitative study was to investigate what design features of hospital rooms are valued by inpatients. Little research has explored how patients evaluate the physical environment of their hospital rooms. Most responses are captured by the Hospital Consumer Assessment of Healthcare Providers and Systems survey, which includes only two questions about the physical environment. Two hundred thirty-six orthopedic patients (78 in the United States and 158 in Portugal) listed three features of their hospital room that influenced their level of satisfaction with their hospital stay, indicating whether the feature was positive or negative. The comments were more positive (71.4%) than negative (28.6%). Using the framework of supportive design from Ulrich, over half the comments (64.31%) could be categorized in one of the three dimensions: 33.2% (positive distraction), 22.4% (perceived control), and 6.0% (social support). This total includes Internet (2.7%), which could be categorized as either social support or positive distraction. Comments called "other aspects" focused on overall environmental appraisals, cleanliness, and functionality and maintenance. The majority of comments could be accommodated by Ulrich's theory, but it is noteworthy that other aspects emerge from patients' comments and affect their experience. Cross-cultural differences pointed to the greater role of light and sun for Portuguese patients and health status whiteboard for U.S. Qualitative research can add significantly to our understanding of the healthcare experience and may inform design decisions. © The Author(s) 2015.

  16. Neutron distribution and induced activity inside a Linac treatment room.

    PubMed

    Juste, B; Miró, R; Verdú, G; Díez, S; Campayo, J M

    2015-01-01

    Induced radioactivity and photoneutron contamination inside a radiation therapy bunker of a medical linear accelerator (Linac) is investigated in this work. The Linac studied is an Elekta Precise electron accelerator which maximum treatment photon energy is 15 MeV. This energy exceeds the photonuclear reaction threshold (around 7 MeV for high atomic number metals). The Monte Carlo code MCNP6 has been used for quantifying the neutron contamination inside the treatment room for different gantry rotation configuration. Walls activation processes have also been simulated. The approach described in this paper is useful to prevent the overexposure of patients and medical staff.

  17. A Study to Determine the Most Resource Efficient Method to Provide Initial Treatment of Adult Nonurgent Patients Who Access Darnall Army Community Hospital via the Emergency Room

    DTIC Science & Technology

    1990-09-01

    editions are obsolete. SECURITY CLASIFICATION OF T;41S PAGE DE PAP RIEINIJ OF TitE API lY HEADOUAFTE PS, 130 T H $TAT 1ON HOOP TA Oil) NEW YOkK 09...room patient popul ation by triage cdtegory, shiT and age over aj c m -odll 0 er .iTht, establi srrrent of an evenirg shuiIt ia I Carie K Tinic, O~y

  18. 14. Water treatment plant interior view of chlorination room. View ...

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

    14. Water treatment plant interior view of chlorination room. View to N - Fort Benton Water Treatment Plant, Filtration Plant, Lots 9-13 of Block 7, Fort Benton Original Townsite at Missouri River, Fort Benton, Chouteau County, MT

  19. [Antimicrobial treatment of bronchial infections in hospital emergency rooms].

    PubMed

    Vallano Ferraz, A; Danés Carreras, I; Ochoa Sangrador, C

    2004-08-01

    To analyze antimicrobial prescribing habits in children diagnosed with bronchial infections in hospital emergency rooms. A descriptive study was performed in a random sample of children diagnosed with acute bronchitis and bronchiolitis in the emergency rooms of 11 Spanish hospitals. Information about the type of bronchial infection diagnosed and the antimicrobial treatment prescribed was gathered. The appropriateness of antibiotic prescriptions was assessed by comparing clinical practice in the use of antibiotics for bronchial infections with consensus guidelines developed for this study. A total of 731 children were selected. The diagnosis was acute bronchitis in 531 (73 %) and bronchiolitis in 200 (27 %). Antimicrobial treatment was prescribed to 234 children (32 %; 95 % CI: 29-35 %). The most commonly prescribed antimicrobials were the aminopenicillins in 138 children (19 %; 95 % CI 16-22 %), cephalosporins in 54 (7 %; 95 % CI 5-9 %) and macrolides in 45 (6 % 95 % CI 4-8 %). The prescribed treatment was inappropriate in 26 % (95 % CI 23-29 %) of patients [31.5 % (95 % CI 27-35 %) of cases of acute bronchitis and 11.5 % (95 % CI 95 % 7-16 %) of cases of bronchiolitis]. Wide variability was observed in the inappropriate use of antimicrobial agents among the different hospitals, both in acute bronchitis (14-80 %) and in bronchiolitis (0-71 %). Inappropriate antimicrobial treatment is prescribed to a considerable proportion of the children with bronchial infections attended in hospital emergency rooms, although there is wide variability among different hospitals. Programs to improve the quality of antimicrobial prescription should be developed. These should combine regulatory and educational measures directed at health professionals and the general public.

  20. Survey Report: Mercury Vapor Levels in Dental Treatment Rooms.

    DTIC Science & Technology

    1982-08-01

    AD-AII9 782 AIRVFORCE OCCUPATIONAL AND ENVIRONMENTAL HEALTH LAS --ETC F/6 6/5 SURVEY REPORT: MERCURY VAPOR LEVELS IN DENTAL TREATMENT ROOMS. (U) AU...2A M C VAUGHN UNCLASSIFIlED OEHLA-2-02EH253HGA m ____ USAF OEHL REPORT 82-02EH4253HGA SURVEY REPORT: MERCURY VAPOR LEVELS IN DENTAL TREATMENT ROOMS...4. TITLE (and Subtitle) 5. TYPE OF REPORT & PERIOD COVERED Survey Report: Mercury Vapor Levels in Preliminary - May 1982 Dental Treatment Rooms

  1. [Operating Room Nurses' Experiences of Securing for Patient Safety].

    PubMed

    Park, Kwang Ok; Kim, Jong Kyung; Kim, Myoung Sook

    2015-10-01

    This study was done to evaluate the experience of securing patient safety in hospital operating rooms. Experiential data were collected from 15 operating room nurses through in-depth interviews. The main question was "Could you describe your experience with patient safety in the operating room?". Qualitative data from the field and transcribed notes were analyzed using Strauss and Corbin's grounded theory methodology. The core category of experience with patient safety in the operating room was 'trying to maintain principles of patient safety during high-risk surgical procedures'. The participants used two interactional strategies: 'attempt continuous improvement', 'immersion in operation with sharing issues of patient safety'. The results indicate that the important factors for ensuring the safety of patients in the operating room are manpower, education, and a system for patient safety. Successful and safe surgery requires communication, teamwork and recognition of the importance of patient safety by the surgical team.

  2. 18. PLAIN OFFICE; SHOWS WOODWORK AND WALL TREATMENT. ROOM 2662, ...

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

    18. PLAIN OFFICE; SHOWS WOODWORK AND WALL TREATMENT. ROOM 2662, SECOND FLOOR, SOUTH SIDE. - Hughes Aircraft Company, Processing & Electronics Building, 6775 Centinela Avenue, Los Angeles, Los Angeles County, CA

  3. "Boarding" Psychiatric Patients in Emergency Rooms: One Court Says "No More".

    PubMed

    Appelbaum, Paul S

    2015-07-01

    "Boarding" involuntary psychiatric patients in medical emergency rooms is common in many parts of the United States. The practice, driven by a shortage of alternative resources, including limited inpatient capacity, can result in patients' being held for days without treatment or a hospital room, often in busy corridors or treatment rooms. A recent challenge to this practice led the Washington Supreme Court to declare it illegal and resulted in the appropriation of substantial funding to create new psychiatric beds. Centralized psychiatric crisis services, with appropriate payment models, may offer another approach to reducing the need for holding patients awaiting inpatient admission.

  4. Acoustical criteria for hospital patient rooms: Resolving competing requirements

    NASA Astrophysics Data System (ADS)

    Brooks, Bennett M.

    2003-10-01

    The acoustical criteria for patient rooms in hospitals, nursing homes, and rehabilitation facilities may be based on several needs. One important requirement is that noise levels in the room be conducive to restful sleep. Also, caregivers must have easy auditory and visual access to the patients, and be able to hear vital sign monitor alarms. This often means that patient rooms are located near central nurse stations and that patient room doors are left open. Further, the recently published federal privacy standards developed by the U.S. Department of Health and Human Services (HSS) under the Health Insurance Portability and Accountability Act (HIPAA) require that ``appropriate physical safeguards'' be put in place to protect the confidentiality of patient health information. The simultaneous and competing requirements for speech privacy, caregiver access, and good sleeping conditions present a serious acoustical challenge to health care facility designers. Specific facility design issues and potential solution strategies are presented.

  5. 20. VIEW OF WASTE TREATMENT CONTROL ROOM IN BUILDING 374. ...

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

    20. VIEW OF WASTE TREATMENT CONTROL ROOM IN BUILDING 374. THE BUILDING 371/374 COMPLEX WAS DESIGNED TO EMPHASIZE AUTOMATICALLY CONTROLLED, REMOTELY OPERATED PROCESSES. (1/80) - Rocky Flats Plant, Plutonium Recovery Facility, Northwest portion of Rocky Flats Plant, Golden, Jefferson County, CO

  6. Room for caring: patients' experiences of well-being, relief and hope during serious illness.

    PubMed

    Timmermann, Connie; Uhrenfeldt, Lisbeth; Birkelund, Regner

    2015-09-01

    This study explores how seriously ill hospitalized patients' experience and assign meaning to their patient room. Modern hospitals and the rational underlying care and treatment of today have their emphasis on diagnosis, cure and treatment. Consequently, aesthetics in the patient rooms such as a view of nature or natural light entering the room are often neglected in caring for these patients. A phenomenological-hermeneutic study design was applied and data was collected through multiple qualitative interviews combined with observations at a teaching hospital in Denmark. Twelve patients participated. The findings show that a view of nature and natural light in the form of sunlight or daylight in the patient room play a significant role in creating positive and supportive thoughts and emotions in the seriously ill patients. Three themes were identified: (i) Experiencing inner peace and an escape from negative thoughts, (ii) Experiencing a positive mood and hope and (iii) Experiencing good memories. Our findings highlight aesthetic sensory impressions in the form of nature sights and natural light in the patient room as a powerful source of well-being, relief and hope for the patients during serious illness. Therefore, these sensory impressions should be thought of as holding palliative potential and should be included as a part of caring for the seriously ill patients. © 2014 Nordic College of Caring Science.

  7. [A project to promote patient positioning accuracy in operating rooms].

    PubMed

    Huang, Jui-Chen; Pan, Shu-Pan; Huang, Yi-Tzu; Chen, Shu-Hua

    2011-12-01

    Inappropriate patient positioning during surgery causes respiratory pattern changes, inadequate gaseous exchange, tissue hypoperfusion and disruption of skin integrity. Inadvertent loosening of positioning devices on a patient in our ward during surgery caused surgical field contamination. We thus proposed a project to promote patient positioning accuracy in operating rooms to improve patient safety. This project was intended to promote accurate patient positioning by operating room nurses, raise nursing professionalism, ensure patient safety, and avoid unnecessary patient injury. Under the project, we held educational training programs, developed patient positioning standard operating procedures (SOPs) and check lists, inspected all positioning assistance devices, purchased additional belt restraint straps, and conducted periodic monitoring. Patient positioning execution accuracy increased from 80% to 100%; cognition of patient positioning increased from 88% to 100%. The operating room committee adopted the proposed procedures and they are now SOPs in all operating rooms at our hospital. We suggest including the SOPs developed in this project in continuous education programs and urge making well-designed positioning assistance devices available to protect patient safety during surgery.

  8. Aggression and recent substance abuse: absence of association in psychiatric emergency room patients.

    PubMed

    Dhossche, D M

    1999-01-01

    Substance abuse has been linked to aggression in community and psychiatric samples. A retrospective chart review in 311 consecutive psychiatric emergency room patients was conducted to assess the association of substance abuse and aggression in an acute psychiatric setting. Various indices of substance abuse, including positive urine toxicology for alcohol, cocaine, and/or cannabis, were not associated with aggressive behavior. Patients with positive toxicology for cocaine were less frequently aggressive than cocaine-negative patients. Among aggressive patients, the presence of psychotic symptoms was the most important factor associated with admission. These findings suggest that aggression is not a common acute manifestation of recent substance abuse in psychiatric emergency room patients. Selection factors in this population and the specifics of an acute psychiatric setting may obscure the association, if any. Acute psychosis seems to have a more important role in this setting. Future studies should focus on the prevention and early treatment of aggression in psychotic emergency room patients.

  9. 33 CFR 149.685 - May a medical treatment room be used for other purposes?

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... other purposes? A medical treatment room may be used as a sleeping space if the room meets the requirements of this subpart for both medical treatment rooms and sleeping spaces. It may also be used as an office. However, when used for medical purposes, the room may not be used as a sleeping space or...

  10. 33 CFR 149.685 - May a medical treatment room be used for other purposes?

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... other purposes? A medical treatment room may be used as a sleeping space if the room meets the requirements of this subpart for both medical treatment rooms and sleeping spaces. It may also be used as an office. However, when used for medical purposes, the room may not be used as a sleeping space or...

  11. 33 CFR 149.685 - May a medical treatment room be used for other purposes?

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... other purposes? A medical treatment room may be used as a sleeping space if the room meets the requirements of this subpart for both medical treatment rooms and sleeping spaces. It may also be used as an office. However, when used for medical purposes, the room may not be used as a sleeping space or...

  12. 33 CFR 149.685 - May a medical treatment room be used for other purposes?

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... other purposes? A medical treatment room may be used as a sleeping space if the room meets the requirements of this subpart for both medical treatment rooms and sleeping spaces. It may also be used as an office. However, when used for medical purposes, the room may not be used as a sleeping space or...

  13. 33 CFR 149.685 - May a medical treatment room be used for other purposes?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... other purposes? A medical treatment room may be used as a sleeping space if the room meets the requirements of this subpart for both medical treatment rooms and sleeping spaces. It may also be used as an office. However, when used for medical purposes, the room may not be used as a sleeping space or...

  14. Use of blood alcohol concentration in resuscitation room patients

    PubMed Central

    Csipke, Emese; Touquet, Robin; Patel, Tim; Franklin, James; Brown, Adrian; Holloway, Paul; Batrick, Nicola; Crawford, Michael J

    2007-01-01

    Objective To clarify the use of blood alcohol concentration (BAC) in the emergency department resuscitation room, by comparing it with a subsequent alcohol questionnaire and by surveying patients' attitudes to BAC testing. Design Observational study. Participants 273 resuscitation room patients at St Mary's Hospital, Paddington between August 2005 and February 2006. Main outcome measures BAC comparison to questionnaire results, and attitudes to BAC testing. Results The level of agreement between positive screening by questionnaire and a BAC of >80 mg/100 ml was low (κ = 0.29, 95% confidence interval 0.12 to 0.46) because each test measures different aspects of drinking. Patients accepted the use of BAC tests in detecting alcohol use, though a small minority reported concerns over confidentiality. Conclusion Use of BAC testing complements later questionnaire screening to identify alcohol misuse in patients initially brought to the emergency department resuscitation room, providing results are fed back to the patient. Potential ethical, judicial and insurance concerns should not prevent the use of BAC when judged to be in the patient's best interest. PMID:17652671

  15. Lived experience of caring for dying patients in emergency room.

    PubMed

    Kongsuwan, Waraporn; Matchim, Yaowarat; Nilmanat, Kittikorn; Locsin, Rozzano C; Tanioka, Tetsuya; Yasuhara, Yuko

    2016-03-01

    Dying often occurs in hospitals and frequently in emergency rooms. Understanding caring for critical and dying patients is necessary for quality nursing. This study described the meaning of nurses' lived experience of caring for critical and dying patients in the emergency rooms. This study was conducted in three emergency rooms of tertiary hospitals in southern Thailand. Twelve nurses met the inclusion criteria: nurses working in emergency room for at least 2 years, and experienced caring for critical and dying patients in an emergency department. Data were collected using in-depth individual interviews. Data transcription and analysis used van Manen's hermeneutic phenomenological approach. Trustworthiness was established following Lincoln and Guba's criteria. Experiences of caring for critical and dying patients revealed four thematic categories: defying death; no time for palliative care; lacking support for family; and privacy for peaceful deaths. These thematic categories reflected van Manen's four lived worlds of body, time, relations and space. The study described the meaning of the experience of caring for critical and dying patients while supporting the development of nursing knowledge for palliative and end-of-life care in emergent settings. Findings of the study influence nursing policies toward enhancing education of nurses regarding palliative and end-of-life care in emergency settings. These findings can also influence the value of caring-healing environments for critical and dying patients and their families. Policies can focus on practice and education of families particularly about end-of-life care for critical and dying patients. © 2016 International Council of Nurses.

  16. Seclusion room vs. physical restraint in an adolescent inpatient setting: patients' attitudes.

    PubMed

    Vishnivetsky, Sergey; Shoval, Gal; Leibovich, Vadim; Giner, Lucas; Mitrany, Marsel; Cohen, Dorit; Barzilay, Aliza; Volovick, Louisa; Weizman, Abraham; Zalsman, Gil

    2013-01-01

    The use of physical restraints or a seclusion room for the treatment of adolescents in a psychiatric inpatient setting raises ethical dilemmas. We investigated the attitudes of adolescents towards these two means of confinement. We used a structured questionnaire to collect data on the attitudes of 50 adolescent patients, hospitalized in a closed psychiatric ward, towards the use of physical restraint versus a seclusion room. Seventy per cent of the participants in the study preferred seclusion in the seclusion room over bed restraint, whereas 22% preferred physical restraint. Eighty-two percent described seclusion in the seclusion room as less frightening than restraint. Seventy-four per cent reported that seclusion in the seclusion room improved their mental state to a larger extent than restraint. The inpatient adolescents reported feeling the time they needed to reach a state of calm was shorter when they were confined to the seclusion room than when they were physically restrained (p>.001). The use of a seclusion room may be preferable compared to physical restraint for inpatient adolescents.

  17. Patient room considerations in the intensive care unit: caregiver, patient, family.

    PubMed

    Evans, Jennie; Reyers, Evelyn

    2014-01-01

    The Patient Room is one of the most important and costly rooms in the design of an inpatient bed unit. As a result, the patient room mock-up requires knowledge of the components that inform the patient room environment. This article provides the intensive care nurse with questions about patient care processes and unit policies that should be considered in a mock-up. The mock-up outcome should align with the project's goals and objectives of the health care system, infuse the principles of evidence-based design, and ensure that the design accommodates the best workflow for the patient population that will be served. The template will serve as a guide to evaluate the various features of the patient room and for the mock-up discussion between the nurse and the architect.

  18. To lock or not to lock patients'rooms: the key to autonomy?

    PubMed

    Shoenfeld, Netta; Ulman, Anne-Marie; Weiss, Mordechai; Strous, Rael D

    2008-10-01

    Many patients with schizophrenia experience prominent negative symptoms. Functional impairment often results in patients who remain in their rooms for most of the day. It has thus become common practice in many psychiatric wards to lock patients' rooms during much of the morning and afternoon hours to encourage participation in ward activities and treatment modalities. Within the context of a quality control evaluation, two self-report surveys were conducted among patients (N=20) and staff members (N=9) in Beer Yaakov, Israel: the first survey was given when the rooms were locked at certain times, and the second survey was given after the rooms had been unlocked for one week. Patients and staff members expressed differing views both before and after the week-long open-door policy (patients enjoyed the policy, whereas many staff did not). Behavior during the period of the open-door policy varied among patients. The authors discuss the ethical grounds of locking doors and whether it is a best practice in keeping with rehabilitation interests.

  19. Suicide Mortality of Suicide Attempt Patients Discharged from Emergency Room, Nonsuicidal Psychiatric Patients Discharged from Emergency Room, Admitted Suicide Attempt Patients, and Admitted Nonsuicidal Psychiatric Patients

    ERIC Educational Resources Information Center

    Choi, Jae W.; Park, Subin; Yi, Ki K.; Hong, Jin P.

    2012-01-01

    The suicide mortality rate and risk factors for suicide completion of patients who presented to an emergency room (ER) for suicide attempt and were discharged without psychiatric admission, patients who presented to an ER for psychiatric problems other than suicide attempt and were discharged without psychiatric admission, psychiatric inpatients…

  20. Suicide Mortality of Suicide Attempt Patients Discharged from Emergency Room, Nonsuicidal Psychiatric Patients Discharged from Emergency Room, Admitted Suicide Attempt Patients, and Admitted Nonsuicidal Psychiatric Patients

    ERIC Educational Resources Information Center

    Choi, Jae W.; Park, Subin; Yi, Ki K.; Hong, Jin P.

    2012-01-01

    The suicide mortality rate and risk factors for suicide completion of patients who presented to an emergency room (ER) for suicide attempt and were discharged without psychiatric admission, patients who presented to an ER for psychiatric problems other than suicide attempt and were discharged without psychiatric admission, psychiatric inpatients…

  1. Medical errors and patient safety in the operating room.

    PubMed

    Ugur, Esra; Kara, Sevim; Yildirim, Songul; Akbal, Elif

    2016-05-01

    To investigate medical errors in the operating room, attitudes of healthcare professionals in case of errors and educational needs of professionals. The descriptive study was conducted at a university hospital in Turkey from January 25 to February 14, 2011, and comprised operating room staff, including physicians, nurses, anaesthesia technicians and perfusion technicians. Data was obtained using a questionnaire. Of the 69 respondents, 45(65.2%) had experienced medical errors and 29(42%) had verbally warned the person who caused the error. The main cause of the medical errors was a lack of healthcare professionals and their inadequate qualifications, 51(73.9%); and insufficient communication, 41(59.4%). Coping with stress and communication 45(65.2%) and radiation safety 28(40.6%) were the most common educational needs. Patient safety applications in the operating room can be improved by offering educational programmes, designing an easy reporting system, encouraging reporting of medical errors and active participation of healthcare professionals in decisions that might affect patient safety.

  2. Patient walk detection in hospital room using Microsoft Kinect V2.

    PubMed

    Liang Liu; Mehrotra, Sanjay

    2016-08-01

    This paper describes a system using Kinect sensor to detect patient walk automatically in a hospital room setting. The system is especially essential for the case when the patient is alone and the nursing staff is absent. The patient activities are represented by the features extracted from Kinect V2 skeletons. The analysis to the recognized walk could help us to better understand the health situation of the patient and the possible hospital acquired infection (HAI), and provide valuable information to healthcare givers for making a corresponding treatment decision and alteration. The Kinect V2 depth sensor provides the ground truth.

  3. [Patient safety recommendations for out of operating room procedure sedation].

    PubMed

    Arnal Velasco, D; Romero García, E; Martínez Palli, G; Muñoz Corsini, L; Rey Martínez, M; Postigo Morales, S

    There is an increasing and more complex demand for sedation for procedures out of the operating room. For different reasons, nowadays the administration of sedation varies considerably. We believe that a patient safety approach rather an approach out of corporate or economic interests is desirable. We created a working group of experts within the Spanish Anaesthesia and Reanimation Incident Reporting System (SENSAR) to prepare a series of recommendations through a non-systematic review. These recommendations were validated by an expert panel of 31 anaesthesiologists through two rounds of an adaptation of the Delphi Method where more than 70% agreement was required. The resulting recommendations include previous evaluation, material and staffing needs for sedation for procedures, post-sedation recommendations and activity and quality control advice. We present patient centred recommendations for the safe use of sedation for out of the operating room procedures from the point of view of the professionals with the most experience in its administration. We believe that these can be used as a guide to reduce variability and increase patient safety in the organisation of healthcare. Copyright © 2016 SECA. Publicado por Elsevier España, S.L.U. All rights reserved.

  4. Patient safety recommendations for out of operating room procedure sedation.

    PubMed

    Arnal Velasco, D; Romero García, E; Martínez Palli, G; Muñoz Corsini, L; Rey Martínez, M; Postigo Morales, S

    2016-12-01

    There is an increasing and more complex demand for sedation for procedures out of the operating room. For different reasons, nowadays the administration of sedation varies considerably. We believe that a patient safety approach rather an approach out of corporate or economic interests is desirable. We created a working group of experts within the Spanish Anaesthesia and Reanimation Incident Reporting System (SENSAR) to prepare a series of recommendations through a non-systematic review. These recommendations were validated by an expert panel of 31 anaesthesiologists through two rounds of an adaptation of the Delphi Method where more than 70% agreement was required. The resulting recommendations include previous evaluation, material and staffing needs for sedation for procedures, post-sedation recommendations and activity and quality control advice. We present patient centred recommendations for the safe use of sedation for out of the operating room procedures from the point of view of the professionals with the most experience in its administration. We believe that these can be used as a guide to reduce variability and increase patient safety in the organisation of healthcare. Copyright © 2016 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  5. Analysis of Patients with Facial Lacerations Repaired in the Emergency Room of a Provincial Hospital

    PubMed Central

    Lee, Joon Ho; Jeon, Myeong Su; Shin, Hea Kyeong; Seul, Jung Hyun

    2015-01-01

    Background Facial laceration is the most common injury encountered in the emergency room in the plastic surgery field, and optimal treatment is important. However, few authors have investigated this injury in all age groups or performed follow-up visit after repair. In the present study, the medical records of patients with lacerations in the facial area and underwent primary repair in an emergency room over a 2-year period were reviewed and analyzed. Methods Medical records of 3,234 patients with lacerations in facial area and underwent primary repair in an emergency room between March 2011 and February 2013 were reviewed and identified. Results All the 3,234 patients were evaluated, whose ratio of men to women was 2.65 to 1. The forehead was the most common region affected and a slip down was the most common mechanism of injury. In terms of monthly distribution, May had the highest percentage. 1,566 patients received follow-up managements, and 58 patients experienced complications. The average days of follow-up were 9.8. Conclusions Proportion of male adolescents was significantly higher than in the other groups. Facial lacerations exhibit a 'T-shaped' facial distribution centered about the forehead. Careful management is necessary if a laceration involves or is located in the oral cavity. We were unable to long term follow-up most patients. Thus, it is necessary to encourage patients and give them proper education for follow-up in enough period. PMID:25606487

  6. The sound environment in an ICU patient room--a content analysis of sound levels and patient experiences.

    PubMed

    Johansson, Lotta; Bergbom, Ingegerd; Waye, Kerstin Persson; Ryherd, Erica; Lindahl, Berit

    2012-10-01

    This study had two aims: first to describe, using both descriptive statistics and quantitative content analysis, the noise environment in an ICU patient room over one day, a patient's physical status during the same day and early signs of ICU delirium; second, to describe, using qualitative content analysis, patients' recall of the noise environment in the ICU patient room. The final study group comprised 13 patients. General patient health status data, ICU delirium observations and sound-level data were collected for each patient over a 24-hour period. Finally, interviews were conducted following discharge from the ICU. The sound levels in the patient room were higher than desirable and the LAF max levels exceed 55dB 70-90% of the time. Most patients remembered some sounds from their stay in the ICU and whilst many were aware of the sounds they were not disturbing to them. However, some also experienced feelings of fear related to sounds emanating from treatments and investigations of the patient beside them. In this small sample, no statistical connection between early signs of ICU delirium and high sound levels was seen, but more research will be needed to clarify whether or not a correlation does exist between these two factors.

  7. Gender, patient comfort and the neurosurgical operating room.

    PubMed

    Zener, Rebecca; Bernstein, Mark

    2011-01-01

    Neurosurgical patients may be unaware of components of their intra-operative care. The relationship between patient gender and comfort level in the neurosurgical operating room (OR) has not been previously studied. Our objective was to gain insight into patients' perspective of the OR environment, including staffing and observers, the role of medical students, catheterization, exposure, and verbiage, using a qualitative needs assessment. Face-to-face semi-structured interviews were conducted with 20 patients (14 female, six male) who had a neurosurgical operation under general anesthetic within the previous two years. The majority underwent craniotomy for benign tumours. Interviews were transcribed and subjected to modified thematic analysis. Nine themes emerged: 1) perception of the intra-operative environment varies between men and women; 2) lacking awareness about observers is anxiety-provoking for women; 3) being unaware of the hands-on involvement of students is a concern for all patients; 4) disclosure of implantation of foreign and permanent materials into patients is important; 5) catheterization is anxiety provoking for women; 6) pre-operative menstruation screening may minimize embarrassment for women; 7) patients perceive extraneous conversation as a distraction for surgeons; 8) patients trust their surgeon; 9) a relationship exists between interviewer gender and patient comfort in the interview. Although most male and female patients are unaware of OR activities, they are generally not fearful since they trust their surgeon. Women appear to have greater information needs. Patients' information needs must be met without provoking anxiety and yet preserving their personal sense of modesty in the intra-operative environment.

  8. Treatment of Pediatric Migraine in the Emergency Room

    PubMed Central

    Gelfand, Amy A.; Goadsby, Peter J.

    2013-01-01

    Migraine is a relatively common reason for pediatric emergency room visits. Given the paucity of randomized trials involving pediatric migraineurs in the emergency department setting compared to adults, recommendations for managing these children are largely extrapolated from adult migraine emergency room studies and trials involving outpatient home pediatric migraine therapy. This paper reviews what is known about pediatric migraineurs who present to the emergency room and how they are currently managed, then goes on to summarize the best evidence currently available to guide clinical decision making. PMID:22964436

  9. Islam and the healthcare environment: designing patient rooms.

    PubMed

    Kopec, D A K; Han, Li

    2008-01-01

    Islam and the Muslim population are often the source of much misunderstanding and media-influenced misconceptions. Muslim patients who enter the healthcare environment are often weak and likely to experience feelings of vulnerability. Because of the complex and interwoven nature of culture and religion in a person's identity, it is important to consider patient belief systems and values when designing a patient's immediate environment. Through an exploration of literature related to culture and diversity and the beliefs and value system of the Muslim population, the authors were able to identify flexible design initiatives that could accommodate an array of cultural and spiritual practices. Islam and the Muslim population were chosen as the points of reference for this study because of the strong influence of the religion on the culture, and because of the many nuances that differ from the dominant culture within the United States. From these points of reference, a hypothetical design was developed for a patient room that considers differing notions of privacy, alternatives for cultural and religious practices, and ways to include symbolic meaning derived from attributes such as color.

  10. 33 CFR 149.680 - What are the requirements for medical treatment rooms?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 33 Navigation and Navigable Waters 2 2010-07-01 2010-07-01 false What are the requirements for medical treatment rooms? 149.680 Section 149.680 Navigation and Navigable Waters COAST GUARD, DEPARTMENT... Design and Equipment Medical Treatment Rooms § 149.680 What are the requirements for medical...

  11. Radiation shielding design of BNCT treatment room for D-T neutron source.

    PubMed

    Pouryavi, Mehdi; Farhad Masoudi, S; Rahmani, Faezeh

    2015-05-01

    Recent studies have shown that D-T neutron generator can be used as a proper neutron source for Boron Neutron Capture Therapy (BNCT) of deep-seated brain tumors. In this paper, radiation shielding calculations have been conducted based on the computational method for designing a BNCT treatment room for a recent proposed D-T neutron source. By using the MCNP-4C code, the geometry of the treatment room has been designed and optimized in such a way that the equivalent dose rate out of the treatment room to be less than 0.5μSv/h for uncontrolled areas. The treatment room contains walls, monitoring window, maze and entrance door. According to the radiation protection viewpoint, dose rate results of out of the proposed room showed that using D-T neutron source for BNCT is safe.

  12. Acinetobacter baumannii: association between environmental contamination of patient rooms and occupant status.

    PubMed

    Munoz-Price, L Silvia; Namias, Nicholas; Cleary, Timothy; Fajardo-Aquino, Yovanit; Depascale, Dennise; Arheart, Kristopher L; Rivera, Jesabel I; Doi, Yohei

    2013-05-01

    We aimed to determine the association between the presence of Acinetobacter baumannii in patient rooms and the carrier status of the occupants. Fifty-six (39%) of 143 rooms with A. baumannii-positive patients had results positive for A. baumannii. Only 49 (10%) of 485 rooms with A. baumannii-negative patients were positive (odds ratio, 5.72 [95% confidence interval, 3.66-8.96]; [Formula: see text]). Clinical and environmental isolates shared pulsed-field gel electrophoresis patterns.

  13. Associations among emergency room visits, parenting styles, and psychopathology among pediatric patients with sickle cell.

    PubMed

    Latzman, Robert D; Shishido, Yuri; Latzman, Natasha E; Elkin, T David; Majumdar, Suvankar

    2014-10-01

    To examine associations between frequency of emergency room (ER) visits and various parenting styles, both conjointly and interactively, and psychopathological outcomes among pediatric patients with sickle cell disease (SCD). Ninety-eight parents/caregivers of 6- to 18-year-old patients with SCD completed instruments assessing parenting style, child psychopathology, and reported on the frequency of ER visits during the previous year. ER visits were found to significantly explain Withdrawn/Depressed problems and parenting styles were found to incrementally contribute to the explanation of all forms of psychopathology. Further, Permissive parenting was found to explain Rule Breaking Behavior for those patients with low ER visit frequency but not for those with high ER visit frequency. Results of the current study confirm the importance of considering both the frequency of ER visits and parenting style in the explanation of psychopathology among pediatric patients with SCD. Results have important implications for both research and treatment. © 2014 Wiley Periodicals, Inc.

  14. [Standard operating procedures and operating room management: Improvement of patient safety and the efficiency of processes].

    PubMed

    Bleyl, Jörg U; Heller, Axel R

    2008-01-01

    Financial pressures have led the way more efficiency in health care management. To decrease hospital costs a more proficient use of personal resources is required. The drive to increase efficiency with the concomitant increase in workload can cause a reduction in quality of patient care and of patient security. A professional operating room (OR) management and the introduction of standard operating procedures (SOP) have helped to optimise workflow in and around the OR. OR management can control an efficient workflow and generate data concerning performance, costs and quality. SOPs lead to a standardisation of workflow in the OR and in patient treatment modalities. This guaranties a high quality in patient care and more safety despite an increase in work-load.

  15. Suicide mortality of suicide attempt patients discharged from emergency room, nonsuicidal psychiatric patients discharged from emergency room, admitted suicide attempt patients, and admitted nonsuicidal psychiatric patients.

    PubMed

    Choi, Jae W; Park, Subin; Yi, Ki K; Hong, Jin P

    2012-06-01

    The suicide mortality rate and risk factors for suicide completion of patients who presented to an emergency room (ER) for suicide attempt and were discharged without psychiatric admission, patients who presented to an ER for psychiatric problems other than suicide attempt and were discharged without psychiatric admission, psychiatric inpatients admitted for suicide attempt, and psychiatric inpatients admitted for other reasons were examined. The records of 3,897 patients who were treated at a general hospital in Seoul, Korea, from July 2003 to December 2006 were reviewed. Forty-three of the 3,897 subjects died by suicide during the 2.5-year observation period. Compared to the general Korean population, the suicide mortality rate was 82-fold higher for suicide attempt patients, admitted; 54-fold higher for suicide attempt patients, discharged; 21-fold higher for nonsuicidal patients, admitted; and 11-fold higher for nonsuicidal patients, discharged. In all four groups, diagnosis of a depressive disorder and suicide attempt at presentation were each significant independent risk factors for suicide completion. These results highlight the need for suicide prevention strategies for depressed patients who present to the ER or are admitted to a psychiatric ward after a suicide attempt.

  16. 33 CFR 149.680 - What are the requirements for medical treatment rooms?

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... on a stretcher; (c) A single berth or examination table that is accessible from both sides; and (d) A... accommodation modules, must have a medical treatment room that has— (a) A sign at the entrance designating it as...

  17. 33 CFR 149.680 - What are the requirements for medical treatment rooms?

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... on a stretcher; (c) A single berth or examination table that is accessible from both sides; and (d) A... accommodation modules, must have a medical treatment room that has: (a) A sign at the entrance designating it as...

  18. 33 CFR 149.680 - What are the requirements for medical treatment rooms?

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... on a stretcher; (c) A single berth or examination table that is accessible from both sides; and (d) A... accommodation modules, must have a medical treatment room that has: (a) A sign at the entrance designating it as...

  19. Patient and environmental service employee satisfaction of using germicidal bleach wipes for patient room cleaning.

    PubMed

    Aronhalt, Kimberly C; McManus, James; Orenstein, Robert; Faller, Rebecca; Link, Mary

    2013-01-01

    More healthcare institutions are using bleach products which are sporicidal to reduce Clostridium difficile infection (CDI). There may be patient and employee concerns about the appearance of bleach residue left on surfaces, odors, and respiratory tract irritation. The intervention used bleach wipes for daily and terminal patient room cleaning to reduce transmission of CDI and was implemented on patient care units with a relatively high incidence of CDI. Both patients and Environmental Services (ES) staff were surveyed to assess their satisfaction of the bleach wipe product used during room cleaning. Patients (n = 94) (91%) continued to be very satisfied with how well their rooms were cleaned every day. Bleach wipes were well tolerated by patients (n = 44) (100%) surveyed on the medical units and less tolerated by patients (n = 50) (22%) on the hematology-oncology units. ES staff (6) reported less satisfaction and more respiratory irritation from using the bleach wipes; however, later their satisfaction improved. © 2012 National Association for Healthcare Quality.

  20. Ornamental indoor plants in hospital rooms enhanced health outcomes of patients recovering from surgery.

    PubMed

    Park, Seong-Hyun; Mattson, Richard H

    2009-09-01

    Clinical trials have not been reported concerning the health benefits of viewing indoor plants on stress and recovery of surgical patients within a hospital setting. Using various medical and psychologic measurements, this study performed a randomized clinical trial with surgical patients to evaluate whether plants in hospital rooms have therapeutic influences. Ninety (90) patients recovering from a hemorrhoidectomy were randomly assigned to either control or plant rooms. With half the patients, live plants were placed in their rooms during postoperative recovery periods. Data collected for each patient included length of hospitalization, analgesics used for postoperative pain control, vital signs, ratings of pain intensity, pain distress, anxiety and fatigue, the State-Trait Anxiety Inventory Form Y-1, the Environmental Assessment Scale, and the Patient's Room Satisfaction Questionnaire. Viewing plants during the recovery period had a positive influence linking directly to health outcomes of surgical patients. Patients in hospital rooms with plants and flowers had significantly more positive physiologic responses evidenced by lower systolic blood pressure, and lower ratings of pain, anxiety, and fatigue than patients in the control room. Patients with plants also felt more positively about their rooms and evaluated them with higher satisfaction when compared with patients in similar rooms without plants. Based on patients' comments, plants brightened up the room environment, reduced stress, and also conveyed positive impressions of hospital employees caring for patients. Findings of this study confirmed the therapeutic value of plants in the hospital environment as a noninvasive, inexpensive, and effective complementary medicine for surgical patients. Health care professionals and hospital administrators need to consider the use of plants and flowers to enhance healing environments for patients.

  1. Impact of imaging room environment: staff job stress and satisfaction, patient satisfaction, and willingness to recommend.

    PubMed

    Quan, Xiaobo; Joseph, Anjali; Ensign, Janet C

    2012-01-01

    The built environment significantly affects the healthcare experiences of patients and staff. Healthcare administrators and building designers face the opportunity and challenge of improving healthcare experience and satisfaction through better environmental design. The purpose of the study was to evaluate how a novel environmental intervention for imaging rooms, which integrated multiple elements of healing environments including positive distractions and personal control over environment, affects the perceptions and satisfactions of its primary users-patients and staff. Anonymous questionnaire surveys were conducted to compare patient and staff perceptions of the physical environment, satisfaction, and stress in two types of imaging rooms: imaging rooms with the intervention installed (intervention rooms) and traditionally designed rooms without the intervention (comparison rooms). Imaging technologists and patients perceived the intervention rooms to be significantly more pleasant-looking. Patients in the intervention rooms reported significantly higher levels of environmental control and were significantly more willing to recommend the intervention rooms to others. The environmental intervention was effective in improving certain aspects of the imaging environment: pleasantness and environmental control. Further improvement of the imaging environment is needed to address problematic areas such as noise.

  2. Do patients in hospitals benefit from single rooms? A literature review.

    PubMed

    van de Glind, Irene; de Roode, Stanny; Goossensen, Anne

    2007-12-01

    In the context of growing attention for 'healing environments' and 'evidence based design' an increasing number of hospitals have decided to provide single-bedded rooms. However it remains unclear to what extent these policy decisions are based on scientific evidence. The aim of this study is to review the literature on benefits of single patient rooms for patients. The following outcome measures were used: privacy and dignity, patient satisfaction with care, noise and quality of sleep, hospital infection rates, recovery rates, and patient safety issues. We selected 25 studies for review. Randomized controlled trials on this subject were scarce, but other empirical studies have been found. We found that single rooms have a moderate effect on patient satisfaction with care, noise and quality of sleep, and the experience of privacy and dignity. Conflicting results have been found on hospital infection rates. Some studies did not show significant differences, while others concluded that single rooms decrease the risk of hospital infections. Evidence on recovery rates and patient safety was lacking. Too few sound studies were found to evaluate the effects of single patient rooms thoroughly. Future research should build the body of knowledge on single-bedded rooms in order to explore their impact on well-being and healing on both patients and staff. Also consequences of single rooms to management of care should be explored. Research should support policy making by exploring, indicating and initiating improvements in patient housing and quality of care.

  3. Decreasing patient length of stay via new flexible exam room allocation policies in ambulatory care clinics.

    PubMed

    Vahdat, Vahab; Griffin, Jacqueline; Stahl, James E

    2017-08-09

    To address prolonged lengths of stay (LOS) in ambulatory care clinics, we analyze the impact of implementing flexible and dynamic policies for assigning exam rooms to providers. In contrast to the traditional approaches of assigning specific rooms to each provider or pooling rooms among all practitioners, we characterize the impact of alternate compromise policies that have not been explored in previous studies. Since ambulatory care patients may encounter multiple different providers in a single visit, room allocation can be determined separately for each encounter accordingly. For the first phase of the visit, conducted by the medical assistant, we define a dynamic room allocation policy that adjusts room assignments based on the current state of the clinic. For the second phase of the visit, conducted by physicians, we define a series of room sharing policies which vary based on two dimensions, the number of shared rooms and the number of physicians sharing each room. Using a discrete event simulation model of an outpatient cardiovascular clinic, we analyze the benefits and costs associated with the proposed room allocation policies. Our findings show that it is not necessary to fully share rooms among providers in order to reduce patient LOS and physician idle time. Instead, most of the benefit of pooling can be achieved by implementation of a compromise room allocation approach, limiting the need for significant organizational changes within the clinic. Also, in order to achieve most of the benefits of room allocation policies, it is necessary to increase flexibility in the two dimensions simultaneously. These findings are shown to be consistent in settings with alternate patient scheduling and distinctions between physicians.

  4. Hydrogen Peroxide Vapor Decontamination in a Patient Room Using Feline Calicivirus and Murine Norovirus as Surrogate Markers for Human Norovirus.

    PubMed

    Holmdahl, Torsten; Walder, Mats; Uzcátegui, Nathalie; Odenholt, Inga; Lanbeck, Peter; Medstrand, Patrik; Widell, Anders

    2016-05-01

    To determine whether hydrogen peroxide vapor (HPV) could be used to decontaminate caliciviruses from surfaces in a patient room. Feline calicivirus (FCV) and murine norovirus (MNV) were used as surrogate viability markers to mimic the noncultivable human norovirus. Cell culture supernatants of FCV and MNV were dried in triplicate 35-mm wells of 6-well plastic plates. These plates were placed in various positions in a nonoccupied patient room that was subsequently exposed to HPV. Control plates were positioned in a similar room but were never exposed to HPV. Virucidal activity was measured in cell culture by reduction in 50% tissue culture infective dose titer for FCV and by both 50% tissue culture infective dose titer and plaque reduction for MNV. Neither viable FCV nor viable MNV could be detected in the test room after HPV treatment. At least 3.65 log reduction for FCV and at least 3.67 log reduction for MNV were found by 50% tissue culture infective dose. With plaque assay, measurable reduction for MNV was at least 2.85 log units. The successful inactivation of both surrogate viruses indicates that HPV could be a useful tool for surface decontamination of a patient room contaminated by norovirus. Hence nosocomial spread to subsequent patients can be avoided.

  5. The Psychogeriatric Patient in the Emergency Room: Focus on Management and Disposition

    PubMed Central

    Patel, Priyanka; Grossberg, George T.

    2014-01-01

    Background. The growing geriatric population in the United States (US) has prompted better understanding of treatment of the elderly in the hospital and emergency room (ER) settings. This study examines factors influencing the disposition of psychogeriatric patients after their initial presentation in the ER. Methods. Data was collected on patients 65 years of age or older arriving at the ER of a large urban hospital in the USA (January 2009–December 2010). Results. Of the total subjects (n = 95) included in the study, majority were females (66.3%) with an average age of 75.5 years. The chief complaint for psychogeriatric patients coming to the ER was delirium (61.6%). Caucasians were significantly more likely than African-American patients to get a psychiatric consult (33% versus 9%). Patients with delirium were less likely than patients with other psychiatric complaints to get a psychiatric consult in the ER (1.2% versus 47.2%) and less likely to be referred to a psychiatric inpatient unit compared to patients with other psychiatric complaints (2.4% versus 16.7%). Conclusion. Even though delirium is the most common reason for ER visits among psychogeriatric patients, very few delirium patients got a psychiatric consultation in the ER. A well-equipped geriatric psychiatry unit can manage delirium and associated causes. PMID:24734206

  6. Introducing therapeutic lasers in the hospitals and treatment rooms in Romania

    NASA Astrophysics Data System (ADS)

    Siposan, Dan G.; Manastireanu, Dan I.

    2005-11-01

    Background: Presently, there is no unanimous consensus regarding the methods to introduce laser therapy, on a large scale, into a medical assistance system. These methods may vary from one country to another, depending on some factors. Although, there are some compulsory stages that must be reached. Purpose: This paper's purpose is to present the necessary stages, in our opinion, to successfully introduce laser therapy in hospitals and treatment rooms in our country. They include, among others: an information of the public at large, by brochures or other informative materials, on therapeutic lasers' action; the introducing in high level medicine schools of courses on the biological action of low-level lasers; laboratory studies on action mechanisms of low level laser radiation on live tissues; establishing the more objective methods of patients' assessment; obtaining approval from the Bioethics Committee for clinical studies on volunteers, according to current legislation. Materials and methods: There had been done a preliminary clinical study on volunteers (over 100 in number), using mainly subjective methods of evaluation. The patients have been also monitored also after the treatment, during one to six months. We present briefly a method of monitoring and objective assessment, by optical means, for laser therapy results, which we intend to use in the near future. Results:-There are presented the stages we reached till now. In the preliminary clinical study we have treated patients with various pathologies: skin diseases, dental, surgical and neuralgic pathology etc. We observed an amelioration or total remission on the most patients and also a good mood after the treatments. There are presented a few cases with significant results. Discussion and conclusion: We estimate the success rate of our treatments with over 60 percents. We hope this study shall be useful for the purpose mentioned in the paper's title. In a country where living standard is low, laser

  7. Clinical Application of In-Room Positron Emission Tomography for In Vivo Treatment Monitoring in Proton Radiation Therapy

    SciTech Connect

    Min, Chul Hee; Zhu, Xuping; Winey, Brian A.; Grogg, Kira; Testa, Mauro; El Fakhri, Georges; Bortfeld, Thomas R.; Paganetti, Harald; Shih, Helen A.

    2013-05-01

    Purpose: The purpose of this study is to evaluate the potential of using in-room positron emission tomography (PET) for treatment verification in proton therapy and for deriving suitable PET scan times. Methods and Materials: Nine patients undergoing passive scattering proton therapy underwent scanning immediately after treatment with an in-room PET scanner. The scanner was positioned next to the treatment head after treatment. The Monte Carlo (MC) method was used to reproduce PET activities for each patient. To assess the proton beam range uncertainty, we designed a novel concept in which the measured PET activity surface distal to the target at the end of range was compared with MC predictions. The repositioning of patients for the PET scan took, on average, approximately 2 minutes. The PET images were reconstructed considering varying scan times to test the scan time dependency of the method. Results: The measured PET images show overall good spatial correlations with MC predictions. Some discrepancies could be attributed to uncertainties in the local elemental composition and biological washout. For 8 patients treated with a single field, the average range differences between PET measurements and computed tomography (CT) image-based MC results were <5 mm (<3 mm for 6 of 8 patients) and root-mean-square deviations were 4 to 11 mm with PET-CT image co-registration errors of approximately 2 mm. Our results also show that a short-length PET scan of 5 minutes can yield results similar to those of a 20-minute PET scan. Conclusions: Our first clinical trials in 9 patients using an in-room PET system demonstrated its potential for in vivo treatment monitoring in proton therapy. For a quantitative range prediction with arbitrary shape of target volume, we suggest using the distal PET activity surface.

  8. From the Test Tube to the Treatment Room

    PubMed Central

    Del Rosso, James Q.; Plattner, Jacob J.

    2014-01-01

    The development of new drug classes and novel molecules that are brought to the marketplace has been a formidable challenge, especially for dermatologic drugs. The relative absence of new classes of antimicrobial agents is also readily apparent. Several barriers account for slow drug development, including regulatory changes, added study requirements, commercial pressures to bring drugs to market quickly by developing new generations of established compounds, and the greater potential for failure and higher financial risk when researching new drug classes. In addition, the return on investment is usually much lower with dermatologic drugs as compared to the potential revenue from “blockbuster” drugs for cardiovascular or gastrointestinal disease, hypercholesterolemia, and mood disorders. Nevertheless, some researchers are investigating new therapeutic platforms, one of which is boron-containing compounds. Boron-containing compounds offer a wide variety of potential applications in dermatology due to their unique physical and chemical properties, with several in formal phases of development. Tavaborole, a benzoxaborole compound, has been submitted to the United States Food and Drug Administration for approval for treatment of onychomycosis. This article provides a thorough overview of the history of boron-based compounds in medicine, their scientific rationale, physiochemical and pharmacologic properties, and modes of actions including therapeutic targets. A section dedicated to boron-based compounds in development for treatment of various skin disorders is also included. PMID:24578778

  9. Three-dimensional conformal setup (3D-CSU) of patients using the coordinate system provided by three internal fiducial markers and two orthogonal diagnostic X-ray systems in the treatment room

    SciTech Connect

    Shirato, Hiroki . E-mail: hshirato@radi.med.hokudai.ac.jp; Oita, Masataka; Fujita, Katsuhisa; Shimizu, Shinichi; Onimaru, Rikiya; Uegaki, Shinji; Watanabe, Yoshiharu; Kato, Norio; Miyasaka, Kazuo

    2004-10-01

    Purpose: To test the accuracy of a system for correcting for the rotational error of the clinical target volume (CTV) without having to reposition the patient using three fiducial markers and two orthogonal fluoroscopic images. We call this system 'three-dimensional conformal setup' (3D-CSU). Methods and materials: Three 2.0-mm gold markers are inserted into or adjacent to the CTV. On the treatment couch, the actual positions of the three markers are calculated based on two orthogonal fluoroscopies crossing at the isocenter of the linear accelerator. Discrepancy of the actual coordinates of gravity center of three markers from its planned coordinates is calculated. Translational setup error is corrected by adjustment of the treatment couch. The rotation angles ({alpha}, {beta}, {gamma}) of the coordinates of the actual CTV relative to the planned CTV are calculated around the lateral (x), craniocaudal (y), and anteroposterior (z) axes of the planned CTV. The angles of the gantry head, collimator, and treatment couch of the linear accelerator are adjusted according to the rotation of the actual coordinates of the tumor in relation to the planned coordinates. We have measured the accuracy of 3D-CSU using a static cubic phantom. Results: The gravity center of the phantom was corrected within 0.9 {+-} 0.3 mm (mean {+-} SD), 0.4 {+-} 0.2 mm, and 0.6 {+-} 0.2 mm for the rotation of the phantom from 0-30 degrees around the x, y, and z axes, respectively, every 5 degrees. Dose distribution was shown to be consistent with the planned dose distribution every 10 degrees of the rotation from 0-30 degrees. The mean rotational error after 3D-CSU was -0.4 {+-} 0.4 (mean {+-} SD), -0.2 {+-} 0.4, and 0.0 {+-} 0.5 degrees around the x, y, and z axis, respectively, for the rotation from 0-90 degrees. Conclusions: Phantom studies showed that 3D-CSU is useful for performing rotational correction of the target volume without correcting the position of the patient on the treatment couch

  10. The effects of treatment room lighting color on time perception and emotion.

    PubMed

    Han, Seulki; Lee, Daehee

    2017-07-01

    [Purpose] The purpose of this study was to investigate the perceived treatment times and emotional reactions under different light colors in the treatment room. [Subjects and Methods] Subjects in this study were 20 healthy young students in their 20s. Under each lighting condition (blue, red, white, and yellow) differentiated by color, each subject laid on a therapeutic bed and underwent ultrasound therapy. Subjects were instructed to press a stopwatch every 1 minute, for a total of 5 times, after therapy started according to their perception of time while the stopwatch's time indicator was blocked. After the experiments, self-administered questionnaires were given to subjects to measure their emotional reactions. [Results] In terms of K-POMS scores, the mood states of depression-dejection, anger-hostility, and confusion-bewilderment were higher scores for blue and red lights compared to yellow light. The mood state of vigor-activity were higher scores for yellow and white lights compared to blue and red lights. [Conclusion] Therefore, it is important to take necessary measures to prevent the negative effects that blue and red light-based therapy can have on patient mood.

  11. Environmental Cues in Double-Occupancy Rooms to Support Patients With Dementia.

    PubMed

    Motzek, Tom; Bueter, Kathrin; Marquardt, Gesine

    2016-04-01

    The purpose of this study was to evaluate the effectiveness of different environmental cues in double-occupancy rooms of an acute care hospital to support patients' abilities to identify their bed and wardrobe. The quasi-experiment was conducted on a geriatric ward of an acute care hospital. Patients with dementia were included (n = 42). To test the effectiveness of environmental cues, two rooms were enhanced with the environmental cue "color," two rooms with the cue "number," and two rooms with the cue "patient's name". Four rooms were not redesigned and were used as control rooms. For analysis, we pooled the intervention groups color and number (n = 14) and compared it with the control group (n = 22). The environmental cues color and number were significantly effective to improve the identification of the wardrobe from the third to the fifth day after admission. However, for the 10th-12th day after admission, we found no difference in results. Furthermore, results indicate improvements in the ability to identify the bed by using the environmental cues color and number. As this study indicated, the environmental cues color and number are helpful for these patients to identify their bed and wardrobe. However, these cues were most effective from the third to the fifth day after admission. To sustain their effectiveness on patients' identification abilities during their hospital stay, we discuss, whether verbal prompting and an ongoing mentioning of such cues, embedded in the daily work of nurses, could be beneficial. © The Author(s) 2015.

  12. Identifying Patient Door-to-Room Goals to Minimize Left-Without-Being-Seen Rates

    PubMed Central

    Pielsticker, Shea; Whelan, Lori; Arthur, Annette O.; Thomas, Stephen

    2015-01-01

    Introduction Emergency department (ED) patients in the leave-without-being-seen (LWBS) group risk problems of inefficiency, medical risk, and financial loss. The goal at our hospital is to limit LWBS to <1%. This study’s goal was to assess the influence on LWBS associated with prolonging intervals between patient presentation and placement in an exam room (DoorRoom time). This study’s major aim was to identify DoorRoom cutoffs that maximize likelihood of meeting the LWBS goal (i.e. <1%). Methods We conducted the study over one year (8/13–8/14) using operations data for an ED with annual census ~50,000. For each study day, the LWBS endpoint (i.e. was LWBS <1%: “yes or no”) and the mean DoorRoom time were recorded. We categorized DoorRoom means by intervals starting with ≤10min and ending at >60min. Multivariate logistic regression was used to assess for DoorRoom cutoffs predicting high LWBS, while adjusting for patient acuity (triage scores and admission %) and operations parameters. We used predictive marginal probability to assess utility of the regression-generated cutoffs. We defined statistical significance at p<0.05 and report odds ratio (OR) and 95% confidence intervals (CI). Results Univariate results suggested a primary DoorRoom cutoff of 20′, to maintain a high likelihood (>85%) of meeting the LWBS goal. A secondary DoorRoom cutoff was indicated at 35′, to prevent a precipitous drop-off in likelihood of meeting the LWBS goal, from 61.1% at 35′ to 34.4% at 40′. Predictive marginal analysis using multivariate techniques to control for operational and patient-acuity factors confirmed the 20′ and 35′ cutoffs as significant (p<0.001). Days with DoorRoom between 21–35′ were 74% less likely to meet the LWBS goal than days with DoorRoom ≤20′ (OR 0.26, 95% CI [0.13–0.53]). Days with DoorRoom >35′ were a further 75% less likely to meet the LWBS goal than days with DoorRoom of 21–35′ (OR 0.25, 95% CI [0.15–0.41]). Conclusion

  13. Decontamination of targeted pathogens from patient rooms using an automated ultraviolet-C-emitting device.

    PubMed

    Anderson, Deverick J; Gergen, Maria F; Smathers, Emily; Sexton, Daniel J; Chen, Luke F; Weber, David J; Rutala, William A

    2013-05-01

    OBJECTIVE. To determine the effectiveness of an automated ultraviolet-C (UV-C) emitter against vancomycin-resistant enterococci (VRE), Clostridium difficile, and Acinetobacter spp. in patient rooms. DESIGN. Prospective cohort study. SETTING. Two tertiary care hospitals. PARTICIPANTS. Convenience sample of 39 patient rooms from which a patient infected or colonized with 1 of the 3 targeted pathogens had been discharged. INTERVENTION. Environmental sites were cultured before and after use of an automated UV-C-emitting device in targeted rooms but before standard terminal room disinfection by environmental services. RESULTS. In total, 142 samples were obtained from 27 rooms of patients who were colonized or infected with VRE, 77 samples were obtained from 10 rooms of patients with C. difficile infection, and 10 samples were obtained from 2 rooms of patients with infections due to Acinetobacter. Use of an automated UV-C-emitting device led to a significant decrease in the total number of colony-forming units (CFUs) of any type of organism (1.07 log10 reduction; P < .0001), CFUs of target pathogens (1.35 log10 reduction; P < .0001), VRE CFUs (1.68 log10 reduction; P < .0001), and C. difficile CFUs (1.16 log10 reduction; P < .0001). CFUs of Acinetobacter also decreased (1.71 log10 reduction), but the trend was not statistically significant (P = .25). CFUs were reduced at all 9 of the environmental sites tested. Reductions similarly occurred in direct and indirect line of sight. CONCLUSIONS. Our data confirm that automated UV-C-emitting devices can decrease the bioburden of important pathogens in real-world settings such as hospital rooms.

  14. 9 CFR 590.548 - Drying, blending, packaging, and heat treatment rooms and facilities.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 9 Animals and Animal Products 2 2010-01-01 2010-01-01 false Drying, blending, packaging, and heat treatment rooms and facilities. 590.548 Section 590.548 Animals and Animal Products FOOD SAFETY AND INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE EGG PRODUCTS INSPECTION INSPECTION OF EGGS AND EGG...

  15. LPT. Shield test facility (TAN646) interior. Water treatment room contains ...

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

    LPT. Shield test facility (TAN-646) interior. Water treatment room contains water softeners, deionizers, and display panel. Note metal ceiling and walls. Photographer: Jack L. Anderson. Date: February 20, 1959. INEEL negative no. 59-856 - Idaho National Engineering Laboratory, Test Area North, Scoville, Butte County, ID

  16. Patient attitudes toward physician use of tablet computers in the exam room.

    PubMed

    Strayer, Scott M; Semler, Matthew W; Kington, Marit L; Tanabe, Kawai O

    2010-10-01

    Previous research has examined patients' attitudes toward use of exam room computers by physicians. Our objective was to determine patient attitudes toward physicians' exam room use of new tablet computers. A random sample of 96 patients was interviewed immediately following a visit to a physician at an outpatient family medicine clinic at a large academic medical center in central Virginia. We excluded visits to first-year residents. Patients were asked about their attitudes toward technology use in the exam room using a previously validated 16-item structured questionnaire on patient attitudes toward technology use in the exam room. The response rate was 97%. Survey results showed mostly positive patient perceptions of the tablets regardless of age, gender, race, ethnicity, and income. There were differences in attitudes toward privacy (by race and education), use of tablets by the physician (by education and age), depersonalization of the office visit (by race), and speed of medical files overview (by age). The use of tablet computers by physicians in the examining room is perceived positively by most patients.

  17. Shielding design of a treatment room for an accelerator-based epithermal neutron irradiation facility for BNCT.

    PubMed

    Evans, J F; Blue, T E

    1996-11-01

    Protecting the facility personnel and the general public from radiation exposure is a primary safety concern of an accelerator-based epithermal neutron irradiation facility. This work makes an attempt at answering the questions "How much?" and "What kind?" of shielding will meet the occupational limits of such a facility. Shielding effectiveness is compared for ordinary and barytes concretes in combination with and without borated polyethylene. A calculational model was developed of a treatment room , patient "scatterer," and the epithermal neutron beam. The Monte Carlo code, MCNP, was used to compute the total effective dose equivalent rates at specific points of interest outside of the treatment room. A conservative occupational effective dose rate limit of 0.01 mSv h-1 was the guideline for this study. Conservative Monte Carlo calculations show that constructing the treatment room walls with 1.5 m of ordinary concrete, 1.2 m of barytes concrete, 1.0 m of ordinary concrete preceded by 10 cm of 5% boron-polyethylene, or 0.8 m of barytes concrete preceded by 10 cm of 5% boron-polyethylene will adequately protect facility personnel.

  18. Shielding design of a treatment room for an accelerator-based epithermal neutron irradiation facility for BNCT

    SciTech Connect

    Evans, J.F.; Blue, T.E.

    1996-11-01

    Protecting the facility personnel and the general public from radiation exposure is a primary safety concern of an accelerator-based epithermal neutron irradiation facility. This work makes an attempt at answering the questions {open_quotes}How much?{close_quotes} and {open_quotes}What kind?{close_quotes} of shielding will meet the occupational limits of such a facility. Shielding effectiveness is compared for ordinary and barytes concretes in combination with and without borated polyethylene. A calculational model was developed of a treatment room, patient {open_quotes}scatterer,{close_quotes} and the epithermal neutron beam. The Monte Carlo code, MCNP, was used to compute the total effective dose equivalent rates at specific points of interest outside of the treatment room. A conservative occupational effective dose rate limit of 0.01 mSv h{sup {minus}1} was the guideline for this study. Conservative Monte Carlo calculations show that constructing the treatment room walls with 1.5 m of ordinary concrete, 1.2 m of barytes concrete, 1.0 m of ordinary concrete preceded by 10 cm of 5% boron-polyethylene, or 0.8 m of barytes concrete preceded by 10 cm of 5% boron-polyethylene will adequately protect facility personnel. 20 refs., 8 figs., 2 tabs.

  19. Experiences of the transplant nurses caring for renal transplant patients in an acuity-adaptable patient room.

    PubMed

    Bonuel, Nena; Cesario, Sandra K

    2013-01-01

    This article describes transplant nurses' experiences in caring for renal transplant patients in the acuity-adaptable patient room using Husserl's descriptive phenomenology. The setting was a twice-redesignated magnet urban tertiary center in the Southwest United States with 14 acuity-adaptable patient rooms. Audiotaped interviews were analyzed using Colaizzi's method and a purposive sample of 10 transplant nurses. Three theme clusters emerged that described the essence of the transplant nurses' experiences in caring for renal transplant patients in the acuity-adaptable patient room: Patient and family comfort: "...I think their anxiety of just not knowing what's going on-that need is being met." Nurse empowerment: "...Her urine output was going down to the 40s and so I had to call the surgeon recommending that we maybe change the normal saline to half normal for replacement." Acuity-adaptable patient room future potential: "I wish that all patients had this kind of access." The nurses felt empowered in caring for renal transplant patients in the acuity-adaptable patient room thereby creating a healing environment for the patient and the family.

  20. Room service improves patient food intake and satisfaction with hospital food.

    PubMed

    Williams, R; Virtue, K; Adkins, A

    1998-07-01

    Cancer therapy causes side effects that interfere with oral intake. Frequently, patients undergoing such therapy suffer from anorexia, nausea, vomiting, food aversions, dysgeusia, and xerostomia, all which adversely affect oral intake. Adequate nutrition intake is an important part of therapy for the cancer patient, especially when that patient is a child. Children who are well nourished are better able to withstand infection and tolerate therapy. Parents and staff at our hospital have worked diligently to improve patient's oral intake with limited success. Hence, a multidisciplinary team was organized to develop a new approach to food services that would improve patients' oral intake. The team initiated patient "room service," and patients were allowed to call the kitchen when they were ready to eat. The system works much like room service in a hotel. After the introduction of room service, patients' caloric intake improved significantly (P = .008), and protein intake increased by 18%. Patient satisfaction with hospital food service also improved; excellent ratings increased by as much as 35%. We conclude that room service is a viable alternative to traditional food services in the pediatric oncology setting and may be useful in other patient populations, such as maternity and general pediatrics.

  1. Treating patients with smallpox in the operating room.

    PubMed

    Beasley, Amy; Kenenally, Shelley; Mickel, Natalie; Korowicki, Kija; McCann, Sue; Arundell, Julie; Simmons, Wylie; Williams, Harold

    2004-10-01

    Recent events around the world have emphasized the need for health care facilities to prepare to deal with biological threats, including smallpox. At Walter Reed Army Medical Center, Washington, DC, administrators recognized the need for a policy on handling patients with smallpox in the OR and asked a group of students to create a template policy for care of patients with smallpox in need of surgery. This article provides a brief history of smallpox, concerns surrounding smallpox today, and smallpox characteristics with which perioperative personnel should be familiar, as well as a guideline for treating patients in the OR who have smallpox.

  2. Health physics aspects in treatment rooms after 18-MV X-ray irradiations.

    PubMed

    Kalef-Ezra, John A

    2011-09-01

    Delayed activation products contribute to the exposure of the staff operating high-energy accelerators. Induced activity was studied in a treatment room following 18-MV X-ray irradiations using a hand-held system that allows both dose rate measurements and spectroscopic analysis. The major activation products and the corresponding nuclear reactions were identified. At the majority of the studied locations, β(+) emitters were the main short-term dose contributors. The time variation of the absorbed dose rate in a treatment room during the first 20-min post-irradiation was represented by the sum of two exponential components with half-lives of 1-2 min and either 4 or 10 min, depending on the location in the room. Components with a half-life of hours or days contribute <1 % to the initial dose rate. The activation of some accessories, such as iron filters and portal imagers, deserve special attention. The collection of such data with the proposed method allows the development of optimised working protocols at each treatment room.

  3. [General anesthesia outside the operating room in patients with Pierre-Robin syndrome].

    PubMed

    Kamitani, Junko; Toda, Yuichiro; Nakatsuka, Hideki; Sato, Kenji; Morimatsu, Hiroshi; Taga, Naoyuki; Takeuchi, Mamoru; Morita, Kiyoshi

    2005-06-01

    Anesthesiologists are increasingly asked to involve in administering general anesthesia outside the operating room for such procedures as computed tomography, magnetic resonance imaging or angiography. Especially, pediatric patients require some kind of sedation or general anesthesia during these procedures. We report general anesthesia outside the operating room in patients with Pierre-Robin syndrome, who are expected to have possible difficult airway. A one-year-old girl and a 16-year-old boy were anesthetized for cardiac catheterization. General anesthesia was given at the angiography room which was located outside the operating room. Anesthesia was induced with oxygen, nitrous oxide and sevoflurane while portable storage unit for difficult airway was prepared including various types and size of laryngoscopes, laryngeal mask airway, fiberoptic intubation equipment and surgical airway access. Fortunately, tracheas were successfully intubated without using special devices, although cautious care during induction was taken. According to development of medical and surgical procedures, it is readily presumed that anesthesiologists will be more often involved in the sedation or anesthesia conducted outside the operating room in future. Anesthesiologists should always ensure enough staffing, proper monitoring and equipment when sedation or anesthesia is conducted outside the operating room, particularly if patients have anesthetic risks.

  4. Room Service Improves Nutritional Intake and Increases Patient Satisfaction While Decreasing Food Waste and Cost.

    PubMed

    McCray, Sally; Maunder, Kirsty; Krikowa, Renee; MacKenzie-Shalders, Kristen

    2017-07-01

    Room service is a foodservice model that has been increasingly implemented across health care facilities in an effort to improve patient satisfaction and reduce food waste. In 2013, Mater Private Hospital Brisbane, Australia, was the first hospital in Australia to implement room service, with the aim of improving patient nutrition care and reducing costs. The aim of this study was to comprehensively evaluate the nutritional intake, plate waste, patient satisfaction, and patient meal costs of room service compared to a traditional foodservice model. A retrospective analysis of quality-assurance data audits was undertaken to assess patient nutritional intake between a facility utilizing a traditional foodservice model and a facility utilizing room service and in a pre-post study design to assess plate waste, patient satisfaction, and patient meal costs before and after the room service implementation. Audit data were collected for eligible adult inpatients in Mater Private Hospital Brisbane and Mater Hospital Brisbane, Australia, between July 2012 and May 2015. The primary outcome measures were nutritional intake, plate waste, patient satisfaction, and patient meal costs. Independent samples t-tests and χ(2) analyses were conducted between pre and post data for continuous data and categorical data, respectively. Pearson χ(2) analysis of count data for sex and reasons for plate waste for data with counts more than five was used to determine asymptotic (two-sided) significance and n-1 χ(2) used for the plate waste analysis. Significance was assessed at P<0.05. This study reported an increased nutritional intake, improved patient satisfaction, and reduced plate waste and patient meal costs with room service compared to a traditional foodservice model. Comparison of nutritional intake between a traditional foodservice model (n=85) and room service (n=63) showed statistically significant increases with room service in both energy (1,306 kcal/day vs 1,588 kcal/day; P=0

  5. Teaching avian patients and caregivers in the examination room.

    PubMed

    Cook, Ellen K

    2012-09-01

    Client education and patient well-being should be primary goals and responsibilities for practicing avian veterinarians. Time is limited in the normal clinical appointment setting. However, this opportunity can still be used to introduce clients to the basics of training with positive reinforcement. These methods build a healthy relationship of trust between caregivers and their birds. Within the allotted appointment time, it is possible to teach clients how to train a simple behavior. This article outlines and demonstrates how training avian patients is successfully applied in a typical clinical practice.

  6. Group Therapy with Patients in the Waiting Room of an Oncology Clinic.

    ERIC Educational Resources Information Center

    Arnowitz, Edward; And Others

    1983-01-01

    Describes a therapy group for cancer patients, conducted by cotherapists in an oncology waiting room. Group members provided mutual support and shared concerns and coping methods. Medical staff members became more involved and were more able to address the affective needs of the patients and their families. (JAC)

  7. Group Therapy with Patients in the Waiting Room of an Oncology Clinic.

    ERIC Educational Resources Information Center

    Arnowitz, Edward; And Others

    1983-01-01

    Describes a therapy group for cancer patients, conducted by cotherapists in an oncology waiting room. Group members provided mutual support and shared concerns and coping methods. Medical staff members became more involved and were more able to address the affective needs of the patients and their families. (JAC)

  8. Why do geriatric patients attend otolaryngology emergency rooms?

    PubMed

    Dagan, Elad; Wolf, Michael; Migirov, Lela M

    2012-10-01

    With an aging population, health care of the elderly population is becoming increasingly important; however, the principles of geriatric medicine and issues of concern specific to geriatric otolaryngologic patients have not been widely applied. To qualitatively analyze otolaryngological (EN1) emergencies in a geriatric population in an ENT emergency department (ED). In this retrospective study the medical records of patients > or = 65 years of age who attended our ENT-ED between 3 pm and 8 am and who were observed and/or treated by the on-call otorhinolaryngologist at Sheba Medical Center in 2009 were reviewed for age, gender, main complaint, and preliminary diagnosis. Allergic reactions, balance disorders, epistaxis, head/facial trauma and swallowing-related complaints were considered true emergencies. The staff in the ENT-ED examined and treated 1-10 geriatric patients daily (mean 2.35). A total of 597 subjects met the study entry criteria (median age 75 years); 16.6% were > or = 85 years old. There was approximately equal gender representation. More elderly patients presented to the ENT-ED on the weekends (37.9% of the total) compared to weekdays (62.1%). There were 393 patients (65.8%) with true emergencies, of which epistaxis, balance disorders and head and facial trauma were the most common diagnoses (20.1%, 15.75% and 13.7%, respectively), while 46.5% of all vestibulopathy cases involved benign paroxysmal positional vertigo. More than 65% of visits of the elderly presenting to ENT-ED involve true emergencies. This growing population may benefit from the presence of geriatric specialists in emergency departments.

  9. Patient safety in the operating room: an intervention study on latent risk factors

    PubMed Central

    2012-01-01

    Background Patient safety is one of the greatest challenges in healthcare. In the operating room errors are frequent and often consequential. This article describes an approach to a successful implementation of a patient safety program in the operating room, focussing on latent risk factors that influence patient safety. We performed an intervention to improve these latent risk factors (LRFs) and increase awareness of patient safety issues amongst OR staff. Methods Latent risk factors were studied using a validated questionnaire applied to the OR staff before and after an intervention. A pre-test/post-test control group design with repeated measures was used to evaluate the effects of the interventions. The staff from one operating room of an university hospital acted as the intervention group. Controls consisted of the staff of the operating room in another university hospital. The outcomes were the changes in LRF scores, perceived incident rate, and changes in incident reports between pre- and post-intervention. Results Based on pre-test scores and participants’ key concerns about organizational factors affecting patient safety in their department the intervention focused on the following LRFs: Material Resources, Training and Staffing Recourses. After the intervention, the intervention operating room - compared to the control operating room - reported significantly fewer problems on Material Resources and Staffing Resources and a significantly lower score on perceived incident rate. The contribution of technical factors to incident causation decreased significantly in the intervention group after the intervention. Conclusion The change of state of latent risk factors can be measured using a patient safety questionnaire aimed at these factors. The change of the relevant risk factors (Material and Staffing resources) concurred with a decrease in perceived and reported incident rates in the relevant categories. We conclude that interventions aimed at unfavourable

  10. Listening to "How the Patient Presents Herself": A Case Study of a Doctor-Patient Interaction in an Emergency Room

    ERIC Educational Resources Information Center

    Delbene, Roxana

    2015-01-01

    This is a case-study based on a micro-ethnography analyzing a doctor-patient interaction in an emergency room (ER) in New York City. Drawing on the framework of narrative medicine (Charon, 2006), the study examines how a phenomenological approach to listening to the patient facilitated the patient's narrative orientation not only to relevant…

  11. Care of patients in emergency department waiting rooms--an integrative review.

    PubMed

    Innes, Kelli; Jackson, Debra; Plummer, Virginia; Elliott, Doug

    2015-12-01

    To conduct an integrative review of primary research examining patient care roles introduced into emergency department waiting rooms. Internationally, emergency departments are under pressure to meet increasing patient demand with limited resources. Several initiatives have been developed that incorporate a healthcare role in waiting rooms, to assess and initiate early interventions to decrease waiting times, detect patient deterioration and improve communication. The literature reporting these roles has not been systematically evaluated. Integrative review. Published English-language peer reviewed articles in CINAHL, Scopus, Medline and Web of Knowledge between 2003-2014. Identified literature was evaluated using an integrative review framework, incorporating methodological critique and narrative synthesis of findings. Six papers were included, with three waiting room roles identified internationally - clinical initiative nurse, Physician-Nurse Supplementary Assessment Team and clinical assistants. All roles varied in terms of definitions, scope, responsibilities and skill sets of individuals in the position. There was limited evidence that the roles decreased waiting times or improved patient care, especially during busy periods. Of note, staff members performing these roles require high-level therapeutic relationship and effective interpersonal skills with patients, family and staff. The role requires support from other staff, particularly during periods of high workload, for optimal functioning and effective patient care. Generalisations and practice recommendations are limited due to the lack of available literature. Further research is required to evaluate the impact emergency department waiting room roles have on patient outcomes and staff perspectives. © 2015 John Wiley & Sons Ltd.

  12. Patient Treatment Tracking Chart

    MedlinePlus

    ... the Media Room Public Affairs News Releases Speeches Videos Publications National Observances Veterans Day Memorial Day Celebrating America's Freedoms Special Events Adaptive Sports Program Creative Arts Festival Golden Age Games Summer Sports Clinic Training - Exposure - Experience (TEE) Tournament ...

  13. Hearing Aid Patient Education Materials: Is There Room for Improvement?

    PubMed

    Joseph, John; Svider, Peter F; Shaigany, Kevin; Eloy, Jean Anderson; McDonald, Paulette G; Folbe, Adam J; Hong, Robert S

    2016-04-01

    The purpose of this study was to analyze and compare the readability of patient education materials (PEMs) from leading manufacturers of behind-the-ear style hearing aids and popular hearing aid information Web sites to determine if they meet guidelines recommended by public health agencies. Analysis of hearing aid PEMs. Printed user guides from six of the leading manufacturers of BTE hearing aids and 15 of the most popular hearing aid-information Web sites were accessed online and analyzed for readability using the Gunning-Fog Index, New Fog Count, Raygor Estimate Graph, Simple Measure of Gobbledygook, and Flesch Reading Ease score. Overall average grade-level readability for all six printed manufacturer user manuals was calculated to be written at a 10th grade reading level. Overall average grade-level readabilities for all 15 popular online hearing aid-information Web sites representing professional organizations, suppliers, and health information services were calculated to be written at 10th, 10th, and 11th grade reading levels, respectively. Average Flesch Reading Ease scores for all printed guides and online patient information Web sites were calculated to fall within the fairly difficult category for readability. PEMs provided by top hearing aid manufactures and popular hearing aid Web sites are written well above the reading level recommended by the National Institutes of Health. Consideration should be given toward simplifying these materials in order to enhance user experience and increase compliance among behind-the-ear hearing aid users. American Academy of Audiology.

  14. Patient preferences for single rooms or shared accommodation in a district general hospital.

    PubMed

    Florey, L; Flynn, R; Isles, C

    2009-05-01

    To determine whether patients who have used a Scottish district general hospital would prefer single or shared accommodation on a future admission. We surveyed 80 in-patients in January 2008 in order to obtain 20 medical and 20 surgical patients in single rooms and the same number in shared accommodation. Each patient received a seven point questionnaire that had been validated in another centre. Forty four men and 36 women, median 64 years, who had been in hospital for a median of 4.5 days (range 1 to 53 days) participated in the survey. Seventy per cent of patients in shared and 40% of patients in single rooms said they would prefer shared accommodation during a future hospital admission. Those expressing a preference for shared accommodation were older (median age 68 versus 58 years) and had been in hospital for longer (median 5.5 versus 3.5 days) than those who said they would prefer a single room. It is likely that the desire for company among older people who have to spend a week or more in hospital is driving the responses we obtained. Our findings do not support claims that the argument in favour of 100% single rooms is 'overwhelming'.

  15. Nurses' solutions to prevent inpatient falls in hospital patient rooms.

    PubMed

    Tzeng, Huey-Ming; Yin, Chang-Yi

    2008-01-01

    Patient fall rates are perceived as the indicator that could be most improved through nurse-led safety strategies or interventions. A safety-driven design with a goal to prevent inpatient fall-related injuries should be a hospital design principle. In this qualitative study, researchers used inductive and deductive methods to understand the clinically accessible solutions to minimize the extrinsic risk factors of inpatient falls. The findings from the nurse interviews were compared with the intervention strategies toward the five primary root causes of fatal falls as suggested by the Joint Commission (2005b). Twenty-four solutions were identified from the nurse interview transcriptions: five were related to the dimension of inadequate caregiver communication, none was associated with the dimension of inadequate staff orientation and training, three were related to inadequate assessment and reassessment, 15 were associated with unsafe care environment, and one was related to inadequate care planning and provision.

  16. Shielding design of a treatment room for an accelerator-based neutron source for BNCT

    SciTech Connect

    Evans, J.F.; Blue, T.E.

    1995-12-31

    For several years, research has been ongoing in the Ohio State University (OSU) Nuclear Engineering Program toward the development of an accelerator-based irradiation facility (ANIF) neutron source for boron neutron capture therapy (BNCT). The ANIF, which is planned to be built in a hospital, has been conceptually designed and analyzed. After Qu, an OSU researcher, determined that the shielding design of a 6-MV X-ray treatment room was inadequate to protect personnel from an accelerator neutron source operating at 30 mA, we decided to analyze and determine the shielding requirements of a treatment room for an ANIF. We determined the amount of shielding that would be sufficient to protect facility personnel from excessive radiation exposure caused by operation of the accelerator at 30 mA.

  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. A Retrospective Case-Matched Cost Comparison of Surgical Treatment of Melanoma and Nonmelanoma Skin Cancer in the Outpatient Versus Operating Room Setting.

    PubMed

    Johnson, Ryan P; Butala, Niraj; Alam, Murad; Lawrence, Naomi

    2017-07-01

    To date, no study has used authentic billing data in a case-control matched fashion to examine the cost of treating skin cancer in different settings. To compare the cost of surgical treatment of skin cancer in the outpatient versus operating room setting using matched cases based on patient and skin cancer characteristics. ICD-9 diagnosis codes for skin cancers were used to find patients who had a malignant excision current procedural terminology code in the operating room setting during 2010 to 2014. Patient and skin cancer characteristics were used to match cases to those treated as an outpatient. A total of 36 cases (18 operating room and 18 outpatient) had the required information and characteristics to be matched and analyzed for cost. Health status was determined using the American Society of Anesthesiologists anesthesia grading scale. No statistically significant differences were found in the age (p > 0.9) or American Society of Anesthesiologists scores (p > 0.6) of the outpatient and operating room cases. The median cost for outpatient cases was $1,745. For operating room cases, the median cost was $11,323. This was a statistically significant difference (p < 0.001). The outpatient setting remains a cost-effective location to treat skin cancer compared with the operating room.

  19. Ventilation Rates and Airflow Pathways in Patient Rooms: A Case Study of Bioaerosol Containment and Removal.

    PubMed

    Mousavi, Ehsan S; Grosskopf, Kevin R

    2015-11-01

    Most studies on the transmission of infectious airborne disease have focused on patient room air changes per hour (ACH) and how ACH provides pathogen dilution and removal. The logical but mostly unproven premise is that greater air change rates reduce the concentration of infectious particles and thus, the probability of airborne disease transmission. Recently, a growing body of research suggests pathways between pathogenic source (patient) and control (exhaust) may be the dominant environmental factor. While increases in airborne disease transmission have been associated with ventilation rates below 2 ACH, comparatively less data are available to quantify the benefits of higher air change rates in clinical spaces. As a result, a series of tests were conducted in an actual hospital to observe the containment and removal of respirable aerosols (0.5-10 µm) with respect to ventilation rate and directional airflow in a general patient room, and, an airborne infectious isolation room. Higher ventilation rates were not found to be proportionately effective in reducing aerosol concentrations. Specifically, increasing mechanical ventilation from 2.5 to 5.5 ACH reduced aerosol concentrations only 30% on average. However, particle concentrations were more than 40% higher in pathways between the source and exhaust as was the suspension and migration of larger particles (3-10 µm) throughout the patient room(s). Computational analyses were used to validate the experimental results, and, to further quantify the effect of ventilation rate on exhaust and deposition removal in patient rooms as well as other particle transport phenomena. © The Author 2015. Published by Oxford University Press on behalf of the British Occupational Hygiene Society.

  20. An empirical examination of patient room handedness in acute medical-surgical settings.

    PubMed

    Pati, Debajyoti; Cason, Carolyn; Harvey, Thomas E; Evans, Jennie

    2010-01-01

    The study objective was to examine whether standardized same-handed room configurations contribute more to operational performance in comparison to standardized mirror-image room configurations. Based on a framework that physical environment standardization supports process and workflow standardization, thus contributing to safety and efficiency, the study examined the comparative effectiveness of the standardized same-handed configuration and the standardized mirror-image configuration. Patient room handedness has emerged as an important issue in inpatient unit design, with many hospitals adopting the standardized same-handed room concept at all levels of patient acuity. Although it is argued that standardized same-handed rooms offer greater levels of safety and efficiency in comparison to standardized mirror-image rooms, there is little empirical evidence either to support or refute these contentions. An experimental setting was developed where elements of the physical environment and approach to the caregiver zone were systematically manipulated. Twenty registered nurses (10 left-handed and 10 right-handed) provided three types of care to a patient-actor across nine physical design configurations, which were videotaped in 540 separate segments. Structured interviews of the subjects were conducted at the end of each individual set of simulation runs to obtain triangulation data. Video segments were coded by nursing experts. Statistical and content analyses of the data were conducted. Study data show that standardized same-handed configurations may not contribute to process and workflow standardization--hence, to safety and efficiency--any more than standardized mirror-image configurations in acute medical-surgical settings. Data suggest that a global view of the patient care environment upon entry is the most sought-after familiarization factor to reduce cognitive load.

  1. The reactions of patients to a video camera in the consulting room

    PubMed Central

    Martin, Edwin; Martin, P. M. L.

    1984-01-01

    In a general practice survey of reactions to the presence of a video camera in the consulting room 13 per cent of patients refused to be filmed, and 11 per cent of those who did consent disapproved of recording. Patients were more willing to express their reservations about video recording if asked to fill in a questionnaire later at home rather than immediately at the surgery. Patients with anxiety, depression, or problems relating to the breasts or reproductive system were more likely to withhold consent. Patients were less likely to refuse video recording of their consultation if they were asked by the doctor for their verbal permission as they entered the consulting room rather then if they were asked to sign a consent form. Only a small minority of the patients who refused to be filmed felt that this refusal had affected their consultation with the doctor. PMID:6502570

  2. Shielding hospital rooms for brachytherapy patients: design, regulatory and cost/benefit factors.

    PubMed

    Gitterman, M; Webster, E W

    1984-03-01

    The current regulations of the U.S. Nuclear Regulatory Commission (NRC) normally require limitation of radiation exposure in any part of unrestricted occupied areas to 2 mrem in any one hour and to 100 mrem in 7 days. To meet these limits when patients are treated therapeutically with radioactive materials, it is advisable to designate specific rooms in a hospital and often necessary to incorporate substantial costly shielding into one or more walls and the room door. Plans have been formulated for shielding existing hospital rooms housing brachytherapy patients receiving 192Ir and 137Cs therapy in order to meet the above NRC requirements for adjacent corridors and rooms. Typical shielding thicknesses required are 4-6 in. of concrete for certain walls and 1/4 in. of lead in the doors. Shielding costs are approx. $6000 per room for one shielded wall and a shielded door. Applying recent estimates of the cancer risk from low-level gamma radiation, the cost of shielding per cancer fatality averted has been estimated to range from $1.8 million to $10.9 million. Cost/benefit comparisons with many other life-saving activities suggest that these costs and the application of the 2 mrem/hr limit which necessitated them are not justified.

  3. The ICU patient room: views and meanings as experienced by the next of kin: a phenomenological hermeneutical study.

    PubMed

    Olausson, Sepideh; Ekebergh, Margaretha; Lindahl, Berit

    2012-06-01

    The rooms in Intensive Care Units are considered as high-tech environments and believed to affect recovery process and wellbeing of patients. Moreover, the design and interiors affect the interplay between the patient and the next of kin. The aim of this study was to describe and interpret the meanings of the intensive care patient room as experienced by next of kin. Next of kin (n=14) from two different intensive care units participated. Data were collected through photo-voice and analysed using a phenomenological hermeneutical method. Three major themes emerged; dwelling in the room and time, becoming at home and extension of the room. The results show that the room is perceived as a lived and extended place and space. The design, interiors and furnishing in the patient room are fundamental in shaping the next of kin's experiences in the room and affect wellbeing. How intensive care patient rooms are designed, the place given to next of kin and the way they are received in the room are decisive for the support given to the loved one. Simple interventions can make the patient room a more healing environment. Copyright © 2011 Elsevier Ltd. All rights reserved.

  4. Use of Critical Access Hospital Emergency Rooms by Patients with Mental Health Symptoms

    ERIC Educational Resources Information Center

    Hartley, David; Ziller, Erika C.; Loux, Stephenie L.; Gale, John A.; Lambert, David; Yousefian, Anush E.

    2007-01-01

    Context: National data demonstrate that mental health (MH) visits to the emergency room (ER) comprise a small, but not inconsequential, proportion of all visits; however, we lack a rural picture of this issue. Purpose: This study investigates the use of critical access hospital (CAH) ERs by patients with MH problems to understand the role these…

  5. Use of Critical Access Hospital Emergency Rooms by Patients with Mental Health Symptoms

    ERIC Educational Resources Information Center

    Hartley, David; Ziller, Erika C.; Loux, Stephenie L.; Gale, John A.; Lambert, David; Yousefian, Anush E.

    2007-01-01

    Context: National data demonstrate that mental health (MH) visits to the emergency room (ER) comprise a small, but not inconsequential, proportion of all visits; however, we lack a rural picture of this issue. Purpose: This study investigates the use of critical access hospital (CAH) ERs by patients with MH problems to understand the role these…

  6. Evaluation of Access, a Primary Care Program for Indigent Patients: Inpatient and Emergency Room Utilization.

    ERIC Educational Resources Information Center

    Davidson, Richard A.; Giancola, Angela; Gast, Andrea; Ho, Janice; Waddell, Rhondda

    2003-01-01

    Evaluated the impact of Accessing Community Care through Eastside Social Services (ACCESS), a program that provided indigent patients with free primary care, on inpatient admissions, emergency room (ER) visits, and subsequent charges. Data on 19 people before and after program enrollment showed significant decreases in ER visits following…

  7. Criteria for the safe discharge of patients from the recovery room.

    PubMed

    Reed, Helen

    Guidelines need to be in place to help nurses in the recovery room make appropriate and safe decisions when discharging patients to a surgical ward. Consciousness level, respiration, circulation, pain control, homeostasis and wound care should all be considered. Criteria from the Freeman Hospital provides practical guidance.

  8. Patient room lighting influences on sleep, appraisal and mood in hospitalized people.

    PubMed

    Giménez, Marina C; Geerdinck, Leonie M; Versteylen, Mathijs; Leffers, Pieter; Meekes, Gaby J B M; Herremans, Hannelore; de Ruyter, Boris; Bikker, Jan Willem; Kuijpers, Petra M J C; Schlangen, Luc J M

    2017-04-01

    Irregular 24 h light/dark cycles with night-time light exposure and a low amplitude are disruptive for sleep, mood and circadian rhythms. Nevertheless such lighting conditions are quite common in medical care facilities. A controlled clinical trial among 196 cardiology ward patients (mean age 66.5 ± 13.1 years SD) investigated how a patient room lighting intervention affects sleep, appraisal and mood across hospitalization. Patients were either assigned to a standardly-lit room or to a room with an interventional lighting system offering a dynamic 24 h light/dark cycle with low nocturnal light exposure and 2 h of bright light (1750 lux) during daytime. Measures included wrist actigraphy and questionnaires assessing alertness, sleep quality, anxiety, depression and lighting appraisal. The median length of hospitalization was 5 days in both study arms. Subjective scores on sleep, alertness, anxiety and depression did not differ between arms. Lighting appraisal in intervention rooms was better as compared to standardly-lit rooms, both in patients (P < 0.001) and staff (P < 0.005). Actigraphic sleep duration of patients improved by 5.9 min (95% CI: 0.6-11.2; P = 0.03 intervention × time effect) per hospitalization day with interventional lighting instead of standard lighting. After 5 days of hospitalization, sleep duration in the lighting intervention rooms increased by 29 min, or a relative 7.3%, as compared to standardly-lit rooms. A 24 h lighting system with enhanced daytime brightness and restricted nocturnal light exposure can improve some aspects of appraisal and objective sleep in hospital patients. More clinical research is needed to establish the best lighting strategy to promote healing and wellbeing within healthcare settings. © 2016 The Authors. Journal of Sleep Research published by John Wiley & Sons Ltd on behalf of European Sleep Research Society.

  9. Determining patients' satisfaction level with hospital emergency rooms in Iran: a meta-analysis.

    PubMed

    Kardanmoghadam, Vida; Movahednia, Nima; Movahednia, Mahtab; Nekoei-Moghadam, Mahmood; Amiresmaili, Mohammadreza; Moosazadeh, Mahmood; Kardanmoghaddam, Hossein

    2015-01-14

    Emergency department is one of the important parts of hospitals, and patients' satisfaction with this department significantly affects their overall satisfaction with the hospital. Therefore, evaluating patients' satisfaction level with the emergency part has been taken into account in different studies. The purpose of this study was to systematically review all available primary studies and their results and to evaluate patients' satisfaction level with emergency rooms of hospitals. In this study, previous documents were reviewed; to do this, national and international databases were searched electronically and related articles were extracted. Reference list of the published studies were also reviewed to increase sensitivity and to select a greater number of articles. Reviewing and studying titles and texts of the articles, repeated and unrelated cases were excluded. The remaining articles were entered into stat aver., 11 for meta-analysis. After meta-analysis, 24 articles were selected. The lowest and highest satisfaction level was 24 and 98.4% respectively. Meta-analysis results of studies showed that general evaluation of patients' satisfaction level with emergency rooms of hospitals was 68.9% in Iran. This meta-analysis revealed that patients' satisfaction level with performance and with the way services were presented in emergency rooms of hospitals was desirable in Iran. Concerning multifactorial nature of patients' satisfaction, it is necessary to take this matter into regular and routine consideration.

  10. Standard work for room entry: Linking lean, hand hygiene, and patient-centeredness.

    PubMed

    O'Reilly, Kristin; Ruokis, Samantha; Russell, Kristin; Teves, Tim; DiLibero, Justin; Yassa, David; Berry, Hannah; Howell, Michael D

    2016-03-01

    Healthcare-associated infections are costly and fatal. Substantial front-line, administrative, regulatory, and research efforts have focused on improving hand hygiene. While broad agreement exists that hand hygiene is the most important single approach to infection prevention, compliance with hand hygiene is typically only about 40%(1). Our aim was to develop a standard process for room entry in the intensive care unit that improved compliance with hand hygiene and allowed for maximum efficiency. We recognized that hand hygiene is a single step in a substantially more complicated process of room entry. We applied Lean engineering techniques to develop a standard process that included both physical steps and also standard communication elements from provider to patients and families and created a physical environment to support this. We observed meaningful improvement in the performance of the new standard as well as time savings for clinical providers with each room entry. We also observed an increase in room entries that included verbal communication and an explanation of what the clinician was entering the room to do. The design and implementation of a standardized room entry process and the creation of an environment that supports that new process has resulted in measurable positive outcomes on the medical intensive care unit, including quality, patient experience, efficiency, and staff satisfaction. Designing a process, rather than viewing tasks that need to happen in close proximity in time (either serially or in parallel) as unrelated, simplifies work for staff and results in higher compliance to individual tasks. Copyright © 2015 Elsevier Inc. All rights reserved.

  11. [In-hospitaltraumamanagement - radiation emergency and multiple trauma - principals of treatment in the emergency room].

    PubMed

    Wurmb, Thomas; Kühne, Christian A; Schneider, Rita

    2014-09-01

    Exposure to ionizing radiation combined with multiple trauma is a very rare but severe event. There are some important basic principles for the early inpatient management. An externally exposed patient poses no risk to the treatment team. Injuries require treatment in order of priority as known for example by ATLS(®). Against external contamination, the treatment team is adequately protected by wearing protective clothing and gloves in conformity with universal medical precautions. Treatment of life threatening injuries takes priority over decontamination. Specialized treatment centres should be involved early on in patient treatment. © Georg Thieme Verlag Stuttgart · New York.

  12. Impacting patient outcomes through design: acuity adaptable care/universal room design.

    PubMed

    Brown, Katherine Kay; Gallant, Dennis

    2006-01-01

    To succeed in today's challenging healthcare environment, hospitals must examine their impact on customers--patients and families--staff and physicians. By using competitive facility design and incorporating evidence-based concepts such as the acuity adaptable care delivery model and the universal room, the hospital will realize an impact on patient satisfaction that will enhance market share, on physician satisfaction that will foster loyalty, and on staff satisfaction that will decrease turnover. At the same time, clinical outcomes such as a reduction in mortality and complications and efficiencies such as a reduction in length of stay and minimization of hospital costs through the elimination of transfers can be gained. The results achieved are dependent on the principles used in designing the patient room that should focus on maximizing patient safety and improving healing. This article will review key design elements that support the success of an acuity adaptable unit such as the use of a private room with zones dedicated to patients, families, and staff, healing environment, technology, and decentralized nursing stations that support the success of the acuity adaptable unit. Outcomes of institutions currently utilizing the acuity adaptable concept will be reviewed.

  13. Thermal neutron fluence in a treatment room with a Varian linear accelerator at a medical university hospital

    NASA Astrophysics Data System (ADS)

    Liu, Wen-Shan; Changlai, Sheng-Pin; Pan, Lung-Kwang; Tseng, Hsien-Chun; Chen, Chien-Yi

    2011-09-01

    The indium foil activation technique has been employed to measure thermal neutron fluences ( Φth) among various locations in the treatment room with a 20×20 cm 2 field size and a 15 and 10 MV X-ray beam. Spatial Φth are visualized using colored three-dimensional graphical representations; intensities are up to (1.97±0.13)×10 5 and (1.46±0.13)×10 4 n cm -2/Gy-X at isocenter, respectively. The Φth is found to increase with the X-ray energy of the LINAC and decreases as it moves away from the beam center. However, thermal neutron exposure is not assessed in routine dosimetry planning and radiation assessment of patients since neutron dose contributes <1% of the given therapy dose. However, unlike the accelerated beam limited within the gantry window, photoneutrons are widely spread in the treatment room. Distributions of Φth were measured in water phantom irradiated with 15 MV X-ray beams. The shielding effect of the maze was also evaluated. The experimentally estimated Φth along the maze distance was fitted explicate and the tenth-value layer (TVL) was calculated and discussed. Use of a 10 cm-thick polyethylene door placed at the maze was suitable for radiation shielding.

  14. Ultrafast Room-Temperature Crystallization of TiO2 Nanotubes Exploiting Water-Vapor Treatment

    NASA Astrophysics Data System (ADS)

    Lamberti, Andrea; Chiodoni, Angelica; Shahzad, Nadia; Bianco, Stefano; Quaglio, Marzia; Pirri, Candido F.

    2015-01-01

    In this manuscript a near-room temperature crystallization process of anodic nanotubes from amorphous TiO2 to anatase phase with a fast 30 minutes treatment is reported for the first time. This method involves the exposure of as-grown TiO2 nanotubes to water vapor flow in ambient atmosphere. The water vapor-crystallized samples are deeply investigated in order to gain a whole understanding of their structural, physical and chemical properties. The photocatalytic activity of the converted material is tested by dye degradation experiment and the obtained performance confirms the highly promising properties of this low-temperature processed material.

  15. Antimicrobial Non-Susceptibility of Escherichia coli from Outpatients and Patients Visiting Emergency Rooms in Taiwan

    PubMed Central

    Wang, Jann-Tay; Chang, Shan-Chwen; Chang, Feng-Yee; Fung, Chang-Phone; Chuang, Yin-Ching; Chen, Yao-Shen; Shiau, Yih-Ru; Tan, Mei-Chen; Wang, Hui-Ying; Lai, Jui-Fen; Huang, I-Wen; Yang Lauderdale, Tsai-Ling

    2015-01-01

    Longitudinal nationwide surveillance data on antimicrobial non-susceptibility and prevalence of extended-spectrum β-lactamases (ESBLs) as well as AmpC β-lactamases producers among Escherichia coli from different sources in the community settings are limited. Such data may impact treatment practice. The present study investigated E. coli from outpatients and patients visiting emergency rooms collected by the Taiwan Surveillance of Antimicrobial Resistance (TSAR) program. A total of 3481 E. coli isolates were studied, including 2153 (61.9%) from urine and 1125 (32.3%) from blood samples. These isolates were collected biennially between 2002 and 2012 from a total of 28 hospitals located in different geographic regions of Taiwan. Minimum inhibitory concentrations (MIC) were determined using methods recommended by the Clinical Laboratory Standards Institute (CLSI). The prevalence and factors associated with the presence of ESBL and AmpC β-lactamase-producers were determined. Significant increases in non-susceptibility to most β-lactams and ciprofloxacin occurred during the study period. By 2012, non-susceptibility to cefotaxime and ciprofloxacin reached 21.1% and 26.9%, respectively. The prevalence of ESBL- and AmpC- producers also increased from 4.0% and 5.3%, respectively, in 2002–2004, to 10.7% for both in 2010–2012 (P < 0.001). The predominant ESBL and AmpC β-lactamase genes were CTX-M and CMY-types, respectively. Non-susceptibility of urine isolates to nitrofurantoin remained at around 8% and to fosfomycin was low (0.7%) but to cefazolin (based on the 2014 CLSI urine criteria) increased from 11.5% in 2002–2004 to 23.9% in 2010–2012 (P <0.001). Non-susceptibility of isolates from different specimen types was generally similar, but isolates from elderly patients were significantly more resistant to most antimicrobial agents and associated with the presence of ESBL- and AmpC- β-lactamases. An additional concern is that decreased ciprofloxacin

  16. Antimicrobial Non-Susceptibility of Escherichia coli from Outpatients and Patients Visiting Emergency Rooms in Taiwan.

    PubMed

    Wang, Jann-Tay; Chang, Shan-Chwen; Chang, Feng-Yee; Fung, Chang-Phone; Chuang, Yin-Ching; Chen, Yao-Shen; Shiau, Yih-Ru; Tan, Mei-Chen; Wang, Hui-Ying; Lai, Jui-Fen; Huang, I-Wen; Yang Lauderdale, Tsai-Ling

    2015-01-01

    Longitudinal nationwide surveillance data on antimicrobial non-susceptibility and prevalence of extended-spectrum β-lactamases (ESBLs) as well as AmpC β-lactamases producers among Escherichia coli from different sources in the community settings are limited. Such data may impact treatment practice. The present study investigated E. coli from outpatients and patients visiting emergency rooms collected by the Taiwan Surveillance of Antimicrobial Resistance (TSAR) program. A total of 3481 E. coli isolates were studied, including 2153 (61.9%) from urine and 1125 (32.3%) from blood samples. These isolates were collected biennially between 2002 and 2012 from a total of 28 hospitals located in different geographic regions of Taiwan. Minimum inhibitory concentrations (MIC) were determined using methods recommended by the Clinical Laboratory Standards Institute (CLSI). The prevalence and factors associated with the presence of ESBL and AmpC β-lactamase-producers were determined. Significant increases in non-susceptibility to most β-lactams and ciprofloxacin occurred during the study period. By 2012, non-susceptibility to cefotaxime and ciprofloxacin reached 21.1% and 26.9%, respectively. The prevalence of ESBL- and AmpC- producers also increased from 4.0% and 5.3%, respectively, in 2002-2004, to 10.7% for both in 2010-2012 (P < 0.001). The predominant ESBL and AmpC β-lactamase genes were CTX-M and CMY-types, respectively. Non-susceptibility of urine isolates to nitrofurantoin remained at around 8% and to fosfomycin was low (0.7%) but to cefazolin (based on the 2014 CLSI urine criteria) increased from 11.5% in 2002-2004 to 23.9% in 2010-2012 (P <0.001). Non-susceptibility of isolates from different specimen types was generally similar, but isolates from elderly patients were significantly more resistant to most antimicrobial agents and associated with the presence of ESBL- and AmpC- β-lactamases. An additional concern is that decreased ciprofloxacin susceptibility (MIC

  17. Patients visiting the emergency room for seizures: insurance status and clinic follow-up.

    PubMed

    Farhidvash, Fariba; Singh, Pradumna; Abou-Khalil, Bassel; Arain, Amir

    2009-11-01

    Epilepsy is a chronic condition that is best treated in the outpatient clinic setting. However, many epilepsy patients use the hospital emergency room (ER) as a primary resource for seizure management. We studied characteristics of these patients in comparison with patients attending an epilepsy clinic. We reviewed ER data of patients seen in 2002 and 2003 for seizures, in Vanderbilt University Hospital (VUH) and Metro Nashville General Hospital (MNGH), seeking to identify patients who had visited the emergency room more than once. We collected demographic and insurance information on these patients and identified those who followed up in the epilepsy clinic. There were 1005 patients who visited the VUH ER and 205 the MNGH ER for seizures. Patients visiting the ER for seizures were less likely to be insured than epilepsy patients followed in the clinic, in both institutions. The proportion of patients visiting the ER more than once was 15.2% at VUH and 29.2% at MNGH. Among these patients, 3.2% at VUH and 26.7% at MNGH were uninsured. Clinic follow-up occurred in 68.6% of VUH and 13.3% of MNGH repeat ER visitors. Combining institutions, insured patients were much more likely to follow-up in the clinic. Repeated use of the ER for seizures was more common in the county hospital, where the proportion of uninsured patients was also higher. Patients visiting the county hospital ER repeatedly tend not to follow-up in the neurology clinic. This element of disparity of care requires further attention.

  18. [Screening and brief intervention for alcoholic patients treated at emergency rooms: prospects and challenges].

    PubMed

    Segatto, Maria Luiza; Pinsky, Ilana; Laranjeira, Ronaldo; Rezende, Fabiana Faria; dos Reis Vilela, Thaís

    2007-08-01

    The purpose of this article was to present the general principles, concepts, and main elements of brief intervention, with a literature review on its use for alcoholic patients treated at emergency rooms. It also presents the applicability of screening as a first step to the brief intervention process and the use of validated standard instruments that allow useful information for consistent feedback. Finally, it highlights the challenges associated with screening in emergency rooms due to insufficient time, inadequate professional training, fear of annoying the patient, and common beliefs that alcoholics do not respond to such interventions. Meanwhile, it emphasizes the relevancy of brief emergency intervention, which is both feasible and efficient, and the need for research to define the relevant adjustments by professionals and the health care system.

  19. Have we lost sight of the mirrors?: the therapeutic utility of mirrors in patient rooms.

    PubMed

    Freysteinson, Wyona M; Cesario, Sandra K

    2008-01-01

    There is little known research in nursing or in hospital design on mirrors. This article reports the results of a survey of the mirrors in patient rooms in 10 hospitals. The survey focused on the mirrors within rooms where women with breast cancer who have had a partial or complete mastectomy might stay after surgery. Mirrors to view one's full body and mirrors for the bed-bound patient were not available in the majority of hospitals. Privacy to view self in the mirror was also lacking. Viewing self in the mirror is an everyday lived experience for many outside the hospital. This survey points to a need for further research on the mirror in nursing practice and within our healing healthcare environments.

  20. [Orthodontic treatment in periodontal patients].

    PubMed

    Krausz, E; Einy, S; Aizenbud, D; Levin, L

    2011-07-01

    Orthodontic treatment poses a significant challenge in patients suffering from periodontal disease. Providing orthodontic treatment to periodontal patients should be carefully planned and performed in a tight collaboration between the orthodontist and periodontist. Resolution and stabilization of the periodontal condition is a pre-requisite for orthodontic treatment initiation. Careful oral hygiene performance and highly frequent recall periodontal visits are also crucial. Pre- or post- orthodontic periodontal surgery might help providing better treatment outcomes.

  1. [Influence of patient's sex in the form of presentation and the management of acute heart failure in Spanish emergency rooms].

    PubMed

    Riesgo, Alba; Herrero, Pablo; Llorens, Pere; Jacob, Javier; Martín-Sánchez, Francisco Javier; Bragulat, Ernest; Miró, Oscar

    2010-05-22

    To evaluate the differences by sex in clinic presentation, diagnostic approach and initial treatment in patients with acute heart failure who are attended in emergency rooms. Prospective, evaluated, descriptive, transverse and multicentric study, which includes all patients attended by acute heart failure in emergency rooms of 10 Spanish centers between April 15th and May 15th, 2007 (n=944). Data were recorded regarding socio-demographic, comorbidity, previous heart disease, complementary explorations, previous home treatment, and therapeutic measurements in emergency. Regarding men, women (n=501; 53%) were older (79+/-9 and 75+/-10, P<.001), and had more hypertension (83,4% vs 74,9%, P<.01), valvular heart disease (23,1% vs 17,8%, P<.05) and obesity (21,9% vs 15,6%, P<.05); however, they also had less prevalence of coronary heart disease (26,5% vs 43,3%, P=.001) and smoking (4,4 % vs 18,7%, P<.001). According to outpatient treatment, women were less likely to be treated with beta blockers (19,6% vs 30,2%, P<.001) and antithrombotics (34,1% vs 41,3%, P<.05). Treatment administered in the emergency was similar in both groups, yet women received more frequently digoxin (25,7% vs 17,4%, P<.01). Moreover, women were admitted to the cardiology department less often (8,0% vs 13,8%, P<.01). In emergency, the diagnostic and therapeutic approach is very similar in both sexes and the most cases, differences can be justified due to the different patients' profile and the ambulatory handling before their consultation to emergency.

  2. A new active method for the measurement of slow-neutron fluence in modern radiotherapy treatment rooms

    NASA Astrophysics Data System (ADS)

    Gómez, F.; Iglesias, A.; Sánchez Doblado, F.

    2010-02-01

    This work focuses on neutron monitoring at clinical linac facilities during high-energy modality radiotherapy treatments. Active in-room measurement of neutron fluence is a complex problem due to the pulsed nature of the fluence and the presence of high photon background, and only passive methods have been considered reliable until now. In this paper we present a new active method to perform real-time measurement of neutron production around a medical linac. The device readout is being investigated as an estimate of patient neutron dose exposure on each radiotherapy session. The new instrument was developed based on neutron interaction effects in microelectronic memory devices, in particular using neutron-sensitive SRAM devices. This paper is devoted to the description of the instrument and measurement techniques, presenting the results obtained together with their comparison and discussion. Measurements were performed in several standard clinical linac facilities, showing high reliability, being insensitive to the photon fluence and EM pulse present inside the radiotherapy room, and having detector readout statistical relative uncertainties of about 2% on measurement of neutron fluence produced by 1000 monitor units irradiation runs.

  3. Insufflation using carbon dioxide versus room air during colonoscopy: comparison of patient comfort, recovery time, and nursing resources.

    PubMed

    Lynch, Isabelle; Hayes, Ann; Buffum, Martha D; Conners, Erin E

    2015-01-01

    The standard of practice for colonoscopy is room air insufflation. Recent research demonstrates safety and significant decrease in postcolonoscopy discomfort from distention when carbon dioxide (CO2) is used during insufflation. Reducing abdominal pain after colonoscopy may lead to increased acceptance of colonoscopy screening for colorectal cancer. This study aims to compare patient comfort intra- and postprocedure, length of recovery, and nursing time in patients undergoing colonoscopy using room air vs. CO2 insufflation. This study uses an experimental design with patients randomly assigned to either room air or CO2 during colonoscopy. Physician endoscopists, postprocedure nurses, and patients were blinded to assignment. Prior bowel surgery, inflammatory bowel disease, or inability to consent excluded participants. Outcome measures included discomfort assessment, nursing tasks, and recovery time.Of 191 participants, 177 were men and 14 were women; 94 received room air; 97 received CO2. Patients insufflated with room air reported higher levels of some measures of discomfort: (a) during colonoscopy (p = .02), (b) on admission to recovery (p = .001), and (c) on discharge from recovery (p = .001). Patients receiving room air required more nursing tasks in recovery (p = .001) and more total nursing time (p = .001).Compared with room air, CO2 insufflation increases patient comfort and decreases nursing tasks and time.

  4. Occupancy and patient care quality benefits of private room relative to multi-bed patient room designs for five different children's hospital intensive and intermediate care units.

    PubMed

    Smith, Thomas J

    2016-07-25

    Prior research documents occupancy and patient care quality (OPCQ) benefits for private room (PR) relative to multi-bed (MB) designs in neonatal intensive care units (NICUs). To extend this research design to four additional types of children's hospital units: a cardiovascular care center (CVCC), an infant care center (ICC), a medical/surgical unit (Med/Surg), and a pediatric intensive care unit (PICU). Staff comments, task activities, patient care demands, and perceptual survey rankings for twelve major indicators of OPCQ were assessed with nursing staff on these units plus an NICU. With the PR designs, for 38 of 48 pairwise comparisons for the twelve major OPCQ indicators, CVCC staff rankings are significantly lower than those by staff on the other four units. For 47 of 48 pairwise comparisons for the twelve major OPCQ indicators, NICU, ICC, Med/Surg, and PICU staff rankings for PR designs do not differ significantly from those for MB designs. Comments by staff on all five units target numerous PR OPCQ defects. Design, operation and management of the patient care environments on the five different PR units evaluated in this research confront a challenge in realizing OPCQ benefits that match experience with PR NICU designs in other contexts.

  5. Practicability of avoiding hypothermia in resuscitation room phase in severely injured patients.

    PubMed

    Jensen, K O; Jensen, J M; Sprengel, K

    2015-05-01

    Hypothermia in severely injured patients is a high demanding situation resulting from an effect of injury severity, surrounding temperature at trauma site and admittance. This article reviews the possible options to combat hypothermia in the resuscitation room with respect to practicability. This review summarizes available passive and active re-warming techniques and trys to offer a practicable chronology to restore normothermia. Resources should be applied depending on the availability of each institution and manifestation of hypothermia, but there is a strong demand for improvements with respect to practicability, convenience and safety for the patient.

  6. Telesurveillance of elderly patients by use of passive infra-red sensors in a 'smart' room.

    PubMed

    Banerjee, S; Steenkeste, F; Couturier, P; Debray, M; Franco, A

    2003-01-01

    We have developed an automated surveillance system based on passive infra-red sensors. Eight sensors were installed in a hospital room. A computer automatically captured data from the sensors every night from 21:00 until 06:00 the following morning. The sensors were polled twice per second and when a sensor was activated by movement, the event and time were recorded in a data file. At the end of the surveillance period the program analysed the data and generated a report showing the activities taking place in the room and their times. Four elderly patients were observed for a total of 97 nights. A total of 1637 possible sequences of movements by the patient and the hospital staff were detected. The computer was able to identify 1450 sequences (89%) correctly, in comparison with manual analysis. Only 10 movements (0.6%) were undetected by the system; all were very short sequences (five or six activations of the sensors). The system was generally capable of detecting and classifying all major movements in the room.

  7. [Hybrid room - the new standard for cooperation of cardiosurgeon, anaesthesiologist and invasive cardiologist in treating difficult, complex cardiovascular patients].

    PubMed

    Hawranek, Michał; Gąsior, Mariusz; Tajstra, Mateusz; Zembala, Michał; Filipiak, Krzysztof J; Hrapkowicz, Tomasz; Poloński, Lech; Zembala, Marian

    2012-01-01

    The concept of hybrid room is to combine capabilities of cardiosurgery operating room and fully equipped cathlab. Since May 2011, an ultramodern hybrid room has been working, in our center. The cases reported in this article show the possibilities of cooperation of cardiosurgeons, anaesthesiologists and invasive cardiologists in performing difficult, complex cardiovascular interventions. In near future the capabilities of hybrid room will allow to perform simultaneously a number of complex cardiovascular procedures. It should not only shorten the time of hospitalisation but also substantially improve the patients comfort.

  8. Two loose screws: near-miss fall of a morbidly obese patient after an operating room table failure.

    PubMed

    McAllister, Russell K; Booth, Robert T; Bittenbinder, Timothy M

    2016-09-01

    Operating room surgical table failure is a rare event but can lead to a dangerous situation when it does occur. The dangers can be compounded in the presence of obesity, especially in the anesthetized or sedated patient. We present a case of a near-miss fall of a morbidly obese patient while turning the patient in preparation to transfer from the operating room table to the hospital bed when 2 fractured bolts in the tilt cylinder mechanism led to an operating room table failure. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. An Exploration of the Use of a Sensory Room in a Forensic Mental Health Setting: Staff and Patient Perspectives.

    PubMed

    Wiglesworth, Sophie; Farnworth, Louise

    2016-09-01

    Despite the increased use of sensory rooms, there is little published evidence related to their benefits. The purpose of this study was to explore staff and patient perspectives of the use of a sensory room in an Australian forensic mental health setting. Staff and patients on a forensic hospital unit were recruited for this study. Focus group data was obtained from the perspective of the healthcare staff. A sensory assessment identified patients' sensory preferences. The details of the patients sensory room use and stress experienced before and after using the sensory room were recorded. The results showed a mean decrease in stress that was attributed to the use of the sensory room. Stress reducing benefits of sensory room use may improve a patient's experience within a forensic mental health facility while applying a recovery approach. As a limitation of the study, patient stress was rated on an un-validated scale. Further research is needed for greater insight and evidence in evaluating the use of sensory rooms in forensic mental health settings in reducing stress. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  10. [How many patient transfer rooms are necessary for my OR suite? : Effect of the number of OR transfer rooms on waiting times and patient throughput in the OR - analysis by simulation].

    PubMed

    Messer, C; Zander, A; Arnolds, I V; Nickel, S; Schuster, M

    2015-12-01

    In most hospitals the operating rooms (OR) are separated from the rest of the hospital by transfer rooms where patients have to pass through for reasons of hygiene. In the OR transfer room patients are placed on the OR table before surgery and returned to the hospital bed after surgery. It could happen that the number of patients who need to pass through a transfer room at a certain point in time exceed the number of available transfer rooms. As a result the transfer rooms become a bottleneck where patients have to wait and which, in turn, may lead to delays in the OR suite. In this study the ability of a discrete event simulation to analyze the effect of the duration of surgery and the number of ORs on the number of OR transfer rooms needed was investigated. This study was based on a discrete event simulation model developed with the simulation software AnyLogic®. The model studied the effects of the number of OR transfer rooms on the processes in an OR suite of a community hospital by varying the number of ORs from one to eight and using different surgical portfolios. Probability distributions for the process duration of induction, surgery and recovery and transfer room processes were calculated on the basis of real data from the community hospital studied. Furthermore, using a generic simulation model the effect of the average duration of surgery on the number of OR transfer rooms needed was examined. The discrete event simulation model enabled the analysis of both quantitative as well as qualitative changes in the OR process and setting. Key performance indicators of the simulation model were patient throughput per day, the probability of waiting and duration of waiting time in front of OR transfer rooms. In the case of a community hospital with 1 transfer room the average proportion of patients waiting before entering the OR was 17.9 % ± 9.7 % with 3 ORs, 37.6 % ± 9.7 % with 5 ORs and 62.9 % ± 9.1 % with 8 ORs. The average waiting

  11. [Significance of physical examination and radiography of the pelvis during treatment in the shock emergency room].

    PubMed

    Pehle, B; Nast-Kolb, D; Oberbeck, R; Waydhas, C; Ruchholtz, S

    2003-08-01

    Physical examination and radiography of the pelvis is part of most routine protocols in the emergency room (ER) management of blunt trauma patients. The purpose of this study was to determine the usefulness of these diagnostic tests with respect to diagnostic accuracy, therapeutic consequences, and prognosis in severely injured patients. In a prospective study including all trauma patients admitted to the ER, physical examination and clinical management were evaluated. All patients underwent physical examination of the pelvis and were grouped into two categories: patients without (group I) and with (group II) clinical pelvic instability. A comparison between these two groups was made for standard demographic data, indices of shock, diagnostic and therapeutic procedures, and results. During a 45-month period a total of 1160 patients were enrolled: 979 subjects (ISS 21+/-16) with blunt trauma were included in this analysis. Of these, 929 patients had negative (group I) and 51 (group II) positive examination results for clinical stability of the pelvis. When comparing these two groups, group II patients had a higher injury severity score, higher incidence of shock with a lower initial systolic blood pressure, a lower initial hemoglobin, and a higher rate of associated severe chest and abdominal injuries (AIS > or = 3). Among the 51 patients with abnormal pelvis instability, there were 6 type A, 16 type B, and 27 type C fractures, whereas in two cases no pelvic fracture could be found. Of the 928 patients without positive clinical signs, 866 (93%) had no pelvic fracture. There were 40 type A, 19 type B, and 3 type C fractures missed on clinical examination. The physical examination had a sensitivity of 44% and specificity of 99% for detecting pelvic fracture. A comparison between groups I and II showed the patients with positive physical pelvic examination to have greater transfusion requirements and a higher rate of surgical intervention for pelvic stabilization and

  12. Crew resource management improved perception of patient safety in the operating room.

    PubMed

    Gore, Dennis C; Powell, Jennifer M; Baer, Jennifer G; Sexton, Karen H; Richardson, C Joan; Marshall, David R; Chinkes, David L; Townsend, Courtney M

    2010-01-01

    To improve safety in the operating theater, a company of aviation pilots was employed to guide implementation of preprocedural briefings. A 5-point Likert scale survey that assessed the attitudes of operating room personnel toward patient safety was distributed before and 6 months following implementation of the briefings. Using Mann-Whitney analysis, the survey showed a significant (P < .05) improvement in 2 questions (of 13) involving reporting error and 2 questions (of 11) involving patient safety climate. When analyzed by occupation, there were no significant changes for faculty physicians; for resident physicians, there was a significant improvement in 1 question (of 13) regarding error reporting. For nurses, there were significant improvements in 3 questions (of 4) involving teamwork, 1 question (of 13) involving reporting error, and 3 questions (of 11) regarding patient safety climate. These results suggest that aviation-based crew resource management initiatives lead to an improved perception of patient safety, which was largely demonstrated by nursing personnel.

  13. Study of variation of materials patients room's door related of neutron flux iradiation

    NASA Astrophysics Data System (ADS)

    Nirmalasari, Yuliana Dian; Suparmi, A.; Sardjono, Y.

    2017-08-01

    The treatment chamber of patients has been simulating with MCNPX Code. Optimation of simulation design of Irradiation chamber is corresponding to ISO standards for 30 MeV cyclotron generator. The simulation has used the variation of door's materials that was applied at treatment room's door. The variation of materials was Stainless Steel 202 and Pb, the thickness Pb and stainless steel 202 with the thickness were 2 cm, respectively. Neutron flux that was radiated to stainless steel 202 in the sequence was 3.34195 × 105 n . Cm-2 s-1 and 8.41568 × 104 n . Cm-2 s-1, while for Pb was 4.01349 × 105 n . Cm-2 s-1 and 2.58058 × 104 n . Cm-2 s-1. The further, neutron flux that was radiated to Pb and stainless steel 202 with the thickness were 4 cm in sequence was 4.00601 × 105 n . Cm-2 s-1 and 1.71713 × 104 n . Cm-2 s-1 for Pb, while for SS 202 was 3.09925 × 105 n . Cm-2 s-1. From this ratio we concluded that material Pb absorbed higher neutron flux than material Stainless Steel 202. On the other hand, the cost of Pb was more expensive than Stainless Steel 202. In addition, the material Stainless Steel 202 was obtaine more easily than the material Pb. There fore to overcome the economics problem, can try to build the door with stainless still 202 sheet and Pb sheet together. The further, the neutron dose with 2 cm of thickness was 7.69603 × 10-2 Gy and 2.10623 × 10-2 Gy for SS 202, while for Pb was 4.19444 × 10-2 Gy and 1.50581 × 10-2 Gy. While the neutron dose with 4 cm of thickness for SS 202 was 9.39602 × 10-2 Gy and for Pb was 4.46541 × 10-2 Gy and 1.50502 × 10-2 Gy. We recommend that this simulation should be further optimized.

  14. Patient use of blood pressure self-screening facilities in general practice waiting rooms: a qualitative study in the UK

    PubMed Central

    Tompson, Alice C; Grant, Sabrina; Greenfield, Sheila M; McManus, Richard J; Fleming, Susannah; Heneghan, Carl J; Hobbs, FD Richard; Ward, Alison M

    2017-01-01

    Background Blood pressure (BP) self-screening, whereby members of the public have access to BP monitoring equipment outside of healthcare consultations, may increase the detection and treatment of hypertension. Currently in the UK such opportunities are largely confined to GP waiting rooms. Aim To investigate the reasons why people do or do not use BP self-screening facilities. Design and setting A cross-sectional, qualitative study in Oxfordshire, UK. Method Semi-structured interviews with members of the general public recruited using posters in GP surgeries and community locations were recorded, transcribed, and coded thematically. Results Of the 30 interviewees, 20% were hypertensive and almost half had self-screened. Those with no history of elevated readings had limited concern over their BP: self-screening filled the time waiting for their appointment or was done to help their doctor. Patients with hypertension self-screened to avoid the feelings they associated with ‘white coat syndrome’ and to introduce more control into the measurement process. Barriers to self-screening included a lack of awareness, uncertainty about technique, and worries over measuring BP in a public place. An unanticipated finding was that several interviewees preferred monitoring their BP in the waiting room than at home. Conclusion BP self-screening appeared acceptable to service users. Further promotion and education could increase awareness among non-users of the need for BP screening, the existence of self-screening facilities, and its ease of use. Waiting room monitors could provide an alternative for patients with hypertension who are unwilling or unable to monitor at home. PMID:28483823

  15. Factors predicting the increased risk for return to the operating room in bariatric patients: a NSQIP database study.

    PubMed

    Nandipati, Kalyana; Lin, Edward; Husain, Farah; Perez, Sebastian; Srinivasan, Jahnavi; Sweeney, John F; Davis, S Scott

    2013-04-01

    The objective of the study was to assess the risk factors associated with return to the operating room in bariatric surgery patients. Using the American College of Surgeons-National Surgical Quality Improvement Project's participant-use file, patients who underwent laparoscopic gastric bypass (LRYGB) and adjustable gastric band (LAGB) procedures for morbid obesity were identified. Several pre-, peri-, and postoperative variables, including 30 day morbidity and mortality, were collected. The study population was divided into two groups: patients returning to the operating room (group 1), and patients not returning to the operating room (group 2). Variables analyzed included postoperative complications, overall morbidity, and mortality. Relationships between preoperative and perioperative factors leading to the return to the operating room also were analyzed. Of 28,241 (LRYGB = 18,671, LAGB = 9,570) patients included in the study, 644 (2.3 %) patients returned to the operating room. Of the study population, 30 day mortality rate was 0.13 % (37/28,241) and morbidity was 4.1 % (1,155/28,241). Patients returning to the operating room had a higher mortality [14/644 (2.2 %) vs. 23/27,597 (0.01 %); P < 0.001], and morbidity [258/644 (40 %) vs. 897/27,579 (3.3 %); P < 0.001] compared with those who did not return to the operating room. Postoperative complications (superficial wound infection, deep surgical site infection, organ space infection, pneumonia, pulmonary embolism, renal insufficiency, renal failure, septic shock, and length of stay) were significantly higher for patients who required reoperation. On multivariate logistic regression analysis, the bypass operation, bleeding disorder, patients on dialysis, preoperative hematocrit, preoperative low albumin, and length of operation were associated with increased risk of return to the operating room. In the bariatric population, return to the operating room is associated with significantly higher morbidity and

  16. Mathematical modeling to define optimum operating room staffing for pediatric patients in trauma centers.

    PubMed

    Tuggle, David; Lucas, Charles E; Coscia, Robert L; Hurst, James M; Meredith, John W; Middleton, John D; Rinker, Charles R; Vlahos, Angie L; Wilberger, Jack

    2010-12-01

    Adult trauma centers (TCs) in the United States may be verified with an on-call operating room team if the performance improvement program shows no adverse outcome. Using queuing and simulation methodology, this study attempts to add a volume guideline for injured children. Data from 63 verified TCs identified demographic factors including specific information regarding the first pediatric trauma-related operation done between 11 pm and 7 am each month for 1 year. The annual pediatric admits correlated with the number of operations (383) done from 11 pm to 7 am (P < .001). The probability of operation within 30 minutes of arrival varies with the number of admits and the percent of penetrating vs blunt injuries. This likely number of operations from 11 pm to 7 am beginning within 30 minutes of patient arrival would be 3.45, 4.21, and 4.95 for TCs admitting 150, 250, and 350 injured children per year, respectively. The probability that 2 rooms would be occupied simultaneously is 0.074 and 0.109 for centers with 160 and 260 pediatric trauma admissions, respectively. Trauma centers performing less than 6 pediatric trauma operations per year from 11 pm to 7 am could conserve resources by using an on-call operating room team. Copyright © 2010 Elsevier Inc. All rights reserved.

  17. The effects of general anesthesia legislation on operating room visits by preschool children undergoing dental treatment.

    PubMed

    White, Halley R; Lee, Jessica Y; Rozier, R Gary

    2008-01-01

    The purpose of this study was to examine the impact of state-level general anesthesia (GA) legislation on operating room visits for the treatment of dental caries on preschool-aged children. The North Carolina Ambulatory Surgery Discharge Database was used to observe GA visits for fiscal years (FY) 1997 to 2001. A pretest/post-test design with concurrent comparison groups was used for 2 analyses: (1) all children treated for dental caries were compared to those treated for otitis media; and (2) those whose treatment for dental caries was reimbursed by Medicaid were compared to those whose treatment for dental caries was not reimbursed by Medicaid. In the prelegislation period (FY 1997 and 1998), there were 3,857 GA visits for dental core and 21,038 for otitis media. Postlegislation (FY 2000 and 2001) dental visits increased to 5,511(43%), and otitis media visits increased to 22,279 (6%)-a statistically significant difference (P<.05). Before the legislation, there were 1,370 non-Medicaid dental visits and 2,487 Medicaid dental visits. Non-Medicaid and Medicaid dental visits postlegislation increased to 2,195 (60%) and 3,316 (33%), respectively. This difference was significant (P<.05). General anesthesia legislation resulted in an increase in access to care for children needing dental care in North Carolina.

  18. Norovirus GII.4 Detection in Environmental Samples from Patient Rooms during Nosocomial Outbreaks

    PubMed Central

    Hannoun, Charles; Svensson, Lennart; Torén, Kjell; Andersson, Lars-Magnus; Westin, Johan; Bergström, Tomas

    2014-01-01

    Norovirus (NoV) is an important cause of nosocomial gastroenteric outbreaks. This 5-month study was designed to characterize NoV contamination and airborne dispersal in patient rooms during hospital outbreaks. Air vents, overbed tables, washbasins, dust, and virus traps designed to collect charged particles from the air were swabbed to investigate the possibility of NoV contamination in patient rooms during outbreaks in seven wards and in an outbreak-free ward. Symptomatic inpatients were also sampled. Nucleic acid extracts of the samples were examined for NoV RNA using genogroup I (GI) and GII real-time reverse transcription-PCR (RT-PCR). The NoV strains were characterized by RT-PCR, sequencing, and phylogenetic analysis of the RNA-dependent RNA-polymerase-N/S capsid-coding region (1,040 nucleotides [nt]). Patient strains from two outbreaks in one ward were sequenced across the RNA-dependent-RNA-polymerase major capsid-coding region (2.5 kb), including the hypervariable P2 domain. In the outbreak wards, NoV GII was detected in 48 of 101 (47%) environmental swabs and 63 of 108 patients (58%); NoV genotype II.4 was sequenced from 18 environmental samples, dust (n = 8), virus traps (n = 4), surfaces (n = 6), and 56 patients. In contrast, NoV GII was detected in 2 (GII.4) of 28 (7%) environmental samples and in 2 (GII.6 and GII.4) of 17 patients in the outbreak-free ward. Sequence analyses revealed a high degree of similarity (>99.5%, 1,040 nt) between NoV GII.4 environmental and patient strains from a given ward at a given time. The strains clustered on 11 subbranches of the phylogenetic tree, with strong correlations to time and place. The high nucleotide similarity between the NoV GII.4 strains from patients and their hospital room environment provided molecular evidence of GII.4 dispersal in the air and dust; therefore, interventional cleaning studies are justified. PMID:24759712

  19. Norovirus GII.4 detection in environmental samples from patient rooms during nosocomial outbreaks.

    PubMed

    Nenonen, Nancy P; Hannoun, Charles; Svensson, Lennart; Torén, Kjell; Andersson, Lars-Magnus; Westin, Johan; Bergström, Tomas

    2014-07-01

    Norovirus (NoV) is an important cause of nosocomial gastroenteric outbreaks. This 5-month study was designed to characterize NoV contamination and airborne dispersal in patient rooms during hospital outbreaks. Air vents, overbed tables, washbasins, dust, and virus traps designed to collect charged particles from the air were swabbed to investigate the possibility of NoV contamination in patient rooms during outbreaks in seven wards and in an outbreak-free ward. Symptomatic inpatients were also sampled. Nucleic acid extracts of the samples were examined for NoV RNA using genogroup I (GI) and GII real-time reverse transcription-PCR (RT-PCR). The NoV strains were characterized by RT-PCR, sequencing, and phylogenetic analysis of the RNA-dependent RNA-polymerase-N/S capsid-coding region (1,040 nucleotides [nt]). Patient strains from two outbreaks in one ward were sequenced across the RNA-dependent-RNA-polymerase major capsid-coding region (2.5 kb), including the hypervariable P2 domain. In the outbreak wards, NoV GII was detected in 48 of 101 (47%) environmental swabs and 63 of 108 patients (58%); NoV genotype II.4 was sequenced from 18 environmental samples, dust (n = 8), virus traps (n = 4), surfaces (n = 6), and 56 patients. In contrast, NoV GII was detected in 2 (GII.4) of 28 (7%) environmental samples and in 2 (GII.6 and GII.4) of 17 patients in the outbreak-free ward. Sequence analyses revealed a high degree of similarity (>99.5%, 1,040 nt) between NoV GII.4 environmental and patient strains from a given ward at a given time. The strains clustered on 11 subbranches of the phylogenetic tree, with strong correlations to time and place. The high nucleotide similarity between the NoV GII.4 strains from patients and their hospital room environment provided molecular evidence of GII.4 dispersal in the air and dust; therefore, interventional cleaning studies are justified. Copyright © 2014, American Society for Microbiology. All Rights Reserved.

  20. Orthodontic treatment in oncological patients.

    PubMed

    Mituś-Kenig, Maria; Łoboda, Magdalena; Marcinkowska-Mituś, Agata; Durka-Zajac, Magdalena; Pawłowska, Elzbieta

    2015-01-01

    The progress in oncological treatment has led to the current increase of childhood cancer survival rate to 80%. That is why orthodontists more and more frequently consult patients who had completed a successful anti-cancer therapy in childhood. Oncological treatments such as chemotherapy, radiotherapy or supportive immunosuppressive therapy cause numerous side effects in growing patients, connected i.a. with growth, the development of teeth or the viscerocranium. This is a special group of patients that needs an optimised plan of orthodontic treatment and often has to accept a compromise result. The purpose of the current work is to discuss the results of orthodontic treatment in patients after an anti-cancer therapy. Time of treatment was 12,5 months. In 6 patients (from 40 undergoing orthodontic therapy) we haven't reached a normocclusion, in 9 patients we should have stopped the therapy because of the recurrence. In 11 patients we found mucosa inflammation and in 1 patient the therapy stopped before the end because of very low oral hygiene level. Bearing in mind the limited number of original works on the above topic in Polish medical literature, the study has been carried out in order to make Polish orthodontists more acquainted with the topic and the standards of dealing with an oncological patient.

  1. Understanding the effects of nurses, patients' hospital rooms, and patients' perception of control on the perceived quality of a hospital.

    PubMed

    Gotlieb, J B

    2000-01-01

    Service marketing researchers suggest that the physical environment, the people, and the process strongly affect consumers' judgements when they evaluate services. Previous research has rarely applied this general framework to help identify specific hospital variables that affect the perceived quality of a hospital. This article presents a proposed model and empirical evidence that is based upon this general framework. That is, this article reports the results of a study which found that the physical environment (i.e., patients' perception of their hospital rooms) and people (i.e., patients' perception of nurses) affected patients' perception of hospital quality. The process (i.e., patients' perception of control over the process) did not directly affect their perception of hospital quality. However, patients' perception of control over the process and their perception of their hospital rooms affected their perception of their nurses. Consequently, this research suggests that the general framework identified by service marketing researchers can be applied to help understand how patients develop their perception of hospital quality.

  2. [Evaluation of Radiation Dose during Stent-graft Treatment Using a Hybrid Operating Room System].

    PubMed

    Haga, Yoshihiro; Chida, Kouichi; Kaga, Yuji; Saitou, Kazuhisa; Arai, Takeshi; Suzuki, Shinichi; Iwaya, Yoshimi; Kumasaka, Eriko; Kataoka, Nozomi; Satou, Naoto; Abe, Mitsuya

    2015-12-01

    In recent years, aortic aneurysm treatment with stent graft grafting in the X-ray fluoroscopy is increasing. This is an endovascular therapy, because it is a treatment which includes the risk of radiation damage, having to deal with radiation damage, to know in advance is important. In this study, in order to grasp the trend of exposure stent graft implantation in a hybrid operating room (OR) system, focusing on clinical data (entrance skin dose and fluoroscopy time), was to count the total. In TEVAR and EVAR, fluoroscopy time became 13.40 ± 7.27 minutes, 23.67 ± 11.76 minutes, ESD became 0.87 ± 0.41 mGy, 1.11 ± 0.57 mGy. (fluoroscopy time of EVAR was 2.0 times than TEVAR. DAP of EVAR was 1.2 times than TEVAR.) When using the device, adapted lesions and usage are different. This means that care changes in exposure-related factors. In this study, exposure trends of the stent graft implantation was able to grasp. It can be a helpful way to reduce/optimize the radiation dose in a hybrid OR system.

  3. [The TraumaRegister DGU® as the basis of medical quality management. Ten years experience of a national trauma centre exemplified by emergency room treatment].

    PubMed

    Helm, M; Bitzl, A; Klinger, S; Lefering, R; Lampl, L; Kulla, M

    2013-07-01

    The trauma register of the German Society of Trauma Surgery (TraumaRegister DGU®/TR-DGU) has been proven to be a valuable tool for external assessment of quality in the treatment of patients with major trauma. This publication shows for the first time how the quality of trauma treatment in a level I trauma centre could be improved over a period of almost ten years with the help of continuous quality management, i.e. recognizing a problem, developing a solution and evaluating its effect. Tracer parameters and indicators of quality are presented in four periods over a total study period from 1st January 1989 to 31st March 2007. The division into four periods is due to major changes in the trauma treatment algorithms or structural changes in the trauma room. The results are displayed for all patients treated in the trauma room and for those patients with an injury severity score (ISS)≥16. Over all four periods a total number of n=2,239 patients were admitted to the trauma room. Based on the results of the trauma register a number of changes were made, not only structural changes, such as the introduction of point-of-care diagnostics, initially conventional X-ray, then digital X-ray and finally multislice computed tomography (CT) scanning in the trauma room but also changes in the way personnel participating in the trauma treatment are trained. Advanced trauma life support (ATLS®) has become the standard training for doctors and prehospital trauma life support (PHTLS®) for nurses. Time efficient treatment algorithms were introduced. All measures led to changes in several parameters which are chosen as indicators for good treatment quality. It was for instance possible to reduce the average total trauma treatment time for patients with an ISS≥16 from initially 90.9±48.6 min to 37.4±18.  min in the final study period. The external quality management performed by the TR-DGU has proved to be a constant source of inspiration. The effects of the changes made can

  4. Predicting nonrecovery among whiplash patients in the emergency room and in an insurance company setting.

    PubMed

    Rydman, Eric; Ponzer, Sari; Ottosson, Carin; Järnbert-Pettersson, Hans

    2017-04-01

    To construct and validate a prediction instrument for early identification of patients with a high risk of delayed recovery after whiplash injuries (PPS-WAD) in an insurance company setting. Prospective cohort study. On the basis of a historic cohort (n = 130) of patients with a whiplash injury identified in an emergency room (ER, model-building set), we used logistic regression to construct an instrument consisting of two demographic variables (i.e. questions of educational level and work status) and the patient-rated physical and mental status during the acute phase to predict self-reported nonrecovery after 6 months. We evaluated the instrument's ability to predict nonrecovery in a new cohort (n = 204) of patients originating from an insurance company setting (IC, validation set). The prediction instrument had low reproducibility when the setting was changed from the ER cohort to the IC cohort. The overall percentage of correct predictions of nonrecovery in the ER cohort was 78 % compared with 62 % in the IC cohort. The sensitivity and specificity in relation to nonrecovery were both 78 % in the ER cohort. The sensitivity and specificity in the insurance company setting was lower, 67 and 50 %. Clinical decision rules need validation before they are used in a new setting. An instrument consisting of four questions with an excellent possibility of identifying patients with a high risk of nonrecovery after a whiplash injury in the emergency room was not as useful in an insurance company setting. The importance and type of the risk factors for not recovering probably differ between the settings, as well as the individuals.

  5. A phenomenological study of experiences of being cared for in a critical care setting: the meanings of the patient room as a place of care.

    PubMed

    Olausson, Sepideh; Lindahl, Berit; Ekebergh, Margaretha

    2013-08-01

    Previous research highlights the impact of care and treatment in ICUs on the patient recovery process and wellbeing. However, little is known about how the interior design in the ICU settings may affect patients' wellbeing. The aim of this study is, by using a lifeworld perspective, to reveal the meanings of the ICU settings as a place of care. Nine patients from three ICUs in Sweden participated. Data were collected using photo-voice methodology and were analysed using a reflective lifeworld phenomenological approach. The ICU setting as a place of care for critically ill patients is a complex and multidimensional phenomenon. The place is constituted of patients, staff and technical equipment. The struggle for life and occurrences taking place there determine how the room is perceived. The tone and touch of caring together with interior design are fundamental for the room as lived. The room is experienced in various moods; a place of vulnerability, a place inbetween, a place of trust and security, a life-affirming place, a place of tenderness and care and an embodied place. Promoting patients' well-being and satisfaction of care involves integrating a good design and a caring attitude and paying attention to patients' needs. Copyright © 2013 Elsevier Ltd. All rights reserved.

  6. [Treatment of patients with osteoarthritis].

    PubMed

    Vargas Negrín, Francisco; Medina Abellán, María D; Hermosa Hernán, Juan Carlos; de Felipe Medina, Ricardo

    2014-01-01

    The therapeutic management of patients with osteoarthritis aims to decrease pain and inflammation, improve physical function, and to apply safe and effective treatments. A patient-centered approach implies the active participation of the patient in the design of the treatment plan and in timely and informed decision-making at all stages of the disease. The nucleus of treatment is patient education, physical activity and therapeutic exercise, together with weight control in overweight or obese patients. Self-care by the individual and by the family is fundamental in day-to-day patient management. The use of physical therapies, technical aids (walking sticks, etc.) and simple analgesics, opium alkaloids, and antiinflammatory drugs have demonstrated effectiveness in controlling pain, improving physical function and quality of life and their use is clearly indicated in the treatment of osteoarthritis. Conservative surgery and joint replacement is indicated when treatment goals are not achieved in specific patients. Copyright © 2014 Elsevier España, S.L. All rights reserved.

  7. Impact of visual art on patient behavior in the emergency department waiting room.

    PubMed

    Nanda, Upali; Chanaud, Cheryl; Nelson, Michael; Zhu, Xi; Bajema, Robyn; Jansen, Ben H

    2012-07-01

    Wait times have been reported to be one of the most important concerns for people visiting emergency departments (EDs). Affective states significantly impact perception of wait time. There is substantial evidence that art depicting nature reduces stress levels and anxiety, thus potentially impacting the waiting experience. To analyze the effect of visual art depicting nature (still and video) on patients' and visitors' behavior in the ED. A pre-post research design was implemented using systematic behavioral observation of patients and visitors in the ED waiting rooms of two hospitals over a period of 4 months. Thirty hours of data were collected before and after new still and video art was installed at each site. Significant reduction in restlessness, noise level, and people staring at other people in the room was found at both sites. A significant decrease in the number of queries made at the front desk and a significant increase in social interaction were found at one of the sites. Visual art has positive effects on the ED waiting experience. Copyright © 2012 Elsevier Inc. All rights reserved.

  8. [Roentgen image presentation in the patient's room. Simple equipment for demonstration and storage of roentgen images].

    PubMed

    Prokop, A; Rehm, K E; Sagebiel, A

    1996-12-01

    Immediate presentation of the more significant X-ray pictures facilitates planning and supervision of therapy in trauma surgery and orthopedics. If a wire rope is stretched in front of the window X-ray pictures can be clipped onto it, which avoids time-consuming searches. Suspended filing boxes placed in each sickroom make appropriate storage of each patient's X-ray pictures possible. The expenditure for all this amounted to 100 DM for each two-bedded room. Wire ropes and boxes were technically easy to install with a minimum investment of time. The presentation of X-ray pictures considerably increased the patients' understanding of their illness. It was also very rare for X-ray pictures to get mixed up once this system had been instituted.

  9. Music and ambient operating room noise in patients undergoing spinal anesthesia.

    PubMed

    Ayoub, Chakib M; Rizk, Laudi B; Yaacoub, Chadi I; Gaal, Dorothy; Kain, Zeev N

    2005-05-01

    Previous studies have indicated that music decreases intraoperative sedative requirements in patients undergoing surgical procedures under regional anesthesia. In this study we sought to determine whether this decrease in sedative requirements results from music or from eliminating operating room (OR) noise. A secondary aim of the study was to examine the relationship of response to intraoperative music and participants' culture (i.e., American versus Lebanese). Eighty adults (36 American and 54 Lebanese) undergoing urological procedures with spinal anesthesia and patient-controlled IV propofol sedation were randomly assigned to intraoperative music, white noise, or OR noise. We found that, controlling for ambient OR noise, intraoperative music decreases propofol requirements (0.004 +/- 0.002 mg . kg(-1) . min(-1) versus 0.014 +/- 0.004 mg . kg(-1) . min(-1) versus 0.012 +/- 0.002 mg . kg(-1) . min(-1); P = 0.026). We also found that, regardless of group assignment, Lebanese patients used less propofol as compared with American patients (0.005 +/- 0.001 mg . kg(-1) . min(-1) versus 0.017 +/- 0.003 mg . kg(-1) . min(-1); P = 0.001) and that, in both sites, patients in the music group required less propofol (P < 0.05). We conclude that when controlling for ambient OR noise, intraoperative music decreases propofol requirements of both Lebanese and American patients who undergo urological surgery under spinal anesthesia.

  10. Room transfers and the risk of delirium incidence amongst hospitalized elderly medical patients: a case-control study.

    PubMed

    Goldberg, Amanda; Straus, Sharon E; Hamid, Jemila S; Wong, Camilla L

    2015-06-25

    Room transfers are suspected to promote the development of delirium in hospitalized elderly patients, but no studies have systematically examined the relationship between room transfers and delirium incidence. We used a case-control study to determine if the number of room transfers per patient days is associated with an increased incidence of delirium amongst hospitalized elderly medical patients, controlling for baseline risk factors. We included patients 70 years of age or older who were admitted to the internal medicine or geriatric medicine services at St. Michael's Hospital between October 2009 and September 2010 for more than 24 h. The cases consisted of patients who developed delirium during the first week of hospital stay. The controls consisted of patients who did not develop delirium during the first week of hospital stay. Patients with evidence of delirium at admission were excluded from the analysis. A multivariable logistic regression model was used to determine the relationship between room transfers and delirium development within the first week of hospital stay. 994 patients were included in the study, of which 126 developed delirium during the first week of hospital stay. Using a multivariable logistic regression model which controlled for age, gender, cognitive impairment, vision impairment, dehydration, and severe illness, room transfers per patient days were associated with delirium incidence (OR: 9.69, 95 % CI (6.20 to15.16), P < 0.0001). An increased number of room transfers per patient days is associated with an increased incidence of delirium amongst hospitalized elderly medical patients. This is an exploratory analysis and needs confirmation with larger studies.

  11. Developing a usability evaluation tool to assess the patient room bathroom.

    PubMed

    Fink, Nicole; Pak, Richard; Battisto, Dina

    2010-01-01

    The goal of this project was to create an easy-to-administer and inexpensive tool that can help identify usability issues in a patient room bathroom during the design process so improvements can be made before the final product is constructed and put into operation. The bathroom is an essential part of any hospital patient room, yet it is associated with nurse dissatisfaction and patient falls. Minimal literature has examined whether the physical structure of various elements within the bathroom are efficient, safe, and satisfactory for the majority of users. Furthermore, there is a paucity of human factor guidelines for architects and designers to follow to ensure the usability of bathroom space for a wide variety of users. The authors adapted a common technique used in software usability: the heuristic evaluation. A heuristic evaluation is a "discount" evaluation method used to quickly and efficiently evaluate the usability flaws of user interfaces. Three methods were used to provide input for the heuristic evaluation: (1) Review of existing heuristic evaluations, reported hospital bathroom problems, and safety checklists; (2) Interviews with nurses and nursing assistants; and (3) Focus groups with nurses. Analysis of the interview and focus group transcripts enabled the categorization of the types of problems nurses encounter in the patient room bathroom. These categories served as the basis for the heuristics in the heuristic evaluation tool. Eleven major heuristics (or categories of problems in the bathroom) were identified initially. The authors then went through several iterations of designing and refining the heuristic evaluation to form parsimonious categories and subcategories. Each of the eventual six major heuristic categories contains a general description as well as specific exemplar questions. These detailed subcategories enable an evaluator to easily gauge whether a bathroom adheres to the guideline, to write any comments about a particular issue

  12. Patients' refusal of recommended treatment.

    PubMed

    Dickens, Bernard M; Cook, Rebecca J

    2015-10-01

    When patients require information to decide whether to accept recommended treatments, a question in both law and ethics is whether the same information is adequate whether they consent or refuse, or whether refusal requires more or repeated information. Refusals of recommended treatment can carry increased risks for patients' well-being and so require more emphatic disclosure without imposing pressure. A related question is whether guardians of dependents who would decline recommended treatment for themselves--for instance on religious grounds--can similarly decline it for their dependents. When pregnant women, children, and adolescents are able to give consent for recommended treatment, the question arises whether they are equally competent to refuse it and prevent their decisions being overridden by guardians or courts. Consenting to and refusing medical treatments recommended in one's own or dependents' best interests might not be the same sorts of decisions and could require different levels of disclosure and capacity. Copyright © 2015. Published by Elsevier Ireland Ltd.

  13. Consulting room computers and their effect on general practitioner-patient communication.

    PubMed

    Noordman, Janneke; Verhaak, Peter; van Beljouw, Ilse; van Dulmen, Sandra

    2010-12-01

    in the western medical world, computers form part of the standard equipment in the consulting rooms of most GPs. As the use of a computer requires time and attention from GPs, this may well interfere with the communication process. Yet, the information accessed on the computer may also enhance communication. the present study affords insight into the relationship between computer use and GP-patient communication recorded by the same GPs over two periods. videotaped GP consultations collected in 2001 and 2008 were used to observe computer use and GP-patient communication. In addition, patients questionnaires about their experiences with communication by the GP were analysed using multilevel models with patients (Level 1) nested within GPs (Level 2). both in 2008 and in 2001, GPs used their computer in almost every consultation. Still, our study showed a change in computer use by the GPs over time. In addition, the results indicate that computer use is negatively related to some communication aspects: the patient-directed gaze of the GP and the amount of information given by GPs. There is also a negative association between computer use and the body posture of the GP. Computer use by GPs is not associated with other (analysed) non-verbal and verbal behaviour of GPs and patients. Moreover, computer use is scarcely related to patients' experiences with the communication behaviour of the GP. GPs show greater reluctance to use computers in 2008 compared to 2001. Computer use can indeed affect the communication between GPs and patients. Therefore, GPs ought to remain aware of their computer use during consultations and at the same time keep the interaction with the patient alive.

  14. Time accuracy of a radio frequency identification patient tracking system for recording operating room timestamps.

    PubMed

    Marjamaa, Riitta A; Torkki, Paulus M; Torkki, Markus I; Kirvelä, Olli A

    2006-04-01

    A patient tracking system is a promising tool for managing patient flow and improving efficiency in the operating room. Wireless location systems, using infrared or radio frequency transmitters, can automatically timestamp key events, thereby decreasing the need for manual data input. In this study, we measured the accuracy and precision of automatically documented timestamps compared with manual recording. Each patient scheduled for urgent surgery was given an active radio frequency/infrared transmitter. The prototype software tracked the patient throughout the perioperative process, automatically documenting the timestamps. Both automatic and traditional data entry were compared with the reference data. The absolute value of median error was 64% smaller (P < 0.01), and the average quartile deviation of error was 69% smaller in automatic documentation. The average delay between an activity and the documentation was 80 seconds in automatic documentation and 735 seconds in manual documentation. Both the accuracy and the precision were better in automatic documentation and the data were immediately available. Automatic documentation with the Indoor Positioning System can help in managing patient flow and in increasing transparency with faster availability and better accuracy of data.

  15. Silent peripheral arterial disease in patients admitted to the emergency room.

    PubMed

    Loría-Castellanos, Jorge; Hernández-Cruz, Angélica

    2011-01-01

    Peripheral arterial disease (PAD) is a syndrome that manifests atherothrombotic systemic atherosclerosis. Detection during preclinical stages (silent) may help to identify individuals and populations at risk (elderly patients) for atherothrombotic disease (stroke or coronary). We carried out an observational study approved by the investigation committee which, through a simple random method, included patients >50 years admitted to the emergency room. After signing an informed consent, ankle-brachial index (ABI) was determined and patients were interviewed about risk factors, as well as specifying the reason for consultation. Descriptive statistics and χ(2) were used for analysis. There were 100 patients; 53% were female. Average age was 67.05 ± 10.26 years and 54% of patients had ABI values considered as mild PAD. None had higher levels of severity. Inferential analysis showed a significant association with history of heart disease, renal failure, dyslipidemia, smoking and obesity, as well as the causes of admission of stroke and acute myocardial infarction. The frequency of silent PAD in this population is higher than most reports. PAD was significantly associated with higher atherothrombotic syndromes and it will be necessary to establish appropriate preventive actions to limit its development.

  16. Reorganizing patient care and workflow in the operating room: a cost-effectiveness study.

    PubMed

    Stahl, James E; Sandberg, Warren S; Daily, Bethany; Wiklund, Richard; Egan, Marie T; Goldman, Julian M; Isaacson, Keith B; Gazelle, Scott; Rattner, David W

    2006-06-01

    Many surgeons believe that long turnover times between cases are a major impediment to their productivity. We hypothesized that redesigning the operating room (OR) and perioperative-staffing system to take advantage of parallel processing would improve throughput and lower the cost of care. A state of the art high tech OR suite equipped with augmented data collection systems served as a living laboratory to evaluate both new devices and perioperative systems of care. The OR suite and all the experimental studies carried out in this setting were designated as the OR of the Future Project (ORF). Before constructing the ORF, modeling studies were conducted to inform the architectural and staffing design and estimate their benefit. In phase I a small prospective trial tested the main hypothesized benefits of the ORF: reduced patient intra-operative flow-time, wait-time and operative procedure time. In phase II a larger retrospective study was conducted to explore factors influencing these effects. A modified process costing method was used to estimate costs based on nationally derived data. Cost-effectiveness was evaluated using standard methods. There were 385 cases matched by surgeon and procedure type in the retrospective dataset (182 ORF, 193 standard operating room [SOR]). The median Wait Time (12.5 m ORF vs 23.8 m SOR), Operative Procedure Time (56.1 m ORF vs 70.5 m SOR), Emergence Time (10.9 m ORF vs 14.5 m SOR) and Total Patient OR Flowtime (79.5 m ORF vs 108.9 m SOR) were all shorter in the ORF (P < .05 for all comparisons). The median cost/patient was $3,165 in the ORF (interquartile range, $1,978 to $4,426) versus $2,645 in SORs (interquartile range, $1,823 to $3,908) (P = ns). The potential change in patient throughput for the ORF was 2 additional patients/day. This improved throughput was primarily attributable to a marked reduction in the non-operative time (ie, those activities commonly accounting for "turnover time") rather than facilitation of faster

  17. Techniques and clinical effect of aseptic procedures on patients with acute leukemia in laminar airflow rooms.

    PubMed

    Takeo, H; Sakurai, T; Amaki, I

    1983-01-01

    The techniques of aseptic procedures in the laminar airflow room (LAF) were evaluated in 110 adult patients undergoing antileukemic chemotherapy for remission induction. The patients were divided into three groups according to the regimens: Group A, consisting of 20 patients who stayed in the LAF and received the gown technique + sterile food + prophylactic oral and topical antibiotics; Group B, consisting of 12 patients who stayed in the LAF and received sterile food + prophylactic oral antibiotics; and Group C, consisting of 78 patients in open wards, who received prophylactic oral antibiotics alone. Species and numbers of microorganisms on the skin surface were far less in the patients in Group A than in those in Group B. Airborne microorganisms were counted by the air sampling method. No microorganisms could be detected at the time of the patient's rest and of blood collection in either Group A or B. Electrocardiography and X-ray examination caused an increase in the number of colonies to more than one colony in Group B, but Group A had a count of less than 0.5 colony. The colony counts became negative within 5 min after the cessation of each operation. The percentage of febrile days for patients with a peripheral granulocyte count of less than 100/microliter was 29% in Group A, 21% in Group B and 44% in Group C. The incidence of documented infections during the total hospital stay was 25% (5/20), 42% (5/12) and 86% (67/78), respectively. The aseptic procedures in Group B were not as strict as in Group A, but the incidence of infections in Group B was significantly lower than in Group C.

  18. A Coordinated Patient Transport System for ICU Patients Requiring Surgery: Impact on Operating Room Efficiency and ICU Workflow.

    PubMed

    Brown, Michael J; Kor, Daryl J; Curry, Timothy B; Marmor, Yariv; Rohleder, Thomas R

    2015-01-01

    Transfer of intensive care unit (ICU) patients to the operating room (OR) is a resource-intensive, time-consuming process that often results in patient throughput inefficiencies, deficiencies in information transfer, and suboptimal nurse to patient ratios. This study evaluates the implementation of a coordinated patient transport system (CPTS) designed to address these issues. Using data from 1,557 patient transfers covering the 2006-2010 period, interrupted time series and before and after designs were used to analyze the effect of implementing a CPTS at Mayo Clinic, Rochester. Using a segmented regression for the interrupted time series, on-time OR start time deviations were found to be significantly lower after the implementation of CPTS (p < .0001). The implementation resulted in a fourfold improvement in on-time OR starts (p < .01) while significantly reducing idle OR time (p < .01). A coordinated patient transfer process for moving patient from ICUs to ORs can significantly improve OR efficiency, reduce nonvalue added time, and ensure quality of care by preserving appropriate care provider to patient ratios.

  19. Implications of Patient Age and ASA Physical Status for Operating Room Management Decisions.

    PubMed

    Luedi, Markus M; Kauf, Peter; Mulks, Lisa; Wieferich, Katharina; Schiffer, Ralf; Doll, Dietrich

    2016-04-01

    In elderly, high-risk patients, operating room (OR) turnaround times are especially difficult to estimate, and the managerial implications of patient age and ASA physical status for OR management decisions remain unclear. We hypothesized that evaluating patient age and ASA physical status in the right model would improve accuracy of turnaround time estimates and, thus, would have decisive implications for OR management. By using various multivariate techniques, we modeled turnaround times of 13,632 OR procedures with respect to multiple variables including surgical list, age, ASA physical status, duration of the procedure, and duration of the preceding procedure. We first assessed correlations and general descriptive features of the data. Then, we constructed decision tables for OR management consisting of 50th and 95th percentiles of age/ASA-dependent estimates of turnaround times. In addition, we applied linear and generalized linear multivariate models to predict turnaround times. The forecasting power of the models was assessed in view of single cases but also in view of critical managerial key figures (50th and 95th percentile turnaround times). The models were calibrated on 80% of the data, and their predictive value was tested on the remaining 20%. We considered our data in a Monte Carlo simulation to deduce actual reductions of overutilized OR time when applying the results as presented in this work. Using the best models, we achieved an increase in predictive accuracy of 7.7% (all lists), ranging from 2.5% (general surgery) to 21.0% (trauma surgery) relative to age/ASA-independent medians of turnaround times. All models decreased the forecasting error, signifying a relevant increase in planning accuracy. We constructed a management decision table to estimate age/ASA-dependent turnaround time for OR scheduling at our hospital. The decision tables allow OR managers at our hospital to schedule procedures more accurately. Evaluation of patient age and ASA

  20. Association of increased emergency rooms costs for patients without access to necessary medications.

    PubMed

    Watanabe, Jonathan Hirohiko; Ney, John P

    2015-01-01

    Prescription medications are an important component of chronic disease management. They are vital in preventing unnecessary ER visits. However, few studies have examined the association between patients' self-reported inability to receive necessary medications and emergency room costs. The study objectives were to: 1) determine differences in ER costs based on self-reported ability to obtain necessary medications. 2) identify differences in ER costs based on self-reported ability to obtain necessary medications among medication users. The association was also examined by insurance category. Respondent data from 10 years (2002-2011) of the U.S. Medical Expenditure Panel Survey was analyzed. The models employed estimated the association of respondents reporting being 'unable to receive necessary medications' on ER expenditures. Secondarily, the relationship was assessed by insurance category: private, public, and uninsured. Two-part cost regression models with bootstrapped estimates to produce 95% confidence intervals of cost differences were applied for these analyses. Significance was set at α = 0.05. Analyses were completed using SAS 9.4 (Cary, NC) and Stata 13 (College Station, TX). Estimates were in 2011 US dollars. People unable to receive necessary medications experienced increased average annual ER costs of $46.62 with 95% a confidence interval [CI] of 34.76-58.49) compared to patients able to receive necessary medications. By insurance category, respondents unable to receive necessary medications experienced increased ER costs of $104.80 (95% CI: 60.57-149.03), $42.16 (95% CI: 24.65-59.68), and $33.18 (95% CI: 18.54-47.82), for Publically Insured, Privately Insured, and Uninsured, respectively. Findings were similar for those already using medications. Inability to obtain necessary medications is associated with increased emergency room costs. Those with public insurance have a larger increase in ER costs if they are without necessary medications compared

  1. Multidisciplinary operating room simulation-based team training to reduce treatment errors: a feasibility study in New Zealand hospitals.

    PubMed

    Weller, Jennifer; Cumin, David; Torrie, Jane; Boyd, Matthew; Civil, Ian; Madell, Dominic; MacCormick, Andrew; Gurisinghe, Nishanthi; Garden, Alexander; Crossan, Michael; Ng, Wai Leap; Johnson, Sharee; Corter, Arden; Lee, Tracey; Selander, Ludvig; Cokorilo, Martina; Merry, Alan Forbes

    2015-08-07

    Communication failures in healthcare are frequent and linked to adverse events and treatment errors. Simulation-based team training has been proposed to address this. We aimed to explore the feasibility of a simulation-based course for all members of the operating room (OR) team, and to evaluate its effectiveness. Members of experienced OR teams were invited to participate in three simulated clinical events using an integrated surgical and anesthesia model. We collected information on costs, Behavioural Marker of Risk Index (BMRI) (a measure of team information sharing) and participants' educational gains. We successfully recruited 20 full OR teams. Set up costs were NZ$50,000. Running costs per course were NZ$4,000, excluding staff. Most participants rated the course highly. BMRI improved significantly (P = 0.04) and thematic analysis identified educational gains for participants. We demonstrated feasibility of multidisciplinary simulation-based training for surgeons, anesthetists, nurses and anaesthetic technicians. The course showed evidence of participant learning and we obtained useful information on cost. There is considerable potential to extend this type of team-based simulation to improve the performance of OR teams and increase safety for surgical patients.

  2. Meanings of being critically ill in a sound-intensive ICU patient room - a phenomenological hermeneutical study.

    PubMed

    Johansson, Lotta; Bergbom, Ingegerd; Lindahl, Berit

    2012-01-01

    The aim of this study was to illuminate the meanings of being critically ill in a sound-intensive ICU patient room, as disclosed through patients' narratives. Patient rooms in ICUs are filled with loud activity and studies have revealed sound levels comparable to those of a busy road above the patient's head. There is a risk that the sound or noise is disturbing and at worst a major problem for the patient, but there is a lack of knowledge concerning the patients' own experiences. Thirteen patients were asked to narrate their experiences of the sound environment in ICU patient rooms. The interviews were analyzed using a phenomenological- hermeneutical method inspired by the philosophy of Ricoeur. Six themes emerged from the analysis. The meanings of being a patient in a sound- intensive environment were interpreted as never knowing what to expect next regarding noise, but also of being situated in the middle of an uncontrollable barrage of noise, unable to take cover or disappear. This condition is not to be seen as static; for some patients there is movement and change over time. The meanings indicate that the unpredictable shifts between silence and disturbing sounds stress the critically ill patient and impede sleep and recovery. Our findings indicate the need to reduce disturbing and unexpected sounds and noise around critically ill patients in high-tech environments in order to facilitate wellbeing, sleep and recovery. Nurses have a vital role in developing such an environment.

  3. Patient satisfaction, preventive services, and emergency room use among African-Americans with type 2 diabetes.

    PubMed

    Gary, Tiffany L; Maiese, Eric M; Batts-Turner, Marian; Wang, Nae-Yuh; Brancati, Fredrick L

    2005-12-01

    The aim of this study was to determine the relationship between patient satisfaction and diabetes- related preventive health care and emergency room (ER) use. We studied 542 urban African-Americans with type 2 diabetes aged > or =25 years who were enrolled in a primary carebased intervention trial to improve diabetes control and reduce adverse health events; 73% female, mean age 58 years, 35% had yearly household incomes of <$7500, and all participants had health insurance. All completed a baseline interview-administered questionnaire. Patient satisfaction was measured using a modified version (nine questions) of the Consumer Assessment of Health Plans Survey (CAHPS) and use of diabetes-related preventive health care and ER were assessed by self-report. We then followed participants for 12 months to determine ER use prospectively. In general, participants gave favorable ratings of their care; over 70% reported that they had no problem getting care, over 60% reported the highest ratings on the communication and courtesy domains, and mean ratings (0-10 scale) for personal doctor and overall health care were high (8.8 and 8.4, respectively). Using poisson regression models adjusted for age, education, and self-reported rating of health, several aspects of patient satisfaction were associated with subsequent ER use. Participants who reported that medical staff were usually helpful or that doctors and nurses usually spent enough time were 0.49 and 0.37 times, respectively, less likely to use the ER (all p < 0.05). However, few aspects of patient satisfaction were associated with better preventive services. These data suggest that greater patient satisfaction was associated with lower ER use in urban African-Americans. Whether measures to improve patient satisfaction would reduce ER use requires further prospective study.

  4. [Nursing professionals and health care assistants' perception of patient safety culture in the operating room].

    PubMed

    Bernalte-Martí, Vicente; Orts-Cortés, María Isabel; Maciá-Soler, Loreto

    2015-01-01

    To assess nursing professionals and health care assistants' perceptions, opinions and behaviours on patient safety culture in the operating room of a public hospital of the Spanish National Health Service. To describe strengths and weaknesses or opportunities for improvement according to the Agency for Healthcare Research and Quality criteria, as well as to determine the number of events reported. A descriptive, cross-sectional study was conducted using the Spanish version of the questionnaire Hospital Survey on Patient Safety Culture. The sample consisted of nursing professionals, who agreed to participate voluntarily in this study and met the selection criteria. A descriptive and inferential analysis was performed depending on the nature of the variables and the application conditions of statistical tests. Significance if p < .05. In total, 74 nursing professionals responded (63.2%). No strengths were found in the operating theatre, and improvements are needed concerning staffing (64.0%), and hospital management support for patient safety (52.9%). A total of 52.3% (n = 65) gave patient safety a score from 7 to 8.99 (on a 10 point scale); 79.7% (n = 72) reported no events last year. The total variance explained by the regression model was 0.56 for "Frequency of incident reporting" and 0.26 for "Overall perception of safety". There was a more positive perception of patient safety culture at unit level. Weaknesses have been identified, and they can be used to design specific intervention activities to improve patient safety culture in other nearby operating theatres. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

  5. Intraparticle phosphorus diffusion in a drinking water treatment residual at room temperature.

    PubMed

    Makris, Konstantinos C; El-Shall, Hassan; Harris, Willie G; O'Connor, George A; Obreza, Thomas A

    2004-09-15

    Phosphorus (P) has been recognized as one of the major limiting nutrients that are responsible for eutrophication of surface waters, worldwide. Efforts have been concentrated on reducing P loads reaching water bodies, via surface runoff and/or leaching through a soil profile. Use of drinking water treatment residuals (WTRs) is an emerging cost-effective practice to reduce soluble P in poorly P-sorbing soils or systems high in P. Literature suggests that WTRs have huge P sorption capacities. We hypothesized that P sorption would be limited by diffusional constraints imposed by the WTR particles. Selected chemical and physical (specific surface area, particle size distribution) characteristics of an iron-based WTR were measured. Sorption P isotherms at room temperature were constructed, and sorption kinetics were monitored. An intraparticle diffusion model was utilized to fit the kinetic data. Results showed that the WTR dramatically reduced soluble P, showing nonequilibrium characteristics, even after 80 d of reaction. Specific surface area (SSA) measured with CO2 gas was significantly greater than the traditional BET-N2 value (28 versus 3.5 m2 g(-1)), suggesting that a large amount of internal surfaces might be present in the WTR. The intraparticle P diffusion model was modified to include the wide particle size distribution of the WTR. The intraparticle diffusion model fitted the data well (r2 = 0.83). We calculated a maximum apparent P diffusion coefficient value of 4 x 10(-15) cm2 s(-1), which agrees with published values for intraparticle diffusion in microporous sorbents. This work may be useful for predicting long-term sorption characteristics of WTRs, since WTRs have been suggested as potential long-term immobilizers of sorbed P in P-sensitive ecosystems.

  6. Computers in the exam room: differences in physician-patient interaction may be due to physician experience.

    PubMed

    Rouf, Emran; Whittle, Jeff; Lu, Na; Schwartz, Mark D

    2007-01-01

    The use of electronic medical records can improve the technical quality of care, but requires a computer in the exam room. This could adversely affect interpersonal aspects of care, particularly when physicians are inexperienced users of exam room computers. To determine whether physician experience modifies the impact of exam room computers on the physician-patient interaction. Cross-sectional surveys of patients and physicians. One hundred fifty five adults seen for scheduled visits by 11 faculty internists and 12 internal medicine residents in a VA primary care clinic. Physician and patient assessment of the effect of the computer on the clinical encounter. Patients seeing residents, compared to those seeing faculty, were more likely to agree that the computer adversely affected the amount of time the physician spent talking to (34% vs 15%, P = 0.01), looking at (45% vs 24%, P = 0.02), and examining them (32% vs 13%, P = 0.009). Moreover, they were more likely to agree that the computer made the visit feel less personal (20% vs 5%, P = 0.017). Few patients thought the computer interfered with their relationship with their physicians (8% vs 8%). Residents were more likely than faculty to report these same adverse effects, but these differences were smaller and not statistically significant. Patients seen by residents more often agreed that exam room computers decreased the amount of interpersonal contact. More research is needed to elucidate key tasks and behaviors that facilitate doctor-patient communication in such a setting.

  7. [Telemetric monitoring reduces visits to the emergency room and cost of care in patients with chronic heart failure].

    PubMed

    Pérez-Rodríguez, Gilberto; Brito-Zurita, Olga Rosa; Sistos-Navarro, Enrique; Benítez-Aréchiga, Zaria Margarita; Sarmiento-Salazar, Gloria Leticia; Vargas-Lizárraga, José Feliciano

    2015-01-01

    Tele-cardiology is the use of information technologies that help prolong survival, improve quality of life and reduce costs in health care. Heart failure is a chronic disease that leads to high care costs. To determine the effectiveness of telemetric monitoring for controlling clinical variables, reduced emergency room visits, and cost of care in a group of patients with heart failure compared to traditional medical consultation. A randomized, controlled and open clinical trial was conducted on 40 patients with Heart failure in a tertiary care centre in north-western Mexico. The patients were divided randomly into 2 groups of 20 patients each (telemetric monitoring, traditional medical consultation). In each participant was evaluated for: blood pressure, heart rate and body weight. The telemetric monitoring group was monitored remotely and traditional medical consultation group came to the hospital on scheduled dates. All patients could come to the emergency room if necessary. The telemetric monitoring group decreased their weight and improved control of the disease (P=.01). Systolic blood pressure and cost of care decreased (51%) significantly compared traditional medical consultation group (P>.05). Admission to the emergency room was avoided in 100% of patients in the telemetric monitoring group. In patients with heart failure, the telemetric monitoring was effective in reducing emergency room visits and saved significant resources in care during follow-up. Copyright © 2015 Academia Mexicana de Cirugía A.C. Published by Masson Doyma México S.A. All rights reserved.

  8. Clinical characteristics of adverse reactions to nonionic low osmolality contrast media in patients transferred from the CT room to the emergency room.

    PubMed

    Ha, Sang Ook; Kim, Dae Yong; Sohn, You Dong

    2016-01-01

    Nonionic low osmolality contrast media (LOCMs) are used universally in computed tomography (CT) imaging. Although adverse reactions due to nonionic LOCMs are a common cause of emergency room (ER) admissions, few studies have investigated these adverse reactions. In the present study, we evaluated the characteristics of patients who were transferred from the CT room to the ER due to adverse reactions to contrast media, and we determined the risk factors for severe adverse reactions. A single-center retrospective study was conducted over a 41-month period. Baseline and clinical characteristics were evaluated and analyzed according to moderate and severe severity. In particular, risk factors of severe reactions were determined using logistic regression analysis. In total, 70 patients were admitted to the ER with adverse reactions due to nonionic LOCMs. Of these, 33 developed a moderate reaction, and 37 developed a severe reaction. Compared with the moderate reaction group, the severe reaction group was older, had higher blood pressures, showed more symptoms indicating the cardiovascular and central nervous system, and developed faster reactions to LOCMs. According to the multivariate logistic regression analysis, the age of the patient and time to onset of reaction demonstrated a statistical relationship with severe adverse reactions. In the receiver operating characteristic analysis, the optimal cutoff values for age and time to onset were 60 years and 5 min. In conclusion, clinicians should be attentive to anaphylaxis due to nonionic LOCM, in particular, for elderly patients aged older than 60 years and a time to reaction onset of less than 5 min.

  9. Recruiting diverse patients to a breast cancer risk communication trial--waiting rooms can improve access.

    PubMed Central

    Bodurtha, Joann N.; Quillin, John M.; Tracy, Kelly A.; Borzelleca, Joseph; McClish, Donna; Wilson, Diane Baer; Jones, Resa M.; Quillin, Julie; Bowen, Deborah

    2007-01-01

    Low participation among underserved populations in health research constrains progress in public health practices. From 2003 to 2005, Women's Health Clinic patients at the VCU Health System were recruited to a trial investigating breast cancer risk communication. In secondary analyses, we examined dimensions of the recruitment of these diverse women. The sample characteristics (age, insurance, race and previous mammograms) were compared to the overall clinic. Of recruitment attempts for eligible women, 45% consented; of those who declined, the top cited reasons were lack of time (40%) and lack of interest (18%). Of 899 participants, 35% qualified for the indigent care program, compared to 31% of the overall clinic (P<0.001). Forty-five percent of participants were African American, compared to 54% of overall clinic patients (P<0.001). Participants were younger (50 vs. 53 years, P<0.001) than the overall clinic population. Nonrepresentative enrollment of patients in clinical trials is common and could lead to suboptimal applicability of findings. Although there were statistically significant race and age differences between the study sample and the overall population, we demonstrate that waiting room recruitment can engage diverse women in a clinical trial and cancer risk communication. PMID:17722671

  10. Using human factors engineering to improve patient safety in the cardiovascular operating room.

    PubMed

    Gurses, Ayse P; Martinez, Elizabeth A; Bauer, Laura; Kim, George; Lubomski, Lisa H; Marsteller, Jill A; Pennathur, Priyadarshini R; Goeschel, Chris; Pronovost, Peter J; Thompson, David

    2012-01-01

    Despite significant medical advances, cardiac surgery remains a high risk procedure. Sub-optimal work system design characteristics can contribute to the risks associated with cardiac surgery. However, hazards due to work system characteristics have not been identified in the cardiovascular operating room (CVOR) in sufficient detail to guide improvement efforts. The purpose of this study was to identify and categorize hazards (anything that has the potential to cause a preventable adverse patient safety event) in the CVOR. An interdisciplinary research team used prospective hazard identification methods including direct observations, contextual inquiry, and photographing to collect data in 5 hospitals for a total 22 cardiac surgeries. We performed thematic analysis of the qualitative data guided by a work system model. 60 categories of hazards such as practice variations, high workload, non-compliance with evidence-based guidelines, not including clinicians' in medical device purchasing decisions were found. Results indicated that hazards are common in cardiac surgery and should be eliminated or mitigated to improve patient safety. To improve patient safety in the CVOR, efforts should focus on creating a culture of safety, increasing compliance with evidence based infection control practices, improving communication and teamwork, and designing better tools and technologies through partnership among all stakeholders.

  11. Patient portal doldrums: does an exam room promotional video during an office visit increase patient portal registrations and portal use?

    PubMed Central

    Hanna, Barbara K; Crane, Sarah J; Smith, Steven A; Tulledge-Scheitel, Sidna M; Stroebel, Robert J

    2011-01-01

    The patient portal is a web service which allows patients to view their electronic health record, communicate online with their care teams, and manage healthcare appointments and medications. Despite advantages of the patient portal, registrations for portal use have often been slow. Using a secure video system on our existing exam room electronic health record displays during regular office visits, the authors showed patients a video which promoted use of the patient portal. The authors compared portal registrations and portal use following the video to providing a paper instruction sheet and to a control (no additional portal promotion). From the 12 050 office appointments examined, portal registrations within 45 days of the appointment were 11.7%, 7.1%, and 2.5% for video, paper instructions, and control respectively (p<0.0001). Within 6 months following the interventions, 3.5% in the video cohort, 1.2% in the paper, and 0.75% of the control patients demonstrated portal use by initiating portal messages to their providers (p<0.0001). PMID:21976028

  12. Patient portal doldrums: does an exam room promotional video during an office visit increase patient portal registrations and portal use?

    PubMed

    North, Frederick; Hanna, Barbara K; Crane, Sarah J; Smith, Steven A; Tulledge-Scheitel, Sidna M; Stroebel, Robert J

    2011-12-01

    The patient portal is a web service which allows patients to view their electronic health record, communicate online with their care teams, and manage healthcare appointments and medications. Despite advantages of the patient portal, registrations for portal use have often been slow. Using a secure video system on our existing exam room electronic health record displays during regular office visits, the authors showed patients a video which promoted use of the patient portal. The authors compared portal registrations and portal use following the video to providing a paper instruction sheet and to a control (no additional portal promotion). From the 12,050 office appointments examined, portal registrations within 45 days of the appointment were 11.7%, 7.1%, and 2.5% for video, paper instructions, and control respectively (p<0.0001). Within 6 months following the interventions, 3.5% in the video cohort, 1.2% in the paper, and 0.75% of the control patients demonstrated portal use by initiating portal messages to their providers (p<0.0001).

  13. [Impact of The Netherlands Health Care Inspectorate report on patient safety in operating rooms: teamwork is better than bureaucracy].

    PubMed

    Lange, J F

    2008-10-18

    The Netherlands Health Care Inpectorate recently concluded that patient safety in operating rooms should improve. One example of improvement is the implementation of the time out procedure, which consists of a preoperative briefing and a postoperative debriefing in the operating room. There is, however, a risk of bureaucray and pro forma procedures, due to the time pressure the inspectorate has imposed. Sustainable improvement in patient safety requires teamwork and training of all members of surgical teams in non-technical skills such as communication. Crew resource management has been implemented in the intensive care departments in The Netherlands and is now being adapted for the training of integrated surgical teams.

  14. Detection of Infectious Influenza Virus in Cough Aerosols Generated in a Simulated Patient Examination Room

    PubMed Central

    Noti, John D.; Lindsley, William G.; Blachere, Francoise M.; Cao, Gang; Kashon, Michael L.; Thewlis, Robert E.; McMillen, Cynthia M.; King, William P.; Szalajda, Jonathan V.; Beezhold, Donald H.

    2015-01-01

    Background The potential for aerosol transmission of infectious influenza virus (ie, in healthcare facilities) is controversial. We constructed a simulated patient examination room that contained coughing and breathing manikins to determine whether coughed influenza was infectious and assessed the effectiveness of an N95 respirator and surgical mask in blocking transmission. Methods National Institute for Occupational Safety and Health aerosol samplers collected size-fractionated aerosols for 60 minutes at the mouth of the breathing manikin, beside the mouth, and at 3 other locations in the room. Total recovered virus was quantitated by quantitative polymerase chain reaction and infectivity was determined by the viral plaque assay and an enhanced infectivity assay. Results Infectious influenza was recovered in all aerosol fractions (5.0% in >4 µm aerodynamic diameter, 75.5% in 1–4 µm, and 19.5% in <1 µm; n = 5). Tightly sealing a mask to the face blocked entry of 94.5% of total virus and 94.8% of infectious virus (n = 3). A tightly sealed respirator blocked 99.8% of total virus and 99.6% of infectious virus (n = 3). A poorly fitted respirator blocked 64.5% of total virus and 66.5% of infectious virus (n = 3). A mask documented to be loosely fitting by a PortaCount fit tester, to simulate how masks are worn by healthcare workers, blocked entry of 68.5% of total virus and 56.6% of infectious virus (n = 2). Conclusions These results support a role for aerosol transmission and represent the first reported laboratory study of the efficacy of masks and respirators in blocking inhalation of influenza in aerosols. The results indicate that a poorly fitted respirator performs no better than a loosely fitting mask. PMID:22460981

  15. Meanings of Being Critically Ill in a Sound-Intensive ICU Patient Room - A Phenomenological Hermeneutical Study

    PubMed Central

    Johansson, Lotta; Bergbom, Ingegerd; Lindahl, Berit

    2012-01-01

    The aim of this study was to illuminate the meanings of being critically ill in a sound-intensive ICU patient room, as disclosed through patients’ narratives. Patient rooms in ICUs are filled with loud activity and studies have revealed sound levels comparable to those of a busy road above the patient’s head. There is a risk that the sound or noise is disturbing and at worst a major problem for the patient, but there is a lack of knowledge concerning the patients’ own experiences. Thirteen patients were asked to narrate their experiences of the sound environment in ICU patient rooms. The interviews were analyzed using a phenomenological- hermeneutical method inspired by the philosophy of Ricoeur. Six themes emerged from the analysis. Conclusion: The meanings of being a patient in a sound- intensive environment were interpreted as never knowing what to expect next regarding noise, but also of being situated in the middle of an uncontrollable barrage of noise, unable to take cover or disappear. This condition is not to be seen as static; for some patients there is movement and change over time. The meanings indicate that the unpredictable shifts between silence and disturbing sounds stress the critically ill patient and impede sleep and recovery. Our findings indicate the need to reduce disturbing and unexpected sounds and noise around critically ill patients in high-tech environments in order to facilitate wellbeing, sleep and recovery. Nurses have a vital role in developing such an environment. PMID:22977654

  16. Seizure Treatment in Transplant Patients

    PubMed Central

    Shepard, Paul W.

    2013-01-01

    Opinion statement Solid organ transplantation is frequently complicated by a spectrum of seizure types, including single partial-onset or generalized tonic-clonic seizures, acute repetitive seizures or status epilepticus, and sometimes the evolution of symptomatic epilepsy. There is currently no specific evidence involving the transplant patient population to guide the selection, administration, or duration of antiepileptic drug (AED) therapy, so familiarity with clinical AED pharmacology and application of sound judgment are necessary for successful patient outcomes. An initial detailed search for symptomatic seizure etiologies, including metabolic, infectious, cerebrovascular, and calcineurin inhibitor treatment-related neuro-toxic complications such as posterior reversible encephalopathy syndrome (PRES), is imperative, as underlying central nervous system disorders may impose additional serious risks to cerebral or general health if not promptly detected and appropriately treated. The mainstay for post-transplant seizure management is AED therapy directed toward the suspected seizure type. Unfavorable drug interactions could place the transplanted organ at risk, so choosing an AED with limited interaction potential is also crucial. When the transplanted organ is dysfunctional or vulnerable to rejection, AEDs without substantial hepatic metabolism are favored in post-liver transplant patients, whereas after renal transplantation, AEDs with predominantly renal elimination may require dosage adjustment to prevent adverse effects. Levetiracetam, gabapentin, pregabalin, and lacosamide are drugs of choice for treatment of partial-onset seizures in post-transplant patients given their efficacy spectrum, generally excellent tolerability, and lack of drug interaction potential. Levetiracetam is the drug of choice for primary generalized seizures in post-transplant patients. When intravenous drugs are necessary for acute seizure management, benzodiazepines and

  17. The identification and epidemiology of meticillin-resistant Staphylococcus aureus and Clostridium difficile in patient rooms and the ward environment

    PubMed Central

    2013-01-01

    Background Research has indicated that the environment may play an important role in the transmission of meticillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile in healthcare facilities. Despite the significance of this finding, few data exist from longitudinal studies investigating MRSA and C. difficile contamination, concurrently, in both patient rooms and the general ward environment. The objectives of this study were to determine the prevalence of MRSA and C. difficile contamination in patient rooms and the ward environment and identify risk factors associated with a surface being contaminated with these pathogens. Methods Environmental surfaces in patient rooms and the general environment in the medical and surgical wards of a community hospital were sampled six times over a 15 week period. Sterile electrostatic cloths were used for sampling and information pertaining to the surface sampled was recorded. MRSA isolates and C. difficile specimens were obtained from hospitalized patients. Enrichment culture was performed and spa typing or ribotyping was conducted for MRSA or C. difficile, respectively. Exact logistic regression models were constructed to examine risk factors associated with MRSA and C. difficile contamination. Results Sixteen (41%) patient rooms had ≥ 1 surfaces contaminated with MRSA and/or C. difficile. For 218 surfaces investigated, 3.2% and 6.4% were contaminated with MRSA or C. difficile, respectively. Regression models indicated that surfaces in rooms exposed to a C. difficile patient had significantly increased odds of being contaminated with C. difficile, compared to surfaces in unexposed patient rooms. Additionally, compared to plastic surfaces, cork surfaces had significantly increased odds of being contaminated with C. difficile. For 236 samples collected from the ward environment, MRSA and C. difficile were recovered from 2.5% and 5.9% of samples, respectively. Overall, the majority of MRSA and C. difficile

  18. Identifying Patients with Bacteremia in Community-Hospital Emergency Rooms: A Retrospective Cohort Study

    PubMed Central

    Takeshima, Taro; Yamamoto, Yosuke; Noguchi, Yoshinori; Maki, Nobuyuki; Gibo, Koichiro; Tsugihashi, Yukio; Doi, Asako; Fukuma, Shingo; Yamazaki, Shin; Kajii, Eiji; Fukuhara, Shunichi

    2016-01-01

    Objectives (1) To develop a clinical prediction rule to identify patients with bacteremia, using only information that is readily available in the emergency room (ER) of community hospitals, and (2) to test the validity of that rule with a separate, independent set of data. Design Multicenter retrospective cohort study. Setting To derive the clinical prediction rule we used data from 3 community hospitals in Japan (derivation). We tested the rule using data from one other community hospital (validation), which was not among the three “derivation” hospitals. Participants Adults (age ≥ 16 years old) who had undergone blood-culture testing while in the ER between April 2011 and March 2012. For the derivation data, n = 1515 (randomly sampled from 7026 patients), and for the validation data n = 467 (from 823 patients). Analysis We analyzed 28 candidate predictors of bacteremia, including demographic data, signs and symptoms, comorbid conditions, and basic laboratory data. Chi-square tests and multiple logistic regression were used to derive an integer risk score (the “ID-BactER” score). Sensitivity, specificity, likelihood ratios, and the area under the receiver operating characteristic curve (i.e., the AUC) were computed. Results There were 241 cases of bacteremia in the derivation data. Eleven candidate predictors were used in the ID-BactER score: age, chills, vomiting, mental status, temperature, systolic blood pressure, abdominal sign, white blood-cell count, platelets, blood urea nitrogen, and C-reactive protein. The AUCs was 0.80 (derivation) and 0.74 (validation). For ID-BactER scores ≥ 2, the sensitivities for derivation and validation data were 98% and 97%, and specificities were 20% and 14%, respectively. Conclusions The ID-BactER score can be computed from information that is readily available in the ERs of community hospitals. Future studies should focus on developing a score with a higher specificity while maintaining the desired sensitivity

  19. Identifying Patients with Bacteremia in Community-Hospital Emergency Rooms: A Retrospective Cohort Study.

    PubMed

    Takeshima, Taro; Yamamoto, Yosuke; Noguchi, Yoshinori; Maki, Nobuyuki; Gibo, Koichiro; Tsugihashi, Yukio; Doi, Asako; Fukuma, Shingo; Yamazaki, Shin; Kajii, Eiji; Fukuhara, Shunichi

    2016-01-01

    (1) To develop a clinical prediction rule to identify patients with bacteremia, using only information that is readily available in the emergency room (ER) of community hospitals, and (2) to test the validity of that rule with a separate, independent set of data. Multicenter retrospective cohort study. To derive the clinical prediction rule we used data from 3 community hospitals in Japan (derivation). We tested the rule using data from one other community hospital (validation), which was not among the three "derivation" hospitals. Adults (age ≥ 16 years old) who had undergone blood-culture testing while in the ER between April 2011 and March 2012. For the derivation data, n = 1515 (randomly sampled from 7026 patients), and for the validation data n = 467 (from 823 patients). We analyzed 28 candidate predictors of bacteremia, including demographic data, signs and symptoms, comorbid conditions, and basic laboratory data. Chi-square tests and multiple logistic regression were used to derive an integer risk score (the "ID-BactER" score). Sensitivity, specificity, likelihood ratios, and the area under the receiver operating characteristic curve (i.e., the AUC) were computed. There were 241 cases of bacteremia in the derivation data. Eleven candidate predictors were used in the ID-BactER score: age, chills, vomiting, mental status, temperature, systolic blood pressure, abdominal sign, white blood-cell count, platelets, blood urea nitrogen, and C-reactive protein. The AUCs was 0.80 (derivation) and 0.74 (validation). For ID-BactER scores ≥ 2, the sensitivities for derivation and validation data were 98% and 97%, and specificities were 20% and 14%, respectively. The ID-BactER score can be computed from information that is readily available in the ERs of community hospitals. Future studies should focus on developing a score with a higher specificity while maintaining the desired sensitivity.

  20. Patient warming excess heat: the effects on orthopedic operating room ventilation performance.

    PubMed

    Belani, Kumar G; Albrecht, Mark; McGovern, Paul D; Reed, Mike; Nachtsheim, Christopher

    2013-08-01

    Patient warming has become a standard of care for the prevention of unintentional hypothermia based on benefits established in general surgery. However, these benefits may not fully translate to contamination-sensitive surgery (i.e., implants), because patient warming devices release excess heat that may disrupt the intended ceiling-to-floor ventilation airflows and expose the surgical site to added contamination. Therefore, we studied the effects of 2 popular patient warming technologies, forced air and conductive fabric, versus control conditions on ventilation performance in an orthopedic operating room with a mannequin draped for total knee replacement. Ventilation performance was assessed by releasing neutrally buoyant detergent bubbles ("bubbles") into the nonsterile region under the head-side of the anesthesia drape. We then tracked whether the excess heat from upper body patient warming mobilized the "bubbles" into the surgical site. Formally, a randomized replicated design assessed the effect of device (forced air, conductive fabric, control) and anesthesia drape height (low-drape, high-drape) on the number of bubbles photographed over the surgical site. The direct mass-flow exhaust from forced air warming generated hot air convection currents that mobilized bubbles over the anesthesia drape and into the surgical site, resulting in a significant increase in bubble counts for the factor of patient warming device (P < 0.001). Forced air had an average count of 132.5 versus 0.48 for conductive fabric (P = 0.003) and 0.01 for control conditions (P = 0.008) across both drape heights. Differences in average bubble counts across both drape heights were insignificant between conductive fabric and control conditions (P = 0.87). The factor of drape height had no significant effect (P = 0.94) on bubble counts. Excess heat from forced air warming resulted in the disruption of ventilation airflows over the surgical site, whereas conductive patient warming devices had

  1. Improving operating room safety

    PubMed Central

    2009-01-01

    Despite the introduction of the Universal Protocol, patient safety in surgery remains a daily challenge in the operating room. This present study describes one community health system's efforts to improve operating room safety through human factors training and ultimately the development of a surgical checklist. Using a combination of formal training, local studies documenting operating room safety issues and peer to peer mentoring we were able to substantially change the culture of our operating room. Our efforts have prepared us for successfully implementing a standardized checklist to improve operating room safety throughout our entire system. Based on these findings we recommend a multimodal approach to improving operating room safety. PMID:19930577

  2. Nursing care system development for patients with cleft lip-palate and craniofacial deformities in operating room Srinagarind Hospital.

    PubMed

    Riratanapong, Saowaluck; Sroihin, Waranya; Kotepat, Kingkan; Volrathongchai, Kanittha

    2013-09-01

    For a successful surgical outcome for patients with cleft lip/palate (CLP), the attending nurses must continuously develop their potential, knowledge, capacity and skills. The goal is to meet international standards of patient safety and efficiency. To assess and improve the nursing care system for patients with CLP and craniofacial deformities at the operating room (OR), Srinagarind Hospital, Khon Kaen University. Data were collected for two months (between March 1, 2011 and April 30, 2011). Part I was an enquiry regarding the attitude of OR staff on serving patients with CLP; and, Part 2.1) patient and caregiver satisfaction with service from the OR staff and 2.2) patient and caregiver satisfaction with the OR transfer service. The authors interviewed 28 staff in OR unit 2 of the OR nursing division and 30 patients with CLP and his/her caregiver. The respective validity according to the Cronbach's alpha coefficient was 0.87 and 0.93. The OR staff attitude visa-vis service provision for patients with CLP service was middling. Patient and caregiver satisfaction with both OR staff and the transfer service was very satisfactory. Active development of the nursing care system for patients with CLP and craniofacial deformities in the operating room, Srinagarind Hospital improved staff motivation with respect to serving patients with CLP. The operating theater staff was able to co-ordinate the multidisciplinary team through the provision of surgical service for patients with CLP.

  3. Operating Room to Intensive Care Unit Handoffs and the Risks of Patient Harm

    PubMed Central

    McElroy, Lisa M.; Collins, Kelly M.; Koller, Felicitas L.; Khorzad, Rebeca; Abecassis, Michael M.; Holl, Jane L.; Ladner, Daniela P.

    2015-01-01

    Background The goal of this study was to assess systems and processes involved in the operating room (OR) to intensive care unit (ICU) handoff in an attempt to understand the criticality of specific steps of the handoff. Methods We performed a failure modes, effects and criticality analysis (FMECA) of the OR to ICU handoff of deceased donor liver transplant recipients using in-person observations and descriptions of the handoff process from a multidisciplinary group of clinicians. For each step in the process, failures were identified along with frequency of occurrence, causes, potential effects and safeguards. A risk priority number (RPN) was calculated for each failure (Frequency x Potential effect x Safeguard; range 1-least risk to 1000-most risk). Results The FMECA identified 37 individual steps in the OR to ICU handoff process. In total, 81 process failures were identified, 22 of which were determined to be critical and 36 of which relied on weak safeguards such as informal human verification. Process failures with the highest risk of harm were lack of preliminary OR to ICU communication (RPN 504), team member absence during handoff communication (RPN 480) and transport equipment malfunction (RPN 448). Conclusions Based on the analysis, recommendations were made to reduce potential for patient harm during OR to ICU handoffs. These included automated transfer of OR data to ICU clinicians, enhanced ICU team member notification processes and revision of the postoperative order sets. The FMECA revealed steps in the OR to ICU handoff that are high risk for patient harm and are currently being targeted for process improvement. PMID:26067459

  4. Thinking in three's: changing surgical patient safety practices in the complex modern operating room.

    PubMed

    Gibbs, Verna C

    2012-12-14

    The three surgical patient safety events, wrong site surgery, retained surgical items (RSI) and surgical fires are rare occurrences and thus their effects on the complex modern operating room (OR) are difficult to study. The likelihood of occurrence and the magnitude of risk for each of these surgical safety events are undefined. Many providers may never have a personal experience with one of these events and training and education on these topics are sparse. These circumstances lead to faulty thinking that a provider won't ever have an event or if one does occur the provider will intuitively know what to do. Surgeons are not preoccupied with failure and tend to usually consider good outcomes, which leads them to ignore or diminish the importance of implementing and following simple safety practices. These circumstances contribute to the persistent low level occurrence of these three events and to the difficulty in generating sufficient interest to resource solutions. Individual facilities rarely have the time or talent to understand these events and develop lasting solutions. More often than not, even the most well meaning internal review results in a new line to a policy and some rigorous enforcement mandate. This approach routinely fails and is another reason why these problems are so persistent. Vigilance actions alone have been unsuccessful so hospitals now have to take a systematic approach to implementing safer processes and providing the resources for surgeons and other stakeholders to optimize the OR environment. This article discusses standardized processes of care for mitigation of injury or outright prevention of wrong site surgery, RSI and surgical fires in an action-oriented framework illustrating the strategic elements important in each event and focusing on the responsibilities for each of the three major OR agents-anesthesiologists, surgeons and nurses. A Surgical Patient Safety Checklist is discussed that incorporates the necessary elements to

  5. Reasons Military Patients with Primary Care Access Leave an Emergency Department Waiting Room Before Seeing a Provider

    DTIC Science & Technology

    2012-10-01

    Reasons Military Patients With Primary Care Access Leave an Emergency Department Waiting Room Before Seeing a Provider Shawn M. Varney, MD, Toni E...the severity of their illness, meaning that they were ill enough to require medical attention during that visit. Fernandes et al reported that most...2004;97: 729 733. 9. Fernandes CM, Price A, Christenson JM. Does reduced length of stay decrease the number of emergency department patients who leave

  6. Auto identification technology and its impact on patient safety in the Operating Room of the Future.

    PubMed

    Egan, Marie T; Sandberg, Warren S

    2007-03-01

    Automatic identification technologies, such as bar coding and radio frequency identification, are ubiquitous in everyday life but virtually nonexistent in the operating room. User expectations, based on everyday experience with automatic identification technologies, have generated much anticipation that these systems will improve readiness, workflow, and safety in the operating room, with minimal training requirements. We report, in narrative form, a multi-year experience with various automatic identification technologies in the Operating Room of the Future Project at Massachusetts General Hospital. In each case, the additional human labor required to make these ;labor-saving' technologies function in the medical environment has proved to be their undoing. We conclude that while automatic identification technologies show promise, significant barriers to realizing their potential still exist. Nevertheless, overcoming these obstacles is necessary if the vision of an operating room of the future in which all processes are monitored, controlled, and optimized is to be achieved.

  7. [The treatment of cancer patients].

    PubMed

    Pretorius, H L; Falkson, G

    1986-04-12

    Advances in the field of medical oncology were spurred by the development of cytostatic drugs, and cancer is today one of the most treatable (and most curable) of the chronic diseases. Because of the diversity of neoplastic diseases, classification, staging and the important individual patient discriminants must be taken into account more than ever before because of the availability of drugs that can cure or palliate many forms of cancer. The results obtained in advanced disease acted as an impetus to start chemotherapy at an earlier stage. In highly malignant neoplasms and especially in children with cancer, drug treatment has become of increasing importance, and when given appropriately complements surgery and radiotherapy.

  8. [Patient positioning using in-room kV CT for image-guided radiotherapy (IGRT) of prostate cancer].

    PubMed

    Kliton, Jorgo; Agoston, Péter; Major, Tibor; Polgár, Csaba

    2012-09-01

    automatic and manual image registrations were 0.31 cm and 0.26 cm in LAT, 0.27 cm and 0.27 cm in LONG and 0.24 cm and 0.33 cm in VERT directions, respectively. In case of manual image co-registration, the required PTV to CTV margins to cover at least 95% of the CTVs with at least 95% percent of the prescribed dose were calculated to 0.93 cm in LAT, 0.65 cm in LONG, and 0.89 cm in VERT directions. Patients set up can be verified with manual image co-registration based on soft tissues around the prostate using a kV CT-on-rails system installed in the treatment room. The difference between automatic and manual image co-registration was significant in LAT direction. A PTV to CTV margin <1 cm seems to be appropriate to cover the CTVs in image-guided prostate radiotherapy. These findings support our recent clinical protocol.

  9. The patient safety culture perception of Turkish nurses who work in operating room and intensive care unit.

    PubMed

    Rizalar, Selda; Topcu, Sacide Yildizeli

    2017-01-01

    To determine the patient safety culture perception of operating room and intensive care nurses and the factors affecting this perception. This descriptive study was conducted on 232 nurses working in a Turkish city hospitals. The data obtained from the nurses were collected using personal information form and Patient Safety Culture Scale (PSCS) from June to July 2015. The total score average of the nurses on the PSCS was 2.58±0.39. The nurses obtained the highest score on the employee behavior subscale, and the lowest score on the the adverse event reporting system subscale. No significant difference was found between the total score averages of the PSCS of the operating room and intensive care nurses (p>0.05). The patient safety culture score average of the operating room and intensive care nurses was at medium level. In addition, being able to choose the unit in which they worked, working day or night shifts, and being educated on patient safety were found to affect the patients safety cultures of the nurses (P<0.05).

  10. Nursing staff's experiences of working in an evidence-based designed ICU patient room-An interview study.

    PubMed

    Sundberg, Fredrika; Olausson, Sepideh; Fridh, Isabell; Lindahl, Berit

    2017-06-05

    It has been known for centuries that environment in healthcare has an impact, but despite this, environment has been overshadowed by technological and medical progress, especially in intensive care. Evidence-based design is a concept concerning integrating knowledge from various research disciplines and its application to healing environments. The aim was to explore the experiences of nursing staff of working in an evidence-based designed ICU patient room. Interviews were carried out with eight critical care nurses and five assistant nurses and then subjected to qualitative content analysis. The experience of working in an evidence-based designed intensive care unit patient room was that the room stimulates alertness and promotes wellbeing in the nursing staff, fostering their caring activities but also that the interior design of the medical and technical equipment challenges nursing actions. The room explored in this study had been rebuilt in order to create and evaluate a healing environment. This study showed that the new environment had a great impact on the caring staffs' wellbeing and their caring behaviour. At a time when turnover in nurses is high and sick leave is increasing, these findings show the importance of interior design ofintensive care units. Copyright © 2017 Elsevier Ltd. All rights reserved.

  11. Room temperature wafer direct bonding of smooth Si surfaces recovered by Ne beam surface treatments

    NASA Astrophysics Data System (ADS)

    Kurashima, Yuichi; Maeda, Atsuhiko; Takagi, Hideki

    2013-06-01

    We examined the applicability of a Ne fast atom beam (FAB) to surface activated bonding of Si wafers at room temperature. With etching depth more than 1.5 nm, the bonding strength comparable to Si bulk strength was attained. Moreover, we found the improvement of the bonding strength by surface smoothing effect of the Ne FAB. Silicon surface roughness decreased from 0.40 to 0.17 nm rms by applying a Ne FAB of 30 nm etching depth. The bonding strength between surfaces recovered by Ne FAB surface smoothing was largely improved and finally became equivalent to Si bulk strength.

  12. Scheduling elective surgeries: the tradeoff among bed capacity, waiting patients and operating room utilization using goal programming.

    PubMed

    Li, Xiangyong; Rafaliya, N; Baki, M Fazle; Chaouch, Ben A

    2017-03-01

    Scheduling of surgeries in the operating rooms under limited competing resources such as surgical and nursing staff, anesthesiologist, medical equipment, and recovery beds in surgical wards is a complicated process. A well-designed schedule should be concerned with the welfare of the entire system by allocating the available resources in an efficient and effective manner. In this paper, we develop an integer linear programming model in a manner useful for multiple goals for optimally scheduling elective surgeries based on the availability of surgeons and operating rooms over a time horizon. In particular, the model is concerned with the minimization of the following important goals: (1) the anticipated number of patients waiting for service; (2) the underutilization of operating room time; (3) the maximum expected number of patients in the recovery unit; and (4) the expected range (the difference between maximum and minimum expected number) of patients in the recovery unit. We develop two goal programming (GP) models: lexicographic GP model and weighted GP model. The lexicographic GP model schedules operating rooms when various preemptive priority levels are given to these four goals. A numerical study is conducted to illustrate the optimal master-surgery schedule obtained from the models. The numerical results demonstrate that when the available number of surgeons and operating rooms is known without error over the planning horizon, the proposed models can produce good schedules and priority levels and preference weights of four goals affect the resulting schedules. The results quantify the tradeoffs that must take place as the preemptive-weights of the four goals are changed.

  13. Effect of Welding and Post-weld Heat Treatment on Tensile Properties of Nimonic 263 at Room and Elevated Temperatures

    NASA Astrophysics Data System (ADS)

    Jeon, Minwoo; Lee, Jae-Hyun; Woo, Ta Kwan; Kim, Sangshik

    2011-04-01

    Nimonic 263 has been developed for the improved ductility in welded assemblies and is a candidate material for gas turbine combustor and transition pieces along with its good weldability and mechanical properties at room and elevated temperatures. In this study, the tensile behavior of an as-welded Nimonic 263 specimen at room temperature and 1053 K (780 °C) was examined in conjunction with microstructural evolution during welding and postweld heat treatment (PWHT). With the welding and the PWHT, the yield strength (YS), ultimate tensile strength (UTS), and tensile elongation of Nimonic 263 varied in a complex manner. It was observed that the PWHT of resolutionization at 1423 K (1150 °C) for 2 hours gave the highest YS and UTS values, whereas the tensile elongation was the lowest, at both testing temperatures. With increasing resolutionization time, the YS and UTS tended to decrease along with the increase in tensile ductility. The tensile behaviors of as-welded Nimonic 263 specimens was affected by several factors, including grain size, residual stress, possible microsegregation of γ' forming elements, a tendency for interdendritic or intergranular fracture and a morphological change in both M23C6 and MC type carbides, depending on the testing temperature and the PWHT. The complex changes in tensile properties of Nimonic 263 with welding and PWHT at room temperature and 1053 K (780 °C) were discussed based on the micrographic and fractographic observations.

  14. One size fits all? Mixed methods evaluation of the impact of 100% single-room accommodation on staff and patient experience, safety and costs

    PubMed Central

    Maben, Jill; Penfold, Clarissa; Simon, Michael; Anderson, Janet E; Robert, Glenn; Pizzo, Elena; Hughes, Jane; Murrells, Trevor; Barlow, James

    2016-01-01

    Background and objectives There is little strong evidence relating to the impact of single-room accommodation on healthcare quality and safety. We explore the impact of all single rooms on staff and patient experience; safety outcomes; and costs. Methods Mixed methods pre/post ‘move’ comparison within four nested case study wards in a single acute hospital with 100% single rooms; quasi-experimental before-and-after study with two control hospitals; analysis of capital and operational costs associated with single rooms. Results Two-thirds of patients expressed a preference for single rooms with comfort and control outweighing any disadvantages (sense of isolation) felt by some. Patients appreciated privacy, confidentiality and flexibility for visitors afforded by single rooms. Staff perceived improvements (patient comfort and confidentiality), but single rooms were worse for visibility, surveillance, teamwork, monitoring and keeping patients safe. Staff walking distances increased significantly post move. A temporary increase of falls and medication errors in one ward was likely to be associated with the need to adjust work patterns rather than associated with single rooms per se. We found no evidence that single rooms reduced infection rates. Building an all single-room hospital can cost 5% more with higher housekeeping and cleaning costs but the difference is marginal over time. Conclusions Staff needed to adapt their working practices significantly and felt unprepared for new ways of working with potentially significant implications for the nature of teamwork in the longer term. Staff preference remained for a mix of single rooms and bays. Patients preferred single rooms. PMID:26408568

  15. One size fits all? Mixed methods evaluation of the impact of 100% single-room accommodation on staff and patient experience, safety and costs.

    PubMed

    Maben, Jill; Griffiths, Peter; Penfold, Clarissa; Simon, Michael; Anderson, Janet E; Robert, Glenn; Pizzo, Elena; Hughes, Jane; Murrells, Trevor; Barlow, James

    2016-04-01

    There is little strong evidence relating to the impact of single-room accommodation on healthcare quality and safety. We explore the impact of all single rooms on staff and patient experience; safety outcomes; and costs. Mixed methods pre/post 'move' comparison within four nested case study wards in a single acute hospital with 100% single rooms; quasi-experimental before-and-after study with two control hospitals; analysis of capital and operational costs associated with single rooms. Two-thirds of patients expressed a preference for single rooms with comfort and control outweighing any disadvantages (sense of isolation) felt by some. Patients appreciated privacy, confidentiality and flexibility for visitors afforded by single rooms. Staff perceived improvements (patient comfort and confidentiality), but single rooms were worse for visibility, surveillance, teamwork, monitoring and keeping patients safe. Staff walking distances increased significantly post move. A temporary increase of falls and medication errors in one ward was likely to be associated with the need to adjust work patterns rather than associated with single rooms per se. We found no evidence that single rooms reduced infection rates. Building an all single-room hospital can cost 5% more with higher housekeeping and cleaning costs but the difference is marginal over time. Staff needed to adapt their working practices significantly and felt unprepared for new ways of working with potentially significant implications for the nature of teamwork in the longer term. Staff preference remained for a mix of single rooms and bays. Patients preferred single rooms. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  16. Capturing patient benefits of treatment.

    PubMed

    Carr, Alan; Wolfaardt, John; Garrett, Neal

    2011-01-01

    Findings from the Academy of Osseointegration State of the Science on Implant Dentistry Conference clearly demonstrate that data are lacking regarding both quality of design and adequate outcome measures (standardization, validity, and relevance to patient) to support an evidence-based systematic evaluation of implant efficacy. Despite the dearth of controlled trials and the variability in defining implant survival/success, the preponderance of evidence is viewed as lending support for consideration of dental implant therapy as a safe and predictable alternative to conventional restorations for many applications. However, this minimal conclusion undermines the best intentions of the dental profession, which is striving to substantiate to the patient, third-party providers, and the government the relative benefits and risks of various prosthetic treatment alternatives. The conclusions of multiple consensus conferences have repeatedly stressed that additional research with good strength of evidence following a broad spectrum of outcomes is vital to extend the breadth of conclusions regarding dental implant treatment efficacy. However, without a set of consensus-based core outcome measures addressing pertinent clinical and patient-centered factors, future expensive, time-consuming, and technically complex clinical studies may suffer the same critical flaws seen in the current body of research. It may be possible and useful to establish a core set of well-defined, discriminatory, and feasible outcome measures for common utilization and a hierarchy of additional recommended outcome measures for specific benefit categories. Such a standardized group of outcome measures would be likely to significantly enhance the potential for future research. In addition, with the formation of consensus guidelines, there would be an opportunity for scientific journals to promote the quality of implant dentistry research by suggesting the inclusion of these core outcome measures in

  17. An exploration of the basis for patient complaints about the oldness of magazines in practice waiting rooms: cohort study.

    PubMed

    Arroll, Bruce; Alrutz, Stowe; Moyes, Simon

    2014-12-11

    To explore the basis for patient complaints about the oldness of most magazines in practice waiting rooms. Cohort study. Waiting room of a general practice in Auckland, New Zealand. 87 magazines stacked into three mixed piles and placed in the waiting room: this included non-gossipy magazines (Time magazine, the Economist, Australian Women's Weekly, National Geographic, BBC History) and gossipy ones (not identified for fear of litigation). Gossipy was defined as having five or more photographs of celebrities on the front cover and most gossipy as having up to 10 such images. The magazines were marked with a unique number on the back cover, placed in three piles in the waiting room, and monitored twice weekly. Disappearance of magazines less than 2 months old versus magazines 3-12 months old, the overall rate of loss of magazines, and the rate of loss of gossipy versus non-gossipy magazines. 47 of the 82 magazines with a visible date on the front cover were aged less than 2 months. 28 of these 47 (60%) magazines and 10 of the 35 (29%) older magazines disappeared (P=0.002). After 31 days, 41 of the 87 (47%, 95% confidence interval 37% to 58%) magazines had disappeared. None of the 19 non-gossipy magazines (the Economist and Time magazine) had disappeared compared with 26 of the 27 (96%) gossipy magazines (P<0.001). All 15 of the most gossipy magazines and none of the non-gossipy magazines [corrected] had disappeared by 31 days. The study was terminated at this point. General practice waiting rooms contain mainly old magazines. This phenomenon relates to the disappearance of the magazines rather than to the supply of old ones. Gossipy magazines were more likely to disappear than non-gossipy ones. On the grounds of cost we advise practices to supply old copies of non-gossipy magazines. A waiting room science curriculum is urgently needed. © Arroll et al 2014.

  18. A novel technique to optimise the length of a linear accelerator treatment room maze without compromising radiation protection.

    PubMed

    Al-Affan, Ihsan A M; Evans, Simon C; Qutub, Mohammed; Hugtenburg, Richard P

    2017-10-05

    A novel technique to optimise the length of a linear accelerator treatment room maze without compromising radiation protection I A M Al-Affan†, S C Evans‡, M Qutub†,1 and R P Hugtenburg†,‡ †Swansea University, Swansea SA2 8PP, UK ‡Department of Medical Physics and Clinical Engineering, Singleton Hospital, Swansea, SA2 8QA, UK 1Department of Physics, Umm Al-Qura University, Makkah, Saudi Arabia Abstract Simulations with the FLUKA Monte Carlo code were used to establish the possibility of using lead to cover the existing concrete walls of a linear accelerator treatment room maze, in order to reduce the dose of the scattered photons at the maze entrance. In the present work, a pilot study performed at Singleton Hospital in Swansea was used to pioneer the use of lead sheets of various thicknesses to absorb scattered low energy photons in the maze. The dose reduction was considered to be due to the strong effect of the photoelectric interaction in lead resulting in attenuation of the back-scattered photons. Calculations with FLUKA with mono-energetic photons were used to represent the main components of the X-ray spectrum up to 10 MV. The reason for using mono-energetic photons was to study the behaviour of each energy component from associated interaction processes. The results showed that adding lead of 1 to 4 mm thickness to the walls and floor of the maze reduced the dose at the maze entrance by up to 80%. Subsequent scatter dose measurements performed at the maze entrance of an existing treatment room with 1.3 mm thickness of lead sheets added to the maze walls and floor supported the results from the simulations. The dose reduction at the maze entrance with the lead in place was up to 50%. The variation between simulation and measurement was attributed to the fact that insufficient lead was available to completely cover the maze walls and floor. This novel proposal of covering part or

  19. A simple intervention to improve patient safety, save time and improve staff experience in the AMU procedure room.

    PubMed

    Misselbrook, Gary Peter; Kause, Juliane; Yeoh, Su-Ann

    2016-01-01

    Over the last decade, operating theatres and Intensive Care Units (ICUs) have established systematic methods for performing procedures on patients that have been shown to reduce complications and improve patient safety. Whilst the use of procedure rooms on Acute Medicine Units (AMUs) is highly recommended by patient safety groups and Royal College publications, they are not universally available or appropriately utilised. In this article we discuss a quality improvement project that was undertaken on an AMU at a large university teaching hospital in the United Kingdom, highlighting its successes and challenges.

  20. "Waiting and the waiting room: how do you experience them?" emotional implications and suggestions from patients with cancer.

    PubMed

    Catania, Chiara; De Pas, Tommaso; Minchella, Ida; De Braud, Filippo; Micheli, Daniela; Adamoli, Laura; Spitaleri, Gianluca; Noberasco, Cristina; Milani, Alessandra; Zampino, Maria Giulia; Toffalorio, Francesca; Radice, Davide; Goldhirsch, Aron; Nolè, Franco

    2011-06-01

    Waiting can increase discomfort. The goal of this study was to identify moods and fears of cancer patients while in a waiting room and to capture their concrete suggestions for an anthropocentric transformation of waiting itself. A 15-item questionnaire was given to 355 patients who came to our Out-patient Oncology Clinic. Eighty-three percent of patients felt that waiting has an emotional cost, 35% were upset by talking about their condition with others while waiting, and 26% suffered a major emotional impact seeing other sick people and witnessing their clinical decline. Eighty-nine percent of patients suggested that alternative activities, such as meetings with professionals, doctors, and psychologists, be organized during the waiting period; 65% suggested fun activities (music therapy, drawing courses, library, TV). Most patients asked to have the freedom to leave the waiting room. This option, feasibly by means of IMs/"beepers," would limit their sense of having a lack of freedom or being robbed of their time. This study highlighted the complexity and heterogeneity of emotional implications that waiting causes in patients with cancer and collected many patients' suggestions about how to create a constructive, free, and personalized waiting period, overcoming the boredom, distress, and psychological suffering it causes.

  1. In-room display of day and time patient is anticipated to leave hospital: a "discharge appointment".

    PubMed

    Manning, Dennis M; Tammel, Karyl J; Blegen, R Nicole; Larson, Lori A; Steffens, Fay L; Rosenman, David J; Mundell, William C; Naessens, James M; Resar, Roger K; Huddleston, Jeanne M

    2007-01-01

    We learned from a focus group that many patients find discharge to be one of the least satisfying elements of the hospital experience. Patients cited insufficient communication about the day and time of the impending discharge as a cause of dissatisfaction. In partnership with the Institute for Healthcare Improvement, Improvement Action Network collaborative, we tested the practicality of an in-room "discharge appointment" (DA) display. Eight inpatient care units in 2 hospitals at an academic medical center (Mayo Clinic, Rochester, MN). DA displayed on a specially designed bedside dry-erase board. The primary outcome was the proportion of discharged patients who had been given a DA, including same-day DAs. Secondary outcomes were (1) the proportion of DAs scheduled before the actual dismissal day and (2) the timeliness of the actual departure compared with the DA. During the 4-month period, 2046 patients were discharged. Of those, 1256 patients (61%) were given a posted DA, of which 576 (46%) were scheduled at least a day in advance and 752 (60%) departed from the care unit within 30 minutes of the appointed time. With a program for in-room display of a DA in various hospital units, more than half the patients had a DA set, and most of the DA patients departed on time. Further investigation is needed to determine the effect of DAs on patient and provider satisfaction. (c) 2007 Society of Hospital Medicine.

  2. Surface treatment of aluminum alloy at room temperature with titanium-nitride films by dynamic mixing

    NASA Astrophysics Data System (ADS)

    Sato, T.; Ohata, K.; Asahi, N.; Ono, Y.; Oka, Y.; Hashimoto, I.; Arimatsu, K.

    Titanium-nitride coating films were prepared on aluminum alloy plates at room temperature with simultaneous ion implantation and metal vapor deposition (dynamic mixing) by using a high current ion source. The films were analysed by means of Auger electron spectroscopy, X-ray photoelectron spectroscopy and X-ray diffraction. The results showed the presence of small amount of oxygen and carbon impurities due to a high current density (0.5-1.0 mA/cm 2) of the nitrogen beam (energy: 20 keV). Films of 1.2 μm thickness showed uniform composition. Titanium-nitride coated aluminum alloy (film thickness: 15 μm) was ten times harder than the untreated one. The coated plate was examined by a pin-on-disc wear tester. The results showed better wear properties.

  3. Relative influence on total cancelled operating room time from patients who are inpatients or outpatients preoperatively.

    PubMed

    Dexter, Franklin; Maxbauer, Tina; Stout, Carole; Archbold, Laura; Epstein, Richard H

    2014-05-01

    In previous studies, hospitals' operating room (OR) schedules were influenced markedly by decisions made within a few days of surgery. At least half of ORs had their last case scheduled or changed within 2 working days of surgery. In the current investigation, we studied whether many of these changes were due to patients who were admitted before surgery. We differentiated these "inpatients" from "outpatients" having ambulatory surgery or admitted on the day of surgery. From 21 facilities of a nonacademic health system throughout the United States, N = 5 eight-week periods of cancellation data were obtained. From an academic hospital, N = 8 thirteen-week periods of cancellation data were obtained, including detailed audit data with timestamps of the entire scheduling/rescheduling/cancellation history for each case. (1) In the non-academic health system, outpatients accounted for 1.6% ± 0.1% (SEM) of the scheduled minutes that were cancelled, whereas inpatients accounted for 8.1% ± 0.4%. Consequently, even though inpatients represented much less than half the total scheduled minutes of surgery (16.2% ± 0.5%, P < 0.0001), they accounted for approximately half of the total cancelled minutes (overall P = 0.55, 49% ± 2%; hospitals only P = 0.062, 57% ± 3%). (2) In the nonacademic health system, each 10% increase in a facility's percentage of outpatients making a physical visit to a preoperative clinic (versus only a preoperative phone call) was associated with a 0.0% ± 0.1% absolute decrease in cancelled minutes (P = 0.58). (3) In the academic hospital, inpatients accounted for 22.3% ± 0.4% of the scheduled minutes but most of the total cancelled minutes (70% ± 2%, P < 0.0001). Slightly more than half the total inpatient cancelled minutes (54% ± 1%, P = 0.006) were due to cases scheduled within 1 workday prior to the day of surgery (e.g., Friday for Monday, Monday for Tuesday). During this period, inpatient cancellation rates, measured in minutes, were several

  4. [Care of a patient in the recovery room after a hepatectomy].

    PubMed

    Bourges, Patrick

    2013-03-01

    A hepatectomy is a surgical procedure involving a high risk of haemorrhage and an operation lasting several hours. It is for this reason that a period of monitoring by trained nursing staff in the postanaesthetic recovery room is essential until the vital functions stabilise and a protocol for effective analgesia is implemented.

  5. Effect of thermomechanical treatments on the room-temperature mechanical behavior of iron aluminide Fe{sub 3}Al

    SciTech Connect

    Agarwal, A.; Balasubramaniam, R.; Bhargava, S.

    1996-10-01

    The room-temperature hydrogen embrittlement (HE) problem in iron aluminides has restricted their use as high-temperature structural materials. The role of thermomechanical treatments (TMT), i.e., rolling at 500 C, 800 C, and 1,000 C, and post-TMT heat treatments, i.e., recrystallization at 750 C and ordering at 500 C, in affecting the room-temperature mechanical properties of Fe-25Al intermetallic alloy has been studied from a processing-structure-properties correlation viewpoint. It was found that when this alloy is rolled at higher temperature, it exhibits a higher fracture strength. This has been attributed to find subgrain size (28 {micro}) due to dynamic recrystallization occurring at the higher rolling temperature of 1,000 C. However, when this alloy is rolled at 1,000 C and then recrystallized, it shows the highest ductility but poor fracture strength. This behavior has been ascribed to the partially recrystallized microstructure, which prevents hydrogen ingress through grain boundaries and minimizes hydrogen embrittlement. When the alloy is rolled at 1,000 C and then ordered at 500 C for 100 hours, it shows the highest fracture strength, due to its finer grain size. The alloy rolled at 500 C and then ordered undergoes grain growth. Hence, it exhibits a lower fracture strength of 360 MPa. Fracture morphologies of the alloy were found to be typical of brittle fracture, i.e., cleavage-type fracture in all the cases.

  6. Role of the trauma-room chest x-ray film in assessing the patient with severe blunt traumatic injury

    PubMed Central

    McLellan, Barry A.; Ali, Jameel; Towers, Mark J.; Sharkey, P. William

    1996-01-01

    Objectives To examine the accuracy of standard trauma-room chest x-ray films in assessing blunt abdominal trauma and to determine the significance of missed injuries under these circumstances. Design A retrospective review. Setting A regional trauma unit in a tertiary-care institution. Patients Multiply injured trauma patients admitted between January 1988 and December 1990 who died within 24 hours of injury and in whom an autopsy was done. Intervention Standard radiography of the chest. Main Outcome Measures Chest injuries diagnosed and recorded by the trauma room team from standard anteroposterior x-ray films compared with the findings at autopsy and with review of the films by a staff radiologist initially having no knowledge of the injuries and later, if injuries remained undetected, having knowledge of the autopsy findings. Results Thirty-seven patients met the study criteria, and their cases were reviewed. In 11 cases, significant injuries were noted at autopsy and not by the trauma-room team, and in 7 cases these injuries were also missed by the reviewing radiologist. Injuries missed by the team were: multiple rib fractures (11 cases), sternal fractures (3 cases), diaphragmatic tear (2 cases) and intimal aortic tear (1 case). In five cases, chest tubes were not inserted despite the presence (undiagnosed) of multiple rib fractures and need for intubation and positive-pressure ventilation. Conclusions Significant blunt abdominal trauma, potentially requiring operative management or chest-tube insertion, may be missed on the initial anteroposterior chest x-ray film. Caution must therefore be exercised in interpreting these films in the trauma resuscitation room. PMID:8599789

  7. Initial presentation in psychiatry emergency room led to diagnosis of many urinary bladder stones in a male patient.

    PubMed

    El-Hennawy, Adel S; Nagaraja, Aarathi; Mahmood, Aza K

    2013-01-01

    The first case of man who presented to psychiatry emergency room for evaluation of abnormal behavior because of urinary stones was reported. Careful evaluation of patient led to a diagnosis of 37 urinary bladder stones in an Egyptian man with obstructive uropathy and metabolic defects in the form of hyperoxaluria and hypocitraturia. Knowledge of the differential diagnosis of metabolic defects can lead to successful outcome in preventing reformation of urinary tract stones after surgery. A 61-year-old Egyptian man presented to psychiatry emergency room because he was found lying on floor in bathroom to urinate by his wife who thought her husband needed psychiatric evaluation. Patient gave history of frequent urination and dysuria on and off for 3 years. In the last 3 months before his presentation to emergency room, he got into a habit of lying down on his left side when he went to bathroom to urinate because it was easier for him to pass urine. Renal consultation requested because of presence of red blood cells in urinalysis. Computed tomography of the abdomen and pelvis showed bilateral hydronephrosis and multiple bladder stones. Twenty-four-hour urine collection showed low urinary citrate and high oxalate. Patient underwent open vesicolithotomy and removal of 36 stones. Stone analysis showed 75% uric acid and 25% calcium oxalate. Patient did very well after surgery, and 1 month later, he underwent transuretheral resection of prostate without any complications. Now patient has no difficulty passing urine and he has no recent attack of urinary tract infection. Knowledge of the differential diagnosis of metabolic defects in men with urinary bladder stones would hopefully provide clinicians with the proper diagnostic tools to more specifically treat such patients with improved success in preventing reformation of urinary tract stones after surgery.

  8. The evolution of a purpose designed hybrid trauma operating room from the trauma service perspective: the RAPTOR (Resuscitation with Angiography Percutaneous Treatments and Operative Resuscitations).

    PubMed

    Kirkpatrick, Andrew W; Vis, Christine; Dubé, Mirette; Biesbroek, Susan; Ball, Chad G; Laberge, Jason; Shultz, Jonas; Rea, Ken; Sadler, David; Holcomb, John B; Kortbeek, John

    2014-09-01

    Traumatic injury is the leading cause of potentially preventable lost years of life in the Western world and exsanguination is the most potentially preventable cause of post-traumatic death. With mature trauma systems and experienced trauma centres, extra-abdominal sites, such as the pelvis, constitute the most frequent anatomic site of exsanguination. Haemorrhage control for such bleeding often requires surgical adjuncts most notably interventional radiology (IR). With the usual paradigm of surgery conducted within an operating room and IR procedures within distant angiography suites, responsible clinicians are faced with making difficult decisions regarding where to transport the most physiologically unstable patients for haemorrhage control. If such a critical patient is transported to the wrong suite, they may die unnecessarily despite having potentially salvageable injuries. Thus, it seems only logical that the resuscitative operating room of the future would have IR capabilities making it the obvious geographic destination for critically unstable patients, especially those who are exsanguinating. Our trauma programme recently had the opportunity to conceive, design, build, and operationalise a purpose-designed hybrid trauma operating room, designated as the resuscitation with angiographic percutaneous techniques and operative resuscitation (RAPTOR) suite, which we believe to be the first such resource designed primarily to serve the exsanguinating trauma patient. The project was initiated after consultations between the trauma programme and private philanthropists regarding the greatest potential impacts on regional trauma care. The initial capital construction costs were thus privately generated but coincided with a new hospital wing construction allowing the RAPTOR to be purpose-designed for the exsanguinating patient. Many trauma programmes around the world are now starting to navigate the complex process of building new facilities, or else retrofitting

  9. [Treatment of patients with trophic ulcer].

    PubMed

    Karapetian, G É; Iakimov, S V; Mikitin, I L; Kochetova, L V; Pakhomova, R A

    2014-01-01

    The authors present the investigation of inpatient treatment of 137 patients with trophic ulcers of venous aethiology. All the patients were hospitalized in the "Road clinical hospital" on the Krasnoyarsk station. A comparative analysis of treatment results of the patients with trophic ulcers using different medical methods was made. The efficacy of combined use of low-frequency ultrasound and ozone therapy was proved.

  10. Factors associated with the use of physical restraints for agitated patients in psychiatric emergency rooms.

    PubMed

    Migon, Marcelo N; Coutinho, Evandro S; Huf, Giselle; Adams, Clive E; Cunha, Geraldo M; Allen, Michael H

    2008-01-01

    To examine factors associated with physical restraint in psychiatric emergency rooms. We extracted variables likely to predict use of physical restraints from a large randomised trial undertaken in three psychiatric emergency rooms in Rio de Janeiro. We fitted a Bayesian binary multivariate model using only variables clearly preceding the restraints. Of 301 agitated, aggressive people admitted to emergency rooms, 73 (24%) were restrained during the first 2 h of admission. In Rio, younger people (OR=1.03 for each year younger), exhibiting intense (OR=2.53) or extreme agitation (OR=7.71), thought to result from substance misuse (OR=1.75) or diagnoses other than psychosis (OR=1.88), arriving in the morning (OR=1.64) were at greater risk of physical restraints than older, less severely aggressive or agitated people, arriving at the hospital during the afternoon or night. Hospital, gender, first admission to hospital and medication were not associated with risk of being restrained. Restraint practices in Rio are predictable and based on a limited clinical assessment. Predictive factors for physical restraint may vary worldwide, but should be monitored and studied to assist training, and to establish programs to evaluate and refine this controversial practice.

  11. Methanogenic degradation of toilet-paper cellulose upon sewage treatment in an anaerobic membrane bioreactor at room temperature.

    PubMed

    Chen, Rong; Nie, Yulun; Kato, Hiroyuki; Wu, Jiang; Utashiro, Tetsuya; Lu, Jianbo; Yue, Shangchao; Jiang, Hongyu; Zhang, Lu; Li, Yu-You

    2017-03-01

    Toilet-paper cellulose with rich but refractory carbon sources, are the main insoluble COD fractions in sewage. An anaerobic membrane bioreactor (AnMBR) was configured for sewage treatment at room temperature and its performance on methanogenic degradation of toilet paper was highlighted. The results showed, high organic removal (95%), high methane conversion (90%) and low sludge yield (0.08gVSS/gCOD) were achieved in the AnMBR. Toilet-paper cellulose was fully biodegraded without accumulation in the mixed liquor and membrane cake layer. Bioconversion efficiency of toilet paper approached 100% under a high organic loading rate (OLR) of 2.02gCOD/L/d and it could provide around 26% of total methane generation at most of OLRs. Long sludge retention time and co-digestion of insoluble/soluble COD fractions achieving mutualism of functional microorganisms, contributed to biodegradation of toilet-paper cellulose. Therefore the AnMBR successfully implemented simultaneously methanogenic bioconversion of toilet-paper cellulose and soluble COD in sewage at room temperature.

  12. [Diagnosis and treatment in the emergency room of acute asthma in childhood].

    PubMed

    Aldana Vergara, Ruth Saraí; Olivar Lòpez, Victor; Sienra Monge, Juan José Luis; Lezana Fernández, José Luis; Zepeda Ortega, Benjamin

    2009-01-01

    Acute asthma is characterized by acute air way obstruction episodes presented as short breath, increased coughing, wheezing and difficult breathing, reversible with bronchodilator. It constitutes one of the most frequent causes of pediatric ER visits whose diagnosis and treatment is not always adequate. It is necessary to carry out a complete medical history searching for the number of previous attacks, risk factors, associated illnesses, triggers, prior hospitalizations, preventive and maintenance treatment used, along with a complete physical examination. During the management of moderate-severe attacks frequent systematic assessments are required to ensure treatment response. In children above 5 years old, monitoring of expiratory peak flow (EPF) during mild-moderate attacks is recommended. In general, a national consensus to classify and treat acute asthma in emergency services does not exist for which the need to develop a clinical practice guide of diagnosis and management arises.

  13. Determinants of Treatment Modification in Hypercholesterolemic Patients

    PubMed Central

    Wang, Ko-Fan; Wu, Cheng-Hsueh; Chang, Chun-Chin; Chen, Lung-Ching; Wang, Kang-Ling; Lu, Tse-Min; Lin, Shing-Jong; Chiang, Chern-En

    2017-01-01

    Background There is a lack of knowledge of those contemporary factors associated with modifying subtherapeutic treatments in hypercholesterolemic patients. The aim of this study was to assess determinants of treatment modification in patients not attaining their low-density lipoprotein cholesterol goals. Methods The centralized Pan-Asian survey on the under-treatment of hypercholesterolemia enrolled patients taking stable lipid-lowering medications. The study physicians then determined existing patient treatments, which were to be continued or modified when treatments failed. The patient questionnaire surveying patient attitudes and perceptions toward their hypercholesterolemia management was prospectively collected. The odds ratios (ORs) (95% confidence intervals) were calculated. Results Among the 420 patients included for analysis, 35.7% were designated for planned treatment modification. Those patients assigned to treatment modification were more likely to have a family history of premature coronary heart disease (40% vs. 19%), an indication for secondary prevention (76% vs. 61%), elevated triglyceride (60% vs. 48%) and fasting sugar (84% vs. 67%), and were less adherent to their medications (29% vs. 12%) than patients assigned to treatment continuation. Patient recognition of treatment failure [OR, 1.82 (1.13-2.94)], the lower frequency of cholesterol checkup [OR, 2.40 (1.41-4.08)], patient satisfaction with provided cholesterol information [OR, 2.30 (1.21-4.39)], and their feelings toward cholesterol management [OR, 0.25 (0.10-0.62) and 3.80 (2.28-6.32)] for confusion and no strong feeling, respectively were determinants of the treatment modification assignment. Conclusions There was a large gap between evidence-based goals and modification of subtherapeutic treatments, particularly among patients with lower treatment satisfaction and better compliance. Our findings have emphasized the need to further reduce inertia in implementing hypercholesterolemia

  14. Treatment of Venous Thromboembolism in Pediatric Patients

    PubMed Central

    Malec, Lynn; Young, Guy

    2017-01-01

    Given the increased incidence of venous thromboembolism (VTE) in pediatric patients, which has been associated with increased survival of medically complex patients and increased use of invasive supportive measures, it is important to understand treatment options and unique aspects of anticoagulant use in children. The objective of this mini-review is to outline the goals of treatment, treatment options, and adverse events associated with the use of anticoagulants in pediatric patients with VTE. PMID:28293549

  15. Treatment of the special patient with schizophrenia

    PubMed Central

    Conley, Robert R.; Kelly, Deanna L.

    2001-01-01

    Special patient populations with schizophrenia have received little attention. These populations include adolescents, the elderly, substance abusers, and patients who are considered treatment-resistant. Interest in these populations is rapidly growing, especially with regard to their treatment with second-generation antipsychotics. This article describes the treatment of special patient populations and summarizes the research that has been done in this field. PMID:22034474

  16. Patient resistance as agency in treatment decisions.

    PubMed

    Koenig, Christopher J

    2011-04-01

    Medication is critical to the management of medical problems, however relatively little attention has been paid to the treatment recommendation process where a new medication is first prescribed. This article argues that how and when a patient agrees to a physician's treatment demonstrates a patient's active involvement in decisions about treatment. Using 100 video recorded primary care visits across 10 internal medicine clinics in the Western United States, this paper uses conversation analysis to document the delivery and reception of treatment recommendations in acute medical visits with adult patients. Specifically, this article analyzes patients demonstrating active participation regarding treatment decisions as a limited form of agency. Starting from the premise that participants orient to physicians' treatment recommendations as normatively requiring patient acceptance before moving to a next activity, this article argues that when patients resist a recommendation, they actively participate in how the treatment recommendation emerges as acceptable. This article argues that through resistance to a treatment recommendation, patients work to negotiate and collaboratively co-construct what counts as an acceptable recommendation. Overall, this article argues that patient resistance is an interactional resource for patients to assert their agency by ensuring the ensuing recommendation is acceptable and in accord with their treatment preferences and concerns. Copyright © 2011 Elsevier Ltd. All rights reserved.

  17. Treatment planning for the pediatric patient.

    PubMed

    McWhorter, Alton G

    2010-12-01

    Treatment planning for pediatric dental patients is a multifactorial, complex process that requires careful consideration of three distinct areas: the patient's caries risk status, the available treatment options and the child's behavior. Components of a caries risk assessment include: a review of the child's medical and dental history in combination with the findings of the clinical and radiographic examination. All decisions regarding appropriate treatment options for the patient are guided by the outcome of the caries risk assessment. The child's behavior is another overriding consideration as it determines how the treatment can be rendered. Information obtained through careful evaluation of each area results in a treatment plan specifically designed for each child's circumstance.

  18. An exploration of the basis for patient complaints about the oldness of magazines in practice waiting rooms: cohort study

    PubMed Central

    Alrutz, Stowe; Moyes, Simon

    2014-01-01

    Objective To explore the basis for patient complaints about the oldness of most magazines in practice waiting rooms. Design Cohort study. Setting Waiting room of a general practice in Auckland, New Zealand. Participants 87 magazines stacked into three mixed piles and placed in the waiting room: this included non-gossipy magazines (Time magazine, the Economist, Australian Women’s Weekly, National Geographic, BBC History) and gossipy ones (not identified for fear of litigation). Gossipy was defined as having five or more photographs of celebrities on the front cover and most gossipy as having up to 10 such images. Interventions The magazines were marked with a unique number on the back cover, placed in three piles in the waiting room, and monitored twice weekly. Main outcome measures Disappearance of magazines less than 2 months old versus magazines 3-12 months old, the overall rate of loss of magazines, and the rate of loss of gossipy versus non-gossipy magazines. Results 47 of the 82 magazines with a visible date on the front cover were aged less than 2 months. 28 of these 47 (60%) magazines and 10 of the 35 (29%) older magazines disappeared (P=0.002). After 31 days, 41 of the 87 (47%, 95% confidence interval 37% to 58%) magazines had disappeared. None of the 19 non-gossipy magazines (the Economist and Time magazine) had disappeared compared with 26 of the 27 (96%) gossipy magazines (P<0.001). All 15 of the most gossipy magazines and all 19 of the non-gossipy magazines had disappeared by 31 days. The study was terminated at this point. Conclusions General practice waiting rooms contain mainly old magazines. This phenomenon relates to the disappearance of the magazines rather than to the supply of old ones. Gossipy magazines were more likely to disappear than non-gossipy ones. On the grounds of cost we advise practices to supply old copies of non-gossipy magazines. A waiting room science curriculum is urgently needed. PMID:25500116

  19. Monte Carlo simulations for the design of the treatment rooms and synchrotron access mazes in the CNAO Hadrontherapy facility.

    PubMed

    Porta, Alessandro; Agosteo, Stefano; Campi, Fabrizio

    2005-01-01

    The Italian National Centre for Hadrontherapy is based on a synchrotron capable of accelerating protons and carbon ions up to 250 MeV and 400 MeV u(-1), respectively. The present work describes some Monte Carlo simulations performed to verify the design of the treatment rooms and synchrotron access mazes. The different shielding efficiency and induced activations of the common concrete and the baryte concrete were analysed. In such a radiation field, i.e. with high-energy neutrons, the baryte concrete gains twice the activation than the common concrete without any relevant dose reduction. Moreover, the simulations have stressed, again, the discrepancies between H*(10) and E in such cases where the neutron radiation field is the dominant component and, particularly, in the medium-high energy range.

  20. Gliomatosis cerebri treatment in 11 elderly patients.

    PubMed

    Piccirilli, M; Landi, A; Salvati, M

    2006-06-01

    The Authors report their experience in the treatment of eleven patients over 70 years old (range from 70 to 83, average age 74.8, 7 males and 4 females), with histologically proven diagnosis of glioblastoma multiforme. The GC golden standard treatment is still debated, particularly in elderly patients. All the patients underwent a first line treament with chemotherapy (Temozolomide), followed by Whole Brain Radiotherapy (WBRT) and PCV schedule without Vincristine in case of progression of the disease. The median survival was 16.3 months, ranging from 13 to 22 months. According to our experience, elderly patients should undergo the same treatment of younger patients, provided they are in good health conditions.

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

    PubMed Central

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

    2011-01-01

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

  2. Clinician Perceptions of Operating Room to Intensive Care Unit Handoffs and Implications for Patient Safety: A Qualitative Study

    PubMed Central

    McElroy, Lisa M.; Macapagal, Kathryn R.; Collins, Kelly M.; Abecassis, Michael M.; Holl, Jane L.; Ladner, Daniela P.; Gordon, Elisa J.

    2015-01-01

    Background Operating room (OR) to the intensive care unit (ICU) handoffs are known sources of medical error, yet little is known about the relationship between process failures and patient harm. Materials and Methods Interviews were conducted with clinicians involved in the OR-to-ICU handoff to characterize the relationship between handoff process failures and patient harm. Thematic analysis was used to inductively identify key themes. Results A total of 38 interviews were conducted. Dominant themes included early communication from the OR to the ICU, team member participation in the handoff, and relationships between clinicians; clinician perspectives varied depending substantially on role within the team. Conclusions The findings suggest that ambiguous roles and conflicting expectations of team members during the OR-to-ICU handoff can increase risk of patient harm. Future studies should investigate early postoperative ICU care as outcome markers of handoff quality and the effect of inter-professional education on clinician adherence to interventions. PMID:26198333

  3. A Research Note on Drug Related Emergency Room Cases.

    ERIC Educational Resources Information Center

    Russe, Brian R.; And Others

    1980-01-01

    Examines some of the demographic and medical characteristics exhibited by drug users treated in a hospital's emergency room, to present some of the problems these patients experience and the hospital staff must deal with. Suggests alternatives to emergency room treatment, including counseling. (Author)

  4. The association between patient activation and medication adherence, hospitalization, and emergency room utilization in patients with chronic illnesses: a systematic review.

    PubMed

    Kinney, Rebecca L; Lemon, Stephenie C; Person, Sharina D; Pagoto, Sherry L; Saczynski, Jane S

    2015-05-01

    A systematic review of the published literature on the association between the PAM (Patient Activation Measure) and hospitalization, emergency room use, and medication adherence among chronically ill patient populations. A literature search of several electronic databases was performed. Studies published between January 1, 2004 and June 30, 2014 that used the PAM measure and examined at least one of the outcomes of interest among a chronically ill study population were identified and systematically assessed. Ten studies met the eligibility criteria. Patients who scored in the lower PAM stages (Stages 1 and 2) were more likely to have been hospitalized. Patients who scored in the lowest stage were also more likely to utilize the emergency room. The relationship between PAM stage and medication adherence was inconclusive in this review. Chronically ill patients reporting low stages of patient activation are at an increased risk for hospitalization and ER utilization. Future research is needed to further understand the relationship between patient activation and medication adherence, hospitalization and/or ER utilization in specific chronically ill (e.g. diabetic, asthmatic) populations. Research should also consider the role of patient activation in the development of effective interventions which seek to address the outcomes of interest. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  5. Implementation of hospital-wide enhanced terminal cleaning of targeted patient rooms and its impact on endemic Clostridium difficile infection rates.

    PubMed

    Manian, Farrin A; Griesnauer, Sandra; Bryant, Alex

    2013-06-01

    Implementation of a hospital-wide program of terminal cleaning of patient rooms revolving around hydrogen peroxide vapor (HPV) technology and evaluation of its impact on endemic nosocomial Clostridium difficile-associated diarrhea (CDAD) have not been previously reported. This was a retrospective quasiexperimental study involving a 900-bed community hospital. During the preintervention period (January 2007-November 2008), rooms vacated by patients with CDAD or on contact precautions for other targeted pathogens underwent 1 or more rounds of cleaning with bleach. During the intervention period (January-December 2009), targeted newly evacuated rooms underwent "enhanced cleaning" consisting of use of bleach followed by HPV decontamination utilizing a priority scale based on the pathogen and room location. Rooms vacated by patients with CDAD but for which HPV decontamination was not possible the same day underwent 4 rounds of cleaning with bleach instead. During the intervention period, 1,123 HPV decontamination rounds were performed involving 96.7% of hospital rooms. Of 334 rooms vacated by patients with CDAD (May-December 2009), 180 (54%) underwent HPV decontamination. The rate of nosocomial CDAD rate dropped significantly from 0.88 cases/1,000 patient-days to 0.55 cases/1,000 patient-days (rate ratio, 0.63; 95% confidence interval: 0.50-0.79, P < .0001). A hospital-wide program of enhanced terminal cleaning of targeted patient rooms revolving around HPV technology was practical and was associated with a significant reduction in CDAD rates. Copyright © 2013 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

  6. Room Acoustics

    NASA Astrophysics Data System (ADS)

    Kuttruff, Heinrich; Mommertz, Eckard

    The traditional task of room acoustics is to create or formulate conditions which ensure the best possible propagation of sound in a room from a sound source to a listener. Thus, objects of room acoustics are in particular assembly halls of all kinds, such as auditoria and lecture halls, conference rooms, theaters, concert halls or churches. Already at this point, it has to be pointed out that these conditions essentially depend on the question if speech or music should be transmitted; in the first case, the criterion for transmission quality is good speech intelligibility, in the other case, however, the success of room-acoustical efforts depends on other factors that cannot be quantified that easily, not least it also depends on the hearing habits of the listeners. In any case, absolutely "good acoustics" of a room do not exist.

  7. Reducing Cancer Patients' Painful Treatment

    NASA Image and Video Library

    A NASA light technology originally developed to aid plant growth experiments in space has proved to reduce the painful side effects resulting from chemotherapy and radiation treatment in bone marro...

  8. Computed tomography angiography of lower extremities in the emergency room for evaluation of patients with gunshot wounds.

    PubMed

    Adibi, Ali; Krishnam, Mayil S; Dissanayake, Sumudu; Plotnik, Adam N; Mohajer, Kiyarash; Arellano, Cesar; Ruehm, Stefan G

    2014-07-01

    To assess the role of CT angiography in the evaluation of patients with lower extremity gunshot wounds in the emergency room. Eighty patients (73 male, 7 female, mean age 26 years) underwent CT angiography for the evaluation of lower extremity gunshot injuries. Imaging was conducted on the basis of standardized protocols utilizing 16-slice and 64-slice multidetector systems and images were qualitatively graded and assessed for various forms of arterial injury. CT angiography findings indicative of arterial injury were observed in 24 patients (30%) and a total of 43 arterial injuries were noted; the most common form was focal narrowing/spasm (n = 16, 37.2%); the most common artery involved was the superficial femoral artery (n = 12, 50%). In qualitative assessment of images based on a 4-point grading system, both readers considered CT angiography diagnostically excellent (grade 4) in most cases. Surgical findings were consistent with CT angiography and follow-up of patients' medical records showed no arterial injuries in patients with normal findings on initial imaging. Our findings demonstrate that CT angiography is an effective imaging modality for evaluation of lower extremity gunshot wounds and could help limit more invasive procedures such as catheter angiography to a select group of patients. • CT angiography efficiently evaluates lower extremity gunshot wounds. • CT angiography provides image quality sufficiently reliable for assessment of gunshot injuries. • CT angiography could help limit invasive procedures to select patients.

  9. Patients' and parents' expectations of orthodontic treatment.

    PubMed

    Hiemstra, Renske; Bos, Annemieke; Hoogstraten, Johan

    2009-12-01

    To investigate the expectations of children and their primary care-givers towards orthodontic treatment and to compare the results with those of a UK sample. A questionnaire survey of children and their primary care-givers attending for their first consultation. The Department of Orthodontics at the Academic Centre for Dentistry Amsterdam (ACTA), the Netherlands. A total of 168 subjects (84 patients and 84 parents) completed the questionnaire. The children were aged 10 to 14 years. The responses of the children and parents and differences between boys and girls were examined using parametric statistical methods. The data from the Dutch sample were compared with a similar UK sample. Patients and parents shared similar expectations of orthodontic treatment, with the exception of expectations of having a brace fitted at the first appointment, orthodontic treatment involving headgear, any problems with orthodontic treatment, duration of orthodontic treatment and concerning reactions from the public. Among the child participants, boys and girls only differed in their expectations of orthodontic treatment involving jaw surgery. Differences between Dutch and English participants were found regarding the first visit, type of orthodontic treatment, reactions from the public, and pain and problems with orthodontic treatment. Since the expectations of patients and their parents differ on several aspects, effective communication between the orthodontist, patient and parent is considered to be essential. Our hypothesis that Dutch patients' and parents' expectations of orthodontic treatment differ from the expectations of English patients and parents was supported.

  10. Sunny hospital rooms expedite recovery from severe and refractory depressions.

    PubMed

    Beauchemin, K M; Hays, P

    1996-09-09

    Bright light therapy is an effective treatment for seasonal affective disorder, an uncommon condition marked by mild winter depression. Bright lights have been used as adjuncts in the pharmacological treatment of other types of depressive illness. The rooms in our psychiatric inpatient unit are so placed that half are bright and sunny and the rest are not. Reasoning that some patients were getting light therapy inadvertently, we compared the lengths of stay of depressed patients in sunny rooms with those of patients in dull rooms. Those in sunny rooms had an average stay of 16.9 days compared to 19.5 days for those in dull rooms, a difference of 2.6 days (15%): P < 0.05.

  11. Psychodynamic Assessment and Treatment of Traumatized Patients

    PubMed Central

    Chertoff, Judith

    1998-01-01

    This article describes how psychodynamic assessment and treatment of traumatized patients can improve clinical acuity. The author describes an ego psychological, psychodynamic approach that involves 1) assessing the impact of trauma on the patient's ego defensive functioning and 2) elucidating the dynamic meaning of both the patient's presenting symptoms and the traumatic events that precipitated them. Clinical descriptions illustrate the ways in which psychodynamic psychotherapy may be particularly useful with patients whose acute symptoms develop following specific events. The author points out the advantages of an ego psychological, psychodynamic approach for her patients and the limitations of more symptom-based diagnostic assessments and treatments. PMID:9407474

  12. The influence of goal setting and SmartRoom patient education videos on readmission rate, length of stay, and patient satisfaction in the orthopedic spine population.

    PubMed

    Wang, Weiwen; Dudjak, Linda A; Larue, Elizabeth M; Ren, Dianxu; Scholle, Carol; Wolf, Gail A

    2013-09-01

    The SmartRoom technology, a system now owned by TeleTracking Technologies, aims to transform the delivery of patient care in the inpatient environment. The purpose of this project was to use goal setting and SmartRoom patient education videos to examine whether the videos more effectively engaged patients and their families in their discharge plan and encouraged them to take a more active role in their care while hospitalized. This study used a descriptive design to analyze the effect of goal setting and patient education videos on patient satisfaction at discharge, hospital average length of stay, and 30-day readmission rate in the orthopedic spine surgical care setting. Comparisons were made among three patient groups. No statistically significant difference was found for average length of stay and 30-day readmission across these three groups. However, patient satisfaction with discharge, as measured by the Hospital Consumer Assessment of Health Providers and Systems, revealed an increase in five items regarding discharge with statistically significant differences on two of the five items.

  13. SCREENING, BRIEF INTERVENTION AND REFERRAL TO TREATMENT (SBIRT) IN A POLISH EMERGENCY ROOM: CHALLENGES IN CULTURAL TRANSLATION OF SBIRT.

    PubMed

    Cherpitel, Cheryl J; Bernstein, Edward; Bernstein, Judith; Moskalewicz, Jacek; Swiatkiewicz, Grazyna

    2009-09-01

    A randomized clinical controlled trial of screening, brief intervention and referral to treatment (SBIRT) for drinking and related problems among at-risk and dependent drinkers, using nurse interventionists, was undertaken in an emergency room (ER) in Sosnowiec, Poland, the first level-one trauma center in that country. This study was the first outside of the U.S. to test protocols developed in a 14-site collaborative SBIRT study. Because Poland has both a pattern of heavy drinking and a highly accessible specialized alcohol treatment system, it offered a key setting for cultural translation of SBIRT to the international context of a new and emerging health care system. It also offered the opportunity to test the effectiveness of SBIRT with both at-risk and dependent drinkers, and to test the feasibility of using ER nursing staff to provide the brief intervention, serving as a potential model for ongoing implementation of SBIRT in ER settings. Findings suggest that the U.S.-based SBIRT protocols can be successfully translated to other cultures, and that nurses can be successfully trained to provide brief intervention for problem drinking in the ER setting.

  14. SCREENING, BRIEF INTERVENTION AND REFERRAL TO TREATMENT (SBIRT) IN A POLISH EMERGENCY ROOM: CHALLENGES IN CULTURAL TRANSLATION OF SBIRT

    PubMed Central

    Cherpitel, Cheryl J.; Bernstein, Edward; Bernstein, Judith; Moskalewicz, Jacek; Swiatkiewicz, Grazyna

    2009-01-01

    A randomized clinical controlled trial of screening, brief intervention and referral to treatment (SBIRT) for drinking and related problems among at-risk and dependent drinkers, using nurse interventionists, was undertaken in an emergency room (ER) in Sosnowiec, Poland, the first level-one trauma center in that country. This study was the first outside of the U.S. to test protocols developed in a 14-site collaborative SBIRT study. Because Poland has both a pattern of heavy drinking and a highly accessible specialized alcohol treatment system, it offered a key setting for cultural translation of SBIRT to the international context of a new and emerging health care system. It also offered the opportunity to test the effectiveness of SBIRT with both at-risk and dependent drinkers, and to test the feasibility of using ER nursing staff to provide the brief intervention, serving as a potential model for ongoing implementation of SBIRT in ER settings. Findings suggest that the U.S.-based SBIRT protocols can be successfully translated to other cultures, and that nurses can be successfully trained to provide brief intervention for problem drinking in the ER setting. PMID:20046538

  15. Measurement of stray neutron doses inside the treatment room from a proton pencil beam scanning system.

    PubMed

    Mojżeszek, N; Farah, J; Kłodowska, M; Ploc, O; Stolarczyk, L; Waligórski, M P R; Olko, P

    2017-02-01

    To measure the environmental doses from stray neutrons in the vicinity of a solid slab phantom as a function of beam energy, field size and modulation width, using the proton pencil beam scanning (PBS) technique. Measurements were carried out using two extended range WENDI-II rem-counters and three tissue equivalent proportional counters. Detectors were suitably placed at different distances around the RW3 slab phantom. Beam irradiation parameters were varied to cover the clinical ranges of proton beam energies (100-220MeV), field sizes ((2×2)-(20×20)cm(2)) and modulation widths (0-15cm). For pristine proton peak irradiations, large variations of neutron H(∗)(10)/D were observed with changes in beam energy and field size, while these were less dependent on modulation widths. H(∗)(10)/D for pristine proton pencil beams varied between 0.04μSvGy(-1) at beam energy 100MeV and a (2×2)cm(2) field at 2.25m distance and 90° angle with respect to the beam axis, and 72.3μSvGy(-1) at beam energy 200MeV and a (20×20) cm(2) field at 1m distance along the beam axis. The obtained results will be useful in benchmarking Monte Carlo calculations of proton radiotherapy in PBS mode and in estimating the exposure to stray radiation of the patient. Such estimates may be facilitated by the obtained best-fitted simple analytical formulae relating the stray neutron doses at points of interest with beam irradiation parameters. Copyright © 2017 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

  16. Room for improvement: patients' experiences of primary care in Quebec before major reforms.

    PubMed

    Haggerty, Jeannie L; Pineault, Raynald; Beaulieu, Marie-Dominique; Brunelle, Yvon; Gauthier, Josée; Goulet, François; Rodrigue, Jean

    2007-06-01

    To investigate variations in accessibility, continuity of care, and coordination of services as experienced by patients in Quebec on the eve of major reforms, and to provide baseline information against which reforms could be measured. Multilevel cross-sectional survey of practice. One hundred primary health care settings were randomly selected in urban, suburban, rural, and remote locations in 5 health regions in Quebec. In each clinic, we chose up to 4 physicians and 20 consecutive patients consulting each physician. Patients' responses to a self-administered questionnaire, the Primary Care Assessment Tool, that assessed patient-provider affiliation, accessibility, relational continuity, coordination of primary and specialty care, and whether patients received health promotion and preventive services. A total of 3441 patients participated (87% acceptance rate) in 100 clinics (64% response rate). Timely access was difficult; only 10% expressed confidence they could be seen by their regular doctors within a day if they became suddenly ill. Average waiting time for a doctor's appointment was 24 days. Coordination of care with specialists was at minimally acceptable levels. Patients with family physicians recalled them addressing only 56% of the health promotion and preventive issues appropriate for their age and sex, and patients without family physicians recalled physicians addressing substantially fewer (38%). Most patients reported they were highly confident that their physicians knew them well and would manage their care beyond clinical encounters (relational continuity). The exception was the 16% of patients overall who did not have family physicians (34% of patients at walk-in clinics). This survey highlights serious problems with accessibility. Improvement is needed urgently to avoid deterioration of patients' confidence in the health system even though patients rate their relationships with their physician highly. Health promotion, preventive services, and

  17. Treatment of the Depressed Alcoholic Patient

    PubMed Central

    DeVido, Jeffrey J.; Weiss, Roger D.

    2013-01-01

    Alcohol use disorders (AUDs) and depressive illnesses are highly prevalent, frequently co-occur, and are associated with worse outcomes when paired. The assessment and treatment of patients with co-occurring alcohol use disorders and depressive illnesses is wrought with many significant challenges. When it comes to advocating treatment guidelines for this dually diagnosed population, the data are limited, but nonetheless do suggest that an integrated approach to patients presenting with co-occurring AUD and depressive symptoms can be efficacious. In this approach, ongoing evaluation and treatment are provided under one roof according to the evolving needs of each patient. Utilizing antidepressant medications in conjunction with psychosocial therapies may augment overall treatment efficacy; data also suggest that combining and tailoring psychosocial therapies such as motivational enhancement therapies, cognitive therapies, and twelve-step facilitation may further improve treatment outcomes for patients with co-occurring depressive and alcohol use disorders. PMID:22907336

  18. Direct-to-consumer teledermatology services for pediatric patients: Room for improvement.

    PubMed

    Fogel, Alexander L; Teng, Joyce; Sarin, Kavita Y

    2016-11-01

    Direct-to-consumer teledermatology is radically changing the way some patients obtain dermatologic care. Many direct-to-consumer teledermatology services offer care to patients younger than 18 years, but policies and standards are nonuniform. For pediatric patients, direct-to-consumer teledermatology is a substantial departure from in-person care. More consensus, standards, and guidelines are necessary. Copyright © 2016 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

  19. SU-E-T-619: Planning 131I Thyroid Treatments for Patients Requiring Hemodialysis

    SciTech Connect

    Stroud, D

    2015-06-15

    Purpose: Treatment of 131I thyroid cancer patients who also require regular hemodialysis (HD) treatments requires consideration of the administered activity and the HD schedule. In this work the red bone marrow is considered the dose limiting organ and the treatment plan optimized the HD schedule with the amount of radioactivity administered. Methods: The ‘Safe’ dose was considered to be 2 Gy (200 rad) to the red bone marrow.1 131Iodine doses of 50 mCi to 100 mCi were modeled and found to require a range of HD schedules. In order to achieve the safe dose to the red marrow, more aggressive HD schedules are required. 100 mCi required an aggressive HD treatment of every 24 hours for at least one week to achieve the ‘safe’ dose and an exposure appropriate for release from the hospital. A more normal schedule of HD beginning at 18 hours then every 48 hours allowed for up to 60 mCi administered dose allowed for a safe dose and expected release after less than one week.2In addition room was equipped with video cameras cameras for monitoring the patient and their vital signs from an adjacent room during HD. In this way the dialysis nurses were able to monitor the patient closely from an adjoining room. Results: Two HD patients were administered adjusted doses of about 50 mCi. The medical and nursing staff were exposed to no more than 4 mR for the entire treatment. The residual Iodine in the patient appeared to be normal after 4 to 6 days when the patient was released. Conclusion: With careful treatment planning 131Iodine treatments can be performed safely for patients needing HD and treatments appear to be as effective as those for patients with normal renal function.

  20. Methicillin-Resistant Staphylococcus aureus Infection Is a Risk Factor for Unplanned Return to the Operating Room in the Surgical Treatment of a Septic Knee.

    PubMed

    Jaffe, David; Costales, Timothy; Greenwell, Patrick; Christian, Matthew; Henn, Iii Ralph Frank

    2017-03-01

    Surgical irrigation and debridement is the mainstay of treatment after the diagnosis of a septic knee. Arthroscopic treatment has been validated as a treatment option, but there is limited literature comparing it to an open arthrotomy regarding risk factors for failing single-stage surgical treatment. A retrospective review of surgically treated native adult septic knees at one urban tertiary care center was conducted to evaluate rates of unplanned return to the operating room (OR) following both arthroscopic and open treatment of an adult septic knee. The primary outcome studied was unplanned return to the OR for persistent infection within 4 months of the initial surgery. Demographics, laboratory, and microbiology data were collected to identify factors associated with unplanned return visits to the OR. Fisher's exact tests and two-tailed paired Student's t-tests were used for categorical and continuous data comparisons, respectively. A multivariate analysis was performed to identify independent risk factors of initial washout failure. Thirty-three patients underwent arthroscopy and 47 had open arthrotomy. Eight failed arthroscopy and nine failed open treatment (75.8 and 80.9% success rates, p = 0.59). Unplanned repeat washouts in arthroscopically treated knees was associated with methicillin-resistant Staphylococcus aureus (MRSA) (62.5 vs. 12%, p = 0.01) and increased synovial white blood cell (WBC) count (160,000 vs. 52,000, p = 0.004). Unplanned return for repeat washout after open treatment was associated with lower American Society of Anesthesiologists scores (2.3 vs. 2.9, p = 0.019). MRSA was the only independent predictor of failure of single washout in a multivariable logistic regression analysis (p = 0.017). This study did not detect a difference in success of single washout between arthroscopic and open treatment of septic arthritis. However, MRSA was identified as a risk factor for an unplanned return to the OR after arthroscopic

  1. Strategizing EHR use to achieve patient-centered care in exam rooms: a qualitative study on primary care providers

    PubMed Central

    Zhang, Jing; Ashfaq, Shazia; Bell, Kristin; Calvitti, Alan; Farber, Neil J; Gabuzda, Mark T; Gray, Barbara; Liu, Lin; Rick, Steven; Street, Richard L; Zheng, Kai; Zuest, Danielle; Agha, Zia

    2016-01-01

    Objective Electronic health records (EHRs) have great potential to improve quality of care. However, their use may diminish “patient-centeredness” in exam rooms by distracting the healthcare provider from focusing on direct patient interaction. The authors conducted a qualitative interview study to understand the magnitude of this issue, and the strategies that primary care providers devised to mitigate the unintended adverse effect associated with EHR use. Methods and Materials Semi-structured interviews were conducted with 21 healthcare providers at 4 Veterans Affairs (VAs) outpatient primary care clinics in San Diego County. Data analysis was performed using the grounded theory approach. Results The results show that providers face demands from both patients and the EHR system. To cope with these demands, and to provide patient-centered care, providers attempt to perform EHR work outside of patient encounters and create templates to streamline documentation work. Providers also attempt to use the EHR to engage patients, establish patient buy-in for EHR use, and multitask between communicating with patients and using the EHR. Discussion and Conclusion This study has uncovered the challenges that primary care providers face in integrating the EHR into their work practice, and the strategies they use to overcome these challenges in order to maintain patient-centered care. These findings illuminate the importance of developing “best” practices to improve patient-centered care in today’s highly “wired” health environment. These findings also show that more user-centered EHR design is needed to improve system usability. PMID:26568605

  2. [Patient satisfaction when seen in the Emergency room of San Juan de Dios del Aljarafe Hospital (Spain)].

    PubMed

    Ruiz Romero, V; Fajardo Molina, J; García-Garmendia, J L; Cruz Villalón, F; Rodríguez Ortiz, R; Varela Ruiz, F J

    2011-01-01

    To find out the level of satisfaction of patients seen in the Emergency room of the of San Juan de Dios Hospital, Aljarafe; to identify the determining factors and to define the areas that need improvement and reinforcement in order to improve the quality of care. A telephone survey was carried out between July and September, 2008, containing 44 questions, 2 with a closed response, 3 with yes/no answers and the remaining questions scored based on a Likert type scale of 1 (most negative answer) to 5 (most positive answer). Observations were also recorded. Overall satisfaction was 84.7%: 82% would recommend this Emergency room, and 59.6% considered it better than others. The aspects to be emphasised are: respect (97.6%), cleanliness (97.1%) and intimacy (94.6%). Following these were: the doctor's disposition to listen (93.1%); the preparation of the professionals (from 92.3% for the administration professionals to 88.6% for auxiliary nurses); kindness (from 91.8% for doctors to 89.9% for nurses); and the ease of getting orientated (90%). The information given was evaluated positively by 70.3%, and 87% acknowledged understanding this information. However, 52.4% of patients were satisfied with the information given during triage related to the stay in the emergency room, and, 22.3% as regards the probable waiting period. The satisfaction with the waiting between triage and first medical consultation was higher in the one-two-triage patients and was lower in the four-triage ones; in the waiting between first medical consultation and the discharge, the one-triage patients were more satisfied than the rest. Nevertheless, there were no statistically significant differences with satisfaction with the waiting until the triage. The percentages of satisfaction was greater than 80% in 23 of the 34 items, with certain aspects having a satisfaction rate over 90%: respect, cleanliness, the doctor's predisposition to listen, qualification and kindness of the personnel. On the

  3. Motivating patient adherence to allergic rhinitis treatments.

    PubMed

    Bender, Bruce G

    2015-03-01

    Patient nonadherence significantly burdens the treatment of allergic rhinitis (AR). Fewer than half of prescribed doses of intranasal corticosteroid medication are taken. The challenges for immunotherapies are even greater. While sustained treatment for 3 to 5 years is required for full benefit, most patients receiving immunotherapy, either subcutaneous or sublingual, stop treatment within the first year. Although research into interventions to improve AR adherence is lacking, lessons learned from adherence interventions in other chronic health conditions can be applied to AR. Two well-established, overriding models of care-the chronic care model and patient-centered care-can improve adherence. The patient-centered care model includes important lessons for allergy providers in their daily practice, including understanding and targeting modifiable barriers to adherence. Additionally, recent studies have begun to leverage health information and communication technologies to reach out to patients and promote adherence, extending patient-centered interventions initiated by providers during office visits.

  4. Resource utilization, costs and treatment patterns of switching and discontinuing treatment of MS patients with high relapse activity

    PubMed Central

    2013-01-01

    Background Multiple sclerosis (MS) is a chronic disease that affects mainly adults in the prime of their lives. However, few studies report the impact of high annual relapse rates on outcomes. The purpose of this study was to identify high relapse activity (HRA) in patients with MS, comparing differences in outcomes between patients with and without HRA. Methods A retrospective longitudinal study was conducted using the MarketScan® Commercial Claims and Encounters and Medicare Supplemental Database. Patients had to have at least one ICD-9 for MS (340.XX) in 2009 and one in 2008, be older than 18 years, and have continuous enrolment in the years 2009–2010. HRA was defined as having ≥2 relapses in 2009. Multivariate analyses compared all-cause and MS-specific emergency room (ER) visits, hospitalizations, and all-cause costs, excluding disease modifying therapy (DMT) costs, in 2010 between patients with and without HRA, controlling for baseline characteristics. A subgroup analysis using treatment exposure was also performed. Results 19,219 patients were included: 5.3% (n=1,017) had ≥2 relapses in 2009. Patients with HRA were more likely to have all-cause and MS-specific resource utilization than patients without HRA. Mean total all-cause non DMT costs were $12,057 higher for the HRA group. In the subgroup analysis, HRA treatment-naïve patients were more likely to start treatment, and HRA treatment-experienced patients were more likely to discontinue or switch index DMT (P<0.01). Conclusions Patients with ≥2 relapses annually have higher resource utilization and costs. The difference in cost was over twice as large in treatment-naïve patients versus treatment-experienced patients. HRA was also associated with an increased likelihood of starting DMT treatment (treatment-naïve patients), and switching or discontinuing DMT therapy (treatment-experienced patients). PMID:23565628

  5. Length of stay, wait time to surgery and 30-day mortality for patients with hip fractures after the opening of a dedicated orthopedic weekend trauma room

    PubMed Central

    Taylor, Michel; Hopman, Wilma; Yach, Jeff

    2016-01-01

    Background In September 2011, Kingston General Hospital (KGH) opened a dedicated orthopedic weekend trauma room. Previously, 1 weekend operating room (OR) was used by all surgical services. We assessed the impact this dedicated weekend trauma room had on hospital length of stay (LOS), time to surgery and 30-day mortality for patients with hip fractures. Methods Patients admitted between Oct. 1, 2009, and Sept. 30, 2012, were identified through our trauma registry, representing the 2 years before and 1 year after the opening of the orthopedic weekend trauma room. We documented type of fracture, mode of fixation, age, sex, American Society of Anesthesiologists (ASA) score, time to OR, LOS, discharge disposition and 30-day mortality. We excluded patients with multiple fractures, open fractures and those requiring trauma team activation. Results Our study included 609 patients (405 pre- and 204 post–trauma room opening). Mean LOS decreased from 11.6 to 9.4 days (p = 0.005) and there was a decreasing trend in mean time to OR from 31.5 to 28.5 hours (p = 0.16). There was no difference in 30-day mortality (p = 0.24). The LOS decreased by an average of 2 days following opening of the weekend trauma room (p = 0.031) and by an average of 2.2 additional days if the patient was admitted on the weekend versus during the week (p = 0.024). Conclusion The weekend trauma OR at KGH significantly decreased the LOS and appears to have decreased wait times to surgery. Further analysis is needed to assess the cost-effectiveness of the current strategy, the long-term outcome of this patient population and the impact the additional orthopedic weekend trauma room has had on other surgical services (i.e., general surgery) and their patients. PMID:27668332

  6. Outcome of in-patient falls in hospitals with 100% single rooms and multi-bedded wards.

    PubMed

    Singh, Inderpal; Okeke, Justin; Edwards, Chris

    2015-11-01

    Falls in hospital account for almost two-fifths of the patient safety incidents reported to the National Reporting and Learning System in U.K. Studies have suggested an increased incidence of falls in single-bedded hospitals. To compare the outcome of in-patient falls occurring in units with 100% single rooms (SRs) and multi-bedded wards (M-BWs). SAMPLING DESIGN AND METHODS: An observational study. Retrospective standard incident reporting data (DATIX) on in-patient falls and associated injury were obtained from both sites over 18 months each. There was no change in demographics, size and characteristics of population except change in the geography of new hospitals. The total number of in-patient fall incidents reported over the 3 years was 1,749. The mean age of patients on M-BW and SR sites was 81.0 ± 2.4 (51.3% females) and 80.3 ± 10.3 (50.7% females), respectively. The mean incidence of falls/1,000 patient-bed days on M-BW and SR sites was 5.44 ± 4.76 and 15.82 ± 19.56, respectively (P < 0.01). Overall fracture incidence/1,000 patient-bed days on M-BW and SR sites was 0.07 ± 0.48 and 0.36 ± 1.52 (P < 0.01), respectively. The hip fracture incidence/1,000 patient-bed days on M-BW and SR sites was 0.04 ± 0.38 and 0.15 ± 1.00 (P < 0.01), respectively. One-year mortality from the date of first incident fall was lower in M-BWs (41.1%) compared with SRs (47.1%), but this is not significant (P = 0.12). This observational study shows a significantly increased incidence of falls and fracture in a hospital design with SRs compared with a multi-bedded facility. Consideration should be given to increased incidence of falls and falls-related injury in SRs when deciding on the percentage of single-room provision in new hospitals to admit frail older adults. © The Author 2015. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  7. Hypo- and hypernatraemia in surgical patients: is there room for improvement?

    PubMed

    Herrod, Philip J J; Awad, Sherif; Redfern, Andrew; Morgan, Linda; Lobo, Dileep N

    2010-03-01

    Up to 30% of surgical inpatients develop complications related to fluid and electrolyte therapy. We sought to study the occurrence of hypo- and hypernatraemia in these patients to inform current standards of care. This prospective audit took place over 80 days in a university hospital. Patients with a serum sodium concentration less than 130 or greater than 150 mmol/l were included. Daily intakes of Na(+), K(+) and Cl(-), and fluid balance were recorded before and after development of dysnatraemia. Fluid balance charts were assessed, as was the presence of documented patient weights. Patients were followed up until one of these milestones was reached: normonatraemia, death, or hospital discharge. During the study period 55 (4%) of the 1,383 surgical admissions met the inclusion criteria. Fifteen patients had hypernatraemia, 13 (87%) of whom were identified on ICU/HDU. In the days preceding the hypernatraemia, patients received (in mmol/day) a median (IQR) of 157 (76-344) Na(+), 38 (6-65) K(+), 157 (72-310) Cl(-), and 1.96 (1.13-2.96) L water. In the days preceding the hyponatraemia, patients received 50 (0-189) Na(+), 0 (0-10) K(+), 56 (0-188) Cl(-), and 1.45 (0-2.60) L water. Before the dysnatraemias only 28% of fluid balance charts were completed accurately. During the audit 42% of patients were not weighed. Dysnatraemic patients had a higher hospital mortality rate than those who did not develop dysnatraemia (12.7 vs. 2.3%, P < 0.001). Four percent of surgical inpatients developed dysnatraemias, which were associated with increased mortality. Fluid balance documentation was suboptimal and daily weights were not measured routinely, even in patients with severe electrolyte derangements.

  8. Miscarriages of psychoanalytic treatment with suicidal patients.

    PubMed

    Gabbard, Glen O

    2003-04-01

    The author describes a particularly perilous frontier on the psychoanalytic landscape--namely, the treatment of suicidal patients with serious personality disorders. Using a clinical example of egregious boundary violations by an analyst, he describes specific countertransference pitfalls that lead to mishandling the patients' expressions of suicidal despair. These include disidentification with the aggressor, failure of mentalization, collapse of the analytic play space, reactions to loss in the analyst's personal life, omnipotence, envy of the patient and masochistic surrender. The author emphasizes the unique vulnerabilities that accompany analytic treatment of such patients.

  9. Evaluating the effect of distractions in the operating room on clinical decision-making and patient safety.

    PubMed

    Murji, Ally; Luketic, Lea; Sobel, Mara L; Kulasegaram, Kulamakan Mahan; Leyland, Nicholas; Posner, Glenn

    2016-10-01

    Answering telephone calls and pagers is common distraction in the operating room. We sought to evaluate the impact of distractions on patient care by (1) assessing the accuracy and safety of responses to clinical questions posed to a surgeon while operating and (2) determining whether pager distractions affect simulation-based surgical performance. We conducted a randomized crossover study of obstetrics and gynecology residents. After studying a patient sign-out list, subjects performed a virtual salpingectomy. They were randomized to a distraction phase followed by quiet phase or vice versa. In the distraction phase, a pager beeped and subjects were asked questions based on the sign-out list. Accuracy of responses and the number of unsafe responses were recorded. In the quiet phase, trainees performed the task uninterrupted. Measures of surgical performance were successful task completion, time to task completion and operative blood loss. The mean score for correct responses to clinical questions during the distracted phase was 80 % (SD ±14 %). Nineteen residents (63 %) made at least 1 unsafe clinical decision while operating on the simulator (range 0-3). Subjects were more likely to successfully complete the surgical task in the allotted time under the quiet compared to distraction condition (OR 11.3, p = 0.03). There was no difference between the conditions in paired analysis for mean time (seconds) to task completion [426 (SD 133) vs. 440 (SD 186), p = 0.61] and mean operative blood loss (mL) [73.14 (SD 106) vs. 112.70 (SD 358), p = 0.47]. Distractions in the operating room may have a profound impact on patient safety on the wards. While multitasking in a simulated setting, the majority of residents made at least one unsafe clinical decision. Pager distractions also hindered surgical residents' ability to complete a simulated laparoscopic task in the allotted time without affecting other variables of surgical performance.

  10. A robust and non-obtrusive automatic event tracking system for operating room management to improve patient care.

    PubMed

    Huang, Albert Y; Joerger, Guillaume; Salmon, Remi; Dunkin, Brian; Sherman, Vadim; Bass, Barbara L; Garbey, Marc

    2016-08-01

    Optimization of OR management is a complex problem as each OR has different procedures throughout the day inevitably resulting in scheduling delays, variations in time durations and overall suboptimal performance. There exists a need for a system that automatically tracks procedural progress in real time in the OR. This would allow for efficient monitoring of operating room states and target sources of inefficiency and points of improvement. We placed three wireless sensors (floor-mounted pressure sensor, ventilator-mounted bellows motion sensor and ambient light detector, and a general room motion detector) in two ORs at our institution and tracked cases 24 h a day for over 4 months. We collected data on 238 total cases (107 laparoscopic cases). A total of 176 turnover times were also captured, and we found that the average turnover time between cases was 35 min while the institutional goal was 30 min. Deeper examination showed that 38 % of laparoscopic cases had some aspect of suboptimal activity with the time between extubation and patient exiting the OR being the biggest contributor (16 %). Our automated system allows for robust, wireless real-time OR monitoring as well as data collection and retrospective data analyses. We plan to continue expanding our system and to project the data in real time for all OR personnel to see. At the same time, we plan on adding key pieces of technology such as RFID and other radio-frequency systems to track patients and physicians to further increase efficiency and patient safety.

  11. Clinical and epidemiological characteristics of patients with influenza A (H1N1) 2009 attended to at the emergency room of a children's hospital.

    PubMed

    Lera, Esther; Wörner, Núria T; Sancosmed, Mónica; Fàbregas, Anna; Casquero, Alejandro; Melendo, Susana; Miserachs, Mar; Tórtola, Teresa; Borrego, Astrid; Campins, Magda; Moraga, Fernando; Figueras, Concepció; Cebrián, Rocío

    2011-03-01

    In June 2009, the first influenza pandemic of the twenty-first century, due to the swine origin influenza A (H1N1) 2009 virus, was declared. This study aimed to describe the epidemiological and clinical features, complications, lethality and risk factors for hospital admission of microbiologically confirmed cases of influenza A (H1N1) 2009 infection seen at the emergency department of a children's hospital. All cases of children with influenza A (H1N1) 2009 viral infection, confirmed microbiologically by real-time reverse transcription polymerase chain reactions and treated in the emergency room between July and December 2009, were prospectively included. Patients were compared according to admission requirement to study variables associated with the risk of hospitalisation. Oseltamivir was the antiviral used for the treatment and its safety was analysed. Four hundred and twelve patients with influenza A (H1N1) 2009 infection were included. The most frequent symptoms were: fever (96%), cough (95%) and coryza (90%). Eighty-five patients (20.6%) were admitted: three to the paediatric intensive care unit and two died. Hospitalised children were younger than those not admitted (median age 5 vs 8 years; p = 0.001). Age under 1 year (OR 6.01; CI 95% 2.77-13.05), pneumonia (OR 7.99; CI 95% 3.50-18.22) and haemoglobinopathy or underlying blood disorders (OR 5.99; CI 95% 1.32-27.30) were statistically significant risk factors for admission. No differences were observed regarding onset of antiviral treatment among admitted and non-admitted patients. Treatment with oseltamivir was well tolerated. In conclusion, the incidence of severe cases and lethality of influenza A (H1N1) 2009 infection were low in our setting, even in a population with risk factors for developing complications.

  12. [Cost analysis of the treatment of patients with multiple trauma].

    PubMed

    Rösch, M; Klose, T; Leidl, R; Gebhard, F; Kinzl, L; Ebinger, T

    2000-08-01

    Current clinical management after multiple trauma is expensive. The aim of the present study was to quantify the actual costs of inpatient treatment after multiple trauma in a German university hospital, to compare the actual costs with the reimbursement rates, and to identify important determinants of costs. Routine documentation of hospital costs at a patient level was not available. Therefore a method for calculating the costs of resource utilization during clinical treatment of patients was developed. The concept was based on financial and utilization data provided by the hospital administration and patient-specific data. The average costs per case in the study group (mean ISS = 37) were 73.613 DM, maximal costs were up to 292.490 DM. The most costly components were intensive care, accounting for 60%, followed by procedures in the operating room (24%). A comparison with the reimbursement rates resulted in an average loss of 23.211 DM per case. Factors significantly associated with the costs of acute care hospitalization were outcome, injury severity, pattern of injury, blood volume replacement, length of mechanical ventilation, and number of operations. Whereas patient age, CNS state, mechanism of injury, pre-hospital care, and time between accident and hospital admission revealed no effect. Given the current reimbursement rates, multiple trauma care clearly belongs to those categories of care which have to be subsidized within the hospital. Any challenge to the optimal level of care resulting from this should be avoided.

  13. The current status of procedural sedation for pediatric patients in out-of-operating room locations.

    PubMed

    Havidich, Jeana E; Cravero, Joseph P

    2012-08-01

    To illustrate the changes that are occurring in the rapidly growing field of pediatric sedation. In the USA and throughout the world, children receive sedation from a multitude of specialists with varying levels of training. The current pediatric sedation literature reflects a growing body of sedation literature by medical specialists other than anesthesiologists. This article will review the controversial use of propofol by nonanesthesiologists and the manner in which this varied group of providers along with government entities, regulatory agencies, and national organizations contribute to the continuing evolution of sedation practices. The number of diagnostic and therapeutic procedures performed on children outside of the operating room continues to increase. The growing body of pediatric sedation literature suggests anesthesiologists are no longer at the forefront of pediatric sedation training, education, and research. Articles published by nonanesthesiologists describe pediatric sedation services, safety, and quality initiatives, drugs, and original sedation research. Medications that were considered under the realm of anesthesiologists are utilized by nonanesthesiologists to provide sedation to children. Regulating and government agencies, including the Joint Commission and the Center for Medicaid and Medicare Services have recently issued statements on the oversight and practice of sedation. The direction of pediatric sedation is no longer solely under the leadership of anesthesiologists. The use of anesthetic agents, including propofol, have been administered by nonanesthesiologists and reported as safe and effective agents. Nonanesthesiologists and governmental and regulatory agencies influence the delivery of sedation services. The future direction of pediatric sedation will ultimately depend upon the ability of anesthesiologists to collaborate with specialists, hospital administrators, credentialing committees, and oversight agencies in order to

  14. A Novel ICU Hand-Over Tool: The Glass Door of the Patient Room.

    PubMed

    Wessman, Brian T; Sona, Carrie; Schallom, Marilyn

    2017-09-01

    Poor communication among health-care providers is cited as the most common cause of sentinel events involving patients. Patient care in the critical care setting is incredibly complex. A consistent care plan is necessary between day/night shift teams and among bedside intensive care unit (ICU) nurses, consultants, and physicians. Our goal was to create a novel, easily accessible communication device to improve ICU patient care. This communication improvement project was done at an academic tertiary surgical/trauma/mixed 36-bed ICU with an average of 214 admissions per month. We created a glass door template embossed on the glass that included 3 columns for daily goals to be written: "day team," "night team," and "surgery/consultant team." Assigned areas for tracking "lines," "antibiotics," "ventilator weaning," and "Deep vein thrombosis (DVT) screening" were included. These doors are filled out/updated throughout the day by all of the ICU providers. All services can review current plans/active issues while evaluating the patient at the bedside. Patient-identifying data are not included. We retrospectively reviewed all ICU safety reported events over a 4-year period (2 years prior/2 years after glass door implementation) for specific handover communication-related errors and compared the 2 cohorts. Information on the glass doors is entered daily on rounds by all services. Prior to implementation, 7.96% of reported errors were related to patient handover communication errors. The post glass-door era had 4.26% of reported errors related to patient handover communication errors with a relative risk reduction of 46.5%. Due to its usefulness, this method of communication was quickly adopted by the other critical care services (cardiothoracic, medical, neurology/neurosurgery, cardiology) at our institution and is now used for over 150 ICU beds. Our glass door patient handover tool is an easily adaptable intervention that has improved communication leading to an overall

  15. Interprofessional team assessments of the patient safety climate in Swedish operating rooms: a cross-sectional survey.

    PubMed

    Göras, Camilla; Unbeck, Maria; Nilsson, Ulrica; Ehrenberg, Anna

    2017-09-01

    A positive patient safety climate within teams has been associated with higher safety performance. The aim of this study was to describe and compare attitudes to patient safety among the various professionals in surgical teams in Swedish operating room (OR) departments. A further aim was to study nurse managers in the OR and medical directors' estimations of their staffs' attitudes to patient safety. A cross-sectional survey with the Safety Attitudes Questionnaire (SAQ) was used to elicit estimations from surgical teams. To evoke estimations from nurse managers and medical directors about staff attitudes to patient safety, a short questionnaire, based on SAQ, was used. Three OR departments at three different hospitals in Sweden participated. All licensed practical nurses (n=124), perioperative nurses (n=233), physicians (n=184) and their respective manager (n=22) were invited to participate. Mean percentage positive scores for the six SAQ factors and the three professional groups varied, and most factors (safety climate, teamwork climate, stress recognition, working conditions and perceptions of management), except job satisfaction, were below 60%. Significantly lower mean values were found for perioperative nurses compared with physicians for perceptions of management (56.4 vs 61.4, p=0.013) and working conditions (63.7 vs 69.8, p=0.007). Nurse managers and medical directors' estimations of their staffs' ratings of the safety climate cohered fairly well. This study shows variations and some weak areas for patient safety climate in the studied ORs as reported by front-line staff and acknowledged by nurse managers and medical directors. This finding is a concern because a weak patient safety climate has been associated with poor patient outcomes. To raise awareness, managers need to support patient safety work in the OR. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is

  16. Patients dropping out of treatment in Italy.

    PubMed

    Morlino, M; Martucci, G; Musella, V; Bolzan, M; de Girolamo, G

    1995-07-01

    The aim of this study was to explore the extent and the specific features of drop-out for patients having a first contact with an university psychiatric outpatient clinic in Italy over the course of 1 year and to determine which variables were associated with early termination of treatment. Of the 158 patients selected for this study, there was an overall 3-month drop-out rate following the first visit of 63%. Of the 59 patients who had returned once after the initial contact, 28 interrupted subsequently the treatment, although the therapist's plan included further visits. The overall drop-out rate at 3 months was thus 82%. The only 2 variables associated with drop-out rates were the patients' perception of the severity of their disorder and the psychiatric history: continuing patients were more frequently in agreement with the clinician's judgment as compared with those who dropped out and were more likely to have already been in psychiatric treatment.

  17. Pneumonia in hemodialysis patients: a challenging diagnosis in the emergency room.

    PubMed

    Judd, Eric; Ahmed, Mustafa I; Harms, James C; Terry, Nina L; Sonavane, Sushilkumar K; Allon, Michael

    2013-01-01

    Diagnosing pneumonia in hemodialysis patients is challenging. We hypothesized that pulmonary edema, which occurs commonly in hemodialysis patients, may frequently be misdiagnosed as pneumonia. We retrospectively reviewed the records of 105 hemodialysis patients admitted with the diagnosis of pneumonia. Two experienced radiologists masked to the clinical course and subsequent imaging, independently interpreted the admission chest radiographs. In 68 of the patients, 2 internists independently reviewed the hospitalization records to diagnose pneumonia and pulmonary edema. The level of agreement among the radiologists was assessed using the kappa test. Using the clinical diagnoses, chest radiograph attributes were calculated. Logistic regression was performed to identify clinical and laboratory markers associated with pneumonia and pulmonary edema. The radiologist showed slight agreement on pneumonia (κ = 0.32) and pulmonary edema (κ = 0.28). Using clinical consensus, pneumonia was diagnosed in only 21% (14/68) of patients. Chest radiograph attributes for diagnosing pneumonia included: sensitivity 50%, specificity 58%, positive predictive value 25% and negative predictive value 81%. Pneumonia was associated with presenting temperature (odds ratio [OR] = 
2.01; 95% CI, 1.03-3.93). Pulmonary edema was associated with shortness of breath (SOB) at admission 
(OR = 4.83; 95% CI, 1.25-18.6), presenting temperature (OR = 0.44; 95% CI, 0.21-0.92) and volume removed during hemodialysis (OR = 1.96; 95% CI, 1.16-3.31). The admission chest radiograph has significant limitations when used to diagnose pneumonia in hemodialysis patients. A high presenting temperature supports the diagnosis of pneumonia, while a low presenting temperature, SOB and large volume ultrafiltration favor the diagnosis of pulmonary edema.

  18. [Shuttle Challenger disaster: what lessons can be learned for management of patients in the operating room?].

    PubMed

    Suva, Domizio; Poizat, Germain

    2015-02-04

    For many years hospitals have been implementing crew resource management (CRM) programs, inspired by the aviation industry, in order to improve patient safety. However, while contributing to improved patient care, CRM programs are controversial because of their limited impact, a decrease in effectiveness over time, and the underinvestment by some caregivers. By analyzing the space shuttle Challenger accident, the objective of this article is to show the potential impact of the professional culture in decision-making processes. In addition, to present an approach by cultural factors which are an essential complement to current CRM programs in order to enhance the safety of care.

  19. Is "intra-operating room" thromboelastometry useful in liver transplantation? A case-control study in 303 patients.

    PubMed

    Alamo, J-M; León, A; Mellado, P; Bernal, C; Marín, L M; Cepeda, C; Suárez, G; Serrano, J; Padillo, J; Gómez, M-Á

    2013-01-01

    Coagulation monitoring during liver transplantation (LT) is, even today, fundamental to reduce blood loss during surgery. Thromboelastometry (TEM) is a proven technique for controlling the various parameters that influence coagulation. However, there are no studies linking "intra-operating room" TEM (orTEM) with LT outcomes. We describe a case-control study in 303 liver graft recipients analyzing variables associated with operative complications and long-term LT outcomes. The results showed that orTEM reduced the use of blood products in patients with Model for End-Stage Liver Disease scores of ≥ 21, retransplantation, and high surgical difficulty and important intraoperative bleeding. In addition, results in survival and postoperative complications were better when orTEM was used. In conclusion, we confirm that use of orTEM is associated with less use of blood products and a lower rate of complications after LT.

  20. Commissioning and clinical implementation of a sliding gantry CT scanner installed in an existing treatment room and early clinical experience for precise tumor localization.

    PubMed

    Cheng, Chee-Wai; Wong, James; Grimm, Lisa; Chow, Michael; Uematsu, Minoru; Fung, Albert

    2003-06-01

    The primary objective of the present study is to demonstrate that a unique computed tomography (CT)-linear accelerator combination can be used to reduce uncertainties caused by organ motion and setup inaccuracy. The acceptance, commissioning, and clinical implementation of a sliding gantry CT scanner installed in an existing linear accelerator room are reported in this paper. A Siemens CT scanner was installed directly opposite to an existing accelerator. The scanner is movable on a pair of horizontal rails mounted parallel to the longitudinal axis of the treatment couch replaced with a carbon fiber tabletop. Acceptance and commissioning of the CT scanner were verified with phantom studies. For clinical implementation, quality assurance (QA) procedures have been instituted to ensure the integrity of the CT gantry axis alignment and the accuracy of its movement using a phantom designed in house. A clinical example employing the CT-Linac combination to correct the isocenter positioning caused by organ motion and setup inaccuracy was presented for a prostate irradiation. Dose calculations were performed to study the effects on tumor coverage without the adjustments of the isocenter. A summary of the isocenter adjustments for the first 30 patients is also presented. The geometric accuracy of the CT scanner is < or =1 mm. An isocenter deviation of > or =2 mm from the original plan can be detected. For the clinical example of a prostate patient, the average movement of the prostate gland was found to be approximately 3mm in the anterior-posterior (AP/PA) direction and 5 mm in the cephalic-caudal direction. Variations in the isocenter position may result in underdosage of the PTV if correction is not made for the change in the isocenter position. Our experience with the first 30 patients indicates that while the left-right adjustment of the isocenter is minimal, in the AP/PA direction, about 33% of treatments required an adjustment of 3-5 mm, and about 18% required a 5

  1. A nosocomial epidemic model with infection of patients due to contaminated rooms.

    PubMed

    Browne, Cameron; Webb, Glenn F

    2015-08-01

    A model of epidemic bacterial infections in hospitals is developed. The model incorporates the infection of patients and the contamination of healthcare workers due to environmental causes. The model is analyzed with respect to the asymptotic behavior of solutions. The model is interpreted to provide insight for controlling these nosocomial epidemics.

  2. [The risk of infection with patients with multi-drug resistant bacteria in the operating room].

    PubMed

    Latroche, Marie-France; Roche, Géraldine; Velardo, Danielle

    2015-01-01

    The risk of infection in the operating theatre is constant and multifactorial. It can be contained through a prevention process. The organisation, implementation, monitoring and the results of the patient pathway are all sources for the analysis of practices, quality and professional progress in order to limit the risks of transmitting multi-drug or highly resistant bacteria.

  3. Measuring patient attributes and engagement in treatment.

    PubMed

    Joe, George W; Broome, Kirk M; Rowan-Szal, Grace A; Simpson, D Dwayne

    2002-06-01

    Brief but comprehensive instruments measuring patient motivation, psychosocial functioning, treatment process, social network support, and services received are needed for monitoring drug abuse treatment delivery and patient progress. Combining this information across patients within a program also provides useful indicators about institutional composition and functioning. Consequently, the same assessment tools can be used to identify areas where treatment protocols need to be changed, and to monitor improvements following such changes. The Texas Christian University (TCU) Client Evaluation of Self and Treatment (CEST)(1) is a 144-item self-rating instrument that includes 16 scales measuring patient functioning and treatment perceptions. Psychometric properties (including reliability and construct validity) of the scales are examined in this article, based on patient samples drawn from 87 programs that participated in a series of staff training workshops. Acceptable reliabilities (.70 or above) were generally reported, and construct validity was also demonstrated (although the confirmatory factor analyses suggested some item pools could represent more than one factor). Prediction analyses were conducted using selected scales from each measurement domain to illustrate their sensitivity to treatment program contexts.

  4. Dental Treatment in Patients with Leukemia

    PubMed Central

    Meurer, Maria Inês; Grando, Liliane Janete; Gonzaga Del Moral, Joanita Ângela; da Silva Rath, Inês Beatriz; Schaefer Tavares, Silvia

    2015-01-01

    Dental treatment of patients with leukemia should be planned on the basis of antineoplastic therapy which can be chemotherapy with or without radiotherapy and bone marrow transplantation. Many are the oral manifestations presented by these patients, arising from leukemia and/or treatment. In addition, performing dental procedures at different stages of treatment (before, during, or after) must follow certain protocols in relation to the haematological indices of patients, aimed at maintaining health and contributing to the effectiveness of the results of antineoplastic therapy. Through a literature review, the purpose of this study was to report the hematological abnormalities present in patients with leukemia, trying to correlate them with the feasibility of dental treatment at different stages of the disease. It is concluded in this paper that dental treatment in relation to haematological indices presented by patients with leukemia must follow certain protocols, mainly related to neutrophil and platelet counts, and the presence of the dentist in a multidisciplinary team is required for the health care of this patient. PMID:25784937

  5. Treatment Opportunities in Patients With Metabolic Myopathies.

    PubMed

    Ørngreen, Mette Cathrine; Vissing, John

    2017-09-21

    Metabolic myopathies are disorders affecting utilization of carbohydrates or fat in the skeletal muscle. Adult patients with metabolic myopathies typically present with exercise-induced pain, contractures or stiffness, fatigue, and myoglobinuria. Symptoms are related to energy failure. Purpose of review In this review, the current treatment options, including exercise therapy, dietary treatment, pharmacological supplementation, gene transcription, and enzyme replacement therapy, are described. Recent findings Recognition of the metabolic block in the metabolic myopathies has started the development of new therapeutic options. Enzyme replacement therapy with rGAA has revolutionized treatment of early onset Pompe disease. Supplements of riboflavin, carnitine, and sucrose show promise in patients with respectively riboflavin-responsive multiple acyl-CoA dehydrogenase deficiency, primary carnitine deficiency, and McArdle disease. Treatment with citric acid cycle intermediates supply by triheptanoin seems promising in patients with glucogenoses, and studies are ongoing in patients with McArdle disease. Summary Treatment of metabolic myopathies primarily relies on avoiding precipitating factors and dietary supplements that bypass the metabolic block. Only a few of the used supplements are validated, and further studies are needed to define efficacious treatments. Further potential treatment targets are molecular therapies aimed at enzyme correction, such as chaperone therapy, gene therapy, gene expression therapy, and enzyme replacement therapies.

  6. At Your Request(®) room service dining improves patient satisfaction, maintains nutritional status, and offers opportunities to improve intake.

    PubMed

    Doorduijn, Astrid S; van Gameren, Yvonne; Vasse, Emmelyne; de Roos, Nicole M

    2016-10-01

    Malnutrition in hospitals may be combatted by improving the meal service. To evaluate whether At Your Request(®), a meal service concept by Sodexo with a restaurant style menu card and room service, improved patient satisfaction, nutritional status, and food intake compared to the traditional 3-meals per day service. We prospectively collected data in Hospital Gelderse Vallei (Ede, the Netherlands) before (2011/2012; n = 168, age 63 ± 15 y) and after (2013/2014; n = 169, 66 ± 15 y) implementing At Your Request(®). Patient satisfaction increased after implementing At Your Request(®) from 7.5 to 8.1 (scale 1-10) and from 124.5 to 132.9 points on a nutrition-related quality of life questionnaire (p < 0.05). Body weight and handgrip strength did not significantly change in both periods. At admission, more patients in the At Your Request(®) period had risk of malnutrition (MUST ≥ 1; 47 vs 37). MUST scores improved in 18 patients in both periods. With At Your Request(®) 0.92 g protein per kg (g/kg) bodyweight was ordered. Protein intake based on food records from patients on an energy and protein enriched diet was 0.84 g/kg during At Your Request(®) (n = 38) versus 0.91 g/kg during the traditional meal service (n = 34). At Your Request(®) is a highly rated hospital menu concept that helps patients to maintain nutritional status. The concept offers options for improving the intake of specific nutrients and foods, which should be evaluated in further studies. Copyright © 2015 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

  7. Compliance with dental treatment recommendations by rural paediatric patients after a live-video teledentistry consultation: A preliminary report.

    PubMed

    McLaren, Sean W; Kopycka-Kedzierawski, Dorota T

    2016-04-01

    The purpose of this research was to assess the compliance rate with recommended dental treatment by rural paediatric dental patients after a live-video teledentistry consultation. A retrospective dental chart review was completed for 251 rural paediatric patients from the Finger Lakes region of New York State who had an initial teledentistry appointment with a paediatric dentist located remotely at the Eastman Institute for Oral Health in Rochester, NY. The recommended treatment modalities were tabulated and comprehensive dental treatment completion rates were obtained. The recommended treatment modality options of: treatment in the paediatric dental clinic; treatment using nitrous oxide anxiolysis; treatment with oral sedation; treatment in the operating room with general anaesthesia; or teleconsultation were identified for the 251 patients. Compliance rates for completed dental treatment based on initial teleconsultation recommendations were: 100% for treatment in the paediatric dental clinic; 56% for nitrous oxide patients; 87% for oral sedation; 93% for operating room; and 90% for teleconsultations. The differences in the compliance rates for all treatment modalities were not statistically significant (Fisher's exact test, p > 0.05). Compliance rates for completed comprehensive dental treatment for this rural population of paediatric dental patients were quite high, ranging from 56% to 100%, and tended to be higher when treatment was completed in fewer visits. Live-video teledentistry consultations conducted among rural paediatric patients and a paediatric dentist in the specialty clinic were feasible options for increasing dental treatment compliance rates when treating complex paediatric dental cases. © The Author(s) 2015.

  8. Current treatments for patients with Alzheimer disease.

    PubMed

    Osborn, Gerald G; Saunders, Amanda Vaughn

    2010-09-01

    There is neither proven effective prevention for Alzheimer disease nor a cure for patients with this disorder. Nevertheless, a spectrum of biopsychosocial therapeutic measures is available for slowing progression of the illness and enhancing quality of life for patients. These measures include a range of educational, psychological, social, and behavioral interventions that remain fundamental to effective care. Also available are a number of pharmacologic treatments, including prescription medications approved by the US Food and Drug Administration for Alzheimer disease, "off-label" uses of medications to manage target symptoms, and controversial complementary therapies. Physicians must make the earliest possible diagnosis to use these treatments most effectively. Physicians' goals should be to educate patients and their caregivers, to plan long-term care options, to maximally manage concurrent illnesses, to slow and ameliorate the most disabling symptoms, and to preserve effective functioning for as long as possible. The authors review the various current treatments for patients with Alzheimer disease.

  9. Invisalign treatment in periodondal patient: case report

    PubMed Central

    BARLATTANI, A.; MAMPIERI, G.; OTTRIA, L.; BOLLERO, P.

    2010-01-01

    SUMMARY Scope of work. To evaluate the results obtained from the use of removable orthodontic aligners in patients with periodontal and systemic issues to improve the aesthetics of the smile. Materials and methods. Invisalign technique, a new technique based on the use of orthodontic removable transparent overlay representing the mechanotherapy. This technique through a dedicated software (Clin-Check) enables you to view the 3D resolution of the malocclusion. Results. In the case study examined the results support the Invisalign treatment in periodontal patients with a systemic disease, both for an easier home oral hygiene and also to maintain alignment and an aesthetic smile achieved without the use of invasive techniques. Conclusion. The Invisalign orthodontic treatment is ideal for patients with periodontal problems. The removal of the masks ensures control of normal oral hygiene but also requires the cooperation of the patient during the treatment. PMID:23285373

  10. Invisalign treatment in periodondal patient: case report.

    PubMed

    Barlattani, A; Mampieri, G; Ottria, L; Bollero, P

    2009-10-01

    SCOPE OF WORK.: To evaluate the results obtained from the use of removable orthodontic aligners in patients with periodontal and systemic issues to improve the aesthetics of the smile. MATERIALS AND METHODS.: Invisalign technique, a new technique based on the use of orthodontic removable transparent overlay representing the mechanotherapy. This technique through a dedicated software (Clin-Check) enables you to view the 3D resolution of the malocclusion. RESULTS.: In the case study examined the results support the Invisalign treatment in periodontal patients with a systemic disease, both for an easier home oral hygiene and also to maintain alignment and an aesthetic smile achieved without the use of invasive techniques. CONCLUSION.: The Invisalign orthodontic treatment is ideal for patients with periodontal problems. The removal of the masks ensures control of normal oral hygiene but also requires the cooperation of the patient during the treatment.

  11. The impact of electronic health records on care of heart failure patients in the emergency room

    PubMed Central

    Park, Young-Taek; Du, Jing; Theera-Ampornpunt, Nawanan; Gordon, Bradley D; Bershow, Barry A; Gensinger, Raymond A; Shrift, Michael; Routhe, Daniel T; Speedie, Stuart M

    2011-01-01

    Objective To evaluate if electronic health records (EHR) have observable effects on care outcomes, we examined quality and efficiency measures for patients presenting to emergency departments (ED). Materials and methods We conducted a retrospective study of 5166 adults with heart failure in three metropolitan EDs. Patients were termed internal if prior information was in the EHR upon ED presentation, otherwise external. Associations of internality with hospitalization, mortality, length of stay (LOS), and numbers of tests, procedures, and medications ordered in the ED were examined after adjusting for age, gender, race, marital status, comorbidities and hospitalization as a proxy for acuity level where appropriate. Results At two EDs internals had lower odds of mortality if hospitalized (OR 0.55; 95% CI 0.38 to 0.81 and 0.45; 0.21 to 0.96), fewer laboratory tests during the ED visit (−4.6%; −8.9% to −0.1% and −14.0%; −19.5% to −8.1%) as well as fewer medications (−33.6%; −38.4% to −28.4% and −21.3%; −33.2% to −7.3%). At one of these two EDs, internals had lower odds of hospitalization (0.37; 0.22 to 0.60). At the third ED, internal patients only experienced a prolonged ED LOS (32.3%; 6.3% to 64.8%) but no other differences. There was no association with hospital LOS or number of procedures ordered. Discussion EHR availability was associated with salutary outcomes in two of three ED settings and prolongation of ED LOS at a third, but evidence was mixed and causality remains to be determined. Conclusions An EHR may have the potential to be a valuable adjunct in the care of heart failure patients. PMID:22071528

  12. Stories from the sealed rooms: patient interviews during the Gulf war.

    PubMed

    Borkan, J; Shvartzman, P; Reis, S; Morris, A G

    1993-06-01

    The mass deployment of gas masks to an entire population, which occurred in Israel prior to the Persian Gulf crisis and their use in early 1991, were phenomena without precedent. In addition to the historical significance, there were considerable health and psychological ramifications. This research examines the experiences of the Israeli public during the Gulf war using a qualitative methodological approach, narrative analysis. Interviews of a convenience sample of 60 patients attending primary care clinics were audio-recorded by three family physicians using an open-ended interview guide. Encounters took place at sites located in the north, south and centre of the country during the period of Iraqi missile attacks. Patients' stories were analysed using a multistep narrative analysis protocol. Seventy per cent of subjects reported deleterious health effects related to the missile attacks or civil defence measures, mainly psychological and neurological complaints, sleep disorders, gastrointestinal and respiratory symptoms. Recurrent themes and metaphors in the narratives most often focused on the difference of this war to others, the central involvement of the family, concern for children and identification and connection to the nation. The Scud missile attacks combined with the civil defence measures had significant impact on the population, as manifested in subjects' stories, symptoms, symbols and behaviour. Narrative analysis provided an efficient method to capture the rich texture of patients' experiences.

  13. Adjuvant treatment of GIST: patient selection and treatment strategies.

    PubMed

    Joensuu, Heikki

    2012-04-24

    Tyrosine kinase inhibitors that target the key molecular drivers of gastrointestinal stromal tumour (GIST) are effective treatments of advanced-stage GIST. Yet, most of these patients succumb to the disease. Approximately 60% of patients with GIST are cured by surgery, and these individuals can be identified by risk stratification schemes based on tumour size, mitosis count and site, and assessment of rupture. Two large randomized trials have evaluated imatinib as adjuvant treatment for operable, KIT-positive GIST; adjuvant imatinib substantially improved time to recurrence. One of these trials reported that 3 years of adjuvant imatinib improves overall survival of patients who have a high estimated risk for recurrence of GIST compared with 1 year of imatinib. The optimal adjuvant strategy remains unknown and some patients might benefit from longer than 3 years of imatinib treatment. However, a strategy that involves GIST risk assessment following surgery using a validated scheme, administration of adjuvant imatinib for 3 years, patient monitoring during and after completion of imatinib to detect recurrence early, and reinstitution of imatinib if GIST recurs is a reasonable choice for care of patients with high-risk GIST.

  14. Association between weather conditions and the number of patients at the emergency room in an Argentine hospital

    NASA Astrophysics Data System (ADS)

    Rusticucci, Matilde; Bettolli, Laura M.; de los Angeles Harris, M.

    2002-02-01

    The aim of this paper is to study the relationships between hospital emergencies and weather conditions by analysing summer and winter cases of patients requiring attention at the emergency room of a hospital in the city of Buenos Aires, Argentina. Hospital data have been sorted into seven different diagnostic groups as follows: (1) respiratory, cardiovascular and chest-pain complaints; (2) digestive, genitourinary and abdominal complaints; (3) neurological and psychopathological disorders; (4) infections; (5) contusion and crushing, bone and muscle complaints; (6) skin and allergies and (7) miscellaneous complaints. In general, there is an increase of 16.7% in winter while, for group 2 and group 6, there are more patients in summer, 54% and 75% respectively. In summer, the total number of patients for group 6 shows a significant positive correlation with temperature and dew-point temperature, and a negative correlation with the sea-level pressure for the same day. In winter, the same relationship exists, however its correlation is not as strong. The lags observed between these three variables: maximum dew-point temperature, maximum temperature, minimum air pressure and the peaks in admissions are 1, 2 and 4 days respectively. In winter, increases in temperature and dew point and decreases in pressure are followed by a peak in admissions for group 2. In winter, there are significantly more cases in group 5 on warm, dry days and on warm, wet days in the summer.

  15. Considering patient values and treatment preferences enhances patient involvement in rectal cancer treatment decision making.

    PubMed

    Kunneman, Marleen; Marijnen, Corrie A M; Baas-Thijssen, Monique C M; van der Linden, Yvette M; Rozema, Tom; Muller, Karin; Geijsen, Elisabeth D; Stiggelbout, Anne M; Pieterse, Arwen H

    2015-11-01

    The shared decision making (SDM) model states that patients' values and preferences should be clarified to choose a strategy that best fits the patient. This study aimed to assess whether values and preferences of rectal cancer patients are voiced and considered in deciding about preoperative radiotherapy (PRT), and whether this makes patients feel more involved in treatment decision making. Pre-treatment consultations of radiation oncologists and patients eligible for PRT were audiotaped (N=90). Tapes were transcribed and coded to identify patients' values and treatment preferences. Patients filled in a post-consultation questionnaire on their perceived involvement in decision making (N=60). Patients' values were voiced for 62/611 of benefits/harms addressed (10%), in 38/90 consultations (42%; maximum 4 values per consultation), and most often related to major long-term treatment outcomes. Patients' treatment preferences were discussed in 20/90 consultations (22%). In 16/90 consultations (18%), the oncologists explicitly indicated to consider patients' values or preferences. Patients perceived a significantly more active role in decision making if their values or preferences had been voiced or considered. Patients' values and treatment preferences are voiced or considered in a minority of consultations. If they are, this increases patients' perceived involvement in the decision making process. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  16. The effects of nature images on pain in a simulated hospital patient room.

    PubMed

    Vincent, Ellen; Battisto, Dina; Grimes, Larry; McCubbin, James

    2010-01-01

    Views of nature have been reported to relieve stress and pain, making nature an ideal medium for use in healthcare settings. In hospitals whose design does not allow for a view of nature, virtual and surrogate views of nature may be viable therapeutic options. This study tests the effects of specific nature images, as defined by Appleton's prospect refuge theory of landscape preference, on participants experiencing pain. The hypotheses were: (1) Nature views are variable in their impact on specific psychological and physiological health status indicators; and (2) Prospect and refuge nature scenes are more therapeutic than hazard nature scenes. The research question was (1) Which nature image categories are most therapeutic as evidenced by reduced pain and positive mood? An experiment using mixed methods assessed the effects of four different nature scenes on physiological (blood pressure, heart rate) and psychological (mood) responses when a person was subjected to a pain stressor. Four groups were subjected to a specific nature image category of prospect, refuge, hazard, or mixed prospect and refuge; the fifth group viewed no image. The Short-Form McGill Pain Questionnaire and the Profile of Mood States survey instruments were used to assess pain and mood, respectively. Continuous physiological readings of heart rate and blood pressure were collected. Pain was induced through a cold pressor task, which required participants to immerse their nondominant hand in ice water for up to 120 seconds. The mixed prospect and refuge image treatment showed significantly lower sensory pain responses, and the no-image treatment indicated significantly higher affective pain perception responses. The hazard image treatment had significantly lower diastolic blood pressure readings during the pain treatment, but it also had significantly high total mood disturbance. Although there was no clear "most" therapeutic image, the mixed prospect and refuge image showed significant

  17. Treatment of the multiply injured patient: plans for treatment and problems of major trauma.

    PubMed

    Dabezies, E J; D'Ambrosia, R D

    1984-01-01

    Certain principles involved in the treatment of fractures have stood the test of time. The thrust of modern orthopaedics has been to decrease morbidity by combining these principles with developments in physiology, bioengineering, radiology, and antibiotics. The goal remains anatomic bone union without infection and normal joint and muscle function. The surgeon's mission is to achieve this goal. For the multiply injured patient, survival depends on the quality of care. Surgical orientation permits one to stabilize the fractures and restore the patient to activities of daily living. Multiple fractures set the stage for multiple organ failure, and, as we have discussed, stabilization reduces the incidence of these problems. Basically, open fractures must be stabilized with plaster, traction, or surgery. Multiple fractures need rigid stabilization, which can be achieved with various techniques without jeopardizing limb or life. A simple, comprehensive plan should be implemented when the patient arrives in the emergency room. Treatment requires an interdisciplinary approach, with the surgeon heading a team of physicians, nurses, and technicians capable of handling the complications of each organ system. Teamwork and dedication to excellence by all involved will decrease mortality and morbidity. Survival is to be anticipated. If we have restored the anatomy early, before any organ failure, we are then ready to begin rehabilitation and achieve a much finer and enduring end result for the injured patient.

  18. Formulating an effective response to emergency room drug diversion by drug seeking patients.

    PubMed

    Clark, Sam

    2009-01-01

    Drug diversion has become a $100 billion a year problem for the healthcare industry. By far the leading source of such diversion is the obtaining of prescription drugs by bogus patients from ER staff, the author claims. Solving the problem will not be easy, he says, because drug seekers are experts in avoiding detection or in persuading health providers to supply them with the pharmaceuticals they want. But, he adds, a program for reducing such diversion in your health facility can be successful if a multi-disciplinary approach is taken. Such a program is described in this article.

  19. A Case Study to Improve Emergency Room Patient Flow at Womack Army Medical Center

    DTIC Science & Technology

    2009-06-01

    and School; (Army-Baylor Program in Health 3151 Scott Road, Suite 1411; 78234-6135 11 . SPONSOR/MONITOR’S REPORT NUMBER(S) 2-09 12. DISTRIBUTION...leadership over the last year , provided a realistic perspective that allowed me to truly grasp the challenges of being the front door for Fort Bragg...and completing this project over the last two years . Womack ED Patient Flow case study 2 Abstract This graduate project is a case study on how to

  20. [Nuclear magnetic resonance based metabolic phenotyping for patient evaluations in operating rooms and intensive care units].

    PubMed

    Blaise, B J; Gouel-Chéron, A; Floccard, B; Monneret, G; Plaisant, F; Chassard, D; Javouhey, E; Claris, O; Allaouchiche, B

    2014-03-01

    Metabolic phenotyping consists in the identification of subtle and coordinated metabolic variations associated with various pathophysiological stimuli. Different analytical methods, such as nuclear magnetic resonance, allow the simultaneous quantification of a large number of metabolites. Statistical analyses of these spectra thus lead to the discrimination between samples and the identification of a metabolic phenotype corresponding to the effect under study. This approach allows the extraction of candidate biomarkers and the recovery of perturbed metabolic networks, driving to the generation of biochemical hypotheses (pathophysiological mechanisms, diagnostic tests, therapeutic targets…). Metabolic phenotyping could be useful in anaesthesiology and intensive care medicine for the evaluation, monitoring or diagnosis of life-threatening situations, to optimise patient managements. This review introduces the physical and statistical fundamentals of NMR-based metabolic phenotyping, describes the work already achieved by this approach in anaesthesiology and intensive care medicine. Finally, potential areas of interest are discussed for the perioperative and intensive management of patients, from newborns to adults. Copyright © 2013 Société française d’anesthésie et de réanimation (Sfar). Published by Elsevier SAS. All rights reserved.

  1. Rui Liao's work on patient-specific 3-D model guidance for interventional and hybrid-operating-room applications.

    PubMed

    Liao, Rui

    2011-06-28

    Compared to surgery, interventional and hybrid-operating-room (OR) approaches diagnose or treat pathology with the most minimally invasive techniques possible. By minimizing the physical trauma to the patient, peripheral or hybrid approaches can reduce infection rates and recovery time as well as shorten hospital stays. Minimally invasive approaches therefore are the trend and often the preferred choice, and may even be the only option for the patients associated with high surgery risks. Common interventional imaging modalities include 2-D X-ray fluoroscopy and ultrasound. However, fluoroscopic images do not display the anatomic structures without a contrast agent, which on the other hand, needs to be minimized for patients' safety. Ultrasound images suffer from relatively low image quality and tissue contrast problems. To augment the doctor's view of the patient's anatomy and help doctors navigate the devices to the targeted area with more confidence and a higher accuracy, high-resolution pre-operative volumetric data such as computed tomography and/or magnetic resonance can be fused with intra-operative 2-D images during interventions. A seamless workflow and accurate 2-D/3-D registration as well as cardiac and/or respiratory motion compensation are the key components for a successful image guidance system using a patient-specific 3-D model. Dr. Liao's research has been focused on developing methods and systems of 3-D model guidance for various interventions and hybrid-OR applications. Dr. Liao's work has led to several Siemens products with high clinical and/or market impact and a good number of scientific publications in leading journals/conferences on medical imaging.

  2. Changes in Stroke Volume Induced by Lung Recruitment Maneuver Predict Fluid Responsiveness in Mechanically Ventilated Patients in the Operating Room.

    PubMed

    Biais, Matthieu; Lanchon, Romain; Sesay, Musa; Le Gall, Lisa; Pereira, Bruno; Futier, Emmanuel; Nouette-Gaulain, Karine

    2017-02-01

    Lung recruitment maneuver induces a decrease in stroke volume, which is more pronounced in hypovolemic patients. The authors hypothesized that the magnitude of stroke volume reduction through lung recruitment maneuver could predict preload responsiveness. Twenty-eight mechanically ventilated patients with low tidal volume during general anesthesia were included. Heart rate, mean arterial pressure, stroke volume, and pulse pressure variations were recorded before lung recruitment maneuver (application of continuous positive airway pressure of 30 cm H2O for 30 s), during lung recruitment maneuver when stroke volume reached its minimal value, and before and after volume expansion (250 ml saline, 0.9%, infused during 10 min). Patients were considered as responders to fluid administration if stroke volume increased greater than or equal to 10%. Sixteen patients were responders. Lung recruitment maneuver induced a significant decrease in mean arterial pressure and stroke volume in both responders and nonresponders. Changes in stroke volume induced by lung recruitment maneuver were correlated with those induced by volume expansion (r = 0.56; P < 0.0001). A 30% decrease in stroke volume during lung recruitment maneuver predicted fluid responsiveness with a sensitivity of 88% (95% CI, 62 to 98) and a specificity of 92% (95% CI, 62 to 99). Pulse pressure variations more than 6% before lung recruitment maneuver discriminated responders with a sensitivity of 69% (95% CI, 41 to 89) and a specificity of 75% (95% CI, 42 to 95). The area under receiver operating curves generated for changes in stroke volume induced by lung recruitment maneuver (0.96; 95% CI, 0.81 to 0.99) was significantly higher than that for pulse pressure variations (0.72; 95% CI, 0.52 to 0.88; P < 0.05). The authors' study suggests that the magnitude of stroke volume decrease during lung recruitment maneuver could predict preload responsiveness in mechanically ventilated patients in the operating room.

  3. Patient assessment and diagnosis in implant treatment.

    PubMed

    Zitzmann, N U; Margolin, M D; Filippi, A; Weiger, R; Krastl, G

    2008-06-01

    As in any dental treatment procedure, a thorough patient assessment is a prerequisite for adequate treatment planning including dental implants. The literature was searched for references to patient assessment in implant treatment up to September 2007 in Medline via PubMed and an additional handsearch was performed. Patient assessment included the following aspects: (1) evaluation of patient's history, his/her complaints, desires and preferences; (2) extra-and intra-oral examination with periodontal and restorative status of the remaining dentition; (3) obligatory prerequisites were a panoramic radiograph and periapical radiographs (at least from the adjacent teeth) for diagnosis and treatment planning. Additional tomographs are required depending on the anatomic situation and the complexity of the planned restoration; (4) study casts are needed especially in more complex situations also requiring a diagnostic set-up, which can be tried-in and transferred into a provisional restoration as well as into a radiographic and surgical template. The current review clearly revealed the necessity for a thorough, structured patient assessment. Following an evaluation, a recommendation is given for implant therapy or, if not indicated, conventional treatment alternatives can be presented.

  4. Evaluating markers for selecting a patient's treatment.

    PubMed

    Song, Xiao; Pepe, Margaret Sullivan

    2004-12-01

    Selecting the best treatment for a patient's disease may be facilitated by evaluating clinical characteristics or biomarker measurements at diagnosis. We consider how to evaluate the potential impact of such measurements on treatment selection algorithms. For example, magnetic resonance neurographic imaging is potentially useful for deciding whether a patient should be treated surgically for Carpal Tunnel Syndrome or should receive less-invasive conservative therapy. We propose a graphical display, the selection impact (SI) curve that shows the population response rate as a function of treatment selection criteria based on the marker. The curve can be useful for choosing a treatment policy that incorporates information on the patient's marker value exceeding a threshold. The SI curve can be estimated using data from a comparative randomized trial conducted in the population as long as treatment assignment in the trial is independent of the predictive marker. Estimating the SI curve is therefore part of a post hoc analysis to determine whether the marker identifies patients that are more likely to benefit from one treatment over another. Nonparametric and parametric estimates of the SI curve are proposed in this article. Asymptotic distribution theory is used to evaluate the relative efficiencies of the estimators. Simulation studies show that inference is straightforward with realistic sample sizes. We illustrate the SI curve and statistical inference for it with data motivated by an ongoing trial of surgery versus conservative therapy for Carpal Tunnel Syndrome.

  5. Ceiling art in a radiation therapy department: its effect on patient treatment experience

    PubMed Central

    Bonett, Jotham

    2015-01-01

    Introduction A new initiative has been implemented at the Sunshine Hospital Radiation Therapy Centre, to provide a calming and comforting environment for patients attending radiation therapy treatment. As part of this initiative, the department's computed tomography (CT) room and radiation therapy bunkers were designed to incorporate ceiling art that replicates a number of different visual scenes. The study was undertaken to determine if ceiling art in the radiation therapy treatment CT and treatment bunkers had an effect on a patient's experience during treatment at the department. Additionally, the study aimed to identify which of the visuals in the ceiling art were most preferred by patients. Methods Patients were requested to complete a 12-question survey. The survey solicited a patient's opinion/perception on the unit's unique ceiling display with emphasis on aesthetic appeal, patient treatment experience and the patient's engagement due to the ceiling display. The responses were dichotomised to ‘positive’ or ‘negative’. Every sixth patient who completed the survey was invited to have a general face-to-face discussion to provide further information about their thoughts on the displays. Results The results demonstrate that the ceiling artwork solicited a positive reaction in 89.8% of patients surveyed. This score indicates that ceiling artwork contributed positively to patients’ experiences during radiation therapy treatment. Conclusion The study suggests that ceiling artwork in the department has a positive effect on patient experience during their radiation therapy treatment at the department. PMID:26451241

  6. Ceiling art in a radiation therapy department: its effect on patient treatment experience

    SciTech Connect

    Bonett, Jotham

    2015-09-15

    A new initiative has been implemented at the Sunshine Hospital Radiation Therapy Centre, to provide a calming and comforting environment for patients attending radiation therapy treatment. As part of this initiative, the department's computed tomography (CT) room and radiation therapy bunkers were designed to incorporate ceiling art that replicates a number of different visual scenes. The study was undertaken to determine if ceiling art in the radiation therapy treatment CT and treatment bunkers had an effect on a patient's experience during treatment at the department. Additionally, the study aimed to identify which of the visuals in the ceiling art were most preferred by patients. Patients were requested to complete a 12-question survey. The survey solicited a patient's opinion/perception on the unit's unique ceiling display with emphasis on aesthetic appeal, patient treatment experience and the patient's engagement due to the ceiling display. The responses were dichotomised to ‘positive’ or ‘negative’. Every sixth patient who completed the survey was invited to have a general face-to-face discussion to provide further information about their thoughts on the displays. The results demonstrate that the ceiling artwork solicited a positive reaction in 89.8% of patients surveyed. This score indicates that ceiling artwork contributed positively to patients’ experiences during radiation therapy treatment. The study suggests that ceiling artwork in the department has a positive effect on patient experience during their radiation therapy treatment at the department.

  7. [Anesthetic management of patients with mental retardation during autologous transplantation of peripheral blood mononuclear cells outside the operating room].

    PubMed

    Li, Meng-meng; Zhang, Qing-hong; Liu, Ying-hui; Yue, Li; Liu, Zhi-hui; Hao, Jian-hua

    2011-06-01

    To observe the anesthetic effect and safety of differential airway management in patients with mental retardation (MR) during autologous peripheral blood mononuclear cell transplantation (APBMCT) outside the operating room. In this prospective study, 30 uncooperative patients with MR receiving total intravenous anesthesia (TIVA) with propofol for APBMCT were randomized into 3 groups with monitored anesthesia care (MAC group), inserted classic laryngeal mask airway under general anesthesia (LMA group), or endotracheal tube placement (ETT group). The blood pressure (BP), heart rate (HR), SpO(2) and pH, PaCO(2), and HCO(3)(-) were monitored at 5 min and 1 h after anesthesia, before completion of the operation and at 1 h after the operation. The total operative time, dosage of propofol, awake time and body movement during the procedure were recorded. Compared with LMA and ETT groups, the MAC groups showed a significantly increased total dosage of propofol (66.07±5.41, 35.83±5.80, and 34.61±3.68 g·kg(-1)·min(-1), respectively, P<0.05 ), body movements (9.90±3.07, 2.5 1±1.50, and 0.82±0.93, P<0.05) and awake time (16.82±7.60, 4.31±1.32, and 3.73±1.33 min, P<0.05). The pH, PaCO(2), or HCO(3)(-) showed no marked changes at 5 min after anesthesia and at 1 h after the operation in the 3 groups (P>0.05). At 1 h after anesthesia, the pH in MAC group decreased markedly compared with that in LMA and ETT groups (P<0.05), and maintained a low level till the completion of the operation; the PaCO(2) was significantly elevated in MAC group and remained so till the end of the surgery (P<0.05). Endotracheal tube placement is safer than laryngeal mask airway placement and monitored anesthesia care in patients with MR during APBMCT, and allows rapid onset of sedation with minimal cardiovascular responses, body movement and recovery, therefore is more suitable in the setting outside the operating room.

  8. Treatment of alcohol withdrawal in hospitalized patients.

    PubMed

    Lohr, R H

    1995-08-01

    Alcoholism can be encountered in many aspects of medicine. Frequently, primary-care physicians are asked to treat patients who are experiencing various stages of alcohol withdrawal while hospitalized for intercurrent illness. A thorough assessment of the patient is important because the symptoms and signs of alcohol withdrawal are nonspecific. Recognizing the patient who is at risk for alcohol withdrawal and initiating appropriate treatment can prevent progression to more serious symptoms and complications. Benzodiazepines are the drugs of choice for pharmacologic treatment of alcohol withdrawal. Their application by means of a symptom-triggered approach based on frequent, objective assessment of the patient is recommended. Adjunctive therapy for specific complications of alcohol withdrawal is discussed. After the acute withdrawal symptoms have been controlled, psychiatric or chemical dependence assessment (or both) is strongly encouraged.

  9. Depression and its treatment in cardiac patients.

    PubMed Central

    Fernandez, F

    1993-01-01

    In general medical-surgical hospital services, depression is the most common reason for seeking psychiatric consultation in behalf of patients with cardiovascular disease. The nontreatment of depression or the use of a psychotropic agent mismatched to a patient's particular cardiac condition or individual sensitivities has considerable negative impact. Therefore, a systematic approach should be used in the differential diagnosis of depression in cardiac patients, to eliminate other psychiatric disorders and to assure the correct treatment strategy. Physicians can develop an appropriate rationale for the use of a psychopharmacologic regimen in cardiovascular settings through recognition of the diagnostic criteria for depression and through comprehensive knowledge of the pharmacologic properties and possible cardiovascular effects of these vital treatments. Standard and alternative pharmacotherapies for depression in cardiac patients are reviewed. PMID:8219822

  10. [Treatment of hip fractures in elderly patients].

    PubMed

    Hack, Juliana; Bliemel, Christopher; Ruchholtz, Steffen; Bücking, Benjamin

    2015-04-01

    Hip fractures are among the most common fractures in elderly people. The annual number of femoral fractures is even expected to increase because of an aging society. Due to the high number of comorbidities, there are special challenges in treating geriatric hip fracture patients, which require a multidisciplinary management. This includes surgical treatment allowing full weight bearing in the immediate postoperative period, osteoporosis treatment and falls prevention as well as an early ortho-geriatric rehabilitation program.

  11. Office-Based vs Traditional Operating Room Management of Recurrent Respiratory Papillomatosis: Impact of Patient Characteristics and Disease Severity.

    PubMed

    Tatar, Emel Çadalli; Kupfer, Robbi A; Barry, Jonnae Y; Allen, Clint T; Merati, Albert L

    2017-01-01

    Management of recurrent respiratory papillomatosis (RRP) in adults has evolved to include office-based laser techniques. To determine whether demographic or disease characteristics differ between patients undergoing office-based (office group) vs traditional operating room (OR group) surgical approaches for RRP. This study was a medical record review of adult patients with RRP treated between January 2011 and September 2013 at a tertiary care center. Patients were divided into 2 groups according to the setting in which the patient had the most procedures during the past 2 years. Demographic and disease characteristics were compared between patients receiving predominantly office-based vs predominantly OR management. Of 57 patients (47 male and 10 female, with a mean [SD] age of 53.5 [16.4] years) treated during the 2-year period, 34 patients underwent predominantly office-based management and 23 patients underwent predominantly OR management. Sex, age, and weight were not statistically significantly different between the 2 groups. Patients in the OR group had a younger age at RRP diagnosis (mean [SD], 28.7 [22.0] years in the OR group and 45.5 [20.5] years in the office group), with a mean difference of 16.8 years (95% CI, -28.3 to -5.4 years). Patients in the OR group also had a significantly higher Derkay score (mean [SD], 15.1 [5.7] in the OR group and 10.7 [5.0] in the office group), with a mean difference of 4.4 (95% CI, 1.6-7.3). No statistically significant differences in comorbidities were observed between the 2 groups except for type 1 or 2 diabetes, which was more common in the OR group. There were 5 patients (22%) with diabetes in the OR group and 1 patient (3%) with diabetes in the office group, with a mean difference of 19% (95% CI, 2.7%-35%). In a subanalysis that excluded patients with juvenile-onset RRP, Derkay score (mean [SD], 13.9 [4.5] in the OR group and 10.8 [5.1] in the office group), with a mean difference of 3.1 (95% CI, 0.5-6.1), and the

  12. Treatment of acne vulgaris in pregnant patients.

    PubMed

    Pugashetti, Rupa; Shinkai, Kanade

    2013-01-01

    The management of acne vulgaris in the setting of pregnancy raises important clinical considerations regarding the efficacy and safety of acne treatments in this special patient population. Particular challenges include the absence of safety data, discrepancy in safety data between different safety rating systems, and lack of evidence-based recommendations for the treatment of acne during pregnancy. Nonetheless, many therapeutic options exist, and the treatment of acne in pregnant women can be safely and often effectively accomplished. For mild or moderate disease, patients can be treated with topical antimicrobial agents, anti-inflammatory agents, as well as glycolic and salicylic acid. Several topical agents, notably benzoyl peroxide, previously viewed as potentially dangerous are cited by many sources as being considered safe. When necessary, systemic therapies that can be safely added include penicillins, amoxicillin, cephalosporins, erythromycin, clindamycin, and tetracyclines or sulfonamides, depending on the stage of fetal development. Adjunct therapy may include phototherapy or laser treatments. Physicians should work with this often highly motivated, safety-conscious patient population to tailor an individualized treatment regimen. This treatment regimen will likely shift throughout the different stages of fetal development, as distinct safety considerations are raised prior to conception as well as during each of the trimesters of pregnancy. Important considerations regarding acne management in breast-feeding mothers is also discussed.

  13. The effects of presence and influence in nature images in a simulated hospital patient room.

    PubMed

    Vincent, Ellen; Battisto, Dina; Grimes, Larry

    2010-01-01

    Nature images are frequently used for therapeutic purposes in hospital settings. Nature images may distract people from pain and promote psychological and physiological well-being, yet limited research is available to guide the selection process of nature images. The hypothesis is that higher degrees of presence and/or influence in the still photograph make it more effective at holding the viewer's attention, which therefore may distract the viewer from pain, and therefore be considered therapeutic. Research questions include: (1) Is there a significant difference in the level of perceived presence among the selected images? (2) Is there a significant difference in the level of perceived influence among the selected images? (3) Is there a correlation between levels of presence and levels of influence? 109 college students were randomly assigned to one of four different image categories defined by Appleton's prospect refuge theory of landscape preference. Categories included prospect, refuge, hazard, and mixed prospect and refuge. A control group was also included. Each investigation was divided into five periods: prereporting, rest, a pain stressor (hand in ice water for up to 120 seconds), recovery, and postreporting. Physiological readings (vital signs) were measured repeatedly using a Dinamap automatic vital sign tracking machine. Psychological responses (mood) to the image were collected using a reliable instrument, the Profile of Mood States. No significant statistical difference in levels of presence was found among the four image categories. However, levels of influence differed and the hazard nature image category had significantly higher influence ratings and lower diastolic blood pressure readings during the pain treatment. A correlation (r = .62) between presence and influence was identified; as one rose, so did the other. Mood state was significantly low for the hazard nature image after the pain stressor experience. Though the hazard image caused

  14. Treatment of Patients With Diabetic Gastroparesis

    PubMed Central

    Parkman, Henry P.; Fass, Ronnie; Foxx-Orenstein, Amy E.

    2010-01-01

    Gastroparesis, or chronic delayed gastric emptying without mechanical obstruction, affects about 40% of patients with type 1 diabetes and up to 30% of patients with type 2 diabetes. Diabetic gastroparesis (DGP) typically causes nausea, vomiting, early satiety, bloating, and postprandial fullness. These symptoms can be extremely troubling and result in poor quality of life. The diagnosis of DGP is made by documenting the presence of chronic upper gastrointestinal (GI) symptoms, ruling out mechanical obstruction, and demonstrating delayed gastric emptying. The usual treatment for DGP includes dietary modifications, prokinetic agents, and antiemetic agents. Although the majority of patients have mild-to-moderate disease that can be managed using these measures, a substantial percentage of patients have severe DGP that is characterized by inadequate oral intake, malnutrition, weight loss, and frequent hospitalizations. Optimal management of these patients presents a difficult challenge for the clinician, although emerging treatment options, such as gastric neurostimulation, are encouraging. Patients with DGP often present with gastric comorbidities, including gastroesophageal reflux disease, intestinal dysmotility, and fungal and bacterial infections of the GI tract. This monograph will present an overview of the pathophysiology of DGP, review diagnostic testing with a discussion of emerging technology, and present the latest research in treatment options for DGP. In addition, management strategies for refractory DGP and gastric comorbidities will be described. PMID:20733935

  15. Ethical dilemmas in the delivery room.

    PubMed

    Stevenson, D K; Goldworth, A

    1998-06-01

    The decision to withhold or withdraw life support in the neonatal intensive care unit (NICU) is common but is never routine. Often, moral demands make such decisions difficult and emotionally exhausting. But, what is perhaps more challenging from the moral point of view is the transition from the delivery room to the NICU. A satisfactory analysis of the moral issues of delivery room practices must include a discussion of quality of life, the best interest of the infant, the best interests of the family members, and futile treatment. Although these topics are relevant in any discussion of the moral justification of the omission, withdrawal, or use of treatment for patients, they are especially telling when entertained in the context of the transition of the fetus to a newborn. This article uses these four topics as a moral compass for certain decisions made in the delivery room.

  16. [How to manage very elderly patients in the emergency room? Evaluation of 150 very elderly patients at the Rouen university hospital center].

    PubMed

    Moritz, F; Benez, F; Verspyck, V; Lemarchand, P; Noel, D; Moirot, E; Chassagne, P; Muller, J M

    2001-01-20

    There are few data in the literature concerning care provided to very elderly subjects referred to emergency care units. The emergency room setting would not be particularly adapted to management of this rising population. The purpose of our work was to assess the frequency of referral to emergency care units, the characteristics of the elderly population, and patient management. One hundred fifty consecutive patients aged over 90 years addressed to the emergency unit of the Charles Nicolle hospital in Rouen France were studied. These patients were cared for by the medical and surgical teams. We recorded, type of referral, hour and reason for admission, degree of handicap and residence, gravity at admission using the clinical classification for emergency care patients (CCMU), complementary tests performed in the emergency unit, duration of stay in the unit and subsequent referral. The characteristics of these "very" elderly patients aged over 90 years were compared with those of "elderly" patients aged 75-90 years. Over a period of 33 days, the unit cared for 4888 patients, including 150 very elderly patients aged over 90 years (mean age 92.6 years). Daily, 4.4 patients were referred by a primary care physician (76.), mainly between 8 a.m. and 8 p.m. (81.3%). Forty-two percent of the patients had a surgical problem. Two-thirds were unable to walk, one-third had cognitive disorders, and one-third had urinary incontinence. However, half of these very elderly patients lived in a private home. According to the CCMU classification, 14.6% of the patients had a life-threatening disorder. Complementary tests were ordered for most patients (85%). Mean duration of stay in the emergency unit was 3.6 +/- 2.6 days. One quarter of the patients returned to their former residence, with a higher percentage among the surgery patients (37%) than among the medical patients (14.6%). There was no significant difference between the "very elderly" and "elderly" patients in terms of type

  17. Antipsychotic Treatment of Adolescent Dual Diagnosis Patients

    PubMed Central

    Price, Scott A.; Brahm, Nancy C.

    2011-01-01

    BACKGROUND A diagnosis of schizophrenia requires development of a pharmacotherapy regimen that balances many factors in the therapeutic decision-making process. Patient age and the presence or absence of comorbid chemical dependency represent two factors. Comorbid chemical dependency can have a profound impact on the successful treatment of schizophrenia, making patients with dual diagnoses of schizophrenia and chemical dependence a uniquely challenging population. There is little information regarding treatment of schizophrenia and chemical dependence in the pediatric population. Existing data from pediatric and adult populations may facilitate a well-guided and knowledgeable approach to treating pediatric dual diagnosis patients. METHODS A review of the literature for medication trials evaluating antipsychotic medication used to treat schizophrenia in childhood and adolescence as well as antipsychotic use in the treatment of the dual diagnoses of schizophrenia and chemical dependence was done. Databases for Ovid MEDLINE, PubMed, and PsycInfo were searched using the terms “addiction,” “adolescence,” “childhood,” “dual diagnosis,” “schizophrenia,” and “substance abuse.” Results were limited to English-language articles. RESULTS Seven articles were identified related to psychotic disorders and substance abuse in pediatric populations. Psychosis measurement instruments included the Brief Psychiatric Rating Scale, Positive and Negative Syndrome Scale, and Clinical Global Impression. Mean improvements were insignificant in most cases. Medication trials included clozapine, olanzapine, risperidone, and molindone. Trial safety concerns included metabolic effects, increased prolactin levels, and akathisia. One study with random assignment to olanzapine was discontinued early because of substantial weight gain without evidence of superior efficacy. Clozapine treatment was associated with more adverse drug events. CONCLUSION There is a great need for

  18. Multislice CT in emergency room management of patients with chest pain and medium-low probability of acute coronary syndrome.

    PubMed

    Olivetti, L; Mazza, G; Volpi, D; Costa, F; Ferrari, O; Pirelli, S

    2006-12-01

    The main cause of acute chest pain, which accounts for 6.5% of urgent medical examinations in emergency rooms in Italy, is acute coronary syndrome (ACS). We performed this prospective study to evaluate the diagnostic accuracy of a 16-channel computed tomography (CT) scanner with dedicated software in a group of patients with chest pain and medium to low risk of ACS. This study involved a selected group of 31 patients reporting chest pain with a medium to low probability of ACS, defined on the basis of preliminary tests [electrocardiogram (ECG) and serum cardiac markers]. Coronary angiography, performed within 24 h of MSCT, was used as the gold standard. MSCT identified the presence of occlusions and significant (>50%) or nonsignificant stenoses in the main coronary segments, with a sensitivity of 65%, a specificity of 98.8%, a positive predictive value (PPV) of 81.2%, a negative predictive value (NPV) of 97.3% and an accuracy of 96.4%. Significant stenoses and occlusions were detected with a sensitivity of 71.4%, a specificity of 99.6%, a PPV of 93.7%, an NPV of 97.7% and an accuracy of 97.5%. Due to its high NPV, this technique can rule out significant stenoses or coronary occlusions provided that image quality is excellent. In patients with a medium to low coronary risk, MSCT is a more accurate indicator of the need for coronary angiography than is exercise stress testing, which is less expensive but has lower predictive values.

  19. Using On-Line Analytical Processing (OLAP) and Data Mining to Estimate Emergency Room Activity in DoD Medical Treatment Facilities in the Tricare Central Region

    DTIC Science & Technology

    2001-03-01

    On-line Analytical Processing (OLAP) and data mining can greatly enhance the ability of the Military Medical Treatment Facility (MTF) emergency room...extract. OLAP tools enable the analysis of multi-dimensional data, which can give the user access to previously undiscovered information. Data mining has...data into useful information. This research presents a brief overview of the DoD medical system, OLAP, and data mining . OLAP and data mining tools then

  20. Impact of patient characteristics, education and knowledge on emergency room visits in patients with asthma and COPD: a descriptive and correlative study.

    PubMed

    Emtner, Margareta; Hedin, Anna; Andersson, Mikael; Janson, Christer

    2009-09-07

    Asthma and COPD are major health problems and an extensive burden for the patient and the health care system. Patient education has been recommended, but the influence on knowledge and health outcomes is not fully examined. Our aims were to compare patient characteristics, education and knowledge in patients who had an emergency room (ER) visit, to explore factors related to disease knowledge, and to investigate patient characteristics, patient education and knowledge in relation to further ER visits over a 12 month period. Eighty-four patients with asthma and 52 with COPD, who had had an ER visit, were included. They were interviewed by telephone 4 to 6 weeks after the ER visit and followed for a year. Patients with COPD were older, more sedentary, had had more ER visits the previous year, and had more co morbidity than patients with asthma. About 80% of the patients had received information from health professionals or participated in education/rehabilitation, but a minority (< 20%) reported that their knowledge about how to handle the disease was good. Patients with "good knowledge" were younger, were more likely to have asthma diagnose, and had a higher educational background (p < 0.05). Sixty-seven percent of the patients with COPD had repeated ER visits during the following year versus 42% in asthma (p < 0.05) (adjusted HRR: 1.73 (1.03-2.90)). Patients who had had ER visits the year before inclusion had a higher risk of ER visits the following year (adjusted HRR: 3.83 (1.99-7.38)). There were no significant differences regarding patient education and knowledge between the group with and without further ER visits after adjusting for sex, diagnose, age, and educational background. Patients with asthma had a better self reported knowledge of disease management and were less likely to have new exacerbations than patients with COPD. Reported level of knowledge was, however, in it self not a predictor of exacerbations. This indicates that information is not

  1. Memory's Room.

    ERIC Educational Resources Information Center

    Carruthers, Mary

    1999-01-01

    Describes the Liberal Arts Studiolo from the Ducal Palace at Guibbio, Italy. Discusses how the room's design and decoration mirrors its educational uses. Notes that the object of education was to provide the young person with a kind of mental library of materials that could be drawn upon quickly. (RS)

  2. Memory's Room.

    ERIC Educational Resources Information Center

    Carruthers, Mary

    1999-01-01

    Describes the Liberal Arts Studiolo from the Ducal Palace at Guibbio, Italy. Discusses how the room's design and decoration mirrors its educational uses. Notes that the object of education was to provide the young person with a kind of mental library of materials that could be drawn upon quickly. (RS)

  3. Criminological profile of patients in addiction treatment.

    PubMed

    Fernández-Montalvo, Javier; López-Goñi, José J; Arteaga, Alfonso; Cacho, Raúl

    2013-01-01

    This study explores the prevalence of criminal behaviour in patients addicted to drugs who are in treatment. A sample of 252 addicted patients (203 male and 49 female) who sought outpatient treatment at a specialized centre was assessed. Information on criminal behaviours, socio-demographic factors, consumption factors (assessed by the EuropAsi), psychopathological factors (assessed by SCL-90-R) and personality variables (assessed by MCMI-II) was collected. Patients presenting criminal behaviour were compared with those who were not associated with crime for all the variables studied. The rate of drug-addicted patients with criminal behaviour in this sample was 60.3% (n = 150), and it was mainly related to traffic offenses, followed by drug dealing offenses. Significant differences were observed between patients with and without criminal behaviour. Patients with criminal problems were mostly men and single. Moreover, they were more likely to report poly-consumption. Furthermore, significant differences were observed on several variables: EuropAsi, SCL-90-R and MCMI-II. According to these results, patients with associated criminal behaviour presented a more severe addiction problem. The implications of these findings for clinical practice and future research are discussed.

  4. [Treatment of breakthrough pain in cancer patients].

    PubMed

    Magdelijns, Fabienne J H; van den Beuken-van Everdingen, Marieke H J; Courtens, Annemie M; Janssen, Daisy J A

    2015-01-01

    Pain is common in patients with cancer (33-64%) and can be divided into background and breakthrough pain (BTP). BTP is a passing, acute pain that occurs despite the use of analgesia to control background pain. BTP may arise spontaneously or be provoked by certain movements or activities. It lasts 30-60 minutes and is generally self-limiting and is often undertreated. We describe 2 patients aged 68 and 57 years with metastatic disease who were admitted for pain management. BTP was inadequately managed during their hospital stay. Both patients had to wait too long before they received their BTP medication, causing the BTP to have passed its peak. After consultation with their nurses, both patients were allowed to have one dose of breakthrough medication in advance, which resulted in better treatment of their BTP. Every hospitalized patient with BTP should have one dose of breakthrough medication ready for taking in advance.

  5. [Hepatitis C treatment in special patient groups].

    PubMed

    Berenguer, Marina; Jorquera, Francisco; Ángel Serra, Miguel; Sola, Ricard; Castellano, Gregorio

    2014-07-01

    The treatment plan for chronic hepatitis C in special populations varies according to comorbidity and the current evidence on treatment. In patients with hepatitis C virus and HIV coinfection, the results of dual therapy (pegylated interferon plus ribavirin) are poor. In patients with genotype 1 infection, triple therapy (dual therapy plus boceprevir or telaprevir) has doubled the response rate, but protease inhibitors can interact with some antiretroviral drugs and provoke more adverse effects. These disadvantages are avoided by the new, second-generation, direct-acting antiviral agents. In patients who are candidates for liver transplantation or are already liver transplant recipients, the optimal therapeutic option at present is to combine the new antiviral agents, with or without ribavirin and without interferon. The treatment of patients under hemodialysis due to chronic renal disease continues to be dual therapy (often with reduced doses of pegylated interferon and ribavirin), since there is still insufficient information on triple therapy and the new antiviral agents. In mixed cryoglobulinemia, despite the scarcity of experience, triple therapy seems to be superior to dual therapy and may be used as rescue therapy in non-responders to dual therapy. However, a decision must always be made on whether antiviral treatment should be used concomitantly or after immunosuppressive therapy. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

  6. Dental extraction in patients on warfarin treatment

    PubMed Central

    Abdullah, Walid Ahmed; Khalil, Hesham

    2014-01-01

    Background Warfarin is one of the most common oral anticoagulants used to prevent thromboembolic episodes. The benefits of discontinuation of this drug before simple surgical procedures are not clear and this approach could be associated with complications. The aim of this study was to evaluate the risk of bleeding in a series of 35 patients (in cases where the international normalized ratio [INR] is less than 4) following simple tooth extraction without modification of the warfarin dose given to patients. Methods Thirty-five patients taking warfarin who had been referred to the Oral and Maxillofacial Department, College of Dentistry, King Saud University, for dental extractions were included in the study. Exclusion criteria included patients with an INR of ≥4 or with a history of liver disease or coagulopathies. No alteration was made in warfarin dose, and the CoaguChek System was used to identify the INR on the same day of dental extraction. Bleeding from the extraction site was evaluated and recorded immediately after extraction until the second day. Results A total of 35 patients (16 women and 19 men) aged between 38 and 57 years (mean =48.7) were included in the present study. All patients underwent simple one-tooth extraction while undergoing warfarin treatment. Oozing, considered mild bleeding and which did not need intervention was seen in 88.6% of patients. Moderate bleeding occurred in 11.4% of all cases. The INR of the patients ranged from 2.00 to 3.50, with 77.2% of patients having INR between 2.0 and 2.5 on the day of extraction. No severe bleeding which needed hospital management was encountered after any of the extractions. The patients who suffered moderate bleeding were returned to the clinic where they received local treatment measures to control bleeding. Moderate bleeding occurred only in four patients, where three had INR between 3.1 and 3.5, and one with INR less than 3. Conclusion In the present study, we have shown that simple tooth

  7. Diagnosis and treatment of organotin poisoned patients

    PubMed Central

    Guo, Feng; Lu, Xiao-wei; Xu, Qiu-ping

    2010-01-01

    BACKGROUND: With the development of industry and agriculture, organotin compounds have been widely used in China. Organotin compounds cause a common occupational poisoning. The toxicity of organotin was reported in animal studies; however the reports about human organotin intoxication are very rare. In this study we retrospectively analyzed the clinical manifestations of 15 organotin-poisoned patients who had been treated at our hospital from 2002 through 2007. METHODS: Fifteen patients with organotin poisoning were admitted to Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine from 2002 to 2007. They were 9 males and 6 females, aged from 25 to 52 years. Clinical manifestations and Glasgow Coma Scales showed that the poisoning was mild in 4 patients, moderate in 6 and severe in 5. The severe patients were given glucocorticoid after hospitalization by intravenous guttae of 500 mg methylprednisolone for the first day, followed by 160 mg methylprednisolone per day for three days, and then 80 mg methylprednisolone per day for another three days. Potassium glutamate and sodium glutamate were intravenously dripped to reduce blood ammonia; intravenous guttae plus oral administration of potassium 9 g/day was used to correct intractable hypokalemia; sodium bicarbonate was used to correct metabolic acidosis, and sedatives were used to control spasm and twitch; mechanical ventilators were used in 4 patients with dyspnea. RESULTS: Most of the patients showed elevated level of blood ammonia, decreased level of blood potassium and metabolic acidosis, but some had demyelination changes shown by CT and MRI. Treatments included correction of metabolic acids, blood potassium and ammonia, and mechanical ventilation when necessary. For patients with injuries of the nervous system, glucocorticoids were given immediately after hospitalization. These patients showed intractable hypokalemia and metabolic acidosis during the treatment. Forteen patients recovered

  8. Impact of the rapid antigen detection test in diagnosis and treatment of acute pharyngotonsillitis in a pediatric emergency room.

    PubMed

    Cardoso, Débora Morais; Gilio, Alfredo Elias; Hsin, Shieh Huei; Machado, Beatriz Marcondes; de Paulis, Milena; Lotufo, João Paulo B; Martinez, Marina Baquerizo; Grisi, Sandra Josefina E

    2013-01-01

    To evaluate the impact of the routine use of rapid antigen detection test in the diagnosis and treatment of acute pharyngotonsillitis in children. This is a prospective and observational study, with a protocol compliance design established at the Emergency Unit of the University Hospital of Universidade de São Paulo for the care of children and adolescents diagnosed with acute pharyngitis. 650 children and adolescents were enrolled. Based on clinical findings, antibiotics would be prescribed for 389 patients (59.8%); using the rapid antigen detection test, they were prescribed for 286 patients (44.0%). Among the 261 children who would not have received antibiotics based on the clinical evaluation, 111 (42.5%) had positive rapid antigen detection test. The diagnosis based only on clinical evaluation showed 61.1% sensitivity, 47.7% specificity, 44.9% positive predictive value, and 57.5% negative predictive value. The clinical diagnosis of streptococcal pharyngotonsillitis had low sensitivity and specificity. The routine use of rapid antigen detection test led to the reduction of antibiotic use and the identification of a risk group for complications of streptococcal infection, since 42.5% positive rapid antigen detection test patients would not have received antibiotics based only on clinical diagnosis.

  9. Bypassing the emergency room to reduce door-to-balloon time and improve outcomes of patients with ST elevation myocardial infarction: the Acute Coronary Syndrome Israeli Survey experience.

    PubMed

    Lubovich, Alla; Hamood, Hatem; Behar, Solomon; Rosenschein, Uri

    2011-04-01

    Rapid reperfusion of an infarct-related artery is crucial for the successful treatment of ST elevation myocardial infarction. Every effort should be made to shorten door-to-balloon time. To investigate whether bypassing the emergency room (ER) has a positive influence on door-to-balloon time in patients presenting with ST elevation myocardial infarction (STEMI) and whether the reduction in door-to-balloon time improves patients' clinical outcome. We analyzed data of 776 patients with STEMI from the 2004 and the 2006 Acute Coronary Syndrome Israeli Survey (ACSIS) registry. The ACSIS is a biennial survey on acute myocardial infarction performed in all 25 intensive cardiac care units in Israel during a 2-month period. Twenty-five percent of patients (193 of 776) arrived directly to the intensive cardiac care unit (ICCU) and 75% (583 of 776) were assessed first in the ER. We compared door-to-balloon time, ejection fraction, 30 days MACE (major adverse cardiac and cerebrovascular events) and 30 days mortality in the two study groups. There was significantly shorter door-to-balloon time in the direct ICCU group as compared with the ER group (45 vs. 79 minutes, P< 0.002). Patients in the direct ICCU group were more likely to have door-to-balloon time of less than 90 minutes in accordance with ACC/AHA guidelines (88.7% vs. 59.2%, P < 0.0001). Moreover, patients in the direct ICCU group were less likely to have left ventricular ejection fraction < 30% (5.4% vs. 12.2%, P= 0.045) and less likely to have symptoms of overt congestive heart failure. Lastly, 30 days MACE was significantly lower in the direct ICCU group (22 vs. 30%, P< 0.004). There is significant reduction of the door-to-balloon time in the direct ICCU admission strategy. This reduction translates into improvement in clinical outcome of patients. It is reasonable to apply the direct ICCU strategy to patients with STEMI.

  10. [Intestinal obstruction in cancer patients. Palliative treatment].

    PubMed

    Costa, I; Conçalves, F

    1997-05-01

    The treatment of intestinal obstruction (IO) in patients with advanced or terminal cancer represents an open and widely discussed topic in clinical oncology practice. As surgical palliation is a complex issue, the decision to advance with surgery should be made in consultation with the patients and family members. The prognostic factors, mainly the survival time and the surgical risks can be considered guideline indicators. If there is any possibility that surgery will be of benefit, the patient should be treated with intravenous fluids and nasogastric suction while appropriate radiological investigations are performed. When surgical intervention is contraindicated, symptomatic medical treatment should be started through continuous subcutaneous administration of analgesic and antiemetic drugs. Minor episodes of vomiting may occur, which do not trouble patients since the most distressing symptom, nausea, can be controlled. Dehydration may be avoided with a liquid diet in small quantities. In this way, it is possible to manage patients with IO for several weeks without the need of nasogastric suction or intravenous fluids. Percutaneous gastrostomy, nasogastric tube, or hypodermoclysis may be necessary for a small number of patients, principally with high obstruction, who have refractory symptoms.

  11. [Compliance of treatment in glaucoma patients].

    PubMed

    Banc, Ana; Stan, Cristina

    2013-01-01

    To evaluate the treatment compliance level of glaucoma patients and the correlation between the compliance level and a series of patient's demographic characteristics. We conducted an observational study in which we studied 100 glaucoma patients who answered the questions we included into a questionnaire. We defined and calculated a broad compliance score and a narrow score, and we investigated the connection between the first score and age, gender, demographic location (urban versus rural), education level, current occupation and duration of disease respectively. The mean of the broad compliance score was 9.64 +/- 1.72, which represents 80% of the maximum value of the score, and the mean of the narrow compliance score was 4.73 +/- 1.12, (78% of the maximum value). The correlation coefficient between score and age was z = -0.09 (p value = 0.19), the Z value for the evaluation of the connection between score and gender was -1.16 (p value = 0.24), and for the connection between compliance score and demographic location Z value = -2.42 (p value = 0.01). Chi-square value for the evaluation of the relation between the score and education level was 14.66 (p value = 0.001), and for the current occupation Chi-square value = 3.47 (p value = 0.06). The correlation coefficient between score and disease duration was tau = 0.09 (p value = 0.23). According to the answers the patients gave, we identified the parameters that require more attention in the ophthalmologist - glaucoma patient communication: genetic transmission of glaucoma, treatment's side effects, number of visits to the ophthalmologist, awareness of the life-long gradului period of treatment. In this study, the compliance level of glaucoma patients is relatively high and we observe a correlation between the compliance level and demographic location, and between the compliance level and patient's education level respectively.,

  12. Treatment of older patients with AML.

    PubMed

    Büchner, Thomas; Berdel, Wolfgang E; Wörmann, Bernhard; Schoch, Claudia; Haferlach, Torsten; Schnittger, Susanne; Kern, Wolfgang; Aul, Carlo; Lengfelder, Eva; Schumacher, Andrea; Reichle, Albrecht; Staib, Peter; Balleisen, Leopold; Eimermacher, Hartmut; Grüneisen, Andreas; Rasche, Herbert; Sauerland, Maria Cristina; Heinecke, Achim; Mesters, Rolf M; Serve, Hubert L; Kienast, Joachim; Hiddemann, Wolfgang

    2005-11-01

    Undertreatment of the older patients with AML can explain, in part, their inferior outcome when compared with that in younger patients. In analogy to the benefit of patients under the age of 60 years from high-dose AraC there are dosage related therapeutic effects in the patients over 60 years in particular for daunorubicin in the induction treatment, and for maintenance versus no maintenance in the post-remission treatment. Utilizing these effects can partly overcome the mostly unfavorable disease biology in older age AML, whereas the role of risk factors involved is not completely understood and the concept of dose-response needs to be requestioned. We recommend an adequate dosage of 60 mg/(m2day) daunorubicin for 3 days in a combination with standard dose AraC and 6-thioguanine given for induction and consolidation and followed by a prolonged monthly maintenance chemotherapy. Further improvements in supportive care may help delivering additional anti-leukemic cytotoxicity. As a novel approach, reduced toxicity preparative regimens may open up allogeneic transplantation for older patients with AML. Other new options like MDR modulators, antibody targeted therapies and tyrosine kinase inhibitors are under clinical investigation. A questionnaire study in patients with AML showed that according to patients' self-assessment intensive and prolonged treatment did not result in decreasing quality of life. This finding did not vary by age under or above 60 years. Given the actual median age in this disease being more than 60 years the adequate management of older age AML remains as the major challenge.

  13. Population-based use of sphincter-preserving surgery in patients with rectal cancer: is there room for improvement?

    PubMed

    Richardson, Devon P; Porter, Geoff A; Johnson, Paul M

    2013-06-01

    Treatment of rectal cancer in North America has been associated with lower rates of sphincter-preserving surgery in comparison with other regions. It is unclear if these lower rates are due to patient, tumor, or treatment factors; thus, the potential to increase the use of sphincter-preserving surgery is unknown. The aim of this study is to identify the factors associated with the use of sphincter-preserving surgery and to quantify the potential for an increase in sphincter preservation. This population-based retrospective cohort study used patient-level data collected through a comprehensive, standardized review of hospital inpatient and outpatient medical records and cancer center charts. This study was conducted in all hospitals providing rectal cancer surgery in a Canadian province. All patients with a new diagnosis of rectal cancer from July 1, 2002 to June 30, 2006 who underwent potentially curative radical surgery were included. Logistic regression was used to identify factors associated with receiving a permanent colostomy. Patients were categorized as having received an appropriate or potentially inappropriate colostomy based on a priori determined patient, tumor, operative, and pathologic criteria. Of 466 patients who underwent radical surgery, 48% received a permanent colostomy. There was significant variation in the rate of sphincter-preserving surgery among the 10 hospitals that provided rectal cancer care (12%-73%, p = 0.0001). On multivariate analysis, male sex, low tumor height, and increasing tumor stage were associated with the receipt of a permanent colostomy. Among patients who received a permanent stoma, 65 of 224 (29%) patients received a potentially inappropriate stoma. On multivariate analysis, male sex and treatment in a medium- or low-volume hospital was associated with the receipt of a potentially inappropriate colostomy. This study was limited by its retrospective design. These data suggest that the receipt of a permanent colostomy by

  14. A randomized controlled study comparing room air with carbon dioxide for abdominal pain, distention, and recovery time in patients undergoing colonoscopy.

    PubMed

    Chen, Yen-Ju; Lee, Jennifer; Puryear, Magaly; Wong, Roy K H; Lake, Jason M; Maydonovitch, Corrine L; Belle, Lavern; Moawad, Fouad J

    2014-01-01

    Colonoscopy remains the gold standard for colorectal cancer screening. Many barriers to the procedure exist including the possibility of abdominal discomfort that may occur with insufflation. Carbon dioxide (CO2), which is rapidly absorbed in the blood stream, is an alternate method used to distend the lumen during colonoscopy. The goal of this study was to compare patient discomfort, abdominal girth, and recovery time in 2 groups of patients randomized to CO2 versus room air insufflation during colonoscopy. Using a Wong-Baker score, we found statistical difference in postprocedural discomfort levels (CO2 Group: 1.15 ± 2.0 vs. room air: 0.41 ± 0.31, p = .015) and a significantly greater increase in abdominal girth over CO2 immediately postprocedure (room air: 1.06 ± 1.29 inches vs. CO2: 0.56 ± 0.73 inches, p = .054) girth immediately postprocedure; however, recovery time was similar between the 2 study arms (CO2: 9.1 ± 16.2 minutes vs. room air: 10.2 ± 18.6 minutes, p = .713). Further studies are needed to determine whether CO2 is cost-effective and improves patient satisfaction with colonoscopy.

  15. HIV treatment cascade in tuberculosis patients

    PubMed Central

    Lessells, Richard J.; Swaminathan, Soumya; Godfrey-Faussett, Peter

    2015-01-01

    Purpose of review Globally, the number of deaths associated with tuberculosis (TB) and HIV coinfection remains unacceptably high. We review the evidence around the impact of strengthening the HIV treatment cascade in TB patients and explore recent findings about how best to deliver integrated TB/HIV services. Recent findings There is clear evidence that the timely provision of antiretroviral therapy (ART) reduces mortality in TB/HIV coinfected adults. Despite this, globally in 2013, only around a third of known HIV-positive TB cases were treated with ART. Although there is some recent evidence exploring the barriers to achieve high coverage of HIV testing and ART initiation in TB patients, our understanding of which factors are most important and how best to address these within different health systems remains incomplete. There are some examples of good practice in the delivery of integrated TB/HIV services to improve the HIV treatment cascade. However, evidence of the impact of such strategies is of relatively low quality for informing integrated TB/HIV programming more broadly. In most settings, there remain barriers to higher-level organizational and functional integration. Summary There remains a need for commitment to patient-centred integrated TB/HIV care in countries affected by the dual epidemic. There is a need for better quality evidence around how best to deliver integrated services to strengthen the HIV treatment cascade in TB patients, both at primary healthcare level and within community settings. PMID:26352390

  16. Measuring the patient experience in primary care: Comparing e-mail and waiting room survey delivery in a family health team.

    PubMed

    Slater, Morgan; Kiran, Tara

    2016-12-01

    To compare the characteristics and responses of patients completing a patient experience survey accessed online after e-mail notification or delivered in the waiting room using tablet computers. Cross-sectional comparison of 2 methods of delivering a patient experience survey. A large family health team in Toronto, Ont. Family practice patients aged 18 or older who completed an e-mail survey between January and June 2014 (N = 587) or who completed the survey in the waiting room in July and August 2014 (N = 592). Comparison of respondent demographic characteristics and responses to questions related to access and patient-centredness. Patients responding to the e-mail survey were more likely to live in higher-income neighbourhoods (P = .0002), be between the ages of 35 and 64 (P = .0147), and be female (P = .0434) compared with those responding to the waiting room survey; there were no significant differences related to self-rated health. The differences in neighbourhood income were noted despite minimal differences between patients with and without e-mail addresses included in their medical records. There were few differences in responses to the survey questions between the 2 survey methods and any differences were explained by the underlying differences in patient demographic characteristics. Our findings suggest that respondent demographic characteristics might differ depending on the method of survey delivery, and these differences might affect survey responses. Methods of delivering patient experience surveys that require electronic literacy might underrepresent patients living in low-income neighbourhoods. Practices should consider evaluating for nonresponse bias and adjusting for patient demographic characteristics when interpreting survey results. Further research is needed to understand how primary care practices can optimize electronic survey delivery methods to survey a representative sample of patients. Copyright© the College of Family Physicians of

  17. Reduction in the microbial load on high-touch surfaces in hospital rooms by treatment with a portable saturated steam vapor disinfection system.

    PubMed

    Sexton, Jonathan D; Tanner, Benjamin D; Maxwell, Sheri L; Gerba, Charles P

    2011-10-01

    Recent scientific literature suggests that portable steam vapor systems are capable of rapid, chemical-free surface disinfection in controlled laboratory studies. This study evaluated the efficacy of a portable steam vapor system in a hospital setting. The study was carried out in 8 occupied rooms of a long-term care wing of a hospital. Six surfaces per room were swabbed before and after steam treatment and analyzed for heterotrophic plate count (HPC), total coliforms, methicillin-intermediate and -resistant Staphylococcus aureus (MISA and MRSA), and Clostridium difficile. The steam vapor device consistently reduced total microbial and pathogen loads on hospital surfaces, to below detection in most instances. Treatment reduced the presence of total coliforms on surfaces from 83% (40/48) to 13% (6/48). Treatment reduced presumptive MISA (12/48) and MRSA (3/48) to below detection after cleaning, except for 1 posttreatment isolation of MISA (1/48). A single C difficile colony was isolated from a door push panel before treatment, but no C difficile was detected after treatment. The steam vapor system reduced bacterial levels by >90% and reduced pathogen levels on most surfaces to below the detection limit. The steam vapor system provides a means to reduce levels of microorganisms on hospital surfaces without the drawbacks associated with chemicals, and may decrease the risk of cross-contamination. Copyright © 2011 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

  18. [Inpatient treatment in the addicted patient].

    PubMed

    Capece, José

    2010-01-01

    We review the patient hospitalization criteria for Substance Abuse Disorder, taking into account current controversies and the weight of the evidence in the investigation in relation to clinical efficacy and effectiveness. We raise the parameters that mark the 24.455 law on the basic treatment plan from the current data in Argentina, which are inpatient detoxification and residential rehabilitation. We identify the need for detoxification and comprehensive for dual patients rehabilitation centers as peremptory. Criteria are defined according to international validation. We discuss the advantages and disadvantages of hospitalization. Finally, we conclude in the need for a system where devices appropriate epidemiological needs, and that the clinical handle current information.

  19. Treatment of patients with essential tremor.

    PubMed

    Deuschl, Günther; Raethjen, Jan; Hellriegel, Helge; Elble, Rodger

    2011-02-01

    Essential tremor is a common movement disorder. Tremor severity and handicap vary widely, but most patients with essential tremor do not receive a diagnosis and hence are never treated. Furthermore, many patients abandon treatment because of side-effects or poor efficacy. A newly developed algorithm, based on the logarithmic relation between tremor amplitude and clinical tremor ratings, can be used to compare the magnitude of effect of available treatments. Drugs with established efficacy (propranolol and primidone) produce a mean tremor reduction of about 50%. Deep brain stimulation (DBS) in the thalamic nucleus ventrointermedius or neighbouring subthalamic structures reduces tremor by about 90%. However, no controlled trials of DBS have been done, and the best target is still uncertain. Better drugs are needed, and controlled trials are required to determine the safety and efficacy of DBS in the nucleus ventrointermedius and neighbouring subthalamic structures. Copyright © 2011 Elsevier Ltd. All rights reserved.

  20. The relationship of the emotional climate of work and threat to patient outcome in a high-volume thoracic surgery operating room team.

    PubMed

    Nurok, Michael; Evans, Linda A; Lipsitz, Stuart; Satwicz, Paul; Kelly, Andrea; Frankel, Allan

    2011-03-01

    It is widely believed that the emotional climate of surgical team's work may affect patient outcome. To analyse the relationship between the emotional climate of work and indices of threat to patient outcome. Interventional study. Operating rooms in a high-volume thoracic surgery centre from September 2007 to June 2008. Thoracic surgery operating room teams. Two 90 min team-skills training sessions focused on findings from a standardised safety-culture survey administered to all participants and highlighting positive and problematic aspects of team skills, communication and leadership. Relationship of functional or less functional emotional climates of work to indices of threat to patient outcome. A less functional emotional climate corresponded to more threat to outcome in the sterile surgical environment in the pre-intervention period (p<0.05), but not in the post-intervention or sustaining period of this study. This relationship did not exist in the anaesthesia or circulating environments of the operating room. The emotional climate of work in the sterile surgical environment appeared to be related to threat to patient outcome prior to, but not after, a team-training intervention. Further study of the relationship between the emotional climate of work and threat to patient outcome using reproducible methods is required.

  1. Addiction treatment dropout: exploring patients' characteristics.

    PubMed

    López-Goñi, José J; Fernández-Montalvo, Javier; Arteaga, Alfonso

    2012-01-01

    This study explored the characteristics associated with treatment dropout in substance dependence patients. A sample of 122 addicted patients (84 treatment completers and 38 treatment dropouts) who sought outpatient treatment was assessed to collect information on sociodemographic, consumption (assessed by EuropASI), psychopathological (assessed by SCL-90-R), and personality variables (assessed by MCMI-II). Completers and dropouts were compared on all studied variables. According to the results, dropouts scored significantly higher on the EuropASI variables measuring employment/support, alcohol consumption, and family/social problems, as well as on the schizotypal scale of MCMI-II. Because most of the significant differences were found in EuropASI variables, three clusters analyses (2, 3, and 4 groups) based on EuropASI mean scores were carried out to determine clinically relevant information predicting dropout. The most relevant results were obtained when four groups were used. Comparisons between the four groups derived from cluster analysis showed statistically significant differences in the rate of dropout, with one group exhibiting the highest dropout rate. The distinctive characteristics of the group with highest dropout rate included the presence of an increased labor problem combined with high alcohol consumption. Furthermore, this group had the highest scores on three scales of the MCMI-II: phobic, dependent, and schizotypal. The implications of these results for further research and clinical practice are discussed.  Copyright © American Academy of Addiction Psychiatry.

  2. [Treatment of patients with acute asthma exacerbation].

    PubMed

    Ostojić, Jelena; Mose, Jakov

    2009-01-01

    Asthma is a chronic inflammatory disease of the airways. The global prevalence of asthma ranges from 1% to 18% of the population, so it remains a common problem with enormous medical and economic impacts. In majority of patients, asthma can be well controlled with simple regimens of inhaled anti-inflammatory and bronchodilating medications. However, some patients tend to suffer from poorly controlled disease in terms of chronic symptoms with episodic severe exacerbations. Major factors that may be related to the emergency department visits and hospitalisation include prior severe attacks, nonadherence to therapeutic regimens, inadequate use of inhaled corticosteroids, poor self-management skills, frequent use of inhaled short-acting beta-agonists, cigarette smoking, poor socioeconomic status and age over 40 years. Severe exacerbations of asthma are life-threatening medical emergencies and require careful brief assesment, treatment according to current GINA (Global Initiative for Asthma) guidelines with periodic reassesment of patient's response to therapy usually in an emergency department.

  3. Factors predicting a change in diagnosis in patients hospitalised through the emergency room: a prospective observational study

    PubMed Central

    Hautz, Stefanie C; Schuler, Luca; Kämmer, Juliane E; Schauber, Stefan K; Ricklin, Meret E; Sauter, Thomas C; Maier, Volker; Birrenbach, Tanja; Exadaktylos, Aristomenis

    2016-01-01

    Introduction Emergency rooms (ERs) generally assign a preliminary diagnosis to patients, who are then hospitalised and may subsequently experience a change in their lead diagnosis (cDx). In ERs, the cDx rate varies from around 15% to more than 50%. Among the most frequent reasons for diagnostic errors are cognitive slips, which mostly result from faulty data synthesis. Furthermore, physicians have been repeatedly found to be poor self-assessors and to be overconfident in the quality of their diagnosis, which limits their ability to improve. Therefore, some of the clinically most relevant research questions concern how diagnostic decisions are made, what determines their quality and what can be done to improve them. Research that addresses these questions is, however, still rare. In particular, field studies that allow for generalising findings from controlled experimental settings are lacking. The ER, with its high throughput and its many simultaneous visits, is perfectly suited for the study of factors contributing to diagnostic error. With this study, we aim to identify factors that allow prediction of an ER's diagnostic performance. Knowledge of these factors as well as of their relative importance allows for the development of organisational, medical and educational strategies to improve the diagnostic performance of ERs. Methods and analysis We will conduct a field study by collecting diagnostic decision data, physician confidence and a number of influencing factors in a real-world setting to model real-world diagnostic decisions and investigate the adequacy, validity and informativeness of physician confidence in these decisions. We will specifically collect data on patient, physician and encounter factors as predictors of the dependent variables. Statistical methods will include analysis of variance and a linear mixed-effects model. Ethics and dissemination The Bern ethics committee approved the study under KEK Number 197/15. Results will be published in

  4. Factors predicting a change in diagnosis in patients hospitalised through the emergency room: a prospective observational study.

    PubMed

    Hautz, Stefanie C; Schuler, Luca; Kämmer, Juliane E; Schauber, Stefan K; Ricklin, Meret E; Sauter, Thomas C; Maier, Volker; Birrenbach, Tanja; Exadaktylos, Aristomenis; Hautz, Wolf E

    2016-05-11

    Emergency rooms (ERs) generally assign a preliminary diagnosis to patients, who are then hospitalised and may subsequently experience a change in their lead diagnosis (cDx). In ERs, the cDx rate varies from around 15% to more than 50%. Among the most frequent reasons for diagnostic errors are cognitive slips, which mostly result from faulty data synthesis. Furthermore, physicians have been repeatedly found to be poor self-assessors and to be overconfident in the quality of their diagnosis, which limits their ability to improve. Therefore, some of the clinically most relevant research questions concern how diagnostic decisions are made, what determines their quality and what can be done to improve them. Research that addresses these questions is, however, still rare. In particular, field studies that allow for generalising findings from controlled experimental settings are lacking. The ER, with its high throughput and its many simultaneous visits, is perfectly suited for the study of factors contributing to diagnostic error. With this study, we aim to identify factors that allow prediction of an ER's diagnostic performance. Knowledge of these factors as well as of their relative importance allows for the development of organisational, medical and educational strategies to improve the diagnostic performance of ERs. We will conduct a field study by collecting diagnostic decision data, physician confidence and a number of influencing factors in a real-world setting to model real-world diagnostic decisions and investigate the adequacy, validity and informativeness of physician confidence in these decisions. We will specifically collect data on patient, physician and encounter factors as predictors of the dependent variables. Statistical methods will include analysis of variance and a linear mixed-effects model. The Bern ethics committee approved the study under KEK Number 197/15. Results will be published in peer-reviewed scientific medical journals. Authorship will be

  5. Room-Temperature Chemical Solution Treatment for Flexible ZnS(O,OH)/Cu(In,Ga)Se2 Solar Cell: Improvements in Interface Properties and Metastability.

    PubMed

    Ho, Wei-Hao; Hsu, Chia-Hao; Yeh, Tzu-Hsuan; Chang, Yu-Han; Wei, Shih-Yuan; Lin, Tzu-Ying; Lai, Chih-Huang

    2016-03-01

    We demonstrate an effective room-temperature chemical solution treatment, by using thioacetamide (S treatment) or thioacetamide-InCl3 (In-S treatment) solution, on Cu(In,Ga)Se2 (CIGSe) surface to engineer the ZnS(O,OH)/CIGSe interface and junction quality, leading to enhanced efficiency and minimized metastability of flexible solar cells. The control device without treatment reveals a relatively low efficiency of 8.15%, which is significantly improved to 9.74% by In-S treatment, and 10.39% by S treatment. Results of X-ray photoelectron spectroscopy suggest that S is incorporated into CIGSe surface forming CIGSSe by S treatment, whereas a thin In-S layer is formed on CIGSe surface by In-S treatment with reduced amount of S diffusing into CIGSe. PL spectra and TRPL lifetime further reveal that S incorporation into CIGS surface may substitute the OSe and/or directly occupy the vacant anion site (VSe), resulting in the effective passivation of the recombination centers at CIGSe surface. Moreover, reducing the concentrations of VSe may thereby decrease the density of (VCu-VSe) acceptors, which can minimize the metastability of ZnS(O,OH)/CIGSe solar cells. With S treatment, the light soaking (LS) time of ZnS(O,OH)/CIGSe device is reduced approximately to one-half of control one. Our approach can be potentially applied for alternative Cd-free buffer layers to achieve high efficiency and low metastability.

  6. Some folded issues related to over-shielded and unplanned rooms for medical linear accelerators - A case study

    NASA Astrophysics Data System (ADS)

    Muhammad, Wazir; Ullah, Asad; Hussain, Amjad; Ali, Nawab; Alam, Khan; Khan, Gulzar; Matiullah; Maeng, Seongjin; Lee, Sang Hoon

    2015-08-01

    A medical linear accelerator (LINAC) room must be properly shielded to limit the outside radiation exposure to an acceptable safe level defined by individual state and international regulations. However, along with this prime objective, some additional issues are also important. The current case-study was designed to unfold the issues related to over-shielded and unplanned treatment rooms for LINACs. In this connection, an apparently unplanned and over-shielded treatment room of 610 × 610 cm2 in size was compared with a properly designed treatment room of 762 × 762 cm2 in size ( i.e., by following the procedures and recommendations of the IAEA Safety Reports Series No. 47 and NCRP 151). Evaluation of the unplanned room indicated that it was over-shielded and that its size was not suitable for total body irradiation (TBI), although the license for such a treatment facility had been acquired for the installed machine. An overall 14.96% reduction in the total shielding volume ( i.e., concrete) for an optimally planned room as compared to a non-planned room was estimated. Furthermore, the inner room's dimensions were increased by 25%, in order to accommodate TBI patients. These results show that planning and design of the treatment rooms are imperative to avoid extra financial burden to the hospitals and to provide enough space for easy and safe handling of the patients. A spacious room is ideal for storing treatment accessories and facilitates TBI treatment.

  7. Basement utility room (room 24; air handling room), near the ...

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

    Basement utility room (room 24; air handling room), near the west end of the combat operations center, looking southwest towards fan system one, air ducts, and walk-in filter rooms. The exterior equipment well is visible at the left - March Air Force Base, Strategic Air Command, Combat Operations Center, 5220 Riverside Drive, Moreno Valley, Riverside County, CA

  8. Brief behavioral treatment for patients with treatment-resistant insomnia

    PubMed Central

    Wang, Jihui; Wei, Qinling; Wu, Xiaoli; Zhong, Zhiyong; Li, Guanying

    2016-01-01

    Objective To evaluate the efficacy of brief behavioral treatment for insomnia (BBTI) in treating patients with treatment-resistant insomnia. Methods Seventy-nine adults with treatment-resistant insomnia were randomly assigned to receive either individualized BBTI (delivered in two in-person sessions and two telephone “booster” sessions, n=40) or sleep hygiene education (n=39). The primary outcome was subjective (sleep diary) measures of self-report symptoms and questionnaire measures of Pittsburgh sleep quality index (PSQI), insomnia severity index (ISI), Epworth sleeping scale (ESS), and dysfunctional beliefs and attitudes about sleep scale (DBAS). Results The repeated-measures analysis of variance showed significant time effects between pretreatment and posttreatment in the scale ratings of PSQI, ESS, DBAS, ISI, sleep latency (SL), time in bed (TIB), sleep efficiency (SE), and wake after sleep onset (WASO) in both groups and group × time interaction (FPSQI =3.893, FESS =4.500, FDBAS =5.530, FISI =15.070, FSL =8.909, FTIB =7.895, FSE =2.926, and FWASO =2.595). The results indicated significant differences between BBTI and sleep hygiene in change scores of PSQI, ESS, DBAS, ISI, SL, TIB, SE, and WASO. Effect sizes were moderate to large. Conclusion BBTI is a simple and efficacious intervention for chronic insomnia in adults. PMID:27536119

  9. Neutron measurements with ultra-thin 3D silicon sensors in a radiotherapy treatment room using a Siemens PRIMUS linac

    NASA Astrophysics Data System (ADS)

    Guardiola, C.; Gómez, F.; Fleta, C.; Rodríguez, J.; Quirion, D.; Pellegrini, G.; Lousa, A.; Martínez-de-Olcoz, L.; Pombar, M.; Lozano, M.

    2013-05-01

    The accurate detection and dosimetry of neutrons in mixed and pulsed radiation fields is a demanding instrumental issue with great interest both for the industrial and medical communities. In recent studies of neutron contamination around medical linacs, there is a growing concern about the secondary cancer risk for radiotherapy patients undergoing treatment in photon modalities at energies greater than 6 MV. In this work we present a promising alternative to standard detectors with an active method to measure neutrons around a medical linac using a novel ultra-thin silicon detector with 3D electrodes adapted for neutron detection. The active volume of this planar device is only 10 µm thick, allowing a high gamma rejection, which is necessary to discriminate the neutron signal in the radiotherapy peripheral radiation field with a high gamma background. Different tests have been performed in a clinical facility using a Siemens PRIMUS linac at 6 and 15 MV. The results show a good thermal neutron detection efficiency around 2% and a high gamma rejection factor.

  10. Neutron measurements with ultra-thin 3D silicon sensors in a radiotherapy treatment room using a Siemens PRIMUS linac.

    PubMed

    Guardiola, C; Gómez, F; Fleta, C; Rodríguez, J; Quirion, D; Pellegrini, G; Lousa, A; Martínez-de-Olcoz, L; Pombar, M; Lozano, M

    2013-05-21

    The accurate detection and dosimetry of neutrons in mixed and pulsed radiation fields is a demanding instrumental issue with great interest both for the industrial and medical communities. In recent studies of neutron contamination around medical linacs, there is a growing concern about the secondary cancer risk for radiotherapy patients undergoing treatment in photon modalities at energies greater than 6 MV. In this work we present a promising alternative to standard detectors with an active method to measure neutrons around a medical linac using a novel ultra-thin silicon detector with 3D electrodes adapted for neutron detection. The active volume of this planar device is only 10 µm thick, allowing a high gamma rejection, which is necessary to discriminate the neutron signal in the radiotherapy peripheral radiation field with a high gamma background. Different tests have been performed in a clinical facility using a Siemens PRIMUS linac at 6 and 15 MV. The results show a good thermal neutron detection efficiency around 2% and a high gamma rejection factor.

  11. Genetic Similarity among One Aspergillus flavus Strain Isolated from a Patient Who Underwent Heart Surgery and Two Environmental Strains Obtained from the Operating Room

    PubMed Central

    Diaz-Guerra, Teresa M.; Mellado, Emilia; Cuenca-Estrella, Manuel; Gaztelurrutia, Lourdes; Navarro, Jose Ignacio Villate; Tudela, Juan L. Rodríguez

    2000-01-01

    We report the simultaneous isolation of one Aspergillus flavus strain from the aortic prosthesis of a heart surgery patient and another two isolates recovered from a dual-reservoir cooler-heater used in the operating room where this patient was operated on. Genetic typing of these three isolates by randomly amplified polymorphic DNA (RAPD) revealed identical genotypes. Eight unrelated control strains of A. flavus had eight different genotypes. These results clearly indicated the nosocomial origin of the A. flavus strain isolated from the patient. We suggest that the RAPD technique is a rapid and reliable tool to ascertain the epidemiology of infections caused by A. flavus. PMID:10835021

  12. Children and the Emergency Room

    ERIC Educational Resources Information Center

    Resnick, Rene; Hergenroeder, Elizabeth

    1975-01-01

    Describes a pilot study on emergency room treatment for children 3-13 years of age. The study focuses on children, parents, and their interactions under stress. Results indicate several areas of emergency room care which should be investigated and improved. (ED)

  13. Internal thoracic artery grafting in the elderly patient undergoing coronary artery bypass grafting: room for process improvement?

    PubMed

    Ferguson, T Bruce; Coombs, Laura P; Peterson, Eric D

    2002-05-01

    The acute and long-term benefits of internal thoracic artery grafting are clear in younger patients undergoing coronary artery bypass grafting. The elderly, however, face higher surgical risks and have shorter life expectancy, and thus the use of internal thoracic artery grafting in this age group has been debated. This study examined the use, complication risks, and operative (30-day) mortality associated with internal thoracic artery grafting in patients 75 years of age and older. Between 1996 and 1999, 522,656 patients in the Society of Thoracic Surgeons National Cardiac Database underwent primary, nonemergency-salvage coronary artery bypass grafting; of these, 99,942 were 75 years of age or older. The influence of internal thoracic artery use on operative mortality and 5 major complications in this elderly group was examined by means of (1) risk adjustment (adjusting for 28 baseline risk factors and site) and (2) a treatment propensity score analysis that compares patients with similar baseline likelihood for receiving an internal thoracic artery graft. In the National Cardiac Database 77.4% of patients aged 75 to 84 years received an internal thoracic artery graft compared with 93.5% for those aged 55 years or less. In this elderly group use of the internal thoracic artery was strongly associated with decreased operative mortality (unadjusted mortality, 6.20% vs. 4.05%; P <.0001) that persisted after controlling for baseline risk and provider effects (adjusted odds ratio, 0.85; 95% confidence intervals, 0.79-0.91). This mortality benefit was seen among those with low-to-high baseline propensity for receiving an internal thoracic artery graft. Use of the internal thoracic artery in elderly patients undergoing coronary artery bypass grafting provides an acute survival benefit. This benefit is similar to that seen in younger patients and persists after adjusting for both patient and provider selection factors. The internal thoracic artery appears to be underused

  14. Effect of ultrasonic treatment of palygorskite on catalytic performance of Pd-Cu/palygorskite catalyst for room-temperature CO oxidation in humid circumstances.

    PubMed

    Wang, Yongzhao; Wang, Yongning; Li, Xiao; Liu, Zhaotie; Zhao, Yongxiang

    2017-03-27

    Pd-Cu/palygorskite catalysts were prepared by a wet impregnation method using palygorskite (PC/N-Pal) and ultrasonic treated palygorskite (PC/U-Pal) as the support. Their catalytic activities toward CO oxidation at room temperature and in humid circumstances were investigated. PC/U-Pal exhibits much higher catalytic activity and stability than PC/N-Pal under the conditions of 1.0 vol.% CO and 3.3 vol.% H2O in the feed gas. The XRD results indicate that quartz impurities were eliminated from the palygorskite after the ultrasonic treatment, and more copper species exist in the form of Cu2Cl(OH)3 in PC/U-Pal. The TPR results suggest that there is an enhanced reducibility of PC/U-Pal after ultrasonic treatment. Furthermore, the ultrasonic treatment can properly decrease the hydrophilicity of the support and catalyst, which may also contribute to the excellent catalytic performance.

  15. A literature review and guidance for nurse-led patient extubation in the recovery room/post anaesthetic care unit: endotracheal tubes.

    PubMed

    Dawkins, Sarah

    2011-10-01

    A review of current literature highlighted the lack of national or local guidelines for post anaesthetic care unit (PACU) practitioners/recovery room nurses to extubate their own patients. This article documents the findings of a systematic literature review and gives simple diagrammatic representations from a comprehensive flow chart that has been developed to assist nurses in the extubation process. A knowledge and skills competency validated training package was developed locally with the anaesthetic department to train practitioners to undertake endotracheal extubation safely.

  16. [Treatment of older patients with dyslipidemia].

    PubMed

    González, David Fierro

    2014-05-01

    Elderly persons represent a growing percentage of the total population, and this tendency will become stronger in the coming years. To date, the little evidence available on primary and secondary prevention indicates that this population has high cholesterol levels, that few are under treatment, and that the degree of control requires improvement. Current guidelines recommend that treatment targets in older persons should be the same as those in younger patients. Nevertheless, it is important to remember certain characteristics in older persons, such as biological and metabolic changes or the higher incidence of atherogenic dyslipidemia, which will affect them. Moreover, quality of life and maintaining independence rather than mere survival are especially important in older individuals, as demonstrated by various surveys. Consequently, pravastatin -the most widely studied statin- seems to be the statin of choice for the control of triglycerides and residual risk, although fenofibrate is also useful.

  17. Risk factors for hypothermia in patients under general anesthesia: Is there a drawback of laminar airflow operating rooms? A prospective cohort study.

    PubMed

    Yang, Lu; Huang, Chan-Yan; Zhou, Zhi-Bin; Wen, Zhi-Shuang; Zhang, Guan-Rong; Liu, Ke-Xuan; Huang, Wen-Qi

    2015-09-01

    The aim of this study was to estimate the prevalence and risk factors of hypothermia under general anesthesia in a large domestic hospital. All of the consecutive 1840 patients who underwent scheduled surgery between August and December 2013 were admitted to the study. The nasopharyngeal temperature was measured, and the following variables were also recorded: sex, age, type of surgery, duration of anesthesia, active warming devices and type of operating room. Univariate and multiple regression binary logistic analyses with odds ratios (ORs) and 95% confidence intervals (95% CIs) were used to assess the relationship between each clinical risk factor and hypothermia. The prevalence of hypothermia under general anesthesia was 25.7%. In the univariate analysis, the risk factors of hypothermia were age, the duration of anesthesia, the type of operating room and the type of surgery. Sex was not included. In the multiple logistic regression analysis, the significant risk factors of hypothermia were advanced age, laminar airflow operating rooms and general surgeries. Intraoperative hypothermia is still common and should therefore receive serious attention. Advanced age, the use of a laminar airflow operating room and general surgeries are high risk factors of hypothermia. Copyright © 2015 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.

  18. [Check-list "Patient Safety" in the operating room: one year experience of 40,000 surgical procedures at the university hospital of Nice].

    PubMed

    Rateau, F; Levraut, L; Colombel, A-L; Bernard, J-L; Quaranta, J-F; Cabarrot, P; Raucoules-Aimé, M

    2011-06-01

    The implementation of the check-list "Safe surgery saves live" (CL) has proven effective to reduce morbidity and perioperative mortality. Since 1st January 2010 it is a requirement of the HAS as part of the process of certification of hospitals. The CL has been established on all the operating rooms of our hospital after the onset of a near accident. The CL has been computerized to facilitate its adoption by professionals. An internal benchmarking was immediately implemented to allow each surgical specialty to benchmark themselves with other teams. We conducted an audit concerning the CL and periodic assessments in order to learn more precisely concerning the expectations and feelings of medical and nursing teams. Nearly 40 000 CL were collected in the patient record. The completeness of information of some items seems to reflect the difficulty for professionals to realize the difference between traceability and information sharing within the team on the implementation of a protocol. This audit has confirmed the difficulty in sharing information orally. The CL is involved in developing a safety culture in the operating room and led to the establishment of a risk mapping in the operating room and the recovery room and participation in the program error prevention procedure and surgical site through international program "High 5s" whose purpose is to improve the safety of care. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

  19. Correlation between rapid HIV testing and fourth-generation ELISA results for HIV detection among pregnant patients in the delivery room.

    PubMed

    Almaguer, Alejandro G; Mendoza-Flores, Lidia; Sánchez-López, Luis A; Palau-Dávila, Laura A; Padilla-Orozco, Magaly; Camacho-Ortiz, Adrián

    2017-04-01

    To analyze the usefulness of rapid HIV testing in pregnant patients in the delivery room. This prospective study compared a rapid test and a fourth-generation enzyme-linked immunoassay (ELISA) for HIV screening among pregnant patients admitted in labor with an unknown HIV status at a university hospital in Mexico between July 2015 and February 2016. Pearson correlation analysis was performed, and the diagnostic accuracy of the two tests was assessed with HIV RNA polymerase chain reaction (PCR) as the reference method. Overall, 534 patients were included. With a signal-to-cutoff (S/CO) value of 1.0 or more as a diagnostic criterion, 6 (1.1%) patients had a positive ELISA result. Three had a negative rapid test and three had a positive test (r=0.705). With an S/CO value of 2.0 or more as cutoff, 4 (0.7%) patients had a positive ELISA result. Three had a positive rapid test and one had a negative test (r=0.865). Only three of six patients with an S/CO of 1.0 or more were confirmed to have HIV by RNA PCR. The rapid test showed a strong correlation with the fourth-generation ELISA. Therefore, rapid testing is a useful tool in the delivery room for patients with unknown HIV status. © 2017 International Federation of Gynecology and Obstetrics.

  20. In Vivo Intracanal Temperature Evolution during Endodontic Treatment after the Injection of Room Temperature or Preheated Sodium Hypochlorite.

    PubMed

    de Hemptinne, Ferdinand; Slaus, Gunter; Vandendael, Mathieu; Jacquet, Wolfgang; De Moor, Roeland J; Bottenberg, Peter

    2015-07-01

    Heating a sodium hypochlorite solution improves its effectiveness. The aim of this study was to measure the in vivo temperature changes of sodium hypochlorite solutions that were initially preheated to 66°C or at room temperature inside root canals during routine irrigation. Thirty-five root canals were prepared to ISO size 40 with 4% taper. A type K (nickel-chromium-nickel) thermocouple microprobe (Testo NV, Ternat, Belgium) was positioned within 3 mm of the working length to measure the temperature at 1-second intervals. In each canal, 2 test protocols were evaluated in a randomized order with 3% sodium hypochlorite solutions: (1) preheated to 66°C and (2) at room temperature. The temperature measurements began 5 seconds before the 25 seconds of irrigant injections and continued for 240 seconds. This resulted in 270 data points for each protocol. The temperature of the irrigant at room temperature increased from the initial intracanal temperature after injection of 20.7°C (±1.2°C) to 30.9°C (±1.3°C) in 10 seconds and to 35°C (±0.9°C) after 240 seconds. The temperature of the preheated to 66°C solution decreased from 56.4°C (±2.7°C) to 45.4°C (±3.0°C) after 5 seconds, reached 37°C (±0.9°C) after 60 seconds, and reached 35.7°C (±0.8°C) after 240 seconds. The original temperatures of the sodium hypochlorite solutions were buffered inside the root canal and tended to rapidly evolve to equilibrium. The findings of this study contribute to an improved understanding of the thermodynamic behaviors of irrigant solutions inside root canals in vivo. Copyright © 2015 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

  1. Inappropriate treatments for patients with cognitive decline.

    PubMed

    Robles Bayón, A; Gude Sampedro, F

    2014-01-01

    Some treatments are inappropriate for patients with cognitive decline. We analyse their use in 500 patients and present a literature review. Benzodiazepines produce dependence, and reduce attention, memory, and motor ability. They can cause disinhibition or aggressive behaviour, facilitate the appearance of delirium, and increase accident and mortality rates in people older than 60. In subjects over 65, low systolic blood pressure is associated with cognitive decline. Maintaining this figure between 130 and 140 mm Hg (145 in patients older than 80) is recommended. Hypocholesterolaemia < 160 mg/dl is associated with increased morbidity and mortality, aggressiveness, and suicide; HDL-cholesterol<40 mg/dl is associated with memory loss and increased vascular and mortality risks. Old age is a predisposing factor for developing cognitive disorders or delirium when taking opioids. The risks of prescribing anticholinesterases and memantine to patients with non-Alzheimer dementia that is not associated with Parkinson disease, mild cognitive impairment, or psychiatric disorders probably outweigh the benefits. Anticholinergic drugs acting preferentially on the peripheral system can also induce cognitive side effects. Practitioners should be aware of steroid-induced dementia and steroid-induced psychosis, and know that risk of delirium increases with polypharmacy. Of 500 patients with cognitive impairment, 70.4% were on multiple medications and 42% were taking benzodiazepines. Both conditions were present in 74.3% of all suspected iatrogenic cases. Polypharmacy should be avoided, if it is not essential, especially in elderly patients and those with cognitive impairment. Benzodiazepines, opioids and anticholinergics often elicit cognitive and behavioural disorders. Moreover, systolic blood pressure must be kept above 130 mm Hg, total cholesterol levels over 160 mg/dl, and HDL-cholesterol over 40 mg/dl in this population. Copyright © 2012 Sociedad Española de Neurolog

  2. Surface treatment and analysis of aluminum alloy at room temperature with titanium-nitride films by dynamic mixing

    NASA Astrophysics Data System (ADS)

    Sato, T.; Ohata, K.; Fukushima, M.

    1988-06-01

    Titanium-nitride films were prepared on aluminum alloy (Al-11 wt.% Si) plates at room temperature by simultaneous ion bombardment and metal vapor deposition (dynamic mixing) using a high current ion source. The films were analysed by means of Auger electron spectroscopy and scanning electron microscopy. The results were compared with those made by metal vapor deposition and ion plating. The process of impurity inclusion in the titanium-nitride films made by dynamic mixing is discussed. Titanium films deposited by electron beam evaporation had high levels of oxygen impurities. However, when the same film was simultaneously bombarded by nitrogen ions, the levels of oxygen impurities decreased in the deposited titanium-nitride films.

  3. User-Centered Design of a Tablet Waiting Room Tool for Complex Patients to Prioritize Discussion Topics for Primary Care Visits

    PubMed Central

    Altschuler, Andrea; Chawla, Neetu; Kowalski, Christine; McQuillan, Deanna; Bayliss, Elizabeth; Heisler, Michele; Grant, Richard W

    2016-01-01

    Background Complex patients with multiple chronic conditions often face significant challenges communicating and coordinating with their primary care physicians. These challenges are exacerbated by the limited time allotted to primary care visits. Objective Our aim was to employ a user-centered design process to create a tablet tool for use by patients for visit discussion prioritization. Methods We employed user-centered design methods to create a tablet-based waiting room tool that enables complex patients to identify and set discussion topic priorities for their primary care visit. In an iterative design process, we completed one-on-one interviews with 40 patients and their 17 primary care providers, followed by three design sessions with a 12-patient group. We audiorecorded and transcribed all discussions and categorized major themes. In addition, we met with 15 key health communication, education, and technology leaders within our health system to further review the design and plan for broader implementation of the tool. In this paper, we present the significant changes made to the tablet tool at each phase of this design work. Results Patient feedback emphasized the need to make the tablet tool accessible for patients who lacked technical proficiency and to reduce the quantity and complexity of text presentation. Both patients and their providers identified specific content choices based on their personal experiences (eg, the ability to raise private or sensitive concerns) and recommended targeting new patients. Stakeholder groups provided essential input on the need to augment text with video and to create different versions of the videos to match sex and race/ethnicity of the actors with patients. Conclusions User-centered design in collaboration with patients, providers, and key health stakeholders led to marked evolution in the initial content, layout, and target audience for a tablet waiting room tool intended to assist complex patients with setting

  4. Sharps injury reduction: a six-year, three-phase study comparing use of a small patient-room sharps disposal container with a larger engineered container

    PubMed Central

    Naisoro, W

    2014-01-01

    A 350-bed Sydney hospital noted excessive container-associated sharps injuries (CASI) using small sharps containers and compared the effect from 2004 to 2010 of using a larger container engineered to reduce CASI. In Phase 1 (Ph1), disposable 1.4L containers (BD Australia) were carried to/from patients’ rooms. In Phase 2 (Ph2), this stopped and a safety-engineered 32L reusable container (the Device; Sharpsmart, SteriHealth) was mounted in medication stations only and sharps were carried to and from patient rooms using kidney dishes. In Phase 3 (Ph3), the Device was wall-mounted in patient rooms. Sharps injuries were categorised as ‘during-procedure’, ‘after-procedure but before disposal’, ‘CASI’, and ‘improper disposal SI’. Disposal-related SI comprised CASI plus improper-disposal SI. Injuries per 100 full-time-equivalent staff were analysed using Chi2; p ≤ 0.05; and relative risk and 95% confidence limits were calculated. In Ph1 (small containers) 19.4% of SI were CASI and transport injuries were zero. In Ph2 (Device in medication station) CASI fell 94.9% (p <0.001); Disposal-related SI fell 71.1% (p=0.002) but transport injuries rose significantly. In Ph3 (Device in patient room) zero CASI occurred (p<0.001); Disposal-related SI fell 83.1% (p=0.001). Recapping SI fell 85.1% (p=0.01) with the Device. The Device’s volume, large aperture, passive overfill-protection and close-at-hand siting are postulated as SI reduction factors.

  5. Coordinating care and treatment for cancer patients.

    PubMed

    Yip, Cheng Har; Samiei, Massoud; Cazap, Eduardo; Rosenblatt, Eduardo; Datta, Niloy Ranjan; Camacho, Rolando; Weller, David; Pannarunothai, Supasit; Goh, Cynthia; Black, Fraser; Kaur, Ranjit; Fitch, Margaret; Sutcliffe, Catherine; Sutcliffe, Simon

    2012-01-01

    integration of these services into national cancer control plans; the need for public education to reduce the fear and stigma associated with cancer so that patients are better able to make informed decisions regarding follow-up care and treatment; and the need to recognize the challenges and needs of survivors, their increasing number, the necessity to integrate survivorship into cancer control plans and the economic and societal value of functional survival after cancer. Discussions highlighted that coordinated care and treatment for cancer patients is both a ' systems'challenge and solution, requiring the consideration of patient and family circumstances, societal values and priorities, the functioning of the health system (access, capacity, resources, etc.) and the importance assigned to health and illness management within public policy.

  6. Response surface model predictions of emergence and response to pain in the recovery room: an evaluation of patients emerging from an isoflurane and fentanyl anesthetic

    PubMed Central

    Syroid, Noah D.; Johnson, Ken B.; Pace, Nathan L.; Westenskow, Dwayne R.; Tyler, Diane; Brühschwein, Frederike; Albert, Robert W.; Roalstad, Shelly; Costy-Bennett, Samuel; Egan, Talmage D.

    2009-01-01

    Introduction Sevoflurane - remifentanil interaction models that predict responsiveness and response to painful stimuli have been evaluated in patients undergoing elective surgery. Preliminary evaluations of model predictions were found to be consistent with observations in patients anesthetized with sevoflurane, remifentanil and fentanyl. The present study explored the feasibility of adapting the predictions of sevoflurane-remifentanil interaction models to an isoflurane-fentanyl anesthetic. We hypothesized that model predictions adapted for isoflurane and fentanyl are consistent with observed patient responses and are similar to the predictions observed in our prior work with sevoflurane-remifentanil/fentanyl anesthetics. Methods Twenty-five patients scheduled for elective surgery received a fentanyl-isoflurane anesthetic. Model predictions of unresponsiveness were recorded at emergence and predictions of a response to noxious stimulus were recorded when patients first required analgesics in the recovery room. Model predictions were compared to observations with graphical and temporal analyses. Results were also compared to our prior predictions following a sevoflurane-remifentanil/fentanyl anesthetic. Results While patients were anesthetized, model predictions indicated a high likelihood that patients would be unresponsive (≥ 99%). Following termination of the anesthetic, model predictions of responsiveness well described the actual fraction of patients observed to be responsive during emergence. Half of the patients awoke within 2 minutes of the 50% model predicted probability of unresponsiveness; 70% awoke within 4 minutes. Similarly, predictions of a response to a noxious stimulus were consistent with the number of patients who required fentanyl in the recovery room. Model predictions following an isoflurane-fentanyl anesthetic were similar to model predictions following a sevoflurane-remifentanil/fentanyl anesthetic. Discussion Results confirmed our study

  7. Pharmacological treatment of the obese diabetic patient.

    PubMed

    Scheen, A J; Lefebvre, P J

    1993-01-01

    Obesity is a well-known risk factor for non-insulin-dependent (or Type 2) diabetes mellitus. Consequently, reduction of weight excess comes to the front line in the prevention and management of NIDDM. It is only when diet and physical exercise fail that drug treatment should be considered. Pharmacological treatment of obesity should favour drugs which not only promote weight loss, by reducing caloric intake and/or increasing thermogenesis and energy expenditure, but also, and especially, improve insulin sensitivity. Serotoninergic anorectic compounds (dexfenfluramine, fluoxetine) appear to possess, to some extent, all these properties. Metformin significantly reduces insulin resistance and improves glycaemic control without inducing weight gain, and even favouring some weight loss. This biguanide is now considered as the first line drug for the obese diabetic patient. Alpha-glucosidase inhibitors may help to reduce post-prandial glucose excursions but do not promote weight loss per se. Sulfonylureas can be prescribed to an obese patient when hyperglycaemia persists despite diet and the above-mentioned oral agents, but their use should be associated with reinforcement of dietary advices in order to prevent further weight increase; it is also the case for insulin therapy. Finally, drugs specifically stimulating thermogenesis and energy expenditure, new agents sensitizing tissues to the action of insulin and various compounds interfering with lipid metabolism are currently under extensive investigation with promising preliminary results in the obese diabetic patient. In conclusion, obesity remains a major problem in the management of Type 2 diabetes mellitus and this justifies the search for new, safe and effective, pharmacological approaches.

  8. [Effect of vacuum cleaning of room floors and bed clothes of patients on house dust mites counts and clinical scores of atopic dermatitis. A double blind control trial].

    PubMed

    Endo, K; Fukuzumi, T; Adachi, J; Kojima, M; Aoki, T; Yoshida, M; Morita, K; Nari, T; Tsujino, M

    1997-10-01

    By a randomized double blind control trial we studied the effect of vacuum cleaning of room floors, mattresses and quilts for twelve months on clinical symptoms and laboratory data of atopic dermatitis patients. All patients used the identical new vacuum cleaners. Thirty patients (3-12 years of age) with relatively stable skin conditions were randomly allocated to either of the following two groups. In the monitor group we visited patient's home every three weeks and mite specialists cleaned drastically the room floors, mattresses and quilts and the patient continued to clean in the same way in-between. In the control group we visited similarly but the cleaning was made insufficiently which was also followed by the patient. But, at 2 occasions (the first and the last visits), cleaning was made drastically also in the control group. Thus the mite numbers were counted precisely at the start and the end of the experiment both in the monitor and control groups. Each patient was seen every six weeks by the same doctor and estimated of his symptoms using our unique scoring system (Fig. 1). At the start and the end of the study, total IgE and specific IgE antibodies to house dust mites in the serum were evaluated. The monitor group showed a tendency to count smaller number of mites than the control group after a year, when there was a significant difference only in quilts. However, a statistically significant decrease in the mite counts was observed only in room floors and not in mattresses and quilts both in the monitor and control groups (Fig. 2). Clinical scores after a year significantly improved only in the monitor group and not in the control group (Fig. 3). Serum IgE value and specific antibody titer to house dust mites were not changed significantly after the trial in both groups. As a conclusion, vacuum cleaning of the patient's room improved the clinical symptoms of atopic dermatitis but this could not be related to the reduction of house dust mite number.

  9. Positive predictive values of International Classification of Diseases, 10th revision codes for dermatologic events and hypersensitivity leading to hospitalization or emergency room visit among women with postmenopausal osteoporosis in the Danish and Swedish national patient registries

    PubMed Central

    Adelborg, Kasper; Christensen, Lotte Brix; Munch, Troels; Kahlert, Johnny; Trolle Lagerros, Ylva; Tell, Grethe S; Apalset, Ellen M; Xue, Fei; Ehrenstein, Vera

    2017-01-01

    Background Clinical epidemiology research studies, including pharmacoepidemiology and pharmacovigilance studies, use routinely collected health data, such as diagnoses recorded in national health and administrative registries, to assess clinical effectiveness and safety of treatments. We estimated positive predictive values (PPVs) of International Classification of Diseases, 10th revision (ICD-10) codes for primary diagnoses of dermatologic events and hypersensitivity recorded at hospitalization or emergency room visit in the national patient registries of Denmark and Sweden among women with postmenopausal osteoporosis (PMO). Methods This validation study included women with PMO identified from the Danish and Swedish national patient registries (2005–2014). Medical charts of the potential cases served as the gold standard for the diagnosis confirmation and were reviewed and adjudicated by physicians. Results We obtained and reviewed 189 of 221 sampled medical records (86%). The overall PPV was 92.4% (95% confidence interval [CI], 85.1%–96.3%) for dermatologic events, while the PPVs for bullous events and erythematous dermatologic events were 52.5% (95% CI, 37.5%–67.1%) and 12.5% (95% CI, 2.2%–47.1%), respectively. The PPV was 59.0% (95% CI, 48.3%–69.0%) for hypersensitivity; however, the PPV of hypersensitivity increased to 100.0% (95% CI, 67.6%–100.0%) when restricting to diagnostic codes for anaphylaxis. The overall results did not vary by country. Conclusion Among women with PMO, the PPV for any dermatologic event recorded as the primary diagnosis at hospitalization or at an emergency room visit was high and acceptable for epidemiologic research in the Danish and Swedish national patient registries. The PPV was substantially lower for hypersensitivity leading to hospitalization or emergency room visit.

  10. Positive predictive values of International Classification of Diseases, 10th revision codes for dermatologic events and hypersensitivity leading to hospitalization or emergency room visit among women with postmenopausal osteoporosis in the Danish and Swedish national patient registries.

    PubMed

    Adelborg, Kasper; Christensen, Lotte Brix; Munch, Troels; Kahlert, Johnny; Trolle Lagerros, Ylva; Tell, Grethe S; Apalset, Ellen M; Xue, Fei; Ehrenstein, Vera

    2017-01-01

    Clinical epidemiology research studies, including pharmacoepidemiology and pharmacovigilance studies, use routinely collected health data, such as diagnoses recorded in national health and administrative registries, to assess clinical effectiveness and safety of treatments. We estimated positive predictive values (PPVs) of International Classification of Diseases, 10th revision (ICD-10) codes for primary diagnoses of dermatologic events and hypersensitivity recorded at hospitalization or emergency room visit in the national patient registries of Denmark and Sweden among women with postmenopausal osteoporosis (PMO). This validation study included women with PMO identified from the Danish and Swedish national patient registries (2005-2014). Medical charts of the potential cases served as the gold standard for the diagnosis confirmation and were reviewed and adjudicated by physicians. We obtained and reviewed 189 of 221 sampled medical records (86%). The overall PPV was 92.4% (95% confidence interval [CI], 85.1%-96.3%) for dermatologic events, while the PPVs for bullous events and erythematous dermatologic events were 52.5% (95% CI, 37.5%-67.1%) and 12.5% (95% CI, 2.2%-47.1%), respectively. The PPV was 59.0% (95% CI, 48.3%-69.0%) for hypersensitivity; however, the PPV of hypersensitivity increased to 100.0% (95% CI, 67.6%-100.0%) when restricting to diagnostic codes for anaphylaxis. The overall results did not vary by country. Among women with PMO, the PPV for any dermatologic event recorded as the primary diagnosis at hospitalization or at an emergency room visit was high and acceptable for epidemiologic research in the Danish and Swedish national patient registries. The PPV was substantially lower for hypersensitivity leading to hospitalization or emergency room visit.

  11. [TREATMENT OPTIMIZATION IN PATIENTS WITH ERECTILE DYSFUNCTION].

    PubMed

    Pushkar, D Ju; Kolontarev, K B

    2015-01-01

    Erectile dysfunction (ED) is one of the most urgent problems of modern urology, significantly affecting quality of life of male population worldwide. According to European Association of Urology ED is defined as the persistent inability to attain and maintain an erection sufficient to permit satisfactory sexual performance. Premature ejaculation (PE) is also a significant medical and social issue as it seriously affects the quality of life, especially in the presence of more or less severe ED. The aim of this study was to determine the clinical efficacy and safety of combination therapy of phosphodiesterase type 5 inhibitors and dietary supplements NeyroDoz in patients with ED and PE. The study results demonstrate the effectiveness and good compatibility of phosphodiesterase type 5 inhibitors and dietary supplements NeyroDoz as a combination therapy in patients with ED and PE. Dietary supplement, having a good tolerance, reduced psychosomatic symptom and significantly increased duration of intercourse, thus significantly improving the quality of patients' sexual life. The feasibility to prolong the effect of the therapy by the individual adjustment of NeyroDoz dosing mode after a 60-day treatment course offers new opportunities for personalized medicine, and the dietary supplement may be recommended as a complementary preparation to provide an adequate sexual functioning.

  12. Periodontal Treatment Reduces Risk of Adverse Respiratory Events in Patients With Chronic Obstructive Pulmonary Disease

    PubMed Central

    Shen, Te-Chun; Chang, Pei-Ying; Lin, Cheng-Li; Chen, Chia-Hung; Tu, Chih-Yen; Hsia, Te-Chun; Shih, Chuen-Ming; Hsu, Wu-Huei; Sung, Fung-Chang; Kao, Chia-Hung

    2016-01-01

    Abstract Treatment of periodontal diseases has been associated with benefit outcomes for patients with chronic obstructive pulmonary disease (COPD). However, no population-based cohort study has been conducted. We evaluated this relationship by retrospective cohort study using a large population data. Using the National Health Insurance claims data of Taiwan, we identified 5562 COPD patients with periodontal diseases who had received periodontal treatment as the treatment group. The comparison group was selected at a 1:1 ratio matched by the propensity score estimated with age, sex, date of COPD diagnosis and periodontal treatment, and comorbidities. Both groups were followed up for 5 years to compare risks of acute exacerbation, pneumonia, and acute respiratory failure. The incidence rates of adverse respiratory events were significantly lower in the treatment group than in the comparison group: 3.79 versus 4.21 per 100 person-years for emergency room visits, 2.75 versus 3.65 per 100 person-years for hospitalizations, and 0.66 versus 0.75 per 100 person-years for intensive care unit admissions. The treatment group also had a 37% reduced risk of deaths (1.81 vs 2.87 per 100 person-years), with an adjusted hazard ratio of 0.57 (95% confidence interval 0.52–0.62). Periodontal treatment for COPD patients could reduce the risk of adverse respiratory events and mortality. The adequate periodontal health care is important for COPD patients with periodontal diseases. PMID:27196497

  13. Patients' and parents' concerns and decisions about orthodontic treatment.

    PubMed

    Kazancı, Fatih; Aydoğan, Cihan; Alkan, Özer

    2016-01-01

    Patients' and parents' expectations are important in orthodontic treatment decision making. The literature generally demonstrates the perceived benefits of orthodontic treatment, but patients' and their parents' concerns about orthodontic treatment have not been investigated comprehensively. The aim of this study was to identify patients' and parents' concerns about orthodontic treatment and compare them according to sex, age, and treatment demand level. One hundred and eighty-nine children and their parents were interviewed about concerns related to orthodontic treatment. Patients and parents were asked about orthodontic treatment decisions. Answers were recorded as "yes," "no," or "don't know." Chi-squared and Fisher's exact tests were used to compare concerns between age groups, sexes, and treatment demand levels. Kappa statistics were used to assess agreement between patients and their parents. Concerns about orthodontic treatment were gathered under 10 items as follows: "feeling pain," "the appearance of braces," "being teased," "avoiding smiling," "speech problems," "dietary changes," "problems with transportation," "economic problems," "long treatment duration," and "missing school." There was no statistically significant difference in concerns between the sexes or age groups. Some concern items and treatment demand were inversely related in patients. The results of this study demonstrate patients' and parents' concerns about orthodontic treatment. Differences between the concerns of patients with different treatment demands imply that children might reject orthodontic treatment because of their concerns. Appropriate consultation of patients addressing their concerns may help reduce anxiety and improve the acceptance of treatment.

  14. Patients' and parents' concerns and decisions about orthodontic treatment

    PubMed Central

    Aydoğan, Cihan; Alkan, Özer

    2016-01-01

    Objective Patients' and parents' expectations are important in orthodontic treatment decision making. The literature generally demonstrates the perceived benefits of orthodontic treatment, but patients' and their parents' concerns about orthodontic treatment have not been investigated comprehensively. The aim of this study was to identify patients' and parents' concerns about orthodontic treatment and compare them according to sex, age, and treatment demand level. Methods One hundred and eighty-nine children and their parents were interviewed about concerns related to orthodontic treatment. Patients and parents were asked about orthodontic treatment decisions. Answers were recorded as "yes," "no," or "don't know." Chi-squared and Fisher's exact tests were used to compare concerns between age groups, sexes, and treatment demand levels. Kappa statistics were used to assess agreement between patients and their parents. Results Concerns about orthodontic treatment were gathered under 10 items as follows: "feeling pain," "the appearance of braces," "being teased," "avoiding smiling," "speech problems," "dietary changes," "problems with transportation," "economic problems," "long treatment duration," and "missing school." There was no statistically significant difference in concerns between the sexes or age groups. Some concern items and treatment demand were inversely related in patients. Conclusions The results of this study demonstrate patients' and parents' concerns about orthodontic treatment. Differences between the concerns of patients with different treatment demands imply that children might reject orthodontic treatment because of their concerns. Appropriate consultation of patients addressing their concerns may help reduce anxiety and improve the acceptance of treatment. PMID:26877979

  15. Photoinduced superhydrophilicity of amorphous TiOx-like thin films by a simple room temperature sol-gel deposition and atmospheric plasma jet treatment

    NASA Astrophysics Data System (ADS)

    Vrakatseli, V. E.; Pagonis, E.; Amanatides, E.; Mataras, D.

    2014-11-01

    A room temperature sol gel process of TTIP / iPrOH / H2O /HNO3 sol was applied for the deposition of functional Ti alkoxide thin films on glass and polymeric substrates (PEEK). The unheated - amorphous films become superhydrophilic after 7 minutes of UV exposure which deteriorates after one day of storage in dark, exhibiting stable amphiphilic behavior. Superhydrophilicity is also obtained after 5 min of atmospheric pressure Ar - O2 plasma jet treatment. As the plasma power and the oxygen content of the mixture of the treatment increase (70W, 3.2 -5% O2) the films high hydrophilicity is maintained for many days even in dark atmospheric conditions providing long term hydrophilic coatings.

  16. Likelihood of Attending Treatment for Anxiety Among Veteran Primary Care Patients: Patient Preferences for Treatment Attributes.

    PubMed

    Shepardson, Robyn L; Funderburk, Jennifer S

    2016-09-01

    Anxiety is common, but under-treated, in primary care. Behavioral health providers embedded in primary care can help address this treatment gap. Guidance on anxiety treatment preferences would help inform tailoring of clinical practice and new interventions to be more patient-centered and increase treatment engagement. We surveyed 144 non-treatment seeking Veteran primary care patients (82.6 % male, 85.4 % White, age M = 59.8 years, SD = 13.9) reporting current anxiety symptoms (M = 13.87, SD = 3.66, on the Generalized Anxiety Disorder-7 Questionnaire) on their likelihood of attending anxiety treatment featuring various levels of 11 attributes (modality, type, location, format, provider, visit frequency, visit length, treatment duration, type of psychotherapy, symptom focus, and topic/skill). Participants indicated clear preferences for individual, face-to-face treatment in primary care, occurring once a month for at least 30 min and lasting at least three sessions. They also tended to prefer a stress management approach focused on trouble sleeping or fatigue, but all topics/skills were rated equivalently. For most attributes, the highest rated options were consistent with characteristics of integrated care. Implications for research and practice are discussed.

  17. [The emergency treatment of the psychotic patient].

    PubMed

    Naumann, Ute; Mavrogiorgou, Paraskevi; Pajonk, Frank-Gerald B; Juckel, Georg

    2012-06-01

    Psychosis can cause multiple psychiatric and somatic emergencies. Due to the complex character of the disease the communication and accessibility of the patient can be severely disturbed. In the pre-clinical emergency medical care the etiology of a psychosis remains often unclear, the most common causes are schizophrenia and drug-induced psychosis. Frequent emergencies are states of psychomotor agitation, self-endangerment and endangerment of others including suicidal tendencies/acts as well as catatonic and manic states. Antipsychotic drugs and benzodiazepines are the most efficient pharmacotherapeutic treatments. Extrapyramidal side effects of the prescribed medication can also cause the need for urgent medical care. In any case needs to be considered a severe somatic comorbidity. It is particularly necessary that all available information at the scene of emergency should be transferred to the clinicians since the further diagnostic and therapeutic assessment will rely hereon.

  18. Patient Satisfaction and Sustained Outcomes of Drug Abuse Treatment

    PubMed Central

    ZHANG, ZHIWEI; GERSTEIN, DEAN R.; FRIEDMANN, PETER D.

    2009-01-01

    The authors investigated the relationship between patients’ self-rated satisfaction with treatment services during and shortly after treatment with their drug use outcomes at one year follow-up, using a U.S. national panel survey of patients in 62 methadone, outpatient, short-term residential, and long-term residential programs. A favorable evaluation of treatment near the time of discharge had a significant positive relationship with drug use improvement outcomes approximately one year later, independent of the separately measured effects of treatment duration, counseling intensity, patient adherence to treatment protocols, pre-treatment drug use patterns, and other characteristics of patients and treatment programs. PMID:18420772

  19. Multioccupancy hospital rooms: veterans' experiences and preferences.

    PubMed

    Ehrlander, Wyatt; Ali, Fazalit; Chretien, Katherine Chang

    2009-10-01

    Although common, multioccupancy hospital rooms have long been criticized for concerns about safety and privacy. In 2006, despite limited evidence, the Health Guidelines Revision Committee recommended to eliminate them entirely from U.S. hospitals. We used a survey to evaluate patients' experiences and preferences regarding room type in order to help inform public policy decisions. Medical service inpatients at the Washington DC Veterans Affairs Medical Center were asked upon discharge to complete an anonymous written survey containing questions about privacy, nursing availability, loneliness, fear of death, interactions with roommates, and room preferences. Of the 162 patients who completed surveys, private room patients were more likely to report adequate privacy (92% vs. 53%; P < or = 0.01) and available nursing (79% vs. 64%; P = 0.025) than shared room patients. There was no difference in reported loneliness or fear of death. Most shared room patients (59%) indicated that they enjoyed speaking with their roommates, and 35% reported receiving help from roommates. The overall preference strongly favored private rooms (79%), most commonly for the sake of privacy. Patients who preferred shared rooms most often cited a desire for conversation. Patients felt that privacy was inadequate in the shared rooms, and a strong preference was found for private rooms. For those who preferred shared rooms, positive aspects of the experience included exchange of conversation and assistance between roommates. Copyright 2009 Society of Hospital Medicine

  20. HUMAN MACHINE INTERFACE (HMI) EVALUATION OF ROOMS TA-50-1-60/60A AT THE RADIOACTIVE LIQUID WASTE TREATMENT FACILITY (RLWTF)

    SciTech Connect

    Gilmore, Walter E.; Stender, Kerith K.

    2012-08-29

    This effort addressed an evaluation of human machine interfaces (HMIs) in Room TA-50-1-60/60A of the Radioactive Liquid Waste Treatment Facility (RLWTF). The evaluation was performed in accordance with guidance outlined in DOE-STD-3009, DOE Standard Preparation Guide for U.S. Department of Energy Nonreactor Nuclear Facility Documented Safety Analyses, 2006 [DOE 2006]. Specifically, Chapter 13 of DOE 2006 highlights the 10 CFR 830, Nuclear Safety Management, 2012, [CFR 2012] and DOE G 421.1-2 [DOE 2001a] requirements as they relate to the human factors process and, in this case, the safety of the RLWTF. The RLWTF is a Hazard Category 3 facility and, consequently, does not have safety-class (SSCs). However, safety-significant SSCs are identified. The transuranic (TRU) wastewater tanks and associated piping are the only safety-significant SSCs in Rooms TA-50-1-60/60A [LANL 2010]. Hence, the human factors evaluation described herein is only applicable to this particular assemblage of tanks and piping.

  1. Treatment satisfaction and recovery in Saami and Norwegian patients following psychiatric hospital treatment: a comparative study.

    PubMed

    Sørlie, Tore; Nergård, Jens-Ivar

    2005-06-01

    Treatment, treatment satisfaction and recovery in Saami and Norwegian patients treated in a psychiatric hospital were compared. Although half of the Saami patients preferred to speak Saami with their therapists, only one patient did. The extensive use of traditional helpers was only partly recognized. Despite no differences in type and amount of treatment or symptom-change during the hospital stay, the Saami patients showed less satisfaction with all investigated treatment parameters including contact with staff, treatment alliance, information and global treatment satisfaction. There was less agreement between the ratings of the therapists and the Saami patients. Suggestions for improvements are made.

  2. In control?: Ukrainian opiate substitution treatment patients strive for a voice in their treatment.

    PubMed

    Golovanevskaya, Maria; Vlasenko, Leonid; Saucier, Roxanne

    2012-04-01

    This article explores the burgeoning advocacy movement for methadone and buprenorphine treatment by patients, parents, and doctors in Ukraine, and their efforts to remake a system that infantilizes and controls patients into one where patients have a voice in their treatment. Through a review of gray literature and in-depth interviews with 28 patient-advocates and doctors in five Ukrainian cities between October 2009 and July 2010, this piece chronicles the emergence of opiate substitution treatment in Ukraine, describes successes toward patient-friendly treatment, and explores the institutionalized barriers that have pushed the patients to become advocates for their own treatment.

  3. The dedicated orthopedic trauma operating room.

    PubMed

    Min, William; Wolinsky, Philip R

    2011-08-01

    The development and implementation of a dedicated orthopedic trauma operating room (OTOR) that is used for the treatment of orthopedic trauma patients has changed and improved the practice of orthopedic trauma surgery. Advantages noted with OTOR implementation include improvements in morbidity and complication rates, enhancements in the professional and personal lifestyles of the on-call surgeon, and increased physician recruitment and retention in orthopedic traumatology. However, the inappropriate use of the OTOR, which can waste valuable resources and delay the treatment of emergent cases, must be monitored and avoided.

  4. Facile, room-temperature pre-treatment of rice husks with tetrabutylphosphonium hydroxide: Enhanced enzymatic and acid hydrolysis yields.

    PubMed

    Lau, B B Y; Luis, E T; Hossain, M M; Hart, W E S; Cencia-Lay, B; Black, J J; To, T Q; Aldous, L

    2015-12-01

    Aqueous solutions of tetrabutylphosphonium hydroxide have been evaluated as pretreatment media for rice husks, prior to sulphuric acid hydrolysis or cellulase enzymatic hydrolysis. Varying the water:tetrabutylphosphonium hydroxide ratio varied the rate of delignification, as well as silica, lignin and cellulose solubility. Pre-treatment with 60wt% hydroxide dissolved the rice husk and the regenerated material was thus heavily disrupted. Sulphuric acid hydrolysis of 60wt%-treated samples yielded the highest amount of glucose per gram of rice husk. Solutions with good lignin and silica solubility but only moderate to negligible cellulose solubility (10-40wt% hydroxide) were equally effective as pre-treatment media for both acid and enzymatic hydrolysis. However, pre-treatment with 60wt% hydroxide solutions was incompatible with downstream enzymatic hydrolysis. This was due to significant incorporation of phosphonium species in the regenerated biomass, which significantly inhibited the activity of the cellulase enzymes.

  5. Treatment of Muscle-Invasive Bladder Cancer in Older Patients.

    PubMed

    Skinner, Eila C

    2016-01-01

    Treatment of muscle-invasive bladder cancer in older patients is challenging. Definitive therapy of localized disease requires either surgery or radiation therapy, ideally combined with systemic chemotherapy. However, current population data suggest that less than half of patients older than age 70 are offered such treatments. We will review tools available to assess the fitness of older patients for surgery, alternatives, and tips for perioperative patient treatment.

  6. Isolation of Acinetobacter baumannii complex and methicillin-resistant Staphylococcus aureus from hospital rooms following terminal cleaning and disinfection: can we do better?

    PubMed

    Manian, Farrin A; Griesenauer, Sandra; Senkel, Diane; Setzer, Janice M; Doll, Sara A; Perry, Annie M; Wiechens, Michelle

    2011-07-01

    To study the frequency of isolation of Acinetobacter baumannii complex (ABC) and methicillin-resistant Staphylococcus aureus (MRSA) from surfaces of rooms newly vacated by patients with multidrug-resistant (MDR) ABC following various rounds of routine terminal cleaning and disinfection (C/D) with bleach or 1 round of C/D followed by hydrogen peroxide vapor (HPV) treatment. A 900-bed tertiary care hospital. ABC and MRSA cultures were obtained from hospital rooms including 312 rooms (mean, 18.3 sites/room) following 4 rounds of C/D, 37 rooms (mean, 20 sites/room) following 1 round of C/D before and after HPV treatment, and 134 rooms (mean, 20 sites/room) following 1 round of C/D and HPV treatment. Following 4 rounds of C/D, 83 (26.6%) rooms had 1 or more culture-positive sites; 102 (1.8%) sites in 51 (16.4%) rooms grew ABC, and 108 (1.9%) sites in 44 (14.1%) rooms grew MRSA. The addition of HPV treatment to 1 round of C/D resulted in a significant drop in ABC- and MRSA-positive room sites (odds ratio, 0 [95% confidence interval, 0-0.8]; P = .04 for both organisms). Following 1 round of C/D and HPV treatment, 6 (4.5%) rooms were culture-positive for ABC, MRSA, or both. Routine terminal C/D of hospital rooms vacated by MDRABC-positive patients may be associated with a significant number of ABC- or MRSA-positive room surfaces even when up to 4 rounds of C/D are performed. The addition of HPV treatment to 1 round of C/D appears effective in reducing the number of persistently contaminated room sites in this setting.

  7. Uptake of Depression Treatment Recommendations among Latino Primary Care Patients

    PubMed Central

    Ishikawa, Rachel Zack; Cardemil, Esteban V.; Alegría, Margarita; Schuman, Catherine C.; Joseph, Robert C.; Bauer, Amy M.

    2014-01-01

    Background Primary care providers (PCP) are the entry point for public sector depression treatment for many Latino patients. However, many Latino patients do not initiate their PCPs’ recommended treatment, which likely contributes to ethnic disparities in depression treatment. This study examined factors related to Latino patients’ uptake of their PCPs’ recommendations for depression treatment. Method Ninety Latino primary care patients who received a depression treatment recommendation from their PCP participated in a telephone interview. Patients rated their working alliance with their PCPs and their PCPs’ cultural competence. They also reported their treatment preference, the type of recommendation, and their intended and actual uptake of the recommendation. Patients were contacted at two time points (Time 1: M = 14 days after PCP appointment; Time 2: M = 84 days after PCP appointment) to report their uptake status. Results At Time 1, 23% of patients had initiated uptake of the treatment recommendation, increasing to 53% at Time 2. Patients who received a medication recommendation were more likely to have followed though on the recommendation, compared to patients who received a psychotherapy recommendation. The working alliance was positively associated with intention to follow up on a treatment recommendation, and also mediated the relationship between cultural competence and intention of following up on the recommendation. Conclusion PCP’s treatment recommendation and the PCP – patient alliance play a role in Latino primary care patients intention to follow a treatment recommendation for depression. An improved understanding of this role could enhance efforts to improve depression treatment uptake. PMID:24512538

  8. Home intravenous antibiotic treatment for febrile episodes in immune-compromised pediatric patients.

    PubMed

    Shemesh, E; Yaniv, I; Drucker, M; Hadad, S; Goshen, Y; Stein, J; Ash, S; Fisher, S; Zaizov, R

    1998-02-01

    The purpose of this work was to assess the feasibility of home intravenous antibiotic treatment (HIAT) for febrile episodes in immune-compromised (neutropenic, splenectomized), low-risk pediatric patients. Thirty hematology-oncology patients who presented to our emergency room from January 1993 to January 1995 and who suffered from a febrile episode and were considered at low risk for septic complications were immediately discharged on HIAT. Patients were followed for at least 3 weeks after recovery. Patients and parents were retrospectively questioned about adverse effects and about their degree of satisfaction with home treatment. Patients who required hospitalization during this period were considered unresponsive to HIAT and were analyzed for causes and adverse effects. Thirteen out of 60 (22%) febrile episodes, or eight out of 42 (19%) episodes of fever and neutropenia eventually led to hospitalization. Pseudomonas species infections were associated with the highest rate of unresponsiveness (88%). A central venous catheter infection developed in two cases following HIAT (two cases out of 640 days of therapy). No other complications were identified. No infection-related morbidity was observed. Patients and parents were highly satisfied with HIAT and wanted to use it again, if necessary. Immediate discharge on HIAT for low-risk pediatric immune-compromised patients suffering from a febrile episode is feasible, safe, and well accepted by patients and families. Patients who are found to have Pseudomonas infections should probably be hospitalized. Our results are preliminary and must be confirmed by a prospective, randomized trial before definite recommendations can be made.

  9. Delays in diagnosis and treatment of pulmonary tuberculosis in AFB smear-negative patients with pneumonia.

    PubMed

    Zhang, Z X; Sng, L-H; Yong, Y; Lin, L M; Cheng, T W; Seong, N H; Yong, F K

    2017-03-16

    BACKGROUND:

    Diagnostic and treatment delays increase the severity and transmission of pulmonary tuberculosis (PTB). This study aimed to evaluate TB diagnostic and treatment delays in acid-fast bacilli (AFB) smear-negative patients.

    METHODS:

    This was a retrospective observational study. Patients with positive AFB culture of Mycobacterium tuberculosis complex (MTC) were selected from among hospitalised patients with a diagnosis of pneumonia. Admission ward, anti-tuberculosis treatment and the duration of AFB culture were compared between smear-positive and smear-negative patients.

    RESULTS:

    Of the 70 patients with positive isolation of MTC in AFB culture, 27 (38.5%) were smear-negative; of these, 18 (66.7%) were not isolated while in hospital, and 17 (63%) were neither diagnosed nor treated for TB. In contrast, 41 of the 43 smear-positive patients (95.3%) were directly admitted or quickly transferred to the isolation room and started on anti-tuberculosis treatment (P < 0.001). Samples from smear-negative patients required more time to grow MTC in AFB culture than those of smear-positive patients (23 days vs. 14 days, P < 0.001). Diabetes was significantly associated with AFB smear positivity, with an odds ratio of 12.2.

    CONCLUSIONS:

    Negative AFB smears caused significant diagnostic and treatment delay. Patients staying in the general ward were exposed to TB patients who were not diagnosed in time.

  10. Patient perceptions of multiple sclerosis and its treatment

    PubMed Central

    de Seze, Jérôme; Borgel, Florent; Brudon, Frédérique

    2012-01-01

    Background In order to improve the treatment outcome in multiple sclerosis, it is important to document the factors that influence adherence to therapy. The purpose of this study was to determine patient perceptions and awareness of multiple sclerosis and its treatment, treatment adherence, and impact on quality of life and daily living. Methods This was a cross-sectional observational study performed in France. Each participating neurologist included the first three patients with relapsing-remitting multiple sclerosis who consulted after the start of the study. Data on clinical features were collected from a physician questionnaire and on disease and treatment perception and on quality of life from a patient autoquestionnaire. Results A total of 175 neurologists entered 202 patients in the study. The mean duration of disease was 8.0 ± 7.0 years, and immunomodulatory treatment had been administered for a mean duration of 3.0 ± 2.0 years. A total of 166 patients (82.2%) were treated with interferon-β preparations and 36 patients (17.8%) with glatiramer acetate. Eighty-five patients (42.1%) reported missing their injections from time to time and 36 patients (17.8%) reported “drug holidays”. The most frequently given reason for nonadherence was forgetfulness (38.7% of cases). Eighty-six patients (42.6%) and 70 patients (34.7%) claimed to be well informed about their disease and treatment, respectively. Adherence was significantly higher in well informed patients (P = 0.035). The majority of patients (176 patients, 87.1%) intended continuing their current treatment and 49.5% considered that their current treatment might reduce relapses. The most frequently reported side effect was muscle pain (124 patients, 61.4%). Conclusion Patient understanding of treatment for disease enhances treatment adherence. Greater patient involvement in disease management requires better communication between physicians and their patients. PMID:22536062

  11. Unsuccessful DTIC treatment of a patient with glucagonoma syndrome.

    PubMed

    Hallengren, B; Dymling, J F; Manhem, P; Tennvall, L; Tibblin, S

    1983-01-01

    Various chemotherapeutic modalities have been tried in the treatment of patients with malignant glucagonomas. Promising results have been reported after drug treatment with dimethyltriazenoimidazole carboxamide (DTIC). We present a patient with a metastasizing pancreatic glucagonoma, in whom treatment with neither DTIC nor with the combination of streptozotocin and 5-fluorouracil resulted in any noticeable improvement.

  12. Survey Finds That Many Prisons And Jails Have Room To Improve HIV Testing And Coordination Of Postrelease Treatment

    PubMed Central

    Solomon, Liza; Montague, Brian T.; Beckwith, Curt G.; Baillargeon, Jacques; Costa, Michael; Dumont, Dora; Kuo, Irene; Kurth, Ann; Rich, Josiah D.

    2014-01-01

    Early diagnosis of HIV and effective antiretroviral treatment are key elements in efforts to reduce the morbidity and mortality associated with HIV. Incarcerated populations are disproportionately affected by HIV, with the disease’s prevalence among inmates estimated to be three to five times higher than among the general population. Correctional institutions offer important opportunities to test for HIV and link infected people to postrelease treatment services. To examine HIV testing and policies that help HIV-positive people obtain treatment in the community after release, we administered a survey to the medical directors of the fifty state prison systems and of forty of the largest jails in the United States. We found that 19 percent of prison systems and 35 percent of jails provide opt-out HIV testing, which is recommended by the Centers for Disease Control and Prevention (CDC). Additionally, fewer than 20 percent of prisons and jails conform to the CDC’s recommendations regarding discharge planning services for inmates transitioning to the community: making an appointment with a community health care provider, assisting with enrollment in an entitlement program, and providing a copy of the medical record and a supply of HIV medications. These findings suggest that opportunities for HIV diagnosis and linking HIV-positive inmates to community care after release are being missed in the majority of prison systems and jails. PMID:24590942

  13. Survey finds that many prisons and jails have room to improve HIV testing and coordination of postrelease treatment.

    PubMed

    Solomon, Liza; Montague, Brian T; Beckwith, Curt G; Baillargeon, Jacques; Costa, Michael; Dumont, Dora; Kuo, Irene; Kurth, Ann; Rich, Josiah D

    2014-03-01

    Early diagnosis of HIV and effective antiretroviral treatment are key elements in efforts to reduce the morbidity and mortality associated with HIV. Incarcerated populations are disproportionately affected by HIV, with the disease's prevalence among inmates estimated to be three to five times higher than among the general population. Correctional institutions offer important opportunities to test for HIV and link infected people to postrelease treatment services. To examine HIV testing and policies that help HIV-positive people obtain treatment in the community after release, we administered a survey to the medical directors of the fifty state prison systems and of forty of the largest jails in the United States. We found that 19 percent of prison systems and 35 percent of jails provide opt-out HIV testing, which is recommended by the Centers for Disease Control and Prevention (CDC). Additionally, fewer than 20 percent of prisons and jails conform to the CDC's recommendations regarding discharge planning services for inmates transitioning to the community: making an appointment with a community health care provider, assisting with enrollment in an entitlement program, and providing a copy of the medical record and a supply of HIV medications. These findings suggest that opportunities for HIV diagnosis and linking HIV-positive inmates to community care after release are being missed in the majority of prison systems and jails.

  14. Evaluation of thermal discomfort in Athens territory and its effect on the daily number of recorded patients at hospitals' emergency rooms

    NASA Astrophysics Data System (ADS)

    Pantavou, Katerina; Theoharatos, Georgios; Nikolopoulos, Georgios; Katavoutas, Georgios; Asimakopoulos, Dimosthenis

    2008-11-01

    Previous research has shown that temperature and humidity affect human health. However, only a few studies have examined the association of a biometeorological index, which combines several meteorological parameters and human physiology, with health outcomes. The aim of the present study is to assess the thermal discomfort in Athens city by using the Predicted Mean Vote (PMV) as well as to examine its association with the number of patients recorded at the emergency rooms of four main hospitals. Patients were selected based on their diagnosis during the summer season (June August) from 1998 to 2004. Data included hourly values of meteorological parameters and daily numbers of patients who visited the emergency units of cardiology departments. Poisson regression models were applied using generalized estimating equations. A strong negative correlation between mean and maximum daily values of PMV and the number of emergency department visits was identified. More studies are needed to explore the association of this biometeorological index with health outcomes in other regions.

  15. SU-E-T-590: An Activation Study of Materials and Devices Present in a Proton Treatment Room

    SciTech Connect

    Spitznagel, D

    2014-06-01

    Purpose: The use of protons for radiation therapy is growing rapidly. One consequence of protons interacting with different media is activation. These nuclear reactions induced by the protons, scattered neutrons, and gamma rays, activate different materials encountered, particularly by the therapists. The purpose of this study was to examine the derived nuclides from the activation, and also the decay rate. Methods: The study was conducted in our proton therapy facility. Protons are derived from a synchrocyclotron and pass through field shipping systems, apertures, and range compensators to define the beam within the patient.Included materials of concerns measured; the patient support couch, sheet rock in the wall, solid plastics used for quality assurance and dosimetry, and the passive scattering system itself, which includes brass apertures, and Lucite or blue wax compensators. All devices were studied post irradiation using gamma spectroscopy to determine the nuclides, and a sodium iodine scintillation detector to measure decay, particularly when the dose rate fell to background levels. Results: We have also determined from the measurements we will maintain brass apertures for three months before sending them for scrap. Some of the radionuclides arrived from these measurements included Na-22 for the blue wax compensator, C1-34m for the sheetrock, and Sc-44 and Co-60 for the brass apertures. We found compensators made out of Lucite or wax decayed to background in 2 hours. The patient support couch decayed to background in approximately 40 minutes, and sheet rock decayed in 80 minutes. In terms of the aperture layers, the most proximal aperture slab had much higher activity than the distal slab. Also the proximal sides of the slabs were much more activate than the distal. Conclusion: We have given proper instruction to therapists performing quality assurance in terms of the handled plastics, and to handle apertures rapidly as possible.

  16. Involvement of surgical residents in the management of trauma patients in the emergency room: does the presence of an attending physician affect outcomes?

    PubMed

    Cohen, Robert; Adini, Bruria; Radomislensky, Irina; Givon, Adi; Rivkind, Avraham I; Peleg, Kobi

    2012-03-01

    Few studies have investigated whether the presence or absence of attending physicians (AP) in the emergency department (ED) during the management of trauma patients by residents. Six level 1 trauma center admissions for years 2006-2008 were analyzed to determine whether presence of an AP affected the time spent in the ED, post-ED disposition, and in-hospital mortality. Patient demographics differed in relation to the presence of APs (P < 0.01). Patients with ISS > 25 who died during hospitalization were more often managed when APs were present. Male patients, those <65, and patients with Injury Severity Score (ISS) > 16 were more often treated in the presence of an AP (P < 0.01). Penetrating, terror trauma, motor vehicle collision and assaults were more often managed in the presence APs. Presence of APs differed by hospital (P < 0.0001). Adjusted logistic regression revealed that patients spent less time in the ED, went directly to the operating room or the ICU for definitive care, if an AP was present. Presence of an attending physician improved and focused patient triage, disposition decisions, and outcomes.

  17. [Combined treatment of palmoplantar syndrome in patients under antitumor therapy].

    PubMed

    Kruglova, L S; Shatokhina, E A; Elfimov, M A; Illarionov, V E; Chervinskaya, A V; Portnov, V V; Filatova, E V; Petrova, M S

    2016-01-01

    Observation covered 12 patients under various antitumor medications. Group 1 was formed of patients with developed palmoplantar syndrome varying in severity, who received complex treatment including IR-therapy and local antioxidant medication. Group 2 included patients without palmoplantar syndrome, who received preventive treatment with IR-therapy. All patients of group 1 demonstrated lower severity of palmoplantar syndrome manifestations. In group 2, 80% of the patients avoided palmoplantar syndrome development, and 20% of the patients had light course of the syndrome manifestations. Patients at high risk of palmoplantar syndrome under antitumor therapy are recommended to undergo IR-therapy and local antioxidant medication.

  18. Factors affecting engagement of dual diagnosis patients in outpatient treatment.

    PubMed

    Bogenschutz, M P; Siegfreid, S L

    1998-10-01

    This study examined factors associated with engagement in outpatient treatment of patients with dual diagnoses of psychiatric disorder and substance use disorder. The charts of all 57 patients referred to a dual diagnosis treatment program during a six-month period were reviewed, and data on patients' substance use diagnosis, psychiatric diagnosis, sex, ethnicity, and referral source were collected. Patients referred from inpatient treatment were more likely to attend three or more appointments at the dual diagnosis program than those referred from outpatient treatment. Substance of abuse interacted with both referral source and sex in predicting engagement.

  19. Cosmetic Makeover Ensuring Patient Input in a Multidisciplinary Treatment.

    PubMed

    Magid-Katz, Sabrina; Magid, Kenneth S; Mantzikos, Theo

    2015-07-01

    A cosmetic smile makeover has become a sought after procedure in our esthetically driven society. To promote patient satisfaction with treatment outcomes, all parties involved, including the patient, must be aware of the results that can be achieved and what it will require to achieve them. Although treatment can be redone, it cannot be undone. Therefore, much patient input must be solicited and considered before beginning treatment and before the final restorations are cemented. This article provides a treatment sequence that minimizes the possibility of an unhappy patient. Copyright © 2015 Elsevier Inc. All rights reserved.

  20. Tuberculosis in hospitalized patients: clinical characteristics of patients receiving treatment within the first 24 h after admission*

    PubMed Central

    Silva, Denise Rossato; da Silva, Larissa Pozzebon; Dalcin, Paulo de Tarso Roth

    2014-01-01

    Objective: To evaluate clinical characteristics and outcomes in patients hospitalized for tuberculosis, comparing those in whom tuberculosis treatment was started within the first 24 h after admission with those who did not. Methods: This was a retrospective cohort study involving new tuberculosis cases in patients aged ≥ 18 years who were hospitalized after seeking treatment in the emergency room. Results: We included 305 hospitalized patients, of whom 67 (22.0%) received tuberculosis treatment within the first 24 h after admission ( ≤24h group) and 238 (88.0%) did not (>24h group). Initiation of tuberculosis treatment within the first 24 h after admission was associated with being female (OR = 1.99; 95% CI: 1.06-3.74; p = 0.032) and with an AFB-positive spontaneous sputum smear (OR = 4.19; 95% CI: 1.94-9.00; p < 0.001). In the ≤24h and >24h groups, respectively, the ICU admission rate was 22.4% and 15.5% (p = 0.258); mechanical ventilation was used in 22.4% and 13.9% (p = 0.133); in-hospital mortality was 22.4% and 14.7% (p = 0.189); and a cure was achieved in 44.8% and 52.5% (p = 0.326). Conclusions: Although tuberculosis treatment was initiated promptly in a considerable proportion of the inpatients evaluated, the rates of in-hospital mortality, ICU admission, and mechanical ventilation use remained high. Strategies for the control of tuberculosis in primary care should consider that patients who seek medical attention at hospitals arrive too late and with advanced disease. It is therefore necessary to implement active surveillance measures in the community for earlier diagnosis and treatment. PMID:25029651

  1. Increased Risk of Vascular Events in Emergency Room Patients Discharged Home with Diagnosis of Dizziness or Vertigo: A 3-Year Follow-Up Study

    PubMed Central

    Lee, Ching-Chih; Ho, Hsu-Chueh; Su, Yu-Chieh; Chiu, Brian C-H; Su, Yung-Cheng; Lee, Yi-Da; Chou, Pesus

    2012-01-01

    Background Dizziness and vertigo symptoms are commonly seen in emergency room (ER). However, these patients are often discharged without a definite diagnosis. Conflicting data regarding the vascular event risk among the dizziness or vertigo patients have been reported. This study aims to determine the risk of developing stroke or cardiovascular events in ER patients discharged home with a diagnosis of dizziness or vertigo. Methodology A total of 25,757 subjects with at least one ER visit in 2004 were identified. Of those, 1,118 patients were discharged home with a diagnosis of vertigo or dizziness. A Cox proportional hazard model was performed to compare the three-year vascular event-free survival rates between the dizziness/vertigo patients and those without dizziness/vertigo after adjusting for confounding and risk factors. Results We identified 52 (4.7%) vascular events in patients with dizziness/vertigo and 454 (1.8%) vascular events in patients without dizziness/vertigo. ER patients discharged home with a diagnosis of vertigo or dizziness had 2-fold (95% confidence interval [CI], 1.35–2.96; p<0.001) higher risk of stroke or cardiovascular events after adjusting for patient characteristics, co-morbidities, urbanization level of residence, individual socio-economic status, and initially taking medications after the onset of dizziness or vertigo during the first year. Conclusions ER patients discharged home with a diagnosis of dizziness or vertigo were at a increased risk of developing subsequent vascular events than those without dizziness/vertigo after the onset of dizziness or vertigo. Further studies are warranted for developing better diagnostic and follow-up strategies in increased risk patients. PMID:22558272

  2. Follow up of patients who start treatment with antidepressants: treatment satisfaction, treatment compliance, efficacy and safety

    PubMed Central

    2013-01-01

    Background Measuring satisfaction with treatment has proved useful to ascertain the treatment features that are most important to the patients, and to explain increased treatment compliance. However, there are few studies that relate satisfaction to other clinical or self-perceived health status indicators. Recent studies have shown the close relationship between satisfaction with treatment, treatment compliance, and effectiveness. This study attempts to design and validate a scale to evaluate satisfaction with antidepressant drug therapy, assess treatment compliance (self-reported, validated questionnaire, drug accountability and electronic monitorization system), assess efficacy in reducing depressive symptoms and safety in patients who initiate antidepressant drug therapy, as well as to establish predictors of satisfaction, compliance and effectiveness with these drugs. Methods/design This is an observational longitudinal study with a cohort of adults initiating treatment with antidepressant drugs. A multi-centre study will be performed in which 20 Primary Care practices from Castilla-La Mancha are expected to participate. An initial interview and follow-up visits at 15 days, 1, 3, 6, 9 and 12 months will be conducted with all study participants. 706 subjects will be studied (95% confidence interval, precision ± 3%, expected rate of non-compliance 50%, expected non-responders and lost to follow up rate 15%). The following measurements will be performed: development and validation of a scale of satisfaction with antidepressant therapy, participant and antidepressant characteristics, treatment compliance evaluation (Haynes-Sackett Test, Morisky-Green Test, drug accountability and Medication Event Monitoring System), depression symptom reduction (Hamilton Depression Rating Scale and Montgomery-Asberg Depression Rating Scale), observation of adverse effects, and beliefs about treatment (The Beliefs about Medicines Questionnaire). Discussion Antidepressant drugs are

  3. [Optimization of complex treatment of patients with severe oral leukoplakia].

    PubMed

    Rabinovich, O F; Rabinovich, I M; Abramova, E S

    2015-01-01

    The aim of the study was to prove the rationale for antiviral therapy combined with surgical procedures for treatment of severe oral leukoplakia. Complex clinical and laboratory evaluation and treatment was performed in 56 patients divided in 2 groups. Control group was presented by 13 patients receiving dental treatment, local and systemic keratoplastic formulations. Main group involved 43 patients in which conventional treatment protocol was completed by antiviral therapy and surgical procedures. Leukoplakia diagnosis was based on clinical findings, histological and immunohistochemical studies as well as optic coherent tomography data. The obtained results evidently prove the necessity for including antiviral therapy and surgical procedures in treatment scheme of severe oral leukoplakia.

  4. Burn Patient Acuity Demographics, Scar Contractures and Rehabilitation Treatment Time Related to Patient Outcomes (ACT)

    DTIC Science & Technology

    2011-10-01

    Patient Acuity Demographics, Scar Contractures and Rehabilitation Treatment Time Related to Patient Outcomes (ACT) Mr. Reginald Richard American Burn...and Rehabilitation Treatment Time Related to Patient Outcomes, conveniently referred to as the ACT representing Acuity, Contractures and Time, is...wound leading to scar contracture begins almost immediately after the burning process stops. Rehabilitation treatment delivered prior to beginning

  5. Greater Postimplant Swelling in Small-Volume Prostate Glands: Implications for Dosimetry, Treatment Planning, and Operating Room Technique

    SciTech Connect

    Chung, Eugene; Stenmark, Matthew H.; Evans, Cheryl; Narayana, Vrinda; McLaughlin, Patrick W.

    2012-04-01

    Purpose: Postimplant prostatic edema has been implicated in suboptimal permanent implants, and smaller prostates have been reported to have worse dosimetric coverage. In this study we compare the degree of postimplant edema between larger and smaller prostates and examine the effects of prostate size on the dose delivered to 90% of the prostate (D90). Methods and Materials: From September 2003 to February 2006, 105 hormone-naive patients underwent permanent prostate brachytherapy with {sup 125}I Rapid Strand (Oncura Inc., Arlington Heights, IL). All patients underwent pelvic magnetic resonance imaging (MRI) within 3 weeks before implant, transrectal ultrasound at the time of implant, and both computed tomography and MRI 2.5 to 3 weeks after implant. Prostates were divided into 5 subgroups based on preimplant MRI volumes: less than 25 mL, 25 to 35 mL, 35 to 45 mL, 45 to 55 mL, and greater than 55 mL. Prostate swelling was assessed by use of preimplant and postimplant MRI volumes. Postimplant dosimetry was determined by MRI and compared between the subgroups. Results: All prostates showed postimplant swelling on MRI when compared with preimplant MRI, with a mean increase of 31% {+-} 31% (p < 0.0001). The greatest swelling was noted in small prostates (volume less than 25 mL), with a mean increase of 70% {+-} 36%. The degree of swelling in the group with a volume less than 25 mL was significantly larger than the degree of swelling in all other prostate subgroups (p < 0.003). Transrectal ultrasound significantly overestimates the prostate volume when compared with MRI by a mean of 15% {+-} 25% (p = 0.0006) and is more pronounced for smaller prostates. Although prostates with volumes less than 25 mL did not have significantly worse D90 compared with larger prostates, they had the largest percent of suboptimal implants by the standard ratio of D90 divided by the prescription dose. Conclusions: Although small prostates have the greatest postimplant edema, planning

  6. Profile of addicted patients who reenter treatment programs.

    PubMed

    López-Goñi, José J; Fernández-Montalvo, Javier; Cacho, Raúl; Arteaga, Alfonso

    2014-01-01

    Clinical experience shows that some patients who suffer from drug addiction are readmitted to treatment programs multiple times because of relapses that occur after they leave these programs. Patients who reenter treatment programs repeatedly may do so because they have problems or difficulties that were not addressed or that were not satisfactorily solved during previous treatment periods. This study explored the differential profile of addicted patients who reenter treatment programs. A sample of 252 addicted patients (203 male and 49 female) who sought outpatient treatment was assessed. Data regarding sociodemographic factors, drug consumption factors (assessed using the EuropASI), psychopathological factors (assessed using the Symptom Checklist-90-Revised [SCL-90-R]), and personality variables (assessed using the Millon Clinical Multiaxial Inventory II [MCMI-II]) were collected. A 65.9% (n = 166) of drug-addicted patients were readmitted into treatment programs. All of the variables for which data were collected were compared between these treatment repeaters and patients who were admitted for the first time. Significant differences between the 2 groups of patients were found for some of the variables that we examined. Treatment repeaters were generally older and had a poorer employment situation than first-time admits. Treatment repeaters were also more likely to report polyconsumption and to have sought treatment for alcohol abuse. Moreover, some of the scores for several EuropASI, SCL-90-R, and MCMI-II variables were statistically significantly different from those of the first-time admits. According to these results, patients who reenter treatment programs often present with more severe addiction problems. All of these data suggest that treatment programs should incorporate a detailed analysis regarding the existence and nature of prior treatments into the baseline protocols and they should offer follow-up services to patients who have completed their

  7. [Alcohol drinking-related disorders in 1901 patients treated at Taubaté's Municipal Emergency room in 2000: a contribution to sociocentric education in neurology].

    PubMed

    Ferri-de-Barros, João E; Winter, Daniel Hugo; César, Karolina Gouveia; Gavinier, Leandro Camille dos Santos; Alencar, Maurício José de; Faria, Maria Carolina Soares de

    2004-06-01

    Medical education must focus prevalent themes in communities; alcohol consumption is one of these themes. Our objective was to determine the frequency of the alcohol consumption related disorders and verify if a patient had more than one disease diagnosed, contributing to sociocentric education. It was a transversal retrospective study made by collection of medical records that had any reference to alcohol in a emergency room in 2000 (1901 cases). Alcohol direct effects were found in 80.38% of the patients, trauma in 28.56%, digestive and/or metabolic diseases in 27%, infections in 6.42% and nutritional disorders in 5.94%. Only one diagnosis was attributed in 46.6% of the cases and more than one in 48.67%. The most frequent disturbs were: intoxication, abstinence syndrome, gastritis, cirrhosis, dehydration, low or high glucose levels and trauma. Alcohol related disturbances are frequent and often associated; thus, alcohol abuse is an important content in a medical education.

  8. Feasibility of early emergency room notification to improve door-to-balloon times for patients with acute ST segment elevation myocardial infarction.

    PubMed

    Sekulic, Milan; Hassunizadeh, Bischan; McGraw, Steve; David, Shukri

    2005-11-01

    An algorithm to lower time from first contact in the field by EMS personnel to in-hospital mechanical reperfusion is described. ECG tracings were telemetered via cellular phone to an emergency room physician, who then activated the cardiac catheterization call team to bypass usual delays seen during ER triage. Seventy-one ECGs were sent to the ER in the time interval from October 2003 to October 2004. Five ECGs (7.0%) failed to transmit due to failure of the cellular phone to receive an adequate signal. Sixty-six patients (93.0%) had an adequate ECG transmitted to the ER and six patients with ST elevation myocardial infarction were identified. Door-to-balloon times were lowered to 44 +/- 17.4 min, a substantial decrease over historical norms that range from 120 min (25th percentile) to 289 min (75th percentile). Copyright 2005 Wiley-Liss, Inc.

  9. Improvement in Patient Transfer Process From the Operating Room to the PICU Using a Lean and Six Sigma-Based Quality Improvement Project.

    PubMed

    Gleich, Stephen J; Nemergut, Michael E; Stans, Anthony A; Haile, Dawit T; Feigal, Scott A; Heinrich, Angela L; Bosley, Christopher L; Tripathi, Sandeep

    2016-08-01

    Ineffective and inefficient patient transfer processes can increase the chance of medical errors. Improvements in such processes are high-priority local institutional and national patient safety goals. At our institution, nonintubated postoperative pediatric patients are first admitted to the postanesthesia care unit before transfer to the PICU. This quality improvement project was designed to improve the patient transfer process from the operating room (OR) to the PICU. After direct observation of the baseline process, we introduced a structured, direct OR-PICU transfer process for orthopedic spinal fusion patients. We performed value stream mapping of the process to determine error-prone and inefficient areas. We evaluated primary outcome measures of handoff error reduction and the overall efficiency of patient transfer process time. Staff satisfaction was evaluated as a counterbalance measure. With the introduction of the new direct OR-PICU patient transfer process, the handoff communication error rate improved from 1.9 to 0.3 errors per patient handoff (P = .002). Inefficiency (patient wait time and non-value-creating activity) was reduced from 90 to 32 minutes. Handoff content was improved with fewer information omissions (P < .001). Staff satisfaction significantly improved among nearly all PICU providers. By using quality improvement methodology to design and implement a new direct OR-PICU transfer process with a structured multidisciplinary verbal handoff, we achieved sustained improvements in patient safety and efficiency. Handoff communication was enhanced, with fewer errors and content omissions. The new process improved efficiency, with high staff satisfaction. Copyright © 2016 by the American Academy of Pediatrics.

  10. Radiation protection design philosophy for a door interlock system for shared room remote afterloading brachytherapy.

    PubMed

    Woo, M K; Gillies, B A; McParland, C S

    1995-12-01

    A single remote afterloading system can sometimes be used for the radiation treatment of two or more patients in separate rooms simultaneously. This configuration poses certain radiation protection problems, especially in a busy clinic where some of the treatment rooms have to be used for other non-radiation related patients even though not all radiation treatments have been completed. In this report we describe a door interlock system that has been designed to allow for radiation protection purposes during radiation treatment but is disabled when the radiation treatment is completed--with enough safeguard built in to prevent accidental bypass of the interlock. In addition, the quality control procedures of the radiation monitor devices for these treatment rooms are described. These radiation protection procedures could be generalized to other remote afterloading systems.

  11. Treatment preferences of psychotherapy patients with chronic PTSD.

    PubMed

    Markowitz, John C; Meehan, Kevin B; Petkova, Eva; Zhao, Yihong; Van Meter, Page E; Neria, Yuval; Pessin, Hayley; Nazia, Yasmin

    2016-03-01

    Patient treatment preference may moderate treatment effect in major depressive disorder (MDD) studies. Little research has addressed preference in posttraumatic stress disorder (PTSD); almost none has assessed actual patients' PTSD psychotherapy preferences. From a 14-week trial of chronic PTSD comparing prolonged exposure, relaxation therapy, and interpersonal psychotherapy, we report treatment preferences of the 110 randomized patients, explore preference correlates, and assess effects on treatment outcome. Patients recruited between 2008 and 2013 with chronic DSM-IV PTSD (Clinician-Administered PTSD Scale [CAPS] score ≥ 50) received balanced, scripted psychotherapy descriptions prerandomization and indicated their preferences. Analyses assessed relationships of treatment attitudes to demographic and clinical factors. We hypothesized that patients randomized to preferred treatments would have better outcomes, and to unwanted treatment worse outcomes. Eighty-seven patients (79%) voiced treatment preferences or disinclinations: 29 (26%) preferred prolonged exposure, 29 (26%) preferred relaxation therapy, and 56 (50%) preferred interpersonal psychotherapy (Cochran Q = 18.46, P < .001), whereas 29 (26%) were disinclined to prolonged exposure, 18 (16%) to relaxation therapy, and 3 (3%) to interpersonal psychotherapy (Cochran Q = 22.71, P < .001). Several baseline clinical variables correlated with treatment preferences. Overall, treatment preference/disinclination did not predict change in CAPS score, treatment response, or dropout. Comorbidly depressed patients receiving unwanted treatment had worse final CAPS scores. These exploratory findings are the first relating patients' PTSD psychotherapy preferences to outcome. Despite explanations emphasizing prolonged exposure's greater empirical support, patients significantly preferred interpersonal psychotherapy. Preference subtly affected psychotherapy outcome; depression appeared an important moderator of the effect

  12. Indoor Temperatures in Patient Waiting Rooms in Eight Rural Primary Health Care Centers in Northern South Africa and the Related Potential Risks to Human Health and Wellbeing.

    PubMed

    Wright, Caradee Y; Street, Renée A; Cele, Nokulunga; Kunene, Zamantimande; Balakrishna, Yusentha; Albers, Patricia N; Mathee, Angela

    2017-01-06

    Increased temperatures affect human health and vulnerable groups including infants, children, the elderly and people with pre-existing diseases. In the southern African region climate models predict increases in ambient temperature twice that of the global average temperature increase. Poor ventilation and lack of air conditioning in primary health care clinics, where duration of waiting time may be as long as several hours, pose a possible threat to patients seeking primary health care. Drawing on information measured by temperature loggers installed in eight clinics in Giyani, Limpopo Province of South Africa, we were able to determine indoor temperatures of waiting rooms in eight rural primary health care facilities. Mean monthly temperature measurements inside the clinics were warmer during the summer months of December, January and February, and cooler during the autumn months of March, April and May. The highest mean monthly temperature of 31.4 ± 2.7 °C was recorded in one clinic during February 2016. Maximum daily indoor clinic temperatures exceeded 38 °C in some clinics. Indoor temperatures were compared to ambient (outdoor) temperatures and the mean difference between the two showed clinic waiting room temperatures were higher by 2-4 °C on average. Apparent temperature (AT) incorporating relative humidity readings made in the clinics showed 'realfeel' temperatures were >4 °C higher than measured indoor temperature, suggesting a feeling of 'stuffiness' and discomfort may have been experienced in the waiting room areas. During typical clinic operational hours of 8h00 to 16h00, mean ATs fell into temperature ranges associated with heat-health impact warning categories of 'caution' and 'extreme caution'.

  13. Indoor Temperatures in Patient Waiting Rooms in Eight Rural Primary Health Care Centers in Northern South Africa and the Related Potential Risks to Human Health and Wellbeing

    PubMed Central

    Wright, Caradee Y.; Street, Renée A.; Cele, Nokulunga; Kunene, Zamantimande; Balakrishna, Yusentha; Albers, Patricia N.; Mathee, Angela

    2017-01-01

    Increased temperatures affect human health and vulnerable groups including infants, children, the elderly and people with pre-existing diseases. In the southern African region climate models predict increases in ambient temperature twice that of the global average temperature increase. Poor ventilation and lack of air conditioning in primary health care clinics, where duration of waiting time may be as long as several hours, pose a possible threat to patients seeking primary health care. Drawing on information measured by temperature loggers installed in eight clinics in Giyani, Limpopo Province of South Africa, we were able to determine indoor temperatures of waiting rooms in eight rural primary health care facilities. Mean monthly temperature measurements inside the clinics were warmer during the summer months of December, January and February, and cooler during the autumn months of March, April and May. The highest mean monthly temperature of 31.4 ± 2.7 °C was recorded in one clinic during February 2016. Maximum daily indoor clinic temperatures exceeded 38 °C in some clinics. Indoor temperatures were compared to ambient (outdoor) temperatures and the mean difference between the two showed clinic waiting room temperatures were higher by 2–4 °C on average. Apparent temperature (AT) incorporating relative humidity readings made in the clinics showed ‘realfeel’ temperatures were >4 °C higher than measured indoor temperature, suggesting a feeling of ‘stuffiness’ and discomfort may have been experienced in the waiting room areas. During typical clinic operational hours of 8h00 to 16h00, mean ATs fell into temperature ranges associated with heat–health impact warning categories of ‘caution’ and ‘extreme caution’. PMID:28067816

  14. Briefing and debriefing in the cardiac operating room. Analysis of impact on theatre team attitude and patient safety.

    PubMed

    Papaspyros, Sotiris C; Javangula, Kalyana C; Adluri, Rajeshwara Krishna Prasad; O'Regan, David J

    2010-01-01

    Error in health services delivery has long been recognised as a significant cause of inpatient morbidity and mortality. Root-cause analyses have cited communication failure as one of the contributing factors in adverse events. The formalised fighter pilot mission brief and debrief formed the basis of the National Aeronautics and Space Administration (NASA) crew resource management (CRM) concept produced in 1979. This is a qualitative analysis of our experience with the briefing-debriefing process applied to cardiac theatres. We instituted a policy of formal operating room (OR) briefing and debriefing in all cardiac theatre sessions. The first 118 cases were reviewed. A trouble-free operation was noted in only 28 (23.7%) cases. We experienced multiple problems in 38 (32.2%) cases. A gap was identified in the second order problem solving in relation to instrument repair and maintenance. Theatre team members were interviewed and their comments were subjected to qualitative analysis. The collaborative feeling is that communication has improved. The health industry may benefit from embracing the briefing-debriefing technique as an adjunct to continuous improvement through reflective learning, deliberate practice and immediate feedback. This may be the initial step toward a substantive and sustainable organizational transformation.

  15. Wireless sensor and data transmission needs and technologies for patient monitoring in the operating room and intensive care unit.

    PubMed

    Paksuniemi, M; Sorvoja, H; Alasaarela, E; Myllyla, R

    2005-01-01

    In the intensive care unit, or during anesthesia, patients are attached to monitors by cables. These cables obstruct nursing staff and hinder the patients from moving freely in the hospital. However, rapidly developing wireless technologies are expected to solve these problems. To this end, this study revealed problem areas in current patient monitoring and established the most important medical parameters to monitor. In addition, usable wireless techniques for short-range data transmission were explored and currently employed wireless applications in the hospital environment were studied. The most important parameters measured of the patient include blood pressures, electrocardiography, respiration rate, heart rate and temperature. Currently used wireless techniques in hospitals are based on the WMTS and WLAN standards. There are no viable solutions for short-range data transmission from patient sensors to patient monitors, but potentially usable techniques in the future are based on the WPAN standards. These techniques include Bluetooth, ZigBee and UWB. Other suitable techniques might be based on capacitive or inductive coupling. The establishing of wireless techniques depends on ensuring the reliability of data transmission, eliminating disturbance by other wireless devices, ensuring patient data security and patient safety, and lowering the power consumption and price.

  16. Student-Led Health Education Programmes in the Waiting Room of a Free Clinic for Uninsured Patients

    ERIC Educational Resources Information Center

    Kamimura, Akiko; Tabler, Jennifer; Myers, Kyl; Ahmed, Fattima; Aguilera, Guadalupe; Ashby, Jeanie

    2017-01-01

    Objective: Free clinics provide free or reduced fee healthcare to individuals who lack access to primary care and are socio-economically disadvantaged in the USA. Free clinic patients may have health education needs, but experience barriers to attending health education programmes. In an attempt to reach out to free clinic patients who might not…

  17. An Exploratory and Comparative Evaluation on the Spatial Perception of Two Densities of Multioccupancy Hospital Rooms.

    PubMed

    Yildirim, Kemal; Yalcin, Meryem

    2016-04-01

    The objective of this article was to explore interior spatial qualifications on patient perception of two densities of multioccupancy hospital rooms. The research setting of this study was the three- and six-person capacity hospital rooms used for treatment of patients at a large hospital in a major metropolitan city in Turkey. The subjects used in the study were randomly selected from among patients treated in the surgical medical sciences' departments of the hospital. Accordingly, a research questionnaire was applied to a total of 101 subjects. Results have shown that the three-person rooms were assessed more positively for privacy, functional, and perceptual qualifications compared to the six-person rooms. An increase in the number of persons and interior units of rooms affects negatively the auditory privacy and privacy areas of other patients. Consequently, although these rooms with different spatial sizes were very similar for concentration of persons and commodities, six-person rooms were perceived to be more crowded than three-person rooms. © The Author(s) 2015.

  18. Addition of heart score to high-sensitivity troponin T versus conventional troponin T in risk stratification of patients with chest pain at the coronary emergency rooms.

    PubMed

    Willems, M N I; van de Wijngaart, D J; Bergman, H; Adiyaman, A; Telting, D; Willems, F F

    2014-12-01

    Patients with chest pain have a large impact on available resources in coronary emergency rooms (CER). Clinical judgement, ECG, risk scores and biomarkers guide in risk stratification. We investigated if high-sensitivity troponin T (HsT) and the HEART Score could contribute to risk stratification at the CER. All patients with chest pain, without elevated conventional troponin levels at presentation, were included. HsT levels were determined at admission (T1), at 4-6 h (T2) and 8-10 h after symptom onset (T3). The HEART Score was calculated as risk score for the occurrence of a major adverse cardiac event (MACE). Thirty days after discharge, occurrence of MACE was registered. Eighty-nine patients were included (overall mean age 61 years (range 20-90)). At presentation, 68 patients (76 %) had a HsT below cut-off value of 14 ng/l (mean HEART Score 3.7, range 1-9). Thirty-one of these 68 patients had a HEART Score between 1-3, no MACE occurred in this group. For 3 patients (4 %) HsT levels increased above 14 ng/l. These 3 patients had a HEART Score between 4-6. The majority of patients with chest pain can be safely discharged within 4-6 h after onset of symptoms using HsT and the HEART Score. In contrast, patients with initially normal HsT but a high HEART Score need longer follow-up and repeat HsT determination.

  19. Locker Room Talk.

    ERIC Educational Resources Information Center

    Fickes, Michael

    1999-01-01

    Examines the trends in college and university sports and recreation center locker rooms as envisioned by a specialist. Features of the modern locker room and the different levels of locker room design are explained. Final comments discuss whether college and university facility managers are inclined to move to high-end locker rooms. (GR)

  20. Patient Satisfaction in Military Dental Treatment Facilities

    DTIC Science & Technology

    2006-03-07

    related to technical expertise, Crall and Morris (1988) and Abrams, Ayers and Vogt-Petterson (1986) found that patient satisfaction was not well ...mission of the Army Dental Care Dental Patient Satisfaction 93 System. Dental emergencies in deployed military populations have been well documented...that choice. The ratings of the beliefs about the care received were high as well . Mean scores on the seven belief questions Dental Patient Satisfaction

  1. Craniospinal treatment with the patient supine

    SciTech Connect

    Thomadsen, Bruce; Mehta, Minesh; Howard, Steven; Das, Rupak

    2003-03-31

    Radiotherapy of the craniospinal axis in young children is frequently complicated by the need for access to the patient's airway for sedation and anesthesia delivery or by frequent, unanticipated movement. Positioning the patient supine, instead of in the conventional prone position, allows the use of immobilization facemasks with body molds and more positive patient fixation, and improved airway access. The procedure for establishing the various fields differs from the prone approach. In this paper, we describe the methodology to achieve successful supine positioning.

  2. [Comparison of treatment expenses of naturopathic and orthopedic in-patient treatment].

    PubMed

    Wiebelitz, K R; Teske, W; Henke, T; Knobloch, R; Winnemöller, C; Beer, A M

    2010-01-14

    In health services research comparative studies between orthopaedics and naturopathy are necessary. They allow evidence based decisions between individual therapeutical alternatives as well as decisions on health politics, e.g. concerning allocation of resources. A controlled prospective cohort study is presented. Conservatively treated patients were recruited for the study, if they needed in-patient treatment because of chronic back pain. The conservative orthopaedic treatment including Minimal invasive Therapy (MIT) was compared to in-patient naturopathic "complex"-treatment. The real costs to the public health insurance system are unknown--relating to both the individual patient and the physician. Hence an approximation was attempted on the basis of the billing of the concerned hospitals, the analysis of extensive patient interviews, randomly selected evaluation of in- and out-patient records, validated by an expert panel. Costs for medication decreased in the post stationary phase after orthopedic and naturopathic treatment. Rehabilitation measures and treatments at a health resort increased after orthopedic treatment, whereas the frequency of specialist consultation decreased in both cohorts indicating the efficacy of the in-patient treatment. Incidence of psychotherapy was highest in the naturopathic group before admission to hospital and decreased afterwards. The gathered data point to a reduction of the total outpatient treatment costs in both cohorts. There were treatment-specific differences when regarding single components. Naturopathic complex in-patient treatment is a cost-efficient complement of the conventional orthopedic treatment options.

  3. The effect of a checklist on the quality of patient handover from the operating room to the intensive care unit: A randomized controlled trial.

    PubMed

    Salzwedel, Cornelie; Mai, Victoria; Punke, Mark A; Kluge, Stefan; Reuter, Daniel A

    2016-04-01

    Handover of patient care is a potential safety risk for the patient due to loss of information which may result in adverse outcome. We hypothesized that a checklist for handover from the operating room (OR) to the intensive care unit (ICU) will lead to an increase of quality regarding information transfer compared with a nonstandardized handover procedure. The study was conducted as a prospective, randomized trial in a university hospital. The quality of handovers with checklist was compared with handovers without checklist. Handovers were recorded by digital voice recorder and analyzed using an individual rating sheet for each patient. This enabled to discriminate between items that "must be handed over" (red items) and items that "should be handed over" (yellow items). A total of 121 patient handovers from OR to ICU were included. Significantly more red items were handed over in the study group compared with the control group (study group: median 87.1%, 25-27 percentile 77.1%-90.0%; control group: median 75.0%, 25-75 percentile 66.7%-88.6%; P < .01). This study gives first evidence that the use of a standardized checklist for patient handover from OR to ICU increases the quantity and quality of transmitted medical information. Copyright © 2015 Elsevier Inc. All rights reserved.

  4. Patient preference and willingness to pay for knee osteoarthritis treatments

    PubMed Central

    Posnett, John; Dixit, Sanjeev; Oppenheimer, Brooks; Kili, Sven; Mehin, Nazanin

    2015-01-01

    Purpose To review treatments for osteoarthritis of the knee (OAK) received by patients across five European countries, and to obtain patients’ perceptions and willingness to pay for current treatments. Patients and methods A prospective, internet-based, double-blind survey of adults with OAK was conducted in France, Germany, Italy, Spain, and the United Kingdom. The questionnaire included questions about diagnosis, treatment history, and perceptions of OAK treatments, followed by a discrete choice-based conjoint exercise to identify preferred attributes of OAK treatments, evaluating 14 sets of four unbranded products. Results Two thousand and seventy-three patients with self-reported OAK completed the survey; 17.4% of patients rated their knee pain as drastically affecting their ability to perform normal daily activities, and 39.3% of employed patients reported that they had lost work time because of OAK. The most common treatments were exercise (69.7%), physical therapy (68.2%), and nonprescription oral pain medication (73.9%). Treatments perceived as most effective were: viscosupplement injections (74.1%), narcotics (67.8%), and steroid injection (67.6%). Patient co-pay, duration of pain relief, and type of therapy exhibited the largest impact on patient preference for OAK treatments. The average patient was willing to pay €35 and €64 more in co-pay for steroid and viscosupplement injections, respectively, over the cost of oral over-the-counter painkillers (per treatment course, per knee) (each P<0.05). Conclusion OAK is a debilitating condition that affects normal daily activities. In general, treatments most commonly offered to patients are not those perceived as being the most effective. Patients are willing to pay a premium for treatments that they perceive as being more effective and result in longer-lasting pain relief, and those that can be administered with fewer visits to a physician. PMID:26089650

  5. Anesthesia services outside of the operating room.

    PubMed

    Adams, Kendall; Pennock, Natalie; Phelps, Becky; Rose, Wendy; Peters, Matthew

    2007-01-01

    In January 2000, Primary Children's Medical Center (PCMC) nurses and physicians of specific disciplines including hematology/oncology, surgery, Emergency Department (ED), and anesthesia, identified a need to provide general anesthesia for children undergoing procedures outside of the operating room. This need was based upon two factors: (a) limited availability of the operating room, and (b) lack of proper monitoring of children receiving conscious sedation for painful procedures in PCMC clinics. In September 2000, the Rapid Treatment Unit (RTU) service was developed to provide cost-effective, efficient, patient/family-centered care for a variety of procedures. With limited literature on the subject of anesthesia services outside of the operating room, many hours of planning, education, and organizing occurred to develop this unique service. Parents have reported satisfaction with the service verbally and through an anonymous survey. Increasing numbers of patients seeking services from Utah, Idaho, Nevada, Wyoming, and Montana indicate a need for service expansion within the five-state region surrounding Salt Lake City. The RTU Anesthesia service is an important asset to PCMC and continues to expand to provide safe, efficient health care for children.

  6. Matching the environment to patients with delirium: lessons learned from the delirium room, a restraint-free environment for older hospitalized adults with delirium.

    PubMed

    Flaherty, Joseph H; Little, Milta O

    2011-11-01

    Delirium is associated with several negative outcomes and is not always preventable. Current practices for the management of older hospitalized adults with delirium, such as one-on-one sitters, antipsychotic medications, and physical restraints, have limited effectiveness or potential health risks. An alternative management model, called the Delirium Room (DR), is a four-bed patient room (within an Acute Care for Elders (ACE) Unit) that provides 24-hour nursing care, emphasizes nonpharmacological approaches, and is completely free of physical restraints. This article is based on 13 years of experience at two hospitals. The authors have found that a restraint-free environment can be achieved; "tolerate, anticipate, and don't agitate" (the T-A-DA method) are the core principles of the nonpharmacological approach that go beyond the traditional strategies of management (such as reorientation); based on observational data, it appears that negative outcomes associated with delirium, such as loss of function, longer hospital stay, and greater mortality, can be decreased to levels seen in individuals without delirium; and based on limited data, it appears that the rate of falls is at least not higher in the DR than in the ACE unit overall. The limitations of the DR model include lack of randomized controlled trials and the inability to determine which component of the model provides its benefits. © 2011, Copyright the Authors Journal compilation © 2011, The American Geriatrics Society.

  7. Assessment of DICOM Viewers Capable of Loading Patient-specific 3D Models Obtained by Different Segmentation Platforms in the Operating Room.

    PubMed

    Lo Presti, Giuseppe; Carbone, Marina; Ciriaci, Damiano; Aramini, Daniele; Ferrari, Mauro; Ferrari, Vincenzo

    2015-10-01

    Patient-specific 3D models obtained by the segmentation of volumetric diagnostic images play an increasingly important role in surgical planning. Surgeons use the virtual models reconstructed through segmentation to plan challenging surgeries. Many solutions exist for the different anatomical districts and surgical interventions. The possibility to bring the 3D virtual reconstructions with native radiological images in the operating room is essential for fostering the use of intraoperative planning. To the best of our knowledge, current DICOM viewers are not able to simultaneously connect to the picture archiving and communication system (PACS) and import 3D models generated by external platforms to allow a straight integration in the operating room. A total of 26 DICOM viewers were evaluated: 22 open source and four commercial. Two DICOM viewers can connect to PACS and import segmentations achieved by other applications: Synapse 3D® by Fujifilm and OsiriX by University of Geneva. We developed a software network that converts diffuse visual tool kit (VTK) format 3D model segmentations, obtained by any software platform, to a DICOM format that can be displayed using OsiriX or Synapse 3D. Both OsiriX and Synapse 3D were suitable for our purposes and had comparable performance. Although Synapse 3D loads native images and segmentations faster, the main benefits of OsiriX are its user-friendly loading of elaborated images and it being both free of charge and open source.

  8. [Antiestrogen treatment in postmenopausal patients with metastatic breast cancer].

    PubMed

    Lindberg, Henriette; Nielsen, Dorte Lisbet; Tuxen, Malgorzata; Kamby, Claus

    2007-09-10

    This review discusses the evidence for endocrine treatment in postmenopausal patients with metastatic breast cancer. First line treatment with non-steroid aromatase inhibitors (AI) yields response rates of 30% and improves progression free survival, but not overall survival, compared to tamoxifen. With second line treatment using steroid AI, estrogen antagonists or selective estrogen receptor modulators prolonged disease stabilisation is achieved in 40% of patients. With third line treatment using steroid AI and estrogen antagonists disease stabilisation is achieved in up to 30% of patients.

  9. Real-world treatment patterns of gout patients treated with colchicine or other common treatments for gout in acute care settings: a retrospective chart review study.

    PubMed

    Shiozawa, Aki; Cloutier, Martin; Heroux, Julie; Guerin, Annie; Wu, Eric Q; Jackson, Robert

    2015-08-01

    To describe real-world treatment patterns of patients receiving colchicine or other treatments during a gout-related emergency room or acute care facility (ER/ACF) visit. An online physician-administered questionnaire was used to collect chart data on 500 patients with a gout-related ER/ACF visit after 16 October 2009; 250 patients receiving colchicine (Colchicine Cohort) and 250 receiving NSAIDs, systemic corticosteroids, narcotics, allopurinol, febuxostat, pegloticase, probenecid, or sulfinpyrazone (Other Cohort). Patient characteristics and treatment received/prescribed during the ER/ACF visit (Period 1 [P1]), at discharge (P2), and at the first follow-up visit (P3) are reported. A total of 45 rheumatologists and 63 primary care physicians participated in the study. Patient mean age was 51 years and 74.8% were male. The most common treatments in the Other Cohort were NSAIDs (59.6%), systemic corticosteroids (45.2%), and narcotics (33.6%). The 500 patients contributed 307 distinct treatment patterns from P1 to P3. Of the 20.6% patients not prescribed a treatment in P2, 60.2% were restarted on a treatment in P3. Of the 78.6% treated patients in P2, 27.0% had a treatment adjustment (dose increase, treatment add-on, or initiation of a different gout-related treatment - not with a urate lowering therapy only) in P3; for 72.6% of these patients, physicians justified the treatment adjustment by inadequacy of the treatment for maintenance therapy, insufficient dosage, or inadequate response. In the Colchicine Cohort, 60.8% of patients were prescribed colchicine consistently from P1 to P3, while 26.8% and 17.7% of patients in the Other Cohort were prescribed consistently NSAIDs and systemic corticosteroids from P1 to P3, respectively. Specific nature of the acute gout-related symptoms or potential attack/flare during the ER/ACF visit was not recorded. Real-world clinical practice reveals a substantial number of distinct treatment patterns and frequent treatment

  10. Aligning patient care and asthma treatment guidelines.

    PubMed

    Cannon, Eric

    2005-11-01

    This article describes how the National Asthma Education and Prevention Program Guidelines for the Diagnosis and Management of Asthma can be used in the clinical setting to improve a patient's everyday function and quality of life. Major recommendations are detailed and case studies provide a practical approach for patient management.

  11. Subjective experiences of clozapine treatment by patients with chronic schizophrenia.

    PubMed

    Waserman, J; Criollo, M

    2000-05-01

    A 37-item survey covering a variety of somatopsychic domains was constructed to explore patients' subjective response to treatment with clozapine. The survey was administered to 130 patients with diagnoses of chronic schizophrenic or schizoaffective disorders who were on a stable clozapine regimen. The majority reported improvement in their level of satisfaction, quality of life, compliance with treatment, thinking, mood, and alertness. Most patients reported worsening in nocturnal salivation, and smaller numbers reported worsening in various gastrointestinal and urinary symptoms and weight gain. This general health survey highlights the patients' positive regard for clozapine, despite adverse bodily experiences. Subjective reports are a useful component of outcome measures of drug treatment.

  12. Endoscopic treatment of vesicoureteral reflux in pediatric patients

    PubMed Central

    Kim, Jong Wook

    2013-01-01

    Endoscopic treatment is a minimally invasive treatment for managing patients with vesicoureteral reflux (VUR). Although several bulking agents have been used for endoscopic treatment, dextranomer/hyaluronic acid is the only bulking agent currently approved by the U.S. Food and Drug Administration for treating VUR. Endoscopic treatment of VUR has gained great popularity owing to several obvious benefits, including short operative time, short hospital stay, minimal invasiveness, high efficacy, low complication rate, and reduced cost. Initially, the success rates of endoscopic treatment have been lower than that of open antireflux surgery. However, because injection techniques have been developed, a recent study showed higher success rates of endoscopic treatment than open surgery in the treatment of patients with intermediate- and high-grade VUR. Despite the controversy surrounding its effectiveness, endoscopic treatment is considered a valuable treatment option and viable alternative to long-term antibiotic prophylaxis. PMID:23646052

  13. Bringing patients' social context into the examination room: an investigation of the discussion of social influence during contraceptive counseling.

    PubMed

    Levy, Kira; Minnis, Alexandra M; Lahiff, Maureen; Schmittdiel, Julie; Dehlendorf, Christine

    2015-01-01

    Although social networks are an increasingly recognized influence on contraceptive use, little is known about if and how social influences are discussed during women's contraceptive counseling visits. We performed a mixed-methods analysis of audio recordings of contraceptive counseling visits. We examined predictors of discussion of social influence arising in a contraceptive counseling visit and analyzed the content and process of social influence discussions. Social influences were mentioned in 42% of the 342 visits included in the sample, with these discussions most commonly initiated by patients. Younger patients were more likely to have social influence mentioned than older patients. The content of social influence focused on side effects and adverse events, with the sources of influence being predominantly patients' friends and the media, with little input from partners. Providers were more likely to engage around the content of the social influence than the social influence itself. The frequency with which social influence was mentioned in these visits supports the importance of women's social context on their contraceptive decision making. However, the fact that patients initiated the discussion in the majority of cases suggests that providers may not recognize the relevance of these influences or may not be comfortable engaging with them. Increasing providers' ability to elicit and engage patients about their social context with regard to contraception could enhance providers' ability to understand women's contraceptive preferences and provide appropriate counseling to address their specific concerns or questions. Copyright © 2015 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

  14. Complex soundproofing of industrial rooms

    NASA Technical Reports Server (NTRS)

    Pocsa, V.; Veres, A.; Biborosch, L.

    1974-01-01

    Some structures treated for sound absorption are described that are used to soundproof industrial rooms with a very high noise level. Soundproofing treatments for the walls and coilings or only for the ceilings are considered. In the case of relatively small rooms having a noise source with a high level, complex treatments involve, in addition to soundproofing of the walls and ceiling, suspended panels specially oriented with respect to the noise source. The efficiency of the adopted solutions is compared with calculated damping values.

  15. Complex soundproofing of industrial rooms

    NASA Technical Reports Server (NTRS)

    Pocsa, V.; Veres, A.; Biborosch, L.

    1974-01-01

    Some structures treated for sound absorption are described that are used to soundproof industrial rooms with a very high noise level. Soundproofing treatments for the walls and coilings or only for the ceilings are considered. In the case of relatively small rooms having a noise source with a high level, complex treatments involve, in addition to soundproofing of the walls and ceiling, suspended panels specially oriented with respect to the noise source. The efficiency of the adopted solutions is compared with calculated damping values.

  16. [Combinative methods of treatment of patients with complicated urolithiasis].

    PubMed

    Kochetov, A G; Sitnikov, N V; Gvasaliia, B R; Sidorov, O V; Ponomarev, V K; Borshevetskiĭ, A A; Pavlov, D V

    2013-05-01

    The authors showed that urolithiasis is the second disease after inflammatory nonspecific kidney and urinary tract diseases and has a tendency to increase. 3-5% of patients suffer this disease, and 30-40% of all patients of urology in-patients department suffer nephrolithiasis. Introduction into clinical practice of modern minimally invasive treatment methods changed the paradigm of treatment of urolithiasis, especially coral type nephrolithiasis - cause of 15-50% of all renal calculi. The authors presented results of combinative treatment of 183 patients with different complicated forms of urolithiasis. The technique of percutaneous nephrolithotripsy (in supine position) was modified. It helped to reduce complications, time of surgery and radiation exposure. The effectiveness of simultaneous contact ureterolithotripsy and percutaneous nephrolithotripsy in patients with renal or ureters calculi, and simultaneous litholysis and distance lithotripsy in patients with metabolic disorders is shown. Combinative methods of treatment of complicated forms of urolithiasis are based on modern minimally invasive technologies and are very effective.

  17. Living Alone During Cancer Treatment: An Exploration of Patients' Experiences.

    PubMed

    Benoot, Charlotte; Bilsen, Johan; Grypdonck, Maria; Deschepper, Reginald

    2014-08-01

    The social environment is an important determinant in the overall experience of having cancer. The purpose of this article is to identify how patients experience living alone during their cancer treatment. Using qualitative methods based on grounded theory techniques, we interviewed a sample of 32 cancer patients. Living alone was an ambiguous experience during cancer treatment: patients experienced both a lack of support as well a gain in privacy, freedom, and know-how. Living alone was also seen as a constitutive element of the patients' identity. Consequently, patients saw living alone as either a threat or as a resource for their adjustment to cancer treatment. These divergent meanings of living alone did share one common attribute, which was that staying independent was their key goal during cancer treatment. Health care providers should be attentive to the heterogeneous aspects of the experience of living alone when critically appraising the independence of patients.

  18. [Lithium can be given to patients on haemodialysis treatment].

    PubMed

    Kancir, Anne Sophie Pinholt; Viftrup, Jens Emil; Pedersen, Erling Bjerregaard

    2015-01-26

    Lithium-induced nephropathy is a known complication of lithium treatment in bipolar disorder. Treatment with lithium should be discontinued, if there is evidence of lithium-induced nephropathy. However, lithium can be given to patients with end-stage-renal-disease on haemodialysis treatment, if there is no other way to control the bipolar disorder. We report one patient who was successfully treated with lithium in parallel with haemodialysis.

  19. Depression Treatment Preferences in Older Primary Care Patients

    ERIC Educational Resources Information Center

    Gum, Amber M.; Arean, Patricia A.; Hunkeler, Enid; Tang, Lingqi; Katon, Wayne; Hitchcock, Polly; Steffens, David C.; Dickens, Jeanne; Unutzer, Jurgen

    2006-01-01

    Purpose: For depressed older primary care patients, this study aimed to examine (a) characteristics associated with depression treatment preferences; (b) predictors of receiving preferred treatment; and (c) whether receiving preferred treatment predicted satisfaction and depression outcomes. Design and Methods: Data are from 1,602 depressed older…

  20. Depression Treatment Preferences in Older Primary Care Patients

    ERIC Educational Resources Information Center

    Gum, Amber M.; Arean, Patricia A.; Hunkeler, Enid; Tang, Lingqi; Katon, Wayne; Hitchcock, Polly; Steffens, David C.; Dickens, Jeanne; Unutzer, Jurgen

    2006-01-01

    Purpose: For depressed older primary care patients, this study aimed to examine (a) characteristics associated with depression treatment preferences; (b) predictors of receiving preferred treatment; and (c) whether receiving preferred treatment predicted satisfaction and depression outcomes. Design and Methods: Data are from 1,602 depressed older…

  1. Current Treatments Available for Scleroderma Patients

    MedlinePlus

    ... 5 inhibitors prevent the metabolism of a signaling molecule called cGMP. Treatment with a PDE type 5 ... Esbriet ® ) Tyrosine Kinase Inhibitor Nintedanib is a small molecule tyrosine kinase inhibitor (TKI) that targets growth factor ...

  2. Nonpharmacological treatments for patients with Parkinson's disease.

    PubMed

    Bloem, Bastiaan R; de Vries, Nienke M; Ebersbach, Georg

    2015-09-15

    Since 2013, a number of studies have enhanced the literature and have guided clinicians on viable treatment interventions outside of pharmacotherapy and surgery. Thirty-three randomized controlled trials and one large observational study on exercise and physiotherapy were published in this period. Four randomized controlled trials focused on dance interventions, eight on treatment of cognition and behavior, two on occupational therapy, and two on speech and language therapy (the latter two specifically addressed dysphagia). Three randomized controlled trials focused on multidisciplinary care models, one study on telemedicine, and four studies on alternative interventions, including music therapy and mindfulness. These studies attest to the marked interest in these therapeutic approaches and the increasing evidence base that places nonpharmacological treatments firmly within the integrated repertoire of treatment options in Parkinson's disease.

  3. Treatment of Spinal Epidural Abscess and Predisposing Factors of Motor Weakness: Experience with 48 Patients

    PubMed Central

    Ju, Min-Wook; Kwon, Hyon-Jo; Kim, Seon-Hwan; Koh, Hyeon-Song; Youm, Jin-Young; Song, Shi-Hun

    2015-01-01

    Objective Spinal epidural abscess (SEA) can be fatal if untreated, so early diagnosis and treatment are essential. We conducted a retrospective study to define its clinical features and evaluate the risk factors of motor weakness. Methods We retrospectively analyzed the medical records and images of patients with SEA who had been hospitalized in our institute from January 2005 to June 2012. Pyogenic SEA patients were categorized as patients without motor weakness (Group A) and with motor weakness (Group B). Abscess volume was measured using the Gamma-Plan program. Intervertebral foramen height and posterior disc height were measured to evaluate degree of spinal stenosis. Results Of 48 patients with pyogenic SEA, 33 (68%) were treated surgically, and 15 (32%) were treated with antibiotics. Eleven patients had weakness and abscess volume was unrelated to motor weakness. Old age, 'spare room' (abscess volume subtracted from spinal volume) and intervertebral foramen height and posterior disc height were statistically significant. Among the 48 patients, 43 (85%) had good outcome and erythrocyte sedimentation rate (ESR) was the only meaningful prognostic factor (p=0.014). The cut-off value of ESR was 112mm/h with 80% sensitivity and 79% specificity and had borderline significance (p=0.062). Conclusion SEA needs emergent diagnosis and treatment. Motor weakness is the most important factor in treatment decision. By careful image reading, early surgical treatment can be an option for selected patients with severe spinal stenosis for prevent motor weakness. Inflammatory markers, especially ESR, are valuable to identify worsening of SEA. PMID:26512265

  4. Implant treatment in patients with severe hypodontia: a retrospective evaluation.

    PubMed

    Créton, Marijn; Cune, Marco; Verhoeven, Wim; Muradin, Marvick; Wismeijer, Daniël; Meijer, Gert

    2010-03-01

    The aim of this retrospective study was to evaluate the result of implant treatment in patients with severe hypodontia and compare some basic characteristics of patients with severe hypodontia who received conventional dental treatment or no treatment at all with those who were treated in combination with endosseous implants. All patients who had been referred to an academic center of special dental care between 1990 and 2008 and who had been classified at their first visit as having "oligodontia" or "severe hypodontia" were selected from the hospital's database. Their charts were reviewed, and surgical treatment details and outcomes of the implants were registered from those patients who received endosseous implants. Of the 294 patients who met the inclusion criteria, 44 patients were treated in combination with endosseous implants. The cumulative chance of implant survival of the 214 placed implants after 5 years was 89.8% (SE, 2.6%), with a mean observation period of 2.9 years (minimum, 0.1 years; maximum, 18.3 years). No implants failed thereafter. Patients who received implants were missing fewer teeth and were treated more recently compared with those who received conventional restorative treatment or no treatment at all. Considering the compromised anatomic situation and the complexity of treatment, a 5-year survival rate of 89.8% in patients with severe hypodontia, as seen in this study, is regarded as acceptable. Copyright (c) 2010 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  5. Plastic isolators for treatment of acute leukaemia patients under "germ-free" conditions.

    PubMed Central

    Trexler, P C; Spiers, A S; Gaya, H

    1975-01-01

    A gnotobiotic isolation system based on those developed in veterinary research has been constructed for hospital use. Fifteen patients with leukaemia and neutropenia spent a total of 110 weeks in plastic isolators, and none acquired any infection. Endogenous flora was effectively suppressed by topical antiseptics and gastrointestinal decontamination effected with nonabsorbable antibiotics. The isolator system was acceptable to patients and staff and much cheaper than the use of sterile rooms. Other advantages of the system are portability, easy storage, and use on ordinary open wards without prejudice to the microbiological protection afforded. It is as yet uncertain whether protective environments of this type will substantially improve the outcome of treatment for the acute leukaemias. PMID:1203666

  6. Patients' perspectives on antidepressant treatment in consultations with physicians.

    PubMed

    Fosgerau, Christina Fogtmann; Davidsen, Annette Sofie

    2014-05-01

    Patient perspectives on antidepressant treatment and physician attention, and responses toward these in consultations with patients diagnosed with depression, are rarely studied. We analyzed video-recorded consultations with general practitioners (GPs) and psychiatrists. We used conversation analysis and systemic functional linguistics and found that the perspectives patients expressed related to the possibility of achieving, and the inability to retain, a sense of agency. Patients also presented indirect expressions of shame and expressions suggesting alienation toward medical treatment. GPs attended to patient perspectives by talking about medication indirectly. When patients expressed their perspectives, GPs responded by being nonauthoritative but also without prompting patients to elaborate on their reflections. Psychiatrists responded authoritatively and never urged patients to reflect on their perspectives. Shared decision making did not take place because physicians did not explore patients' perspectives in depth or offer their expertise by taking these perspectives into consideration.

  7. The Effects of Positive Patient Testimonials on PTSD Treatment Choice

    PubMed Central

    Pruitt, Larry D.; Zoellner, Lori A.; Feeny, Norah C.; Caldwell, Daniel; Hanson, Robert

    2012-01-01

    Despite the existence of effective treatment options for PTSD, these treatments are failing to reach those that stand to benefit from PTSD treatment. Understanding the processes underlying an individual’s treatment seeking behavior holds the potential for reducing treatment-seeking barriers. The current study investigates the effects that positive treatment testimonials have on decisions regarding PTSD treatment. An undergraduate (N = 439) and a trauma-exposed community (N = 203) sample were provided with videotaped treatment rationales for prolonged exposure (PE) and sertraline treatments of PTSD. Half of each sample also viewed testimonials, detailing a fictional patient’s treatment experience. All participants then chose among treatment options and rated the credibility of- and personal reactions toward- those options. Among treatment naïve undergraduates, testimonials increased the proportion choosing PE alone; and among treatment naïve members of the trauma-exposed community sample, testimonials increased the proportion choosing a combined PE plus sertraline treatment. These effects were not observed for those with prior history of either psychotherapeutic or pharmacological treatment. Major barriers exist that prevent individuals with PTSD from seeking treatment. For a critical unreached treatment sample, those who are treatment naïve, positive patient testimonials offer a mechanism in which to make effective treatments more appealing and accessible. PMID:23103234

  8. Operating room design and its impact on operating room economics.

    PubMed

    Krupka, Dan C; Sandberg, Warren S

    2006-04-01

    Operating rooms are high-cost/high-revenue environments. In an era of rising costs and declining reimbursement, it is essential to optimize the effectiveness of the operating room suite, maximizing throughput of profitable cases while minimizing the costs of necessary, but unprofitable, procedures. Operating room management focuses on reducing wasted time in order to perform more cases in regular business hours, reduce overtime, or provide a better experience for staff and patients. It has been difficult to improve perioperative efficiency enough to reliably add cases during regular hours because the required time savings are so large, while most interventions can save only a few minutes per case. Recent work, however, has changed the basic paradigms for turning over operating rooms, dramatically reducing nonproductive time and increasing operating room throughput. In some situations, the additional expense required to achieve throughput improvements is more than offset by financial gains. Redesigning perioperative systems can increase operating room throughput, but not all case mixes benefit from the required additional resources. Thus hospitals should choose judiciously if, and to what degree, high throughput environments are implemented. Once implemented, access to these environments can be used as an incentive for improved surgical performance.

  9. Modern treatment strategies for patients with epilepsy: a review.

    PubMed Central

    Duncan, J S

    1991-01-01

    Of patients who develop epilepsy 70-80% will become seizure free, the remaining 20% are the most difficult to treat satisfactorily. Eighty per cent of patients are best treated with a single drug. Stepwise treatment plans for the treatment of newly diagnosed patients and for the evaluation of patients with chronic epilepsy are suggested. There is a lack of consensus regarding the rate at which to taper antiepileptic drugs being discontinued in patients with active epilepsy. There are arguments for making drug changes rapidly; these arguments and strategies for managing the withdrawal of individual drugs are presented. PMID:2013897

  10. Treatment-Resistant Schizophrenia Patients Show Elevated Anterior Cingulate Cortex Glutamate Compared to Treatment-Responsive.

    PubMed

    Mouchlianitis, Elias; Bloomfield, Michael A P; Law, Vincent; Beck, Katherine; Selvaraj, Sudhakar; Rasquinha, Naresh; Waldman, Adam; Turkheimer, Federico E; Egerton, Alice; Stone, James; Howes, Oliver D

    2016-05-01

    Resistance to antipsychotic treatment is a significant clinical problem in patients with schizophrenia with approximately 1 in 3 showing limited or no response to repeated treatments with antipsychotic medication. The neurobiological basis for treatment resistance is unknown but recent evidence implicates glutamatergic function in the anterior cingulate cortex. We examined glutamate levels of chronically ill treatment-resistant patients directly compared to treatment-responsive patients. We acquired proton magnetic resonance spectroscopy (1H-MRS) at 3 Tesla from 21 treatment-resistant and 20 treatment-responsive patients. All participants had a DSM-IV diagnosis of schizophrenia. Treatment-resistant patients were classified using the modified Kane criteria. The groups were matched for age, sex, smoking status, and illness duration. Glutamate to creatine ratio levels were higher in treatment-resistant patients (Mean [SD] = 1.57 [0.24]) than in treatment-responsive patients (Mean[SD] = 1.38 [0.23]), (T[35] = 2.34, P = .025, 2-tailed), with a large effect size of d = 0.76. A model assuming 2 populations showed a 25% improvement in the fit of the Akaike weights (0.55) over a model assuming 1 population (0.44), producing group values almost identical to actual group means. Increased anterior cingulate glutamate level is associated with treatment-resistant schizophrenia. This appears to be a stable neurobiological trait of treatment-resistant patients. We discuss possible explanations for glutamatergic dysfunction playing a significant role in resistance to conventional antipsychotic treatments, which are all dopamine-2 receptor blockers. Our findings suggest that glutamatergic treatments may be particularly effective in resistant patients and that 1H-MRS glutamate indices can potentially have clinical use. © The Author 2015. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved. For permissions, please email

  11. Should we monitor with bispectral index in all patients at high risk for seizures in the operating room?

    PubMed

    Elgueta, M F; Vega, P; Lema, G; Clede, L

    2013-10-01

    We report the case of a patient with a cerebral aneurysm, located in the left middle cerebral artery. During the clipping of this aneurysm, the bispectral index (BIS) increased for no apparent reason. This was then interpreted as intraoperative non-convulsive status epilepticus. This clinical condition may have negative impact in the prognosis of the patient, so it is very important to be able to detect this conditions as early as possible. Measuring the BIS while the patient is anaesthetised could be useful in this situation, considering that an increase in values greater than 60, associated with acidosis and without any other peri-anaesthetic explanation, may provide evidence of a convulsive equivalent state, allowing appropriate action to be taken. Copyright © 2012 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Published by Elsevier España. All rights reserved.

  12. Nutritional Aspects of Treatment in Epileptic Patients

    PubMed Central

    SOLTANI, Danesh; GHAFFAR POUR, Majid; TAFAKHORI, Abbas; SARRAF, Payam; BITARAFAN, Sama

    2016-01-01

    Epilepsy is a neurological disorder characterized by interruption of normal neuronal functions that is manifested by behavioral disorders, changing of awareness level, and presence of some sensory, autonomic and motor symptoms or signs. It is resulted from many different causes. Many antiepileptic drugs (AEDs) are considered to manage epileptic attacks. Some of them change metabolism and absorption of many nutrients. Therefore, epileptic patients may be in higher risk of nutrient deficiency and its unwelcome effects. In the present paper, we intend to review the relationship between nutrition and epilepsy in two aspects. In one aspect we discuss the nutritional status in epileptic patients, the causes of nutritional deficiencies and the way of compensation of the nutrient deficiencies. It will guide these patients to have a healthy life. In another aspect we explain the role of some nutrients and specific diets in management of epileptic attacks. It can help to better control of epileptic attacks in these patients. PMID:27375750

  13. Nutritional Aspects of Treatment in Epileptic Patients.

    PubMed

    Soltani, Danesh; Ghaffar Pour, Majid; Tafakhori, Abbas; Sarraf, Payam; Bitarafan, Sama

    2016-01-01

    Epilepsy is a neurological disorder characterized by interruption of normal neuronal functions that is manifested by behavioral disorders, changing of awareness level, and presence of some sensory, autonomic and motor symptoms or signs. It is resulted from many different causes. Many antiepileptic drugs (AEDs) are considered to manage epileptic attacks. Some of them change metabolism and absorption of many nutrients. Therefore, epileptic patients may be in higher risk of nutrient deficiency and its unwelcome effects. In the present paper, we intend to review the relationship between nutrition and epilepsy in two aspects. In one aspect we discuss the nutritional status in epileptic patients, the causes of nutritional deficiencies and the way of compensation of the nutrient deficiencies. It will guide these patients to have a healthy life. In another aspect we explain the role of some nutrients and specific diets in management of epileptic attacks. It can help to better control of epileptic attacks in these patients.

  14. Pulsed alexandrite laser for treatment of melasma in Asian patients.

    PubMed

    Cheng, Chun-Yu; Huang, Yau-Li; Lee, Mei-Ching; Chang, Shyue-Luen; Lin, Ying-Fang; Hu, Sindy

    2017-08-01

    Melasma is a common acquired facial hypermelanosis with irregular brownish macules and patches. The clinical course is often fluctuated and refractory to treatment. The present study was conducted to evaluate the efficacy and safety of pulsed alexandrite laser for the treatment of melasma. In the present study, we enrolled Asian patients with melasma. All the patients received four monthly treatments with a pulsed alexandrite laser. The severity of melasma was evaluated by a blinded dermatologist, using the Modified Melasma Area and Severity Index (MMASI), and by patient assessment, using a visual analogue scale, at baseline, before each treatment, and at the 1-month and 3-month follow-up visits after the last treatment. Twenty-three patients completed all treatments and follow-up visits. The MMASI scores decreased significantly from 8.71 ± 5.83 at baseline to 6.07 ± 4.65 after four sessions of treatment (P < 0.05) and 6.91 ± 4.97 at 3 months after the last laser treatment (P < 0.05). After 4 sessions of treatment, 10 patients (43.5%) described their improvement as marked and excellent (>60% improvement). The treatments were well tolerated with only mild skin reaction. In the present study, we demonstrated that the pulsed alexandrite laser is safe and effective to treat melasma in Asian skin.

  15. Evaluation and Treatment of the Patient with Vertigo.

    ERIC Educational Resources Information Center

    Glasscock, Michael E. III; Haynes, David S.

    1997-01-01

    The sensation of vertigo is a complex symptom that patients find difficult to describe, and physicians often find evaluating and treating patients with the vertigo a difficult task. This article outlines types and causes of vertigo and the work up, evaluation, and treatment of a patient with vertigo. (Contains references.) (Author/CR)

  16. Evaluation and Treatment of the Patient with Vertigo.

    ERIC Educational Resources Information Center

    Glasscock, Michael E. III; Haynes, David S.

    1997-01-01

    The sensation of vertigo is a complex symptom that patients find difficult to describe, and physicians often find evaluating and treating patients with the vertigo a difficult task. This article outlines types and causes of vertigo and the work up, evaluation, and treatment of a patient with vertigo. (Contains references.) (Author/CR)

  17. 'It was like he was in the room with us': patients' and carers' perspectives of telemedicine in acute stroke.

    PubMed

    Gibson, Josephine; Lightbody, Elizabeth; McLoughlin, Alison; McAdam, Joanna; Gibson, Alison; Day, Elaine; Fitzgerald, Jane; May, Carl; Price, Chris; Emsley, Hedley; Ford, Gary A; Watkins, Caroline

    2016-02-01

    Telemedicine can facilitate delivery of thrombolysis in acute stroke. The aim of this qualitative study was to explore patients' and carers' views of their experiences of using a stroke telemedicine system in order to contribute to the development of reliable and acceptable telemedicine systems and training for health-care staff. We recruited patients who had, and carers who were present at, recent telemedicine consultations for acute stroke in three hospitals in NW England. Semi-structured interviews were conducted using an interview guide based on normalization process theory (NPT). Thematic analysis was undertaken. We conducted 24 interviews with 29 participants (16 patients; 13 carers). Eleven interviews pertained to 'live' telemedicine assessments (at the time of admission); nine had mock-up telemedicine assessments (within 48 h of admission); four had both assessments. Using the NPT domains as a framework for analysis, factors relating to coherence (sense making) included people's knowledge and understanding of telemedicine. Cognitive participation (relational work) included interaction between staff and with patients and carers. Issues relating to collective action (operational work) included information exchange and support, and technical matters. Findings relating to reflexive monitoring (appraisal) included positive and negative impressions of the telemedicine process, and emotional reactions. Although telemedicine was well accepted by many participants, its use added an additional layer of complexity to the acute stroke consultation. The 'remote' nature of the consultation posed challenges for some patients. These issues may be ameliorated by clear information for patients and carers, staff interpersonal skills, and teamworking. © 2015 John Wiley & Sons Ltd.

  18. [Treatment of psychotic patients with music therapy].

    PubMed

    Inselmann, U

    1995-01-01

    The present contribution describes the experience taken from music therapy of psychotic patients. The emotional and cognitive music perception and its possible influence on self perception and strengthening of ego are discussed. Since exercise instructions were limited the observed improvement of communication seems rather due to intra- and interpersonal effects of active improvisation than to a training process. With regard to schizophrenic patients possible effects of music therapy are discussed in the light of self-object-differentiation.

  19. Surgical treatment of dens fractures in elderly patients.

    PubMed

    Platzer, Patrick; Thalhammer, Gerhild; Oberleitner, Gerhard; Schuster, Rupert; Vécsei, Vilmos; Gaebler, Christian

    2007-08-01

    A dens fracture is the most common cervical fracture in elderly patients. The purposes of this study were to analyze the functional and radiographic results after surgical treatment of dens fractures in patients over sixty-five years of age and to compare the two methods that were used for operative treatment. We reviewed the cases of fifty-six patients, with an average age of 71.4 years at the time of surgery, who had undergone surgical treatment of a dens fracture from 1988 to 2002. Thirty-seven fractures were stabilized with anterior screw fixation, and nineteen fractures had posterior cervical arthrodesis. Forty-five patients returned to their preinjury activity level and were satisfied with their treatment. Thirty-five patients had a full range of neck movement, and forty-seven patients were free of pain. Technical failures occurred in eight patients. The thirty-seven patients treated with anterior screw fixation had a good clinical outcome, with fracture-healing in thirty-three patients (89%) and technical failure in five patients (14%). All nineteen patients treated with posterior cervical arthrodesis had fracture union, with technical failure in three patients, but the functional results were worse than those after anterior screw fixation. With the inclusion of the six patients who had been excluded from the clinical and radiographic review, the overall morbidity rate was 16% (ten of sixty-two patients) and the overall mortality rate was 6% (four of sixty-two patients). A satisfactory outcome can be achieved with surgical treatment of a dens fracture in geriatric patients. It appears that anterior screw fixation may maintain better mobility of the cervical spine, but it appears to be associated with a higher rate of fracture nonunion and a greater potential for reoperation.

  20. [Advanced Trauma Life Support (ATLS) in the emergency room. Is it suitable as an SOP?].

    PubMed

    Shafizadeh, S; Tjardes, T; Steinhausen, E; Balke, M; Paffrath, T; Bouillon, B; Bäthis, H

    2010-08-01

    There is clinical evidence that a standardized management of trauma patients in the emergency room improves outcome. ATLS is a training course that teaches a systematic approach to the trauma patient in the emergency room. The aims are a rapid and accurate assessment of the patient's physiologic status, treatment according to priorities, and making decisions on whether the local resources are sufficient for adequate definitive treatment of the patient or if transfer to a trauma center is necessary. Above all it is important to prevent secondary injury, to realize timing as a relevant factor in the initial treatment, and to assure a high standard of care. A standard operating procedure (SOP) exactly regulates the approach to trauma patients and determines the responsibilities of the involved faculties. An SOP moreover incorporates the organizational structure in the treatment of trauma patients as well as the necessary technical equipment and staff requirements. To optimize process and result quality, priorities are in the fields of medical fundamentals of trauma care, education, and fault management. SOPs and training courses increase the process and result quality in the treatment of the trauma patient in the emergency room. These programs should be based on the special demands of the physiology of the trauma as well as the structural specifics of the hospital. ATLS does not equal an SOP but it qualifies as a standardized concept for management of trauma patients in the emergency room.

  1. [Antibiotic treatment in patients amputated for ischemic diabetic foot].

    PubMed

    Fernández Montequín, J I; McCook Martínez, J; Lima Santana, B; Velasco Armas, N; Montalvo Diago, J; Mahía Vilas, M

    1991-01-01

    Thirty diabetic patients submitted to a major amputation were tested by humo-celullar assays (retarded hypersensibility assays). Reactive patients were subdivided into two groups: one group was treated postoperatively with antibiotics, and the other group was not treated. Both groups were homogeneous in age, hemoglobin concentrations, hematocrit, total proteins, glucemy and history of sepsis or leukocytosis. Five patients treated with antibiotics (33.3%) presented sepsis, one patient was reamputated and one patient died. Between the not treated patients, only three presented sepsis (20%) without any other complications. Authors conclude that the development of sepsis in reactive, diabetic, amputated patients is independent of antibiotic treatment.

  2. Treatment Outcome of Patients with Buruli Ulcer Disease in Togo

    PubMed Central

    Beissner, Marcus; Arens, Nathalie; Wiedemann, Franz; Piten, Ebekalisaï; Kobara, Basile; Bauer, Malkin; Herbinger, Karl-Heinz; Badziklou, Kossi; Banla Kere, Abiba; Löscher, Thomas; Nitschke, Jörg; Bretzel, Gisela

    2015-01-01

    Background Following introduction of antimycobacterial treatment of Buruli ulcer disease (BUD), several clinical studies evaluated treatment outcomes of BUD patients, in particular healing times, secondary lesions and functional limitations. Whereas recurrences were rarely observed, paradoxical reactions and functional limitations frequently occurred. Although systematic BUD control in Togo was established as early as 2007, treatment outcome has not been reviewed to date. Therefore, a pilot project on post-treatment follow-up of BUD patients in Togo aimed to evaluate treatment outcomes and to provide recommendations for optimization of treatment success. Methodology/Principal Findings Out of 199 laboratory confirmed BUD patients, 129 could be enrolled in the study. The lesions of 109 patients (84.5%) were completely healed without any complications, 5 patients (3.9%) had secondary lesions and 15 patients (11.6%) had functional limitations. Edema, category III ulcers >15cm, healing times >180 days and a limitation of movement at time of discharge constituted the main risk factors significantly associated with BUD related functional limitations (P<0.01). Review of all BUD related documentation revealed major shortcomings, in particular concerning medical records on adjuvant surgical and physiotherapeutic treatment. Conclusions/Significance This study presents the first systematic analysis of treatment outcome of BUD patients from Togo. Median times to healing and the absence of recurrences were in line with findings reported by other investigators. The percentage of functional limitations of 11.6% was lower than in other studies, and edema, category III ulcers, healing time >180 days and limitation of movement at discharge constituted the main risk factors for functional limitations in Togolese BUD patients. Standardized treatment plans, patient assessment and follow-up, as well as improved management of medical records are recommended to allow for intensified

  3. Treatment outcome of tuberculosis patients under directly observed treatment in Addis Ababa, Ethiopia.

    PubMed

    Getahun, Belete; Ameni, Gobena; Medhin, Girmay; Biadgilign, Sibhatu

    2013-01-01

    Tuberculosis is one of the leading causes of mortality among infectious diseases worldwide. For effective tuberculosis control, it is a pre-requisite to detect the cases as early as possible, and to ensure that the tuberculosis patients complete their treatment and get cured. However, in many resource-constrained settings treatment outcome for tuberculosis has not been satisfactory. The aim of the study was to assess the treatment outcome of tuberculosis patients and investigate the association of demographic and clinical factors with treatment success of patients enrolled in Directly Observed Treatment Short Course program in government owned health centers over the course of five consecutive years in Addis Ababa, Ethiopia. A register based historical cohort study covering the period of July 2004 to June 2009 was conducted to determine the treatment outcome of Directly Observed Treatment Short Course in government owned health centers in Addis Ababa. Sex and age of tuberculosis patients, health center at which the patient was treated, year of treatment, type of tuberculosis for which the patient was treated, type of treatment offered to the patient, follow-up status and documented treatment outcome were extracted from the Directly Observed Treatment Short Course clinics of three randomly selected health centers. Records of 6450 registered tuberculosis patients (n=3147 males and 3433 females) were included in this document review. Of these patients 18.1% were reported as being cured, 64.6% were documented as treatment completed, 3.7% died during follow-up, 5.1% were reported as defaulters, 0.4% were documented as treatment failure and 8.2% were transferred out to another health institution. Treatment center and year of enrollment were significantly associated with treatment success. Year of enrollment and treatment center were significantly associated with treatment success. Although the overall treatment success obtained in this study is in line with the World

  4. The person in the room: how relating holistically contributes to an effective patient-care provider alliance.

    PubMed

    Penner, Leslie A; Roger, Kerstin

    2012-01-01

    The purpose of this paper is to explore how relating to the 'whole' person--both the physical body and the invisible aspects of the 'self'--is essential in the establishment of a strong therapeutic alliance between patients and health care providers. Our work is based on interviews conducted with individuals affected by neurological illnesses (patients and family care providers). Hsieh and Shannon's (2005) conventional content analysis was used to analyze the data. Under the broad theme of 'maintaining a coherent sense of self' we identified four distinct sub-themes related to interactions with health care providers. The results elucidate the more complex and deep needs of patients who must access care on an ongoing basis, and highlight the important role that care providers play in supporting individuals who are experiencing physical, spiritual and social losses. Care must attend to the deep needs of these individuals by communicating in a style that addresses both emotional and cognitive needs of patients, by thorough and holistic assessment and by appropriate referrals.

  5. Community residential program policies, services, and treatment orientations influence patients' participation in treatment.

    PubMed

    Moos, R H; King, M J; Burnett, E B; Andrassy, J M

    1997-01-01

    The study sought to identify community residential program characteristics that predict patients' participation in treatment and to examine the association between these characteristics, participation, and outcomes at discharge from treatment. A sample of 2,790 patients with substance abuse disorders was assessed at entry into and discharge from 87 community residential facilities (CRFs). The CRFs were assessed using a survey that obtained information about program size and staffing, policies and services, and treatment orientation. High expectations for patients' functioning, clear policies, structured programming, a high proportion of staff in recovery from substance abuse problems, and more emphasis on psychosocial treatment were associated with patients' participation in program services and activities. Higher expectations for functioning and a strong treatment orientation enhanced participation more among better functioning patients; program support and structure enhanced participation more among impaired patients. Participation in treatment independently predicted outcomes at discharge even after both patient and program characteristics were controlled. These findings show that community residential program policies, services, and treatment orientations play a key role in influencing patients' engagement in treatment, which, in turn, improves patients' outcomes at discharge.

  6. Burn Patient Acuity Demographics, Scar Contractures, and Rehabilitation Treatment Time Related to Patient Outcomes (ACT)

    DTIC Science & Technology

    2014-10-01

    Scar Contractures, and Rehabilitation Treatment Time Related to Patient Outcomes, conveniently referred to as the ACT for representing Acuity...acute and intermediate phases of burn rehabilitation through the collection of daily treatment information for analysis. In particular, the ACT is...primarily interested in investigating the influence that time spent receiving rehabilitation treatments has on patient outcomes as a reflection of

  7. Patients' Expectations of Screening and Preventive Treatments

    PubMed Central

    Hudson, Ben; Zarifeh, Abby; Young, Lorraine; Wells, J. Elisabeth

    2012-01-01

    PURPOSE An informed decision to accept a health care intervention requires an understanding of its likely benefit. This study assessed participants' estimates of the benefit, as well as minimum acceptable benefit, of screening for breast and bowel cancer and medication to prevent hip fracture and cardiovascular disease. METHODS Three general practitioners sent questionnaires to all registered patients aged 50 to 70 years. Patients agreeing to participate in the study were asked to estimate the number of events (fractures or deaths) prevented in a group of 5,000 patients undergoing each intervention over a period of 10 years, and to indicate the minimum number of events avoided by the intervention that they considered justified its use. The proportions of participants that overestimated each intervention's benefit were calculated, and univariate and multivariable analyses of predictors of response were performed. RESULTS The participation rate was 36%: 977 patients were invited to participate in the study, and 354 returned a completed questionnaire. Participants overestimated the degree of benefit conferred by all interventions: 90% of participants overestimated the effect of breast cancer screening, 94% overestimated the effect of bowel cancer screening, 82% overestimated the effect of hip fracture preventive medication, and 69% overestimated the effect of preventive medication for cardiovascular disease. Estimates of minimum acceptable benefit were more conservative, but other than for cardiovascular disease mortality prevention, most respondents indicated a minimum benefit greater than these interventions achieve. A lower level of education was associated with higher estimates of minimum acceptable benefit for all interventions. CONCLUSION Patients overestimated the risk reduction achieved with 4 examples of screening and preventive medications. A lower level of education was associated with higher minimum benefit to justify intervention use. This tendency to

  8. [Optimizing rheumatoid arthritis treatment with rituximab--individualized patient approach].

    PubMed

    Novak, Srdan

    2010-01-01

    Disease activity assessment is a cornerstone of monitoring rheumatoid arthritis (RA) development and guidance for rituximab treatment. Beside clinical signs and symptoms biomarkers (RF and anti-CCP) are important early predictors of response to therapy and they can predict disease development. Autoantibody (RF and anti-CCP) seropositivity has been associated with positive response to rituximab (RTX) in antiTNF-IR patients, DMARD-IR patients and MTX-naive patients. Selecting therapy for TNF-IR patients providing most likely response it should be taken in consideration results form recently published assessments demonstrating for RTX treated patients significant improvement in DAS28 from baseline versus alternative TNF inhibitor treatment. Recently published NICE treatment guideline is recommending upon antiTNF failure RTX treatment (in combination with MTX) instead antiTNF cycling.

  9. Elderly Patients with Schizophrenia and Depression: Diagnosis and Treatment

    PubMed Central

    Felmet, Kandi; Zisook, Sidney; Kasckow, John W.

    2011-01-01

    Background The treatment of older patients with schizophrenia and depressive symptoms poses many challenges for clinicians. Current classifications of depressive symptoms in patients with schizophrenia include: Major Depressive Episodes that occur in patients with schizophrenia and are not classified as schizoaffective disorder, Schizoaffective Disorder, and Schizophrenia with subsyndromal depression in which depressive symptoms do not meet criteria for Major Depression. Research indicates that the presence of any of these depressive symptoms negatively impacts the lives of patients suffering from schizophrenia-spectrum disorders. Purpose The purpose of this paper is to review the literature related to older patients with schizophrenia-spectrum disorders and co-occurring depressive symptoms, and to guide mental health professionals to better understand the diagnosis and treatment of depressive symptoms in patients with schizophrenia. Conclusions The treatment of elderly patients with schizophrenia and depressive symptoms includes first reassessing the diagnosis to make sure symptoms are not due to a comorbid condition, metabolic problems or medications. If these are ruled out, pharmacological agents in combination with psychosocial interventions are important treatments for older patients with schizophrenia and depressive symptoms. A careful assessment of each patient is needed in order to determine which antipsychotic would be optimal for their care; second-generation antipsychotics are the most commonly used antipsychotics. Augmentation with an antidepressant medication can be helpful for the elderly patient with schizophrenia and depressive symptoms. More research with pharmacologic and psychosocial interventions is needed, however, to better understand how to treat this population of elderly patients. PMID:21177241

  10. The treatment of hypertension in obese patients.

    PubMed

    Wofford, Marion R; Smith, Grant; Minor, Deborah S

    2008-04-01

    Hypertension causes a significant disease burden in all racial and ethnic groups and is directly attributable to excess weight in most cases. The relationship between increasing body mass index and hypertension prevalence has been recognized for decades. Epidemiologic studies clearly demonstrate the correlation between body weight and blood pressure in obese and lean populations. Most patients with hypertension are overweight or obese, and loss of excess weight lowers blood pressure. Although the epidemiologic relationship is clear, the understanding of mechanisms linking hypertension and weight gain is still evolving. Lifestyle modifications and specific pharmacologic agents address many of the known mechanisms; however, blood pressure remains difficult to control in obese hypertensive patients. This review highlights the association of obesity and hypertension, identifies potential mechanisms for this association, and describes nonpharmacologic and pharmacologic strategies that offer potential benefits for the obese patient with hypertension.

  11. Treatment of Hypochondriasis in Two Schizophrenia Patients Using Clozapine.

    PubMed

    Tundo, Antonio; Proietti, Luca; de Filippis, Rocco

    2017-01-01

    Hypochondriasis (HYPO), an obsessive-compulsive spectrum disorder, is frequent in patients with schizophrenia (SCH) (20%), especially among those treated with clozapine (36.7%). Treatment options for OCS/OCD in patients under clozapine (CLZ) include combining clozapine with amisulpride/aripiprazole or a mood stabilizer, augmenting clozapine with a serotoninergic reuptake inhibitor, adding cognitive behavioural therapy, and gradually reducing dosage. No treatments have been proposed for HYPO in patients using clozapine so we examine these options in 2 cases and report the results. Among treatments delivered, only dosage reduction adequately worked. We recommend caution when thinking about escalating treatment and suggest trying it only when alternative interventions were not successful and weighing risk and benefits of this therapeutic strategy. Further research is needed to confirm the hypothesis that CLZ treatment induces hypochondriac symptoms, to investigate the prevalence of the phenomenon, and, mostly, to identify possible treatment strategies.

  12. Treatment of Hypochondriasis in Two Schizophrenia Patients Using Clozapine

    PubMed Central

    2017-01-01

    Hypochondriasis (HYPO), an obsessive-compulsive spectrum disorder, is frequent in patients with schizophrenia (SCH) (20%), especially among those treated with clozapine (36.7%). Treatment options for OCS/OCD in patients under clozapine (CLZ) include combining clozapine with amisulpride/aripiprazole or a mood stabilizer, augmenting clozapine with a serotoninergic reuptake inhibitor, adding cognitive behavioural therapy, and gradually reducing dosage. No treatments have been proposed for HYPO in patients using clozapine so we examine these options in 2 cases and report the results. Among treatments delivered, only dosage reduction adequately worked. We recommend caution when thinking about escalating treatment and suggest trying it only when alternative interventions were not successful and weighing risk and benefits of this therapeutic strategy. Further research is needed to confirm the hypothesis that CLZ treatment induces hypochondriac symptoms, to investigate the prevalence of the phenomenon, and, mostly, to identify possible treatment strategies. PMID:28642831

  13. A conceptual framework for patient-centered fertility treatment.

    PubMed

    Duthie, Elizabeth A; Cooper, Alexandra; Davis, Joseph B; Schoyer, Katherine D; Sandlow, Jay; Strawn, Estil Y; Flynn, Kathryn E

    2017-09-07

    Patient-centered care is a pillar of quality health care and is important to patients experiencing infertility. In this study we used empirical, in-depth data on couples' experiences of infertility treatment decision making to inform and revise a conceptual framework for patient-centered fertility treatment that was developed based on health care professionals' conceptualizations of fertility treatment, covering effectiveness, burden, safety, and costs. In this prospective, longitudinal mixed methods study, we collected data from both members (separately) of 37 couples who scheduled an initial consult with a reproductive specialist. Data collection occurred 1 week before the initial consultation, 1 week after the initial consultation, and then roughly 2, 4, 8, and 12 months later. Data collection included semi-structured qualitative interviews, self-reported questionnaires, and medical record review. Interviews were recorded, transcribed, and content analyzed in NVivo. A single coder analyzed all transcripts, with > 25% of transcripts coded by a second coder to ensure quality control and consistency. Content analysis of the interview transcripts revealed 6 treatment dimensions: effectiveness, physical and emotional burden, time, cost, potential risks, and genetic parentage. Thus, the revised framework for patient-centered fertility treatment retains much from the original framework, with modification to one dimension (from safety to potential risks) and the addition of two dimensions (time and genetic parentage). For patients and their partners making fertility treatment decisions, tradeoffs are explicitly considered across dimensions as opposed to each dimension being considered on its own. Patient-centered fertility treatment should account for the dimensions of treatment that patients and their partners weigh when making decisions about how to add a child to their family. Based on the lived experiences of couples seeking specialist medical care for

  14. Bloodstream infections in patients given treatment with intravenous prostanoids.

    PubMed

    Kallen, Alexander J; Lederman, Edith; Balaji, Alexandra; Trevino, Ingrid; Petersen, Emily E; Shoulson, Rivka; Saiman, Lisa; Horn, Evelyn M; Gomberg-Maitland, Mardi; Barst, Robyn J; Srinivasan, Arjun

    2008-04-01

    In September 2006, the Centers for Disease Control and Prevention was notified of cases of gram-negative bloodstream infection (BSI) occurring among outpatients who received an intravenous formulation of the prostanoid treprostinil. An investigation was conducted to determine rates of prostanoid-associated BSI in this patient population and possible risk factors for infection. We performed a retrospective cohort study of patients who had received intravenous formulations of at least 1 of the 2 approved prostanoids (epoprostenol and treprostinil) from January 1, 2004, through late 2006. Chart reviews were conducted at 2 large centers for pulmonary arterial hypertension, and a survey of infection control practices was conducted at 1 center. A total of 224 patients were given intravenous prostanoid treatment, corresponding to 146,093 treatment-days during the study period. Overall, there were 0.55 cases of BSI and 0.18 cases of BSI due to gram-negative organisms per 1,000 treatment-days. BSI rates were higher for patients who received intravenous treprostinil than for patients who received intravenous epoprostenol (1.13 vs. 0.42 BSIs per 1,000 treatment-days; P < .001), as were rates of BSI due to gram-negative organisms (0.81 vs. 0.04 BSIs per 1,000 treatment-days; P < .001). Adjusted hazard ratios for all BSIs and for BSIs due to gram-negative organisms were higher among patients given treatment with intravenous treprostinil. The survey identified no significant differences in medication-related infection control practices. At 2 centers, BSI due to gram-negative pathogens was more common than previously reported and was more frequent among patients given treatment with intravenous treprostinil than among patients given treatment with intravenous epoprostenol. Whether similar results would be found at other centers for pulmonary arterial hypertension warrants further investigation. This investigation underscores the importance of surveillance and evaluation of

  15. [Treatment education for patients with asthma].

    PubMed

    Halimi, Laurence; Bourdin, Arnaud; Mahjoub, Brigitte Ait-El; Godard, Philippe

    2009-12-01

    Randomized studies show that the best results come from patient-focused educational programs based on self-management (written and individualized action plan, self-monitoring, and regular medical review). The simple provision of information about asthma does not improve health outcomes. Teenagers with asthma are the most fragile patients, because of the lack of specific management for them. Repeated sessions are recommended and educational programs, started in childhood, might make it possible to prevent or at least decrease the risks of non-adherence during adolescence. The absence of consensus on educational interventions impedes the legibility of their impact.

  16. Innovations in agonist maintenance treatment of opioid-dependent patients.

    PubMed

    Haasen, Christian; van den Brink, Wim

    2006-11-01

    To provide an overview of published studies on agonist maintenance treatment options for opioid-dependent patients. The recent publication of controlled trials confirms earlier clinical evidence of the efficacy of diamorphine (heroin) in the treatment of opioid dependence. Findings show not only efficacy with respect to improvement of health, reduction of illicit drug use, reduction of criminality and stabilization of social conditions, but also cost effectiveness in the treatment of chronic treatment-resistant heroin addicts. Agonist maintenance treatment has become the first-line treatment for chronic opioid dependence. High-quality studies demonstrate the effectiveness of a growing number of different agonist maintenance treatments for opioid dependence such as methadone and buprenorphine. In addition, there is new evidence for the effectiveness of other agonists, mainly slow-release morphine, intravenous and inhalable diamorphine and possibly oral diamorphine. Maintenance treatment with intravenous or inhalable diamorphine should be implemented into the healthcare system to treat a group of severely dependent treatment-resistant patients. Furthermore, the opioid-dependent patients not under treatment need to be engaged in maintenance treatments through other harm reduction measures. Agonist maintenance treatment is very effective in stabilizing the health condition and social situation, while also reducing harm, thereby increasing life expectancy and quality of life.

  17. Improvements in patient treatment planning systems

    SciTech Connect

    Wheeler, F.J.; Wessol, D.E.; Nigg, D.W.; Atkinson, C.A.; Babcock, R.; Evans, J.

    1995-01-01

    The Boron Neutron Capture Therapy, Radiation treatment planning environment (BNCT-Rtpe) software system is used to develop treatment planning information. In typical use BNCT-Rtpe consists of three main components: (1) Semi-automated geometric modeling of objects (brain, target, eyes, sinus) derived from MRI, CT, and other medical imaging modalities, (2) Dose computations for these geometric models with rtt-MC, the INEL Monte Carlo radiation transport computer code, and (3) Dose contouring overlaid on medical images as well as generation of other dose displays. We continue to develop a planning system based on three-dimensional image-based reconstructions using Bspline surfaces. Even though this software is in an experimental state, it has been applied for large animal research and for an isolated case of treatment for a human glioma. Radiation transport is based on Monte Carlo, however there will be implementations of faster methods (e.g. diffusion theory) in the future. The important thing for treatment planning is the output which must convey, to the radiologist, the deposition of dose to healthy and tar