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Sample records for bugabo ward kagera

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

    Directory of Open Access Journals (Sweden)

    Mbabazi Pamela K

    2010-07-01

    Full Text Available Abstract Background The Kagera region of north western Tanzania has a rich culture of traditional medicine use and practices. The dynamic inter-ethnic interactions of different people from the surrounding countries constitute a rich reservoir of herbal based healing practices. This study, the second on an ongoing series, reports on the medicinal plant species used in Katoro ward, Bukoba District, and tries to use the literature to establish proof of the therapeutic claims. Methodology Ethnomedical information was collected using Semi-structured interviews in Kyamlaile and Kashaba villages of Katoro, and in roadside bushes on the way from Katoro to Bukoba through Kyaka. Data collected included the common/local names of the plants, parts used, the diseases treated, methods of preparation, dosage, frequency and duration of treatments. Information on toxicity and antidote were also collected. Literature was consulted to get corroborative information on similar ethnomedical claims and proven biological activities of the plants. Results Thirty three (33 plant species for treatement of 13 different disease categories were documented. The most frequently treated diseases were those categorized as specific diseases/conditions (23.8% of all remedies while eye diseases were the least treated using medicinal plants (1.5% of all remedies. Literature reports support 47% of the claims including proven anti-malarial, anti-microbial and anti-inflammatory activity or similar ethnomedical uses. Leaves were the most frequently used plant part (20 species followed by roots (13 species while making of decoctions, pounding, squeezing, making infusions, burning and grinding to powder were the most common methods used to prepare a majority of the therapies. Conclusion Therapeutic claims made on plants used in traditional medicine in Katoro ward of Bukoba district are well supported by literature, with 47% of the claims having already been reported. This study further

  2. Impact of ALSO training on the management of prolonged labor and neonatal care at Kagera Regional Hospital, Tanzania

    DEFF Research Database (Denmark)

    Sorensen, Bjarke Lund; Rasch, Vibeke; Massawe, Siriel

    2010-01-01

    OBJECTIVE: To evaluate the management of prolonged labor and neonatal care before and after Advanced Life Support in Obstetrics (ALSO) training. METHODS: Staff involved in childbirth at Kagera Regional Hospital, Tanzania, attended a 2-day ALSO provider course. In this prospective intervention study...... conducted between July and November 2008, the management and outcomes of 558 deliveries before and 550 after the training were observed. RESULTS: There was no significant difference in the rate of cesarean deliveries owing to prolonged labor, and vacuum delivery was not practiced after the intervention...... 5.6% to 71.5% (RR 12.71; 95% CI, 9.04-17.88). There was a significant decrease from 6 to 0 neonatal deaths before discharge among those born with an Apgar score after 1minute of 4 or more (P=0.03). CONCLUSION: ALSO training had no effect on the management of prolonged labor. Early contact between...

  3. The rise and fall of water hyacinth in Lake Victoria and the Kagera River basin, 1989-2001

    Science.gov (United States)

    Albright, Thomas P.; Moorhouse, T.G.; McNabb, T.J.

    2004-01-01

    Water hyacinth (Eichhornia crassipes (Mart.) Solms) is an invasive aquatic macrophyte associated with major negative economic and ecological impacts to the Lake Victoria region since the plant's establishment in Uganda in the 1980s. Reliable estimates of water hyacinth distribution and extent are required to gauge the severity of the problem through time, relate water hyacinth abundance to environmental factors, identify areas requiring management action, and assess the efficacy of management actions. To provide such estimates and demonstrate the utility of remote sensing for this application, we processed and analyzed remotely sensed imagery to determine the distribution and extent of water hyacinth. Maps were produced and coverage was quantified using a hybrid unsupervised image classification approach with manual editing for each of the riparian countries of Kenya, Tanzania, and Uganda, as well as for numerous gulfs and bays. A similar procedure was carried out for selected lakes in the Rwanda-Tanzania borderlands lakes region in the Kagera River basin. Results confirm the severity of the water hyacinth infestation, especially in the northern parts of the lake. A maximum lake-wide extent of at least 17,374 ha was attained in 1998. Following this, a combination of factors, including conditions associated with the 1997 to 1998 El Nin??o and biocontrol with water hyacinth weevils, appear to have contributed to a major decline in water hyacinth in the most affected parts of the lake. Some lakes in the Kagera basin, such as Lake Mihindi, Rwanda, were severely infested in the late 1990s, but the level of infestation in most of these decreased markedly by the early 2000s.

  4. Doctor Ward's Accidental Terrarium.

    Science.gov (United States)

    Hershey, David R.

    1996-01-01

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

  5. Splitting Ward identity

    Energy Technology Data Exchange (ETDEWEB)

    Safari, Mahmoud [Institute for Research in Fundamental Sciences (IPM), School of Particles and Accelerators, P.O. Box 19395-5531, Tehran (Iran, Islamic Republic of)

    2016-04-15

    Within the background-field framework we present a path integral derivation of the splitting Ward identity for the one-particle irreducible effective action in the presence of an infrared regulator, and make connection with earlier works on the subject. The approach is general in the sense that it does not rely on how the splitting is performed. This identity is then used to address the problem of background dependence of the effective action at an arbitrary energy scale. We next introduce the modified master equation and emphasize its role in constraining the effective action. Finally, application to general gauge theories within the geometric approach is discussed. (orig.)

  6. Splitting Ward identity

    International Nuclear Information System (INIS)

    Safari, Mahmoud

    2016-01-01

    Within the background-field framework we present a path integral derivation of the splitting Ward identity for the one-particle irreducible effective action in the presence of an infrared regulator, and make connection with earlier works on the subject. The approach is general in the sense that it does not rely on how the splitting is performed. This identity is then used to address the problem of background dependence of the effective action at an arbitrary energy scale. We next introduce the modified master equation and emphasize its role in constraining the effective action. Finally, application to general gauge theories within the geometric approach is discussed. (orig.)

  7. Ward identities at finite temperature

    International Nuclear Information System (INIS)

    DOlivo, J.C.; Torres, M.; Tututi, E.

    1996-01-01

    The Ward identities for QED at finite temperature are derived using the functional real-time formalism. They are verified by an explicit one-loop calculation. An effective causal vertex is constructed which satisfy the Ward identity with the associated retarded self-energy. copyright 1996 American Institute of Physics

  8. Ward identities for conformal models

    International Nuclear Information System (INIS)

    Lazzarini, S.; Stora, R.

    1988-01-01

    Ward identities which express the symmetry of conformal models are treated. Diffeomorphism invariance or locally holomorphic coordinate transformations are used. Diffeomorphism invariance is then understood in terms of Riemannian geometry. Two different sets of Ward identities expressing diffeomorphism invariance in a conformally invariant way are found for the free bosonic string. Using a geometrical argument, the correct invariance for a large class of conformal models is given

  9. Exploring the role of cognitive and structural forms of social capital in HIV/AIDS trends in the Kagera region of Tanzania - a grounded theory study.

    Science.gov (United States)

    Frumence, Gasto; Eriksson, Malin; Nystrom, Lennarth; Killewo, Japhet; Emmelin, Maria

    2011-04-01

    The article presents a synthesis of data from three village case studies focusing on how structural and cognitive social capital may have influenced the progression of the HIV epidemic in the Kagera region of Tanzania. Grounded theory was used to develop a theoretical model describing the possible links between structural and cognitive social capital and the impact on sexual health behaviours. Focus group discussions and key informant interviews were carried out to represent the range of experiences of existing social capital. Both structural and cognitive social capital were active avenues for community members to come together, empower each other, and develop norms, values, trust and reciprocal relations. This empowerment created an enabling environment in which members could adopt protective behaviours against HIV infection. On the one hand, we observed that involvement in formal and informal organisations resulted in a reduction of numbers of sexual partners, led people to demand abstinence from sexual relations until marriage, caused fewer opportunities for casual sex, and gave individuals the agency to demand the use of condoms. On the other hand, strict membership rules and regulations excluded some members, particularly excessive alcohol drinkers and debtors, from becoming members of the social groups, which increased their vulnerability in terms of exposure to HIV. Social gatherings (especially those organised during the night) were also found to increase youths' risk of HIV infection through instances of unsafe sex. We conclude that even though social capital may at times have negative effects on individuals' HIV-prevention efforts, this study provides initial evidence that social capital is largely protective through empowering vulnerable groups such as women and the poor to protect against HIV infection and by promoting protective sexual behaviours.

  10. Use of insecticide quantification kits to investigate the quality of spraying and decay rate of bendiocarb on different wall surfaces in Kagera region, Tanzania.

    Science.gov (United States)

    Thawer, Narjis G; Ngondi, Jeremiah M; Mugalura, Frances E; Emmanuel, Isaac; Mwalimu, Charles D; Morou, Evangelia; Vontas, John; Protopopoff, Natacha; Rowland, Mark; Mutagahywa, Joshua; Lalji, Shabbir; Molteni, Fabrizio; Ramsan, Mahdi M; Willilo, Ritha; Wright, Alexandra; Kafuko, Jessica M; Ndong, Isaiah; Reithinger, Richard; Magesa, Stephen Masingili

    2015-04-22

    Bendiocarb was introduced for the first time for Indoor Residual Spraying (IRS) in Tanzania in 2012 as part of the interim national insecticide resistance management plan. This move followed reports of increasingly alarming levels of pyrethroid resistance across the country. This study used the insecticide quantification kit (IQK) to investigate the intra-operational IRS coverage and quality of spraying, and decay rate of bendiocarb on different wall surfaces in Kagera region. To assess intra-operational IRS coverage and quality of spraying, 104 houses were randomly selected out of 161,414 sprayed houses. A total of 509 samples (218 in Muleba and 291 in Karagwe) were obtained by scraping the insecticide samples from wall surfaces. To investigate decay rate, 66 houses (36 in Muleba and 30 in Karagwe) were selected and samples were collected monthly for a period of five months. Laboratory testing of insecticide concentration was done using IQK(TM) [Innovative Vector Control Consortium]. Of the 509 samples, 89.5% met the World Health Organization (WHO) recommended concentration (between 100-400 mg/m(2)) for IRS target dosage. The proportion of samples meeting WHO standards varied between Karagwe (84.3%) and Muleba (96.3%) (p house level revealed that Muleba (84.8%) had a significantly higher proportion of households that met the expected target dosage (100-400 mg/m(2)) compared to Karagwe (68.9%) (p houses with recommended concentration declined from 96.9%, 93.5% and 76.2% at months one, two, and three post IRS, respectively (p-trend = 0.03). The rate of decay increased in the fourth and fifth month post spraying with only 55.9% and 26.3% houses meeting the WHO recommendations, respectively. IQK is an important tool for assessing IRS coverage and quality of spraying. The study found adequate coverage of IRS; however, residual life of bendiocarb was observed to be three months. Results suggest that in order to maintain the recommended concentrations with

  11. Superconformal Ward identities and the supertorus

    International Nuclear Information System (INIS)

    Grundberg, J.; Nakayama, R.

    1987-12-01

    We derive superconformal Ward identities in the context of superspace supergravity. From these Ward identities we extract operator product expansions and the case of a supertorus is studied in some detail. (orig.)

  12. Becoming 'ward smart' medical students.

    Science.gov (United States)

    Walker, Beth; Wallace, Deirdre; Mangera, Zaheer; Gill, Deborah

    2017-10-01

    A small number of medical students elect to work as health care assistants (HCAs) during or prior to their undergraduate training. There is a significant body of evidence in the literature regarding the impact of HCA experience on student nurses; however, little research has examined the effects of such experience on medical students. All fourth-year medical students with self-declared experience as HCAs from a single UK medical school were invited to participate in focus groups to explore their experiences and perceptions. Ten students from the year group took part. Participants felt that their experience as HCAs enhanced their learning in the workplace through becoming 'ward smart', helping them to become socialised into the world of health care, providing early meaningful and humanised patient interaction, and increasing their understanding of multidisciplinary team (MDT) members' roles. Little research has examined the effects of [HCA] experience on medical students DISCUSSION: Becoming 'ward smart' and developing a sense of belonging are central to maximising learning in, from and through work on the ward. Experience as a HCA provides a range of learning and social opportunities for medical students, and legitimises their participation within clinical communities. HCA experience also seems to benefit in the 'hard to reach' dimensions of medical training: empathy; humanisation of patient care; professional socialisation; and providing a sense of belonging within health care environments. © 2016 John Wiley & Sons Ltd and The Association for the Study of Medical Education.

  13. Urinary catheterization in medical wards

    Directory of Open Access Journals (Sweden)

    Nirmanmoh Bhatia

    2010-01-01

    Full Text Available Aims : The study aims to determine the: 1. frequency of inappropriate catheterization in medical wards and the reasons for doing it. 2. various risk factors associated with inappropriate catheterization, catheter associated urinary tract infections (CAUTI and bacterial colonization on Foley′s catheters (BCFC. Settings and Design: Hospital-based prospective study. Materials and Methods: One hundred and twenty five patients admitted consecutively in the medical wards of a tertiary care hospital, who underwent catheterization with a Foley′s catheter, at admission, have been included in the study. Patient profiles were evaluated using the following parameters: age, sex, diagnosis, functional status, mental status, indication, duration and place of catheterization, development of BCFC and CAUTI. Statistical tests used: Chi-square test. Results: Thirty-six out of 125 (28.8% patients included were inappropriately catheterized. BCFC developed in 52.8% and 22.4% were diagnosed with a CAUTI. The most frequent indication for inappropriate catheterization was urinary incontinence without significant skin breakdown (27.8%. The risk factors for inappropriate catheterization were female sex (RR=1.29, 95% CI=0.99, 1.69, P60 years (RR=0.65, 95% CI=0.48, 0.89, P3 days (RR=0.62, 95% CI=0.43, 0.89, P60 years (RR=0.47, 95% CI=0.25, 0.90, P3 days (RR=0.24, 95% CI=0.10, 0.58, P< 0.01. Conclusions : Inappropriate catheterization is highly prevalent in medical wards, especially in patients with urinary incontinence. The patients catheterized in the medical emergency and female patients in particular are at high risk. Careful attention to these factors can reduce the frequency of inappropriate catheterization and unnecessary morbidity.

  14. Food hygiene on the wards.

    Science.gov (United States)

    Steuer, Walter

    2007-09-13

    A PROBLEM THAT IS OFTEN OVERLOOKED OR SIMPLY NOT GIVEN ENOUGH ATTENTION: the food served to patients from the kitchen is not sterile. If food is allowed to stand at room temperature for a long time, both in the case of food cooked for lunch and of food intended for supper which has been previously chilled, there is the possibility of massive spore germination or of dangerous toxin formation. Therefore regulations on how to handle food and beverages (e.g. tea) must be set out in the infection control policy, and checks carried out to monitor compliance with the rules relating to temperature checks, duration and type of storage, need for reheating, etc. Making staff aware of the issues involved is of paramount importance. These include monitoring hygiene standards in the ward kitchen, formulation of a cleaning policy, periodic bacteriological checks (not only of workstations but also of the dishwasher results), whenever possible the use of disposable cloths for working surfaces and equipment, changing cleaning cloths at least once daily and hygienic hand disinfection before and after handing out food. Foodstuffs brought in by visitors represent a special hygienic and organizational problem because in many cases they already have a high baseline microbial count. Visitors must be made aware that, for example, slices of cake left in the patient's room and often eaten only hours later can pose a risk of infection.In summary, the following principles of food hygiene must be observed on the wards:Maintenance of the cold-hot chainNot only reheat food, but ensure it is well heated throughout Avoid situations giving rise to spore germination in foodstuffs brought in by visitorsCleanliness and minimal contamination of kitchen worktopsCleanliness of crockery and kitchen towels Do not allow food to stand at room temperature for a long time, in particular desserts and confectionery A standard policy must be enforced to define the hygienic status and organization for food

  15. Anatomy of the ward round.

    LENUS (Irish Health Repository)

    O'Hare, James A

    2008-07-01

    The ward round has been a central activity of hospital life for hundreds of years. It is hardly mentioned in textbooks. The ward round is a parade through the hospital of professionals where most decision making concerning patient care is made. However the traditional format may be intimidating for patients and inadequate for communication. The round provides an opportunity for the multi-disciplinary team to listen to the patient\\'s narrative and jointly interpret his concerns. From this unfolds diagnosis, management plans, prognosis formation and the opportunity to explore social, psychological, rehabilitation and placement issues. Physical examination of the patient at the bedside still remains important. It has been a tradition to discuss the patient at the bedside but sensitive matters especially of uncertainty may better be discussed elsewhere. The senior doctor as round leader must seek the input of nursing whose observations may be under-appreciated due to traditional professional hierarchy. Reductions in the working hours of junior doctors and shortened length of stay have reduced continuity of patient care. This increases the importance of senior staff in ensuring continuity of care and the need for the joint round as the focus of optimal decision making. The traditional round incorporates teaching but patient\\'s right to privacy and their preferences must be respected. The quality and form of the clinical note is underreported but the electronic record is slow to being accepted. The traditional multi-disciplinary round is disappearing in some centres. This may be regrettable. The anatomy and optimal functioning of the ward round deserves scientific scrutiny and experimentation.

  16. Light Atmosphere in Hospital Wards

    DEFF Research Database (Denmark)

    Stidsen, Lone Mandrup

    by the patients in the ward. The project is based on the Danish Regulation for light in hospitals (DS703), which is a supplement to the regulation of artificial lighting in workplaces (DS700). The kick-off to the project was reading the DS703, second paragraph, chapter 2 about general requirements for lighting...... group has quite diverse needs and preferences, while the staff needs task lighting and the patient a space experienced as homely and pleasant. Categories such as ‘pleasure’ and ‘activities’ are also a part of the user aspect. The space is divided into subcategories as ‘location of the space...

  17. Simulation for ward processes of surgical care.

    Science.gov (United States)

    Pucher, Philip H; Darzi, Ara; Aggarwal, Rajesh

    2013-07-01

    The role of simulation in surgical education, initially confined to technical skills and procedural tasks, increasingly includes training nontechnical skills including communication, crisis management, and teamwork. Research suggests that many preventable adverse events can be attributed to nontechnical error occurring within a ward context. Ward rounds represent the primary point of interaction between patient and physician but take place without formalized training or assessment. The simulated ward should provide an environment in which processes of perioperative care can be performed safely and realistically, allowing multidisciplinary assessment and training of full ward rounds. We review existing literature and describe our experience in setting up our ward simulator. We examine the facilities, equipment, cost, and personnel required for establishing a surgical ward simulator and consider the scenario development, assessment, and feedback tools necessary to integrate it into a surgical curriculum. Copyright © 2013 Elsevier Inc. All rights reserved.

  18. Canonical ward identities in generalized QCD

    International Nuclear Information System (INIS)

    Li Ziping

    1995-01-01

    The canonical Ward identities for a system with singular higher-order Lagrangian are derived and some application to the generalized QCD are given. The new relations of the Ward identities for gauge ghost field proper vertices are obtained which differ from the usual Ward-Takahashi identities arising from BRS invariance. The expressions for PCAC and generalized PCAC of AVV vertices are also obtained

  19. An adolescent ward; 'in name only?'.

    Science.gov (United States)

    Hutton, Alison

    2008-12-01

    The aim of the study was to explore how an adolescent ward was used by the two main users, nurses and adolescents, on a purpose-built adolescent ward. In Australia, caring for the adolescent is part of paediatric nursing and many Australian hospitals boast of 'adolescent-only facilities'. These wards are established on the premise that adolescent patients are a 'special' group deserving their own ward space. With the development of adolescent wards, set ideals around what this type of environment provides have also arisen. These ideals are increased privacy and independence for the patient, a chance for peer interaction, to be nursed by specially trained staff and to provide opportunities for adolescent patients to participate in their own care. This study used ethnography to gain a perspective of how ward space was used. Data were collected using participant observation and formal and informal interviews. Data were then analysed using the works of Lefebvre and Foucault. This study found that patient allocation, nursing observation and patient labels impact on how adolescent patients are nursed. Patients are expected to fit in, accepting all ministrations of nursing and staff. On this ward, nursing work was paramount. Nurses treated the adolescent patient like any other. In saying this, the adolescent patient still found ways to adapt to the ward space and its rules and routines; so in this sense, the ward still worked for them, even if nursing work was paramount. This study contributes to current discourse on the formation of specialized facilities in general, as it shows that no matter how a ward space is set up, if the space is not used in that way, then the purported purpose of that ward space will be lost.

  20. Second Order Ideal-Ward Continuity

    Directory of Open Access Journals (Sweden)

    Bipan Hazarika

    2014-01-01

    Full Text Available The main aim of the paper is to introduce a concept of second order ideal-ward continuity in the sense that a function f is second order ideal-ward continuous if I-limn→∞Δ2f(xn=0 whenever I-limn→∞Δ2xn=0 and a concept of second order ideal-ward compactness in the sense that a subset E of R is second order ideal-ward compact if any sequence x=(xn of points in E has a subsequence z=(zk=(xnk of the sequence x such that I-limk→∞Δ2zk=0 where Δ2zk=zk+2-2zk+1+zk. We investigate the impact of changing the definition of convergence of sequences on the structure of ideal-ward continuity in the sense of second order ideal-ward continuity and compactness of sets in the sense of second order ideal-ward compactness and prove related theorems.

  1. Nursing on the medical ward.

    Science.gov (United States)

    Parker, Judith M

    2004-12-01

    This paper considers some issues confronting contemporary medical nursing and draws upon psychoanalytic theories to investigate some seemingly straightforward and taken-for-granted areas of medical nursing work. I am arguing that the everyday work of medical nurses in caring for patients is concerned with bringing order to and placing boundaries around inherently unsettled and destabilized circumstances. I am also arguing that how nurses manage and organize their work in this regard stems from traditional practices that tend to be taken for granted and not explicitly thought about. It is therefore difficult for nurses to consider changing these practices that often have negative consequences for the nurses. I want to examine the impact upon nurses of the consequences of three taken-for-granted nursing practices: (i) the tendency of nurses to confine their reactions to what is going on so as to present a caring self; (ii) the tendency of nurses in their everyday talk to patients to confine, limit and minimize meaning; and (iii) the tensions and ambiguities that emerge for nurses in the policing function they perform in confining patients to the bed or the ward. Negative consequences on nurses of these practices potentially include stress and confusion regarding their ability to care for patients; an undervaluing of nursing skills; and a deterioration in the nurse-patient relationship. Clinical supervision for medical nurses is proposed as a means of facilitating greater understanding of the nature of nurses' relationships with patients and the complex dimensions of their medical nursing role.

  2. Ward nurses' knowledge of computed tomography scanning.

    Science.gov (United States)

    Majeed, M A; Nayeemuddin, M; Christie, M

    Patients benefit from and are reassured by advance information on procedures that they are to undergo. Ward nurses should have adequate knowledge of radiological investigations to ensure proper patient preparation and good interdepartmental communication to avoid delays and cancellations. This study was conducted to assess the ward nurses' knowledge of the process of computed tomography (CT) scanning. One hundred and twenty qualified nurses were asked to complete a questionnaire regarding CT scanning. The findings revealed a suboptimal level of awareness about the process. This is probably due to lack of formal teaching for nurses on the wards in regards the different radiological procedures and patient preparation. There is a strong case for better educational talks on rapidly changing radiological techniques for ward staff to ensure high-quality patient care.

  3. Anomalous N=2 superconformal Ward identities

    International Nuclear Information System (INIS)

    Ketov, Sergei V.

    2000-01-01

    The N=2 superconformal Ward identities and their anomalies are discussed in N=2 superspace (including N=2 harmonic superspace), at the level of the low-energy effective action (LEEA) in four-dimensional N=2 supersymmetric field theories. The (first) chiral N=2 supergravity compensator is related to the known N=2 anomalous Ward identity in the N=2 (abelian) vector mulitplet sector. As regards the hypermultiplet LEEA given by the N=2 non-linear sigma-model (NLSM), a new anomalous N=2 superconformal Ward identity is found, whose existence is related to the (second) analytic compensator in N=2 supergravity. The celebrated solution of Seiberg and Witten is known to obey the (first) anomalous Ward identity in the Coulomb branch. We find a few solutions to the new anomalous Ward identity, after making certain assumptions about unbroken internal symmetries. Amongst the N=2 NLSM target space metrics governing the hypermultiplet LEEA are the SU(2)-Yang-Mills-Higgs monopole moduli-space metrics that can be encoded in terms of the spectral curves (Riemann surfaces), similarly to the Seiberg-Witten-type solutions. After a dimensional reduction to three spacetime dimensions (3d), our results support the mirror symmetry between the Coulomb and Higgs branches in 3d, N=4 gauge theories

  4. Positioning and change in a hospital ward

    DEFF Research Database (Denmark)

    Kjærbeck, Susanne

    2017-01-01

    Purpose This paper focuses on communication about hygiene in a hospital ward and with the relevant infection control organization. The purpose of this paper is to examine the function of the hygiene coordinator as a key change agent and the communicative challenges and role conflicts implied in her...... practice. The author suggests strategies for improving communication on hygiene on ward level. Design/methodology/approach The empirical material consists of interviews and recordings of communicative events in relation to a breakout of dangerous bacteria in the ward. Change communication is used...... as a contextualizing frame of understanding, and positioning theory and analysis are applied to shed light upon the core challenges of communicating as a change agent when the coordinator's professional position and collegial relations do not support it. Findings It is shown how these challenges are connected...

  5. Geometrical formulation of the conformal Ward identity

    International Nuclear Information System (INIS)

    Kachkachi, M.

    2002-08-01

    In this paper we use deep ideas in complex geometry that proved to be very powerful in unveiling the Polyakov measure on the moduli space of Riemann surfaces and lead to obtain the partition function of perturbative string theory for 2, 3, 4 loops. Indeed, a geometrical interpretation of the conformal Ward identity in two dimensional conformal field theory is proposed: the conformal anomaly is interpreted as a deformation of the complex structure of the basic Riemann surface. This point of view is in line with the modern trend of geometric quantizations that are based on deformations of classical structures. Then, we solve the conformal Ward identity by using this geometrical formalism. (author)

  6. Developing a general ward nursing dashboard.

    Science.gov (United States)

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

    2014-12-15

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

  7. Ward identities of higher order Virasoro algebra

    International Nuclear Information System (INIS)

    Zha Chaozeng; Dolate, S.

    1994-11-01

    The general formulations of primary fields versus quasi-primary ones in the context of high order Virasoro algebra (HOVA) and the corresponding Ward identity are explored. The primary fields of conformal spins up to 8 are given in terms of quasi-primary fields, and the general features of the higher order expressions are also discussed. It is observed that the local fields, either primary of quasi-primary, carry the same numbers of central charges, and not all the primary fields contribute to the anomalies in the Ward identities. (author). 6 refs

  8. Limits of Freedom: The Ward Churchill Case

    Science.gov (United States)

    O'Nell, Robert M.

    2006-01-01

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

  9. Ward identities for amplitudes with reggeized gluons

    International Nuclear Information System (INIS)

    Bartles, J.; Vacca, G.P.

    2012-05-01

    Starting from the effective action of high energy QCD we derive Ward identities for Green's functions of reggeized gluons. They follow from the gauge invariance of the effective action, and allow to derive new representations of amplitudes containing physical particles as well as reggeized gluons. We explicitly demonstrate their validity for the BFKL kernel, and we present a new derivation of the kernel.

  10. Characterization of indoor bioaerosols from a hospital ward in a ...

    African Journals Online (AJOL)

    Characterization of indoor bioaerosols from a hospital ward in a tropical ... assessment of indoor air quality and determine pathogenic microorganisms due to particle fall-out. Key words: Indoor air, bioaerosols, hospital ward, tropical setting ...

  11. 25 CFR 117.23 - Transactions between guardian and ward.

    Science.gov (United States)

    2010-04-01

    ... 25 Indians 1 2010-04-01 2010-04-01 false Transactions between guardian and ward. 117.23 Section... COMPETENCY § 117.23 Transactions between guardian and ward. Business dealings between the guardian and his ward involving the sale or purchase of any property, real or personal, by the guardian to or from the...

  12. Hand decontamination practices in paediatric wards

    Directory of Open Access Journals (Sweden)

    S Jelly

    2003-09-01

    Full Text Available The purpose of this study was to determine and describe hand decontamination practices of health care professionals in the paediatric wards of an academic hospital in Johannesburg. The purpose was addressed within a survey design and through the use of descriptive and comparative methods. Data were collected through direct observation conducted with the use of a researcher-administered checklist. A sample of sixtysix health professionals was obtained through convenience sampling.

  13. Ward-Takahashi identities in quantum electrodynamics

    Energy Technology Data Exchange (ETDEWEB)

    Nishijima, K; Sasaki, R [Tokyo Univ. (Japan). Dept. of Physics

    1975-03-01

    The Ward-Takahashi identities are derived for connected Green's functions in quantum electrodynamics without recourse to equal-time commutation relations, field equations and the Feynman-Dyson perturbation expansions. The argument is based on the dispersion formulation of field theories and only finite expressions are used throughout this derivation. These identities are shown to be consequences of the subtraction conditions imposed upon the 2-, 3- and 4-point Green's functions.

  14. Ward Valley transfer stalled by Babbitt

    International Nuclear Information System (INIS)

    Anon.

    1994-01-01

    Interior Secretary Bruce Babbitt announced on November 24 that he would not authorize the land transfer for the proposed low-level waste disposal site at Ward Valley, California, until a legal challenge to the facility's license and environmental impact statement is resolved. Even if the matter is resolved quickly, there exists the possibility that yet another hearing will be held on the project, even though state courts in California have stated flatly that no such hearings are required

  15. Ward Valley transfer stalled by Babbitt

    Energy Technology Data Exchange (ETDEWEB)

    1994-01-01

    Interior Secretary Bruce Babbitt announced on November 24 that he would not authorize the land transfer for the proposed low-level waste disposal site at Ward Valley, California, until a legal challenge to the facility's license and environmental impact statement is resolved. Even if the matter is resolved quickly, there exists the possibility that yet another hearing will be held on the project, even though state courts in California have stated flatly that no such hearings are required.

  16. Service audit of a forensic rehabilitation ward.

    Science.gov (United States)

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

    2009-10-01

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

  17. Choosing a commode for the ward environment.

    Science.gov (United States)

    Ballinger, C; Pain, H; Pascoe, J; Gore, S

    The choice of appropriate equipment to promote patient independence and enhance nursing care is of major concern to the nurse in the ward environment. This article reports on a recent evaluation of specialist commodes, (Ballinger et al, 1994), with reference to the programme funded by the Medical Devices Agency, Department of Health, under whose auspices the project was carried out. The results of user evaluations and technical tests of six mobile commodes are presented, the preferred model being the Mayfair commode supplied by Carters (J&A) Ltd. The article concludes by identifying a number of important considerations to bear in mind when selecting a commode.

  18. The role of the ward manager in promoting patient safety.

    Science.gov (United States)

    Pinnock, David

    In this article the role of the ward manager in promoting patient safety is explored. The background to the development of the patient safety agenda is briefly discussed and the relationship between quality and safety is illustrated. The pivotal importance of the role of the ward manager in delivering services to patients is underlined and literature on patient safety is examined to identify what a ward manager can do to make care safer. Possible actions of the ward manager to improve safety discussed in the literature are structured around the Leadership Framework. This framework identifies seven domains for the leadership of service delivery. Ward managers use their personal qualities, and network and work within teams, while managing performance and facilitating innovation, change and measurement for improvement. The challenge of promoting patient safety for ward managers is briefly explored and recommendations for further research are made.

  19. The transition from staff nurse to ward leader.

    Science.gov (United States)

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

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

  20. The chiral Ward-Takahashi identity in the ladder approximation

    International Nuclear Information System (INIS)

    Kugo, Taichiro; Mitchard, M.G.

    1992-01-01

    We show that the ladder approximation to the Schwinger-Dyson and Bethe-Salpeter equations preserves the Ward-Takahashi identity for the axial vector vertex if and only if we use the gluon momentum as the argument of the running coupling constant. However, in the usual Landau gauge this is inconsistent with the vector Ward identity. We propose a new method for making the ladder approximation scheme consistent with both vector and axial vector Ward identities. (orig.)

  1. Optimizing Lighting Design for Hospital Wards by Defining User Zones

    DEFF Research Database (Denmark)

    Thuesen, Niels; Stidsen, Lone; Kirkegaard, Poul Henning

    2011-01-01

    of lighting design, so it has the ability to support the different users activity and behavior on the ward. By using RFID tracking and manual observations we have analyzed and evaluated the ward functionality as working environment for the staff. The method creates a higher understanding of the ward...... of lighting design in private and public settings are often not similar. The purpose of this article is therefore present a approach dividing the hospital ward in 3 user zones for patients, staff and visitors. The main user of the zone should be in control of the light scenario and thereby a refining...

  2. The iota(1440) and QCD ward identities

    International Nuclear Information System (INIS)

    Williams, P.G.

    1987-01-01

    Anomalous Ward identities for QCD are analyzed with contributions of all known pseudoscalar mesons, including the glueball candidate iota(1440). Implications for the standard resolution of the U/sub A/(1) problem are examined by imposing the important and crucial constraint of positivity for the topological susceptibility chi/sub t/. The pure Yang-Mills susceptibility chi/sub t//sup YM/ - a quantity relevant in quenched lattice calculations - is shown to increase quite considerably in the presence of the iota, while chi/sub t/ is reduced and may even vanish. Axial couplings are consistent with the suppression expected for a singlet glueball, and give a small width for iota → 2y less than 3 keV

  3. Superconformal Ward identities and their solution

    International Nuclear Information System (INIS)

    Nirschl, M.; Osborn, H.

    2005-01-01

    Superconformal Ward identities are derived for the four point functions of chiral primary BPS operators for N=2,4 superconformal symmetry in four dimensions. Manipulations of arbitrary tensorial fields are simplified by introducing a null vector so that the four point functions depend on two internal R-symmetry invariants as well as two conformal invariants. The solutions of these identities are interpreted in terms of the operator product expansion and are shown to accommodate long supermultiplets with free scale dimensions and also short and semi-short multiplets with protected dimensions. The decomposition into R-symmetry representations is achieved by an expansion in terms of two variable harmonic polynomials which can be expressed also in terms of Legendre polynomials. Crossing symmetry conditions on the four point functions are also discussed

  4. Vacuum Ward identities for higher genera

    International Nuclear Information System (INIS)

    Zamolodchikov, A.B.

    1989-01-01

    The minimal models of two-dimensional conformal field theory are considered on surfaces with nontrivial topology. Due to degeneration of the vacuum module in these models, the stress tensor components satisfy special equations of motion - the vacuum Ward identities. It is shown that these identities can be written in the form of partial differential equations on the moduli space, satisfied by the partition function of the theory. Some examples are written down explicitly in the case of torus and g=2 surface, represented as a double-fold covering of a sphere. For the simplest minimal theory M(2/5), equations are closed on hyperelliptic surface of any genus and the situation is governed by the other minimal model M(3/10). (orig.)

  5. Nurse rostering at a Danish ward

    DEFF Research Database (Denmark)

    Bæklund, Jonas

    2014-01-01

    This paper considers a nurse rostering problem from a ward at a Danish hospital.  The problem is highly constrained and comprises a large set of different constraints. A branch-and-price method for solving the problem exactly is proposed. The master problem is to assign schedules to the nurses......, and its linear relaxation is solved by means of column generation. The pricing sub-problem is to generate feasible schedules for the nurses and -- as a couple of different constraints including several special Danish regulations have to be observed -- is solved by constraint programming. A number...... of specific algorithms for handling these constraints are proposed. The method is very flexible regarding the rules a schedule should comply with, which is a key concern when creating solution methods for nurse rostering problems.  Computational tests show that optimal solutions can be found for instances...

  6. Labour ward midwives' perceptions of stress.

    Science.gov (United States)

    Mackin, P; Sinclair, M

    1998-05-01

    This exploratory study set out to examine labour ward midwives' perceptions of stress. It utilized a combination of two self-report questionnaires, one devised by McGrath et al. and the GHQ12. Additional qualitative data were collected by asking midwives to produce narratives about recent stressful events. A convenience sample of the 43 midwives formed the study population and a response rate of 77% was achieved. Quantitative data were analysed using descriptive statistics and qualitative narratives were explored for content analysis. Midwives in this study demonstrated their awareness of stress in their working and personal lives and many took active steps to redress the negative effects with exercise, hobbies and talking with colleagues. However, the study revealed that 78% of the midwives indicated that having insufficient time to perform their duties was very stressful, paralleled by their perceived inability to influence work-based decisions. The study revealed that both medical and midwifery colleagues frustrated their endeavours to change an unsatisfactory condition. The GHQ12 revealed 30% of the midwives had scores above the threshold level of 2 indicating psychiatric morbidity and this is of major concern. The narratives revealed that lack of communication between the professionals about decision making was a major source of stress and as a result of this study efforts to improve multidisciplinary communication through the development of journal clubs and planned social activities is under consideration by the unit. Overall, the findings from this study highlight stress as a potential, occupational health problem in the working lives of some labour ward midwives.

  7. Clostridium Difficile Infection in the Nephrology Ward

    Directory of Open Access Journals (Sweden)

    Sylwia Dudzicz

    2017-11-01

    Full Text Available Clostridium difficile is currently the most frequently identified pathogen causing antibiotic-associated diarrhea and the main cause of nosocomial diarrhea. In recent years, increases incidence of infection, severe infection, recurrent infection and mortality from Clostridium difficile infection (CDI have been observed. This may be a consequence of excessive antibiotic use and spread of the hypervirulent epidemic BI/NAP1/027 strain of Clostridium difficile. The main risk factors for CDI are: antibiotic therapy, previous hospitalizations and number of comorbid conditions. Prevention of CDI mainly is focused in two directions: reducing the exposure of patients to the disease pathogen by intensifying hygiene measures, and reducing the impact of risk factors. A meta-analyses of clinical studies (observational, cohort and case control showed significantly higher risk of CDI and CDI recurrence in patients with chronic kidney disease and increased mortality risk in chronic kidney disease patients with CDI comparing those without CDI. Increased risk of CDI in patients with chronic kidney disease can be caused by: frequent antibiotic therapy associated with numerous infections resulting in intestinal microflora dysfunction, frequent hospitalizations, older age of the patients and an impaired immune system. Among preventative measures against CDI, the use of probiotics were also studied. In patients hospitalized in nephrology ward highly significant reduction of the CDI incidence was observed after the introduction of Lactobacillus plantarum 299v as CDI prophylaxis. Therefore, the use of Lactobacillus plantarum 299v seems to be a promising method of CDI prevention in chronic kidney disease patients hospitalized in nephrology ward.

  8. HIV infection, tuberculosis and workload in a general paediatric ward

    African Journals Online (AJOL)

    South African Journal of Child Health ... To describe the impact of HIV infection and tuberculosis on the workload of a general paediatric ward at Red Cross War Memorial Children's Hospital in 2007. Methods. Prospective descriptive surveillance of the patient composition of a general paediatric ward over a 1-year period.

  9. Views of pharmacists on involvement in ward rounds in selected ...

    African Journals Online (AJOL)

    Background: Pharmacist participation in ward rounds is of increasing interest for better pharmaceutical care, yet most pharmacists do not engage in this activity. Objective: The objective was to obtain public sector pharmacistsf views and perceptions on their involvement in ward rounds. Method: A rapid assessment was ...

  10. Microbiological assessment of indoor air of teaching hospital wards ...

    African Journals Online (AJOL)

    Thus, the objective of this study is to provide fundamental data related to the microbial quality of indoor air of Jimma University Specialized Hospital wards, to estimate the health hazard and to create standards for indoor air quality control. METHODS: The microbial quality of indoor air of seven wards of Jimma University ...

  11. Team Ward Rounds for Quality Improvement in Patient-Centred ...

    African Journals Online (AJOL)

    In this paper we describe a clinical practice change for evaluation and continuous quality improvement of in-patient services in our ACE unit, such as daily geriatrics (multi disciplinary) team ward rounds preceding traditional ward rounds by other managing teams. The geriatrics team rounds enabled the identification of ...

  12. The labour ward analgesic service at King Edward VIII Hospital ...

    African Journals Online (AJOL)

    The labour ward analgesic service at King Edward VIII. Hospital, Durban. D. A. ROCKE, C. C. ROUT, H. D. RUSSELL, S. SINGH. Abstract The provision of analgesic services to the labour ward at King Edward VIII Hospital was studied during a I-week period. Of249 patients, 113 (45%) received no analgesia whatsoever.

  13. Nursing Education Trial Using a Virtual Nightingale Ward.

    Science.gov (United States)

    Tsuji, Keiko; Iwata, Naomi; Kodama, Hiromi; Hagiwara, Tomoko; Takai, Kiyako; Sasaki, Yoko; Nagata, Yoshie; Matsumoto, Maki

    2017-01-01

    Nursing department students are expected to correctly grasp the entire concept of nursing through their education. The authors created a movie of a Nightingale ward (virtual ward, hereafter) with an architectural computer design software for education. The students' reaction to the virtual ward was categorized into three viewpoints: that of nurses, of patients, and of nurses and patients in common. Most of the reactions in each viewpoint were: "easy to observe patients" in the nurses' viewpoint; "no privacy" in the patients' viewpoint; and "wide room" in the common viewpoint, respectively. These reactions show the effectiveness of using a virtual ward in nursing education. Because these reactions are characteristics of a Nightingale ward, and even students, who have generally less experiences, recognized these characteristics from the both viewpoints of nurses and patients.

  14. Exploring positive hospital ward soundscape interventions.

    Science.gov (United States)

    Mackrill, J; Jennings, P; Cain, R

    2014-11-01

    Sound is often considered as a negative aspect of an environment that needs mitigating, particularly in hospitals. It is worthwhile however, to consider how subjective responses to hospital sounds can be made more positive. The authors identified natural sound, steady state sound and written sound source information as having the potential to do this. Listening evaluations were conducted with 24 participants who rated their emotional (Relaxation) and cognitive (Interest and Understanding) response to a variety of hospital ward soundscape clips across these three interventions. A repeated measures ANOVA revealed that the 'Relaxation' response was significantly affected (n(2) = 0.05, p = 0.001) by the interventions with natural sound producing a 10.1% more positive response. Most interestingly, written sound source information produced a 4.7% positive change in response. The authors conclude that exploring different ways to improve the sounds of a hospital offers subjective benefits that move beyond sound level reduction. This is an area for future work to focus upon in an effort to achieve more positively experienced hospital soundscapes and environments. Copyright © 2014 Elsevier Ltd and The Ergonomics Society. All rights reserved.

  15. Congenital cataract screening in maternity wards is effective

    DEFF Research Database (Denmark)

    Magnusson, Gunilla; Bizjajeva, Svetlana; Haargaard, Birgitte

    2013-01-01

    AIM: To study which eye-screening protocol prevails in Swedish maternity/neonatal wards, evaluate efficacy in a prospective study, and compare results with earlier Swedish retrospective results. METHODS: Surveys were sent in 2006 to maternity/neonatal and women's health departments regarding...... with earlier retrospective results was performed. RESULTS: Eye screening is routine protocol at a rate of 90% of Swedish maternity wards. Sixty-one children were included in the study. An increase was shown in case referrals from maternity wards compared to ten years ago (64% versus 50%). Detection...

  16. Analysis of Ward identities in supersymmetric Yang-Mills theory

    Science.gov (United States)

    Ali, Sajid; Bergner, Georg; Gerber, Henning; Montvay, Istvan; Münster, Gernot; Piemonte, Stefano; Scior, Philipp

    2018-05-01

    In numerical investigations of supersymmetric Yang-Mills theory on a lattice, the supersymmetric Ward identities are valuable for finding the critical value of the hopping parameter and for examining the size of supersymmetry breaking by the lattice discretisation. In this article we present an improved method for the numerical analysis of supersymmetric Ward identities, which takes into account the correlations between the various observables involved. We present the first complete analysis of supersymmetric Ward identities in N=1 supersymmetric Yang-Mills theory with gauge group SU(3). The results indicate that lattice artefacts scale to zero as O(a^2) towards the continuum limit in agreement with theoretical expectations.

  17. Handing over patients from the ICU to the general ward

    DEFF Research Database (Denmark)

    Bunkenborg, Gitte; Bitsch Hansen, Tina; Hølge-Hazelton, Bibi

    2017-01-01

    AIM: To explore nursing practice and perception of engaging in communicative interaction when handing over multi-morbid patients from the ICU to general medical or surgical wards. BACKGROUND: Communication failures impose risks to patient safety. ICU and general ward nurses communicate in writing...... focused ethnography was applied to the study. METHODS: Participant observation of 22 clinical situations of handing over patients from the ICU to general wards was conducted in November and December 2015, followed by five focus group interviews, three interviews with general ward nurses and two with ICU...... towards patient status and the handing over process" emerged from observation notes. From transcribed focus group interviews, the theme "Balancing and negotiating when passing on, consuming and adapting knowledge" was identified. CONCLUSION: A lack of shared goals regarding handing over patients from...

  18. Developing skills in clinical leadership for ward sisters.

    Science.gov (United States)

    Fenton, Katherine; Phillips, Natasha

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

  19. audit of blood transfusion practices in the paediatric medical ward

    African Journals Online (AJOL)

    2013-01-01

    Jan 1, 2013 ... AUDIT OF BLOOD TRANSFUSION PRACTICES IN THE PAEDIATRIC MEDICAL WARD OF A TERTIARY ..... services and even where available, beneficiaries have ... due to lack of existence of quality assurance protocol.

  20. The N=2 supersymmetric Ward-identities on harmonic superspace

    International Nuclear Information System (INIS)

    Lhallabi, T.

    1986-09-01

    The quantization of N=2 supersymmetric Yang-Mills theory coupled to matter hypermultiplet has been done in the harmonic superspace, by requiring BRS and anti-BRS invariance. Also the corresponding Ward-identities have been derived. (author)

  1. Weather Augmented Risk Determination (WARD) System

    Science.gov (United States)

    Niknejad, M.; Mazdiyasni, O.; Momtaz, F.; AghaKouchak, A.

    2017-12-01

    Extreme climatic events have direct and indirect impacts on society, economy and the environment. Based on the United States Bureau of Economic Analysis (BEA) data, over one third of the U.S. GDP can be considered as weather-sensitive involving some degree of weather risk. This expands from a local scale concrete foundation construction to large scale transportation systems. Extreme and unexpected weather conditions have always been considered as one of the probable risks to human health, productivity and activities. The construction industry is a large sector of the economy, and is also greatly influenced by weather-related risks including work stoppage and low labor productivity. Identification and quantification of these risks, and providing mitigation of their effects are always the concerns of construction project managers. In addition to severe weather conditions' destructive effects, seasonal changes in weather conditions can also have negative impacts on human health. Work stoppage and reduced labor productivity can be caused by precipitation, wind, temperature, relative humidity and other weather conditions. Historical and project-specific weather information can improve better project management and mitigation planning, and ultimately reduce the risk of weather-related conditions. This paper proposes new software for project-specific user-defined data analysis that offers (a) probability of work stoppage and the estimated project length considering weather conditions; (b) information on reduced labor productivity and its impacts on project duration; and (c) probabilistic information on the project timeline based on both weather-related work stoppage and labor productivity. The software (WARD System) is designed such that it can be integrated into the already available project management tools. While the system and presented application focuses on the construction industry, the developed software is general and can be used for any application that involves

  2. Hypoglycaemia monitoring in a medical receiving ward.

    Science.gov (United States)

    Ellis, Ryan

    2015-01-01

    It has been suggested that current care for diabetes inpatients remains inadequate and that greater attention is required for high quality management. In this project the aspect of hypoglycaemia was studied in a busy medical receiving ward at the Glasgow Royal Infirmary. A large proportion of inpatients have diabetes and episodes of hypoglycaemia experienced by this population can delay discharge and indeed be detrimental to health. Thus it is important from both an organisational and patient perspective to manage this population well. In this project BM machine data was analysed to identify patients who were hypoglycaemic. These patients were then tracked down to study the subsequent management and compared this against recommended guidance. Following this an intervention was made to promote identification, management, documentation, and prevention of hypoglycaemia. This was deliberately a simple intervention involving discussions with staff and provision of basic documented guidance next to every BM machine. In the first phase 17 patients were identified and in a second and third phase 16 patients each time were further identified. Patients in the study were both type 1 and type 2 diabetics. Initial results in phase I were compared to results in phase II and III respectively. This intervention produced significant improvements in management with correct monitoring of low BMs (i.e. upon identification of low BM repeat within 1 hour) improving from 47% to 100% (for Phase II and III). Also, recording of preventative measures of hypoglycaemia improved from 35% to 88% and 94% with an improvement from 24% to 69% and 75% in recording of treatment given if needed. In conclusion, the study successfully demonstrated that simple measures can significantly improve the quality care of inpatient diabetic patients in relation to hypoglycaemia management.

  3. The ward round--patient experiences and barriers to participation.

    Science.gov (United States)

    Swenne, Christine Leo; Skytt, Bernice

    2014-06-01

    Patients' participation is essential to their well-being and sense of coherence, as well as to their understanding of and adherence to prescribed treatments. Ward rounds serve as a forum for sharing information between patient and caregiver. The purpose of the ward round is to obtain information and plan medical and nursing care through staff-patient communication. The aim and objective of this study was to investigate patients' experiences during the ward round and their ability to participate in their care. The study was qualitative and descriptive in design. Fourteen inpatients at a cardiovascular ward were interviewed. Qualitative content analysis was used for the analysis. The ethics of scientific work were adhered to. Each study participant gave his/her informed consent based on verbal and written information. The study was approved by the Research Ethics Committee at Uppsala University. The analysis revealed one theme and three subthemes related to patients' experiences of ward rounds. The main theme was handling of information from the daily ward round while waiting for private consultation. The subthemes were making the best of the short time spent on ward rounds; encountering traditional roles and taking comfort in staff competency; and being able to choose the degree to which one participates in the decision-making process. Several aspects of traditional ward round routines could be improved in regard to the two-way information exchange process between caregivers and patient. Patients' and caregivers' ability to communicate their goals and the environment in which the communication occurs are of great importance. The information provided by nurses is easier to understand than that provided by physicians. The atmosphere must be open; the patient should be treated with empathy by staff; and patients' right to participate must be acknowledged by all healthcare professionals involved. © 2013 Nordic College of Caring Science.

  4. Ward identities for scale and special conformal transformations in inflation

    International Nuclear Information System (INIS)

    Kundu, Nilay; Shukla, Ashish; Trivedi, Sandip P.

    2016-01-01

    We derive the general Ward identities for scale and special conformal transformations in theories of single field inflation. Our analysis is model independent and based on symmetry considerations alone. The identities we obtain are valid to all orders in the slow roll expansion. For special conformal transformations, the Ward identities include a term which is non-linear in the fields that arises due to a compensating spatial reparametrization. Some observational consequences are also discussed.

  5. Rolling out Productive Ward foundation modules across a hospital trust.

    Science.gov (United States)

    Foster, Sam; Gordon, Pete; McSherry, Wilfred

    The Shrewsbury and Telford Hospitals NHS Trust has spent the last 12 months rolling out the Productive Ward foundation modules across the whole organisation. This has resulted in measurable increases in time spent on direct care, and reduced infection rates and ward non-pay (non-staffing) expenditure. This article discusses the initiative and looks at how problems with the hospital supply chain are being addressed.

  6. Ergonomics in the psychiatric ward towards workers or patients?

    Science.gov (United States)

    Silvana, Salerno; Laura, Forcella; Ursula, Di Fabio; Irene, Figà Talamanca; Paolo, Boscolo

    2012-01-01

    Patient's aggressive behavior is one of the major problem in the psychiatric ward. Here we present the preliminary results of a psychiatric ward case-study, of a public hospital in the Chieti province, in order to plan ergonomic improvement. We applied the Method of Organizational Congruencies in the psychiatric ward in order to study the relationship between organized hospital work and nurses wellbeing in a 24 hour shifts. We observed 58 main phases in the three work shifts. The technical actions are mainly those of any hospital wards (shift briefing, preparing and administering drugs, recording data on clinical charts, etc.). We found important differences mainly due to the nurses overcontrol activities on the patients behavior (preventing suicides or self destructive behavior), the occurrence of restraint procedure towards patients, the pollution due to patient's cigarette smoke. The fear of patient's self destructive behavior or other aggressive behaviour are the main cognitive and social aspects of this hospital ward. Nurses working in this psychiatric ward have to accept: locked doors, poor and polluted environment, restraint procedure with high risk of aggression and no availability of mental health care programs. A new interdisciplinary concept for ergonomics in psychiatry setting may represent a challenge for both nurses and patients and the community.

  7. Behavior observation of major noise sources in critical care wards.

    Science.gov (United States)

    Xie, Hui; Kang, Jian; Mills, Gary H

    2013-12-01

    This study aimed to investigate the behavior patterns of typical noise sources in critical care wards and relate their patterns to health care environment in which the sources adapt themselves in several different forms. An effective observation approach was designed for noise behavior in the critical care environment. Five descriptors have been identified for the behavior observations, namely, interval, frequency, duration, perceived loudness, and location. Both the single-bed and the multiple-bed wards at the selected Critical Care Department were randomly observed for 3 inconsecutive nights, from 11:30 pm to 7:00 am the following morning. The Matlab distribution fitting tool was applied afterward to plot several types of distributions and estimate the corresponding parameters. The lognormal distribution was considered the most appropriate statistical distribution for noise behaviors in terms of the interval and duration patterns. The turning of patients by staff was closely related to the increasing occurrences of noises. Among the observed noises, talking was identified with the highest frequency, shortest intervals, and the longest durations, followed by monitor alarms. The perceived loudness of talking in the nighttime wards was classified into 3 levels (raised, normal, and low). Most people engaged in verbal communication in the single-bed wards that occurred around the Entrance Zone, whereas talking in the multiple-bed wards was more likely to be situated in the Staff Work Zone. As expected, more occurrences of noises along with longer duration were observed in multiple-bed wards rather than single-bed wards. "Monitor plus ventilator alarms" was the most commonly observed combination of multiple noises. © 2013 Elsevier Inc. All rights reserved.

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

    Science.gov (United States)

    Thompson, George A.

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

  9. Non-perturbative construction of the Luttinger-Ward functional

    Directory of Open Access Journals (Sweden)

    M.Potthoff

    2006-01-01

    Full Text Available For a system of correlated electrons, the Luttinger-Ward functional provides a link between static thermodynamic quantities on the one hand and single-particle excitations on the other. The functional is useful in deriving several general properties of the system as well as in formulating the thermodynamically consistent approximations. Its original construction, however, is perturbative as it is based on the weak-coupling skeleton-diagram expansion. Here, it is shown that the Luttinger-Ward functional can be derived within a general functional-integral approach. This alternative and non-perturbative approach stresses the fact that the Luttinger-Ward functional is universal for a large class of models.

  10. Generalized on-shell ward identities in string theory

    International Nuclear Information System (INIS)

    Lee, Jen-Chi

    1994-01-01

    It is demonstrated that an infinite set of string-tree level on-shell Ward identities, which are valid to all σ-model loop orders, can be systematically constructed without referring to the string field theory. As examples, bosonic massive scattering amplitudes are calculated explicitly up to the second massive excited states. Ward identities satisfied by these amplitudes are derived by using zero-norm states in the spectrum. In particular, the inter-particle Ward identity generated by the D 2 xD 2' zero-norm state at the second massive level is demonstrated. The four physical propagating states of this mass level are then shown to form a large gauge multiplet. This result justifies our previous consideration on higher inter-spin symmetry from the generalized worldsheet σ-model point of view. (author)

  11. Generalized ward identities for non-local transformation

    International Nuclear Information System (INIS)

    Li Ziping; Li Ruijie

    2002-01-01

    Based on the phase-space generating functional of Green function for a system with a singular higher-order Lagrangian, the generalized canonical Ward identities under the local and non-local transformation in phase space for such a system have been derived. Starting from the configuration-space generating functional for a gauge-invariant system, the generalized Ward identities were deduced under the local, non-local and global transformation, respectively. The applications to the non-Abelian Chern-Simons theories with higher derivatives were given. Some relationships among the proper vertices have been deduced, in which one does not need to carry out the integration over canonical momenta in phase-space generating functional. The Ward-Takahashi identities for BRS transformation are also obtained

  12. Ward Identity and Scattering Amplitudes for Nonlinear Sigma Models

    Science.gov (United States)

    Low, Ian; Yin, Zhewei

    2018-02-01

    We present a Ward identity for nonlinear sigma models using generalized nonlinear shift symmetries, without introducing current algebra or coset space. The Ward identity constrains correlation functions of the sigma model such that the Adler's zero is guaranteed for S -matrix elements, and gives rise to a subleading single soft theorem that is valid at the quantum level and to all orders in the Goldstone decay constant. For tree amplitudes, the Ward identity leads to a novel Berends-Giele recursion relation as well as an explicit form of the subleading single soft factor. Furthermore, interactions of the cubic biadjoint scalar theory associated with the single soft limit, which was previously discovered using the Cachazo-He-Yuan representation of tree amplitudes, can be seen to emerge from matrix elements of conserved currents corresponding to the generalized shift symmetry.

  13. Postoperative pneumonia-prevention program for the inpatient surgical ward.

    Science.gov (United States)

    Wren, Sherry M; Martin, Molinda; Yoon, Jung K; Bech, Fritz

    2010-04-01

    Postoperative pneumonia can lead to increased morbidity, length of hospital stay, and costs. Pneumonia-prevention programs have been successfully implemented in ICU settings, but no program exists for surgical ward patients. A pilot prevention program was designed and implemented based on literature review. The program consisted of education of physicians and ward staff and a standardized postoperative electronic order set consisting of incentive spirometer, chlorhexidine oral hygiene, ambulation, and head-of-bed elevation. Quarterly staff meetings discussed the results of and compliance with the program. The intervention commenced in April 2007. Baseline incidence of inpatient ward pneumonia was calculated from the National Surgical Quality Improvement Program database for fiscal year (FY) 2006 and FY 2007. Postintervention incidence was calculated in the same manner from FY 2007 through FY 2008. Any patient who contracted pneumonia in the ICU was excluded from analysis. There was a significant decrease in ward pneumonia incidence from 0.78% in the preintervention group compared with 0.18% in the postintervention group (p = 0.006), representing an 81% decrease in incidence from 2006 to 2008. The pneumonia-prevention program was very successful in diminishing postoperative pneumonia on the surgical ward. There was a highly statistically significant 4-fold decrease in pneumonia incidence after program implementation. The interventions were not costly but did require ongoing communication and cooperation between physician and nursing leadership to achieve compliance with the measures. This program has great potential for dissemination to hospital surgical wards and could decrease inpatient postoperative pneumonias. Published by Elsevier Inc.

  14. Developing non-technical ward-round skills.

    Science.gov (United States)

    Harvey, Rachel; Mellanby, Edward; Dearden, Effie; Medjoub, Karima; Edgar, Simon

    2015-10-01

    Conducting clinical 'rounds' is one of the most onerous and important duties that every junior doctor is expected to perform. There is evidence that newly qualified doctors are not adequately prepared by their undergraduate experiences for this task. The aim of this study was to analyse the challenges pertaining to non-technical skills that students would face during ward rounds, and to create a model that facilitates the transition from medical student to doctor. A total of 217 final-year medical students completed a simulated ward round. Free-text responses were analysed using template analysis applying an a priori template developed from the literature by the research team. This drew on the generic categories of non-technical skills suggested by Flin et al. Ninety-seven per cent of students agreed or strongly agreed that the simulated ward round improved their insight into the challenges of ward rounds and their perceived ability to work efficiently as an active member of the ward round. The responding students (206) submitted written feedback describing the learning that they planned to use: 800 learning points were recorded, and all could be categorised into one of seven non-technical skills. Conducting clinical 'rounds' is one of the most onerous and important duties that every junior doctor is expected to perform We believe that improved task efficiency and insight into the challenges of the ward round gained by medical students will lead to an enhancement in performance during clinical rounds, and will have a positive impact on patient safety. We would suggest that undergraduate medical schools consider this model in the preparation for the clinical practice element of the curriculum. © 2015 John Wiley & Sons Ltd.

  15. Ward Identities for the 2PI effective action in QED

    International Nuclear Information System (INIS)

    Reinosa, Urko; Serreau, Julien

    2007-01-01

    We study the issue of symmetries and associated Ward-like identities in the context of two-particle-irreducible (2PI) functional techniques for abelian gauge theories. In the 2PI framework, the n-point proper vertices of the theory can be obtained in various different ways which, although equivalent in the exact theory, differ in general at finite approximation order. We derive generalized (2PI) Ward identities for these various n-point functions and show that such identities are exactly satisfied at any approximation order in 2PI QED. In particular, we show that 2PI-resummed vertex functions, i.e. field-derivatives of the so-called 2PI-resummed effective action, exactly satisfy standard Ward identities. We identify another set of n-point functions in the 2PI framework which exactly satisfy the standard Ward identities at any approximation order. These are obtained as field-derivatives of the two-point function φ, which defines the extremum of the 2PI effective action. We point out that the latter is not constrained by the underlying symmetry. As a consequence, the well-known fact that the corresponding gauge-field polarization tensor is not transverse in momentum space for generic approximations does not constitute a violation of (2PI) Ward identities. More generally, our analysis demonstrates that approximation schemes based on 2PI functional techniques respect all the Ward identities associated with the underlying abelian gauge symmetry. Our results apply to arbitrary linearly realized global symmetries as well

  16. Reviving post-take surgical ward round teaching.

    Science.gov (United States)

    Force, Jade; Thomas, Ian; Buckley, Frances

    2014-04-01

    Learning in the clinical environment is an important feature of medical education. Ward-round teaching leads to relevant, applied and lasting learning of knowledge, skills and attitudes; however, on fast-paced ward rounds in specialties such as general surgery, the student experience is often suboptimal, and teaching can be overlooked. Clinical teaching fellows (CTFs) are postgraduate doctors ranging from foundation year-2 (FY2) level through to specialty trainees, who have elected to spend up to 2 years out of the programme to teach medical undergraduates. This article explores whether CTFs can successfully support the regular delivery of undergraduate medical teaching on the busy post-take surgical ward round (PTSWR). The CTFs at Raigmore Hospital, Inverness, planned and facilitated weekly, structured teaching sessions to accompany the PTSWR. This educational intervention was evaluated using pre- and post-intervention student questionnaires. The questionnaires focused on student enjoyment and depth of learning using Likert scales and free-text components. Students were also asked about barriers to learning on typical PTSWRs. The consultant surgeons leading on these rounds were issued separate questionnaires, to gauge their evaluation of CTF support. The main barrier to effective undergraduate ward round teaching was a lack of time on the part of clinical staff. Ward rounds accompanied by CTF support significantly increased student enjoyment (p student satisfaction, and was welcomed by clinical staff. CTF support could be widened to other busy ward rounds, e.g. acute medical takes, to enhance student learning and reduce the teaching burden on clinical faculty staff. © 2014 John Wiley & Sons Ltd.

  17. Holographic Ward identities for symmetry breaking in two dimensions

    Energy Technology Data Exchange (ETDEWEB)

    Argurio, Riccardo [Physique Théorique et Mathématique and International Solvay Institutes,Université Libre de Bruxelles,C.P. 231, 1050 Brussels (Belgium); Giribet, Gaston [Martin Fisher School of Physics, Brandeis University,Waltham, Massachusetts 02453 (United States); Physics Department, University of Buenos Aires FCEN-UBA and IFIBA-CONICET,Ciudad Universitaria, Pabellón I, 1428, Buenos Aires (Argentina); Marzolla, Andrea; Naegels, Daniel [Physique Théorique et Mathématique and International Solvay Institutes,Université Libre de Bruxelles,C.P. 231, 1050 Brussels (Belgium); Sierra-Garcia, J. Anibal [Department of Particle Physics and IGFAE, University of Santiago de Compostela,E-15782 Santiago de Compostela (Spain)

    2017-04-03

    We investigate symmetry breaking in two-dimensional field theories which have a holographic gravity dual. Being at large N, the Coleman theorem does not hold and Goldstone bosons are expected. We consider the minimal setup to describe a conserved current and a charged operator, and we perform holographic renormalization in order to find the correct Ward identities describing symmetry breaking. This involves some subtleties related to the different boundary conditions that a vector can have in the three-dimensional bulk. We establish which is the correct prescription that yields, after renormalization, the same Ward identities as in higher dimensions.

  18. Dynamic isolation technologies in negative pressure isolation wards

    CERN Document Server

    Xu, Zhonglin

    2017-01-01

    This book presents novel design principles and technologies for dynamic isolation based on experimental studies. These approaches have now become the local standard in Beijing and are currently being promoted for use nationwide. Further, the book provides details of measures and guidelines for the design process. Departing from the traditional understanding that isolation wards should be designed with high negative pressure, airtight doors and fresh air, it establishes the basis for designing biological clean rooms, including isolation wards, using a simple and convenient scientific approach. This book is intended for designers, engineers, researchers, hospital management staff and graduate students in heating ventilation air conditioning (HVAC), air cleaning technologies and related areas.

  19. Ward nurses' experiences of the discharge process between intensive care unit and general ward.

    Science.gov (United States)

    Kauppi, Wivica; Proos, Matilda; Olausson, Sepideh

    2018-05-01

    Intensive care unit (ICU) discharges are challenging practices that carry risks for patients. Despite the existing body of knowledge, there are still difficulties in clinical practice concerning unplanned ICU discharges, specifically where there is no step-down unit. The aim of this study was to explore general ward nurses' experiences of caring for patients being discharged from an ICU. Data were collected from focus groups and in-depth interviews with a total of 16 nurses from three different hospitals in Sweden. An inductive qualitative design was chosen. The analysis revealed three themes that reflect the challenges in nursing former ICU patients: a vulnerable patient, nurses' powerlessness and organizational structure. The nurses described the challenge of nursing a fragile patient based on several aspects. They expressed feeling unrealistic demands when caring for a fragile former ICU patient. The demands were related to their own profession and knowledge regarding how to care for this group of patients. The organizational structure had an impact on how the nurses' caring practice could be realized. This evoked ethical concerns that the nurses had to cope with as the organization's care guidelines did not always favour the patients. The structure of the organization and its leadership appear to have a significant impact on the nurses' ability to offer patients the care they need. This study sheds light on the need for extended outreach services and intermediate care in order to meet the needs of patients after the intensive care period. © 2018 British Association of Critical Care Nurses.

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

    Science.gov (United States)

    Sophia, R. Grace; Veliappan, A.

    2015-01-01

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

  1. Evaluation of Pharmacists' Participation in Post-Admission Ward ...

    African Journals Online (AJOL)

    Objective: The study evaluates pharmacist's perception of and participation in post-admission ward rounds, at the Lagos University Teaching Hospital (LUTH). Method: All the 60 pharmacists covering various units of pharmaceutical services were administered a forty-two element structured questionnaire. Fifty (83.3%) ...

  2. Modelling of coughed droplets in a hospital ward

    DEFF Research Database (Denmark)

    Sadrizadeh, Sasan; Nielsen, Peter Vilhelm

    2016-01-01

    Coughing and its importance for spreading respiratory infectious diseases has been confirmed in many previous studies. The dispersion process of respiratory droplets released by the coughing of a patient in a hospital ward was studied using computational fluid dynamics simulation. Two relatively ...

  3. Accounting for Inpatient Wards when developing Master Surgical Schedules

    NARCIS (Netherlands)

    Vanberkel, P.T.; Boucherie, Richardus J.; Hans, Elias W.; Hurink, Johann L.; van Lent, W.A.M.; van Harten, Willem H.; van Harten, Wim H.

    BACKGROUND: As the demand for health care services increases, the need to improve patient flow between departments has likewise increased. Understanding how the master surgical schedule (MSS) affects the inpatient wards and exploiting this relationship can lead to a decrease in surgery

  4. Design Proposal for Pleasurable Light Atmosphere in Hospital Wards

    DEFF Research Database (Denmark)

    Stidsen, Lone; Kirkegaard, Poul Henning; Fisker, Anna Marie

    2010-01-01

    When constructing and designing Danish hospitals for the future, patients, staff and guests are in focus. It is found important to have a starting point in healing architecture and create an environment with knowledge of users sensory and functionally needs and looks at how hospital wards can sup...

  5. Enhancing the Leadership of Ward Councillors through Emotional ...

    African Journals Online (AJOL)

    This article focuses on how emotional intelligence could be utilised to enhance the leadership skill of ward councillors in the Buffalo City Metropolitan Municipality. In this article, the concept of emotional intelligence is considered to include aspects such as self-awareness, motivation, self-management, social awareness, ...

  6. Ward Round - a boy with multiple joint swellings | Tickell | Malawi ...

    African Journals Online (AJOL)

    Ward Round - a boy with multiple joint swellings. D Tickell. Abstract. No Abstract Malawi Medical Journal Vol. 20 (3) 2008: pp. 99-100. Full Text: EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT · http://dx.doi.org/10.4314/mmj.v20i3.10968 · AJOL African Journals Online.

  7. An outbreak of Burkholderia stabilis colonization in a nasal ward.

    Science.gov (United States)

    Wang, Lijun; Wang, Mei; Zhang, Junyi; Wu, Wei; Lu, Yuan; Fan, Yanyan

    2015-04-01

    The aim of this study was to describe an outbreak of Burkholderia stabilis colonization among patients in a nasal ward. Multilocus sequence typing (MLST) was used for the molecular typing of B. stabilis isolates. Microbiological records were reviewed to delineate the colonization outbreak period. One hundred seventy-one cultures of environment and equipment samples from the nasal ward were performed to trace the source of contamination. Infection control measures were taken in order to end the outbreak. All B. stabilis isolates were identified as a new MLST type, ST821. A total of 53 patients carried this B. stabilis in the nasal ward between March and September 2013, which was defined as the outbreak period. The source of the colonization was not determined because all environment cultures were negative for Burkholderia cepacia complex. No further B. stabilis carriers have been found in the ward since the implementation of interventions. Attention must be paid to asymptomatic colonization in order to identify outbreaks early. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

  8. Ward Round - Late Presentation of Acute Compartment Syndrome in ...

    African Journals Online (AJOL)

    following the course of ibuprofen mentioned. Twelve days after admission he started to complain of increasing pain and tightness in his left thigh. Sensation and motor function. Ward Round - Late Presentation of Acute. Compartment Syndrome in the Thigh. University of Malawi, College of Medicine, Department of Surgery,.

  9. Respiratory support in oncology ward setting: a prospective descriptive study.

    Science.gov (United States)

    Mishra, Seema; Bhatnagar, Sushma; Gupta, Deepak; Goyal, Gaurav Nirvani; Agrawal, Ravi; Jain, Roopesh; Chauhan, Himanshu

    2009-01-01

    Mechanical ventilation in cancer patients is a critical issue The present prospective descriptive study was designed (1) to assess the patient population needing respirator support in ward setting at a premier state-run oncology institute in India, (2) to observe and analyze the course of their disease while on respirator, and (3) to coordinate better quality of life measures in cancer patients at the institute based on the present study's outcomes. Beginning from March 2005 to March 2006, all cancer patients who were connected to respirator in the wards were enrolled in the current study. Our anesthesiology department at the cancer institute also has primary responsibility for airway management and mechanical ventilation in high dependency units of oncology wards. Preventilation variables in cancer patients were assessed to judge the futility of mechanical ventilation in ward setting. Subsequently, patients were observed for disease course while on respirator. Final outcome with its etio-pathogenesis was correlated with predicted futility of mechanical ventilation. Over a period of 1 year, 132 (46 men and 86 women) cancer patients with median age 40 years (range 1-75 years) were connected to respirator in oncology wards. Based on the preventilation variables and indications for respirator support, right prediction of medical futility and hospital discharge was made in 77% of patients. Underestimation and overestimation of survival to hospital discharge was made in 10% cases and 13% cases, respectively. Based on preventilation variables, prediction of outcome in cancer patients needing respirator support can be made in 77% cases. This high probability of prediction can be used to educate patients, and their families and primary physicians, for well-informed and documented advance directives, formulated and regularly revised DNAR policies, and judicious use of respirator support for better quality-of-life outcomes.

  10. Frequency of nursing tasks in medical and surgical wards.

    Science.gov (United States)

    Farquharson, Barbara; Bell, Cheryl; Johnston, Derek; Jones, Martyn; Schofield, Pat; Allan, Julia; Ricketts, Ian; Morrison, Kenny; Johnston, Marie

    2013-09-01

    To explore the frequency of different nursing tasks in medical and surgical wards. The time nurses spend on direct patient care is important for both patients and nurses. However, little is known about the time nurses spend on various nursing tasks. A real-time, repeated measures design conducted amongst 67 (n = 39 medical, n = 28 surgical) UK hospital nurses. Between September 2011 and August 2012 participants completed an electronic diary version of a classification of nursing tasks (WOMBAT) during shifts. A total of 961 real-time measures of nursing task were obtained. Direct patient care [median = 37.5%, interquartile range = 27.8], indirect care (median = 11.1%, interquartile range = 19.4) and medication (median = 11.1%, interquartile range = 18.8) were most commonly reported. Participants were interrupted in 62% of entries (interquartile range = 35), reported adequate time in 78% (interquartile range = 31) and adequate resources in 89% (interquartile range = 36). Ward-related tasks were significantly more frequent on medical wards than surgical wards but otherwise there were no significant differences. Nurses spend the highest proportion of time in direct patient care and majority of this on core nursing activities. Interruptions to tasks are common. Nurses tend to report adequate time/resources. The frequency of nursing tasks is similar in medical and surgical wards. Nurse managers should review the level of interruptions to nurses' work and ensure appropriate levels of supervision. © 2013 John Wiley & Sons Ltd.

  11. Ward based community road safety performance benchmarking, monitoring and intervention programmes in the City of Johannesburg

    CSIR Research Space (South Africa)

    Ribbens, H

    2008-07-01

    Full Text Available benchmarking, monitoring and intervention programme. Community road safety needs in the respective wards are articulated through the ward councillor. The rationale is that the community exactly knows where these problem areas are, because they suffer as a...

  12. Comorbid depression in dementia on psychogeriatric nursing home wards: which symptoms are prominent?

    NARCIS (Netherlands)

    Verkaik, R.; Francke, A.L.; Meijel, B. van; Ribbe, M.W.; Bensing, J.M.

    2009-01-01

    OBJECTIVE: To provide insight into the prevalence and clinically relevant symptoms of comorbid depression among dementia patients in psychogeriatric nursing home wards, to enhance depression recognition. DESIGN: Cross-sectional analyses of multicenter diagnostic data. SETTING: Psychogeriatric wards

  13. Is Ward Experience in Resuscitation Effort Related to the Prognosis of Unexpected Cardiac Arrest?

    Directory of Open Access Journals (Sweden)

    Sen-Kuang Hou

    2007-09-01

    Conclusion: Hospital wards with more than 5 cardiac arrests per year have a better patient survival rate than those with fewer arrests. This is despite all ward staff receiving the same level of training.

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

    Science.gov (United States)

    Hasley, Peggy B.; Arnold, Robert M.

    2009-01-01

    No previous studies have described how faculty give summative evaluations to learners on the medical wards. The aim of this study was to describe summative evaluations on the medical wards. Participants were students, house staff and faculty at the University of Pittsburgh. Ward rotation evaluative sessions were tape recorded. Feedback was…

  15. Pain in the nursing home: assessment and treatment on different types of care wards

    NARCIS (Netherlands)

    Achterberg, W.P.; Pot, A.M.; Scherder, E.J.A.; Ribbe, M.W.

    2007-01-01

    ). Patients on psychogeriatric wards who had pain received less pain medication, adjusted for frequency and intensity of pain (OR 0.37 [95% CI = 0.23–0.59]), compared to patients on somatic wards. We conclude that admission to a psychogeriatric care ward, independent of cognition, is associated with

  16. The relationship between substance use and exit security on psychiatric wards

    NARCIS (Netherlands)

    Simpson, A.; Bowers, L.; Allan, T.; Haglund, K.; Muir-Cochrane, E.; Nijman, H.L.I.; Merwe, M. van der

    2011-01-01

    Aim.  In this paper we report on the rates of drug/alcohol use on acute psychiatric wards in relation to levels and intensity of exit security measures. Background.  Many inpatient wards have become permanently locked, with staff concerned about the risk of patients leaving the ward and harming

  17. 78 FR 14543 - Ward Transformer Superfund Site; Raleigh, Wake County, NC; Notice of Settlement

    Science.gov (United States)

    2013-03-06

    ... ENVIRONMENTAL PROTECTION AGENCY [FRL 9788-2; CERCLA-04-2013-3754] Ward Transformer Superfund Site... Ward Transformer Superfund Site located in Raleigh, Wake County, North Carolina. Under the terms of the.... Submit your comments by Site name Ward Transformer Superfund Site by one of the following methods: [[Page...

  18. 75 FR 81269 - Ward Transformer Superfund Site Raleigh, Wake County, NC; Notice of Settlements

    Science.gov (United States)

    2010-12-27

    ... ENVIRONMENTAL PROTECTION AGENCY [Docket EPA-RO4-SFUND-2010-1053, FRL-9243-2] Ward Transformer... entered into a five settlements for reimbursement of past response costs concerning the Ward Transformer... Docket ID No. EPA-RO4- SFUND-2010-1053 or Site name Ward Transformer Superfund Site by one of the...

  19. Nurses caring for ENT patients in a district general hospital without a dedicated ENT ward score significantly less in a test of knowledge than nurses caring for ENT patients in a dedicated ENT ward in a comparable district general hospital.

    Science.gov (United States)

    Foxton, C R; Black, D; Muhlschlegel, J; Jardine, A

    2014-12-01

    To assess whether there is a difference in ENT knowledge amongst nurses caring for patients on a dedicated ENT ward and nurses caring for ENT patients in a similar hospital without a dedicated ENT ward. A test of theoretical knowledge of ENT nursing care was devised and administered to nurses working on a dedicated ENT ward and then to nurses working on generic non-subspecialist wards regularly caring for ENT patients in a hospital without a dedicated ENT ward. The test scores were then compared. A single specialist ENT/Maxillo-Facial/Opthalmology ward in hospital A and 3 generic surgical wards in hospital B. Both hospitals are comparable district general hospitals in the south west of England. Nursing staff working in hospital A and hospital B on the relevant wards were approached during the working day. 11 nurses on ward 1, 10 nurses on ward 2, 11 nurses on ward 3 and 10 nurses on ward 4 (the dedicated ENT ward). Each individual test score was used to generate an average score per ward and these scores compared to see if there was a significant difference. The average score out of 10 on ward 1 was 6.8 (+/-1.6). The average score on ward two was 4.8 (+/-1.6). The average score on ward three was 5.5 (+/-2.1). The average score on ward 4, which is the dedicated ENT ward, was 9.7 (+/-0.5). The differences in average test score between the dedicated ENT ward and all of the other wards are statistically significant. Nurses working on a dedicated ENT ward have an average higher score in a test of knowledge than nurses working on generic surgical wards. This difference is statistically significant and persists despite banding or training. © 2014 John Wiley & Sons Ltd.

  20. Geriatric consultation services-are wards more effective than teams?

    Science.gov (United States)

    Cameron, Ian D; Kurrle, Susan

    2013-02-22

    Geriatric consultation teams are one of the models for bringing comprehensive geriatric assessment to vulnerable and frail older people in the acute care hospital setting. While ward-based comprehensive geriatric assessment has been established as effective with reference to improving functional status and other outcomes, the team-based variant remains unproven for outcomes other than mortality in the medium term, as shown in a recent study published in BMC Medicine by Deschodt and colleagues. Further research might establish the effectiveness of the team-based model but, for current clinical practice, the emphasis should be on streaming older people with complex problems needing multidisciplinary assessment and treatment to ward-based models of comprehensive geriatric assessment.

  1. Drug dispensing errors in a ward stock system

    DEFF Research Database (Denmark)

    Andersen, Stig Ejdrup

    2010-01-01

    . Multivariable analysis showed that surgical and psychiatric settings were more susceptible to involvement in dispensing errors and that polypharmacy was a risk factor. In this ward stock system, dispensing errors are relatively common, they depend on speciality and are associated with polypharmacy......The aim of this study was to determine the frequency of drug dispensing errors in a traditional ward stock system operated by nurses and to investigate the effect of potential contributing factors. This was a descriptive study conducted in a teaching hospital from January 2005 to June 2007. In five....... These results indicate that strategies to reduce dispensing errors should address polypharmacy and focus on high-risk units. This should, however, be substantiated by a future trial....

  2. Occupational genetic risks for nurses at radiotherapy oncology wards

    Energy Technology Data Exchange (ETDEWEB)

    Srb, V; Kubzova, E

    1985-05-31

    A lymphocyte chromosome analysis of short-term cultured whole peripheral blood of 14 nurses in the radiotherapy/oncology ward of the radiological clinic (working in health risk conditions for an average of 14 years) classified them into a high risk genetic group. They were found to have 4.7% cells with chromosomal aberrations as compared with 1.5% such cells in the control group. The said difference had a high statistical significance (p<0.001). Only aberrations of the structural type were evaluated.The mitotic activity of peripheral blood lymphocytes in the study group was also adversely affected (MI=1.8) compared with the control group (MI=2.9). Cytogenetic peripheral lymphocyte analysis used as a collective biological exposure test is being considered for incorporation in the system of preventive medical chec-kups of nurses working in radiotherapy/oncology wards.

  3. Occupational genetic risks for nurses at radiotherapy oncology wards

    International Nuclear Information System (INIS)

    Srb, V.; Kubzova, E.

    1985-01-01

    A lymphocyte chromosome analysis of short-term cultured whole peripheral blood of 14 nurses in the radiotherapy/oncology ward of the radiological clinic (working in health risk conditions for an average of 14 years) classified them into a high risk genetic group. They were found to have 4.7% cells with chromosomal aberrations as compared with 1.5% such cells in the control group. The said difference had a high statistical significance (p<0.001). Only aberrations of the structural type were evaluated.The mitotic activity of peripheral blood lymphocytes in the study group was also adversely affected (MI=1.8) compared with the control group (MI=2.9). Cytogenetic peripheral lymphocyte analysis used as a collective biological exposure test is being considered for incorporation in the system of preventive medical chec-kups of nurses working in radiotherapy/oncology wards. (author)

  4. The acute pulmonary oedema in the intensive-care ward

    International Nuclear Information System (INIS)

    Marciniak, R.; Aronski, A.

    1989-01-01

    760 patients suffering from acute pulmonary oedema were treated between 1980 and 1986 at the Institute of Anaesthesiology of the Medical Academy in Wroclaw. The radiological image of the pulmonary oedema was subdivided into three forms (hilar, hilar and perihilar, and hilar with massive plane-shaped infiltrates). In the treatment of acute pulmonary oedema in the intensive-care ward a thorough diagnostic programme is mandatory after the immediately necessary measures have been taken. (orig.) [de

  5. Shielding estimation for nuclear medicine therapy ward: our experience

    International Nuclear Information System (INIS)

    Skopljak-Beganovic, A.; Kucukalic-Selimovic, E.; Beganovic, A.; Drljevic, A.

    2008-01-01

    Full text: The aim of this study was to calculate and estimate the shielding thickness for a new Nuclear Medicine Therapy Ward. Parameters available for shielding calculation were: ground plan of the ward, radionuclides planned for use, maximum administered activity of I-131, maximum delivered activity of I-131 to the ward per week, average time spent in the hospital after the treatment. The most hazardous and most commonly used radioisotope is I-131. The target dose that needs to be met for occupationally exposed workers is 0.3 mSv per year. There are several factors that could be changed in order to achieve this value: distance from the source, shielding thickness, angle of incidence, occupational and usage factors. The maximum dose rate at 1 meter from the thyroid gland of the patient was considered to be 100 mSv/h. The distances and incidence angles could not be changed since these vales were predetermined in the ground plan. Different usage and occupational factors were used for different rooms in the ward. We used occupational factor 1 for the bed and 1/6 for the bathroom, and usage factor 1 for nurses' room and patient room and 1/6 for the corridors, etc. The easiest way of calculating dose attenuation in material was by introducing the HVL and TVL for broad beams. TVL and HVL were taken from the graph.The results show that shielding thickness should be in the range of 3 mmPb for room doors to 30 mmPb for the wall adjacent to the nurse's office. Most of the walls are 20 mmPb thick. These values were calculated using conservative assumptions and are more then enough to protect staff, patients and public from external radiation. If the construction cannot support the weight of lead some rearrangements regarding patient positions could be made. (author)

  6. Ward identity for non-equilibrium Fermi systems

    Czech Academy of Sciences Publication Activity Database

    Velický, B.; Kalvová, Anděla; Špička, Václav

    2008-01-01

    Roč. 77, č. 4 (2008), 041201/1-041201/4 ISSN 1098-0121 R&D Projects: GA ČR GC202/07/J051 Institutional research plan: CEZ:AV0Z10100520; CEZ:AV0Z10100521 Keywords : non-equilibrium * Green’s functions * quantum transport equations * Ward identity Subject RIV: BE - Theoretical Physics Impact factor: 3.322, year: 2008

  7. The background scale Ward identity in quantum gravity

    Energy Technology Data Exchange (ETDEWEB)

    Percacci, Roberto [International School for Advanced Studies, Trieste (Italy); INFN, Sezione di Trieste, Trieste (Italy); Vacca, Gian Paolo [INFN, Sezione di Bologna, Bologna (Italy)

    2017-01-15

    We show that with suitable choices of parametrization, gauge fixing and cutoff, the anomalous variation of the effective action under global rescalings of the background metric is identical to the derivative with respect to the cutoff, i.e. to the beta functional, as defined by the exact RG equation. The Ward identity and the RG equation can be combined, resulting in a modified flow equation that is manifestly invariant under global background rescalings. (orig.)

  8. Robot Assisted Surgical Ward Rounds: Virtually Always There

    Directory of Open Access Journals (Sweden)

    Stefanie M. Croghan

    2018-05-01

    Full Text Available Background:  While an explosion in technological sophistication has revolutionized surgery within the operating theatre, delivery of surgical ward-based care has seen little innovation.  Use of telepresence allowing off-site clinicians communicate with patients has been largely restricted to outpatient settings or use of complex, expensive, static devices.  We designed a prospective study to ascertain feasibility and face validity of a remotely controlled mobile audiovisual drone (LUCY to access inpatients.  This device is, uniquely, lightweight, freely mobile and emulates ‘human’ interaction by swiveling and adjusting height to patients’ eye-level.     Methods: Robot-assisted ward rounds(RASWR were conducted over 3 months. A remotely located consultant surgeon communicated with patients/bedside teams via encrypted audiovisual telepresence robot (DoubleRoboticstm, California USA.  Likert-scale satisfaction questionnaires, incorporating free-text sections for mixed-methods data collection, were disseminated to patient and staff volunteers following RASWRs.  The same cohort completed a linked questionnaire following conventional (gold-standard rounds, acting as control group. Data were paired, and non-parametric analysis performed.     Results: RASWRs are feasible (>90% completed without technical difficulty. The RASWR(n=52 observations demonstrated face validity with strong correlations (r>0.7; Spearman, p-value <0.05 between robotic and conventional ward rounds among patients and staff on core themes, including dignity/confidentiality/communication/satisfaction with management plan. Patients (96.08%, n=25 agreed RASWR were a satisfactory alternative when consultant physical presence was not possible. There was acceptance of nursing/NCHD cohort (100% (n=11 willing to regularly partake in RASWR.    Conclusion: RASWRs receive high levels of patient and staff acceptance, and offer a valid alternative to conventional ward rounds

  9. Robot Assisted Surgical Ward Rounds: Virtually Always There.

    Science.gov (United States)

    Croghan, Stefanie M; Carroll, Paul; Reade, Sarah; Gillis, Amy E; Ridgway, Paul F

    2018-05-02

     While an explosion in technological sophistication has revolutionized surgery within the operating theatre, delivery of surgical ward-based care has seen little innovation.  Use of telepresence allowing off-site clinicians communicate with patients has been largely restricted to outpatient settings or use of complex, expensive, static devices.  We designed a prospective study to ascertain feasibility and face validity of a remotely controlled mobile audiovisual drone (LUCY) to access inpatients.  This device is, uniquely, lightweight, freely mobile and emulates 'human' interaction by swiveling and adjusting height to patients' eye-level.   METHODS: Robot-assisted ward rounds(RASWR) were conducted over 3 months. A remotely located consultant surgeon communicated with patients/bedside teams via encrypted audiovisual telepresence robot (DoubleRoboticstm, California USA).  Likert-scale satisfaction questionnaires, incorporating free-text sections for mixed-methods data collection, were disseminated to patient and staff volunteers following RASWRs.  The same cohort completed a linked questionnaire following conventional (gold-standard) rounds, acting as control group. Data were paired, and non-parametric analysis performed.  RESULTS: RASWRs are feasible (>90% completed without technical difficulty). The RASWR(n=52 observations) demonstrated face validity with strong correlations (r>0.7; Spearman, p-value <0.05) between robotic and conventional ward rounds among patients and staff on core themes, including dignity/confidentiality/communication/satisfaction with management plan. Patients (96.08%, n=25) agreed RASWR were a satisfactory alternative when consultant physical presence was not possible. There was acceptance of nursing/NCHD cohort (100% (n=11) willing to regularly partake in RASWR).  CONCLUSION: RASWRs receive high levels of patient and staff acceptance, and offer a valid alternative to conventional ward rounds when a consultant cannot be

  10. Exploring ward nurses' perceptions of continuing education in clinical settings.

    Science.gov (United States)

    Govranos, Melissa; Newton, Jennifer M

    2014-04-01

    Health care systems demand that nurses are flexible skilful workers who maintain currency and competency in order to deliver safe effective patient centered care. Nurses must continually build best practice into their care and acquire lifelong learning. Often this learning is acquired within the work environment and is facilitated by the clinical nurse educator. Understanding clinical nurses' values and needs of continuing education is necessary to ensure appropriate education service delivery and thus enhance patient care. To explore clinical ward-based nurses' values and perceptions towards continuing education and what factors impact on continuing education in the ward. A case study approach was utilized. A major teaching hospital in Melbourne, Australia. A range of clinical nursing staff (n=23). Four focus groups and six semi-structured individual interviews were undertaken. Focus group interviews explored participants' values and perceptions on continuing education through a values clarification tool. Thematic analysis of interviews was undertaken to identify themes and cluster data. Three central themes: 'culture and attitudes', 'what is learning?' and 'being there-being seen', emerged reflecting staffs' values and perceptions of education and learning in the workplace. Multiple factors influence ward nurses' ability and motivation to incorporate lifelong learning into their practice. Despite variance in nurses' values and perceptions of CE in clinical environments, CE was perceived as important. Nurses yearned for changes to facilitate lifelong learning and cultivate a learning culture. Clinical nurse educators need to be cognizant of adult learners' characteristics such as values, beliefs, needs and potential barriers, to effectively facilitate support in a challenging and complex learning environment. Organizational support is essential so ward managers in conjunction with educational departments can promote and sustain continuing education, lifelong

  11. Medical academia clinical experiences of Ward Round Teaching curriculum.

    Science.gov (United States)

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

    2014-01-01

    Medical students spend most of their time in hospital wards and it is necessary to study clinical educational opportunities. This study was aimed to explore faculty members' experience on Ward Round Teaching content. This qualitative study was conducted by purposive sampling with the maximum variation of major clinical departments faculty members in Isfahan University of Medical Sciences (n = 9). Data gathering was based on deep and semi-structured interviews. Data gathering continued till data saturation. Data was analyzed through the Collaizzi method and validated. Strategies to ensure trustworthiness of data (credibility, dependability, conformability, transferability) were employed (Guba and Lincoln). Basic codes extracted from the analyzed data were categorized into two main themes and related subthemes, including (1) tangible teachings (analytic intelligence, technical intelligence, legal duties) and (2) implied teachings (professionalism, professional discipline, professional difficulties). Ward round teaching is a valuable opportunity for learners to learn not only patient care aspects but also ethical values. By appropriate planning, opportunities can be used to teach capabilities that are expected of general practitioners.

  12. Medical academia clinical experiences of Ward Round Teaching curriculum

    Directory of Open Access Journals (Sweden)

    Fariba Haghani

    2014-01-01

    Full Text Available Background: Medical students spend most of their time in hospital wards and it is necessary to study clinical educational opportunities. This study was aimed to explore faculty members′ experience on Ward Round Teaching content. Methods and Materials: This qualitative study was conducted by purposive sampling with the maximum variation of major clinical departments faculty members in Isfahan University of Medical Sciences (n = 9. Data gathering was based on deep and semi-structured interviews. Data gathering continued till data saturation.Data was analyzed through the Collaizzi method and validated. Strategies to ensure trustworthiness of data (credibility, dependability, conformability, transferability were employed (Guba and Lincoln. Results: Basic codes extracted from the analyzed data were categorized into two main themes and related subthemes, including (1 tangible teachings (analytic intelligence, technical intelligence, legal duties and (2 implied teachings (professionalism, professional discipline, professional difficulties. Conclusion: Ward round teaching is a valuable opportunity for learners to learn not only patient care aspects but also ethical values. By appropriate planning, opportunities can be used to teach capabilities that are expected of general practitioners.

  13. Delivery of pharmaceutical services at ward level in a teaching hospital.

    Science.gov (United States)

    Schellack, N; Martins, V; Botha, N; Meyer, J C

    2009-03-01

    Poor management of pharmaceuticals could lead to wastage of financial resources and poor services in the public sector. The main aim of the study was to investigate the quality of pharmaceutical services at ward level in a teaching hospital. The design of the study was descriptive. Three data collection instruments were designed and pilot-tested prior to the actual data collection. Two structured questionnaires were used to interview the sister-in-charge of each ward and the stock and drug controller at the pharmacy. A checklist for the management of pharmaceuticals was completed for each ward. Descriptive statistics were used to describe and summarise the data. Sisters-in-charge of 30 wards and the stock and drug controller at the pharmacy participated in the study. The relationship with the pharmacy was perceived to be average by 54% (n = 30) of the sisters-in-charge of the wards. Communication with the pharmacy was mainly by telephone and 57% of the sisters-in-charge mentioned that they experienced difficulties in conveying messages to the pharmacy. Ten of the wards received regular ward visits by a pharmacist. Expiry dates were checked by all wards but at different intervals. The majority of the wards (90%) used patient cards, which refer to prescription charts, for stock control and ordering from the pharmacy. Fridge temperatures were checked and charted on a daily basis by 30% of the wards. Written standard operating procedures (SOPs) were used by the pharmacy for issuing ward stock. Although 83% of the wards indicated that they used SOPs, evidence of written SOPs was not available. The results indicated that the management of pharmaceutical services at ward level could be improved. Implementation of appropriate communication systems will enhance cooperation between the pharmacy and the wards. A uniform ward stock control system, either by computer or stock cards, should be introduced. Regular ward visits by a pharmacist to oversee ward stock management are

  14. Reported implementation lessons from a national quality improvement initiative; Productive Ward: Releasing Time to Care™. A qualitative, ward-based team perspective.

    Science.gov (United States)

    White, Mark; Butterworth, Tony; Wells, John S G

    2017-10-01

    To explore the experiences of participants involved in the implementation of the Productive Ward: Releasing Time to Care™ initiative in Ireland, identifying key implementation lessons. A large-scale quality improvement programme Productive Ward: Releasing Time to Care™ was introduced nationwide into Ireland in 2011. We captured accounts from ward-based teams in an implementation phase during 2013-14 to explore their experiences. Semi-structured, in-depth interviews with a purposive sample of 24 members of ward-based teams from nine sites involved in the second national phase of the initiative were conducted. Interviews were analysed and coded under themes, using a seven-stage iterative process. The predominant theme identified was associated with the implementation and management of the initiative and included: project management; training; preparation; information and communication; and participant's negative experiences. The most prominent challenge reported related to other competing clinical priorities. Despite the structured approach of Productive Ward: Releasing Time to Care™, it appears that overstretched and busy clinical environments struggle to provide the right climate and context for ward-based teams to engage and interact actively with quality improvement tools, methods and activities. Findings highlight five key aspects of implementation and management that will help facilitate successful adoption of large-scale, ward-based quality improvement programmes such as Productive Ward: Releasing Time to Care™. Utilising pre-existing implementation or quality frameworks to assess each ward/unit for 'readiness' prior to commencing a quality improvement intervention such as Productive Ward: Releasing Time to Care™ should be considered. © 2017 John Wiley & Sons Ltd.

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

    Science.gov (United States)

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

    2013-05-01

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

  16. Words in Maternity Wards: An Aproximation to Perinatal Psychology

    Directory of Open Access Journals (Sweden)

    Alicia Oiberman

    2016-02-01

    Full Text Available The acknowledgment that just born babies interact with human and physical contexts originated changes in behaviors of health teems working in maternity wards settings. Concepts such as initial interactions, attachment, dyads, maternal vulnerability, behavioral competences of the just born babies and their applications to perinatal psychology, marked a transformation in different professionals involved in birth’s approaches. From one side, it can be said that medicalization of the birth act in Western societies had allowed to minimize risk factors. But this progress had been carried out without taking into account emotional expressions. The introduction of psychological interventions in neonatal periods is a new field of knowledge. History shows that in different periods and cultures there were amulets, potions and other elements associated with magic that were used to swear baby or mother’s death risk during childbirth. All these practices were taken the place of words, in a hard emotional moment: parturition. It was necessary to walk a long and difficult road for Perinatal Psycholy to recuperate the ancient place of old good women and incorporate words in maternity wards, knowing that the main scenery is first occupied by the mother’s body and then by the baby. Our daily job in a maternity ward, working together with pediatricians and neonatologists, allowed us to verify that words come out when psychologists themselves “include their body” as well as do mothers, babies and the medical teem. Words contribute to facilitate emotional expressions related to motherhood and place the baby in the family history, making able his or her “psychological birth”. 

  17. A need for play specialists in Japanese children's wards.

    Science.gov (United States)

    Tanaka, Kyoko; Yoshikawa, Naomi; Kudo, Noriko; Negishi, Yoshie; Shimizu, Toshiaki; Hayata, Noriko

    2010-07-01

    The importance of distraction techniques and play therapy for sick children has long been recognised by nurses in the UK and other western countries. Although these techniques are not so well established in Japan there is growing interest in them. The authors conducted a survey and found that children's nurses in Japan appreciated the value of distraction techniques and play therapy. They argue that attitudes to using them on children's wards in Japan are changing, but there is still a lack of training and few play specialists.

  18. Lifshitz anomalies, Ward identities and split dimensional regularization

    Energy Technology Data Exchange (ETDEWEB)

    Arav, Igal; Oz, Yaron; Raviv-Moshe, Avia [Raymond and Beverly Sackler School of Physics and Astronomy, Tel-Aviv University,55 Haim Levanon street, Tel-Aviv, 69978 (Israel)

    2017-03-16

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

  19. Hybrid Patient Record – Supporting Hybrid Interaction in Clinical Wards

    DEFF Research Database (Denmark)

    Houben, Steven; Schmidt, Mathias; Frost, Mads

    2015-01-01

    Despite the widespread dissemination of the electronic health record, the paper medical record remains an important central artefact in modern clinical work. A number of new technological solutions have been proposed to mitigate some of the configuration, mobility and awareness problems that emerge...... when using this dual record setup. In this paper, we present one such technology, the HyPR device, in which a paper record is augmented with an electronic sensing platform that is designed to reduce the configuration overhead, provide awareness cues and support mobility across the patient ward. Our...

  20. Dealing with conflict - The role of the ward sister

    Directory of Open Access Journals (Sweden)

    L.M. Cremer

    1980-09-01

    Full Text Available In the course of her duties, the ward sister has to contend with many forms of conflict, discord and dissension. These involve conflict of the intrapersonal, interpersonal and intergroup varieties. Conflict is in the main, disruptive and dysfunctional. Skilful management, however, embodying cooperative effort in its reduction can produce constructive and positive results. Conflict management strategies are therefore either restrictive or constructive. Persons in serious conflict suffer varied degrees of personality disequilibrium, which necessitates emotional first aid or crisis intervention. Such primary preventive care is applicable to patients, their relatives, and members of the nursing staff in such need.

  1. The educational value of ward rounds for junior trainees

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    Faidon-Marios Laskaratos

    2015-04-01

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

  2. Lifshitz anomalies, Ward identities and split dimensional regularization

    International Nuclear Information System (INIS)

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

    2017-01-01

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

  3. Pediatric resident perceptions of shift work in ward rotations.

    Science.gov (United States)

    Nomura, Osamu; Mishina, Hiroki; Jasti, Harish; Sakai, Hirokazu; Ishiguro, Akira

    2017-10-01

    Although the long working hours of physicians are considered to be a social issue, no effective policies such as duty hour regulations have so far been proposed in Japan. We implemented an overnight call shift (OCS) system for ward rotations to improve the working environment for residents in a pediatric residency program. We later conducted a cross-sectional questionnaire asking the residents to compare this system with the traditional overnight call system. Forty-one pediatric residents participated in this survey. The residents felt that the quality of patient care improved (80.4% agreed). Most felt that there was less emphasis on education (26.8%) and more emphasis on service (31.7%). Overall, the residents reported that the OCS was beneficial (90.2%). In conclusion, the pediatric residents considered the OCS system during ward rotations as beneficial. Alternative solutions are vital to balance improvements in resident work conditions with the requirement for a high quality of education. © 2017 Japan Pediatric Society.

  4. ROMANO-WARD SYNDROME ASSOCIATED WITH TU ELECTRICAL ALTERNANS

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    DJAWAN

    1981-05-01

    Full Text Available A case o f the electrical alternans of t he TU wave and peri odic nega t ive U wave associated with c l ini cal symptoms , e lectrocardi ographic a nd postmortem findi ng s o f Romano- Ward Syndrome has been pres ented. No e lec ~ r o l y te d ist urbance was found t o be r esponsible for t his exceptional l y rare situation . Changes i n A-V conduct i on and left bu n• d Ie branch block could be a t tributed to the d i f f use c or onary s clero sis and s ubs equent i schemia in the myocardial c onduction t.issues . The e lectrical alternans of t he U wave or TU complex of the e lectrocardiogram i s an exceeding ly r are s i t uation without any clearly known mechanism for i ts appea rance . A case of thi s phenome no~ i n as soc iation with RomanoWard Syndrome has been presented whe rein an abnorma l ity i n A-V conduction and left bund le branch block cou ld be encountered .

  5. Mental Health of General Practitioners in Emergency Wards

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    Sepehrmanesh Z.1 PhD,

    2015-01-01

    Full Text Available Aims General practitioners have an essential role in patient care and are exposed to high levels of job stress. General practitioners’ mental health has effects on their functional abilities and medical managements.This study was carried out to evaluate the mental health of general practitioners in emergency wards in KashanUniversity of Medical Sciences, Iran. Materials & Methods In this cross-sectional study, all of General practitioners in emergency wards (n=87 were studied. The survey instruments includedtwo questionnaires: 1-demographic variables and 2- General Health Questionnaire (GHQ-28. Data were analyzed using SPSS 16 software and Chi square, Fisher exactand Mann-Whitney statistical tests. Findings The mean age of general practitioners was 36.11±5.67 years; 89.7% of them were married; 60.3% were male. 41% of the total general practitioners had mental health problems. The mean score of GHQ was 22.56±9.24. There were significant relationships between mental health and each age, employment situation, and number of children (p0.05. Conclusion The majority of employed general practitioners in emergency rooms do not have proper mental health statuses.

  6. The Full Ward-Takahashi Identity for Colored Tensor Models

    Science.gov (United States)

    Pérez-Sánchez, Carlos I.

    2018-03-01

    Colored tensor models (CTM) is a random geometrical approach to quantum gravity. We scrutinize the structure of the connected correlation functions of general CTM-interactions and organize them by boundaries of Feynman graphs. For rank- D interactions including, but not restricted to, all melonic φ^4 -vertices—to wit, solely those quartic vertices that can lead to dominant spherical contributions in the large- N expansion—the aforementioned boundary graphs are shown to be precisely all (possibly disconnected) vertex-bipartite regularly edge- D-colored graphs. The concept of CTM-compatible boundary-graph automorphism is introduced and an auxiliary graph calculus is developed. With the aid of these constructs, certain U (∞)-invariance of the path integral measure is fully exploited in order to derive a strong Ward-Takahashi Identity for CTMs with a symmetry-breaking kinetic term. For the rank-3 φ^4 -theory, we get the exact integral-like equation for the 2-point function. Similarly, exact equations for higher multipoint functions can be readily obtained departing from this full Ward-Takahashi identity. Our results hold for some Group Field Theories as well. Altogether, our non-perturbative approach trades some graph theoretical methods for analytical ones. We believe that these tools can be extended to tensorial SYK-models.

  7. Midwifery students learning experiences in labor wards: a grounded theory.

    Science.gov (United States)

    Brunstad, Anne; Hjälmhult, Esther

    2014-12-01

    The labor ward is an important and challenging learning area for midwifery students. It is there the students learn in authentic complex situations, in intimate situations, with potential risk for the life and health of mothers and their babies. The aim of this study was to explore the main concern expressed by midwifery students in labor wards and how they handled this concern. A longitudinal study based on grounded theory methodology was used. The participants were 10 postgraduate midwifery students, from a University College in Norway. Data were gathered and analyzed throughout the 2-year postgraduate program, in the students first, third and fourth semesters. Every student was interviewed three times in a total of 15 single and three focus-group sessions. The grounded theory of "building relationships" explains how students dealt with their main concern: "how to gain access to learning experiences". This theory consisted of three strategies; a) controlling vulnerability, b) cultivating trust and c) obtaining acceptance. Clarifying discussions involving midwives and students may facilitate the process of building relationships and contribute to confident learning. Students appreciate it when the midwives initiate discussions about acute situations and state that a novice may perceive labor and childbirth as more frightening than an experienced midwife would. Copyright © 2014 Elsevier Ltd. All rights reserved.

  8. The impact on the workload of the Ward Manager with the introduction of administrative assistants.

    Science.gov (United States)

    Locke, Rachel; Leach, Camilla; Kitsell, Fleur; Griffith, Jacki

    2011-03-01

    To evaluate the impact on the workload of the Ward Manager (WM) with the introduction of administrative assistants into eight trusts in the South of England in a year-long pilot. Ward Managers are nurse leaders who are responsible for ward management and delivering expert clinical care to patients. They have traditionally been expected to achieve this role without administrative assistance. Meeting the workload demands of multiple roles and overload has meant the leadership and clinical role has suffered, presenting issues of low morale among existing WMs and issues of recruiting the next generation of WMs. Sixty qualitative interviews were carried out with 16 WMs, 12 Ward Manager Assistants (WMAs), and six senior nurse executives about the impact of the introduction of the WMA post. Quantitative data to measure change in WM workload and ward activity was supplied by 24 wards. Ward Managers reported spending reduced time on administrative tasks and having increased time available to spend on the ward with patients and leading staff. With the introduction of WMAs, there was also improvement in key performance measures (the maintenance of quality under service pressures) and increased staff motivation. There was overwhelming support for the introduction of administrative assistants from participating WMs. The WMAs enabled WMs to spend more time with patients and, more widely, to provide greater support to ward teams. The success of the pilot is reflected in wards working hard to be able to extend contracts of WMAs. The extent of the success is reflected in wards that were not participants in the pilot, observing the benefits of the post, having worked to secure funding to recruit their own WMAs. The widespread introduction of administrative assistance could increase ward productivity and provide support for clinical leaders. Continuing professional development for WMs needs to incorporate training about management responsibilities and how to best use administrative

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

    International Nuclear Information System (INIS)

    Lurkittikul, N; Kittithreerapronchai, O

    2014-01-01

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

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

    Science.gov (United States)

    Lurkittikul, N.; Kittithreerapronchai, O.

    2014-06-01

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

  11. Implementation of Releasing Time to Care - the productive ward.

    Science.gov (United States)

    Wilson, Gwyneth

    2009-07-01

    This paper describes the implementation of the NHS Institute for Innovation and Improvement Productive Ward - releasing time to care programme. It will discuss the benefits and key successes and provides advice for those wishing to implement the programme. In Lord Darzi's Next Stage Review, he advocates an ambitious vision of patient centred - clinician led, locally driven NHS. The Releasing Time to Care programme is a unique opportunity for everyone working within the NHS to improve effectiveness, safety and reliability of the services we provide. Whilst being situated within a National Health Service policy environment learning from this work can be translated nationally and internationally, as the principles underpin the provision of high quality care. Evaluation is currently in relation to each of the 15 modules rather than as the programme as a whole. It uses various methods including audit, observation, activity follow through, satisfaction surveys and process mapping. Each month data is colated for each of the 11 metrics which has shown a reduction in falls, drug administration errors and improvement in the recording of patient observations. One of the key issues is that an essential component for the success of the programme lies in the tangible support of the Trust Board/Board of Directors. Evidence shows that this programme improves patient satisfaction as it enables the provision of an increase in direct patient care by staff and subsequently improved clinical and safety outcomes. Ward Sister/Charge Nurse development includes Leadership, Project management and Lean Methodology techniques. The Releasing Time to Care programme is a key component of the Next Stage Review. It will create productive organisations by being a catalyst for the transformation of Trust services, enabling staff to spend more time caring for patients and users. This release in time will result in better outcomes and subsequent improvement with patient and staff satisfaction and

  12. Iota(1440), anomalous Ward identities, and topological susceptibility for QCD

    International Nuclear Information System (INIS)

    Williams, P.G.

    1986-01-01

    Anomalous Ward identities for QCD are comprehensively analyzed taking into account contributions of all known pseudoscalar mesons, including the iota(1440 MeV) which is a possible glueball candidate. Implications for the standard resolution of the U(1) problem are examined by imposing the important and crucial constraint of positivity for the topological susceptibility. The pure Yang-Mills susceptibility: a quantity relevant in quenched lattice calculations: is shown to increase quite considerably in the presence of the iota, while the total susceptibility is reduced and may even vanish. Allowed ranges for the axial couplings are delineated and two classes of solution emerge: one corresponding to an iota with suppressed singlet axial coupling; the other to a large eta'-like coupling. It may be possible to discriminate between these two alternatives by measurements of the branching ratio for iota→KK-barπ: values near 100% give suppressed couplings; values below 50% unsuppressed ones

  13. Nursing safety management in onco-hematology pediatric wards

    Directory of Open Access Journals (Sweden)

    Marcelle Miranda da Silva

    2015-02-01

    Full Text Available This study aimed at identifying how safety management is applied by nurses to manage the nursing care, and at analyzing their challenges in onco-hematology pediatric wards. Descriptive and qualitative research, conducted at the Instituto Estadual de Hematologia Arthur de Siqueira Cavalcanti, Rio de Janeiro, Brazil, in August 2013. Six nurses were interviewed, and the content analysis was used. The key aspects relate to the importance of training and continuing education, teamwork, with the challenges in the care of hospitalized children and particularities of the disease, and the systematization, use of instruments and protocols. For child safety, the relationship between the administration and support is critical to the quality of care.

  14. Bacteria contamination of touch surfaces in Polish hospital wards

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    Anna Różańska

    2017-08-01

    Full Text Available Background: The objective of the study has been to evaluate the pathogenic bacteria contamination of touch surfaces in hospital wards. Material and Methods: Samples were taken from frequently touched surfaces in the hospital environment in 13 units of various types. Culturing was carried out on solid blood agar and in growth broth (tryptic soy broth – TSB. Species identification was performed using the analytical profile index (API biochemical testing and confirmed with matrix assisted laser desorption ionization time-flight mass spectrometry (MALDI-TOF-MS system. Results: The total of 161 samples were taken for the study. Fifty-two of them, after 24 h of culture on a solid medium, demonstrated bacterial growth and further 60 samples had growth after prior multiplication in TSB. Overall, 69.6% of samples exhibited growth of 19 bacterial species. Pathogenic species – representing indicator organisms of efficiency of hospital cleaning – was demonstrated by 21.4% of samples. Among them Acinetobacter spp., Enterocococci spp. and Staphylococcus aureus were identified. Coagulase-negative staphylococci (CNS were predominant. The proportion of various groups of bacteria significantly varied in respective hospitals, and in various types of wards. Disturbing observation is a large proportion of resistance of isolated CNS strains as a potential reservoir of resistance genes. Conclusions: The results show that touch surfaces in hospital units are contaminated by both potentially pathogenic and pathogenic bacterial species. In connection with the reported, also in Poland, frequent omission or incorrect execution of hand hygiene by hospital staff, and probably patients, touch surfaces still constitute important reservoir of pathogenic bacteria. Improving hand hygiene compliance of health-care workers with recommendations is necessary for increasing biological safety of hospital environment. Med Pr 2017;68(3:459–467

  15. Workplace Violence Toward Mental Healthcare Workers Employed in Psychiatric Wards

    Directory of Open Access Journals (Sweden)

    Gabriele d'Ettorre

    2017-12-01

    Full Text Available Background: Workplace violence (WPV against healthcare workers (HCWs employed in psychiatric inpatient wards is a serious occupational issue that involves both staff and patients; the consequences of WPV may include increased service costs and lower standards of care. The purpose of this review was to evaluate which topics have been focused on in the literature and which are new in approaching the concern of patient violence against HCWs employed in psychiatric inpatient wards, in the past 20 years. Methods: We searched for publications in PubMed and Web of Science using selected keywords. Each article was reviewed and categorized into one or more of the following four categories based on its subject matter: risk assessment, risk management, occurrence rates, and physical/nonphysical consequences. Results: Our search resulted in a total of 64 publications that matched our inclusion criteria. The topics discussed, in order of frequency (from highest to lowest, were as follows: “risk assessment,” “risk management,” “occurrence rates,” and “physical/nonphysical consequences.” Schizophrenia, young age, alcohol use, drug misuse, a history of violence, and hostile-dominant interpersonal styles were found to be the predictors of patients’ violence. Conclusion: Risk assessment of violence by patients appeared the way to effectively minimize the occurrence of WPV and, consequently, to better protect mental HCWs. We found paucity of data regarding psychologic sequelae of WPV. According to these findings, we suggest the need to better investigate the psychologic consequences of WPV, with the aim of checking the effective interventions to assist HCW victims of violence and to prevent psychologic illness. Keywords: assaults, psychiatric inpatients, risk assessment, risk management, violence

  16. Workplace Violence Toward Mental Healthcare Workers Employed in Psychiatric Wards.

    Science.gov (United States)

    d'Ettorre, Gabriele; Pellicani, Vincenza

    2017-12-01

    Workplace violence (WPV) against healthcare workers (HCWs) employed in psychiatric inpatient wards is a serious occupational issue that involves both staff and patients; the consequences of WPV may include increased service costs and lower standards of care. The purpose of this review was to evaluate which topics have been focused on in the literature and which are new in approaching the concern of patient violence against HCWs employed in psychiatric inpatient wards, in the past 20 years. We searched for publications in PubMed and Web of Science using selected keywords. Each article was reviewed and categorized into one or more of the following four categories based on its subject matter: risk assessment, risk management, occurrence rates, and physical/nonphysical consequences. Our search resulted in a total of 64 publications that matched our inclusion criteria. The topics discussed, in order of frequency (from highest to lowest), were as follows: "risk assessment," "risk management," "occurrence rates," and "physical/nonphysical consequences." Schizophrenia, young age, alcohol use, drug misuse, a history of violence, and hostile-dominant interpersonal styles were found to be the predictors of patients' violence. Risk assessment of violence by patients appeared the way to effectively minimize the occurrence of WPV and, consequently, to better protect mental HCWs. We found paucity of data regarding psychologic sequelae of WPV. According to these findings, we suggest the need to better investigate the psychologic consequences of WPV, with the aim of checking the effective interventions to assist HCW victims of violence and to prevent psychologic illness.

  17. Cross-year peer tutoring on internal medicine wards: results of a qualitative focus group analysis.

    Science.gov (United States)

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

    2014-01-01

    Peer-assisted learning (PAL) has become a well-accepted teaching method within medical education. However, descriptions of on-ward PAL programs are rare. A focus group analysis of a newly established PAL program on an internal medicine ward was conducted to provide insights into PAL teaching from a student perspective. To provide insights into students' experiences regarding their on-ward training with and without accompanying PAL tutors. A total of N=168 medical students in their sixth semester participated in the investigation (intervention group: N=88; control group: N=80). The intervention group took part in the PAL program, while the control group received standard on-ward training. There were seven focus groups with N=43 participants (intervention group: four focus groups, N=28 participants; control group: three focus groups, N=15 participants). The discussions were analyzed using content analysis. The intervention group emphasized the role of the tutors as competent and well-trained teachers, most beneficial in supervising clinical skills. Tutors motivate students, help them to integrate into the ward team, and provide a non-fear-based working relationship whereby students' anxiety regarding working on ward decreases. The control group had to rely on autodidactic learning strategies when neither supervising physicians nor final-year students were available. On-ward PAL programs represent a particularly valuable tool for students' support in training clinical competencies on ward. The tutor-student working alliance acts through its flat hierarchy. Nevertheless, tutors cannot represent an adequate substitute for experienced physicians.

  18. Junior staffing changes and the temporal ecology of adverse incidents in acute psychiatric wards

    NARCIS (Netherlands)

    Bowers, L.; Jeffery, D.; Simpson, A.; Daly, C.; Warren, J.; Nijman, H.L.I.

    2007-01-01

    Aim. This paper reports in examination of the relationship between adverse incident rates, the arrival of new junior staff on wards, and days of the week oil acute Psychiatric wards. Background. Incidents of violence, absconding and self-harm in acute inpatient services pose risks to patients and

  19. 77 FR 10960 - Security Zone, East River and Bronx Kill; Randalls and Wards Islands, NY

    Science.gov (United States)

    2012-02-24

    ...'' W (Port Morris Stacks), and all waters of the Bronx Kill southeast of the Bronx Kill Rail Road...-AA87 Security Zone, East River and Bronx Kill; Randalls and Wards Islands, NY AGENCY: Coast Guard, DHS... waters of the East River and Bronx Kill, in the vicinity of Randalls and Wards Islands, New York. This...

  20. Particle Removal Efficiency of the Portable HEPA Air Cleaner in a Simulated Hospital Ward

    DEFF Research Database (Denmark)

    Qian, Hua; Li, Yuguo; Sun, Hequan

    2010-01-01

    of beds in an isolation ward is insufficient. An experiment was conducted in a full scale experimental ward with a dimension of 6.7 m × 6 m × 2.7 m and 6 beds to test these hypotheses for a portable HEPA filter. The removal efficiency for different size particles was measured at different locations...

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

    NARCIS (Netherlands)

    Nijman, H.L.I.; Bowers, L.; Haglund, K.; Muir-Cochrane, E.; Simpson, A.; Merwe, M. van der

    2011-01-01

    Locking the exit doors of psychiatric wards is believed to reduce the risk of patients absconding. The aims of the study were to investigate both the prevalence of door locking and other exit security measures on UK admission wards, as well as whether door locking appears to be effective in keeping

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

    Science.gov (United States)

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

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

  3. Do-not-resuscitate policy on acute geriatric wards in Flanders, Belgium

    NARCIS (Netherlands)

    Gendt, de C.; Bilsen, J.J.; Stichele, van der R.; Lambert, M.; Noortgate, N. Den; Deliens, L.H.J.

    2005-01-01

    OBJECTIVES: To describe the historical development and status of a do-not-resuscitate (DNR) policy on acute geriatric wards in Flanders, Belgium, and to compare it with the international situation. DESIGN: Structured mail questionnaires. SETTING: All 94 acute geriatric wards in hospitals in Flanders

  4. Airflow and Contaminant Distribution in Hospital Wards with a Displacement Ventililation System

    DEFF Research Database (Denmark)

    Qian, H.; Nielsen, Peter Vilhelm; Li, Y.

    2004-01-01

    Airflow and Contaminant Distribution in Hospital Wards with a Displacement Ventilalation System. The 2nd International Conference on Build Environment and Public Health, BEPH 2004, Shenzhen , China . ABSTRACT Displacement ventilation has not been considered to be an applicable system for hospital...... to accurately predict three-dimensional distribution of air velocity, temperature, and contaminant concentration in the ward. Indoor airflow in a displacement ventilation system involves a combination of different flow streams such as the gravity currents and thermal plumes. It is important to choose...... ventilation system in hospital wards. It is for this purpose that we study the performance of displacement ventilation in hospital wards as one of the steps to optimize the ventilation design. When the prospect of applying displacement ventilation system in a hospital ward is examined, it should be necessary...

  5. Does daily nurse staffing match ward workload variability? Three hospitals' experiences.

    Science.gov (United States)

    Gabbay, Uri; Bukchin, Michael

    2009-01-01

    Nurse shortage and rising healthcare resource burdens mean that appropriate workforce use is imperative. This paper aims to evaluate whether daily nursing staffing meets ward workload needs. Nurse attendance and daily nurses' workload capacity in three hospitals were evaluated. Statistical process control was used to evaluate intra-ward nurse workload capacity and day-to-day variations. Statistical process control is a statistics-based method for process monitoring that uses charts with predefined target measure and control limits. Standardization was performed for inter-ward analysis by converting ward-specific crude measures to ward-specific relative measures by dividing observed/expected. Two charts: acceptable and tolerable daily nurse workload intensity, were defined. Appropriate staffing indicators were defined as those exceeding predefined rates within acceptable and tolerable limits (50 percent and 80 percent respectively). A total of 42 percent of the overall days fell within acceptable control limits and 71 percent within tolerable control limits. Appropriate staffing indicators were met in only 33 percent of wards regarding acceptable nurse workload intensity and in only 45 percent of wards regarding tolerable workloads. The study work did not differentiate crude nurse attendance and it did not take into account patient severity since crude bed occupancy was used. Double statistical process control charts and certain staffing indicators were used, which is open to debate. Wards that met appropriate staffing indicators prove the method's feasibility. Wards that did not meet appropriate staffing indicators prove the importance and the need for process evaluations and monitoring. Methods presented for monitoring daily staffing appropriateness are simple to implement either for intra-ward day-to-day variation by using nurse workload capacity statistical process control charts or for inter-ward evaluation using standardized measure of nurse workload intensity

  6. Senile anorexia in acute-ward and rehabilitations settings.

    Science.gov (United States)

    Donini, L M; Savina, C; Piredda, M; Cucinotta, D; Fiorito, A; Inelmen, E M; Sergi, G; Domiguez, L J; Barbagallo, M; Cannella, C

    2008-10-01

    The most common pathological change in eating behaviour among older persons is anorexia, which accounts for a large percent of undernutrition in older adults. The main research aims are to determine, in a sample of acute and rehabilitation elderly subjects, the prevalence of anorexia of aging and the causes most impacting on senile anorexia. four different Units cooperated to this research study. Patients were recruited from geriatric acute and rehabilitation wards in Italy. Each Research Unit, for the estimation of the prevalence of anorexia in elderly subjects evaluated all the patients aged over 65 recruited from April 2006 to June 2007. Nutritional status, depression, social, functional and cognitive status, quality of life, health status, chewing, swallowing, sensorial functions were evaluated in anorexic patients and in a sample of "normal eating" elderly subjects. 96 anorexic subjects were selected in acute and rehabilitation wards (66 women; 81.5 +/- 7 years; 30 men: 81.8 +/- 8 years. The prevalence of anorexia in the sample was 33.3% in women and 26.7% in men. Anorexic subjects were older and more frequently needed help for shopping and cooking. A higher (although not statistically significant) level of comorbidity was present in anorexic subjects. These subjects reported constipation and epigastrium pain more frequently. Nutritional status parameters (MNA, anthropometry, blood parameters) were significantly worst in anorexic subjects whereas CRP was higher. Chewing and swallowing efficiencies were significantly impaired and eating patterns were different for anorexic subjects with a significant reduction of protein rich foods. consequences of anorexia can be extremely serious and deeply affect both patient's mobility, mortality and quality of life. Therefore, it is of utmost importance to perform a special evaluation of the nutritional risk, to constantly evaluate the nutritional status and feeding intake of older patients, to identify and treat the

  7. What scares patients to get admitted in a psychiatry ward? An exploratory study

    Directory of Open Access Journals (Sweden)

    Sushmita Bhattacharya

    2018-01-01

    Full Text Available Background: There has been very little focus on understanding the experiences of people suffering from mental illness during their treatment in the outpatient and inpatient treatment facilities. Majority of the decisions regarding their treatment are taken by the mental health professionals in consultation with the caregivers, and the patient remains a passive recipient of the services. It is commonly seen that patients refuse admission in the psychiatry ward even when clinical needs warrant admission. Aim: The aim of the current study was to explore the perception of patients regarding admission in the psychiatry ward and the fears associated with indoor treatment facility. Methodology: A semistructured interview schedule was administered to 110 patients undergoing treatment from outpatient services to study their attitude toward treatment in psychiatry ward. Results: A large number of patients perceived psychiatry ward as a hostile place with unfriendly atmosphere and dark and unsupportive environment. However, the patients who had been admitted in the past found it less scary and appreciated good and friendly behavior of the staff in the ward. Conclusion: Negative perception of inpatient treatment and psychiatry wards is still highly prevalent among the patients. With growing focus on reducing stigma about psychiatric illnesses, dispelling the myths related to treatment in wards is the need of the hour.

  8. Comparison of the training status of medical students of pediatric ward based on their logbooks

    Directory of Open Access Journals (Sweden)

    MOZHGHAN ZAHMATKESHAN

    2013-04-01

    Full Text Available Introduction: Logbooks show whether medical students have been exposed to a particular disease and whether they are able to perform particular practices or not. To evaluate the training status of the medical students in the pediatric ward of Shiraz University of Medical Sciences, the data about the students’ knowledge of different diseases in different parts of the pediatric ward in 2011 was collected based on their logbooks and compared with similar data in 2005. Methods: In this descriptive study, medical students’ electronic notes were designed and completed by 90 medical students trained in the pediatric ward in 2011. Then the information was compared with the data of the previous study conducted in 2005. Results: In the pediatric outpatient clinic, neonatal emergency room, pediatric emergency room, and general pediatric ward, 50% of the diseases listed in the diaries were observed by the students. However, 19% of the patients were observed by the students in subspecialty wards. Conclusion: Using daily notes (logbooks is a useful method for educational evaluation of the students. It can show the education acquired by the students, and clarify the defects and inadequacies in education. It seems that using electronic diaries in data collection increases the students’ participation and facilitates training. In general, expansion and development of new wards facilitate the exposure of medical students to more diseases and this fact has been shown about pediatric neurology ward in the present study.

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

    Science.gov (United States)

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

    2012-02-01

    There is disagreement among psychiatric professionals about whether the doors of acute psychiatric wards should be kept locked to prevent patients from leaving and harming themselves or others. This study explored patient, staff, and visitor perceptions about the acceptability of locking the ward door on acute psychiatric inpatient wards. Interviews were conducted with 14 registered nurses, 15 patients, and six visitors from three different acute wards. Findings revealed commonalities across all groups, with general agreement that locking the door reduced absconding. Staff expressed feelings of guilt, embarrassment, and fear of being blamed when a patient absconded. Staff also reported that open wards created anxious vigilance to prevent an abscond and increased workload in allocating staff to watch the door, whereas staff on partially-locked doors also perceived an increased workload in letting people in and out of the ward. Patients had mixed feelings about the status of the door, expressing depression, a sense of stigma, and low self-esteem when the door was locked. The issue of balancing safety and security on acute psychiatric wards against the autonomy of patients is not easily resolved, and requires focused research to develop innovative nursing practices. © 2011 The Authors. International Journal of Mental Health Nursing © 2011 Australian College of Mental Health Nurses Inc.

  10. Opening the black box in nursing work and management practice: the role of ward managers.

    Science.gov (United States)

    Townsend, Keith; Wilkinson, Adrian; Kellner, Ashlea

    2015-03-01

    This paper aims to identify and explore key obstacles preventing ward managers from effectively performing the human resource management (HRM) responsibilities required in their role. In the context of increasing costs and the decentralisation of responsibility to ward level, the relevance of the ward manager role within the 'black box' between human resource management and firm performance is becoming increasingly pertinent. This paper presents an intensive case study including 37 interviews across all levels of a hospital where senior management attempted to shift to a high performance model of human resource management. The findings indicated that ward managers played a critical role in maintaining and improving employee performance, although they were restricted from effectively performing their responsibilities due to budget pressure and limited managerial skill development. Our findings support the contention that hospitals would benefit from focusing on the critical role of the ward manager as the central locus of influence in high performance human resource management (HPHRM) systems. Investment into high performance human resource management is discouraged if the hospital cannot adequately enable ward managers who are responsible for implementation. Introduction of managerial skills training to potential and existing ward managers is critical. © 2013 John Wiley & Sons Ltd.

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

    Energy Technology Data Exchange (ETDEWEB)

    Zhu, Xiujuan, E-mail: yzzhuxiujuan@sina.com [Jiangsu Second Normal University, School of Mathematics and Information Technology (China)

    2015-12-15

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

  12. Costs of terminal patients who receive palliative care or usual care in different hospital wards.

    Science.gov (United States)

    Simoens, Steven; Kutten, Betty; Keirse, Emmanuel; Berghe, Paul Vanden; Beguin, Claire; Desmedt, Marianne; Deveugele, Myriam; Léonard, Christian; Paulus, Dominique; Menten, Johan

    2010-11-01

    In addition to the effectiveness of hospital care models for terminal patients, policy makers and health care payers are concerned about their costs. This study aims to measure the hospital costs of treating terminal patients in Belgium from the health care payer perspective. Also, this study compares the costs of palliative and usual care in different types of hospital wards. A multicenter, retrospective cohort study compared costs of palliative care with usual care in acute hospital wards and with care in palliative care units. The study enrolled terminal patients from a representative sample of hospitals. Health care costs included fixed hospital costs and charges relating to medical fees, pharmacy and other charges. Data sources consisted of hospital accountancy data and invoice data. Six hospitals participated in the study, generating a total of 146 patients. The findings showed that palliative care in a palliative care unit was more expensive than palliative care in an acute ward due to higher staffing levels in palliative care units. Palliative care in an acute ward is cheaper than usual care in an acute ward. This study suggests that palliative care models in acute wards need to be supported because such care models appear to be less expensive than usual care and because such care models are likely to better reflect the needs of terminal patients. This finding emphasizes the importance of the timely recognition of the need for palliative care in terminal patients treated in acute wards.

  13. Strengthening the role of the ward manager: a review of the literature.

    Science.gov (United States)

    Pegram, Anne M; Grainger, Michelle; Sigsworth, Janice; While, Alison E

    2014-09-01

    The role of the ward manager is integral to service delivery, however, they may lack the necessary authority and autonomy to achieve the organisation and delivery of patient care. To identify initiatives that have strengthened the ward manager role. A review of published literature was undertaken. Data included were drawn from a variety of sources, including policy, professional literature and research studies. Three policy initiatives were identified along with two innovations from ward managers and two recent professional organisation campaigns. One innovation was identified that could improve the process of care delivery thus empowering ward managers' decision making. The literature identified the need for a review of the role, and adequate administrative support and training for the role. The literature reviewed provided little evidence of initiatives to strengthen the role of the ward manager, highlighting the imperative to develop an evidence base. There was consensus on the importance of education and training before and during appointment to the position. The role of the ward manager remains pivotal in care delivery. The focus should be on how best to support ward managers in achieving their role within health-care systems. © 2013 John Wiley & Sons Ltd.

  14. Caring for cancer patients on non-specialist wards.

    LENUS (Irish Health Repository)

    Gill, Finola

    2012-02-01

    As cancer is the leading cause of death worldwide, every nurse will be required to care for patients with the condition at some point in his\\/her career. However, non-specialized oncology nurses are often ill-prepared to nurse patients suffering from cancer. This literature review aims to provide an overview of current trends and developments in cancer care nursing in an attempt to identify the range of previous research pertaining to caring for patients with cancer on non-specialist wards. The review finds that non-specialized cancer nurses report a lack of education and training with regard to cancer care and cancer treatments, which acts as a barrier to providing quality nursing care. Emotional and communication issues with patients and their families can also cause non-specialist nurses significant distress. International research has shown that specialist oncology nurses make a considerable difference to physical and psychosocial patient care. It is therefore paramount that non-speciality nurses\\' educational needs are met to develop clinical competence and to provide supportive holistic care for both patients and their families.

  15. Enabling coordination within medical settings: case of a maternity ward

    Directory of Open Access Journals (Sweden)

    Fouzi LEZZAR

    2013-06-01

    Full Text Available Purpose: This study evaluates the planning process issues in healthcare institutions that can be considered as a high risk environment. Most recent healthcare research has focused on methods mainly based on communication, rather than collaboration supports. Material Methods: We followed then a collaborative-based planning approach which constitutes an evolution of planning environment toward new shared workspaces supporting collaboration. Our work led us first, to analyse the related tasks in an Algerian maternity ward in order to highlight the vital collaborative medical tasks that need to be modelled. Results: the paper summaries basic design concepts of our collaborative planning system that is designed to make group interaction support flexible for care coordination and continuity. Conclusion: after development and test of our collaborative planning system, we noticed that our collaborative and planning system can increase awareness and hence decrease coordination breakdowns, reduce costs of information collecting and sharing. All these factors constitute a crucial aspect of an efficient management of a hospital.

  16. Ward identities and small-mass behaviour of supersymmetric QCD

    International Nuclear Information System (INIS)

    Knecht, M.; Stern, J.

    1985-04-01

    A general method based on Ward identities of massive SUSY-QCD is developed which allows to exploit systematically the non-trivial interplay between supersymmetry and softly broken chiral symmetry and to obtain unusually strong informations on the (s) quark-mass dependence of the theory. This method is applied in details to the case of chiral-symmetry-breaking vacuum-condensates and to the case of masses of scalar-supermultiplet bound-states. In the first case, it completely fixes the mass-dependence of squark and gaugino condensates, which is argued to imply the vanishing of these condensates for all values of the (s)quark mass m. In the second case, it yields the proof of the previously reported exact mass-formula for all pion-like bound states, which relates the small m behaviour of their masses to the mean value of the axial-charge generating the non-anomalous U A (1)-symmetry of the theory

  17. Ward identities in the derivation of Hawking radiation from anomalies

    International Nuclear Information System (INIS)

    Umetsu, Koichiro

    2008-01-01

    Robinson and Wilczek suggested a new method of deriving Hawking radiation by the consideration of anomalies. The basic idea of their approach is that the flux of Hawking radiation is determined by anomaly cancellation conditions in the Schwarzschild black hole (BH) background. Iso et al. extended the method to a charged Reissner-Nordstroem BH and a rotating Kerr BH, and they showed that the flux of Hawking radiation can also be determined by anomaly cancellation conditions and regularity conditions of currents at the horizon. Their formulation gives the correct Hawking flux for all the cases at infinity and thus provides a new attractive method of understanding Hawking radiation. We present some arguments clarifying for this derivation. We show that the Ward identities and boundary conditions for covariant currents without referring to the Wess-Zumino terms and the effective action are sufficient to derive Hawking radiation. Our method, which does not use step functions, thus simplifies some of the technical aspects of the original formulation. (author)

  18. Equations of motion as constraints: superselection rules, Ward identities

    Energy Technology Data Exchange (ETDEWEB)

    Asorey, M. [Departamento de Física Teórica, Universidad de Zaragoza,C/Pedro Cerbuna 12, E-50009 Zaragoza (Spain); Balachandran, A.P. [Physics Department, Syracuse University,Physics Building Syracuse, NY 13244 (United States); Institute of Mathematical Sciences, C.I.T Campus,Taramani Chennai 600113 (India); Lizzi, F. [Dipartimento di Fisica “E. Pancini” Università di Napoli Federico II,Via Cintia, 80126 Napoli (Italy); INFN - Sezione di Napoli,Via Cintia, 80126 Napoli (Italy); Departament de Estructura i Constituents de la Matèria, Institut de Ciéncies del Cosmos,Universitat de Barcelona, Diagonal 647, 08028 Barcelona, Catalonia (Spain); Marmo, G. [Dipartimento di Fisica “E. Pancini” Università di Napoli Federico II,Via Cintia, 80126 Napoli (Italy); INFN - Sezione di Napoli,Via Cintia, 80126 Napoli (Italy)

    2017-03-27

    The meaning of local observables is poorly understood in gauge theories, not to speak of quantum gravity. As a step towards a better understanding we study asymptotic (infrared) transformations in local quantum physics. Our observables are smeared by test functions, at first vanishing at infinity. In this context we show that the equations of motion can be seen as constraints, which generate a group, the group of space and time dependent gauge transformations. This is one of the main points of the paper. Infrared nontrivial effects are captured allowing test functions which do not vanish at infinity. These extended operators generate a larger group. The quotient of the two groups generate superselection sectors, which differentiate different infrared sectors. The BMS group changes the superselection sector, a result long known for its Lorentz subgroup. It is hence spontaneously broken. Ward identities implied by the gauge invariance of the S-matrix generalize the standard results and lead to charge conservation and low energy theorems. Their validity does not require Lorentz invariance.

  19. Food work and feeding assistance on hospital wards.

    Science.gov (United States)

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

    2013-05-01

    Approximately 60 per cent of UK patients aged 65 years or older are at risk of malnutrition or their situation worsening while in hospital. We report the results of a qualitative study embedded in research to prevent malnutrition in older people in hospital (the mappmal study). Our aim was to understand and describe processes that promote or inhibit nutrition in hospital. Throughout 2009 we examined meal services at four UK hospital sites across two regional locations, focusing on older patients admitted with dementia, for stroke or for fractured neck of femur. Data were collected through semi-structured interviews with National Health Service staff (n = 54), stakeholders (n = 6), and a focus group with former patients and carers (n = 5). We identified ward-based food work as a technical and interpersonal challenge in narratives around malnutrition. Food work constituted two overlapping spheres of activity: interpersonal engagement through feeding assistance and reassurance and the arrangement of resources that facilitate meals such as the preparation of food trolleys. Our analysis is framed by the literature on emotional labour, dirty work and the professionalisation of nursing. We demonstrate how food work is overlooked by being conceptualised as common sense and as one of the most mundane and elementary tasks in hospitals. © 2012 The Authors. Sociology of Health & Illness © 2012 Foundation for the Sociology of Health & Illness/Blackwell Publishing Ltd.

  20. Sodium serum levels in hypoalbuminemic adults at general medical wards

    Directory of Open Access Journals (Sweden)

    Cunha Daniel Ferreira da

    1999-01-01

    Full Text Available Hypoalbuminemia may cause interstitial edema and hemodilution, which we hypothesized may influence serum sodium levels. Our purpose was to compare serum sodium levels of hospitalized adults with or without hypoalbuminemia. All sodium and albumin serum levels of 142 adults hospitalized at general medical wards over a six-month period were searched at a University Hospital mainframe computer. Relevant laboratory data and clinical details were also registered. Hypoalbuminemia was defined by serum albumin concentration < 3.3 g/dl Fisher, Mann-Whitney, and Student's t tests were applied to compare groups with or without hypoalbuminemia. Ninety-nine patients, classified as hypoalbuminemic, had lower blood hemoglobin (10.68 ± 2.62 vs. 13.54 ± 2.41, and sodium (135.1 ± 6.44 vs. 139.9 ± 4.76mEq/l and albumin (2.74 ± 0.35 vs. 3.58 ± 0.28g/dl serum levels than non-hypoalbuminemic (n=43. Pearson's coefficient showed a significant direct correlation between albumin and sodium serum levels (r=0.40 and between serum albumin and blood hemoglobin concentration (r=0.46. Our results suggest that hypoalbuminemic adults have lower serum sodium levels than those without hypoalbuminemia, a phenomenon that may be at least partially attributed to body water retention associated with acute phase response syndrome.

  1. Severe psychosomatic illness in children: effect on a pediatric ward's staff.

    Science.gov (United States)

    Fialkov, M J; Miller, J A

    1981-12-01

    Observations of a pediatric ward's response to the repeated hospitalization of an asthmatic child revealed a close parallel to the transactional patterns described in families of children with psychosomatic illnesses. Characteristics of such families include enmeshment, overprotectiveness, rigidity and resistance to change, lack of conflict resolution, and use of the child's sick role to relieve tension and discomfort within the family. In this article we have attempted to demonstrate the similarity of responses between these families and groups of hospital ward personnel. Resolution of the ward personnel's internal conflict was followed by changes in the coping abilities of the staff, with a successful outcome for a second child with a similar clinical condition.

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

    Science.gov (United States)

    Alexander, J

    2006-10-01

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

  3. Numerical investigation of airborne infection in naturally ventilated hospital wards with central-corridor type

    DEFF Research Database (Denmark)

    Zhou, Qi; Qian, Hua; Liu, Li

    2018-01-01

    Natural ventilation is believed to control airborne infection due to high ventilation rates while an undesired flow pattern may cause infection transmission in hospital wards. A computational fluid dynamics simulation was carried out in this study to investigate the impact of airflow pattern....... The results not only give direct evidence to strongly support World Health Organization’s recommendation but also suggest required amendment of the Chinese standard GB 51039-2014 to improve ventilation arrangement in general hospital wards in China. Our findings are useful for improving the future design...... of general hospital wards for airborne infection control....

  4. Supporting Information Access in a Hospital Ward by a Context-Aware Mobile Electronic Patient Record

    DEFF Research Database (Denmark)

    Skov, Mikael B.; Høegh, Rune Thaarup

    2006-01-01

    Context-awareness holds promise for improving the utility of software products. Context-aware mobile systems encompass the ability to automatically discover and react to changes in an environment. Most contemporary context-aware mobile systems aim to support users in private situations, for example......Ward is to support nurses in conducting morning procedures in a hospital ward. MobileWard is context-aware as it is able to discover and react autonomously according to changes in the environment and since it integrates the ability to provide information and services to the user where the relevancy depends....... Implications and limitations of the proposed solution are further discussed....

  5. Application of the MIT two-channel model to predict flow recirculation in WARD 61-pin blanket tests

    International Nuclear Information System (INIS)

    Huang, T.T.; Todreas, N.E.

    1983-01-01

    The preliminary application of MIT two-channel model to WARD sodium blanket tests was presented in this report. The criterion was employed to predict the recirculation for selected completed (transient and steady state) and proposed (transient only) tests. The heat loss was correlated from the results of the WARD zero power tests. The calculational results show that the criterion agrees with the WARD tests except for WARD RUN 718 for which the criterion predicts a different result from WARD data under bundle heat loss condition. However, if the test assembly is adiabatic, the calculations predict an operating point which is marginally close to the mixed-to-recirculation transition regime

  6. Application of the MIT two-channel model to predict flow recirculation in WARD 61-pin blanket tests

    International Nuclear Information System (INIS)

    Huang, T.T.; Todreas, N.E.

    1983-01-01

    The preliminary application of MIT TWO-CHANNEL MODEL to WARD sodium blanket tests was presented in this report. Our criterion was employed to predict the recirculation for selected completed (transient and steady state) and proposed (transient only) tests. The heat loss was correlated from the results of the WARD zero power tests. The calculational results show that our criterion agrees with the WARD tests except for WARD RUN 718 for which the criterion predicts a different result from WARD data under bundle heat loss condition. However, if the test assembly is adiabatic, the calculations predict an operating point which is marginally close to the mixed-to-recirculation transition regime

  7. Theory of mind in schizophrenia: correlation with clinical symptomatology, emotional recognition and ward behavior.

    Science.gov (United States)

    Lee, Woo Kyeong; Kim, Yong Kyu

    2013-09-01

    Several studies have suggested the presence of a theory of mind (ToM) deficit in schizophrenic disorders. This study examined the relationship of emotion recognition, theory of mind, and ward behavior in patients with schizophrenia. Fifty-five patients with chronic schizophrenia completed measures of emotion recognition, ToM, intelligence, Positive and Negative Syndrome Scale (PANSS) and Nurse's Observation Scale for Inpatient Evaluation (NOSIE). Theory of mind sum score correlated significantly with IQ, emotion recognition, and ward behavior. Ward behavior was linked to the duration of the illness, and even more so to theory of mind deficits. Theory of mind contributed a significant proportion of the amount of variance to explain social behavior on the ward. Considering our study results, impaired theory of mind contributes significantly to the understanding of social competence in patients with schizophrenia. Copyright © 2012 Wiley Publishing Asia Pty Ltd.

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

    Science.gov (United States)

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

    1987-12-01

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

  9. Post natal use of analgesics: comparisons between conventional postnatal wards and a maternity hotel.

    Science.gov (United States)

    Nordeng, Hedvig; Eskild, Anne; Nesheim, Britt-Ingjerd

    2010-04-01

    To investigate factors related to analgesic use after delivery, and especially whether rates of analgesic use were different in a midwife-managed maternity hotel as compared to conventional postnatal wards. One maternity hotel and two conventional postnatal wards at Ullevål University Hospital in Oslo, Norway. Data were obtained from hospital records for 804 women with vaginal deliveries. Postnatal analgesic use. Overall, approximately half the women used analgesics after vaginal delivery in both conventional postnatal wards and maternity hotel. The factors that were significantly associated with use of analgesics postnatally in multivariate analysis were multiparity, having a non-Western ethnicity, smoking in pregnancy, younger age, instrumental delivery, analgesic use during labour, maternal complications post partum, and duration of postnatal stay 4 days or more. The use of analgesics is determined by socio-demographic and obstetric factors rather than the organisation of the ward.

  10. Nurses' experience and attitudes towards inpatient aggression on psychiatric wards

    Directory of Open Access Journals (Sweden)

    Martina Tomagová

    2016-08-01

    Full Text Available Aim: To determine the incidence rate of forms of inpatient aggression towards nurses who working on psychiatric wards; to identify their attitude to patient aggression, to the factors that condition the occurrence and management of aggression. To determine the differences between nurses in relation to educational training aimed at the issue of patient aggression. Design: Quantitative cross-sectional study. Methods: Selection of respondents was deliberate. The sample comprised 223 nurses with an average of 21.27 (± 11.41 years of clinical practice. Data collection was implemented by means of the self-assessment scales: Violence and Aggression of Patients Scale (VAPS, Attitude Towards Aggression Scale (ATAS, The Management of Aggression and Violence Attitude Scale-Likert (MAVAS-L. Results: 98.58% experienced inpatient aggression in the course of the previous year. Negative attitudes to patient aggression predominated in the sample. Nurses expressed strongest agreement with the idea that internal factors foster patient aggression. Regarding methods of aggression management, nurses expressed strongest agreement with the use of medical therapy and restraints. They held a neutral attitude towards the use of non-physical methods. The age of nurses had an effect on how strongly they agreed with the importance of internal factors in prompting patient aggression and with the use of medical therapy and restraints. Conclusion: A high percentage of nurses have had personal experience of various forms of patient aggression. Negative attitudes to aggression predominated in our sample of nurses, emphasizing the influence of internal factors. The attitude of nurses towards patient aggression influences the selection of aggression management strategies.

  11. Venous thromboprophylaxis in general surgery ward admissions: strategies for improvement.

    Science.gov (United States)

    Galante, Mariana; Languasco, Agustín; Gotta, Daniel; Bell, Soledad; Lancelotti, Tomás; Knaze, Viktoria; Saubidet, Cristián Lopez; Grand, Beatriz; Milberg, Matías

    2012-12-01

    To estimate the adherence to institutional venous thromboprophylaxis clinical practice guidelines (CPGs) in general surgery patients and to assess the effectiveness of a multi-strategy improvement intervention. A prospective before-after study. Two teaching hospitals located in the city of Buenos Aires, Argentina. Prescriptions belonging to patients admitted to the general surgery wards were evaluated. A multi-strategy intervention that included (i) simplification of institutional CPGs for venous thromboprophylaxis using a single drug at a single dose, based on the American College of Chest Physicians recommendations, (ii) distribution of pocket cards with an algorithm for the implementation of new recommendations to both, physicians and nurses, working in the general surgery units, (iii) educational talks, (iv) paper-based reminders and (v) audit and feedback. The adherence of the venous thromboprophylaxis prescription to the institutional recommendations. The prescriptions of 100 admitted patients before and 90 after the intervention were included in the analysis. The initial rate of adherence was 31%. After the intervention this rate rose to 71.1% (P< 0.001). The major improvement observed was the reduction in omitted prophylaxis in patients at risk of venous thromboembolism from 45 to 13.3% (P< 0.001). In the adjusted model, prescribing compliance with CPGs was five times more likely during the second stage than during the first stage (OR = 5.60, 95% CI = 2.92-10.74). Simple and economical interventions such as those described in this study can improve general surgeons compliance with the institutional and international guidelines, thus assuring patient safety and quality of health care.

  12. Neonatal abstinence syndrome: Diagnostic dilemmas in the maternity ward

    Directory of Open Access Journals (Sweden)

    Lazić-Mitrović Tanja

    2015-01-01

    Full Text Available Introduction. Neonatal abstinence syndrome (NAS refers to a newborn neurological, gastrointestinal and/or respiratory disorder if a newborn was exposed to psychoactive substances in the intrauterine period. NAS is difficult to diagnose due to unreliability of the data on addictive substances use during pregnancy, limited possibilities of the prenatal exposure diagnosis and postnatal substance detection, which all lead to diagnostic dilemmas. Objective. The aim of this study was to indicate the problems in patients with early NAS diagnosis in the maternity ward and the importance of clinical presentation used as a guide toward the diagnosis. Methods. This retrospective study included five term eutrophic newborns with high Apgar score, good adaptation in the first day and with clinical presentation of NAS during the second day of life. The clinical presentation was dominated by irritability, increased wakefulness, increased muscle tone, shrilly crying, tremors, problems with accepting food, tachypnea, subfebrility and hyperhidrosis. Finnegan scale was introduced in order to diagnose NAS and apply the therapy. Single-medication therapy of phenobarbitone was applied in four cases and a combination of phenobarbitone and morphine in one case. For toxicological analysis newborns’ urine samples were used. Results. Conditions such as perinatal asphyxia, infection, hunger, polycythemia, hypoglycemia or hypocalcemia were excluded. Finnegan score implied that pharmacological treatment had to be administered. The discrepancy between the NAS anamnesis and toxicological analysis existed. Response to the treatment was positive in all cases. Conclusion. NAS is a multisystemic disorder and should be suspected when it is noticed that children exhibit characteristic signs. However, other pathological conditions have to be excluded. Quantification according to the adopted scales for NAS leads toward appropriate treatment and recovery of the newborns.

  13. Rationale for a home dialysis virtual ward: design and implementation.

    Science.gov (United States)

    Schachter, Michael E; Bargman, Joanne M; Copland, Michael; Hladunewich, Michelle; Tennankore, Karthik K; Levin, Adeera; Oliver, Matthew; Pauly, Robert P; Perl, Jeffrey; Zimmerman, Deborah; Chan, Christopher T

    2014-02-14

    Home-based renal replacement therapy (RRT) [peritoneal dialysis (PD) and home hemodialysis (HHD)] offers independent quality of life and clinical advantages compared to conventional in-center hemodialysis. However, follow-up may be less complete for home dialysis patients following a change in care settings such as post hospitalization. We aim to implement a Home Dialysis Virtual Ward (HDVW) strategy, which is targeted to minimize gaps of care. The HDVW Pilot Study will enroll consecutive PD and HHD patients who fulfilled any one of our inclusion criteria: 1. following discharge from hospital, 2. after interventional procedure(s), 3. prescription of anti-microbial agents, or 4. following completion of home dialysis training. Clinician-led telephone interviews are performed weekly for 2 weeks until VW discharge. Case-mix (modified Charlson Comorbidity Index), symptoms (the modified Edmonton Symptom Assessment Scale) and patient satisfaction are assessed serially. The number of VW interventions relating to eight pre-specified domains will be measured. Adverse events such as re-hospitalization and health-services utilization will be ascertained through telephone follow-up after discharge from the VW at 2, 4, 12 weeks. The VW re-hospitalization rate will be compared with a contemporary cohort (matched for age, gender, renal replacement therapy and co-morbidities). Our protocol has been approved by research ethics board (UHN: 12-5397-AE). Written informed consent for participation in the study will be obtained from participants. This report serves as a blueprint for the design and implementation of a novel health service delivery model for home dialysis patients. The major goal of the HDVW initiative is to provide appropriate and effective supports to medically complex patients in a targeted window of vulnerability. (NCT01912001).

  14. Auditing Safety of Compounding and Reconstituting of Intravenous Medicines on Hospital Wards in Finland.

    Science.gov (United States)

    Suvikas-Peltonen, Eeva; Palmgren, Joni; Häggman, Verner; Celikkayalar, Ercan; Manninen, Raija; Airaksinen, Marja

    2017-01-01

    On the hospital wards in Finland, nurses generally reconstitute intravenous medicines, such as antibiotics, analgesics, and antiemetics prescribed by doctors. Medicine reconstitution is prone to many errors. Therefore, it is important to identify incorrect practices in the reconstitution of medicine to improve patient safety in hospitals. The aim of this study was to audit the compounding and reconstituting of intravenous medicines on hospital wards in a secondary-care hospital in Finland by using an assessment tool and microbiological testing for identifying issues posing patient safety risks. A hospital pharmacist conducted an external audit by using a validated 65-item assessment tool for safe-medicine compounding practices on 20 wards of the selected hospital. Also, three different microbiological samples were collected to assure the aseptics. Practices were evaluated using a four-point rating scale of "never performed," "rarely performed," "often performed," and "always performed," and were based on observation and interviews with nurses or ward pharmacists. In addition, glove-, settle plate-, and media fill-tests were collected. Associations between microbial sample results and audit-tool results were discussed. Altogether, only six out of the 65 items were fully implemented in all wards; these were related to logistic practices and quality assurance. More than half of the wards used incorrect practices ("rarely performed" or "never performed") for five items. Most of these obviated practices related to aseptic practices. All media-fill tests were clean but the number of colony forming units in glove samples and settle- plate samples varied from 0 to >100. More contamination was found in wards where environmental conditions were inadequate or the use of gloves was incorrect. Compounding practices were [mostly] quite well adapted, but the aseptic practices needed improvement. Attention should have been directed particularly to good aseptic techniques and

  15. Health Service Quality Based On Dabholkar Dimension At Ward Room Of Internal Disease

    OpenAIRE

    Supriyanto, Stefanus; Rahmawati, Alfi Febriana

    2013-01-01

    The NDR average at ward room of internal disease of Bojonegoro General Hospital during 2009-2011 was 58,6 ‰ (more than standard < 25 ‰). This research was aimed to analyze the importance and satisfaction rating of health service quality based on Dabholkar dimension. It used observational approach with cross sectional design. Interview was conducted to 37 patients in internal disease ward room of Bojonegoro General Hospital which selected by simple random sampling. This study found some issues...

  16. The effects of leadership and ward factors on job satisfaction in nursing homes: a multilevel approach.

    Science.gov (United States)

    Havig, Anders K; Skogstad, Anders; Veenstra, Marijke; Romøren, Tor I

    2011-12-01

    To examine (1) the relationships between job satisfaction and task- and relationship-oriented leadership and (2) the direct and moderating effects on job satisfaction of three ward-level factors: workload, use of teams and staff stability. Job satisfaction in nursing homes is vital to meeting the challenges related to recruitment and turnover. Cross-sectional design. A multilevel analysis approach was used to recognise a hierarchal structure of determined factors and to capture variation in job satisfaction at the individual and ward level. A questionnaire was sent to 444 registered nurses, auxiliary nurses and unskilled nursing assistants. Structured interviews were administered to 40 ward managers and 13 directors, and 900 hours of field observations was conducted in 40 nursing home wards throughout Norway. We found a significant relationship between job satisfaction and task-oriented and relationship-oriented leadership styles, with a stronger effect for task orientation. The effect of the two leadership styles varied significantly across wards. Furthermore, staff stability had both a significant positive direct effect and a moderating effect on job satisfaction, whereas the two other ward-level predictors yielded no significant contributions. The relatively stronger effect of task-oriented leadership on job satisfaction, particularly in wards with low staff stability, is in contrast to most previous studies and suggests that there may be specific conditions in nursing homes that favour the use of this leadership style. The varying effect of both leadership styles indicates that staff in different nursing home wards could benefit from the use of different leadership styles. The study highlights the importance of using different leadership behaviour and the importance of high staff stability to ensure job satisfaction among nursing home personnel. © 2011 Blackwell Publishing Ltd.

  17. Evaluation of fungal air contamination in selected wards of two tertiary hospitals in Tehran, Iran

    Directory of Open Access Journals (Sweden)

    Zahra Kamali Sarwestani

    2017-07-01

    Conclusion: According to the results of this study, the frequency and diversity of fungal spores in hospital wards were different. In addition, since the fungal contamination in the hospital environment are affected by various environmental factors and the efficiency of ventilation systems, some of these wards require better ventilation system as well as regular monitoring to remove these fungal bioaerosols in order to maintain the health of patients and health care workers.

  18. Recommendations for the safety preparation of sterile medicines in medical wards

    Directory of Open Access Journals (Sweden)

    Ana M.ª Martín de Rosales Cabrera

    2014-01-01

    Full Text Available Objective: To develop a recommendations guide about the preparation of sterile medicines in medical wards, and to figure out the current situation of different Spanish hospitals, regarding the preparation of sterile medicines outside the pharmacy. Methods: The autors reviewed the available international guidelines in order to summarize the main quality recommendations. To know about the current situation in Spanish hospitals, a 30 questions survey was designed and spread to 500 different hospitals. Answers were analysed with Survey monkey® platform in the period February-July 2012. Results: Based on the literature review, the authors agreed a recommendations list for the safe preparation of sterile medicines in medical wards, which was structured in 8 sections. Regarding the survey results, 8.4% of the hospitals answered, showing a great variability among centres in the quality requirements for sterile compounding outside the pharmacy. It should be pointed out the lack of assigned areas for drug preparation in wards, the lack of protocols to discern which kind of medicines can be compounded in wards as well as the poor recommendations about garment and aseptic technique. Conclusions: The authors confirm the absence of qualified practice standards to be applied in the preparation of sterile medicines in medical wards, as well as the great variability of diary practice. The implementation of quality and safety recommendations in the preparation of sterile medicines in medical wards may contribute to improve patient safety.

  19. Malnutrition and nutritional care practices in hospital wards for older people.

    Science.gov (United States)

    Vanderwee, Katrien; Clays, Els; Bocquaert, Ilse; Verhaeghe, Sofie; Lardennois, Miguel; Gobert, Micheline; Defloor, Tom

    2011-04-01

    This paper is a report of a study conducted to gain a better insight into the current nutritional care practices in Belgian hospital wards for older people, and to study the association between these practices and the prevalence of malnutrition. In 1999, the Council of Europe assessed nutritional care practices and support in 12 European countries and showed them to be sparse and inconsistent. At the time of research, no studies had described the association between nutritional care practices and malnutrition prevalence in Belgium. In 2007, a cross-sectional survey was carried out in a representative sample of Belgian hospital wards for older people. In total, 2094 patients from 140 wards for older people were included. The overall prevalence rate of malnutrition in wards for older people was 31.9%. Nutritional care practices such as nutritional screening and assessment, use of a standardized screening instrument and a nutritional protocol were suboptimal. Multilevel analysis revealed that ward characteristics explained for 9.1% whether a patient was malnourished or not. None of the registered nutritional care practices could explain a patient's individual risk. Malnutrition is a frequently occurring problem on hospital wards for older people. Increased consciousness among healthcare professionals and hospital policy makers of the importance of nutritional care will contribute to further improvement in care quality. © 2010 The Authors. Journal of Advanced Nursing © 2010 Blackwell Publishing Ltd.

  20. Evaluation of bio-aerosols concentration in the different wards of three educational hospitals in Iran

    Directory of Open Access Journals (Sweden)

    Heshmatollah Nourmoradi

    2012-01-01

    Full Text Available Aims: The aim of this study was to evaluate the bioaerosols level in the various parts of three educational hospitals of Isfahan, Iran. Materials and Methods: The collection of bioaerosols (including bacterial and fungal microorganisms was carried out with one-stage Anderson sampler. The sampling was carried out at the height of 1.5 m from the floor of various hospitals wards (infectious, surgery, urology wards, and operating room. The volume of each sample was determined based on pre-tests carried and was about 50 L. After sampling, the samples were incubated and analyzed. The effect of various environmental conditions including humidity, temperature, and outdoor bioaerosol levels was also investigated. Results: The lowest numbers of fungal and bacterial concentration were obtained in operating rooms of the hospitals and the highest concentration was observed in infectious disease wards of hospital 1 and 2 and surgery ward of hospital 3. The bacterial concentration was observed to be higher in hospital wards than outdoor, except hospitals′ operating rooms. Conclusion: The findings showed that the bioaerosols level in the hospitals was relatively high. The higher levels of indoor bacteria than outdoor might be associated with the presence of patients, their activity, unsuitable ventilation, and disinfection. Therefore, environmental monitoring and control measures are required to improve hospital environmental quality especially in the wards with immune deficiency patients.

  1. Job satisfaction in mainland China: comparing critical care nurses and general ward nurses.

    Science.gov (United States)

    Zhang, Aihua; Tao, Hong; Ellenbecker, Carol Hall; Liu, Xiaohong

    2013-08-01

    To explore the level of nurses' job satisfaction and compare the differences between critical care nurses and general ward nurses in Mainland China. Hospitals continue to experience high nurse turnover. Job satisfaction is a key factor to retain skilled nurses. The differences in job satisfaction among critical care nurses and general ward nurses are unknown. A cross-sectional design was selected for this descriptive correlation study. Cross-sectional study of critical care nurses (n = 446) and general ward nurses (n = 1118) in 9 general hospitals by means of questionnaires that included the Chinese Nurses Job Satisfaction Scale and demographic scale. The data were collected from June 2010-November 2010. Chinese nurses had moderate levels of job satisfaction, were satisfied with co-workers and family/work balance; and dissatisfied with pay and professional promotion. Critical care nurses were younger; less educated and had less job tenure when compared with nurses working on general wards. Critical care nurses were significantly less satisfied than general ward nurses with many aspects of their job. Levels of nurses' job satisfaction can be improved. The lower job satisfaction of critical care nurses compared with general ward nurses should warn the healthcare administrators and managers of potentially increasing the critical care nurses turn over. Innovative and adaptable managerial interventions need to be taken to improve critical care nurse' job satisfaction and retain skilled nurse. © 2012 Blackwell Publishing Ltd.

  2. The locked psychiatric ward: hotel or detention camp for people with dual diagnosis.

    Science.gov (United States)

    Terkelsen, Toril Borch; Larsen, Inger Beate

    2013-10-01

    The concepts of autonomy and liberty are established goals in mental health care; however, involuntary commitment is used towards people with mental health and substance abuse problems (dual diagnosis). To explore how patients and staff act in the context of involuntary commitment, how interactions are described and how they might be interpreted. Ethnographic methodology in a locked psychiatric ward in Norway. Two parallel images emerged: (a) The ward as a hotel. Several patients wanted a locked ward for rest and safety, even when admission was classified as involuntary. The staff was concerned about using the ward for real treatment of motivated people, rather than merely as a comfortable hotel for the unmotivated. (b) The ward as a detention camp. Other patients found involuntary commitment and restrictions in the ward as a kind of punishment, offending them as individuals. Contrary, the staff understood people with dual diagnoses more like a generalized group in need of their control and care. Patients and staff have different perceptions of involuntary commitment. Based on the patients' points of view, mental health care ought to be characterized by inclusion and recognition, treating patients as equal citizens comparable to guests in a hotel.

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

    Science.gov (United States)

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

    2015-04-01

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

  4. Experiences of psychiatric nurses exposed to hostility from patients in a forensic ward.

    Science.gov (United States)

    Tema, T R; Poggenpoel, M; Myburgh, C P H

    2011-10-01

    Hostile behaviour is becoming a way of life in South Africa. Hostility prevails at all settings, including in the health sector. In a forensic ward psychiatric nurses are subjected to hostile behaviour by the patients. The aim of the present study was to explore and describe the psychiatric nurses' experiences of hostile behaviour by patients in a forensic ward and make recommendations for nurse managers to empower these psychiatric nurses to cope with the patients' aggression. Qualitative, in-depth, phenomenological interviews were conducted with nine psychiatric nurses exposed to hostility from patients in a forensic ward. Recommendations were derived from the results from nurse managers to assist psychiatric nurses. It became apparent from the findings that psychiatric nurses in a forensic ward work in a stressful environment. Hostile behaviour in the forensic ward is consistently experienced by the psychiatric nurses as hindering therapeutic relationships. The psychiatric nurses experienced being disempowered. Psychiatric nurses experience hostile behaviour by patients in a forensic ward as disempowering. IMPLICATIONS FOR NURSE MANAGEMENT: Nurse managers can facilitate psychiatric nurses' empowerment by providing them access to: information, support, resources, opportunity and growth. © 2011 Blackwell Publishing Ltd.

  5. Active learning on the ward: outcomes from a comparative trial with traditional methods.

    Science.gov (United States)

    Melo Prado, Hegla; Hannois Falbo, Gilliatt; Rodrigues Falbo, Ana; Natal Figueirôa, José

    2011-03-01

    Academic activity during internship is essentially practical and ward rounds are traditionally considered the cornerstone of clinical education. However, the efficacy and effectiveness of ward rounds for learning purposes have been under-investigated and it is necessary to assess alternative educational paradigms for this activity. This study aimed to compare the educational effectiveness of ward rounds conducted with two different learning methodologies. Student subjects were first tested on 30 true/false questions to assess their initial degree of knowledge on pneumonia and diarrhoea. Afterwards, they attended ward rounds conducted using an active and a traditional learning methodology. The participants were submitted to a second test 48hours later in order to assess knowledge acquisition and were asked to answer two questions about self-directed learning and their opinions on the two learning methodologies used. Seventy-two medical students taking part in a paediatric clinic rotation were enrolled. The active methodology proved to be more effective than the traditional methodology for the three outcomes considered: knowledge acquisition (33 students [45.8%] versus 21 students [29.2%]; p=0.03); self-directed learning (38 students [52.8%] versus 11 students [15.3%]; pmethods (61 students [84.7%] versus 38 students [52.8%]; ptraditional methodology in a ward-based context. This study seems to be valuable in terms of the new evidence it demonstrates on learning methodologies in the context of the ward round. © Blackwell Publishing Ltd 2011.

  6. Medical and surgical ward rounds in teaching hospitals of Kuwait University: students’ perceptions

    Directory of Open Access Journals (Sweden)

    AlMutar S

    2013-09-01

    Full Text Available Sara AlMutar,1 Lulwa AlTourah,1 Hussain Sadeq,2 Jumanah Karim,2 Yousef Marwan3 1Department of Medicine, 2Department of Pediatrics, Mubarak Al-Kabeer Hospital, 3Department of Orthopedic Surgery, Al-Razi Orthopedic Hospital, Kuwait City, Kuwait Background: Teaching sessions for medical students during ward rounds are an essential component of bedside teaching, providing students with the opportunity to regard patients as actual people, and to observe their physical conditions directly, allowing a better understanding of illnesses to be developed. We aim to explore medical students’ perceptions regarding medical and surgical ward rounds within the Faculty of Medicine at Kuwait University, and to evaluate whether this teaching activity is meeting the expectation of learners. Methods: A pretested questionnaire was used to collect data from 141 medical students during the 2012–2013 academic year. They were asked to provide their current and expected ratings about competencies that were supposed to be gained during ward rounds, on a scale from 1 (lowest to 5 (highest. Mean scores were calculated, and the Student t-test was used to compare results. P < 0.05 was the cut-off level for significance. Results: Only 17 students (12.1% declined to participate in the study. The students' current competency scores (for competencies taught within both disciplines – medical and surgical were significantly lower than the scores indicating students’ expectations (P < 0.001. The best-taught competency was bedside examination, in both medical (mean: 3.45 and surgical (mean: 3.05 ward rounds. However, medical ward rounds were better than surgical rounds in covering some competencies, especially the teaching of professional attitude and approach towards patients (P < 0.001. Conclusion: Both medical and surgical ward rounds were deficient in meeting the students’ expectations. Medical educators should utilize the available literature to improve the bedside

  7. The Design and Simulation of Natural Personalised Ventilation (NPV System for Multi-Bed Hospital Wards

    Directory of Open Access Journals (Sweden)

    Zulfikar A. Adamu

    2015-05-01

    Full Text Available Adequate ventilation is necessary for thermal comfort and reducing risks from infectious bio-aerosols in hospital wards, but achieving this with mechanical ventilation has carbon and energy implications. Natural ventilation is often limited to window-based designs whose dilution/mixing effectiveness are subject to constraints of wind speed, cross ventilation, and in the case of hospital wards, proximity of patients to external walls. A buoyancy-driven natural ventilation system capable of achieving dilution/mixing was shown to be feasible in a preceding study of novel system called natural personalised ventilation (NPV. This system combined both architecture and airflow engineering principles of space design and buoyancy and was tested and validated (salt-bath experiment for a single bed ward. This research extends the previous work and is proof-of-concept on the feasibility of NPV system for multi-bed wards. Two different four-bed ward types were investigated of using computational fluid dynamics (CFD simulations under wind-neutral conditions. Results predict that NPV system could deliver fresh air to multiple patients, including those located 10 m away from external wall, with absolute flow rates of between 32 L·s−1 and 54 L·s−1 for each patient/bed. Compared to same wards simulated using window design, ingress of airborne contaminants into patients’ breathing zone and summer overheating potential were minimised, while overall ward dilution was maximised. Findings suggest the NPV has potentials for enabling architects and building service engineers to decouple airflow delivery from the visualisation and illumination responsibilities placed upon windows.

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

    Science.gov (United States)

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

    2015-12-11

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

  9. Sleep quality and mood in mothers and fathers accommodated in the family-centred paediatric ward.

    Science.gov (United States)

    Angelhoff, Charlotte; Edéll-Gustafsson, Ulla; Mörelius, Evalotte

    2018-02-01

    To describe sleep quality and mood in parents accommodated with their sick child in a family-centred paediatric ward. Secondary aims were to compare mothers' and fathers' sleep quality and mood in the paediatric ward and to compare the parents' sleep quality and mood between the paediatric ward and in a daily-life home setting after discharge. Frequent interruptions, ward noise and anxiety affect parents' sleep quality and mood negatively when accommodated with their sick child in paediatric wards. Poor sleep quality and negative mood decrease the parents' ability to sustain attention and focus, and to care for their sick child. This was a prospective and descriptive study. Eighty-two parents (61 mothers and 21 fathers) with children (median age 6.25 years) admitted to six paediatric wards participated in the study. Uppsala Sleep Inventory, a sleep diary and the Mood Adjective Checklist were used to measure sleep quality and mood. The parents had a good sleep quality in the paediatric ward even though they had more nocturnal awakenings compared to home. Moreover, they were less alert, less interested and had reduced concentration, and were more tired, dull and passive in the hospital than at home after discharge. Vital sign checks, noises made by the staff and medical treatment were given reasons influencing sleep. Poor sleep quality correlated with negative mood. Parents' sleep quality in family-centred paediatric care is good. However, the habitual sleep efficacy before admittance to the hospital is lower than expected and needs to be further investigated. The healthcare professionals should acknowledge parents' sleep and mood when they are accommodated with their sick child. Further should care at night be scheduled and sleep promoted for the parents to maintain health and well-being in the family. © 2017 John Wiley & Sons Ltd.

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

    Science.gov (United States)

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

    2016-01-01

    Airborne transmission of pathogenic resistant bacteria is well recognized as an important route for the acquisition of a wide range of nosocomial infections in hospitals. The aim of this study was to determine the prevalence of airborne vancomycin and gentamicin (VM and GM) resistant bacteria in different wards of four educational hospitals. A total of 64 air samples were collected from operating theater (OT), Intensive Care Unit (ICU), surgery ward, and internal medicine ward of four educational hospitals in Isfahan, Iran. Airborne culturable bacteria were collected using all glass impingers. Samples were analyzed for the detection of VM- and GM-resistant bacteria. The average level of bacteria ranged from 99 to 1079 CFU/m(3). The highest level of airborne bacteria was observed in hospital 4 (628 CFU/m(3)) and the highest average concentration of GM- and VM-resistant airborne bacteria were found in hospital 3 (22 CFU/m(3)). The mean concentration of airborne bacteria was the lowest in OT wards and GM- and VM-resistant airborne bacteria were not detected in this ward of hospitals. The highest prevalence of antibiotic-resistant airborne bacteria was observed in ICU ward. There was a statistically significant difference for the prevalence of VM-resistant bacteria between hospital wards (P = 0.012). Our finding showed that the relatively high prevalence of VM- and GM-resistant airborne bacteria in ICUs could be a great concern from the point of view of patients' health. These results confirm the necessity of application of effective control measures which significantly decrease the exposure of high-risk patients to potentially airborne nosocomial infections.

  11. A systematic literature review of Releasing Time to Care: The Productive Ward.

    Science.gov (United States)

    Wright, Stella; McSherry, Wilfred

    2013-05-01

    This systematic review provides an overview of the literature published on Releasing Time to Care: The Productive Ward between 2005 and June 2011. Releasing Time to Care: The Productive Ward programme was developed by the NHS Institute for Innovation and Improvement and launched in England in 2007. The programme comprises thirteen modules that aim to increase time for direct patient care, improve the patient and staff experience and make changes to the ward environment to improve efficiency. A systematic literature review. The terms 'Releasing Time to Care' and 'Productive Ward' were applied to key healthcare databases; CINAHL, Medline, Science Direct, ProQuest, Health Business Elite, British Nursing Index, Embase, Health Management Information Consortium and PsychInfo. All papers were read and subject to a quality assessment. The literature search identified 95 unique sources. A lack of research on The Productive Ward programme meant it was necessary to include non-empirical literature. In total, 18 articles met the inclusion criteria. Seven key themes were identified: the patient and staff experience, direct care time, patient safety, financial impact, embedding and sustainability, executive support and leadership, and common barriers and determinants of success. It also highlighted areas that require further exploration such as long-term sustainability of the programme and consistent data measurement between organisations. The review tentatively reports how The Productive Ward programme has been used to transform nursing practice for the benefit of patients and frontline staff, and how it resulted in cost savings. The literature review identified a potential positive results bias in the current literature whereby favourable outcomes were reported. This paper summarises the types of evidence and current literature on The Productive Ward providing a reference for frontline staff implementing the programme. © 2013 Blackwell Publishing Ltd.

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

    Science.gov (United States)

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

    2013-12-14

    To quantify the consumption of chocolates in a hospital ward environment. Multicentre, prospective, covert observational study. Four wards at three hospitals (where the authors worked) within the United Kingdom. Boxes of Quality Street (Nestlé) and Roses (Cadbury) on the ward and anyone eating these chocolates. Observers covertly placed two 350 g boxes of Quality Street and Roses chocolates on each ward (eight boxes were used in the study containing a total of 258 individual chocolates). These boxes were kept under continuous covert surveillance, with the time recorded when each chocolate was eaten. Median survival time of a chocolate. 191 out of 258 (74%) chocolates were observed being eaten. The mean total observation period was 254 minutes (95% confidence interval 179 to 329). The median survival time of a chocolate was 51 minutes (39 to 63). The model of chocolate consumption was non-linear, with an initial rapid rate of consumption that slowed with time. An exponential decay model best fitted these findings (model R(2)=0.844, P<0.001), with a survival half life (time taken for 50% of the chocolates to be eaten) of 99 minutes. The mean time taken to open a box of chocolates from first appearance on the ward was 12 minutes (95% confidence interval 0 to 24). Quality Street chocolates survived longer than Roses chocolates (hazard ratio for survival of Roses v Quality Street 0.70, 95% confidence interval 0.53 to 0.93, P=0.014). The highest percentages of chocolates were consumed by healthcare assistants (28%) and nurses (28%), followed by doctors (15%). From our observational study, chocolate survival in a hospital ward was relatively short, and was modelled well by an exponential decay model. Roses chocolates were preferentially consumed to Quality Street chocolates in a ward setting. Chocolates were consumed primarily by healthcare assistants and nurses, followed by doctors. Further practical studies are needed.

  13. Assessment of Measurement Tools of Observation Rate of Nursing Handover Standards in Clinical Wards of Hospital

    Directory of Open Access Journals (Sweden)

    Saadi Amini

    2015-08-01

    Full Text Available Background and objectives : In health centers, clinical information of patient is transferred among care staffs regularly. One of the common cases in information transferring is during the time of nurses’ handover in hospital which performing it correctly will help schedule patient care, providing safety and facilitating exact transferring of information. The aim of this study is investigating validity and reliability of assessment of observance rate of shift handover in clinical wards checklist. Material and Methods : In order to determine the reliability of checklist, two experts panel meetings were held with the presence of 10 experts in clinical field that in those meetings the reliability was investigated with discussion and consensus of participants. Checklist validity was investigated through pilot study in 4 wards of 4 hospitals and calculated by Kronbach- alpha method with 28 cases of shifts handover in morning, noon, and night shift. Results : In studying reliability, the primary checklist was divided into two checklists: patient handover, equipments and ward handover that included 27 and 72 items, respectively. The reliability of patient handover checklist was verified with 0.9155 Kronbach-alpha and that of equipments and ward handover was verified with 0.8779 Kronbach-alpha. Conclusion : Verifying checklists by mentioned scientific and statistical methods showed that these are very powerful instruments that can be used as one of the assessment tools of shift handover in clinical wards to be used towards promoting received services by customers of healthcare system.

  14. Comparison of student learning in the out-patient clinic and ward round.

    Science.gov (United States)

    Davis, M H; Dent, J A

    1994-05-01

    In undergraduate medical education there is a trend away from ward-based teaching towards out-patient and community-based teaching. To study the potential effects of this altered emphasis on student learning, a pilot group of final-year medical students at the University of Dundee was asked to keep individual structured log-books. These contained details of patients seen during their 3-week orthopaedic attachment in both a ward and out-patient setting. A comparison of perceived learning in the two settings showed that students learned more from attending an out-patient clinic than a ward round, but did not make full use of the learning potential of either. The setting did not particularly influence the balance of learning as categorized here but only the ward round supplied experience of surgical complications. The amount of learning taking place in an out-patient clinic was influenced by student ability, measured by examination performance, but not by clinic work-load. The implications of increased use of out-patient clinics and the advantages and disadvantages of the approach employed are discussed. It is concluded that in the situation studied student learning in the outpatient setting is as good as or superior to the ward setting but should not totally replace it.

  15. Measuring dynamic social contacts in a rehabilitation hospital: effect of wards, patient and staff characteristics.

    Science.gov (United States)

    Duval, Audrey; Obadia, Thomas; Martinet, Lucie; Boëlle, Pierre-Yves; Fleury, Eric; Guillemot, Didier; Opatowski, Lulla; Temime, Laura

    2018-01-26

    Understanding transmission routes of hospital-acquired infections (HAI) is key to improve their control. In this context, describing and analyzing dynamic inter-individual contact patterns in hospitals is essential. In this study, we used wearable sensors to detect Close Proximity Interactions (CPIs) among patients and hospital staff in a 200-bed long-term care facility over 4 months. First, the dynamic CPI data was described in terms of contact frequency and duration per individual status or activity and per ward. Second, we investigated the individual factors associated with high contact frequency or duration using generalized linear mixed-effect models to account for inter-ward heterogeneity. Hospital porters and physicians had the highest daily number of distinct contacts, making them more likely to disseminate HAI among individuals. Conversely, contact duration was highest between patients, with potential implications in terms of HAI acquisition risk. Contact patterns differed among hospital wards, reflecting varying care patterns depending on reason for hospitalization, with more frequent contacts in neurologic wards and fewer, longer contacts in geriatric wards. This study is the first to report proximity-sensing data informing on inter-individual contacts in long-term care settings. Our results should help better understand HAI spread, parameterize future mathematical models, and propose efficient control strategies.

  16. Barriers to nurse-patient communication in cardiac surgery wards: a qualitative study.

    Science.gov (United States)

    Shafipour, Vida; Mohammad, Eesa; Ahmadi, Fazlollah

    2014-08-15

    An appropriate and effective nurse-patient communication is of the most important aspect of caring. The formation and continuation of such a relationship depends on various factors such as the conditions and context of communication and a mutual understanding between the two. A review of the literature shows that little research is carried out on identification of such barriers in hospital wards between the patients and the healthcare staff. The present study was therefore conducted to explore the experiences of nurses and patients on communication barriers in hospital cardiac surgery wards. This qualitative research was carried out using a content analysis method (Graneheim & Lundman, 2004). The participants were selected by a purposeful sampling and consist of 10 nurses and 11 patients from the cardiac surgery wards of three teaching hospitals in Tehran, Iran. Data was gathered by unstructured interviews. All interviews were audio-taped and transcribed verbatim. Findings were emerged in three main themes including job dissatisfaction (with the sub-themes of workload tension and decreased motivation), routine-centered care (with the sub-themes of habitual interventions, routinized and technical interventions, and objective supervision), and distrust in competency of nurses (with the sub-themes of cultural contrast, less responsible nurses, and their apathy towards the patients). Compared to other studies, our findings identified different types of communication barriers depending on the nursing settings. These findings can be used by the ward clinical nursing managers at cardiac surgery wards to improve the quality of nursing care.

  17. Mini outbreak of Kaposi′s varicelliform eruption in skin ward: A study of five cases

    Directory of Open Access Journals (Sweden)

    Rao GRR

    2007-01-01

    Full Text Available Background: Kaposi`s varicelliform eruption (KVE represents widespread cutaneous herpes simplex virus (HSV infection in patients with preexisting dermatoses. Occasionally, this infection can present as a nosocomial infection in skin wards, if adequate bed-spacing and barrier nursing methods are not followed. We are reporting five cases of KVE; four cases acquired the infection in a makeshift ward after admission of the first case in May 2005, due to the renovation work of the regular skin ward. Aim: The purpose of this study is to create clinical awareness about this uncommon dermatologic entity and to stress upon the importance of bed-spacing and barrier nursing in skin wards. Methods: Five cases of KVE, three females and two males with different primary dermatoses (pemphigus foliaceus - one, pemphigus vulgaris - two, paraneoplastic pemphigus - one and toxic epidemal necrolysis - one were included in this study. Diagnosis was made clinically and supported with Tzanck smear and HSV serology. All the cases were treated with oral acyclovir. Results: Four out of five cases of KVE recovered with treatment, one case of extensive pemphigus vulgaris with KVE succumbed to death. Conclusion: Mini outbreaks of KVE can occur in skin wards with inadequate bed-spacing and overcrowding of patients. Therefore adequate bed-spacing, barrier nursing and isolation of suspected cases are mandatory to prevent such life-threatening infections.

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

    Science.gov (United States)

    Bonner, Gwen; McLaughlin, Sue

    2014-05-01

    This article shares findings of work undertaken with a group of mental health ward managers to consider their roles through workshops using an action learning approach. The tensions between the need to balance the burden of administrative tasks and act as clinical role models, leaders and managers are considered in the context of providing recovery-focused services. The group reviewed their leadership styles, broke down the administrative elements of their roles using activity logs, reviewed their working environments and considered how recovery focused they believed their wards to be. Findings support the notion that the ward manager role in acute inpatient settings is at times unmanageable. Administration is one aspect of the role for which ward managers feel unprepared and the high number of administrative tasks take them away from front line clinical care, leading to frustration. Absence from clinical areas reduces opportunities for role modeling good clinical practice to other staff. Despite the frustrations of administrative tasks, overall the managers thought they were supportive to their staff and that their wards were recovery focused.

  19. Social influence on 5-year survival in a longitudinal chemotherapy ward co-presence network.

    Science.gov (United States)

    Lienert, Jeffrey; Marcum, Christopher Steven; Finney, John; Reed-Tsochas, Felix; Koehly, Laura

    2017-09-01

    Chemotherapy is often administered in openly designed hospital wards, where the possibility of patient-patient social influence on health exists. Previous research found that social relationships influence cancer patient's health; however, we have yet to understand social influence among patients receiving chemotherapy in the hospital. We investigate the influence of co-presence in a chemotherapy ward. We use data on 4,691 cancer patients undergoing chemotherapy in Oxfordshire, United Kingdom who average 59.8 years of age, and 44% are Male. We construct a network of patients where edges exist when patients are co-present in the ward, weighted by both patients' time in the ward. Social influence is based on total weighted co-presence with focal patients' immediate neighbors, considering neighbors' 5-year mortality. Generalized estimating equations evaluated the effect of neighbors' 5-year mortality on focal patient's 5-year mortality. Each 1,000-unit increase in weighted co-presence with a patient who dies within 5 years increases a patient's mortality odds by 42% ( β = 0.357, CI:0.204,0.510). Each 1,000-unit increase in co-presence with a patient surviving 5 years reduces a patient's odds of dying by 30% ( β = -0.344, CI:-0.538,0.149). Our results suggest that social influence occurs in chemotherapy wards, and thus may need to be considered in chemotherapy delivery.

  20. Predictors of suicide in the patient population admitted to a locked-door psychiatric acute ward.

    Directory of Open Access Journals (Sweden)

    Roar Fosse

    Full Text Available No prior study appears to have focused on predictors of suicide in the general patient population admitted to psychiatric acute wards. We used a case-control design to investigate the association between suicide risk factors assessed systematically at admission to a locked-door psychiatric acute ward in Norway and subsequent death by suicide.From 2008 to 2013, patients were routinely assessed for suicide risk upon admission to the acute ward with a 17-item check list based on recommendations from the Norwegian Directorate of Health and Social Affairs. Among 1976 patients admitted to the ward, 40 patients, 22 men and 18 women, completed suicide within December 2014.Compared to a matched control group (n = 120, after correction for multiple tests, suicide completers scored significantly higher on two items on the check list: presence of suicidal thoughts and wishing to be dead. An additional four items were significant in non-corrected tests: previous suicide attempts, continuity of suicidal thoughts, having a suicide plan, and feelings of hopelessness, indifference, and/or aggression. A brief scale based on these six items was the only variable associated with suicide in multivariate regression analysis, but its predictive value was poor.Suicide specific ideations may be the most central risk markers for suicide in the general patient population admitted to psychiatric acute wards. However, a low predictive value may question the utility of assessing suicide risk.

  1. Design in mind: eliciting service user and frontline staff perspectives on psychiatric ward design through participatory methods.

    Science.gov (United States)

    Csipke, Emese; Papoulias, Constantina; Vitoratou, Silia; Williams, Paul; Rose, Diana; Wykes, Til

    2016-01-01

    Psychiatric ward design may make an important contribution to patient outcomes and well-being. However, research is hampered by an inability to assess its effects robustly. This paper reports on a study which deployed innovative methods to capture service user and staff perceptions of ward design. User generated measures of the impact of ward design were developed and tested on four acute adult wards using participatory methodology. Additionally, inpatients took photographs to illustrate their experience of the space in two wards. Data were compared across wards. Satisfactory reliability indices emerged based on both service user and staff responses. Black and minority ethnic (BME) service users and those with a psychosis spectrum diagnosis have more positive views of the ward layout and fixtures. Staff members have more positive views than service users, while priorities of staff and service users differ. Inpatient photographs prioritise hygiene, privacy and control and address symbolic aspects of the ward environment. Participatory and visual methodologies can provide robust tools for an evaluation of the impact of psychiatric ward design on users.

  2. Implementation of an Electronic Checklist to Improve Patient Handover From Ward to Operating Room

    DEFF Research Database (Denmark)

    Münter, Kristine H; Møller, Thea P; Østergaard, Doris

    2017-01-01

    risk factors. The aim of this study was to describe the implementation process and completion rate of a new preoperative, ward-to-OR checklist. Our goal was a 90% fulfillment. METHOD: This study is a prospective, observational study in a Danish University Hospital including all patients undergoing......OBJECTIVE: Research has identified numerous safety risks in perioperative patient handover. In handover from ward to operating room (OR), patients are often transferred by a third person. This adds to the risk of loss of important information and of caregivers in the OR not identifying possible...... surgery in 2013. The checklist was a screen page with 27 checkboxes of information relevant for a safe handover. The checklist should be completed in the ward before handover to the OR and should be checked in the OR before receiving the patient. The Plan-Do-Study-Act (PDSA) cycle method was used...

  3. Participatory Action Research in clinical nursing practice in a medical ward

    DEFF Research Database (Denmark)

    Kjerholt, Mette; Wagner, Lis; Lindhardt, Tove

    2016-01-01

    Background: Action research with a participatory approach (PAR) was used as research design in a medical ward but stopped midway because of lack of active actor participation in the actions. Aim: To describe challenges and barriers influencing lack of participation. Setting: A medical hospital ward......, Denmark. Participants were healthcare staff. Methods: Field observations, interviews, logbook. Data were analysed using content analysis methods. Findings: Multiple factors influenced lack of actor participation. The causes were complex and included: organizational framework, significance/meaning, actor...... roles, responsibility. Conclusion: Before using PAR it is crucial to investigate if the organization and the participants at all levels are suited and agree to participate actively. The findings indicate, that to carry out PAR in a busy medical ward, it is necessary to evaluate whether the necessary...

  4. Situations of Agitation and Violence: the Reality in an Acute Inpatient Ward

    Directory of Open Access Journals (Sweden)

    Fátima Honrado Ferreira

    2013-11-01

    Full Text Available Although aggressiveness/violence is present in all individuals and societies, it may have different manifestations. Even though, on one hand, it is considered innate to Man, on the other it is viewed as a social phenomenon with a cultural, social and historical frames. Violent behaviour in a psychiatric inpatient ward cannot, and should no,t be solely at-tributed to factors that are directly linked to the patient; there is a set of factors that may contribute to a hostile environment within the inpatient ward. The environment in the ward as well as the role of the mental health care professionals, and in particular the role of the nurse, should be taken into account.

  5. Dispersion approach to anomalies in the axial-vector Ward-Takahashi identities

    Energy Technology Data Exchange (ETDEWEB)

    Nishijima, K. Sasaki, R. (Tokyo Univ. (Japan). Dept. of Physic)

    1975-01-01

    On the basis of dispersion relations and unitarity anomalous Ward-Takahashi identities for the axial-vector current are derived in quantum electrodynamics. In this derivation use of divergent unrenormalized expressions is intentionally avoided, and only finite renormalized expressions are employed from the start. The origin of the anormalies is attributed to a mismatch of the subtraction conditions present in the naive Ward-Takahashi identities. The resulting anomalous Ward-Takahashi identities are valid in every order of the perturbation expansion and can be cast in the form of an operator equation. In the course of this derivation we encounter the problem of how to regularize operator products and a possible solution of this problem is provided in terms of subtraction conditions.

  6. The notion of participatory democracy in relation to local ward committees: The distribution of power

    Directory of Open Access Journals (Sweden)

    Leepo J. Modise

    2017-10-01

    Full Text Available This article comprises four important parts: first, the two important components of democracy, namely participatory and non-participatory or representative democracy will be discussed with special reference to the distribution of powers. Second, it will address the roles and responsibilities of ward committees within the democratic society. Third, the ethical question of the basis of the committee members’ capacity to serve on the ward committees in relation to coercive leadership (tyranny of the majority will be investigated. Fourth, the theological standpoint on the distribution of powers or participatory democracy and the role of the church to improve participatory democracy will be discussed. The research question is the following: What can be done by the country to improve participatory democracy in South Africa, through engagement with ward committees?

  7. Validation of a checklist to assess ward round performance in internal medicine

    DEFF Research Database (Denmark)

    Nørgaard, Kirsten; Ringsted, Charlotte; Dolmans, Diana

    2004-01-01

    and construct validity of the task-specific checklist. METHODS: To determine content validity, a questionnaire was mailed to 295 internists. They were requested to give their opinion on the relevance of each item included on the checklist and to indicate the comprehensiveness of the checklist. To determine...... construct validity, an observer assessed 4 groups of doctors during performance of a complete ward round (n = 32). The nurse who accompanied the doctor on rounds made a global assessment of the performance. RESULTS: The response rate to the questionnaire was 80.7%. The respondents found that all 10 items......BACKGROUND: Ward rounds are an essential responsibility for doctors in hospital settings. Tools for guiding and assessing trainees' performance of ward rounds are needed. A checklist was developed for that purpose for use with trainees in internal medicine. OBJECTIVE: To assess the content...

  8. Dispersion approach to anomalies in the axial-vector Ward-Takahashi identities

    International Nuclear Information System (INIS)

    Nishijima, Kazuhiko; Sasaki, Ryu

    1975-01-01

    On the basis of dispersion relations and unitarity anomalous Ward-Takahashi identities for the axial-vector current are derived in quantum electrodynamics. In this derivation use of divergent unrenormalized expressions is intentionally avoided, and only finite renormalized expressions are employed from the start. The origin of the anormalies is attributed to a mismatch of the subtraction conditions present in the naive Ward-Takahashi identities. The resulting anomalous Ward-Takahashi identities are valid in every order of the perturbation expansion and can be cast in the form of an operator equation. In the course of this derivation we encounter the problem of how to regularize operator products and a possible solution of this problem is provided in terms of subtraction conditions. (auth.)

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

    Science.gov (United States)

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

    2016-01-01

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

  10. Canonical symmetry of a constrained Hamiltonian system and canonical Ward identity

    International Nuclear Information System (INIS)

    Li, Zi-ping

    1995-01-01

    An algorithm for the construction of the generators of the gauge transformation of a constrained Hamiltonian system is given. The relationships among the coefficients connecting the first constraints in the generator are made clear. Starting from the phase space generating function of the Green function, the Ward identity in canonical formalism is deduced. We point out that the quantum equations of motion in canonical form for a system with singular Lagrangian differ from the classical ones whether Dirac's conjecture holds true or not. Applications of the present formulation to the Abelian and non-Abelian gauge theories are given. The expressions for PCAC and generalized PCAC of the AVV vertex are derived exactly from another point of view. A new form of the Ward identity for gauge-ghost proper vertices is obtained which differs from the usual Ward-Takahashi identity arising from the BRS invariance

  11. Light-front zero-mode contribution to the Ward Identity

    International Nuclear Information System (INIS)

    Sales, J.H.O.; Suzuki, A.T.

    2010-01-01

    In a covariant gauge we implicitly assume that the Green's function propagates information from one point of the space-time to another, so that the Green's function is responsible for the dynamics of the relativistic particle. In the light front form one would naively expect that this feature would be preserved. In this manner, the fermionic field propagator can be split into a propagating piece and a non-propagating ('contact') term. Since the latter ('contact') one does not propagate information, and therefore, supposedly can be discarded with no harm to the field dynamics we wanted to know what would be the impact of dropping it off. To do that, we investigated its role in the Ward identity in the light front. Here we use the terminology Ward identity to identify the limiting case of photon's zero momentum transfer in the vertex from the more general Ward-Takahashi identity with nonzero momentum transfer.

  12. External equivalent type Ward aiming optimization studies in power systems; Equivalentes externos tipo Ward visando estudos de otimizacao em sistemas de potencia

    Energy Technology Data Exchange (ETDEWEB)

    Nepomuceno, Leonardo

    1993-07-01

    The execution of functions such as contingency analysis, optimization, reactive dispatch, etc, at the control centers requires appropriate models representing the non-observable parts (external system). The classical external equivalents have been developed considering basically the contingency analysis. This work points out the performance of the Extended Ward Equivalent (W.E.), which currently represents the state of art concerning reduced circuit based models. the work analyzes the W.E. response to changes occurred in optimization studied. Moreover, a new model, named INTERNAL REACTIVE WARD (WRINT), resulting from an adaptation of the W.E. is proposed focusing on the improvement of the equivalent in case of changes occurs in optimization studies. The model's general idea is to reflect the equivalent's capacity of reactive response into the internal system. Comparative computational test results are shown. The details of routines implementation are also pointed out. (author)

  13. External equivalent type Ward aiming optimization studies in power systems; Equivalentes externos tipo Ward visando estudos de otimizacao em sistemas de potencia

    Energy Technology Data Exchange (ETDEWEB)

    Nepomuceno, Leonardo

    1993-07-01

    The execution of functions such as contingency analysis, optimization, reactive dispatch, etc, at the control centers requires appropriate models representing the non-observable parts (external system). The classical external equivalents have been developed considering basically the contingency analysis. This work points out the performance of the Extended Ward Equivalent (W.E.), which currently represents the state of art concerning reduced circuit based models. the work analyzes the W.E. response to changes occurred in optimization studied. Moreover, a new model, named INTERNAL REACTIVE WARD (WRINT), resulting from an adaptation of the W.E. is proposed focusing on the improvement of the equivalent in case of changes occurs in optimization studies. The model's general idea is to reflect the equivalent's capacity of reactive response into the internal system. Comparative computational test results are shown. The details of routines implementation are also pointed out. (author)

  14. Comparative study of the prevalence of sepsis in patients admitted to dermatology and internal medicine wards*

    Science.gov (United States)

    Almeida, Luiz Maurício Costa; Diniz, Michelle dos Santos; Diniz, Lorena dos Santos; Machado-Pinto, Jackson; Silva, Francisco Chagas Lima

    2013-01-01

    BACKGROUND Sepsis is a common cause of morbidity and mortality among hospitalized patients. The prevalence of this condition has increased significantly in different parts of the world. Patients admitted to dermatology wards often have severe loss of skin barrier and use systemic corticosteroids, which favor the development of sepsis. OBJECTIVES To evaluate the prevalence of sepsis among patients admitted to a dermatology ward compared to that among patients admitted to an internal medicine ward. METHODS It is a cross-sectional, observational, comparative study that was conducted at Hospital Santa Casa de Belo Horizonte. Data were collected from all patients admitted to four hospital beds at the dermatology and internal medicine wards between July 2008 and July 2009. Medical records were analyzed for the occurrence of sepsis, dermatologic diagnoses, comorbidities, types of pathogens and most commonly used antibiotics. RESULTS We analyzed 185 medical records. The prevalence of sepsis was 7.6% among patients admitted to the dermatology ward and 2.2% (p = 0.10) among those admitted to the internal medicine ward. Patients with comorbidities, diabetes mellitus and cancer did not show a higher incidence of sepsis. The main agent found was Staphylococcus aureus, and the most commonly used antibiotics were ciprofloxacin and oxacillin. There was a significant association between sepsis and the use of systemic corticosteroids (p <0.001). CONCLUSION It becomes clear that epidemiological studies on sepsis should be performed more extensively and accurately in Brazil so that efforts to prevent and treat this serious disease can be made more effectively. PMID:24173179

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

    Science.gov (United States)

    Zaman, Shahaduz

    2004-11-01

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

  16. Prevalence of Nosocomial Infection in Different Wards of Ghaem Hospital, Mashhad

    Directory of Open Access Journals (Sweden)

    Jamal Falahi

    2017-04-01

    Full Text Available Background The CDC defines a nosocomial infection as a localized or systemic condition caused by an adverse reaction to the presence of an infectious agent(s or its toxin(s. It is an infection that occurs between 48 to 72 hours after admission of patients in the hospital or as soon after the hospital discharge and on the admission time, patients don't have this infection. Objectives This study aimed to characterize the prevalence of nosocomial infection in Ghaem hospital, Mashhad, Iran. Methods This retrospective study was conducted in all wards of the Ghaem hospital, Mashhad during the 1 year period (2013; the data were collected from the wards records and HIS system and analyzed by the SPSS software (version16. Results In the present study, of total 35979 hospitalized patients in different wards of the Ghaem hospital was reported 1.1% of nosocomial infection. In the meantime, overall, the most prevalent organism was Acinetobacter baumannii with a prevalence of 37.2% and the minimum was linked to the Bacillus species with a prevalence 0.3%. The highest and lowest prevalence of the nosocomial infection was in the ICU and CCU with 49.9% and 0.3%, respectively. In general, among all wards of the mentioned hospital, the most frequent nosocomial infection was pneumonia (47.4% and the lowest belonged to CSF (2.3%. Conclusions In our study, the ICU ward was accounted for the highest rate of nosocomial infection, due to the critical importance of this ward. Preventive measures and survivelance system for reduction of nosocomial infections is needed.

  17. Safety and security in acute admission psychiatric wards in Ireland and London: a comparative study.

    Science.gov (United States)

    Cowman, Seamus; Bowers, Len

    2009-05-01

    The comparative element of this study is to describe safety and security measures in psychiatric acute admission wards in the Republic of Ireland and London; to describe differences and similarities in terms of safety and security patterns in the Republic of Ireland and London; and to make recommendations on safety and security to mental health services management and psychiatric nurses. Violence is a serious problem in psychiatric services and staff experience significant psychological reactions to being assaulted. Health and Safety Authorities in the UK and Ireland have expressed concern about violence and assault in healthcare, however, there remains a lack of clarity on matters of procedure and policy pertaining to safety and security in psychiatric hospitals. A descriptive survey research design was employed. Questionnaires were circulated to all acute wards in London and in Ireland and the resulting data compared. A total of 124 psychiatric wards from London and 43 wards from Ireland were included in this study and response rates of 70% (London) and 86% (Ireland) were obtained. Differences and similarities in safety and security practices were identified between London and Ireland, with Irish wards having generally higher and more intensive levels of security. There is a lack of coherent policy and procedure in safety and security measures across psychiatric acute admission wards in the Republic of Ireland and London. Given the trends in European Union (EU) regulation, there is a strong argument for the publication of acceptable minimum guidelines for safety and security in mental health services across the EU. There must be a concerted effort to ensure that all policy and procedure in safety and security is founded on evidence and best practice. Mental health managers must establish a review of work safety and security procedures and practices. Risk assessment and environmental audits of all mental health clinical environments should be mandatory.

  18. Care practices of older people with dementia in the surgical ward: A questionnaire survey

    Directory of Open Access Journals (Sweden)

    Nina Hynninen

    2016-11-01

    Full Text Available Objectives: The objective of this study was to describe the care practices of nursing staff caring older people with dementia in a surgical ward. Methods: The data were collected from nursing staff (n = 191 working in surgical wards in one district area in Finland during October to November 2015. Data were collected using a structured questionnaire and analyzed statistically. The instrument consists of a total number of 141 items and four dimensions. The dimensions were as follows: background information (12 of items, specific characteristics of older people with dementia in a surgical ward (24 of items, specific characteristics of their care in a surgical ward (66 of items and use of physical restraints and alternative models for use of restraints for people with dementia (39 of items. Results: The questions which measure the nursing staff’s own assessment of care practices when caring for people with dementia in surgical wards were selected: counseling people with dementia, reaction when a surgical patient with dementia displays challenging behavior and use of alternative approach instead of physical restraints. Most commonly the nursing staff pay attention to patient’s state of alertness before counseling older people with dementia. Instead of using restraints, nursing staff gave painkillers for the patient and tried to draw patients’ attention elsewhere. The nursing staff with longer work experience estimate that they can handle the patients’ challenging behavior. They react by doing nothing more often than others. They pretend not to hear, see or notice anything. Conclusion: The findings of this study can be applied in nursing practice and in future studies focusing on the care practices among older people with dementia in acute care environment. The results can be used while developing patient treatments process in surgical ward to meet future needs.

  19. Does doctors’ workload impact supervision and ward activities of final-year students? A prospective study

    Directory of Open Access Journals (Sweden)

    Celebi Nora

    2012-06-01

    Full Text Available Abstract Background Hospital doctors face constantly increasing workloads. Besides caring for patients, their duties also comprise the education of future colleagues. The aim of this study was to objectively investigate whether the workload arising from increased patient care interferes with student supervision and is associated with more non-medical activities of final-year medical students. Methods A total of 54 final-year students were asked to keep a diary of their daily activities over a three-week period at the beginning of their internship in Internal Medicine. Students categorized their activities – both medical and non-medical - according to whether they had: (1 only watched, (2 assisted the ward resident, (3 performed the activity themselves under supervision of the ward resident, or (4 performed the activity without supervision. The activities reported on a particular day were matched with a ward specific workload-index derived from the hospital information system, including the number of patients treated on the corresponding ward on that day, a correction factor according to the patient comorbidity complexity level (PCCL, and the number of admissions and discharges. Both students and ward residents were blinded to the study question. Results A total of 32 diaries (59 %, 442 recorded working days were handed back. Overall, the students reported 1.2 ± 1.3 supervised, 1.8 ±1.6 medical and 3.6 ± 1.7 non-medical activities per day. The more supervised activities were reported, the more the number of reported medical activities increased (p  Conclusions There was a significant association between ward doctors’ supervision of students and the number of medical activities performed by medical students. The workload had no significant effect on supervision or the number of medical or non-medical activities of final-year students.

  20. Doctors' and nurses' perceptions of a ward-based pharmacist in rural northern Sweden.

    Science.gov (United States)

    Sjölander, Maria; Gustafsson, Maria; Gallego, Gisselle

    2017-08-01

    Background This project is part of the prospective quasi experimental proof-of-concept investigation of clinical pharmacist intervention study to reduce drug-related problems among people admitted to a ward in a rural hospital in northern Sweden. Objective To explore doctors' and nurses' perceptions and expectations of having a ward-based pharmacist providing clinical pharmacy services. Setting Medical ward in a rural hospital in northern Sweden. Method Eighteen face-to-face semi-structured interviews were conducted with a purposive sample of doctors and nurses working on the ward where the clinical pharmacy service was due to be implemented. Semi-structured interviews were digitally recorded, transcribed and analysed using thematic analysis. Main outcome measure Perceptions and expectations of nurses and doctors. Results Doctors and nurses had limited experience of working with pharmacists. Most had a vague idea of what pharmacists can contribute within a ward setting. Participants, mainly nurses, suggested inventory and drug distribution roles, but few were aware of the pharmacists' skills and clinical competence. Different views were expressed on whether the new clinical pharmacy service would have an impact on workload. However, most participants took a positive view of having a ward-based pharmacist. Conclusion This study provided an opportunity to explore doctors' and nurses' expectations of the role of clinical pharmacists before a clinical pharmacy service was implemented. To successfully implement a clinical pharmacy service, roles, clinical competence and responsibilities should be clearly described. Furthermore, it is important to focus on collaborative working relationships between doctors, nurses and pharmacists.

  1. The management pattern carried out in a cataract surgery day ward.

    Science.gov (United States)

    Lin, Jing; Fang, Xiaoqun; Wu, Suhong

    2013-06-01

    To evaluate the management practice and process of a cataract surgery day ward. From January to December in 2012, a portion of the cataract patients were evaluated for the pattern of day ward management. Methods were as follows: 1) Establish the cataract day ward. 2) Enroll the patients who met the following criteria: voluntary, local residents or outsiders who stayed in a hotel near the hospital, accompanied by family, and who had simple senile cataract without any systemic major diseases. 3) Establish the hospitalization process. 4) Analyze the nursing process. After cataract day surgery, the patients were followed for 2 hours and completed a questionnaire about their needs and sentiments. A total of 3971 cases were observed in this study; 49 cases were switched to a normal pattern of hospitalization because of operative complications, 1 case had a strong desire to switch to a normal pattern of hospitalization because of ocular discomfort, 8 cases went back to the hospital for treatment because of ocular pain, and 52 cases called on the phone to seek help. Overall, 3820 cases(96.2%) returned on time the next day to visit the doctor. No patients showed severe postoperative complications and 98% expressed great satisfaction with the day ward process. Only 200 cases expressed great concern about not knowing how to deal with postoperative pain, the changes in condition outside the hospital, the therapeutic effects, and the problem of expense reimburse-ment. Day ward cataract surgery is an efficient and safe mode, and has the potential to relieve the demand for inpatient beds and to ensure timely treatment of the patients. In addition, it helps the patients enjoy health care at public expense, reserving reimbursement for those who need to be hospitalized. Nurses should pay more attention to systemic evaluation of the patients, health education, and psychological guidance, and keep in close communication with doctors, which is the key to ensure the safety of day ward

  2. Cross-year peer tutoring on internal medicine wards: results of a qualitative focus group analysis

    Directory of Open Access Journals (Sweden)

    Krautter M

    2014-09-01

    Full Text Available Markus Krautter,1 Sven Andreesen,2 Nadja Köhl-Hackert,2 Katja Hoffmann,3 Wolfgang Herzog,2 Christoph Nikendei2 1Department of Nephrology, University of Heidelberg, 2Department of General Internal Medicine and Psychosomatics, University of Heidelberg Medical Hospital, 3Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany Background: Peer-assisted learning (PAL has become a well-accepted teaching method within medical education. However, descriptions of on-ward PAL programs are rare. A focus group analysis of a newly established PAL program on an internal medicine ward was conducted to provide insights into PAL teaching from a student perspective.Purpose: To provide insights into students' experiences regarding their on-ward training with and without accompanying PAL tutors.Methods: A total of N=168 medical students in their sixth semester participated in the investigation (intervention group: N=88; control group: N=80. The intervention group took part in the PAL program, while the control group received standard on-ward training. There were seven focus groups with N=43 participants (intervention group: four focus groups, N=28 participants; control group: three focus groups, N=15 participants. The discussions were analyzed using content analysis.Results: The intervention group emphasized the role of the tutors as competent and well-trained teachers, most beneficial in supervising clinical skills. Tutors motivate students, help them to integrate into the ward team, and provide a non-fear-based working relationship whereby students' anxiety regarding working on ward decreases. The control group had to rely on autodidactic learning strategies when neither supervising physicians nor final-year students were available.Conclusion: On-ward PAL programs represent a particularly valuable tool for students' support in training clinical competencies on ward. The tutor–student working alliance

  3. Quality assessment of emergency wards in Khorramabad public hospitals based on EFQM model

    Directory of Open Access Journals (Sweden)

    mohammad hasan Imani-Nasab

    2012-12-01

    Conclusion: Findings show that quality of studied wards is less than the model standards and other similar studies considerably. From view point of the researcher the existing gap with external studies is logical and in comparison with internal studies is irrational. The studied wards acquired the most score in process criterion and the least score in policy and strategy criterion. Also ,findings shows a negative relation between results of assessment based on EFQM model and current evaluation system of the ministry of health, so it is suggested that the current system should be revised fundamenally.

  4. Do daily ward interviews improve measurement of hospital quality and safety indicators? A prospective observational study.

    Science.gov (United States)

    Sarkies, Mitchell N; Bowles, Kelly-Ann; Skinner, Elizabeth H; Haas, Romi; Mitchell, Deb; O'Brien, Lisa; May, Kerry; Ghaly, Marcelle; Ho, Melissa; Haines, Terry P

    2016-10-01

    The aim of this study was to determine if the addition of daily ward interview data improves the capture of hospital quality and safety indicators compared with incident reporting systems alone. An additional aim was to determine the potential characteristics influencing under-reporting of hospital quality and safety indicators in incident reporting systems. A prospective, observational study was performed at two tertiary metropolitan public hospitals. Research assistants from allied health backgrounds met daily with the nurse in charge of the ward and discussed the occurrence of any falls, pressure injuries and rapid response medical team calls. Data were collected from four general medical wards, four surgical wards, an orthopaedic, neurosciences, plastics, respiratory, renal, sub-acute and acute medical assessment unit. An estimated total of 303 falls, 221 pressure injuries and 884 rapid response medical team calls occurred between 15 wards across two hospitals, over a period of 6 months. Hospital incident reporting systems underestimated falls by 30.0%, pressure injuries by 59.3% and rapid response medical team calls by 17.0%. The use of ward interview data collection in addition to hospital incident reporting systems improved data capture of falls by 23.8% (n = 72), pressure injuries by 21.7% (n = 48) and rapid response medical team calls by 12.7% (n = 112). Falls events were significantly less likely to be reported if they occurred on a Monday (P = 0.04) and pressure injuries significantly more likely to be reported if they occurred on a Wednesday (P = 0.01). Hospital quality and safety indicators (falls, pressure injuries and rapid response medical team calls) were under-reported in incident reporting systems, with variability in under-reporting between wards and the day of event occurrence. The use of ward interview data collection in addition to hospital incident reporting systems improved reporting of hospital quality and safety

  5. Hepatitis B antigen HB Ag examination by radioimmunological method in a hemodialysis ward

    Energy Technology Data Exchange (ETDEWEB)

    Opatrny, K; Karlicek, V; Topolcan, O; Farnik, J [Karlova Universita, Plzen (Czechoslovakia). Lekarska Fakulta; Kulich, V [Transfuzni oddeleni FN, Plzen (Czechoslovakia)

    1975-11-07

    The results are reported of regular examinations for the so-called Australian antigen of patients, medical personnel, and of equipment and working surfaces in the hemodialysis ward of the Plzen university hospital using the Ling and Overby method by the Ausria-125 and Ausria II kits by Abbott. It was found that the radioimmunological method was more sensitive than methods previously used and that it allowed for early ascertainment of contamination, thus reducing nosocomial and professional infections and reducing the occurrence of the disease in the ward.

  6. Measurements of Radon Concentration in Several Wards of the University Clinical Center of Kosovo...

    OpenAIRE

    , Y. Halimi; , S. Kadiri; , G. Hodolli; , B. Xhafa; , A. Jonuzaj

    2016-01-01

    Understanding that what’s the level of environment pollution from radioactive pollutant in some wards of UCCK (University Clinical Center of Kosovo) in Prishtina are made measurements of α radiation which is the product of 222Rn and have been read doses of TLD to some staff workers in three wards of UCCK. All this is done to see the risk level of possible pollution. Concentration of radon 222Rn is measured with device CRM-510 portable instruments. During the measurements the apparatus has rec...

  7. Ward identities and differential equations for supercharacters of N = 1 super-Kac-Moody algebras on supertorus

    International Nuclear Information System (INIS)

    Huang Chaoshang; Xu Kaiwen; Zhao Zhiyong.

    1989-09-01

    By using Bernard's method, the Ward identities for N = 1 super-Kac-Moody algebras on supertorus are completely given in the sense that any correlation function with currents inserted in it can be reduced from the correlation functions without insertion. The differential equations for the super-characters on supertorus are derived from the Ward identities. (author). 7 refs

  8. Changes in Emotion Work at Interdisciplinary Conferences Following Clinical Supervision in a Palliative Outpatient Ward

    DEFF Research Database (Denmark)

    Nordentoft, Helle Merete

    2008-01-01

    In this article, I describe changes in emotion work at weekly interdisciplinary conferences in a palliative1 outpatient ward following clinical supervision (CS). I conceive emotions as constantly negotiated in interaction, and I researched the similarity between how this is done during CS and at ...... conclude that CS enhances professional development and may prevent burnout in palliative care....

  9. As His Day in Court Arrives, Ward Churchill Is Depicted in Sharply Different Lights

    Science.gov (United States)

    Schmidt, Peter

    2009-01-01

    The trial in Ward Churchill's lawsuit against the University of Colorado got under way here last week with lawyers for the opposing sides painting starkly different pictures of both the controversial ethnic-studies professor and the circumstances surrounding his dismissal by the university in 2007. In delivering their opening remarks in a crowded…

  10. Audit of a ward-based patient-controlled epidural analgesia service in Ireland.

    LENUS (Irish Health Repository)

    Tan, T

    2012-02-01

    BACKGROUND: Ward-based patient-controlled epidural analgesia (PCEA) for postoperative pain control was introduced at our institution in 2006. We audited the efficacy and safety of ward-based PCEA from January 2006 to December 2008. METHOD: Data were collected from 928 patients who received PCEA in general surgical wards for postoperative analgesia using bupivacaine 0.125% with fentanyl 2 mug\\/mL. RESULTS: On the first postoperative day, the median visual analogue pain score was 2 at rest and 4 on activity. Hypotension occurred in 21 (2.2%) patients, excessive motor blockade in 16 (1.7%), high block in 5 (0.5%), nausea in 5 (0.5%) and pruritus in only 1 patient. Excessive sedation occurred in two (0.2%) patients but no intervention was required. There were no serious complications such as epidural abscess, infection or haematoma. CONCLUSION: Effective and safe postoperative analgesia can be provided with PCEA in a general surgical ward without recourse to high-dependency supervision.

  11. Two-particle renormalizations in many-fermion perturbation theory: the importance of the Ward identity

    Czech Academy of Sciences Publication Activity Database

    Janiš, Václav

    2003-01-01

    Roč. 15, - (2003), s. L311-L317 ISSN 0953-8984 R&D Projects: GA ČR GA202/01/0764 Institutional research plan: CEZ:AV0Z1010914 Keywords : Ward identity * electron correlations * conservation laws Subject RIV: BE - Theoretical Physics Impact factor: 1.757, year: 2003

  12. Pain in the nursing home: assessment and treatment on different types of care wards

    NARCIS (Netherlands)

    Achterberg, W.P.; Pot, A.M.; Scherder, E.J.A.; Ribbe, M.W.

    2007-01-01

    The assessment and management of pain in nursing homes have been shown to be suboptimal, but no study has evaluated differences in clinical setting within these homes. The prevalence and management of pain on different care wards (psychogeriatric, somatic, and rehabilitation) was studied on 562

  13. Transforming the slum: The case of Mumbai's M-Ward | IDRC ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    2016-12-13

    Dec 13, 2016 ... Mumbai, India's largest and wealthiest city, is a study in contrasts: it is rich and ... of state corruption and collusion with private sector developers. ... the Slum through Creation of Property Market: A Case Study of M-Ward in ...

  14. Knowledge and awareness of high blood pressure in Ward F, Ifako ...

    African Journals Online (AJOL)

    Objectives: In Nigeria, most people living with an elevated blood pressure are unaware of it until they suffer complications. The aim of this study was to determine levels of awareness of high blood pressure in Ward F, Ifako-Ijaiye local government area, Lagos, Nigeria. Design: A multistage sampling technique was used to ...

  15. HRM and strategic climates in hospitals: does the message come accross at the ward level?

    NARCIS (Netherlands)

    Veld, M.; Paauwe, J.; Boselie, J.P.P.E.F.

    2010-01-01

    This study examined how employees perceive intended strategic goals and HRM at the ward level, and if these perceptions generate the desired effects. The qualitative part of the research reveals that the hospital pursues two strategic goals (i.e. quality and safety). Analysis of the questionnaire

  16. Eliciting Patients’ Health Concerns in Consulting Rooms and Wards in Vietnamese Public Hospitals

    Directory of Open Access Journals (Sweden)

    Huong Thi Linh Nguyen

    2018-03-01

    Full Text Available This article examines the doctor’s elicitation of the patient’s presenting health concern in two clinical settings in the Vietnamese public hospital system: the consulting room and the ward. The data were taken from 66 audio-recorded consultations. Our analysis shows that the elicitors used by the doctor in the consulting room often communicate a weak epistemic stance towards the patient’s health issue, while those used in the ward tend to signal a strong epistemic stance. In addition, this contrast between the elicitors employed in the consulting room and the ward is evident in our data regardless of whether the consultation is a first visit or a same follow-up (in which the doctor is the same one that treated the patient on their last visit, though the contrast is less clear for different follow-ups (in which the doctor has not treated the patient before. An additional finding is that the clinical setting has some bearing on the use of inappropriate elicitation formats (in which the doctor opens the visit with an elicitor which is more appropriate for another type of visit. The precise way in which each of the consulting room and the ward operates is, of course, a feature of the Vietnamese public hospital system itself. Hence, the overall contrast between the elicitors and elicitation formats used in these two settings illustrates how, on a more general level, the institutional context can have an impact on doctor-patient communication.

  17. Pattern of Morbidity and Mortality in a Children's Ward – the Awka ...

    African Journals Online (AJOL)

    Pattern of morbidity and mortality in children in a hospital setting is essential because it serves as a guide to what happens in the larger society. By these findings, health facilities could be modified and improved upon for better management of those cases. To document the pattern of morbidity and mortality in children's ward ...

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

    Science.gov (United States)

    Byrd, Jodi A.

    2007-01-01

    In an attempt to understand how rival narratives of genocide compete even at the cost of disavowing other historical experiences, this article considers how the U.S. national media represented and framed Red Lake in the wake of Ward Churchill's emergence on the national radar. The first section of this article examines how nineteenth-century…

  19. Surveillance for hospital-acquired infections on surgical wards in a Dutch university hospital

    NARCIS (Netherlands)

    Kamp-Hopmans, Titia E. M.; Blok, Hetty E. M.; Troelstra, Annet; Gigengack-Baars, Ada C. M.; Weersink, Annemarie J. L.; Vandenbroucke-Grauls, Christina M. J. E.; Verhoef, Jan; Mascini, Ellen M.

    2003-01-01

    OBJECTIVES: To determine incidence rates of hospital-acquired infections and to develop preventive measures to reduce the risk of hospital-acquired infections. METHODS: Prospective surveillance for hospital-acquired infections was performed during a 5-year period in the wards housing general and

  20. [Project to improve abdominal obesity in day care ward psychiatric patients].

    Science.gov (United States)

    Liu, Yu-Chieh; Wang, Hui-Yu; Huang, Hui-Ling; Chen, Min-Li

    2011-06-01

    Over half (57.14%) of patients in our ward suffer from abdominal obesity. This rate is on a continuing upward trend. Reasons for such obesity include lack of physical activity classes, inadequate physical activity, high calorie diets and unhealthy eating habits, chronic diseases and drug side effects, poor motivation to reduce weight, and lack of crisis awareness of abdominal obesity. This project was designed to lessen the problem of abdominal obesity among psychiatric day care inpatients. Resolution measures implemented included: (1) arranging aerobic exercise classes; (2) scheduling classes to teach patients healthy diet habits and knowledge regarding diseases and drugs; (3) holding a waistline reduction competition; (4) displaying health education bulletin boards; (5) holding a quiz contest with prizes for correct answers. The eight abdominally obese patients in the ward achieved an average waist circumference reduction of 2.9 cm and the overall abdominal obesity rate in the ward fell to 35.7%. BMI, eating habits, and awareness of weight loss importance and motivation all improved. The outcome achieved targeted project objectives. We recommend the integration of obesity prevention into routine ward activities and quality control indicators. Nurses should provide patients with weight loss concepts, regularly monitor risk factors, and encourage patient family cooperation to maintain medical care quality.

  1. Factors impacting perceived safety among staff working on mental health wards.

    Science.gov (United States)

    Haines, Alina; Brown, Andrew; McCabe, Rhiannah; Rogerson, Michelle; Whittington, Richard

    2017-09-01

    Safety at work is a core issue for mental health staff working on in-patient units. At present, there is a limited theoretical base regarding which factors may affect staff perceptions of safety. This study attempted to identify which factors affect perceived staff safety working on in-patient mental health wards. A cross-sectional design was employed across 101 forensic and non-forensic mental health wards, over seven National Health Service trusts nationally. Measures included an online staff survey, Ward Features Checklist and recorded incident data. Data were analysed using categorical principal components analysis and ordinal regression. Perceptions of staff safety were increased by ward brightness, higher number of patient beds, lower staff to patient ratios, less dayroom space and more urban views. The findings from this study do not represent common-sense assumptions. Results are discussed in the context of the literature and may have implications for current initiatives aimed at managing in-patient violence and aggression. None. © The Royal College of Psychiatrists 2017. This is an open access article distributed under the terms of the Creative Commons Attribution (CC BY) license.

  2. Home births in the Mosvold health ward of KwaZulu | Buchman ...

    African Journals Online (AJOL)

    A community survey was carried out to determine the frequency and the methods of home deliveries in the Mosvold health ward in northern KwaZulu. Of a sample of 210 mothers interviewed 46% had given birth at home, and of these 48% were delivered by traditional birth attendants; 84% gave birth in a kneeling or sitting ...

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

    International Nuclear Information System (INIS)

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

    2008-01-01

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

  4. Differences Between Ward's and UPGMA Methods of Cluster Analysis: Implications for School Psychology.

    Science.gov (United States)

    Hale, Robert L.; Dougherty, Donna

    1988-01-01

    Compared the efficacy of two methods of cluster analysis, the unweighted pair-groups method using arithmetic averages (UPGMA) and Ward's method, for students grouped on intelligence, achievement, and social adjustment by both clustering methods. Found UPGMA more efficacious based on output, on cophenetic correlation coefficients generated by each…

  5. Patient safety ward round checklist via an electronic app: implications for harm prevention.

    Science.gov (United States)

    Keller, C; Arsenault, S; Lamothe, M; Bostan, S R; O'Donnell, R; Harbison, J; Doherty, C P

    2017-11-06

    Patient safety is a value at the core of modern healthcare. Though awareness in the medical community is growing, implementing systematic approaches similar to those used in other high reliability industries is proving difficult. The aim of this research was twofold, to establish a baseline for patient safety practices on routine ward rounds and to test the feasibility of implementing an electronic patient safety checklist application. Two research teams were formed; one auditing a medical team to establish a procedural baseline of "usual care" practice and an intervention team concurrently was enforcing the implementation of the checklist. The checklist was comprised of eight standard clinical practice items. The program was conducted over a 2-week period and 1 month later, a retrospective analysis of patient charts was conducted using a global trigger tool to determine variance between the experimental groups. Finally, feedback from the physician participants was considered. The results demonstrated a statistically significant difference on five variables of a total of 16. The auditing team observed low adherence to patient identification (0.0%), hand decontamination (5.5%), and presence of nurse on ward rounds (6.8%). Physician feedback was generally positive. The baseline audit demonstrated significant practice bias on daily ward rounds which tended to omit several key-proven patient safety practices such as prompting hand decontamination and obtaining up to date reports from nursing staff. Results of the intervention arm demonstrate the feasibility of using the Checklist App on daily ward rounds.

  6. Understanding thermal comfort perception of nurses in a hospital ward work environment.

    NARCIS (Netherlands)

    Derks, M.T.H.; Mishra, A.K.; Loomans, M.G.L.C.; Kort, H.S.M.

    2018-01-01

    In indoor comfort research, thermal comfort of care-professionals in hospital environment is a little explored topic. To address this gap, a mixed methods study, with the nursing staff in hospital wards acting as participants, was undertaken. Responses were collected during three weeks in the summer

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

    Science.gov (United States)

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

    2016-01-01

    There is some research on the impact of open-ward unit design on the health of babies and the stress experienced by parents and nurses in neonatal intensive care units. However, few studies have explored the factors associated with nurse stress and work satisfaction among nurses practicing in open-ward neonatal intensive care units. The purpose of this study was to examine what factors are associated with nurse stress and work satisfaction among nurses practicing in an open-ward neonatal intensive care unit. A cross-sectional correlational design was used in this study. Participants were nurses employed in a 34-bed open-ward neonatal intensive care unit in a major university-affiliated hospital in Montréal, Quebec, Canada. A total of 94 nurses were eligible, and 86 completed questionnaires (91% response rate). Descriptive statistics were computed to describe the participants' characteristics. To identify factors associated with nurse stress and work satisfaction, correlational analysis and multiple regression analyses were performed with the Nurse Stress Scale and the Global Work Satisfaction scores as the dependent variables. Different factors predict neonatal intensive care unit nurses' stress and job satisfaction, including support, family-centered care, performance obstacles, work schedule, education, and employment status. In order to provide neonatal intensive care units nurses with a supportive environment, managers can provide direct social support to nurses and influence the culture around teamwork.

  8. Pattern of deaths in medical wards of a rurally situated tertiary health ...

    African Journals Online (AJOL)

    Analysis of data was carried out using the simple descriptive statistics with Statistical Packaging for Social Sciences (SPSS Inc. Chicago IL) SPSS version 16 software. Results: A total number of 1456 patients were admitted into the medical wards during the study period and 79 deaths were recorded. Male mortality was 94 ...

  9. The Aesthetics of "Ladeoko Festival‟ of Isona Ward in Ilesa, Nigeria ...

    African Journals Online (AJOL)

    The Aesthetics of "Ladeoko Festival‟ of Isona Ward in Ilesa, Nigeria. ... the capacity to produce pleasure in those who experience or appreciate them; they have the ... In another vein, if the objects have the capacity: to help bring about social or ...

  10. Inappropriate use of urinary catheters and its common complications in different hospital wards

    Directory of Open Access Journals (Sweden)

    Parivash Davoodian

    2012-01-01

    Full Text Available Inappropriate use of indwelling urinary catheters (IUCs and their related complications is one of the most important problems in hospital wards. The aim of this study was to evaluate inappropriate use of IUCs and their complications among patients in Tehran, Iran. Two hundred and six consecutive patients hospitalized in the intensive care unit (ICU as well as medical and surgical wards at the Shahid Mohammadi Hospital in Bandarabbas from September 1 to 30, 2005 and in whom IUCs were used, were studied. Data collected included age of the patients, diagnoses, reason for use of IUC and the complications related to it. Overall, 164 patients (79.6% had IUCs used appropriately while 42 of them (20.6% were catheterized unjustifiably. Inappropriate use of IUCs in the ICU, medical and surgical wards was reported in 12 (18.5%, 16 (19.0% and 14 patients (24.6%, respectively. The most common complication of IUCs was urinary tract infection, which occurred in 91 patients (44.2% and hematuria, which was seen in 3.9% of the patients. Our study suggests that inappropriate use of IUCs is prevalent, particularly in the surgical wards, and the most common complication observed was catheter-associated urinary tract infection.

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

    Directory of Open Access Journals (Sweden)

    Paul Moli

    2011-04-01

    Full Text Available Abstract Background Good morale among staff on inpatient psychiatric wards is an important requirement for the maintenance of strong therapeutic alliances and positive patient experiences, and for the successful implementation of initiatives to improve care. More understanding is needed of mechanisms underlying good and poor morale. Method We conducted individual and group interviews with staff of a full range of disciplines and levels of seniority on seven NHS in-patient wards of varying types in England. Results Inpatient staff feel sustained in their potentially stressful roles by mutual loyalty and trust within cohesive ward teams. Clear roles, supportive ward managers and well designed organisational procedures and structures maintain good morale. Perceived threats to good morale include staffing levels that are insufficient for staff to feel safe and able to spend time with patients, the high risk of violence, and lack of voice in the wider organisation. Conclusions Increasing employee voice, designing jobs so as to maximise autonomy within clear and well-structured operational protocols, promoting greater staff-patient contact and improving responses to violence may contribute more to inpatient staff morale than formal support mechanisms.

  12. Risk of Cross-Infection in a Hospital Ward with Downward Ventilation

    DEFF Research Database (Denmark)

    Nielsen, Peter V.; Li, Yuguo; Buus, Morten

    2010-01-01

    A two-bed hospital ward with one standing healthcare person and a ceiling-mounted lowimpulse semicircular inlet diffuser is simulated in a full-scale room. Tracer gas is used for simulating gaseous contaminants, and the concentration is measured at different air change rates and different posture...

  13. Spatial Distribution of Infection Risk of SARS Transmission in a Hospital Ward

    DEFF Research Database (Denmark)

    Qian, Hua; Li, Yuguo; Nielsen, Peter V.

    2009-01-01

    The classical Wells-Riley model for predicting risk of airborne transmission of diseases assumes a uniform spatial distribution of the infected cases in an enclosed space. A new mathematical model is developed here for predicting the spatial distribution of infection risk of airborne transmitted ......, such as inpatients in a hospital ward, passengers in an airplane etc....

  14. My Ward: The Story of St Thomas', Guy's and the Evelina Children's Hospitals and their Ward Names Wendy Mathews My Ward: The Story of St Thomas', Guy's and the Evelina Children's Hospitals and their Ward Names | Walpole House Publishing £5 I 135pp | 9780956394200 0956394205 [Formula: see text].

    Science.gov (United States)

    2011-05-01

    This is a fascinating record of the stories behind the names of wards at three London hospitals and of the hospitals themselves. Made possible by a grant from Guy's and st Thomas' Charity, it is beautifully produced and illustrated and is a great historical read.

  15. Applying mobile and pervasive computer technology to enhance coordination of work in a surgical ward

    DEFF Research Database (Denmark)

    Hansen, Thomas Riisgaard; Bardram, Jakob Eyvind

    2007-01-01

    , and unnecessary stress. To accommodate this situation and to increase the quality of work in operating wards, we have designed a set of pervasive computer systems which supports what we call context-mediated communication and awareness. These systems use large interactive displays, video streaming from key...

  16. Transfers from intensive care unit to hospital ward: a multicentre textual analysis of physician progress notes.

    Science.gov (United States)

    Brown, Kyla N; Leigh, Jeanna Parsons; Kamran, Hasham; Bagshaw, Sean M; Fowler, Rob A; Dodek, Peter M; Turgeon, Alexis F; Forster, Alan J; Lamontagne, Francois; Soo, Andrea; Stelfox, Henry T

    2018-01-28

    Little is known about documentation during transitions of patient care between clinical specialties. Therefore, we examined the focus, structure and purpose of physician progress notes for patients transferred from the intensive care unit (ICU) to hospital ward to identify opportunities to improve communication breaks. This was a prospective cohort study in ten Canadian hospitals. We analyzed physician progress notes for consenting adult patients transferred from a medical-surgical ICU to hospital ward. The number, length, legibility and content of notes was counted and compared across care settings using mixed-effects linear regression models accounting for clustering within hospitals. Qualitative content analyses were conducted on a stratified random sample of 32 patients. A total of 447 patient medical records that included 7052 progress notes (mean 2.1 notes/patient/day 95% CI 1.9-2.3) were analyzed. Notes written by the ICU team were significantly longer than notes written by the ward team (mean lines of text 21 vs. 15, p notes; mean agreement of patient issues was 42% [95% CI 31-53%]. Qualitative analyses identified eight themes related to focus (central point - e.g., problem list), structure (organization, - e.g., note-taking style), and purpose (intention - e.g., documentation of patient course) of the notes that varied across clinical specialties and physician seniority. Important gaps and variations in written documentation during transitions of patient care between ICU and hospital ward physicians are common, and include discrepancies in documentation of patient information.

  17. Nursing performance and the auditory environment in nursing wards: an observational study

    NARCIS (Netherlands)

    Reinten, J.; Hornikx, M.; Kohlrausch, A.; Kort, H.S.M.

    Introduction: Communication is an essential part of nursing care. While conversations with patients mainly take place in patient rooms, the ward corridor is often used for communication between staff members and sometimes visiting family. As many patients suffer from hearing loss due to biological

  18. An Appraisal Of The Colour Of Hospital Wards On The Recovery ...

    African Journals Online (AJOL)

    The environment where psychiatric patients are kept has been identified as an aid to their recovery attitudes. Based on the fact that the patients were being treated by qualified hands, an attempt is made to examine the significance of colour of the psychiatry ward environment as relating to the patients' rehabilitation in this ...

  19. Patients’ experiences of patient education on psychiatric inpatient wards; a systematic review

    DEFF Research Database (Denmark)

    Kristiansen, Sanne Toft; Videbech, Poul; Kragh, Mette

    2018-01-01

    OBJECTIVE: To synthesize the evidence on how patients with serious mental disorders perceived patient education on psychiatric wards and to learn more about the patient perceived benefits and limitations related to patient education and how well patient education meets the perceived needs of inpa...

  20. Nurses' personal and ward accountability and missed nursing care: A cross-sectional study.

    Science.gov (United States)

    Srulovici, Einav; Drach-Zahavy, Anat

    2017-10-01

    Missed nursing care is considered an act of omission with potentially detrimental consequences for patients, nurses, and organizations. Although the theoretical conceptualization of missed nursing care specifies nurses' values, attitudes, and perceptions of their work environment as its core antecedents, empirical studies have mainly focused on nurses' socio-demographic and professional attributes. Furthermore, assessment of missed nursing care has been mainly based on same-source methods. This study aimed to test the joint effects of personal and ward accountability on missed nursing care, by using both focal (the nurse whose missed nursing care is examined) and incoming (the nurse responsible for the same patients at the subsequent shift) nurses' assessments of missed nursing care. A cross-sectional design, where nurses were nested in wards. A total of 172 focal and 123 incoming nurses from 32 nursing wards in eight hospitals. Missed nursing care was assessed with the 22-item MISSCARE survey using two sources: focal and incoming nurses. Personal and ward accountability were assessed by the focal nurse with two 19-item scales. Nurses' socio-demographics and ward and shift characteristics were also collected. Mixed linear models were used as the analysis strategy. Focal and incoming nurses reported occasional missed nursing care of the focal nurse (Mean=1.87, SD=0.71 and Mean=2.09, SD=0.84, respectively; r=0.55, ppersonal socio-demographic characteristics, higher personal accountability was significantly associated with decreased missed care (β=-0.29, p0.05). The interaction effect was significant (β=-0.31, ppersonal accountability and missed nursing care. Similar patterns were obtained for the incoming nurses' assessment of focal nurse's missed care. Use of focal and incoming nurses' missed nursing care assessments limited the common source bias and strengthened our findings. Personal and ward accountability are significant values, which are associated with

  1. Identifying the nontechnical skills required of nurses in general surgical wards.

    Science.gov (United States)

    Marshall, Dianne C; Finlayson, Mary P

    2018-04-01

    To identify the nontechnical skills (NTS) required of nurses in general surgical wards for safe and effective care. As the largest occupational group, nurses are in an ideal position to block the vulnerabilities of patient adverse events in a surgical ward. Previous studies in the surgical environment have identified the NTS required of nurses for safe care in operating rooms; however, these skills have not been identified for nurses in general surgical wards. A nonparticipant observational descriptive design was used. A purposive sample of 15 registered nurses was recruited from four surgical wards and observed for a full shift on a morning, afternoon or night shift. Nonparticipant observations were conducted using field notes to collect data. A coding frame was developed, and an inductive process was used to analyse the data. A taxonomy comprising seven NTS required of nurses in their roles in surgical ward teams emerged from the data analysis. They are communication, leadership and management, planning, decision-making, situation awareness, teamwork and patient advocacy. Patient care provided by general surgical nurses involved the seven identified key NTS. These particular NTS are an important component of safe nursing practice as they underpin the provision of safe and effective care for general surgical patients. Nurses block the trajectory of error by using NTS to address the vulnerabilities in the system that can lead to adverse patient events. Identifying general surgical nurses' NTS enables the development of teaching strategies that target the learning of those skills to achieve successful work outcomes and improve patient safety. © 2018 John Wiley & Sons Ltd.

  2. Barriers to Nurse-Patient Communication in Cardiac Surgery Wards: A Qualitative Study

    Science.gov (United States)

    Shafipour, Vida; Mohammad, Eesa; Ahmadi, Fazlollah

    2014-01-01

    Background: An appropriate and effective nurse-patient communication is of the most important aspect of caring. The formation and continuation of such a relationship depends on various factors such as the conditions and context of communication and a mutual understanding between the two. A review of the literature shows that little research is carried out on identification of such barriers in hospital wards between the patients and the healthcare staff. Objectives: The present study was therefore conducted to explore the experiences of nurses and patients on communication barriers in hospital cardiac surgery wards. Design and Methods: This qualitative research was carried out using a content analysis method (Graneheim & Lundman, 2004). The participants were selected by a purposeful sampling and consist of 10 nurses and 11 patients from the cardiac surgery wards of three teaching hospitals in Tehran, Iran. Data was gathered by unstructured interviews. All interviews were audio-taped and transcribed verbatim. Results: Findings were emerged in three main themes including job dissatisfaction (with the sub-themes of workload tension and decreased motivation), routine-centered care (with the sub-themes of habitual interventions, routinized and technical interventions, and objective supervision), and distrust in competency of nurses (with the sub-themes of cultural contrast, less responsible nurses, and their apathy towards the patients). Conclusions: Compared to other studies, our findings identified different types of communication barriers depending on the nursing settings. These findings can be used by the ward clinical nursing managers at cardiac surgery wards to improve the quality of nursing care. PMID:25363126

  3. Improving the Quality of Ward-based Surgical Care With a Human Factors Intervention Bundle.

    Science.gov (United States)

    Johnston, Maximilian J; Arora, Sonal; King, Dominic; Darzi, Ara

    2018-01-01

    This study aimed to explore the impact of a human factors intervention bundle on the quality of ward-based surgical care in a UK hospital. Improving the culture of a surgical team is a difficult task. Engagement with stakeholders before intervention is key. Studies have shown that appropriate supervision can enhance surgical ward safety. A pre-post intervention study was conducted. The intervention bundle consisted of twice-daily attending ward rounds, a "chief resident of the week" available at all times on the ward, an escalation of care protocol and team contact cards. Twenty-seven junior and senior surgeons completed validated questionnaires assessing supervision, escalation of care, and safety culture pre and post-intervention along with interviews to further explore the impact of the intervention. Patient outcomes pre and postintervention were also analyzed. Questionnaires revealed significant improvements in supervision postintervention (senior median pre 5 vs post 7, P = 0.002 and junior 4 vs 6, P = 0.039) and senior surgeon approachability (junior 5 vs 6, P = 0.047). Both groups agreed that they would feel safer as a patient in their hospital postintervention (senior 3 vs 4.5, P = 0.021 and junior 3 vs 4, P = 0.034). The interviews confirmed that the safety culture of the department had improved. There were no differences in inpatient mortality, cardiac arrest, reoperation, or readmission rates pre and postintervention. Improving supervision and introducing clear protocols can improve safety culture on the surgical ward. Future work should evaluate the effect these measures have on patient outcomes in multiple institutions.

  4. Improving the communication between teams managing boarded patients on a surgical specialty ward.

    Science.gov (United States)

    Puvaneswaralingam, Shobitha; Ross, Daniella

    2016-01-01

    Transferring patients from the ward of their specialty or consultant is described as boarding. 1 Boarding patients is becoming increasingly prevalent due to greater pressure on hospital capacity. This practice compromises patient safety through delayed investigations, prolonged hospital stays, and increased risk of hospital-acquired infections. 1 2 We evaluated how regularly boarded patients were reviewed, and how effectively information regarding their management was communicated from their primary specialty to ward staff. We aimed to improve the frequency of patient reviews by ensuring that each patient was reviewed every weekday and increase communication between primary specialty, and medical and nursing teams by 20% from baseline during the data collection period. The project was based in the Otolaryngology ward in Ninewells Hospital, Dundee, where there was a high prevalence of boarded patients. Baseline data showed a clear deficit in communication between the primary specialty and ward staff with only 31% of patient reviews being communicated to ward doctors. We designed and implemented a communication tool, in the form of a sticker, to be inserted into patients' medical notes for use by the primary specialty. Implementation of the sticker improved communication between teams as stickers were completed in 93% of instances. In 88% of patient reviews, the junior doctor was informed of the management plan, showing a large increase from baseline. Through PDSA cycles, we aimed to increase the sustainability and reliability of the sticker; however, we faced challenges with sustainability of sticker insertion. We aim to engage more stakeholders to raise awareness of the problem, brainstorm solutions together, and review the production and implementation of stickers with senior hospital management to discuss the potential use of this tool within practice. There is potentially a large scope for utilisation of this communication tool on a local level, which we hope

  5. Medical ward round competence in internal medicine - an interview study towards an interprofessional development of an Entrustable Professional Activity (EPA).

    Science.gov (United States)

    Wölfel, Teresa; Beltermann, Esther; Lottspeich, Christian; Vietz, Elisa; Fischer, Martin R; Schmidmaier, Ralf

    2016-07-11

    The medical ward round is a central but complex activity that is of relevance from the first day of work. However, difficulties for young doctors have been reported. Instruction of ward round competence in medical curricula is hampered by the lack of a standardized description of the procedure. This paper aims to identify and describe physicians' tasks and relevant competences for conducting a medical ward round on the first day of professional work. A review of recent literature revealed known important aspects of medical ward rounds. These were used for the development of a semi-structured interview schedule. Medical ward round experts working at different hospitals were interviewed. The sample consisted of 14 ward physicians (M = 8.82 years of work experience) and 12 nurses (M = 14.55 years of work experience) working in different specializations of internal medicine. All interviews were audiotaped, fully transcribed, and analyzed using an inductive-deductive coding scheme. Nine fields of competences with 18 related sub-competences and 62 observable tasks were identified as relevant for conducting a medical ward round. Over 70 % of the experts named communication, collaborative clinical reasoning and organization as essential competences. Deeper analysis further unveiled the importance of self-management, management of difficult situations, error management and teamwork. The study is the first to picture ward round competences and related tasks in detail and to define an EPA "Conducting an internal medicine ward round" based on systematic interprofessional expert interviews. It thus provides a basis for integration of ward round competences in the medical curricula in an evidence based manner and gives a framework for the development of instructional intervention studies and comparative studies in other medical fields.

  6. [Specificity of the anaerobic bacterial infections in the surgical and orthopedic wards].

    Science.gov (United States)

    Kierzkowska, Marta; Majewska, Anna; Sawicka-Grzelak, Anna; Młynarczyk, Andrzej; Ładomirska-Pestkowska, Katarzvna; Młynarczyk, Grazyna

    2012-01-01

    The aim of this study was to estimate the contribution strictly anaerobic bacteria in the etiology of infections in patients on surgery and orthopedic wards. We examined 159 samples taken from patients hospitalized in surgical wards and 179 clinical specimens taken from orthopedic patients. Clinical strains of obligate anaerobes were identified by API 20A biochemical tests (ATB Expression, bioMerieux S.A., France). Susceptibility of the clinical strains was examined by ATB ANA (bioMerieux S.A., France) system. The MIC values were determined by the gradient diffusion method, Etest (AB BIODISK, Sweden i bioMerieux S.A., France). Gram-negative bacteria predominant in the samples taken from surgical patients, Most frequently we isolated rods of the genus Bacteroides (26%): B. fragilis, B. ovatus/B. thetaiotaomicron, and B. distasonis. In 44 samples (28%) we identified only anaerobic bacteria. Multibacterial isolations, with the participation of anaerobic and aerobic flora, dominated among patients in the study. Overall 238 strictly anaerobic bacteria were cultured from patients hospitalized in orthopedic wards. Gram-positive bacteria accounted for 78%. The most frequently were isolated Peptostreptococcus (56%), Propionibacterium (10%) species. In this study all Bacteroides strains were resistant to penicillin G. Some species were resistant to clindamycin, as well. Overall 40% of Bacteroides strains taken from surgical and 50% isolated from orthopedic wards showed no sensitivity to this antibiotic. A similar phenomenon was observed among bacteria of the genus Prevotella. In samples taken from orthopedic patients we observed the predominance of Gram-positive anaerobic bacteria. Some of them were part of the normal flora but they should not be excluded as an etiology agents of infection. The specimens taken from patients treated in surgical wards showed the presence of a mixed microflora, which included aerobic and anaerobic bacteria, primarily Gram-negative rods

  7. Protected engagement time on older adult mental health wards: A thematic analysis of the views of patients, carers, and staff.

    Science.gov (United States)

    Dodd, Emily; Cheston, Richard; Procter, Charlie; Heneker, Sarah; Gray, Richard; Fox, Chris; Nolan, Fiona

    2018-04-01

    During protected engagement time (PET), ward routines are adjusted so that staff can spend time together with patients without interruption. The aim of PET is to increase staff and patient interaction on wards, and ultimately patient well-being. Although PET has been implemented on inpatient wards within the UK, including older adult wards, there is no systematic evidence as to how PET is carried out or how it is experienced by staff, patients, and families. Semistructured interviews were conducted with 28 participants (8 patients, 10 family members, and 10 ward staff) from three different wards with PET, and transcriptions were analysed using thematic analysis. Three themes were identified: (i) the patient is at the heart of care; (ii) PET depends on staff; and (iii) tensions in how PET operates. There was support in our sample for the principles of PET and its potential for a positive impact on patient well-being. However, the implementation of PET was identified as challenging, highlighting an existing tension between an individual's needs and the wider needs of patients on the ward as a whole. The impact of PET was generally described as being dependent on how PET was organized and the level of staff commitment to PET. Participants emphasized that if PET is to be successful, then it should be a fluid process that fits in with the local context. © 2017 Australian College of Mental Health Nurses Inc.

  8. Obese Japanese Patients with Stroke Have Higher Functional Recovery in Convalescent Rehabilitation Wards: A Retrospective Cohort Study.

    Science.gov (United States)

    Nishioka, Shinta; Wakabayashi, Hidetaka; Yoshida, Tomomi; Mori, Natsumi; Watanabe, Riko; Nishioka, Emi

    2016-01-01

    A protective effect of excessive body mass index (BMI) on mortality or functional outcome in patients with stroke is not well established in the Asian population. This study aimed to explore whether obese patients with stroke have advantages for functional improvement in Japanese rehabilitation wards. This retrospective cohort study included consecutive patients with stroke admitted and discharged from convalescent rehabilitation wards between 2011 and 2015. Demographic data, BMI, Functional Independence Measure (FIM) score, and nutritional status were analyzed. Participants were classified into 4 groups according to BMI (underweight stroke may have some advantages for functional recovery in rehabilitation wards. Copyright © 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  9. The effect of multi-professional education on the recognition and outcome of patients at risk on general wards

    DEFF Research Database (Denmark)

    Fuhrmann, L.; Perner, A.; Klausen, T.W.

    2009-01-01

    The aim of this study was to evaluate the effect of multi-professional full-scale simulation-based education of staff on the mortality and staff awareness of patients at risk on general wards. DESIGN, SETTINGS AND PATIENTS: A prospective before-and-after study conducted on four general wards...... at Herlev Hospital, Denmark. In the pre-intervention period (June-July 2006) and post-intervention period (November-December 2007), all patients on the wards had vital signs measured in the evening by study personnel, who also asked nursing staff questions about patients with abnormal vital signs...

  10. Glueball candidate iota(1440), anomalous Ward identities, and two-photon decays

    International Nuclear Information System (INIS)

    Williams, P.G.

    1984-01-01

    Anomalous Ward identities are given for the U(1) problem, showing that some recent papers have neglected the large topological susceptibility coming from the pure Yang-Mills sector of QCD. A reanalysis of the Ward identities is given, including the pseudoscalar glueball candidate iota(1440) with the pseudoscalar nonet. It is shown that positivity of the topological susceptibility together with other constraints is sufficient to narrow down the permitted range of pseudoscalar axial couplings. In particular the iota(1440) couplings are consistent with those expected for a glueball with the decay iota→γγ probably immeasurably small. Contrary to a recent claim, the results are not sensitive to the branching ratio for iota→KK-barπ, which may be as large as 100%

  11. Patients' experiences of postoperative intermediate care and standard surgical ward care after emergency abdominal surgery

    DEFF Research Database (Denmark)

    Thomsen, Thordis; Vester-Andersen, Morten; Nielsen, Martin Vedel

    2015-01-01

    AIMS AND OBJECTIVES: To elicit knowledge of patient experiences of postoperative intermediate care in an intensive care unit and standard postoperative care in a surgical ward after emergency abdominal surgery. BACKGROUND: Emergency abdominal surgery is common, but little is known about how patie......, intermediate care patients felt hindered in doing so by continuous monitoring of vital signs. RELEVANCE TO CLINICAL PRACTICE: Intermediate care may increase patient perceptions of quality and safety of care.......AIMS AND OBJECTIVES: To elicit knowledge of patient experiences of postoperative intermediate care in an intensive care unit and standard postoperative care in a surgical ward after emergency abdominal surgery. BACKGROUND: Emergency abdominal surgery is common, but little is known about how...... patients experience postoperative care. The patient population is generally older with multiple comorbidities, and the short-term postoperative mortality rate is 15-20%. Thus, vigilant surgeon and nursing attention is essential. The present study is a qualitative sub-study of a randomised trial evaluating...

  12. Development of an adhesive surgical ward round checklist: a technique to improve patient safety.

    LENUS (Irish Health Repository)

    Dhillon, P

    2012-02-01

    Checklists have been shown to improve patient outcomes. Checklist use is seen in the pre-operative to post-operative phases of the patient pathway. An adhesive checklist was developed for ward rounds due to the positive impact it could have on improving patient safety. Over an eight day period data were collected from five consultant-led teams that were randomly selected from the surgical department and divided into sticker groups and control groups. Across the board percentage adherence to the Good Surgical Practice Guidelines (GSPG) was markedly higher in the sticker study group, 1186 (91%) in comparison with the control group 718 (55%). There was significant improvement of documentation across all areas measured. An adhesive checklist for ward round note taking is a simple and cost-effective way to improve documentation, communication, hand-over, and patient safety. Successfully implemented in a tertiary level centre in Dublin, Ireland it is easily transferable to other surgical departments globally.

  13. Medication reconciliation and prescribing reviews by pharmacy technicians in a geriatric ward

    DEFF Research Database (Denmark)

    Buck, Thomas Croft; Gronkjaer, Louise Smed; Duckert, Marie-Louise

    2013-01-01

    OBJECTIVE: Incomplete medication histories obtained on hospital admission are responsible for more than 25% of prescribing errors. This study aimed to evaluate whether pharmacy technicians can assist hospital physicians' in obtaining medication histories by performing medication reconciliation an...... reconciliation and focused medication reviews. Further randomized, controlled studies including a larger number of patients are required to elucidate whether these observations are of significance and of importance for securing patient safety....... and prescribing reviews. A secondary aim was to evaluate whether the interventions made by pharmacy technicians could reduce the time spent by the nurses on administration of medications to the patients. METHODS: This observational study was conducted over a 7 week period in the geriatric ward at Odense...... University Hospital, Denmark. Two pharmacy technicians conducted medication reconciliation and prescribing reviews at the time of patients' admission to the ward. The reviews were conducted according to standard operating procedures developed by a clinical pharmacist and approved by the Head of the Geriatric...

  14. Knowledge and Prevention of Nosocomial Infection among Ward Nurses at Federal Medical Centre, Umuahia, Nigeria

    Directory of Open Access Journals (Sweden)

    Oti A. Aja

    2017-08-01

    Full Text Available This research was conducted for estimating the knowledge and prevention of nosocomial infection among ward nurses at Federal Medical Centre (FMC, Umuahia Abia state. Four objectives were set, and four questions were formulated. A descriptive survey research method was used for the study. A sample size of one hundred and fifty (150 nurses was drawn from eight wards (medical and surgical, at FMC, Umuahia. A self-developed questionnaire with seventeen (17 structured questions was the instrument of data collection. Data were collected, analyzed, and presented in tables, pie chart, bar chart, histogram, and percentages. The results revealed that the nurses were well knowledgeable about nosocomial infection, although little deficiencies existed in the area of infection control practice and compliance, such as hand washing frequency. This study therefore recommends continuing education/seminar/workshop for all health care givers, to sensitize them with the knowledge and practice of nosocomial infection.

  15. [The current aspects of hospital infections in maternity and neonatal wards].

    Science.gov (United States)

    Ribarova, N; Todorova, M; Khristov, Kh

    1994-01-01

    The epidemiologic, etiologic and clinical structure of HAI in the maternity and neonatal wards in the country for the 1982-1992 period has been specified. 934 women in child-birth and 2357 neonates acquire nosocomial infections at an average annually. A comparatively constant level in HAI epidemic process intensity is observed with inconsiderable diversions in the beginning and by the end of the studied period. Staphylococci like causative agents of HAI take up a leading place in both types of wards with especially marked incidence rate among the newborn children. The predominant clinical forms in the women in child-birth are the surgical wound infections, skin and genital infections and in the neonates--the staphylodermatites, upper respiratory airway infections, pulmonary and enteric infections.

  16. Measurement of air contamination in different wards of public sector hospital, Sukkur.

    Science.gov (United States)

    Memon, Badaruddin AllahDino; Bhutto, Gul Hassan; Rizvi, Wajid Hussain

    2016-11-01

    The aim of this study was to evaluate and assess the index of bacterial contamination in different wards of the Public Sector Hospital of Sukkur (Teaching) Pakistan; whether or not the air contamination was statistically different from the acceptable level using active and passive sampling. In addition to this main hypothesis, other investigations included: occurrence of the most common bacteria, whether or not the bacterial contamination in the wards was a persistent problem and identification of the effective antibiotics against the indentified bacteria. The evidence sought based on the One Sample T test suggests that there is a (statistically) significant difference between the observed (higher) than the acceptance level (pcontamination problem was persistent as there was no significant difference among observed contamination of all three visits at (p>0.01) and the result of antibiotic susceptibility test highlights sensitivity and resistance level of antibiotics for the indentified bacteria.

  17. From Paper to PDA: Design and Evaluation of a Clinical Ward Instruction on a Mobile Device

    Science.gov (United States)

    Kanstrup, Anne Marie; Stage, Jan

    Mobile devices with small screens and minimal facilities for interaction are increasingly being used in complex human activities for accessing and processing information, while the user is moving. This paper presents a case study of the design and evaluation of a mobile system, which involved transformation of complex text and tables to digital format on a PDA. The application domain was an emergency medical ward, and the user group was junior registrars. We designed a PDA-based system for accessing information, focusing on the ward instruction, implemented a prototype and evaluated it for usability and utility. The evaluation results indicate significant problems in the interaction with the system as well as the extent to which the system is useful for junior registrars in their daily work.

  18. Integrating psychology and obstetrics for medical students: shared labour ward teaching.

    Science.gov (United States)

    Chalmers, B E; McIntyre, J A

    1993-01-01

    Two studies relating to the inclusion of psycho-social issues in the training of obstetricians are reported here. The first reports on the extent to which currently practising obstetricians have received training in these aspects. The second explored the value of an innovative teaching approach combining psychological and obstetric training for medical students in the labour ward. A postal survey with responses from 220 obstetricians and paediatricians revealed that little information on psychological aspects of obstetric practice had been included in their undergraduate or postgraduate training or obtained from voluntary continuing education programmes. Experience was the primary source of training in these subjects. The second study explored the impact of joint psychological and obstetric teaching ward rounds for medical students. Students attending these integrated sessions reported being better prepared for the psycho-social aspects of obstetrics and showed a greater awareness of cross-cultural differences in needs of women during birth.

  19. The understanding of the special administration of nursing care in the intervention ward

    International Nuclear Information System (INIS)

    Feng Jianyu; Tian Ye; Wang Junlan

    2009-01-01

    Because of the particularity of the interventional therapy,that is,the interventional management covers a large scope in clinical application and involves the diagnosis and treatment of various diseases of multiple systems and organs,the clinical interventional practice has really brought an unprecedented challenge for the administration of the nursing care in the intervention ward. In our hospital, independent nursing group for the intervention ward was established two years ago. For the past two years, we have constantly groped and summarized the reasonable and effect administration of interventional nursing care. Pertinent administrative measures, such as nurse training, strengthening of communication with physicians and focusing on key links in nursing care and promptly finding out the weak points in clinical work, have effectively improved the quality of clinical nursing, in this way the clinical nursing practice has been integrated into the interventional therapy and the safe and high-quality nursing service has been provided to the patients. (authors)

  20. The effects of introducing a clinical pharmacist on orthopaedic wards in Denmark

    DEFF Research Database (Denmark)

    Buck, Thomas Croft; Brandstrup, Lene; Brandslund, Ivan

    2007-01-01

    OBJECTIVE: To assess the effects and cost effects of introducing clinical pharmacists on hospital wards. METHODS: Comparative prospective study on four orthopaedic surgical wards in two hospitals. The primary effect variables were 10 target areas widely considered to be indicators of good...... prescription practice. Prescriptions not following good practice in these intervention areas were defined as "sub-optimal prescriptions," and then discussed between a physician and a clinical pharmacist. The primary parameter was the difference in the number of days with a sub-optimal prescription (Mann......-Whitney test). RESULTS: On an average 20% of all the patients had a sub-optimal prescription. Of these, 70% were changed by the physician after intervention by the clinical pharmacist. There was a statistically significant difference in the duration of days in treatment with a sub-optimal prescription. Where...

  1. [The function of team-meetings for treatment teams on child and adolescent psychiatric wards].

    Science.gov (United States)

    Branik, Emil; Meng, Heiner

    2006-01-01

    In the daily work of multidisciplinary teams on child and adolescent psychiatric wards team-meetings play a central role to coordinate various treatment activities. In medical literature studies on the topic are lacking, and only few articles were found. The authors explore by a descriptive-hermeneutic analysis the numerous functions of meetings for the treatment team. To them belong catharsis, containment, reflection, regulation and integration. Psychodynamic, group dynamical and institutional factors will be described regarding their influence on the therapy management. Issues of power in institutions will be comprised in the discussion. The dialectical tension between professionalism and emotionality in the work with patients especially from the borderline-spectrum as well as between unity and diversity within the treatment team in regard to the different roles of each and everyone team member will be presented. Hints at how to manage these tensions will be given to preserve the therapeutical milieu on the ward.

  2. Relatives' view on collaboration with nurses in acute wards: development and testing of a new measure

    DEFF Research Database (Denmark)

    Lindhardt, Tove; Nyberg, Per; Hallberg, Ingalill Rahm

    2008-01-01

    BACKGROUND: Collaboration between relatives and nurses in acute care settings is sparsely investigated, and that mostly from nurses' point of view. Feasible and valid instruments are needed for assessing collaboration, its prerequisites and outcome. OBJECTIVES: To develop and test an instrument...... to assess, from the relatives' perspective, collaboration between relatives of frail elderly patients and nurses in acute hospital wards, as well as prerequisites for, and outcome of, collaboration. DESIGN: Instrument development and psychometric testing. SETTING: Acute medical and geriatric wards......, item-to-total correlation and item-to-item correlation. Systematic internal dropout was investigated. RESULTS: A five-factor solution labelled "influence on decisions", "quality of contact with nurses", "trust and its prerequisites", "achieved information level" and "influence on discharge" showed...

  3. Inappropriate use of urinary catheters in patients admitted to medical wards in a university hospital.

    Science.gov (United States)

    Fernández-Ruiz, Mario; Calvo, Beatriz; Vara, Rebeca; Villar, Rocío N; Aguado, José María

    2013-10-01

    The prevalence and predisposing factors were determined for inappropriate urinary catheterization (UC) among inpatients in medical wards. A cross-sectional study was conducted including all patients aged ≥ 18 years admitted to medical wards in a 1300-bed tertiary-care centre, and who had a urinary catheter in place on the day of the survey. Of 380 patients observed, 46 (12.1%) had a urinary catheter in place. Twelve of them (26.1%) were inappropriately catheterized. The most common indication for inappropriate UC was urine output monitoring in a cooperative, non-critically ill patient. Inappropriateness was associated with increased age, poor functional status, urinary incontinence, dementia, and admission from a long-term care facility. Further educational efforts should be focused on improving catheterization prescribing practices by physicians. Copyright © 2012 Elsevier España, S.L. All rights reserved.

  4. Checking the transverse Ward-Takahashi relation at one-loop order in four dimensions

    International Nuclear Information System (INIS)

    Pennington, M R; Williams, R

    2006-01-01

    Some time ago Takahashi derived the so-called transverse relations relating Green's functions of different orders to complement the well-known Ward-Green-Takahashi identities of gauge theories by considering wedge rather than inner products. These transverse relations have the potential to determine the full fermion-boson vertex in terms of the renormalization functions of the fermion propagator. He and Yu have given an indicative proof at one-loop level in four dimensions. However, their construct involves the fourth-rank Levi-Civita tensor defined only unambiguously in four dimensions exactly where the loop integrals diverge. Consequently, here we explicitly check the proposed transverse Ward-Takahashi relation holds at one-loop order in d-dimensions, with d = 4 + ε

  5. Mobile and fixed computer use by doctors and nurses on hospital wards

    DEFF Research Database (Denmark)

    Andersen, Pia; Lindgaard, Anne-Mette; Prgomet, M.

    2009-01-01

    devices clinicians completed a very low proportion of observed tasks at the bedside. The design of the devices and ward space configurations place limitations on how and where devices are used and on the mobility of clinical work. In such circumstances, clinicians will initiate workarounds to compensate......, computers on wheels (COWs) and tablet PCs-was made. Two types of COWs were available on the wards: generic COWs (laptops mounted on trolleys) and ergonomic COWs (an integrated computer and cart device). Heuristic evaluation of the user interfaces was also carried out. RESULTS: The majority (93...... and doctors were observed performing workarounds, such as transcribing medication orders from the computer to paper. CONCLUSIONS: The choice of device was related to clinical role, nature of the clinical task, degree of mobility required, including where task completion occurs, and device design. Nurses' work...

  6. Infection control as a topic for ward-based nursing education.

    Science.gov (United States)

    Gould, D; Chamberlain, A

    1994-08-01

    The link between nursing theory and practice remains a topic of ongoing debate. Related to this issue is the best place to effectively combine the two. The solution may be ward-based teaching programmes as part of formal continuing staff development, involving collaboration between college-based lecturers and acknowledged clinical experts. Using infection control as an example of a topic in need of regular and continual updating for qualified practitioners, it is argued that such programmes would be desirable because they would afford sufficient flexibility to fulfil individual learning needs and could be assessed to indicate whether nursing practice had been enhanced. Participants could be accredited for successful completion of ward-based programmes.

  7. Development of Geospatial Map Based Portal for Delimitation of Mcd Wards

    Science.gov (United States)

    Gupta, A. Kumar Chandra; Kumar, P.; Sharma, P. Kumar

    2017-09-01

    The Geospatial Delhi Limited (GSDL), a Govt. of NCT of Delhi Company formed in order to provide the geospatial information of National Capital Territory of Delhi (NCTD) to the Government of National Capital Territory of Delhi (GNCTD) and its organs such as DDA, MCD, DJB, State Election Department, DMRC etc., for the benefit of all citizens of Government of National Capital Territory of Delhi (GNCTD). This paper describes the development of Geospatial Map based Portal for Delimitation of MCD Wards (GMPDW) and election of 3 Municipal Corporations of NCT of Delhi. The portal has been developed as a map based spatial decision support system (SDSS) for delimitation of MCD Wards and draw of peripheral wards boundaries to planning and management of MCD Election process of State Election Commission, and as an MCD election related information searching tools (Polling Station, MCD Wards and Assembly constituency etc.,) for the citizens of NCTD. The GMPDW is based on Client-Server architecture model. It has been developed using Arc GIS Server 10.0 with .NET (pronounced dot net) technology. The GMPDW is scalable to enterprise SDSS with enterprise Geo Database & Virtual Private Network (VPN) connectivity. Spatial data to GMPDW includes Enumeration Block (EB) and Enumeration Blocks Group (EBG) boundaries of Citizens of Delhi, Assembly Constituency, Parliamentary Constituency, Election District, Landmark locations of Polling Stations & basic amenities (Police Stations, Hospitals, Schools and Fire Stations etc.). GMPDW could help achieve not only the desired transparency and easiness in planning process but also facilitates through efficient & effective tools for management of MCD election. It enables a faster response to the changing ground realities in the development planning, owing to its in-built scientific approach and open-ended design.

  8. Ward Identities of W_{\\infty} Symmetry and Higher Genus Amplitudes in 2D String Theory

    OpenAIRE

    Hamada, Ken-ji

    1995-01-01

    The Ward identities of the $W_{\\infty}$ symmetry in two dimensional string theory in the tachyon background are studied in the continuum approach. We consider amplitudes different from 2D string ones by the external leg factor and derive the recursion relations among them. The recursion relations have non-linear terms which give relations among the amplitudes defined on different genus. The solutions agree with the matrix model results even in higher genus. We also discuss differences of role...

  9. Disruption of parent participation: nurses' strategies to manage parents on children's wards.

    Science.gov (United States)

    Coyne, Imelda

    2008-12-01

    To investigate parent participation in the hospitalized child's care from the perspectives of children, parents and nurses. Parent participation in the hospitalized child's care has been increasingly promoted in paediatric nursing for many years because it ameliorates the adverse aspects of hospitalization, avoids parental separation and contributes to quality care for sick children. Parent participation is assumed to be unproblematic but evidence exists that nurses often have difficulty caring for parents. Using grounded method, data were collected through in-depth interviews, questionnaires and observation with 12 nurses from four paediatric wards in two hospitals in England. The dominant process appeared to be the socialization of parents to their role on the ward through inclusionary and exclusionary tactics. Nurses controlled the nature of parents' participation and parents had to 'toe the line'. Although participation was presented as optional, parents were presented with no course other than acceptance. Parents were expected to stay with their child, behave properly and be involved in care. When parents did not adhere to these norms, they caused disruption to the order and routine of the ward. Compliance or non-compliance to the set of norms and rules was followed by reward or punishment. The nurses' dependence on parents' active participation in the organization and delivery of the work suggests that parent participation as it is practised is clearly about administrative efficiency, not consumer empowerment. Organizational and managerial issues must be examined to ensure that nurses are adequately prepared and resourced to support parents on the ward. Continuing assessment of parents' expectations though a structured assessment tool would help reduce misunderstandings and conflict. Nurses should assess the situational context before relying on subjective impressions and assumptions about parents' participation in care.

  10. Supervisors' pedagogical role at a clinical education ward - an ethnographic study.

    Science.gov (United States)

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

    2015-01-01

    Clinical practice is essential for health care students. The supervisor's role and how supervision should be organized are challenging issues for educators and clinicians. Clinical education wards have been established to meet these challenges and they are units with a pedagogical framework facilitating students' training in real clinical settings. Supervisors support students to link together theoretical and practical knowledge and skills. From students' perspectives, clinical education wards have shown potential to enhance students' learning. Thus there is a need for deeper understanding of supervisors' pedagogical role in this context. We explored supervisors' approaches to students' learning at a clinical education ward where students are encouraged to independently take care of patients. An ethnographic approach was used to study encounters between patients, students and supervisors. The setting was a clinical education ward for nursing students at a university hospital. Ten observations with ten patients, 11 students and five supervisors were included in the study. After each observation, individual follow-up interviews with all participants and a group interview with supervisors were conducted. Data were analysed using an ethnographic approach. Supervisors' pedagogical role has to do with balancing patient care and student learning. The students were given independence, which created pedagogical challenges for the supervisors. They handled these challenges by collaborating as a supervisory team and taking different acts of supervision such as allowing students their independence, being there for students and by applying patient-centredness. The supervisors' pedagogical role was perceived as to facilitate students' learning as a team. Supervisors were both patient- and student-centred by making a nursing care plan for the patients and a learning plan for the students. The plans were guided by clinical and pedagogical guidelines, individually adjusted and

  11. Off-shell Ward identities and gauge symmetries in string theory

    International Nuclear Information System (INIS)

    Porrati, M.

    1989-01-01

    I describe a new method of obtaining gauge-symmetry transformation laws for the effective lagrangian of an arbitrary string theory. The method applies to exact as well as spontaneously broken gauge symmetries. The transformation laws, exact to all orders in α' are determined inductively in the number of fields by the corresponding off-shell Ward identities. The case of broken supersymmetry is examined in some detail. (orig.)

  12. Dextrose infusion and glucose disorders in people without diabetes hospitalized in general wards.

    Science.gov (United States)

    Feldman-Billard, Sylvie; Joubert, Michael; Reznik, Yves

    2013-11-01

    We measured fasting plasma glucose (FPG) on a single day in all persons without diabetes history admitted in general wards (N=1922). After age and length of stay adjustment, dextrose infusion was associated with a 3-fold increase (p<0.001) of hospital-related hyperglycemia (FPG ≥ 7 mmol/l), highlighting the need to interpret glucose disorders cautiously. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  13. Malnutrition and nutritional care practices in hospital wards for older people

    OpenAIRE

    Vanderwee, Katrien; Clays, Els; Bocquaert, Ilse; Verhaeghe, Sofie; Lardennois, Miguel; Gobert, Micheline; Defloor, Tom

    2010-01-01

    AIMS: This paper is a report of a study conducted to gain a better insight into the current nutritional care practices in Belgian hospital wards for older people, and to study the association between these practices and the prevalence of malnutrition. BACKGROUND: In 1999, the Council of Europe assessed nutritional care practices and support in 12 European countries and showed them to be sparse and inconsistent. At the time of research, no studies had described the association between nutritio...

  14. Fall prediction according to nurses' clinical judgment: differences between medical, surgical, and geriatric wards.

    Science.gov (United States)

    Milisen, Koen; Coussement, Joke; Flamaing, Johan; Vlaeyen, Ellen; Schwendimann, René; Dejaeger, Eddy; Surmont, Kurt; Boonen, Steven

    2012-06-01

    To assess the value of nurses' clinical judgment (NCJ) in predicting hospital inpatient falls. Prospective multicenter study. Six Belgian hospitals. Two thousand four hundred seventy participants (mean age 67.6 ± 18.3; female, 55.7%) on four surgical (n = 812, 32.9%), eight geriatric (n = 666, 27.0%), and four general medical wards (n = 992, 40.1%) were included upon admission. All participants were hospitalized for at least 48 hours. Within 24 hours after admission, nurses gave their judgment on the question "Do you think your patient is at high risk for falling?" Nurses were not trained in assessing fall risk. Falls were documented on a standardized incident report form. During hospitalization, 143 (5.8%) participants experienced one or more falls, accounting for 202 falls and corresponding to an overall rate of 7.9 falls per 1,000 patient days. NCJ of participant's risk of falling had high sensitivity (78-92%) with high negative predictive value (94-100%) but low positive predictive value (4-17%). Although false-negative rates were low (8-22%) for all departments and age groups, false-positive rates were high (55-74%), except on surgical and general medical wards and in participants younger than 75. This analysis, based on multicenter data and a large sample size, suggests that NCJ can be recommended on surgical and general medical wards and in individuals younger than 75, but on geriatric wards and in participants aged 75 and older, NCJ overestimates risk of falling and is thus not recommended because expensive comprehensive fall-prevention measures would be implemented in a large number of individuals who do not need it. © 2012, Copyright the Authors Journal compilation © 2012, The American Geriatrics Society.

  15. Feynman rules and generalized ward identities in phase space functional integral

    International Nuclear Information System (INIS)

    Li Ziping

    1996-01-01

    Based on the phase-space generating functional of Green function, the generalized canonical Ward identities are derived. It is point out that one can deduce Feynman rules in tree approximation without carrying out explicit integration over canonical momenta in phase-space generating functional. If one adds a four-dimensional divergence term to a Lagrangian of the field, then, the propagator of the field can be changed

  16. Introducing the nurse practitioner into the surgical ward: an ethnographic study of interprofessional teamwork practice.

    Science.gov (United States)

    Kvarnström, Susanne; Jangland, Eva; Abrandt Dahlgren, Madeleine

    2017-08-22

    The first nurse practitioners in surgical care were introduced into Swedish surgical wards in 2014. Internationally, organisations that have adopted nurse practitioners into care teams are reported to have maintained or improved the quality of care. However, close qualitative descriptions of teamwork practice may add to existing knowledge of interprofessional collaboration when introducing nurse practitioners into new clinical areas. The aim was to report on an empirical study describing how interprofessional teamwork practice was enacted by nurse practitioners when introduced into surgical ward teams. The study had a qualitative, ethnographic research design, drawing on a sociomaterial conceptual framework. The study was based on 170 hours of ward-based participant observations of interprofessional teamwork practice that included nurse practitioners. Data were gathered from 2014 to 2015 across four surgical sites in Sweden, including 60 interprofessional rounds. The data were analysed with an iterative reflexive procedure involving inductive and theory-led approaches. The study was approved by a Swedish regional ethics committee (Ref. No.: 2014/229-31). The interprofessional teamwork practice enacted by the nurse practitioners that emerged from the analysis comprised a combination of the following characteristic role components: clinical leader, bridging team colleague and ever-present tutor. These role components were enacted at all the sites and were prominent during interprofessional teamwork practice. The participant nurse practitioners utilised the interprofessional teamwork practice arrangements to enact a role that may be described in terms of a quality guarantee, thereby contributing to the overall quality and care flow offered by the entire surgical ward team. © 2017 Nordic College of Caring Science.

  17. Aspects of solitons in noncommutative field theories. The modified Ward model

    International Nuclear Information System (INIS)

    Petersen, S.

    2006-01-01

    In this thesis several aspects of solutions to the equations of motions to noncommutative field theories are investigated in detail. The main focus of the analysis is on the integrable chiral or modified unitary sigma model with U(n)-valued fields as introduced by Ward and its noncommutative extension where the above mentioned new solutions arise. Of particular interest in this context are to us the question of stability of static solitons and the applicability of the so-called adiabatic approach to as a means to approximate time-dependent solutions by geodesic motion in the moduli space of static solutions. After some introductory remarks we proceed to present the Ward model together with its noncommutative extension and give a unified exposition of its known static solutions. This model, as the prime example of an almost Lorentz-invariant field theory in 1+2 dimensions, has several virtues which make its analysis worthwhile. First of all it is integrable thus allowing for powerful, well developed, techniques to generate soliton solutions. At the same time these feature interaction among them. Furthermore, the commutative counterpart of the Ward model has been investigated in great detail such that many results are available for comparison. Next, the question of stability for the present static solutions is considered. This stability is governed by the quadratic form of the fluctuations, which, upon concentrating on the case of diagonal U(1) solutions, is explicitly computed. We show that the considered solutions are stable within a certain subsector of possible configurations, namely the grassmannian ones, and become unstable upon embedding them into the full unitary sigma model. Finally, we remark on some possible generalization of these results. This subject is followed, after a brief review of time-dependent Ward model solutions, by the application of the adiabatic approach, as proposed by Manton, to the static solutions. (orig.)

  18. The acute pulmonary oedema in the intensive-care ward. Das akute Lungenoedem auf der Intensivstation

    Energy Technology Data Exchange (ETDEWEB)

    Marciniak, R.; Aronski, A. (Akademia Medyczna, Wroclaw (Poland))

    1989-07-01

    760 patients suffering from acute pulmonary oedema were treated between 1980 and 1986 at the Institute of Anaesthesiology of the Medical Academy in Wroclaw. The radiological image of the pulmonary oedema was subdivided into three forms (hilar, hilar and perihilar, and hilar with massive plane-shaped infiltrates). In the treatment of acute pulmonary oedema in the intensive-care ward a thorough diagnostic programme is mandatory after the immediately necessary measures have been taken. (orig.).

  19. What scares patients to get admitted in a psychiatry ward? An exploratory study

    OpenAIRE

    Sushmita Bhattacharya; Bir Singh Chavan

    2018-01-01

    Background: There has been very little focus on understanding the experiences of people suffering from mental illness during their treatment in the outpatient and inpatient treatment facilities. Majority of the decisions regarding their treatment are taken by the mental health professionals in consultation with the caregivers, and the patient remains a passive recipient of the services. It is commonly seen that patients refuse admission in the psychiatry ward even when clinical needs warrant ...

  20. A Study about The Quality of Nursing Services a Hospitals’ Ward, Mojokerto

    OpenAIRE

    Muhith, Abdul; Nurwidji, Nurwidji

    2016-01-01

    Introduction: Nowadays, the trend of hospital visits in Mojokerto is declining. It can caused by man (nurses), such as the quality of nursing services hasn’t been conducted optimally. This study was aimed to analyze the quality of nursing services at hospitals’ ward at Mojokerto. Method: This was explanatory research with survey method and cross sectional approach. The population were nurses and patients who undergo hospitalization minimally in three days at RSU. Dr. Wahidin Sudiro Husodo and...

  1. Canonical symmetry in a system with singular Lagrangian and ward identities

    International Nuclear Information System (INIS)

    Li Ziping

    1994-01-01

    An algorithm to construct the generator of gauge transformation for a constrained Hamiltonian system is given. The relationships among the coefficients connecting with first-class constraints in the generator is cleared. Based on the phase space generating function, the corresponding Ward identities in canonical formalism is deduced. The preliminary applications of above results to a model in field theory which is functionally equivalent to the mixed Chern-Simons Lagrangian is discussed in detail

  2. Medication Prescribing Pattern at a Pediatric Ward of an Ethiopian Hospital

    Directory of Open Access Journals (Sweden)

    Fitsum Sebsibe Teni

    2014-11-01

    Full Text Available Introduction: drug use in pediatric patients is a unique dilemma in the management and monitoring of disease. This study aimed at assessing medication prescribing in a pediatric ward of an  Ethiopian hospital. Materials and Methods: a retrospective cross-sectional study was done by reviewing the medical records of 249 patients among those admitted in the period between 11th of September 2007 and 10th of September 2008 to the pediatric ward of Gondar University Referral Hospital, Northwest Ethiopia. Data on characteristics like age, sex and weight; the diagnoses for which patients were admitted and medications prescribed to them during their stay in the ward was collected from the medical records of the patients. Results: an average of 3 diagnoses per patient with the most frequently diagnosed being malnutrition (29.23%, severe community acquired pneumonia (12.96% and underweight (8.86% were reported. A mean of 4.5 medications per patient with the most commonly prescribed being antibacterials namely penicillins which constituted 25.42%, other antibacterials making up 19.61% and medications used for correcting water, electrolyte and acid-base disturbances accounting for 17.19% of the total number of medications prescribed in the ward. The most common individual medications prescribed to the patients included crystalline penicillin, gentamicin and maintenance fluid constituting 9.22, 7.52 and 6.45 percentages respectively most of them in solution forms which were administered dominantly intravenously. Conclusion In this study the common prescription of antibacterials and those used for correcting water, electrolyte and acid-base disturbances was observed which went with the common diagnoses of malnutrition and pneumonia. 

  3. Implementing ward based clinical pharmacy services in an Ethiopian University Hospital

    Directory of Open Access Journals (Sweden)

    Mekonnen AB

    2013-03-01

    Full Text Available Background: Clinical pharmacy practice has developed internationally to expand the role of a pharmacist well beyond the traditional roles of compounding, dispensing and supplying drugs to roles more directly in caring for patients. Studies on the activities of the clinical pharmacist in an inpatient ward in resource constrained settings are scarce, however.Objective: To assess ward based clinical pharmacy services in an internal medicine ward of Jimma University Specialized Hospital. Methods: The study was carried out in the internal medicine ward from March to April, 2011 at Jimma University Specialized Hospital. The study design was a prospective observational study where pharmaceutical care services provided by clinical pharmacists for inpatients were documented over a period of two months. Interventions like optimization of rational drug use and physician acceptance of these recommendations were documented. Clinical significance of interventions was evaluated by an independent team (1 internist, 1 clinical pharmacologist using a standardized method for categorizing drug related problems (DRPs. Results: A total of 149 drug related interventions conducted for 48 patients were documented; among which 133(89.3% were clinical pharmacists initiated interventions and 16(10.7% interventions were initiated by other health care professionals. The most frequent DRPs underlying interventions were unnecessary drug therapy, 36(24.2%; needs additional drug therapy, 34(22.8% and noncompliance, 29(19.5%. The most frequent intervention type was change of dosage/instruction for use, 23(15.4%. Acceptance rate by physicians was 68.4%. Among the interventions that were rated as clinically significant, 46(48.9% and 25(26.6% had major and moderate clinical importance respectively. Conclusion: Involving trained clinical pharmacists in the healthcare team leads to clinically relevant and well accepted optimization of medicine use in a resource limited settings. This

  4. DEVELOPMENT OF GEOSPATIAL MAP BASED PORTAL FOR DELIMITATION OF MCD WARDS

    Directory of Open Access Journals (Sweden)

    A. Kumar Chandra Gupta

    2017-09-01

    Full Text Available The Geospatial Delhi Limited (GSDL, a Govt. of NCT of Delhi Company formed in order to provide the geospatial information of National Capital Territory of Delhi (NCTD to the Government of National Capital Territory of Delhi (GNCTD and its organs such as DDA, MCD, DJB, State Election Department, DMRC etc., for the benefit of all citizens of Government of National Capital Territory of Delhi (GNCTD. This paper describes the development of Geospatial Map based Portal for Delimitation of MCD Wards (GMPDW and election of 3 Municipal Corporations of NCT of Delhi. The portal has been developed as a map based spatial decision support system (SDSS for delimitation of MCD Wards and draw of peripheral wards boundaries to planning and management of MCD Election process of State Election Commission, and as an MCD election related information searching tools (Polling Station, MCD Wards and Assembly constituency etc., for the citizens of NCTD. The GMPDW is based on Client-Server architecture model. It has been developed using Arc GIS Server 10.0 with .NET (pronounced dot net technology. The GMPDW is scalable to enterprise SDSS with enterprise Geo Database & Virtual Private Network (VPN connectivity. Spatial data to GMPDW includes Enumeration Block (EB and Enumeration Blocks Group (EBG boundaries of Citizens of Delhi, Assembly Constituency, Parliamentary Constituency, Election District, Landmark locations of Polling Stations & basic amenities (Police Stations, Hospitals, Schools and Fire Stations etc.. GMPDW could help achieve not only the desired transparency and easiness in planning process but also facilitates through efficient & effective tools for management of MCD election. It enables a faster response to the changing ground realities in the development planning, owing to its in-built scientific approach and open-ended design.

  5. Dynamic change of surface microbiota with different environmental cleaning methods between two wards in a hospital.

    Science.gov (United States)

    Chen, Chang-Hua; Tu, Chi-Chao; Kuo, Han-Yueh; Zeng, Rong-Fong; Yu, Cheng-Sheng; Lu, Henry Horng-Shing; Liou, Ming-Li

    2017-01-01

    Terminal disinfection and daily cleaning have been performed in hospitals in Taiwan for many years to reduce the risks of healthcare-associated infections. However, the effectiveness of these cleaning approaches and dynamic changes of surface microbiota upon cleaning remain unclear. Here, we report the surface changes of bacterial communities with terminal disinfection and daily cleaning in a medical intensive care unit (MICU) and only terminal disinfection in a respiratory care center (RCC) using 16s ribosomal RNA (rRNA) metagenomics. A total of 36 samples, including 9 samples per sampling time, from each ward were analysed. The clinical isolates were recorded during the sampling time. A large amount of microbial diversity was detected, and human skin microbiota (HSM) was predominant in both wards. In addition, the colonization rate of the HSM in the MICU was higher than that in the RCC, especially for Moraxellaceae. A higher alpha-diversity (p = 0.005519) and a lower UniFrac distance was shown in the RCC due to the lack of daily cleaning. Moreover, a significantly higher abundance among Acinetobacter sp., Streptococcus sp. and Pseudomonas sp. was shown in the RCC compared to the MICU using the paired t test. We concluded that cleaning changes might contribute to the difference in diversity between two wards.

  6. A safe place with space for learning: Experiences from an interprofessional training ward.

    Science.gov (United States)

    Hallin, Karin; Kiessling, Anna

    2016-01-01

    Interprofessional learning in a real ward context effectively increases collaborative and professional competence among students. However, less is known on the processes behind this. The aim of this study was to explore medical, nurse, physiotherapy, and occupational therapy students' perspectives on the process of their own learning at an interprofessional training ward (IPTW). We performed a qualitative content analysis on free-text answers of 333 student questionnaires from the years 2004 to 2011. Two main themes emerged: first, students found that the IPTW provided an enriching learning environment--a safe place with space. It included authentic and relevant patients, well-composed and functioning student teams, competent and supportive supervisors, and adjusted ward structures to support learning. Second, they developed an awareness of their own development with faith in the future--from chaos to clarity. It included personal, professional, and interprofessional development towards a comprehensive view of practice and a faith in their ability to work as professionals in the future. Our findings are discussed with a social constructivist perspective. This study suggests that when an IPTW provides a supportive and permissive learning environment with possibilities to interact with one another--a safe place with space--it enables students to move from insecurity to faith in their abilities--from chaos to clarity. However, if the learning environment is impaired, the students' development could be halted.

  7. Neuroinfection survey at a neurological ward in a Brazilian tertiary teaching hospital

    Directory of Open Access Journals (Sweden)

    Paulo E Marchiori

    2011-01-01

    Full Text Available OBJECTIVES: This study was undertaken to characterize the neuroinfection profile in a tertiary neurological ward. INTRODUCTION: Neuroinfection is a worldwide concern and bacterial meningitis, tetanus and cerebral malaria have been reported as the commonest causes in developing countries. METHODS: From 1999 to 2007, all patients admitted to the Neurology Ward of Hospital das Clínicas, São Paulo University School of Medicine because of neuroinfection had their medical records reviewed. Age, gender, immunological status, neurological syndrome at presentation, infectious agent and clinical outcome were recorded. RESULTS: Three hundred and seventy four cases of neuroinfectious diseases accounted for 4.2% of ward admissions and the identification of infectious agent was successful in 81% of cases. Mean age was 40.5 + 13.4 years, 63.8% were male, 19.7% were immunocompromised patients and meningoencephalitis was the most common clinical presentation despite infectious agent. Viruses and bacteria were equally responsible for 29.4% of neuroinfectious diseases; parasitic, fungal and prion infections accounted for 28%, 9.6% and 3.5% respectively. Human immunodeficiency virus (HIV, herpes simplex virus 1 (HSV1, Mycobacterium tuberculosis, Treponema pallidum, Taenia solium, Schistosoma mansoni, Cryptococcus neoformans and Histoplasma capsulatum were the more common infectious pathogens in the patients. Infection mortality rate was 14.2%, of which 62.3% occurred in immunocompetent patients. CONCLUSION: Our institution appeared to share some results with developed and developing countries. Comparison with literature may be considered as quality control to health assistance.

  8. [The relative's need of participation in the care plan in a general medicine ward].

    Science.gov (United States)

    Artioli, Giovanna; Finotto, Stefano; Paverelli, Luisa; Carpanoni, Marika; Casadei, Elena Turroni

    2006-01-01

    All the scientific literature agrees on the fact that the shelter in hospital is a delicate moment for the patient. Also for relatives the shelter in hospital of their dear one is not of easy management, often they are excluded, insecure, alone and with a frankly uncertain role. The purpose of this study is to explore the role and the needs perceived from the relatives of an in-patient in a general medicine unit and to explore which role and which needs of the relatives are perceived from the nurses of a same ward. The sample of the study consisted of 49 relatives of in-patients in the ward of Medicina III dell'Azienda Ospedaliera di Reggio Emilia and of 18 nurses of the same ward. It was found that information is the most important need expressed by the relatives and that for the nurses is hard to satisfy it. Moreover, the nurses haven't a clear idea of the relative's role and they are inclined to exclude them from the care project.

  9. Nurses' role transition from the clinical ward environment to the critical care environment.

    Science.gov (United States)

    Gohery, Patricia; Meaney, Teresa

    2013-12-01

    To explore the experiences of nurses moving from the ward environment to the critical care environment. Critical care areas are employing nurses with no critical care experience due to staff shortage. There is a paucity of literature focusing on the experiences of nurses moving from the ward environment to the critical care environment. A Heideggerian phenomenology research approach was used in this study. In-depth semi structured interviews, supported with an interview guide, were conducted with nine critical care nurses. Data analysis was guided by Van Manen (1990) approach to phenomenological analysis. Four main themes emerged: The highs and lows, you need support, theory-practice gap, struggling with fear. The participants felt ill prepared and inexperienced to work within the stressful and technical environment of critical care due to insufficient education and support. The study findings indicated that a variety of feelings and emotions are experienced by ward nurses who move into the stressful and technical environment of critical care due to insufficient skills and knowledge. More education and support is required to improve this transition process. Copyright © 2013 Elsevier Ltd. All rights reserved.

  10. Cockroaches ’ bacterial infections in wards of hospitals, Hamedan city, west of Iran

    Directory of Open Access Journals (Sweden)

    Nejati Jalil

    2012-10-01

    Full Text Available Objective: To identify the relationship between different species of cockroaches with their bacterial infection in different wards of Hamedan county hospitals, western Iran. Methods: Using sticky trap, hand collection and glass trap, 250 cockroaches were collected from 14 wards of 5 hospitals. After having their identification determined by detection key, all of them were used to isolate bacteria from cuticle and alimentary tract. Results: From four identified species, Blatella germanica were the most common in all of the wards (88.8% and next was the Periplaneta Americana (8%. 20 bacteria species isolated from cockroaches' surface and 21 from digestive organ. Escherichia coli were the most predominant bacteria isolated from external surface (26.5 % as well as alimentary tract (30.8%. The frequency of investigated bacteria on cockroaches' body surface was not significantly different between Periplaneta Americana and Blattella germanica except for Kllebsiella oxytoca (P<0.001 and Providensia Spp (P=0.035. Also, frequency of detected bacteria in cockroaches' digestive organ was not significantly different between these two species. Furthermore, the frequency of bacteria isolated from the cockroaches' external surface was not significantly different from that of digestive organ except for shigella disantery (P<0.001, Pseudomonas aeroginosa (P<0.001 and Klebsiella oxytoca (P=0.01 3. Conclusions: Since cockroaches can carry pathogenic bacteria, so their existence in the hospitals could be a serious public health problem. It is suggested to compile programs in order to control cockroaches especially in the hospitals.

  11. Gauge-invariant three-boson vertices and their Ward identities in the standard model

    International Nuclear Information System (INIS)

    Papavassiliou, J.; Philippides, K.

    1995-01-01

    In the context of the standard model we extend the S-matrix pinch technique for nonconserved currents to the case of three-boson vertices. We outline in detail how effective gauge-invariant three-boson vertices can be constructed, with all three incoming momenta off shell. Explicit closed expressions for the vertices γW - W + , ZW - W + , and χW - W + are reported. The three-boson vertices so constructed satisfy naive QED-like Ward identities which relate them to the gauge-invariant gauge boson self-energies previously constructed by the same method. The derivation of the aforementioned Ward identities relies on the sole requirement of complete gauge invariance of the S-matrix element considered; in particular, no knowledge of the explicit closed form of the three-boson vertices involved is necessary. The validity of one of these Ward identities is demonstrated explicitly, through a detailed diagrammatic one-loop analysis, in the context of three different gauges

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

    Science.gov (United States)

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

    2015-01-01

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

  13. Ward identities and mass spectrum of N=1 Super Yang-Mills theory on the lattice

    International Nuclear Information System (INIS)

    Kirchner, R.

    2000-11-01

    We study the lattice regularization of N=1 Super Yang-Mills theory. Projecting operators for the low-lying spectrum are discussed. We also consider a ''baryonic'' state consisting of three gluinos, and develop a numerical strategy to determine its mass in a Monte Carlo simulation. We present numerical results on the low-lying spectrum of SU(2) N=1 Super Yang-Mills theory with light dynamical gluinos. The lattice regularization of N=1 Super Yang-Mills theory breaks supersymmetry at any finite lattice spacing. We derive the form of the corresponding SUSY Ward identity and carry out renormalization. The ratios of the renormalization coefficients Z T /Z S and M R /Z S are determined non-perturbatively in a numerical simulation. The form of the renormalized SUSY Ward identity is confirmed numerically. We discuss how the SUSY Ward identity can be used to define a supersymmetric continuum limit, and how its approach can be monitored in numerical simulations. (orig.)

  14. Determination of Noise Level and Its Sources in the Neonatal Intensive Care Unit and Neonatal Ward

    Directory of Open Access Journals (Sweden)

    Mahdi Jahangir Blourchian

    2015-12-01

    Full Text Available Background: In Neonatal intensive care units (NICU different sound intensities and frequencies are produced from different sources, which may exert undesirable physiological effects on the infants. The aim of this study was to determine the noise level and its sources in the NICU and neonatal ward of Al-Zahra Hospital of Rasht, Iran. Methods: In this descriptive cross-sectional study, the intensity of the sounds generated by the internal and external sources in the NICU and neonatal ward was measured using a sound level meter device. The sound produced by each of the sources was individually calculated. Data were analyzed performing descriptive and analytical statistics, using SPSS version 19. Results: The mean noise levels in six rooms and a hallway during morning, afternoon and night shifts with the electromechanical devices turned on were 61.67±4.5, 61.32±4.32 and 60.71±4.56 dB, respectively. Moreover, with the devices tuned off the mean noise levels during morning, afternoon and evening shifts were 64.97±2.6, 60.6±1.29 and 57.91±4.73 dB, respectively. The differences between the mean noise levels in the neonatal wards (standard noise level=45 dB during each shift with the electromechanical devices turned on and off were statistically significant (P=0.002 and P

  15. Clinical leadership for high-quality care: developing future ward leaders.

    Science.gov (United States)

    Enterkin, Judith; Robb, Elizabeth; McLaren, Susan

    2013-03-01

    This paper reports upon the development, delivery and evaluation of a leadership programme for aspiring Ward Leaders in one National Health Service Trust in England. The ward sister role is fundamental to quality patient care and clinical leadership, however the role is increasingly difficult to recruit to. A lack of formal preparation and skills development for the role has been widely acknowledged. An evaluation of a programme of education for leadership. Three cohorts (n = 60) completed the programme. Semi-structured questionnaires were completed by participants (n = 36: 60%) at the conclusion of the programme. Qualitative data from questionnaires was analysed using a thematic approach. Participants reported increased political, organizational and self-awareness, increased confidence, feelings of empowerment and the ability to empower others. Opportunities for networking with peers were valued within the action learning approach. For some participants, career intentions were clarified through reflection. The majority of participants had benefited from the leadership programme and valued this development as an empowering preparation for future careers. Investment in leadership preparation for future ward sister roles is strongly recommended as part of a strategy designed to enhance quality improvement, career path development, workforce empowerment and retention. © 2012 Blackwell Publishing Ltd.

  16. Job satisfaction and intent to leave among psychiatric nurses: closed versus open wards.

    Science.gov (United States)

    Baum, Alexander; Kagan, Ilya

    2015-08-01

    The aim of this study was to investigate: (a) the association between socio-demographic variables, job satisfaction and intent to leave among hospital psychiatric nurses, and (b) the differences in the above between psychiatric nurses working on closed and open wards. After receiving ethical approval, a convenience sample of 52 (70% of total nursing staff) was drawn from psychiatric nurses in a large Israeli psychiatric hospital (95% response rate). The sample completed anonymously a self-administered structured questionnaire. A negative correlation was found between job satisfaction and intent to leave and between age, all categories of seniority, and intent to leave. Closed-ward nurses reported a higher intent to leave psychiatric nursing. Nurses under 35 reported a significantly higher intent to leave psychiatric nursing than nurses over 35. Job satisfaction was significantly higher among full-time nurses than part-time. Psychiatric hospitals need to pay attention to all factors associated with workers' readiness to leave. Given the widespread shortage of nurses, it is especially important that they address the relatively low job satisfaction of both younger and part-time nurses, and the particular stresses that closed-ward nurses work under. Copyright © 2015 Elsevier Inc. All rights reserved.

  17. Multimedia based health information to parents in a pediatric acute ward: a randomized controlled trial.

    Science.gov (United States)

    Botngård, Anja; Skranes, Lars P; Skranes, Jon; Døllner, Henrik

    2013-12-01

    To determine whether multimedia based health information presented to parents of children with breathing difficulties in a pediatric acute ward, is more effective than verbal information, to reduce parental anxiety and increase satisfaction. This randomized controlled trial was conducted in a pediatric acute ward in Norway, from January to March 2011. Parents were randomly assigned to a multimedia intervention (n=53), or verbal health information (n=48). Primary outcome measure was parental anxiety, and secondary outcome measures were parental satisfaction with nursing care and health information. Parental anxiety decreased from arrival to discharge within both groups. At discharge the anxiety levels in the intervention group were no lower than in the control group. There was no difference in satisfaction with nursing care between the groups, but parents in the intervention group reported higher satisfaction with the health information given in the acute ward (p=.005). Multimedia based health information did not reduce anxiety more than verbal information, among parents to children with breathing difficulties. However, after discharge the parents were more satisfied with the multimedia approach. More research is needed to recommend the use of multimedia based information as a routine to parents in pediatric emergency care. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

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

    Science.gov (United States)

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

    2014-05-01

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

  19. Interprofessional collaboration between junior doctors and nurses in the general ward setting: A qualitative exploratory study.

    Science.gov (United States)

    Tang, Charmaine J; Zhou, Wen T; Chan, Sally W-C; Liaw, Sok Y

    2018-01-01

    To explore the collaboration experiences of junior physicians and nurses in the general ward setting. Junior physicians and nurses do not always work collaboratively and this could affect the quality of patient care. The understanding of the issues affecting junior physicians and nurses working together is needed to inform strategies to improve interprofessional collaboration. Nineteen junior physicians and nurses were interviewed in 2012 and 2013. Interviews were transcribed and analysed using thematic analysis. Junior physicians and nurses acknowledged the importance of working collaboratively to achieve better patient care, but they are struggling to cope due to heavy clinical workload, organisational constraints and differing power relationships. Nurses have to take on more responsibilities in the decision-making process of patients' care to foster effective interprofessional collaboration. The study calls for educational and organisational strategies to improve interprofessional collaboration between junior physicians and nurses. Nurse leaders should ensure that ward nurses are given a designated time to participate in ward rounds with physicians and have access to a communication tool that assists them in contributing proactively in the decision-making process of patient care. © 2017 John Wiley & Sons Ltd.

  20. Xerostomia and medication: a cross-sectional study in long-term geriatric wards.

    Science.gov (United States)

    Desoutter, A; Soudain-Pineau, M; Munsch, F; Mauprivez, C; Dufour, T; Coeuriot, J-L

    2012-01-01

    The purpose of this study was to determine the prevalence of xerostomia in old people living in long-term geriatric wards, and to measure the relationship between xerostomia and etiologic factors such as age and medication (total number of medications, xerogenic medications, anticholinergic medications and medications that induce hypersialorrhea). An observational retrospective, comparative, multicentre epidemiological study. Long-term geriatric wards, in Reims, France. 769 old people living in long-term geriatric wards. Prevalence of xerostomia assessed from age, total number of medications, xerogenic medications, anticholinergic medications and those that induce hypersialorrhea. Multivariable logistic regression was used to calculate Odds Ratios (OR) and their 95% Confidence Intervals (95% CI). Among 769 old people (average age 84.6±8.4 years old), 287 residents suffered from xerostomia (37.3%). Significant predictors of xerostomia were: resident's age OR=1.56, 95% CI (1.30-1.88), pxerostomia identified was medications that induce hypersialorrhea OR=0.81, 95% CI (0.67-0.98), p=0.03. The total number of medications and xerogenic medications did not play a significant role in xerostomia. Increasing Age and anticholinergic medications induce a dry mouth. Conversely, the total number of medications and xerogenic medications do not influence xerostomia. Medications that induce hypersialorrhea protect against the occurrence of dry mouth.

  1. Raising adults as children? A report on milieu therapy in a psychiatric ward in Norway.

    Science.gov (United States)

    Oeye, Christine; Bjelland, Anne Karen; Skorpen, Aina; Anderssen, Norman

    2009-03-01

    Milieu therapy is widely used as a therapeutic approach in psychiatric wards in the Nordic countries, but few studies exist that report on what practices a milieu therapy approach implies as seen from an ethnographic perspective. Therefore, there is a need to obtain insight into how milieu therapy unfolds in a psychiatric ward setting. The present ethnographic study aims to explore this in a locked-up psychiatric ward that was tied to a psychodynamic-oriented milieu therapy approach. Metaphors from traditional nuclear family life were widely used. Patients were often understood as harmed children and were taught self-management skills; the staff aimed at providing a caring atmosphere; and the patients seemed to behave, sometimes, in a childlike manner. In a Foucaultian framework, milieu therapy can be seen as a therapeutic normalization technique used to produce self-governing individuals. Milieu therapy "raises" patients in order to transform patients' odd behaviour and nonconforming lifestyles. We see this "raising children" approach as a type of intervention that nicely connects to the national policy of normalization and integration politics towards persons with psychiatric diagnoses.

  2. Gauge fixing, BRS invariance and Ward identities for randomly stirred flows

    International Nuclear Information System (INIS)

    Berera, Arjun; Hochberg, David

    2009-01-01

    The Galilean invariance of the Navier-Stokes equation is shown to be akin to a global gauge symmetry familiar from quantum field theory. This symmetry leads to a multiple counting of infinitely many inertial reference frames in the path integral approach to randomly stirred fluids. This problem is solved by fixing the gauge, i.e., singling out one reference frame. The gauge fixed theory has an underlying Becchi-Rouet-Stora (BRS) symmetry which leads to the Ward identity relating the exact inverse response and vertex functions. This identification of Galilean invariance as a gauge symmetry is explored in detail, for different gauge choices and by performing a rigorous examination of a discretized version of the theory. The Navier-Stokes equation is also invariant under arbitrary rectilinear frame accelerations, known as extended Galilean invariance (EGI). We gauge fix this extended symmetry and derive the generalized Ward identity that follows from the BRS invariance of the gauge-fixed theory. This new Ward identity reduces to the standard one in the limit of zero acceleration. This gauge-fixing approach unambiguously shows that Galilean invariance and EGI constrain only the zero mode of the vertex but none of the higher wavenumber modes.

  3. Gauge fixing, BRS invariance and Ward identities for randomly stirred flows

    Energy Technology Data Exchange (ETDEWEB)

    Berera, Arjun [School of Physics and Astronomy, University of Edinburgh, Edinburgh, EH9 3JZ (United Kingdom)], E-mail: ab@ph.ed.ac.uk; Hochberg, David [Centro de Astrobiologia (CSIC-INTA), Ctra. Ajalvir Km. 4, 28850 Torrejon de Ardoz, Madrid (Spain)], E-mail: hochbergd@inta.es

    2009-06-21

    The Galilean invariance of the Navier-Stokes equation is shown to be akin to a global gauge symmetry familiar from quantum field theory. This symmetry leads to a multiple counting of infinitely many inertial reference frames in the path integral approach to randomly stirred fluids. This problem is solved by fixing the gauge, i.e., singling out one reference frame. The gauge fixed theory has an underlying Becchi-Rouet-Stora (BRS) symmetry which leads to the Ward identity relating the exact inverse response and vertex functions. This identification of Galilean invariance as a gauge symmetry is explored in detail, for different gauge choices and by performing a rigorous examination of a discretized version of the theory. The Navier-Stokes equation is also invariant under arbitrary rectilinear frame accelerations, known as extended Galilean invariance (EGI). We gauge fix this extended symmetry and derive the generalized Ward identity that follows from the BRS invariance of the gauge-fixed theory. This new Ward identity reduces to the standard one in the limit of zero acceleration. This gauge-fixing approach unambiguously shows that Galilean invariance and EGI constrain only the zero mode of the vertex but none of the higher wavenumber modes.

  4. Randomized multicentre feasibility trial of intermediate care versus standard ward care after emergency abdominal surgery (InCare trial)

    DEFF Research Database (Denmark)

    Vester-Andersen, M; Waldau, T; Wetterslev, J

    2015-01-01

    BACKGROUND: Emergency abdominal surgery carries a considerable risk of death and postoperative complications. Early detection and timely management of complications may reduce mortality. The aim was to evaluate the effect and feasibility of intermediate care compared with standard ward care...... ward within 24 h of emergency abdominal surgery. Participants were randomized to either intermediate care or standard surgical ward care after surgery. The primary outcome was 30-day mortality. RESULTS: In total, 286 patients were included in the modified intention-to-treat analysis. The trial...... was terminated after the interim analysis owing to slow recruitment and a lower than expected mortality rate. Eleven (7·6 per cent) of 144 patients assigned to intermediate care and 12 (8·5 per cent) of 142 patients assigned to ward care died within 30 days of surgery (odds ratio 0·91, 95 per cent c.i. 0·38 to 2...

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

    Science.gov (United States)

    Sternal, Danuta; Wilczyński, Krzysztof; Szewieczek, Jan

    2017-01-01

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

  6. Nosocomial transmission of Ebola virus disease on pediatric and maternity wards: Bombali and Tonkolili, Sierra Leone, 2014.

    Science.gov (United States)

    Dunn, Angela C; Walker, Tiffany A; Redd, John; Sugerman, David; McFadden, Jevon; Singh, Tushar; Jasperse, Joseph; Kamara, Brima Osaio; Sesay, Tom; McAuley, James; Kilmarx, Peter H

    2016-03-01

    In the largest Ebola virus disease (EVD) outbreak in history, nosocomial transmission of EVD increased spread of the disease. We report on 2 instances in Sierra Leone where patients unknowingly infected with EVD were admitted to a general hospital ward (1 pediatric ward and 1 maternity ward), exposing health care workers, caregivers, and other patients to EVD. Both patients died on the general wards, and were later confirmed as being infected with EVD. We initiated contact tracing and assessed risk factors for secondary infections to guide containment recommendations. We reviewed medical records to establish the index patients' symptom onset. Health care workers, patients, and caregivers were interviewed to determine exposures and personal protective equipment (PPE) use. Contacts were monitored daily for EVD symptoms. Those who experienced EVD symptoms were isolated and tested. Eighty-two contacts were identified: 64 health care workers, 7 caregivers, 4 patients, 4 newborns, and 3 children of patients. Seven contacts became symptomatic and tested positive for EVD: 2 health care workers (1 nurse and 1 hospital cleaner), 2 caregivers, 2 newborns, and 1 patient. The infected nurse placed an intravenous catheter in the pediatric index patient with only short gloves PPE and the hospital cleaner cleaned the operating room of the maternity ward index patient wearing short gloves PPE. The maternity ward index patient's caregiver and newborn were exposed to her body fluids. The infected patient and her newborn shared the ward and latrine with the maternity ward index patient. Hospital staff members did not use adequate PPE. Caregivers were not offered PPE. Delayed recognition of EVD and inadequate PPE likely led to exposures and secondary infections. Earlier recognition of EVD and adequate PPE might have reduced direct contact with body fluids. Limiting nonhealth-care worker contact, improving access to PPE, and enhancing screening methods for pregnant women, children

  7. The ward atmosphere important for the psychosocial work environment of nursing staff in psychiatric in-patient care.

    Science.gov (United States)

    Tuvesson, Hanna; Wann-Hansson, Christine; Eklund, Mona

    2011-06-16

    The nursing staff working in psychiatric care have a demanding work situation, which may be reflected in how they view their psychosocial work environment and the ward atmosphere. The aims of the present study were to investigate in what way different aspects of the ward atmosphere were related to the psychosocial work environment, as perceived by nursing staff working in psychiatric in-patient care, and possible differences between nurses and nurse assistants. 93 nursing staff working at 12 general psychiatric in-patient wards in Sweden completed two questionnaires, the Ward Atmosphere Scale and the QPSNordic 34+. Data analyses included descriptive statistics, the Mann-Whitney U-test, Spearman rank correlations and forward stepwise conditional logistic regression analyses. The data revealed that there were no differences between nurses and nurse assistants concerning perceptions of the psychosocial work environment and the ward atmosphere. The ward atmosphere subscales Personal Problem Orientation and Program Clarity were associated with a psychosocial work environment characterized by Empowering Leadership. Program Clarity was related to the staff's perceived Role Clarity, and Practical Orientation and Order and Organization were positively related to staff perceptions of the Organizational Climate. The results from the present study indicate that several ward atmosphere subscales were related to the nursing staff's perceptions of the psychosocial work environment in terms of Empowering Leadership, Role Clarity and Organizational Climate. Improvements in the ward atmosphere could be another way to accomplish improvements in the working conditions of the staff, and such improvements would affect nurses and nurse assistants in similar ways.

  8. The ward atmosphere important for the psychosocial work environment of nursing staff in psychiatric in-patient care

    Directory of Open Access Journals (Sweden)

    Wann-Hansson Christine

    2011-06-01

    Full Text Available Abstract Background The nursing staff working in psychiatric care have a demanding work situation, which may be reflected in how they view their psychosocial work environment and the ward atmosphere. The aims of the present study were to investigate in what way different aspects of the ward atmosphere were related to the psychosocial work environment, as perceived by nursing staff working in psychiatric in-patient care, and possible differences between nurses and nurse assistants. Methods 93 nursing staff working at 12 general psychiatric in-patient wards in Sweden completed two questionnaires, the Ward Atmosphere Scale and the QPSNordic 34+. Data analyses included descriptive statistics, the Mann-Whitney U-test, Spearman rank correlations and forward stepwise conditional logistic regression analyses. Results The data revealed that there were no differences between nurses and nurse assistants concerning perceptions of the psychosocial work environment and the ward atmosphere. The ward atmosphere subscales Personal Problem Orientation and Program Clarity were associated with a psychosocial work environment characterized by Empowering Leadership. Program Clarity was related to the staff's perceived Role Clarity, and Practical Orientation and Order and Organization were positively related to staff perceptions of the Organizational Climate. Conclusions The results from the present study indicate that several ward atmosphere subscales were related to the nursing staff's perceptions of the psychosocial work environment in terms of Empowering Leadership, Role Clarity and Organizational Climate. Improvements in the ward atmosphere could be another way to accomplish improvements in the working conditions of the staff, and such improvements would affect nurses and nurse assistants in similar ways.

  9. [A diagnostic algorithm and treatment procedure in disordered vital functions in newborns admitted to a resuscitation ward].

    Science.gov (United States)

    Ostreĭkov, I F; Podkopaev, V N; Moiseev, D B; Karpysheva, E V; Markova, L A; Sizov, S V

    1997-01-01

    Total mortality decreased by 2.5 times in the wards for intensive care of the newborns in the Tushino Pediatric Hospital in 1996 and is now 7.6%. Such results are due to a complex of measures, one such measure being the development and introduction of an algorithm for the diagnosis and treatment of newborns hospitalized in intensive care wards. The algorithm facilitates the work of the staff, helps earlier diagnose a disease, and, hence, carry out timely scientifically based therapy.

  10. Quantitative Risk Assessment of Patient Manual Handling in Wards of One of the Hospitals of Tehran using MAPO Method, Iran

    Directory of Open Access Journals (Sweden)

    Sajad Ataei

    2017-05-01

    Full Text Available Background and Objectives: Manual handling of disabled patients is one of the important and effective factors in acute low back pain among exposed nurses. The present study was conducted with the objective of quantitative risk assessment of patient manual handling among nurses in wards of one of the hospitals in Tehran using MAPO method. Methods: The present study was conducted as an analytical-cross-sectional study in 26 wards of one of the hospitals in Tehran city. Samples were selected by census method from nurses and paramedics of different wards of hospital. Data collection was performed using demographic information and MAPO checklist. Results: The highest score of MAPO were, respectively, related to wards of DI clinic (score, 14.7, men orthopedic (score, 6.3, and general operating room (score, 57. 53.8% of hospital wards were at the level 2 corrective action, which indicated that the risk of musculoskeletal disorder is 2.4 times higher than level 1 corrective action. Conclusion: Given that the proportion of disabled patient in cooperation and/or partial cooperation, lifting tools, auxiliary, wheelchair, and training have the most role among risk factors for above-mentioned wards, increasing the number of human resources and wheelchair, use of lifting and auxiliary tools and training reduce MAPO score and consequently the risk of musculoskeletal disorders.

  11. Establishing female-only areas in psychiatry wards to improve safety and quality of care for women.

    Science.gov (United States)

    Kulkarni, Jayashri; Gavrilidis, Emmy; Lee, Stuart; Van Rheenen, Tamsyn E; Grigg, Jasmin; Hayes, Emily; Lee, Adeline; Ong, Roy; Seeary, Amy; Andersen, Shelley; Worsley, Rosie; Keppich-Arnold, Sandra; Stafrace, Simon

    2014-12-01

    Our aim was to assess the impact of creating a female-only area within a mixed-gender inpatient psychiatry service, on female patient safety and experience of care. The Alfred hospital reconfigured one of its two psychiatry wards to include a female-only area. Documented incidents compromising the safety of women on each ward in the 6 months following the refurbishment were compared. Further, a questionnaire assessing perceived safety and experience of care was administered to female inpatients on both wards, and staff feedback was also obtained. The occurrence of documented incidents compromising females' safety was found to be significantly lower on the ward containing a female-only area. Women staying on this ward rated their perceived safety and experience of care significantly more positively than women staying where no such gender segregation was available. Further, the female-only area was identified by the majority of surveyed staff to provide a safer environment for female patients. Establishing female-only areas in psychiatry wards is an effective way to improve the safety and experience of care for female patients. © The Royal Australian and New Zealand College of Psychiatrists 2014.

  12. Moxa-stick suffumigation for disinfecting air in hematology and hematopoietic stem cell transplantation wards with class 100 laminar flow.

    Science.gov (United States)

    He, Jing-song; Yang, Qing; Huang, Wei-jia; Hu, Xiao-rong

    2014-04-01

    To evaluate the effect of moxa-stick suffumigation in the hematology and hematopoietic stem cell transplantation (HSCT) wards with luminar flow. The plate exposure method was used to measure the effect of air-disinfection of moxa-stick suffumigation in hematology and HSCT wards. The yearly average qualified rates of air sampling in HSCT wards were evaluated from 2007 to 2010. To further investigate the disinfecting effect of moxa-stick suffumigation, the colony counts of common pathogens (including Staphylcoccus aureus and Pseudomonas aeruginosa) before and after moxa-stick suffumigation were compared. The mean air quality rates of the HSCT wards with class 100 laminar flow were all above 90.0% (91.2%-96.2%) from 2007 to 2010. Moxa-stick suffumigation effectively decreased the presence of bacteria in the hematology ward's air (Pplates exposed to air treated with moxa-stick suffumigation (77.1±52.9 cfu/m(2) vs 196.1±87.5 cfu/m(2), P<0.01; and 100.2±35.3 cfu/m(2) vs 371.5±35.3 cfu/m(2), P<0.01). Moxa-stick suffumigation proved to be a reliable and effective airdisinfection method for hematology and HSCT wards, and hence, it should be employed extensively.

  13. iPad use at the bedside: a tool for engaging patients in care processes during ward rounds?

    Science.gov (United States)

    Baysari, M T; Adams, K; Lehnbom, E C; Westbrook, J I; Day, R O

    2014-10-01

    Previous work has examined the impact of technology on information sharing and communication between doctors and patients in general practice consultations, but very few studies have explored this in hospital settings. To assess if, and how, senior clinicians use an iPad to share information (e.g. patient test results) with patients during ward rounds and to explore patients' and doctors' experiences of information sharing events. Ten senior doctors were shadowed on ward rounds on general wards during interactions with 525 patients over 77.3 h, seven senior doctors were interviewed and 180 patients completed a short survey. Doctors reported that information sharing with patients is critical to the delivery of high-quality healthcare, but were not seen to use the iPad to share information with patients on ward rounds. Patients did not think the iPad had impacted on their engagement with doctors on rounds. Ward rounds were observed to follow set routines and patient interactions were brief. Although the iPad potentially creates new opportunities for information sharing and patient engagement, the ward round may not present the most appropriate context for this to be done. © 2014 The Authors; Internal Medicine Journal © 2014 Royal Australasian College of Physicians.

  14. A multisource feedback tool to assess ward round leadership skills of senior paediatric trainees: (1) Development of tool.

    Science.gov (United States)

    Lakshminarayana, Indumathy; Wall, David; Bindal, Taruna; Goodyear, Helen M

    2015-05-01

    Leading a ward round is an essential skill for hospital consultants and senior trainees but is rarely assessed during training. To investigate the key attributes for ward round leadership and to use these results to develop a multisource feedback (MSF) tool to assess the ward round leadership skills of senior specialist trainees. A panel of experts comprising four senior paediatric consultants and two nurse managers were interviewed from May to August 2009. From analysis of the interview transcripts, 10 key themes emerged. A structured questionnaire based on the key themes was designed and sent electronically to paediatric consultants, nurses and trainees at a large university hospital (June-October 2010). 81 consultants, nurses and trainees responded to the survey. The internal consistency of this tool was high (Cronbach's α 0.95). Factor analysis showed that five factors accounted for 72% of variance. The five key areas for ward round leadership were communication skills, preparation and organisation, teaching and enthusiasm, team working and punctuality; communication was the most important key theme. A MSF tool for ward round leadership skills was developed with these areas as five domains. We believe that this tool will add to the current assessment tools available by providing feedback about ward round leadership skills. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

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

    Directory of Open Access Journals (Sweden)

    Rosemarie Sadsad

    Full Text Available Methicillin-resistant Staphylococcus aureus (MRSA is a major cause of preventable nosocomial infections and is endemic in hospitals worldwide. The effectiveness of infection control policies varies significantly across hospital settings. The impact of the hospital context towards the rate of nosocomial MRSA infections and the success of infection control is understudied. We conducted a modelling study to evaluate several infection control policies in surgical, intensive care, and medical ward specialties, each with distinct ward conditions and policies, of a tertiary public hospital in Sydney, Australia. We reconfirm hand hygiene as the most successful policy and find it to be necessary for the success of other policies. Active screening for MRSA, patient isolation in single-bed rooms, and additional staffing were found to be less effective. Across these ward specialties, MRSA transmission risk varied by 13% and reductions in the prevalence and nosocomial incidence rate of MRSA due to infection control policies varied by up to 45%. Different levels of infection control were required to reduce and control nosocomial MRSA infections for each ward specialty. Infection control policies and policy targets should be specific for the ward and context of the hospital. The model we developed is generic and can be calibrated to represent different ward settings and pathogens transmitted between patients indirectly through health care workers. This can aid the timely and cost effective design of synergistic and context specific infection control policies.

  16. [LONG-TERM SURVIVAL OF DUAL DISORDERS PATIENTS AFTER MIXED CARE IN DUAL DISORDERS AND STANDARD WARDS VERSUS CARE ONLY IN DUAL DISORDERS WARD].

    Science.gov (United States)

    Gimelfarb, Yuri; Wolf, Aviva; Ben-Tzarfati, Mashit

    2017-01-01

    Dual disorders (co-occurring mental illness and substance abuse disorders in the same person) are extremely common among patients receiving mental health services. Integrated treatment has been proposed as the standard of care and it describes a flexible combination of treatments from the mental health and addiction fields that are blended together in the therapy. Scientific evidence for survival of dual disorders patients (DDPs), who had integrated dual disorders inpatient care, is lacking. To determine the long term survival rates following integrated care (Integrated Dual Diagnosis Treatment Ward [IDDTW] only) versus mixed care (IDDTW and psychiatric wards) during the life-time of DDPs. The charts of 333 subjects admitted to IDDTW during the period January 2002 - June 2006 were assessed at least 8 years after the first admission. Psychiatric diagnoses have been established and grouped according to international classification of diseases and health-related problems -10th edition (ICD-10). The Kaplan-Meier survival analysis was used to estimate the cumulative survival rates in all the subpopulations, and the predictive values of different variables were assessed by Cox proportional-hazards regression model. The total all-cause 12-year, unadjusted mortality was 21.1% in integrated care versus 24.6% in mixed care (pintegrated care as a predictive factor for all-cause mortality. The findings showed that there was no consistent evidence to support integrated inpatient care over mixed care, as measured by long-term survival. More studies are required in order to address the challenges posed in the treatment of DDPs.

  17. Risk factors for delirium – characteristics of patients at risk of delirium in Geriatric Ward

    Directory of Open Access Journals (Sweden)

    Iwona Otremba

    2016-02-01

    Full Text Available Background. Delirium is an acute cognitive disorder comorbid with impaired consciousness and psychomotor activity. It occurs in 30–50% of patients in geriatric wards. It is the most common and least recognized syndrome in geriatrics. Objectives. The aim of the study was to formulate the characteristics of the patient’s risk of developing delirium in the Geriatric Ward. Material and methods . The study included all patients admitted to the Ward from 15 June 2013 until 15 June 2014 (n = 788. In 5% (n = 41 diagnosed symptoms of delirium. Assessment of the need for care – by Barthel, independence by IADL, the pain by VAS or DOLOPLUS, mental status by MMSE, the risk of falling by the “get up and go” test, occurrence of delirium by CAM, depth of delirium by DOM, agitation-sedation by RASS. Results. In the group with symptoms of delirium (n = 41 there were 76% (n = 31 female and 24% (n = 10 male. In 90% (n = 37 the mobility was impaired. By the Barthel 41% (n = 20 had ≤ 40 points, by IADL 78% (n = 32 had ≤ 16 points. 85% (n = 35 has high risk of falling. By VAS 71% (n = 26, (n = 36 – ≥ 4 points, the pain by DOLOPLUS – 16.7 points (15% of the group (n = 5. By MMSE 66% (n = 27 had ≤ 18 points. Delirium in an interview – 61% (n = 24. 61% (n = 26 had used ≥ 5 drugs. Incontinence – 56% (n = 25, bladder catheterization – 27% (n = 11. 83% (n = 34 had ≥ 10 risk factors for delirium. Conclusions . The patient at risk of delirium is the patient with concomitant: dementia, delirium in the past, urinary incontinence, limited mobility and pain, patients taking drugs ≥ 5, involving ≥ 10 risk factors for delirium.

  18. [Withholding and withdrawing treatment in patients admitted in an Internal Medicine ward].

    Science.gov (United States)

    García Caballero, R; Herreros, B; Real de Asúa, D; Alonso, R; Barrera, M M; Castilla, V

    2016-01-01

    Many of the patients admitted to a general medical ward have a compromised quality of life, or short life expectancy, so they are potential candidates for withhold/withdraw (WH/WD) treatment. The first objectif was to describe which measures were WH/WD among patients who died during their admission in a general medical ward from a tertiary hospital in Madrid. Secondly, to define the clinical characteristics of this population. A cross-sectional descriptive study during 6 months from 2011 and 2012 of all the patients dead while their admission in the Internal Medicine Department. 2007 patients were admitted, 211 died (10.5%). 121 (57%) were female, with 85±9 years of mean age. 103 (48.8%) came from a residential facility and 105 fulfilled terminality criteria (49.8%). One decision to WH/WD treatment was made in 182 patients (86.3%, CI 95%: 81.4-91.1), two in 99 cases (46.9%, CI 95%: 39.9-53.9) and 3 or more in 31 subjects (14.7%, CI 95%: 9.6-19.7). The most frequent decisions involved do-not-resuscitate orders (154, 73.0%), rejection of «aggressive treatment measures» (80, 38.0%), use of antibiotics (19, 9.0%), admission in ICU (18, 8.5%), and/or surgical treatment (11, 5.2%). WH/WD treatment is very frequent among patients who died in a general medical ward. The most frequent involved do-not-resuscitate orders and rejection of «aggressive treatment measures». WH/WD decisions are adopted in an elderly population, with extensive comorbidity and an elevated prevalence of advanced dementia and/or terminal disease. Copyright © 2015 SECA. Published by Elsevier Espana. All rights reserved.

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

    Science.gov (United States)

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

    2016-11-10

    Hospitals pursue different goals at the same time: excellent service to their patients, good quality care, operational excellence, retaining employees. This requires a good balance between patient needs and nursing staff. One way to ensure a proper fit between patient needs and nursing staff is to work with a workload management method. In our view, a nursing workload management method needs to have the following characteristics: easy to interpret; limited additional registration; applicable to different types of hospital wards; supported by nurses; covers all activities of nurses and suitable for prospective planning of nursing staff. At present, no such method is available. The research follows several steps to come to a workload management method for staff nurses. First, a list of patient characteristics relevant to care time will be composed by performing a Delphi study among staff nurses. Next, a time study of nurses' activities will be carried out. The 2 can be combined to estimate care time per patient group and estimate the time nurses spend on non-patient-related activities. These 2 estimates can be combined and compared with available nursing resources: this gives an estimate of nurses' workload. The research will take place in an academic hospital in the Netherlands. 6 surgical wards will be included, capacity 15-30 beds. The study protocol was submitted to the Medical Ethical Review Board of the University Medical Center (UMC) Utrecht and received a positive advice, protocol number 14-165/C. This method will be developed in close cooperation with staff nurses and ward management. The strong involvement of the end users will contribute to a broader support of the results. The method we will develop may also be useful for planning purposes; this is a strong advantage compared with existing methods, which tend to focus on retrospective analysis. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence

  20. One particle properties in the 2D Coulomb problem. Luttinger-Ward variational approach

    International Nuclear Information System (INIS)

    Agnihotri, M.P.

    2007-01-01

    In this work, we have studied the 2D Coulomb problem. We used the Luttinger-Ward variational principle to determine the self-energy Σ in ring approximation. The use of an ansatz for Σ enables us to perform the frequency sums (integrals as T → 0) analytically. Compared to the usual procedure of iterating the self consistency equation with free Green's function as starting points, the present approach is superior. It works for higher density parameter r s (low density) where the iteration already fails to converge. The motivation of the present work is the quantum Hall system at filling factor 1/2. The Luttinger-Ward procedure is a rather powerful method in particular if combined with an analytical ansatz for Σ. The computation performed here for 2DEG has to be seen as a first step: There, the experiment shows the features of a free Fermion system that is interpreted as a system of Composite Fermions. If one studies the self energy of the Composite Fermions in an conserved approximation that corresponds to the ring approximation, one encounters a self consistency equation. However, an iterative solution of this equation meets with a complication: Instead of the polarization part Π 00 , in the case of the Composite Fermion there appears the longitudinal polarization part Π LL that has an additional factor (2k + q) 2 under the k integral. This integral converges only after the frequency integral is performed. It is highly difficult to reproduce this numerically. Here, the Luttinger-Ward variational approach applied to the 2D Coulomb problem in the present work looks promising. For the 2D Coulomb problem, in the ring approximation for the LW thermodynamic potential, that already leads to a formidable integral equation that has to be studied numerically. (orig.)

  1. Air and surface contamination patterns of meticillin-resistant Staphylococcus aureus on eight acute hospital wards.

    Science.gov (United States)

    Creamer, E; Shore, A C; Deasy, E C; Galvin, S; Dolan, A; Walley, N; McHugh, S; Fitzgerald-Hughes, D; Sullivan, D J; Cunney, R; Coleman, D C; Humphreys, H

    2014-03-01

    Meticillin-resistant Staphylococcus aureus (MRSA) can be recovered from hospital air and from environmental surfaces. This poses a potential risk of transmission to patients. To investigate associations between MRSA isolates recovered from air and environmental surfaces with those from patients when undertaking extensive patient and environmental sampling. This was a prospective observational study of patients and their environment in eight wards of a 700-bed tertiary care hospital during 2010 and 2011. Sampling of patients, air and surfaces was carried out on all ward bays, with more extended environmental sampling in ward high-dependency bays and at particular times of the day. The genetic relatedness of isolates was determined by DNA microarray profiling and spa typing. MRSA was recovered from 30/706 (4.3%) patients and from 19/132 (14.4%) air samples. On 9/132 (6.8%) occasions both patient and air samples yielded MRSA. In 32 high-dependency bays, MRSA was recovered from 12/161 (7.4%) patients, 8/32 (25%) air samples, and 21/644 (3.3%) environmental surface samples. On 10/132 (7.6%) occasions, MRSA was isolated from air in the absence of MRSA-positive patients. Patient demographic data combined with spa typing and DNA microarray profiling revealed four likely transmission clusters, where patient and environmental isolates were deemed to be very closely related. Air sampling yielded MRSA on frequent occasions, especially in high-dependency bays. Environmental and air sampling combined with patient demographic data, spa typing and DNA microarray profiling indicated the presence of clusters that were not otherwise apparent. Copyright © 2014 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

  2. Informed switching strongly decreases the prevalence of antibiotic resistance in hospital wards.

    Directory of Open Access Journals (Sweden)

    Roger D Kouyos

    2011-03-01

    Full Text Available Antibiotic resistant nosocomial infections are an important cause of mortality and morbidity in hospitals. Antibiotic cycling has been proposed to contain this spread by a coordinated use of different antibiotics. Theoretical work, however, suggests that often the random deployment of drugs ("mixing" might be the better strategy. We use an epidemiological model for a single hospital ward in order to assess the performance of cycling strategies which take into account the frequency of antibiotic resistance in the hospital ward. We assume that information on resistance frequencies stems from microbiological tests, which are performed in order to optimize individual therapy. Thus the strategy proposed here represents an optimization at population-level, which comes as a free byproduct of optimizing treatment at the individual level. We find that in most cases such an informed switching strategy outperforms both periodic cycling and mixing, despite the fact that information on the frequency of resistance is derived only from a small sub-population of patients. Furthermore we show that the success of this strategy is essentially a stochastic phenomenon taking advantage of the small population sizes in hospital wards. We find that the performance of an informed switching strategy can be improved substantially if information on resistance tests is integrated over a period of one to two weeks. Finally we argue that our findings are robust against a (moderate preexistence of doubly resistant strains and against transmission via environmental reservoirs. Overall, our results suggest that switching between different antibiotics might be a valuable strategy in small patient populations, if the switching strategies take the frequencies of resistance alleles into account.

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

    Science.gov (United States)

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

    2014-10-01

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

  4. Differences in selected medical care parameters in rheumatic disease ward patients of different ages of life

    Directory of Open Access Journals (Sweden)

    Piotr Pobrotyn

    2016-06-01

    Full Text Available Introduction : Rheumatic diseases are becoming more and more common in Poland with the ageing of the population. Nearly 18% of the total hospital admissions in Poland result from rheumatic diseases, which was equivalent to 350 thousand cases in the year 2008. These diseases tend to last for many decades, decreasing both the quality of life and income of the patients as well as increasing the medical institutions’ workload and society’s financial burden. The aim of the study was to determine whether the medical care parameters in a rheumatic disease hospital ward show any significant differences among different patient age groups – especially such that would support taking them into account as a basis for adjusting the financial coverage level of medical services. Material and methods : Data on hospitalizations at the Rheumatic Diseases Ward of Wroclaw University Hospital in Wroclaw in the years 2009–2015 were analyzed, taking into account the age groups, number of hospital admissions, their duration and causes. Relevant statistical data analysis was performed. Discussion: The study revealed that the number of old patients hospitalized at the rheumatic diseases ward increased over the last 6 years and that such statistically significant differences do exist: on average the old patients not only tend to stay much longer at the hospital, but also suffer from a different and more diverse spectrum of diseases in comparison to their younger counterparts. Conclusions : The detected differences in medical care parameters support the need for more individualized medical care and increased cost of the hospital stay in the case of older patients. Consequently, those factors justify the necessity to increase the value of medical services in the case of old patients, possibly also taking into account the variation between age subgroups.

  5. Building a relationship: communications and relationships between staff and stroke patients on a rehabilitation ward.

    Science.gov (United States)

    Jones, M; O'Neill, P; Waterman, H; Webb, C

    1997-07-01

    Communications among staff and patients on a stroke rehabilitation ward form the focus of this article, which reports on some aspects of a larger study using a grounded theory approach. Tape-recorded interviews were transcribed and analysed concurrently according to recommendations for the approach. A main theme entitled building a relationship was identified, and this process was found to occur in a context varying from participative at one end of a continuum to hierarchical at the other. Building a relationship was found to be influenced by role, personal qualities and organizational context. Appropriate relationships between role-holders were subject to negotiation, leading to a resulting congruence or incongruence between participants' expectations of each other and their roles. Personal qualities were brought into play in the process, with patients' views of staff and staff views of patients both being influential. Some of these views seemed to parallel what has been described in earlier literature as 'the sick role' and the labelling of patients as 'good' or 'bad'. Responses to personal qualities led to nurses ascribing meaning to patients' behaviour in terms of adjustment to their stroke, giving time to them to help them to adjust, and withdrawal and handing over to other staff if this strategy failed. Organizational context also had an influence on building a relationship, with time constraints being identified particularly by nurses, and the need to fit in the most essential aspects of care. Place was also important, in that nurses were confined to the ward as a work location, whereas other therapists and doctors worked in other places and sometimes had the facility to take patients off the ward to concentrate on therapy. The findings are discussed against the background of related literature and the conclusion is drawn that the crucial role of nurses in rehabilitation is not recognized and valued, and that shortages of resources-especially suitably

  6. [Extension of psychotherapeutic activities within a psychiatric ward and the team's occupational background].

    Science.gov (United States)

    Antikainen, R

    1991-01-01

    The importance of democratizing the therapeutic process in a psychiatric ward has been emphasized by Hägglund and Pylkkänen (1980). In spite of different levels of training extensive participating of the team members in performing individual psychotherapy promotes the unity of the therapeutic views of the staff. It prevents the formation of antitherapeutic staff groups. The subjective outcome of the treatment on a psychiatric open ward was examined using a questionnaire to patients. All those patients (N = 55) were selected who during a two years' research period stayed at least three weeks on the ward. Three subsamples were formed according to the therapist's occupation: a. patients of registered psychiatric nurses, b. patients of assistant psychiatric nurses and c. patients of residents, psychologists and social workers. There were no significant differences in the evaluations of the general treatment outcome between these three groups. Instead, the occupational background correlated with the patient's evaluation of the importance of the personal therapeutic relationship. The therapeutic relationship with a registered psychiatric nurse or with an assistant psychiatric nurse was significantly more often evaluated to be very or rather important at the end of the treatment than a relationship with a member of the group c. It was concluded that the goal to delegate the psychotherapeutic activities to the whole staff had been achieved quite well. The patients did not devaluate therapeutic relationships with staff members from a lower level of occupational training, on the contrary. The "non academic" personnel had established good contact with their patients. These observations support the views proposed by Hägglund and Pylkkänen (1980). Individual therapy should not be separated from the therapeutic community and the staff should not be divided into therapists and non-therapists.

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

    Science.gov (United States)

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

    2012-01-01

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

  8. One particle properties in the 2D Coulomb problem. Luttinger-Ward variational approach

    Energy Technology Data Exchange (ETDEWEB)

    Agnihotri, M.P.

    2007-04-27

    In this work, we have studied the 2D Coulomb problem. We used the Luttinger-Ward variational principle to determine the self-energy {sigma} in ring approximation. The use of an ansatz for {sigma} enables us to perform the frequency sums (integrals as T {yields} 0) analytically. Compared to the usual procedure of iterating the self consistency equation with free Green's function as starting points, the present approach is superior. It works for higher density parameter r{sub s} (low density) where the iteration already fails to converge. The motivation of the present work is the quantum Hall system at filling factor 1/2. The Luttinger-Ward procedure is a rather powerful method in particular if combined with an analytical ansatz for {sigma}. The computation performed here for 2DEG has to be seen as a first step: There, the experiment shows the features of a free Fermion system that is interpreted as a system of Composite Fermions. If one studies the self energy of the Composite Fermions in an conserved approximation that corresponds to the ring approximation, one encounters a self consistency equation. However, an iterative solution of this equation meets with a complication: Instead of the polarization part {pi}{sub 00}, in the case of the Composite Fermion there appears the longitudinal polarization part {pi}{sub LL} that has an additional factor (2k + q){sup 2} under the k integral. This integral converges only after the frequency integral is performed. It is highly difficult to reproduce this numerically. Here, the Luttinger-Ward variational approach applied to the 2D Coulomb problem in the present work looks promising. For the 2D Coulomb problem, in the ring approximation for the LW thermodynamic potential, that already leads to a formidable integral equation that has to be studied numerically. (orig.)

  9. Blood sample collection and patient identification demand improvement: a questionnaire study of preanalytical practices in hospital wards and laboratories.

    Science.gov (United States)

    Wallin, Olof; Söderberg, Johan; Van Guelpen, Bethany; Stenlund, Hans; Grankvist, Kjell; Brulin, Christine

    2010-09-01

    Scand J Caring Sci; 2010; 24; 581-591 
 Blood sample collection and patient identification demand improvement: a questionnaire study of preanalytical practices in hospital wards and laboratories   Most errors in venous blood testing result from human mistakes occurring before the sample reach the laboratory.   To survey venous blood sampling (VBS) practices in hospital wards and to compare practices with hospital laboratories.   Staff in two hospitals (all wards) and two hospital laboratories (314 respondents, response rate 94%), completed a questionnaire addressing issues relevant to the collection of venous blood samples for clinical chemistry testing.   The findings suggest that instructions for patient identification and the collection of venous blood samples were not always followed. For example, 79% of the respondents reported the undesirable practice (UDP) of not always using wristbands for patient identification. Similarly, 87% of the respondents noted the UDP of removing venous stasis after the sampling is finished. Compared with the ward staff, a significantly higher proportion of the laboratory staff reported desirable practices regarding the collection of venous blood samples. Neither education nor the existence of established sampling routines was clearly associated with VBS practices among the ward staff.   The results of this study, the first of its kind, suggest that a clinically important risk of error is associated with VBS in the surveyed wards. Most important is the risk of misidentification of patients. Quality improvement of blood sample collection is clearly needed, particularly in hospital wards. © 2009 The Authors. Journal compilation © 2009 Nordic College of Caring Science.

  10. Comparative Assessment of Patients’ Rights Observance in the Hospitalization Wards of Shahid Beheshti University of Medical Sciences’ Hospitals

    Directory of Open Access Journals (Sweden)

    M. Sharifi

    2017-06-01

    Full Text Available Background: Patients are one of the most vulnerable social groups. Respecting patients’ rights will lead in advantages like “decrease in hospitalization time” and “increase in patients’ satisfaction”. This study is performed to assess the patients' rights observance in the hospitalization wards of educational hospitals of Shahid Beheshti University of Medical Sciences. Methods: In this descriptive-cross sectional study 137 medical student (intern were selected by convenience sampling method. We used a questionnaire with 12 questions. Reliability of questionnaire was confirmed by experts of the field and validity was confirmed by Cronbach’s Alpha coefficient (81%. The obtained data were analyzed by SPSS (v21 using descriptive statistics, analysis of variance and Tukey test. Findings: In this study the observance rate of patients’ rights was at a good level in 41.6% of cases, at an average level in 55.5% of cases and at a low level in 2.9% of cases. There was a significant difference between several hospitalization wards in the observance rate of patients’ rights. (p = 0.001. The observance rate of patients’ rights in infectious disease ward and gynecology ward was at a lower level in comparison with other wards. Conclusion: The observance rate of patients’ rights was at an average to good level in most of hospitalization ward. However this observance rate is at a low level in some wards. More studies about the causes of these differences can help us in planning about improvement of patients’ rights observance.

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

    Science.gov (United States)

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

    2010-08-25

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

  12. Hypoxaemia in the general surgical ward--a potential risk factor?

    DEFF Research Database (Denmark)

    Rosenberg, J

    1994-01-01

    After major operations, hypoxaemia is common in the late postoperative period in the surgical ward. Recent studies of humans after major operations showed that such hypoxaemia may be related to the development of myocardial ischaemia and cardiac arrhythmias, even in patients with no preoperative...... signs or symptoms of coronary artery disease. Experimental studies have shown an adverse effect of tissue hypoxia on wound healing and on resistance to bacterial wound infections. Finally, mental confusion and surgical delirium may be related to inadequate arterial oxygenation during the late...

  13. Instantons: Dynamical mass generation, chiral ward identities and the topological charge correlation function

    Energy Technology Data Exchange (ETDEWEB)

    McDougall, N.A. (Oxford Univ. (UK). Dept. of Theoretical Physics)

    1983-01-10

    When dynamical mass generation resulting from the breakdown of chiral symmetry is taken into account, instanton dynamics treated within the dilute gas approximation may satisfy the constraints on the quark condensates and the topological charge correlation function derived by Crewther from an analysis of the chiral Ward identities assuming the absence of a physical axial U(1) Goldstone boson. From a consideration of the contribution of the eta' to the topological charge correlation function, a relationship is derived in which msub(eta')/sup 2/fsub(eta')/sup 2/ is proportional to the vacuum energy density.

  14. Instantons: Dynamical mass generation, chiral ward identities and the topological charge correlation function

    International Nuclear Information System (INIS)

    McDougall, N.A.

    1983-01-01

    When dynamical mass generation resulting from the breakdown of chiral symmetry is taken into account, instanton dynamics treated within the dilute gas approximation may satisfy the constraints on the quark condensates and the topological charge correlation function derived by Crewther from an analysis of the chiral Ward identities assuming the absence of a physical axial U(1) Goldstone boson. From a consideration of the contribution of the eta' to the topological charge correlation function, a relationship is derived in which msub(eta') 2 fsub(eta') 2 is proportional to the vacuum energy density. (orig.)

  15. Severe exacerbations of chronic obstructive pulmonary disease: management with noninvasive ventilation on a general medicine ward

    Directory of Open Access Journals (Sweden)

    Sirio Fiorino

    2013-04-01

    Full Text Available Introduction: Recent evidence suggests that, with a well-trained staff, severe exacerbations of chronic obstructive pulmonary disease (COPD with moderate respiratory acidosis (pH > 7.3 can be successfully treated with noninvasive mechanical ventilation (NIMV on a general respiratory care ward. We conducted an open prospective study to evaluate the efficacy of this approach on a general medicine ward. Material and methods: This study population consisted in 27 patients admitted to a general medicine ward (median nurse:patient ratio 1:12 December 1, 2004 May 31, 2006 for acute COPD exacerbation with hypercapnic respiratory failure and acidosis (arterial pH < 7.34, PaC02 > 45 mmHg. All received assist-mode NIMV (average 12 h / day via oronasal masks (inspiratory pressure 10-25 cm H2O, expiratory pressure 4-6 cm H2O to maintain O2 saturation at 90-95%. Treatment was supervised by an experienced pulmonologist, who had also provided specific training in NIMV for medical and nursing staffs (90-day course followed by periodic refresher sessions. Arterial blood pressure, O2 saturation, and respiratory rate were continuously monitored during NIMV. Based on baseline arterial pH, the COPD was classified as moderate (7.25-7.34 or severe (< 7.25. Results: In patients with moderate and severe COPD, significant improvements were seen in arterial pH after 2 (p < 0.05 and 24 h (p< 0.05 of NIMV and in the PaC02 after 24 hours (p < 0.05. Four (15% of the 27 patients died during the study hospitalization (in-hospital mortality 15%, in 2 cases due to NIMV failure. For the other 23, mean long-term survival was 14.5 months (95% CI 10.2 to 18.8, and no significant differences were found between the moderate and severe groups. Over half (61% the patients were alive 1 year after admission. Conclusions: NIMV can be a cost-effective option for management of moderate or severe COPD on a general medicine ward. Its proper use requires: close monitoring of ventilated subjects

  16. Theoretical model for the UV disinfection system in the operating ward of PZU 'Filip Vtori'

    International Nuclear Information System (INIS)

    Ilkov, Marjan

    2010-01-01

    Here we investigate the theoretical modeling of an UV disinfection system for the operating ward in PZU 'FILIP VTORI'. As nocosomial infections pose a serious threat to patients everywhere in the world, here the disinfection of the air and the surfaces is modeled and discussed. The surfaces are disinfected with direct illumination of open UV after hours system, UV curtains, overhead disinfection, floor disinfection and disinfection of the incoming air through the ventilation/air-condition system. From the results it can be seen that the concentrations of bacteria, fungi and viruses drop significantly which in turn should give a significant drop in a number of hospital acquired infections.(Author)

  17. Anomalies in Ward identities revisited. Explicit calculation of the three point functions; Anomalias em identidades de Ward revisitadas. Calculo explicito das funcoes de tres pontos

    Energy Technology Data Exchange (ETDEWEB)

    Dalmolin, Fabricio Tronco

    2007-07-01

    others already performed within the same issue. In particular, in one of such investigation a pioneer and traditional reference has been revisited by using the alternative strategy mentioned above. In such study, a systematic treatment of purely fermionic one, two and three point functions, associated to scalar, pseudo-scalar, vector and axial-vector densities, has done. There, however, only the explicit expressions for one and two point functions were developed. The conclusions pointed out, in a very clear way, that the association between intrinsic ambiguities of the perturbative calculation and violations in symmetry properties is not consistent. At the same time, it was concluded that only in an investigation where the explicit forms for the three point functions involved are considered clean and sound conclusions can be extracted. This is due to the fact that, in the relevant symmetry properties, it is involved three ward identities and a low energy limit. This is precisely the main purpose of the present work: to promote a detailed investigation of the relations among green functions and ward identities, within the context of a model having only one specie of 1/2 spin fermionic field, that consider all the amplitudes having superficial degree of divergence higher than the logarithmic one, in a similar way as that made in the work of Gerstein and Jackiw, taking however the explicit form for the three point functions. This is one to get in the analysis, simultaneously, the ward identities and the low energy limits involved in the anomalous amplitudes as required by the Sutherland-Veltman theorem, in order to get an adequate understanding of the anomaly phenomena. We will show that our final results can be mapped in those found with the use of the Dimensional Regularization, in situation where this technique can be applied, or in those of Gerstein and Jackiw, however with conflicting interpretations. Finally, we will show that in the context of the adopted technique

  18. Pharmacy sales data versus ward stock accounting for the surveillance of broad-spectrum antibiotic use in hospitals

    Science.gov (United States)

    2011-01-01

    Background Antibiotic consumption in hospitals is commonly measured using the accumulated amount of drugs delivered from the pharmacy to ward held stocks. The reliability of this method, particularly the impact of the length of the registration periods, has not been evaluated and such evaluation was aim of the study. Methods During 26 weeks, we performed a weekly ward stock count of use of broad-spectrum antibiotics - that is second- and third-generation cephalosporins, carbapenems, and quinolones - in five hospital wards and compared the data with corresponding pharmacy sales figures during the same period. Defined daily doses (DDDs) for antibiotics were used as measurement units (WHO ATC/DDD classification). Consumption figures obtained with the two methods for different registration intervals were compared by use of intraclass correlation analysis and Bland-Altman statistics. Results Broad-spectrum antibiotics accounted for a quarter to one-fifth of all systemic antibiotics (ATC group J01) used in the hospital and varied between wards, from 12.8 DDDs per 100 bed days in a urological ward to 24.5 DDDs in a pulmonary diseases ward. For the entire study period of 26 weeks, the pharmacy and ward defined daily doses figures for all broad-spectrum antibiotics differed only by 0.2%; however, for single wards deviations varied from -4.3% to 6.9%. The intraclass correlation coefficient, pharmacy versus ward data, increased from 0.78 to 0.94 for parenteral broad-spectrum antibiotics with increasing registration periods (1-4 weeks), whereas the corresponding figures for oral broad-spectrum antibiotics (ciprofloxacin) were from 0.46 to 0.74. For all broad-spectrum antibiotics and for parenteral antibiotics, limits of agreement between the two methods showed, according to Bland-Altman statistics, a deviation of ± 5% or less from average mean DDDs at 3- and 4-weeks registration intervals. Corresponding deviation for oral antibiotics was ± 21% at a 4-weeks interval

  19. Pharmacy sales data versus ward stock accounting for the surveillance of broad-spectrum antibiotic use in hospitals.

    Science.gov (United States)

    Haug, Jon B; Myhr, Randi; Reikvam, Asmund

    2011-12-13

    Antibiotic consumption in hospitals is commonly measured using the accumulated amount of drugs delivered from the pharmacy to ward held stocks. The reliability of this method, particularly the impact of the length of the registration periods, has not been evaluated and such evaluation was aim of the study. During 26 weeks, we performed a weekly ward stock count of use of broad-spectrum antibiotics--that is second- and third-generation cephalosporins, carbapenems, and quinolones--in five hospital wards and compared the data with corresponding pharmacy sales figures during the same period. Defined daily doses (DDDs) for antibiotics were used as measurement units (WHO ATC/DDD classification). Consumption figures obtained with the two methods for different registration intervals were compared by use of intraclass correlation analysis and Bland-Altman statistics. Broad-spectrum antibiotics accounted for a quarter to one-fifth of all systemic antibiotics (ATC group J01) used in the hospital and varied between wards, from 12.8 DDDs per 100 bed days in a urological ward to 24.5 DDDs in a pulmonary diseases ward. For the entire study period of 26 weeks, the pharmacy and ward defined daily doses figures for all broad-spectrum antibiotics differed only by 0.2%; however, for single wards deviations varied from -4.3% to 6.9%. The intraclass correlation coefficient, pharmacy versus ward data, increased from 0.78 to 0.94 for parenteral broad-spectrum antibiotics with increasing registration periods (1-4 weeks), whereas the corresponding figures for oral broad-spectrum antibiotics (ciprofloxacin) were from 0.46 to 0.74. For all broad-spectrum antibiotics and for parenteral antibiotics, limits of agreement between the two methods showed, according to Bland-Altman statistics, a deviation of ± 5% or less from average mean DDDs at 3- and 4-weeks registration intervals. Corresponding deviation for oral antibiotics was ± 21% at a 4-weeks interval. There is a need for caution in

  20. [Perceiving gender or profession: the practical experience of male nursing students in the obstetrics and gynecology ward].

    Science.gov (United States)

    Lee, Ya-Fen; Yang, Yu-O; Tu, Chia-Ling

    2013-06-01

    The impact of general gender stereotypes on nursing is severe and influential, especially with regard to male nursing students working in obstetrics and gynecology wards. This study examined the experience of male nursing students in obstetrics and gynecology wards. We used a phenomenological qualitative research approach and a sample of 10 male nursing students currently studying at a nursing college in central Taiwan. All participants had obstetrics and gynecology ward experience. Individual interviews were transcribed into the procedural record. Colaizzi content analysis analyzed and categorized research data. Based on participants practical experiences in the obstetrics and gynecology ward, the main stages of participants professional development through their internship experience included: (1) Unbalanced self-role recognition; (2) being defined by the gender framework (gender stereotypes); (3) the difference between male doctor and male nurse; (4) learning appropriate communication techniques; (5) mutual and empathetic understanding of the female psychology during childbirth; (6) gaining sources for positive feedback; (7) releasing the shackles of gender and gaining full insight into and comprehension of nursing functions; and (8) given the opportunity to learn. Through ongoing examination and learning, participant internships in the obstetrics and gynecology wards were significant and essential learning experiences that validated their necessity. Nursing schools and internship institutions alike must realize the importance of gender-equality education to the nursing profession. Medical institutions are encouraged to offer equal learning opportunities to male and female nursing students and provide targeted assistance to males to help them master clinical nursing care practices in the obstetrics and gynecology department.

  1. Monitoring of airborne bacteria and aerosols in different wards of hospitals - Particle counting usefulness in investigation of airborne bacteria.

    Science.gov (United States)

    Mirhoseini, Seyed Hamed; Nikaeen, Mahnaz; Khanahmd, Hossein; Hatamzadeh, Maryam; Hassanzadeh, Akbar

    2015-01-01

    The presence of airborne bacteria in hospital environments is of great concern because of their potential role as a source of hospital-acquired infections (HAI). The aim of this study was the determination and comparison of the concentration of airborne bacteria in different wards of four educational hospitals, and evaluation of whether particle counting could be predictive of airborne bacterial concentration in different wards of a hospital. The study was performed in an operating theatre (OT), intensive care unit (ICU), surgery ward (SW) and internal medicine (IM) ward of four educational hospitals in Isfahan, Iran. A total of 80 samples were analyzed for the presence of airborne bacteria and particle levels. The average level of bacteria ranged from 75-1194 CFU/m (3) . Mean particle levels were higher than class 100,000 cleanrooms in all wards. A significant correlation was observed between the numbers of 1-5 µm particles and levels of airborne bacteria in operating theatres and ICUs. The results showed that factors which may influence the airborne bacterial level in hospital environments should be properly managed to minimize the risk of HAIs especially in operating theaters. Microbial air contamination of hospital settings should be performed by the monitoring of airborne bacteria, but particle counting could be considered as a good operative method for the continuous monitoring of air quality in operating theaters and ICUs where higher risks of infection are suspected.

  2. Nurses experiences regarding staffing patterns in the surgical wards of a private hospital in Gauteng South Africa

    Directory of Open Access Journals (Sweden)

    Moloko Malatji

    2017-12-01

    Purpose: The purpose of this study was to explore and describe nurses' experiences regarding staffing patterns in the surgical wards of a private hospital in Gauteng in order to develop recommendations for staffing patterns in these wards. Methodology: A qualitative, exploratory, descriptive and contextual research design was used. Data was collected by means of in-depth semi structured individual interviews from a purposive sample of professional nurses working in the surgical wards of this hospital. Data was analysed using Tesch's method of qualitative thematic analysis. Principles of trustworthiness and ethical principles to ensure the protection of human rights were applied throughout the study. Results: The findings of the study revealed one central theme which reflected that participants experienced the staffing patterns of the surgical wards negatively. Two main themes emerged as, nurses had negative experiences in the surgical wards as well as negative emotional experiences related to the staffing patterns. Conclusion: It is evident from the findings of the study that nurses are experiencing staffing patterns negatively.

  3. Improving clinical handover in a paediatric ward: implications for nursing management.

    Science.gov (United States)

    Mannix, Trudi; Parry, Yvonne; Roderick, Allison

    2017-04-01

    To describe how nursing staff in a paediatric ward improved the conduct of clinical handover, using a practise development approach. ISBAR (Identify, Situation, Background, Assessment and Recommendation) is a mnemonic tool to aid the safe transfer of patient information in clinical handover. The nurses identified the need to improve the use of ISBAR, and other issues related to handover that could compromise patient safety and constrain family-centred care. Sixty-one percent of nurses on the ward contributed to issue identification and the design of the educational material, including a set of written and video resources and incorporating the role of a handover coach. Staff performance was evaluated before and after access to the resources using self-administered Likert scales, observation and a focus group. After the intervention, there was a stronger relationship between the participants' understanding of ISBAR and their application of it in handover. Further, there were statistically significant increases in improved handover practises, including family inclusion and safety checks. A practise development approach is useful in the provision of education to guide clinical performance in patient handover. Nurse managers can use this approach to empower their staff to make positive changes to practise. © 2017 John Wiley & Sons Ltd.

  4. Estimating the intensity of ward admission and its effect on emergency department access block.

    Science.gov (United States)

    Luo, Wei; Cao, Jiguo; Gallagher, Marcus; Wiles, Janet

    2013-07-10

    Emergency department access block is an urgent problem faced by many public hospitals today. When access block occurs, patients in need of acute care cannot access inpatient wards within an optimal time frame. A widely held belief is that access block is the end product of a long causal chain, which involves poor discharge planning, insufficient bed capacity, and inadequate admission intensity to the wards. This paper studies the last link of the causal chain-the effect of admission intensity on access block, using data from a metropolitan hospital in Australia. We applied several modern statistical methods to analyze the data. First, we modeled the admission events as a nonhomogeneous Poisson process and estimated time-varying admission intensity with penalized regression splines. Next, we established a functional linear model to investigate the effect of the time-varying admission intensity on emergency department access block. Finally, we used functional principal component analysis to explore the variation in the daily time-varying admission intensities. The analyses suggest that improving admission practice during off-peak hours may have most impact on reducing the number of ED access blocks. Copyright © 2012 John Wiley & Sons, Ltd.

  5. Arrival in the labour ward in second stage of labour--any prognostic significance?

    Science.gov (United States)

    Nkyekyer, K

    1998-05-01

    A comparative descriptive study was carried out to determine whether, in uncomplicated term pregnancies with the foetus in vertex presentation, there were any differences in maternal or foetal outcome between women who arrived in the labour ward in second stage of labour and those who arrived in early active phase. There were two hundred and seventeen women each in the study and comparison groups. There were no significant differences between the two groups as regards age, parity, marital status and level of education. Women in the comparison group were better antenatal clinic attendants. Those in the study group were more likely to have indicated that they had problems with transportation. They also had considerably shorter labours and all achieved spontaneous vaginal deliveries; a significant proportion (10.6%) of the comparison group had interventional deliveries. The incidence of episiotomies, lower genital tract injuries, manual removal of placenta and postpartum haemorrhage after vaginal delivery were not different between the two groups. Babies born to mothers in the study group were significantly lighter, by about 170 gms, and had a lower incidence of low one-minute Apgar scores. There were no significant differences in the rates of admission to the neonatal intensive care unit or in early neonatal deaths. Arrival in the labour ward in second stage of labour prognosticates non-interventional delivery without any increased risk of adverse outcome to the mother or her baby.

  6. Pattern and outcome of patients discharged from chest ward of a university hospital

    Directory of Open Access Journals (Sweden)

    Ruchi Sachdeva

    2013-01-01

    Full Text Available Aim: To describe morbidity and mortality profile of patients discharged from chest ward of a university hospital. Materials and Methods: Prospectively selected information (age, gender, residence, length of stay, outcome and primary diagnosis of all consecutive in-patients was recorded for six month reference period. Results: Out of 967 patients, mean age was 50.64 years (±15.71; M:F = 3.5:1; 81.3% were from rural area. Primary diagnosis was tuberculosis/sequel among 528 (54.60% and non-TB among 439 (45.4% patients (chronic obstructive pulmonary diseases [COPD] - 20.3%; pneumonia - 15.8%; lung cancer - 5.0%; asthma - 1.6%; bronchiectasis - 0.9%, lung abscess - 0.8%, miscellaneous - 1.0%. Total deaths observed was 142 (14.7% of all discharges and 54.25% of deaths occurred within 48 hours of admission suggesting criticality/late presentation; time distribution of death was similar considering 8-hourly period of 24-h cycle. Average length of stay for all patients was 6.91 (±5.14 days while it was 7.38 (±4.98 days for discharge live and 4.19 (±5.21 days for expired patients. Conclusion: Study provides a snapshot of patients discharged from chest ward that may aid in decision making, improving quality of care and initiation of educational activities at primary level.

  7. Meson-baryon-baryon vertex function and the Ward-Takahashi identity

    International Nuclear Information System (INIS)

    Wang, S.; Banerjee, M.K.

    1996-01-01

    Ohta proposed a solution for the well-known difficulty of satisfying the Ward-Takahashi identity for a photo-meson-baryon-baryon amplitude (γMBB) when a dressed meson-baryon-baryon (MBB) vertex function is present. He obtained a form for the γMBB amplitude which contained, in addition to the usual pole terms, longitudinal seagull terms which were determined entirely by the MBB vertex function. He arrived at his result by using a Lagrangian which yields the MBB vertex function at tree level. We show that such a Lagrangian can be neither Hermitian nor charge conjugation invariant. We have been able to reproduce Ohta close-quote s result for the γMBB amplitude using the Ward-Takahashi identity and no other assumption, dynamical or otherwise, and the most general form for the MBB and γMBB vertices. However, contrary to Ohta close-quote s finding, we find that the seagull terms are not robust. The seagull terms extracted from the γMBB vertex occur unchanged in tree graphs, such as in an exchange current amplitude. But the seagull terms which appear in a loop graph, as in the calculation of an electromagnetic form factor, are, in general, different. The whole procedure says nothing about the transverse part of the (γMBB) vertex and its contributions to the amplitudes in question. copyright 1996 The American Physical Society

  8. Prevalence of distressing symptoms in hospitalised patients on medical wards: A cross-sectional study

    Directory of Open Access Journals (Sweden)

    Sigurdardottir Katrin

    2008-09-01

    Full Text Available Abstract Background Many patients with advanced, serious, non-malignant disease belong to the population generally seen on medical wards. However, little research has been carried out on palliative care needs in this group. The aims of this study were to estimate the prevalence of distressing symptoms in patients hospitalised in a Department of Internal Medicine, estimate how many of these patients might be regarded as palliative, and describe their main symptoms. Methods Cross-sectional (point prevalence study. All patients hospitalised in the Departments of Internal Medicine, Pulmonary Medicine, and Cardiology were asked to do a symptom assessment by use of the Edmonton Symptom Assessment System (ESAS. Patients were defined as "palliative" if they had an advanced, serious, chronic disease with limited life expectancy and symptom relief as the main goal of treatment. Results 222 patients were registered in all. ESAS was completed for 160 patients. 79 (35.6% were defined as palliative and 43 of them completed ESAS. The patients in the palliative group were older than the rest, and reported more dyspnea (70% and a greater lack of wellbeing (70%. Other symptoms reported by this group were dry mouth (58%, fatigue (56%, depression (41%, anxiety (37%, pain at rest (30%, and pain on movement (42%. Conclusion More than one third of the patients in a Department of Internal Medicine were defined as palliative, and the majority of the patients in this palliative group reported severe symptoms. There is a need for skills in symptom control on medical wards.

  9. Whither the Pulmonary Ward Attending? Preserving Subspecialty Exposure in United States Internal Medicine Residency Training.

    Science.gov (United States)

    Santhosh, Lekshmi; Babik, Jennifer; Looney, Mark R; Hollander, Harry

    2017-04-01

    Twenty years ago, the term "hospitalist" was coined at the University of California-San Francisco (San Francisco, CA), heralding a new specialty focused on the care of inpatients. There are now more than 50,000 hospitalists practicing in the United States. At many academic medical centers, hospitalists are largely replacing subspecialists as attendings on the inpatient medicine wards. At University of California-San Francisco, this has been accompanied by declining percentages of residency graduates who enter subspecialty training in internal medicine. The decline in subspecialty medicine interest can be attributed to many factors, including differences in compensation, decreased subspecialist exposure, and a changing research funding landscape. Although there has not been systematic documentation of this trend in pulmonary and critical care medicine, we have noted previously pulmonary and critical care-bound trainees switching to hospital medicine instead. With our broad, multiorgan system perspective, pulmonary and critical care faculty should embrace teaching general medicine. Residency programs have instituted creative solutions to encourage more internal medicine residents to pursue careers in subspecialty medicine. Some solutions include creating rotations that promote more contact with subspecialists and physician-scientists, creating clinician-educator tracks within fellowship programs, and appointing subspecialists to internal medicine residency leadership positions. We need more rigorous research to track the trends and implications of the generalist-specialist balance of inpatient ward teams on resident career choices, and learn what interventions affect those choices.

  10. Assessment of Midwives’ Communication Skills at the Maternity Wards of Teaching Hospitals in Mashhad in 2014

    Directory of Open Access Journals (Sweden)

    Talate Khadivzadeh

    2015-06-01

    Full Text Available Background & aim:The quality of communication between midwives and parturient women is a determinant of maternal satisfaction with midwifery care. Therefore, this study was conducted to determine the communication skills of midwives at maternity wards of Mashhad teaching hospitals in 2014.   Methods:In this descriptive study, 49 midwives, working at Mashhad teaching hospitals, were randomly selected. All midwives worked rotating shifts at the wards. The midwives’ communication skills were assessed by the researcher, using the self-structured  observation checklist of communicative performance.   Results: The mean age of midwives was 39.11±9.66 years and their mean work experience was 15.9±8.77 years. In total, 68.3% of the participants experienced childbirth themselves. 66.7% of midwives were moderately  keen on midwifery as a profession. The mean score of the checklist obtained by midwives was 67.9±10.7. There was no relationship between midwives’ communication skills and work experience, childbirth experience, age or interest in midwifery. Conclusion:Considering the inadequacy of midwives’ communication skills, which could be the major cause of maternal dissatisfaction with delivery care, it is recommended that in-service training courses be held by applying new teaching methods. Moreover, the educational needs of midwives, including communication skills, should be considered in these training programs .

  11. [Cases of pertussis among healthcare workers in a maternity ward: management of a health alert].

    Science.gov (United States)

    Vanjak, D; Delaporte, M F; Bonmarin, I; Levardon, M; Fantin, B

    2006-03-01

    Pertussis is a highly contagious acute respiratory tract infection, with a poor prognosis in non-vaccinated new-borns. The authors had for aim to investigate an epidemic of 5 pertussis cases among health care workers (HCW) in our maternity ward with potential exposure of new-borns and to evaluate HCW compliance and experience gain. A retrospective study was made using a questionnaire with HCW on preventive measures taken (antibiotic prophylaxis with erythromycin and wearing a mask). Two hundred and thirty-eight patients were warned of a potential pertussis contamination. No nosocomial case was detected among patients or their new borns. Ten proved or probable cases were identified among 101 HCW having answered (N=101/210, 48%). Sixty percent of HCW people followed the antibiotic treatment and 85% wore a mask among whom 46% adequately. Non-compliance factors were mainly related to adverse effects (41%), delayed information (41%), and false vaccine protection (22%). Crisis communication was felt as unsatisfactory for 72% of HCW and recommendations not adapted for 39% of the staff. This survey points out the difficulty of managing a pertussis alert in a medical ward.

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

    Directory of Open Access Journals (Sweden)

    Kamran Soltani Arabshahi

    2015-01-01

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

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

    Science.gov (United States)

    Liu, Wei; Manias, Elizabeth; Gerdtz, Marie

    2014-09-01

    Health professionals communicate with each other about medication information using different forms of documentation. This article explores knowledge and power relations surrounding medication information exchanged through documentation among nurses, doctors and pharmacists. Ethnographic fieldwork was conducted in 2010 in two medical wards of a metropolitan hospital in Australia. Data collection methods included participant observations, field interviews, video-recordings, document retrieval and video reflexive focus groups. A critical discourse analytic framework was used to guide data analysis. The written medication chart was the main means of communicating medication decisions from doctors to nurses as compared to verbal communication. Nurses positioned themselves as auditors of the medication chart and scrutinised medical prescribing to maintain the discourse of patient safety. Pharmacists utilised the discourse of scientific judgement to guide their decision-making on the necessity of verbal communication with nurses and doctors. Targeted interdisciplinary meetings involving nurses, doctors and pharmacists should be organised in ward settings to discuss the importance of having documented medication information conveyed verbally across different disciplines. Health professionals should be encouraged to proactively seek out each other to relay changes in medication regimens and treatment goals. © 2013 John Wiley & Sons Ltd.

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

    Science.gov (United States)

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

    2014-01-01

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

  15. Respiratory rates measured by a standardised clinical approach, ward staff, and a wireless device

    DEFF Research Database (Denmark)

    Granholm, A; Pedersen, N E; Lippert, A.

    2016-01-01

    in a medical ward. Respiratory rate was measured by three methods: a standardised approach over 60 s while patients lay still and refrained from talking, by ward staff and by a wireless electronic patch (SensiumVitals). The Bland-Altman method was used to compare measurements and three breaths per minute (BPM......) was considered a clinically relevant difference. RESULTS: We included 50 patients. The mean difference between the standardised approach and the electronic measurement was 0.3 (95% CI: -1.4 to 2.0) BPM; 95% limits of agreement were -11.5 (95% CI: -14.5 to -8.6) and 12.1 (95% CI: 9.2 to 15.1) BPM. Removal...... of three outliers with huge differences lead to a mean difference of -0.1 (95% CI: -0.7 to 0.5) BPM and 95% limits of agreement of -4.2 (95% CI: -5.3 to -3.2) BPM and 4.0 (95% CI: 2.9 to 5.0) BPM. The mean difference between staff and electronic measurements was 1.7 (95% CI: -0.5 to 3.9) BPM; 95% limits...

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

    Science.gov (United States)

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

    2005-07-01

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

  17. Sepsis in Internal Medicine wards: current knowledge, uncertainties and new approaches for management optimization.

    Science.gov (United States)

    Zaccone, Vincenzo; Tosoni, Alberto; Passaro, Giovanna; Vallone, Carla Vincenza; Impagnatiello, Michele; Li Puma, Domenica Donatella; De Cosmo, Salvatore; Landolfi, Raffaele; Mirijello, Antonio

    2017-11-01

    Sepsis represents a global health problem in terms of morbidity, mortality, social and economic costs. Although usually managed in Intensive Care Units, sepsis showed an increased prevalence among Internal Medicine wards in the last decade. This is substantially due to the ageing of population and to multi-morbidity. These characteristics represent both a risk factor for sepsis and a relative contra-indication for the admission to Intensive Care Units. Although there is a lack of literature on the management of sepsis in Internal Medicine, the outcome of these patients seems to be gradually improving. This is due to Internists' increased adherence to guidelines and "bundles". The routine use of SOFA score helps physicians in the definition of septic patients, even if the optimal score has still to come. Point-of-care ultrasonography, lactates, procalcitonin and beta-d-glucan are of help for treatment optimization. The purpose of this narrative review is to focus on the management of sepsis in Internal Medicine departments, particularly on crucial concepts regarding diagnosis, risk assessment and treatment. Key Messages Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. The prevalence of sepsis is constantly increasing, affecting more hospital patients than any other disease. At least half of patients affected by sepsis are admitted to Internal Medicine wards. Adherence to guidelines, routine use of clinical and lab scores and point-of-care ultrasonography are of help for early recognition of septic patients and treatment optimization.

  18. Glycemic control in the infectious diseases ward; role of clinical pharmacist interventions.

    Science.gov (United States)

    Farsaei, Shadi; Karimzadeh, Iman; Elyasi, Sepideh; Hatamkhani, Shima; Khalili, Hossein

    2014-04-15

    Hyperglycemia is one of the most frequent metabolic complications in hospitalized patients. Increased risk of infection following hyperglycemia has been reported in hospitalized patients and infections may also cause insulin resistance which complicates the control of blood glucose level. In this study the impact of the clinical pharmacist interventions on the glycemic control in patients admitted to infectious diseases ward has been evaluated. We conducted a prospective, pre-post interventional study among patients with hyperglycemia. The clinical pharmacist-led multidisciplinary team managed the glycemic profile of patients according to an established insulin protocol commonly used in internal wards. Clinical pharmacists reviewed patients' medical charts for proper insulin administration, evaluated nurses' technique for insulin injection and blood glucose measurement, and educated patients about symptoms of hypoglycemia and the importance of adherence to different aspects of their glycemic management. The percentage of controlled random blood sugar increased from 13.8% in the pre-intervention to 22.3% in the post-intervention group (p value percentage of controlled fasting blood sugars in the post-intervention group was non-significantly higher than in the pre-intervention group. Pharmacists and additional health care providers from other departments such as nursing and dietary departments need to be devoted to glycemic control service. Collaborative practice agreement between physicians is necessary to promote this service and help to increase the use of such services in different settings for diabetes control.

  19. Etiologies of Prolonged Unconjugated Hyperbilirubinemia in Neonates Admitted to Neonatal Wards

    Directory of Open Access Journals (Sweden)

    Mohammad Kazem Sabzehei

    2015-12-01

    Full Text Available Background: Jaundice is a common condition among neonates. Prolonged unconjugated hyperbilirubinemia occurs when jaundice persists beyond two weeks in term neonates and three weeks in preterm neonates. This study aimed to determine the etiologies of prolonged unconjugated hyperbilirubinemia in infants admitted to the neonatal ward of Besat Hospital in Hamadan, Iran. Methods: This study was conducted on all infants diagnosed with prolonged unconjugated hyperbilirubinemia during 2007-2012 in the neonatal ward of Besat Hospital in Hamadan, Iran. Demographic characteristics of infants, physical examination and laboratory findings were collected and analyzed to determine the etiologies of neonatal hyperbilirubinemia. Results: In total, 100 infants diagnosed with neonatal hyperbilirubinemia were enrolled in this study, including 49 male and 51 female neonates with mean age of 20±1 days and mean bilirubin level of 17.5±4.0 mg/dL. Main causes of hyperbilirubinemia were urinary tract infection, ABO incompatibility, hypothyroidism and glucose-6-phosphate dehydrogenase deficiency in 14%, 5%, 6% and 5% of neonates, respectively. Moreover, unknown etiologies, such as breastfeeding, were detected in 70% of the studied infants. Conclusion: According to the results of this study, determining the main causes of prolonged unconjugated hyperbilirubinemia in neonates is of paramount importance. In the majority of cases, neonatal hyperbilirubinemia is associated with physiological factors, such as breastfeeding.

  20. Internet of Health Things: Toward intelligent vital signs monitoring in hospital wards.

    Science.gov (United States)

    da Costa, Cristiano André; Pasluosta, Cristian F; Eskofier, Björn; da Silva, Denise Bandeira; da Rosa Righi, Rodrigo

    2018-06-02

    Large amounts of patient data are routinely manually collected in hospitals by using standalone medical devices, including vital signs. Such data is sometimes stored in spreadsheets, not forming part of patients' electronic health records, and is therefore difficult for caregivers to combine and analyze. One possible solution to overcome these limitations is the interconnection of medical devices via the Internet using a distributed platform, namely the Internet of Things. This approach allows data from different sources to be combined in order to better diagnose patient health status and identify possible anticipatory actions. This work introduces the concept of the Internet of Health Things (IoHT), focusing on surveying the different approaches that could be applied to gather and combine data on vital signs in hospitals. Common heuristic approaches are considered, such as weighted early warning scoring systems, and the possibility of employing intelligent algorithms is analyzed. As a result, this article proposes possible directions for combining patient data in hospital wards to improve efficiency, allow the optimization of resources, and minimize patient health deterioration. It is concluded that a patient-centered approach is critical, and that the IoHT paradigm will continue to provide more optimal solutions for patient management in hospital wards. Copyright © 2018 Elsevier B.V. All rights reserved.

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

    Science.gov (United States)

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

    2015-03-01

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

  2. Continuous pulse oximetry in the general surgical ward: Nellcor N-200 versus Nellcor N-3000

    DEFF Research Database (Denmark)

    Christensen, M; Lie, C; Rosenberg, J

    1999-01-01

    of drop-outs (loss of signal) was 13 (range 1-46) with the N-200 compared with nine (2-41) with the N-3000 (p = 0.06). The N-200 registered saturation values of 85% or below for 23% of the observation time compared with 6% of the observation time with the N-3000 pulse oximeter (p ... Symphony N-3000 with the Nellcor N-200 pulse oximeter, when monitoring patients in the general surgical ward. Twenty-two patients were monitored during unrestricted ward activities for a total of 275 h with a N-3000 and a N-200 pulse oximeter simultaneously. Data were analysed for lack of concordance...... between the two pulse oximeters with respect to frequency of registered hypoxaemic episodes and thus the amount of time spent in the alarm state. The median number of desaturation episodes with the N-200 was 18 (range 0-511) compared with four (range 0-476) with the N-3000 (p

  3. Identification of the benefits, enablers and barriers to integrating junior pharmacists into the ward team within one UK-based hospital.

    Science.gov (United States)

    Hung, Man Yui; Wright, David John; Blacklock, Jeanette; Needle, Richard John

    2017-01-01

    A high nurse-vacancy rate combined with high numbers of applications for junior pharmacist roles resulted in Colchester Hospital University National Health System Foundation Trust trial employing junior pharmacists into traditional nursing posts with the aim of integrating pharmacists into the ward team and enhancing local medicines optimization. The aim of the evaluation was to describe the implementation process and practice of the integrated care pharmacists (ICPs) in order to inform future innovations of a similar nature. Four band 6 ward-based ICPs were employed on two wards funded within current ward staffing expenditure. With ethical committee approval, interviews were undertaken with the ICPs and focus groups with ward nurses, senior ward nurses and members of the medical team. Data were analyzed thematically to identify service benefits, barriers and enablers. Routine ward performance data were obtained from the two ICP wards and two wards selected as comparators. Appropriate statistical tests were performed to identify differences in performance. Four ICPs were interviewed, and focus groups were undertaken with three junior nurses, four senior nurses and three medical practitioners. Service enablers were continuous ward time, undertaking drug administration, positive feedback and use of effective communication methods. Barriers were planning, funding model, career development, and interprofessional working and social isolation. ICPs were believed to save nurse time and improve medicines safety. The proportion of patients receiving medicine reconciliation within 24 hours increased significantly in the ICP wards. All ICPs had resigned from their role within 12 months. It was believed that by locating pharmacists on the ward full time and allowing them to undertake medicines administration and medicines reconciliation, the nursing time would be saved and medicines safety improved. There was however significant learning to be derived from the implementation

  4. How many EMA-workshops are needed to collect a representative sample of events in a hospital ward?

    DEFF Research Database (Denmark)

    Edwards, Kasper

    2017-01-01

    The effect modifier assessment (EMA) method (Edwards & Winkel, 2016) is a method for assessing the impact of an intervention and modifiers on a desired outcome e.g. improved work environment. The EMA-method captures events (a change in work) in a ward and for each event asses 1) impact on work...... and diverse tasks. This poses a problem when using the EMA-method and raises the research question of this abstract: How many EMA-workshops are needed to generate a representative collection of events in a ward? Methods Six EMA-workshops each with a full surgical team of six people was conducted in a heart...... on surgery. The ward was organized in three specialties: Heart surgery, Lung surgery and Child heart surgery. Events differed between specialties and therefor it was expected that saturation would be reached after minimum three workshops. The heart center is comparable to other surgical units...

  5. Correlative degree and collective side ward flow of final state particles in high energy heavy ion collisions

    International Nuclear Information System (INIS)

    Zhang Weigang

    1999-01-01

    A concept of correlative degree is proposed. Using the method of particle-group correlation's function, the effects of the particles with different correlative degrees on collective side ward flow are studied for 1.2A GeV Ar + Bal 2 collisions at the Bevalac stream chamber. The studies indicate that correlative degree is an important parameter on describing collective side ward flow properties. The minority of correlative particles (or fragments) with larger correlative degrees can produce the effect arising from the collective side ward flow, but the effect arising from high-order collective flow correlations can not be dominated by these minority of particles (or fragments). It is results from the collective contribution of the majority of collective particles (or fragments) with various correlative degrees

  6. Nursing ward managers' perceptions of pain prevalence at the aged-care facilities in Japan: a nationwide survey.

    Science.gov (United States)

    Takai, Yukari; Yamamoto-Mitani, Noriko; Fukahori, Hiroki; Kobayashi, Sayuri; Chiba, Yumi

    2013-09-01

    This study aimed to examine nursing ward managers' perceptions of pain prevalence among older residents and the strategies of pain management at the Health Service Facilities for the Elderly Requiring Care (HSFERC) in Japan and to investigate the factors related to the prevalence. Nursing ward managers in 3,644 HSFERC were asked to participate in this study. Questionnaires were sent to them regarding pain prevalence among the older residents in their wards, their provisions for pain care, and other pain management strategies. The perceived pain prevalence factors were examined statistically. The final sample comprised 439 participants (12.0%). A total of 5,219 residents (22.3%) were recognized as suffering from pain on the investigation day. Only 8 wards (1.8%) used pain management guidelines or care manuals, and 14 (3.2%) used a standardized pain scale. The ward managers' age (p = .008) and nursing experience (p = .006) showed a significant negative association with pain prevalence estimation. Moreover, there was a significant association between the groups' pain prevalence estimation and the nursing managers' beliefs that older adults were less sensitive to pain (p = .01), that pain was common among older people (p = .007), and that the time to treat residents' pain was insufficient (p = .001). The ward managers' perceptions regarding pain prevalence varied; the perceived pain rates were possibly lower than the actual percentages. Insufficient pain management strategies at the HSFERC were also suggested. An appropriate pain management strategy for Japanese aged care and its dissemination are urgently required. Copyright © 2013 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

  7. Methicillin-resistant Staphylococcus aureus and Acinetobacter baumannii on computer interface surfaces of hospital wards and association with clinical isolates

    Directory of Open Access Journals (Sweden)

    Ma Ling

    2009-10-01

    Full Text Available Abstract Background Computer keyboards and mice are potential reservoirs of nosocomial pathogens, but routine disinfection for non-water-proof computer devices is a problem. With better hand hygiene compliance of health-care workers (HCWs, the impact of these potential sources of contamination on clinical infection needs to be clarified. Methods This study was conducted in a 1600-bed medical center of southern Taiwan with 47 wards and 282 computers. With education and monitoring program of hand hygiene for HCWs, the average compliance rate was 74% before our surveillance. We investigated the association of methicillin-resistant Staphylococcus aureus (MRSA, Pseudomonas aeruginosa and Acinetobacter baumannii, three leading hospital-acquired pathogens, from ward computer keyboards, mice and from clinical isolates in non-outbreak period by pulsed field gel electrophoresis and antibiogram. Results Our results revealed a 17.4% (49/282 contamination rate of these computer devices by S. aureus, Acinetobacter spp. or Pseudomonas spp. The contamination rates of MRSA and A. baumannii in the ward computers were 1.1% and 4.3%, respectively. No P. aeruginosa was isolated. All isolates from computers and clinical specimens at the same ward showed different pulsotypes. However, A. baumannii isolates on two ward computers had the same pulsotype. Conclusion With good hand hygiene compliance, we found relatively low contamination rates of MRSA, P. aeruginosa and A. baumannii on ward computer interface, and without further contribution to nosocomial infection. Our results suggested no necessity of routine culture surveillance in non-outbreak situation.

  8. Dispersion of exhaled droplet nuclei in a two-bed hospital ward with three different ventilation systems

    DEFF Research Database (Denmark)

    Qian, H.; Li, Y.; Nielsen, Peter V.

    2006-01-01

    hospital ward with three ventilation systems, i.e. mixing, downward and displacement ventilation. Two life-size breathing thermal manikins were used to simulate a source patient and a receiving patient. The exhalation jet from a bed-lying manikin was visualized using smoke. N2O was used as tracer gas...... are well mixed in the ward. Bed distance does not affect the personal exposure of the receiving patient. For displacement ventilation, the exhaled jet can penetrate a long distance. A high concentration layer of exhaled droplet nuclei because of thermal stratification locking has also been observed...

  9. Utilizing distributional analytics and electronic records to assess timeliness of inpatient blood glucose monitoring in non-critical care wards

    Directory of Open Access Journals (Sweden)

    Ying Chen

    2016-04-01

    Full Text Available Abstract Background Regular and timely monitoring of blood glucose (BG levels in hospitalized patients with diabetes mellitus is crucial to optimizing inpatient glycaemic control. However, methods to quantify timeliness as a measurement of quality of care are lacking. We propose an analytical approach that utilizes BG measurements from electronic records to assess adherence to an inpatient BG monitoring protocol in hospital wards. Methods We applied our proposed analytical approach to electronic records obtained from 24 non-critical care wards in November and December 2013 from a tertiary care hospital in Singapore. We applied distributional analytics to evaluate daily adherence to BG monitoring timings. A one-sample Kolmogorov-Smirnov (1S-KS test was performed to test daily BG timings against non-adherence represented by the uniform distribution. This test was performed among wards with high power, determined through simulation. The 1S-KS test was coupled with visualization via the cumulative distribution function (cdf plot and a two-sample Kolmogorov-Smirnov (2S-KS test, enabling comparison of the BG timing distributions between two consecutive days. We also applied mixture modelling to identify the key features in daily BG timings. Results We found that 11 out of the 24 wards had high power. Among these wards, 1S-KS test with cdf plots indicated adherence to BG monitoring protocols. Integrating both 1S-KS and 2S-KS information within a moving window consisting of two consecutive days did not suggest frequent potential change from or towards non-adherence to protocol. From mixture modelling among wards with high power, we consistently identified four components with high concentration of BG measurements taken before mealtimes and around bedtime. This agnostic analysis provided additional evidence that the wards were adherent to BG monitoring protocols. Conclusions We demonstrated the utility of our proposed analytical approach as a monitoring

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

    Science.gov (United States)

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

    2011-01-01

    Identifying and promoting new management techniques for the descentralized pneumology hospitals or wards was one of the most ambitious objectives of the project "Quality in the pneumology medical services through continuous medical education and organizational flexibility", financed by the Human Resourses Development Sectorial Operational Programme 2007-2013 (ID 58451). The "Medium term Strategy on the specific management of the pneumology hospitals or wards after the descentralization of the sanitary system" presented in the article was written by the project's experts and discussed with pneumology managers and local authorities representatives. This Strategy application depends on the colaboration of the pneumology hospitals with professional associations, and local and central authorities.

  11. Micro-spatial distribution of malaria cases and control strategies at ward level in Gwanda district, Matabeleland South, Zimbabwe.

    Science.gov (United States)

    Manyangadze, Tawanda; Chimbari, Moses J; Macherera, Margaret; Mukaratirwa, Samson

    2017-11-21

    Although there has been a decline in the number of malaria cases in Zimbabwe since 2010, the disease remains the biggest public health threat in the country. Gwanda district, located in Matabeleland South Province of Zimbabwe has progressed to the malaria pre-elimination phase. The aim of this study was to determine the spatial distribution of malaria incidence at ward level for improving the planning and implementation of malaria elimination in the district. The Poisson purely spatial model was used to detect malaria clusters and their properties, including relative risk and significance levels at ward level. The geographically weighted Poisson regression (GWPR) model was used to explore the potential role and significance of environmental variables [rainfall, minimum and maximum temperature, altitude, Enhanced Vegetation Index (EVI), Normalized Difference Vegetation Index (NDVI), Normalized Difference Water Index (NDWI), rural/urban] and malaria control strategies [indoor residual spraying (IRS) and long-lasting insecticide-treated nets (LLINs)] on the spatial patterns of malaria incidence at ward level. Two significant clusters (p malaria cases were identified: (1) ward 24 south of Gwanda district and (2) ward 9 in the urban municipality, with relative risks of 5.583 and 4.316, respectively. The semiparametric-GWPR model with both local and global variables had higher performance based on AICc (70.882) compared to global regression (74.390) and GWPR which assumed that all variables varied locally (73.364). The semiparametric-GWPR captured the spatially non-stationary relationship between malaria cases and minimum temperature, NDVI, NDWI, and altitude at the ward level. The influence of LLINs, IRS and rural or urban did not vary and remained in the model as global terms. NDWI (positive coefficients) and NDVI (range from negative to positive coefficients) showed significant association with malaria cases in some of the wards. The IRS had a protection effect on

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

    Science.gov (United States)

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

    2017-04-01

    The aim of this study is to assess the prevalence of sarcopenia and investigate the associations between sarcopenia and long-term mortality and readmission in a population of elderly inpatients in acute care wards. We conducted a prospective observational study in the acute care wards of a teaching hospital in western China. The muscle mass was estimated according to a previously validated anthropometric equation. Handgrip strength was measured with a handheld dynamometer, and physical performance was measured via a 4 m walking test. Sarcopenia was defined according to the recommended diagnostic algorithm of the Asia Working Group for Sarcopenia. The survival status and readmission information were obtained via telephone interviews at 12, 24, and 36 months during the 3 year follow-up period following the baseline investigation. Two hundred and eighty-eight participants (mean age: 81.1 ± 6.6 years) were included. Forty-nine participants (17.0%) were identified as having sarcopenia. This condition was similar in men and women (16.9% vs. 17.5%, respectively, P = 0.915). During the 3 year follow-up period, 49 men (22.7%) and 9 women (16.4%) died (P = 0.307). The mortality of sarcopenic participants was significantly increased compared with non-sarcopenic participants (40.8% vs. 17.1%, respectively, P sarcopenia was an independent predictor of 3 year mortality (adjusted hazard ratio: 2.49; 95% confidential interval: 1.25-4.95) and readmission (adjusted hazard ratio: 1.81; 95% confidential interval: 1.17-2.80). Sarcopenia, which is evaluated by a combination of anthropometric measures, gait speed, and handgrip strength, is valuable to predict hospital readmission and long-term mortality in elderly patients in acute care wards. © 2016 The Authors. Journal of Cachexia, Sarcopenia and Muscle published by John Wiley & Sons Ltd on behalf of the Society on Sarcopenia, Cachexia and Wasting Disorders.

  13. Predictive factors of adrenal insufficiency in patients admitted to acute medical wards: a case control study

    Directory of Open Access Journals (Sweden)

    Oboni Jean-Baptiste

    2013-01-01

    Full Text Available Abstract Background Adrenal insufficiency is a rare and potentially lethal disease if untreated. Several clinical signs and biological markers are associated with glucocorticoid failure but the importance of these factors for diagnosing adrenal insufficiency is not known. In this study, we aimed to assess the prevalence of and the factors associated with adrenal insufficiency among patients admitted to an acute internal medicine ward. Methods Retrospective, case-control study including all patients with high-dose (250 μg ACTH-stimulation tests for suspected adrenal insufficiency performed between 2008 and 2010 in an acute internal medicine ward (n = 281. Cortisol values Results 32 patients (11.4% presented adrenal insufficiency; the others served as controls. Among all clinical and biological parameters studied, history of glucocorticoid withdrawal was the only independent factor significantly associated with patients with adrenal insufficiency (Odds Ratio: 6.71, 95% CI: 3.08 –14.62. Using a logistic regression, a model with four significant and independent variable was obtained, regrouping history of glucocorticoid withdrawal (OR 7.38, 95% CI [3.18 ; 17.11], p-value p-value 0.044, eosinophilia (OR 17.6, 95% CI [1.02; 302.3], p-value 0.048 and hyperkalemia (OR 2.41, 95% CI [0.87; 6.69], p-value 0.092. The AROC (95% CI was 0.75 (0.70; 0.80 for this model, with 6.3 (0.8 – 20.8 for sensitivity and 99.2 (97.1 – 99.9 for specificity. Conclusions 11.4% of patients with suspected adrenal insufficient admitted to acute medical ward actually do present with adrenal insufficiency, defined by an abnormal response to high-dose (250 μg ACTH-stimulation test. A history of glucocorticoid withdrawal was the strongest factor predicting the potential adrenal failure. The combination of a history of glucocorticoid withdrawal, nausea, eosinophilia and hyperkaliemia might be of interest to suspect adrenal insufficiency.

  14. Predictors of length of stay in a ward for demented elderly: gender differences.

    Science.gov (United States)

    Ono, Toshiyuki; Tamai, Akira; Takeuchi, Daisuke; Tamai, Yuzuru; Iseki, Hidenori; Fukushima, Hiromi; Kasahara, Sumie

    2010-09-01

    In our previous studies, we found both gender differences among care recipients and predictors that influenced outcomes after discharge from a ward for demented elderly. Here, we investigate predictors that influence the length of stay for each sex. We studied the data of 390 patients with dementia who were hospitalized in a ward for demented elderly between 1 April 2000 and 31 March 2008, and treated until 31 March 2009. The patients were divided into groups classified by gender. We analyzed the gender differences of characteristics and evaluated the predictors that influenced the length of stay in the ward for demented elderly using Cox's proportional hazards model. A model using the initial scores of the Revised Hasegawa Dementia Scale (HDS-R), Assessment Scale for Symptoms of Dementia (ASSD) and Nishimura's activity of daily living scale (N-ADL), which were examined on admission, was named Model 1. In Model 1, we checked the effect of each patient's characteristics, except for complications and destinations, on their length of stay. Model 2 used the final scores of HDS-R, ASSD and N-ADL including complications and destinations. There was a clear gender difference in the length of stay. The length of stay of women was longer than that of men. It was difficult to predict the length of stay in Model 1. Age was the only predictor in women and no predictor was identified in men. In Model 2, complications and the final HDS-R and N-ADL scores were predictors of the length of stay in men. Age, complications and destinations were predictors of the length of stay in women. It was observed that there were gender differences among predictors of the length of stay. However, it was difficult to predict the length of stay on admission. Retrospectively, the length of stay was determined by physical and psychological conditions, not by the social variables in men. In women, it was supposed that the caregiver's wish to give care at home reduced the length of stay. Besides

  15. Design and validation of a questionnaire to assess organizational culture in French hospital wards.

    Science.gov (United States)

    Saillour-Glénisson, F; Domecq, S; Kret, M; Sibe, M; Dumond, J P; Michel, P

    2016-09-17

    Although many organizational culture questionnaires have been developed, there is a lack of any validated multidimensional questionnaire assessing organizational culture at hospital ward level and adapted to health care context. Facing the lack of an appropriate tool, a multidisciplinary team designed and validated a dimensional organizational culture questionnaire for healthcare settings to be administered at ward level. A database of organizational culture items and themes was created after extensive literature review. Items were regrouped into dimensions and subdimensions (classification validated by experts). Pre-test and face validation was conducted with 15 health care professionals. In a stratified cluster random sample of hospitals, the psychometric validation was conducted in three phases on a sample of 859 healthcare professionals from 36 multidisciplinary medicine services: 1) the exploratory phase included a description of responses' saturation levels, factor and correlations analyses and an internal consistency analysis (Cronbach's alpha coefficient); 2) confirmatory phase used the Structural Equation Modeling (SEM); 3) reproducibility was studied by a test-retest. The overall response rate was 80 %; the completion average was 97 %. The metrological results were: a global Cronbach's alpha coefficient of 0.93, higher than 0.70 for 12 sub-dimensions; all Dillon-Goldstein's rho coefficients higher than 0.70; an excellent quality of external model with a Goodness of Fitness (GoF) criterion of 0.99. Seventy percent of the items had a reproducibility ranging from moderate (Intra-Class Coefficient between 50 and 70 % for 25 items) to good (ICC higher than 70 % for 33 items). COMEt (Contexte Organisationnel et Managérial en Etablissement de Santé) questionnaire is a validated multidimensional organizational culture questionnaire made of 6 dimensions, 21 sub-dimensions and 83 items. It is the first dimensional organizational culture questionnaire

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

    Science.gov (United States)

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

    2017-12-01

    Aggressive behaviour by psychiatric patients is a serious issue in clinical practice, and adequate management of such behaviour is required, with careful evaluation of the factors causing the aggression. To examine the characteristics of aggressive incidents by ward type, a cross-sectional descriptive study was conducted for 6 months between April 2012 and June 2013 using the Staff Observation Aggression Scale - Revised, Japanese version (SOAS-R) in 30 wards across 20 Japanese psychiatric hospitals. Participating wards were categorized into three types based on the Japanese medical reimbursement system: emergency psychiatric, acute psychiatric, and standard wards (common in Japan, mostly treating non-acute patients). On analyzing the 443 incidents reported, results showed significant differences in SOAS-R responses by ward type. In acute and emergency psychiatric wards, staff members were the most common target of aggression. In acute psychiatric wards, staff requiring patients to take medication was the most common provocation, and verbal aggression was the most commonly used means. In emergency psychiatric wards, victims felt threatened. In contrast, in standard wards, both the target and provocation of aggression were most commonly other patients, hands were used, victims reported experiencing physical pain, and seclusion was applied to stop their behaviour. These findings suggest that ward environment was an important factor influencing aggressive behaviour. Ensuring the quality and safety of psychiatric care requires understanding the characteristics of incidents that staff are likely to encounter in each ward type, as well as implementing efforts to deal with the incidents adequately and improve the treatment environment. © 2016 Australian College of Mental Health Nurses Inc.

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

    Science.gov (United States)

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

    2010-11-01

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

  18. Pilot evaluation of a ward-based automated hand hygiene training system.

    Science.gov (United States)

    Ghosh, Anarta; Ameling, Stefan; Zhou, Jiang; Lacey, Gerard; Creamer, Eilish; Dolan, Anthony; Sherlock, Orla; Humphreys, Hilary

    2013-04-01

    A novel artificial intelligence (AI) system (SureWash; GLANTA, Dublin, Ireland) was placed on a ward with 45 staff members for two 6-day periods to automatically assess hand hygiene technique and the potential effectiveness of the automated training system. Two human reviewers assessed videos from 50 hand hygiene events with an interrater reliability (IIR) of 88% (44/50). The IIR was 88% (44/50) for the human reviewers and 80% (40/50) for the software. This study also investigated the poses missed and the impact of feedback on participation (+113%), duration (+11%), and technique (+2.23%). Our findings showed significant correlation between the human raters and the computer, demonstrating for the first time in a clinical setting the potential use of this type of AI technology in hand hygiene training. Copyright © 2013 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

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

    Science.gov (United States)

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

    2016-08-01

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

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

    International Nuclear Information System (INIS)

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

    1992-01-01

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

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

    Science.gov (United States)

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

    2016-01-01

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

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

    Science.gov (United States)

    Congdon, P

    1989-01-01

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

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

    Science.gov (United States)

    Somense, Carolina Bueno; Duran, Erika Christiane Marocco

    2014-09-01

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

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

    LENUS (Irish Health Repository)

    Ennis, Linda

    2014-09-09

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

  5. Dispersion of Exhalation Pollutants in a Two-bed Hospital Ward with a Downward Ventilation System

    DEFF Research Database (Denmark)

    Qian, Hua; Nielsen, Peter V.; Hyldgård, Carl-Erik

    2006-01-01

    The Centers for Disease Control and Prevention has recommended the use of downward ventilation systems in isolation rooms to reduce the risk of cross-infection from airborne transmissible diseases. The expected airflow pattern of a downward ventilation design would supply cooler and slightly...... to investigate the airflow pattern and pollutant dispersion in the test ward. Based on both experimental and numerical results, the laminar airflow pattern was shown to be impossible to achieve due to turbulent flow mixing and flow entrainment into the supply air stream. The thermal plumes produced above people...... were found to induce flow mixing. We also studied the effects of the locations of the supply and extraction openings on both the flow pattern and pollutant exposure level in the occupied zone. A number of practical recommendations are suggested....

  6. The effect of an active on-ward participation of hospital pharmacists in Internal Medicine teams on preventable Adverse Drug Events in elderly inpatients: protocol of the WINGS study (Ward-oriented pharmacy in newly admitted geriatric seniors)

    NARCIS (Netherlands)

    Klopotowska, J.E.; Wierenga, P.C.; de Rooij, S.E.; Stuijt, C.C.; Arisz, L.; Kuks, P.F.; Dijkgraaf, M.G.; Lie-A-Huen, L.; Smorenburg, S.M.

    2011-01-01

    The potential of clinical interventions, aiming at reduction of preventable Adverse Drug Events (preventable ADEs) during hospital stay, have been studied extensively. Clinical Pharmacy is a well-established and effective service, usually consisting of full-time on-ward participation of clinical

  7. A Nurse's Survival Guide to the Ward - Third edition Richards Ann Edwards Sharon A Nurse's Survival Guide to the Ward - Third edition 500pp £19.99 Elsevier 978 0 7020 4603 2 0702046035 [Formula: see text].

    Science.gov (United States)

    2013-05-08

    This guide is a useful 'friend and companion' to keep close at hand. It is an essential reference for nurses, not only on the ward but in every field of practice where patient care is given. In fact, it makes an accessible guide for all healthcare practitioners.

  8. [Security material for venous peripheral..catheterization evaluation in an emergency ward].

    Science.gov (United States)

    Romero Ruiz, Adolfo; Jiménez Ruiz, Manuel; Rodríguez Navarro, Luis Miguel; Muñoz Pascual, José Carlos; Ramos Rueda, M del Carmen; Torres Pérez, Luis

    2007-06-01

    Venous canalization can be one of the most frequent causes of accidents due to an accidental puncture. To carry out activities which serve to lessen these misfortunes, bearing high biological risk, should become a priority for sanitary institutions and for their professionals. Inside a global strategy which deals with this aspect and with the objective of evaluating the convenience these instruments have in our center the authors made a practical evaluation on a series of them to discover their technical viability and their subjective consideration by professionals who employ them. For motives related to the practices of the ward in which this research took place, an emergency ward, the authors intentionally chose two passive instruments, available on the market, and three nurses who received 120 sample security catheters, 60 each for products A and B, to carry out habitual clinical practices, alongside a pad of paper on which to record any incidents. Regarding instrument A, 30 incidents, 52.6%, were detected while 37 sample procedures occurred. Regarding instrument B, 4 incidents, 7.01%, were detected while 47 sample procedures occurred. In absolute terms, neither of the two instruments demonstrated problems of an insecure manner; which is to say neither produced a situation related to the appearance of mis fortunate incidents associated to accidental punctures. The lower number of incidents with instrument B appears to be related to the habitual use of a conventional cathetec not a security one, produced by the same manufacturer in our center This research project was subsidized by the Sanitary Research Fund, PI 051265.

  9. Relationship Between Depression and Perception of Pain Severity in Patients Admitted to General Surgery Ward

    Directory of Open Access Journals (Sweden)

    Mehdi Samadzadeh

    2016-11-01

    Full Text Available Background Depression is considered as the most common psychological problem in individuals. Patients with persistent pain usually suffer from depression, disturbance in interpersonal relations, fatigue, and reduced physical and psychological performance. Objectives The aim of this study was to survey the relationship between depression and perception of pain severity in patients admitted to general surgery ward. Methods This research was a cross-sectional descriptive study. The study population included patients admitted to general surgery ward at hospitals of Ardabil city during 2010 - 2011. The study sample consisted of 168 individuals (male and female who were selected by nonrandomized convenience sampling method. The data were collected using a questionnaire on demographic information, the Beck depression inventory (BDI, and Toren questionnaire on pain beliefs and perceptions. The SPSS software was used for statistical analysis. Results The highest frequency of participants had moderate depression (44.1% while the lowest frequency belonged to healthy individuals (4.2%. The score of depression was higher in men (23.21 ± 7.56 than women (19.19 ± 6.84 as the same as the score of pain perception (8.91 ± 2.34 vs. 7.95 ± 1.87, respectively. The results indicated that there was a positive significant relationship between depression and perception of pain severity (P ≤ 0.01. This means that patients who have a history of depression feel much more pain during hospitalization and after the surgery. Conclusions Depressed or anguished patients report more pain compared to healthy ones.

  10. Nutritional predictors of mortality after discharge in elderly patients on a medical ward.

    Science.gov (United States)

    Buscemi, Silvio; Batsis, John A; Parrinello, Gaspare; Massenti, Fatima M; Rosafio, Giuseppe; Sciascia, Vittoria; Costa, Flavia; Pollina Addario, Sebastiano; Mendola, Serena; Barile, Anna M; Maniaci, Vincenza; Rini, Nadia; Caimi, Gregorio

    2016-07-01

    Malnutrition in elderly inpatients hospitalized on medical wards is a significant public health concern. The aim of this study was to investigate nutritional markers as mortality predictors following discharge in hospitalized medical elderly patients. This is a prospective observational cohort study with follow-up of 48 months. Two hundred and twenty-five individuals aged 60 and older admitted from the hospital emergency room in the past 48 h were investigated at the medical ward in the University hospital in Palermo (Italy). Anthropometric and clinical measurements, Mini-nutritional Assessment (MNA) questionnaire, bioelectrical (BIA) phase angle (PA), grip strength were obtained all within 48 h of admission. Mortality data were verified by means of mortality registry and analysed using Cox-proportional hazard models. Ninety (40%) participants died at the end of follow-up. There were significant relationships between PA, MNA score, age and gender on mortality. Patients in the lowest tertile of PA (< 4·6°) had higher mortality estimates [I vs II tertile: hazard ratio (HR) = 3·40; 95% confidence interval (CI): 2·01-5·77; II vs III tertile: HR = 3·83; 95% CI: 2·21-6·64; log-rank test: χ(2) = 43·6; P < 0·001]. Similarly, the survival curves demonstrated low MNA scores (< 22) were associated with higher mortality estimates (HR = 1·85; 95% CI: 1·22-2·81 χ(2) = 8·2; P = 0·004). The MNA and BIA-derived phase angle are reasonable tools to identify malnourished patients at high mortality risk and may represent useful markers in intervention trials in this high-risk subgroup. © 2016 Stichting European Society for Clinical Investigation Journal Foundation.

  11. Impact of protected mealtimes on ward mealtime environment, patient experience and nutrient intake in hospitalised patients.

    Science.gov (United States)

    Hickson, M; Connolly, A; Whelan, K

    2011-08-01

    Malnutrition is a common problem in hospitalised inpatients, resulting in a range of negative clinical, patient-centred and economic sequelae. Protected mealtimes (PM) aim to enhance the quality of the mealtime experience and maximise nutrient intake in hospitalised patients. The present study aimed to measure mealtime environment, patient experience and nutrient intake before and after the implementation of PM.   PM were implemented in a large teaching hospital through a range of different approaches. Direct observations were used to assess ward-level mealtime environment (e.g. dining room use, removal of distractions) (40 versus 34 wards) and individual patient experience (e.g. assistance with eating, visitors present) (253 versus 237 patients), and nutrient intake was assessed with a weighed food intake at lunch (39 versus 60 patients) at baseline and after the implementation of PM, respectively. Mealtime experience showed improvements in three objectives: more patients were monitored using food/fluid charts (32% versus 43%, P = 0.02), more were offered the opportunity to wash hands (30% versus 40%, P = 0.03) and more were served meals at uncluttered tables (54% versus 64%, P = 0.04). There was no difference in the number of patients experiencing mealtime interruptions (32% versus 25%, P = 0.14). There was no difference in energy intake (1088 versus 837 kJ, P = 0.25) and a decrease in protein intake (14.0 versus 7.5 g, P = 0.04) after PM. Only minor improvements in mealtime experience were made after the implementation of PM and so it is not unexpected that macronutrient intake did not improve. The implementation of PM needs to be evaluated to ensure improvements in mealtime experience are made such that measurable improvements in nutritional and clinical outcomes ensue. © 2011 The Authors. Journal of Human Nutrition and Dietetics © 2011 The British Dietetic Association Ltd.

  12. Nature and frequency of medication errors in a geriatric ward: an Indonesian experience

    Directory of Open Access Journals (Sweden)

    Ernawati DK

    2014-06-01

    Full Text Available Desak Ketut Ernawati,1,2 Ya Ping Lee,2 Jeffery David Hughes21Faculty of Medicine, Udayana University, Denpasar, Bali, Indonesia; 2School of Pharmacy and Curtin Health Innovation and Research Institute, Curtin University, Perth, WA, AustraliaPurpose: To determine the nature and frequency of medication errors during medication delivery processes in a public teaching hospital geriatric ward in Bali, Indonesia.Methods: A 20-week prospective study on medication errors occurring during the medication delivery process was conducted in a geriatric ward in a public teaching hospital in Bali, Indonesia. Participants selected were inpatients aged more than 60 years. Patients were excluded if they had a malignancy, were undergoing surgery, or receiving chemotherapy treatment. The occurrence of medication errors in prescribing, transcribing, dispensing, and administration were detected by the investigator providing in-hospital clinical pharmacy services.Results: Seven hundred and seventy drug orders and 7,662 drug doses were reviewed as part of the study. There were 1,563 medication errors detected among the 7,662 drug doses reviewed, representing an error rate of 20.4%. Administration errors were the most frequent medication errors identified (59%, followed by transcription errors (15%, dispensing errors (14%, and prescribing errors (7%. Errors in documentation were the most common form of administration errors. Of these errors, 2.4% were classified as potentially serious and 10.3% as potentially significant.Conclusion: Medication errors occurred in every stage of the medication delivery process, with administration errors being the most frequent. The majority of errors identified in the administration stage were related to documentation. Provision of in-hospital clinical pharmacy services could potentially play a significant role in detecting and preventing medication errors.Keywords: geriatric, medication errors, inpatients, medication delivery process

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

    Directory of Open Access Journals (Sweden)

    Morphet J

    2014-06-01

    Full Text Available Julia Morphet,1 Kerry Hood,2 Robyn Cant,2 Julie Baulch,3 Alana Gilbee,3 Kate Sandry4 1School of Nursing and Midwifery, Monash University, Frankston, Victoria, Australia; 2School of Nursing and Midwifery, Monash University, Clayton, Victoria, Australia; 3Southern Clinical School, Monash University, Monash Health, Clayton, Victoria, Australia; 4Dandenong Emergency Department, Monash Health, David St, Dandenong, Victoria, Australia Abstract: The establishment of interprofessional teamwork training in the preprofessional health care curriculum is a major challenge for teaching faculties. Interprofessional clinical placements offer an opportunity for teamwork education, as students in various professions can work and learn together. In this sequential, mixed-method study, focus group and survey techniques were used to evaluate students' educational experiences after 2-week ward-based interprofessional clinical placements. Forty-five senior nursing, medicine, and other health care students cared for patients in hospital wards under professional supervision, with nursing-medicine student "teams" leading care. Thirty-six students attended nine exit focus groups. Five central themes that emerged about training were student autonomy and workload, understanding of other professional roles, communication and shared knowledge, interprofessional teamwork/collaboration, and the "inner circle", or being part of the unit team. The learning environment was described as positive. In a postplacement satisfaction survey (n=38, students likewise rated the educational experience highly. In practicing teamwork and collaboration, students were able to rehearse their future professional role. We suggest that interprofessional clinical placements be regarded as an essential learning experience for senior preprofessional students. More work is needed to fully understand the effect of this interactive program on students' clinical learning and preparation for practice

  14. Involvement in decisions about intravenous treatment for nursing home patients: nursing homes versus hospital wards.

    Science.gov (United States)

    Klomstad, Kristin; Pedersen, Reidar; Førde, Reidun; Romøren, Maria

    2018-05-08

    Many of the elderly in nursing homes are very ill and have a reduced quality of life. Life expectancy is often hard to predict. Decisions about life-prolonging treatment should be based on a professional assessment of the patient's best interest, assessment of capacity to consent, and on the patient's own wishes. The purpose of this study was to investigate and compare how these types of decisions were made in nursing homes and in hospital wards. Using a questionnaire, we studied the decision-making process for 299 nursing home patients who were treated for dehydration using intravenous fluids, or for bacterial infections using intravenous antibiotics. We compared the 215 (72%) patients treated in nursing homes to the 84 (28%) nursing home patients treated in the hospital. The patients' capacity to consent was considered prior to treatment in 197 (92%) of the patients treated in nursing homes and 56 (67%) of the patients treated in hospitals (p nursing homes than in hospital (90% vs. 52%). Next of kin and other health personnel were also more rarely involved when the nursing home patient was treated in hospital. Whether advance care planning had been carried out, was more often unknown in the hospital (69% vs. 17% in nursing homes). Hospital doctors expressed more doubt about the decision to admit the patient to the hospital than about the treatment itself. This study indicates a potential for improvement in decision-making processes in general, and in particular when nursing home patients are treated in a hospital ward. The findings corroborate that nursing home patients should be treated locally if adequate health care and treatment is available. The communication between the different levels of health care when hospitalization is necessary, must be better. ClinicalTrials.gov NCT01023763 (12/1/09) [The registration was delayed one month after study onset due to practical reasons].

  15. Nursing physical assessment for patient safety in general wards: reaching consensus on core skills.

    Science.gov (United States)

    Douglas, Clint; Booker, Catriona; Fox, Robyn; Windsor, Carol; Osborne, Sonya; Gardner, Glenn

    2016-07-01

    To determine consensus across acute care specialty areas on core physical assessment skills necessary for early recognition of changes in patient status in general wards. Current approaches to physical assessment are inconsistent and have not evolved to meet increased patient and system demands. New models of nursing assessment are needed in general wards that ensure a proactive and patient safety approach. A modified Delphi study. Focus group interviews with 150 acute care registered nurses at a large tertiary referral hospital generated a framework of core skills that were developed into a web-based survey. We then sought consensus with a panel of 35 senior acute care registered nurses following a classical Delphi approach over three rounds. Consensus was predefined as at least 80% agreement for each skill across specialty areas. Content analysis of focus group transcripts identified 40 discrete core physical assessment skills. In the Delphi rounds, 16 of these were consensus validated as core skills and were conceptually aligned with the primary survey: (Airway) Assess airway patency; (Breathing) Measure respiratory rate, Evaluate work of breathing, Measure oxygen saturation; (Circulation) Palpate pulse rate and rhythm, Measure blood pressure by auscultation, Assess urine output; (Disability) Assess level of consciousness, Evaluate speech, Assess for pain; (Exposure) Measure body temperature, Inspect skin integrity, Inspect and palpate skin for signs of pressure injury, Observe any wounds, dressings, drains and invasive lines, Observe ability to transfer and mobilise, Assess bowel movements. Among a large and diverse group of experienced acute care registered nurses consensus was achieved on a structured core physical assessment to detect early changes in patient status. Although further research is needed to refine the model, clinical application should promote systematic assessment and clinical reasoning at the bedside. © 2016 John Wiley & Sons Ltd.

  16. Manual ward reduction of gastroschisis without anesthesia, a safe procedure – 8 years experience

    Directory of Open Access Journals (Sweden)

    Kamal Nain Rattan

    2017-01-01

    Full Text Available Introduction: Gastroschisis is the most common type of abdominal wall defect at birth. Various modalities of treatment have been proposed ranging from primary closure to the staged closure using prosthetic materials under general anesthesia. One of the modalities is manual ward reduction with primary repair of gastroschisis without anesthesia. We are reporting our 8 years of experience with manual ward reduction of gastroschisis with primary repair without anesthesia.Materials and methods: It is a retrospective analysis of all patients of gastroschisis who presented in our institution from January 2008 to June 2016. The data were analyzed for antenatal diagnosis, sex, day of presentation, weight of baby, associated anomalies, management by manual reduction without anesthesia and post reduction morbidity and mortality.Results: Out of a total of 68 patients, 28 were females and 40 were males. Fifty-five cases (80.8% were antenatally diagnosed. Fifty-nine patients (86.7% presented within 24 hours of birth while the rest had delayed presentation. Preterms (< 37 weeks were 18 (26.4%. Cases of simple gastroschisis were 22 while those complicated were 46. The average birth weight was 1.88 kg with the lowest weight of 1 kg who was a 27-week preterm. In 60 patients (88.2%, bedside manual reduction without anesthesia and primary closure was possible while in 8 patients it could not be done owing to delayed presentation and complications. The mortality in these patients was 40%.Conclusion: Manual reduction and primary closure of gastroschisis without anesthesia is a safe procedure. It requires no ventilator support and can be managed with antibiotics, total parenteral nutrition (TPN and continuous positive airway pressure (CPAP in the post-reduction period.

  17. Translating concerns into action: a detailed qualitative evaluation of an interdisciplinary intervention on medical wards

    Science.gov (United States)

    Archer, Stephanie; Johnston, Maximillian J; Beveridge, Iain; Long, Susannah Jane; Athanasiou, Thanos; Sevdalis, Nick

    2017-01-01

    Objectives To understand how frontline reports of day-to-day care failings might be better translated into improvement. Design Qualitative evaluation of an interdisciplinary team intervention capitalising on the frontline experience of care delivery. Prospective clinical team surveillance (PCTS) involved structured interdisciplinary briefings to capture challenges in care delivery, facilitated organisational escalation of the issues they identified, and feedback. Eighteen months of ethnography and two focus groups were conducted with staff taking part in a trial of PCTS. Results PCTS fostered psychological safety—a confidence that the team would not embarrass or punish those who speak up. This was complemented by a hard edge of accountability, whereby team members would regulate their own behaviour in anticipation of future briefings. Frontline concerns were triaged to managers, or resolved autonomously by ward teams, reversing what had been well-established normalisations of deviance. Junior clinicians found a degree of catharsis in airing their concerns, and their teams became more proactive in addressing improvement opportunities. PCTS generated tangible organisational changes, and enabled managers to make a convincing case for investment. However, briefings were constrained by the need to preserve professional credibility, and staff found some comfort in avoiding accountability. At higher organisational levels, frontline concerns were subject to competition with other priorities, and their resolution was limited by the scale of the challenges they described. Conclusions Prospective safety strategies relying on staff-volunteered data produce acceptable, negotiated accounts, subject to the many interdisciplinary tensions that characterise ward work. Nonetheless, these strategies give managers access to the realities of frontline cares, and support frontline staff to make incremental changes in their daily work. These are goals for learning healthcare

  18. Observations on BI from N=2 supergravity and the general Ward identity

    Energy Technology Data Exchange (ETDEWEB)

    Andrianopoli, Laura [DISAT, Politecnico di Torino, Corso Duca degli Abruzzi 24, I-10129 Turin (Italy); Istituto Nazionale di Fisica Nucleare (INFN) Sezione di Torino,Torino (Italy); Concha, Patrick [DISAT, Politecnico di Torino, Corso Duca degli Abruzzi 24, I-10129 Turin (Italy); Istituto Nazionale di Fisica Nucleare (INFN) Sezione di Torino,Torino (Italy); Departamento de Física, Universidad de Concepción, Casilla 160-C, Concepción (Chile); D’Auria, Riccardo [DISAT, Politecnico di Torino, Corso Duca degli Abruzzi 24, I-10129 Turin (Italy); Istituto Nazionale di Fisica Nucleare (INFN) Sezione di Torino,Torino (Italy); Rodriguez, Evelyn [DISAT, Politecnico di Torino, Corso Duca degli Abruzzi 24, I-10129 Turin (Italy); Istituto Nazionale di Fisica Nucleare (INFN) Sezione di Torino,Torino (Italy); Departamento de Física, Universidad de Concepción, Casilla 160-C, Concepción (Chile); Trigiante, Mario [DISAT, Politecnico di Torino, Corso Duca degli Abruzzi 24, I-10129 Turin (Italy); Istituto Nazionale di Fisica Nucleare (INFN) Sezione di Torino,Torino (Italy)

    2015-11-09

    The multi-vector generalization of a rigid, partially-broken N=2 supersymmetric theory is presented as a rigid limit of a suitable gauged N=2 supergravity with electric, magnetic charges and antisymmetric tensor fields. This on the one hand generalizes a known result by Ferrara, Girardello and Porrati while on the other hand allows to recover the multi-vector BI models of http://dx.doi.org/10.1007/JHEP12(2014)065 from N=2 supergravity as the end-point of a hierarchical limit in which the Planck mass first and then the supersymmetry breaking scale are sent to infinity. We define, in the parent supergravity model, a new symplectic frame in which, in the rigid limit, manifest symplectic invariance is preserved and the electric and magnetic Fayet-Iliopoulos terms are fully originated from the dyonic components of the embedding tensor. The supergravity origin of several features of the resulting rigid supersymmetric theory are then elucidated, such as the presence of a traceless SU(2)- Lie algebra term in the Ward identity and the existence of a central charge in the supersymmetry algebra which manifests itself as a harmless gauge transformation on the gauge vectors of the rigid theory; we show that this effect can be interpreted as a kind of “superspace non-locality” which does not affect the rigid theory on space-time. To set the stage of our analysis we take the opportunity in this paper to provide and prove the relevant identities of the most general dyonic gauging of Special-Kaehler and Quaternionic-Kaehler isometries in a generic N=2 model, which include the supersymmetry Ward identity, in a fully symplectic-covariant formalism.

  19. The impact of a large-scale quality improvement programme on work engagement: Preliminary results from a national cross-sectional-survey of the 'Productive Ward'

    LENUS (Irish Health Repository)

    White, Mark

    2014-05-14

    Quality improvement (QI) Programmes, like the Productive Ward: Releasing-time-to-care initiative, aim to \\'engage\\' and \\'empower\\' ward teams to actively participate, innovate and lead quality improvement at the front line. However, little is known about the relationship and impact that QI work has on the \\'engagement\\' of the clinical teams who participate and vice-versa.

  20. High Flow Nasal Cannula Oxygen Therapy can be used safely in the general paediatric ward using Paediatric Early Warning Scores

    NARCIS (Netherlands)

    Morsing, IE; Tinnevelt, Marcel; Jansen, Nicolaas J.G.; Koomen, E

    2015-01-01

    High Flow Nasal Cannula oxygen therapy (HFNC) is nowadays widely used at paediatric intensive care units (PICU) to provide a safe and comfortable (warm and humidified) oxygen delivery in children with respiratory distress. At general paediatric wards HFNC is hardly used because intensive observation

  1. Comparing Mental Illness Stigma among Nurses in Psychiatric and Non-Psychiatric Wards in Tabriz University of Medical Sciences

    Directory of Open Access Journals (Sweden)

    Ebrahimi Hossein

    2017-03-01

    Full Text Available Stigma can complicate people’s mental health problems by affecting different sides of personal life, increasing negative attitudes, causing discriminatory behavior towards them, and reducing the chances of recovery and returning to normal life. This research aims to compare the stigma of mental illness among nurses working in psychiatric and non-psychiatric wards in Tabriz University of Medical Sciences. A total of 240 nurses participated in this descriptive and analytic study. The data were collected using a demographic questionnaire and the Community Attitudes towards the Mentally Ill (CAMI Scale, which is a 40-item self-report questionnaire. All data were analyzed using SPSS 13. The majority of nurses have a medium level of stigma toward people with mental illness, and there is no significant relation between the type of wards and mean stigma scores. After eliminating factors such as mental illness in nurses and their families, it seems that only working with people with mental illness in psychiatric wards is not enough to create a positive attitude toward them. Additionally, the less physical activity and taking advantage of legal benefits of work hardship for psychiatric nurses, low income, and stigma toward psychiatric nursing, probably may make a difference in inclining to work in psychiatry ward between the two groups in spite of relatively equal stigma scores.

  2. Counterpoint: Practice versus Process--Rigidity of Reinforcement Requirements Results in Regressive Research: A Reply to Ward.

    Science.gov (United States)

    Biederman, Gerald B.; Davey, Valerie A.

    1995-01-01

    This counterpoint responds to Phillip Ward's commentary on a study by Gerald Biederman and others which concluded that verbal reinforcement in combination with interactive modeling strategies may produce confusion in children with language/learning difficulties. The counterpoint argues that the commentary indicates problems with semantics and with…

  3. [The implementation of the week surgery in an orthopedic and urology ward and assessment of its impact].

    Science.gov (United States)

    Mulloni, Giovanna; Petrucco, Stefania; De Marc, Raffaella; Nazzi, Cheti; Petri, Roberto; Guarrera, Giovanni Maria

    2015-01-01

    The implementation of the week surgery in an orthopedic and urology ward and the assessment of its impact. The week surgery (WS) is one of the models organized according the intensity of care that allows the improvement of the appropriateness of the hospital admissions. To describe the implementation and the impact of the WS on costs and levels of care. The WS was gradually implemented in an orthopedic and urology ward. The planning of the surgeries was modified, the wards where patients would have been transferred during the week-end where identified, the nurses were supported by expert nurses to learn new skills and clinical pathways were implemented. The periods January-June 2012 and 2013 were compared identifying a set of indicators according to the health technology assessment method. The nurses were able to take vacations according to schedule; the cost of outsourcing services were reduced (-4.953 Euros) as well as those of consumables. The nursing care could be guaranteed employing less (-5) full-time nurses; the global clinical performance of the ward did not vary. Unfortunately several urology patients could not be discharged during the week-ends. A good planning of the surgeries according to the patients' length of staying, together with interventions to increase the staff-skill mix, and the clinical pathways allowed an effective and efficient implementation of the WS model without jeopardizing patients' safety.

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

    Science.gov (United States)

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

    2015-03-01

    The aim of this study was to investigate the prevalence and characteristics of imipenem-resistant Acinetobacter baumanni isolated from surgical wards in a university hospital, China. A total of 143 non-duplicate A. baumannii were isolated from 517 inpatients in surgery intensive care units (ICUs), burn wards, and general surgery wards. Of these, 102 isolates of A. baumannii (71.3%) were resistant to imipenem. Among imipenem-resistant isolates, all isolates were resistant to almost all antimicrobial agents except polymyxin E, all isolates were positive for blaOXA-23 and blaOXA-51 in addition to ISAba1, 52 (51%) were positive for blaOXA-58, 8 (7.8%) contained blaVIM-2, which co-harbored with blaOXA-58. Molecular typing revealed the presence of three clones among imipenem-resistant isolates. This study confirmed that A. baumannii strains harboring OXA or VIM type β-lactamases are widely distributed throughout the surgery wards. The data demonstrate that there was a high prevalence of imipenem-resistant A. baumannii infection in the region.

  5. Usability, acceptability, and adherence to an electronic self-monitoring system in patients with major depression discharged from inpatient wards

    DEFF Research Database (Denmark)

    Lauritsen, Lise; Andersen, Louise; Olsson, Emilia

    2017-01-01

    Background: Patients suffering from depression have a high risk of relapse and readmission in the weeks following discharge from inpatient wards. Electronic self-monitoring systems that offer patient-communication features are now available to offer daily support to patients, but the usability, a...

  6. Clinical assessment and treatment in paediatric wards in the north-east of the United Republic of Tanzania

    DEFF Research Database (Denmark)

    Reyburn, Hugh; Mwakasungula, Emmanuel; Chonya, Semkini

    2008-01-01

    ; appropriate feeds were not present in any of the hospitals. A diagnosis of HIV-AIDS was made in only two cases while approximately 5% children admitted were expected to be infected with HIV in this area. CONCLUSION: Clinical assessment of children admitted to paediatric wards is disturbingly poor...

  7. Cross Infection in Hospital Wards with Downward Ventilation - Different Locations of Return Openings without and with Partitions between Beds

    DEFF Research Database (Denmark)

    Nielsen, Peter V.; Li, Yuguo; Buus, Morten

    2009-01-01

    A two-bed hospital ward with one standing healthcare assistant and a ceiling-mounted low-impulse semicircular inlet diffuser is simulated in a full-scale room. Tracer gas is used for simulating gaseous contaminants, and the concentration is measured at different air change rates and different pos...

  8. Trace and Ward-Takahashi identity anomalies in an SU(3) current model with energy-momentum tensor

    International Nuclear Information System (INIS)

    Zacrep, D.B.; Young, B.

    1975-01-01

    We discuss the validity of the naive Ward-Takahashi identities and trace identities for arbitrary n-point functions (n-pf's) of scalar, pseudoscalar, vector, and axial-vector currents and the improved energy-momentum tensor, thus extending the previous investigations in a unified way. We show that the validity of the naive Ward-Takahashi identities of the energy-momentum tensor implies the satisfaction of those of the vector currents. This removes an ambiguity concerning the minimal sets of anomalous current Ward-Takahashi identities. We find that all the anomalous Ward-Takahashi identities for the broad structure of n-pf's are again restricted to the axial-vector current of n-pf's of abnormal parity in a well-defined pattern, and the trace identity anomalies occur only in normal-parity n-pf's. We give all these anomalies. Our results show that there are no new anomalies associated with the inclusion of the energy-momentum tensor in the n-pf's

  9. Effect of a ward-based pharmacy team on preventable adverse drug events in surgical patients (SUREPILL study)

    NARCIS (Netherlands)

    de Boer, M.; Boeker, E. B.; Ramrattan, M. A.; Kiewiet, J. J. S.; Ram, K.; Gombert-Handoko, K. B.; van Lent-Evers, N. A. E. M.; Kuks, P. F. M.; Mulder, W. M. C.; Breslau, P. J.; Oostenbroek, R. J.; Dijkgraaf, M. G. W.; Lie-A-Huen, L.; Boermeester, M. A.

    2015-01-01

    Surgical patients are at risk of adverse drug events (ADEs) causing morbidity and mortality. Much harm is preventable. Ward-based pharmacy interventions to reduce medication-related harm have not been evaluated in surgical patients. This multicentre prospective clinical trial evaluated a

  10. Implications of Shared Interactive Displays for Work at a Surgery Ward: Coordination, Articulation Work and Context-awareness

    DEFF Research Database (Denmark)

    Bossen, Claus; Jensen, Lis Witte Kjær

    2008-01-01

    We report on experiences gained from the use at a surgery ward of shared interactive displays to support coordination and communication.  The displays merge large displays, video feed, RFID tag, chat and mobile phones to facilitate better coordination and articulation of work tasks and enhance...

  11. Ward social workers' views of what facilitates or hinders collaboration with specialist palliative care team social workers: A grounded theory.

    Science.gov (United States)

    Firn, Janice; Preston, Nancy; Walshe, Catherine

    2017-07-14

    Inpatient, generalist social workers in discharge planning roles work alongside specialist palliative care social workers to care for patients, often resulting in two social workers being concurrently involved in the same patient's care. Previous studies identifying components of effective collaboration, which impacts patient outcomes, care efficiency, professional job satisfaction, and healthcare costs, were conducted with nurses and physicians but not social workers. This study explores ward social workers' perceptions of what facilitates or hinders collaboration with palliative care social workers. Grounded theory was used to explore the research aim. In-depth qualitative interviews with masters trained ward social workers (n = 14) working in six hospitals located in the Midwest, United States were conducted between February 2014 and January 2015. A theoretical model of ward social workers' collaboration with palliative care social workers was developed. The emerging model of collaboration consists of: 1) trust, which is comprised of a) ability, b) benevolence, and c) integrity, 2) information sharing, and 3) role negotiation. Effective collaboration occurs when all elements of the model are present. Collaboration is facilitated when ward social workers' perceptions of trust are high, pertinent information is communicated in a time-sensitive manner, and a flexible approach to roles is taken. The theoretical model of collaboration can inform organisational policy and social work clinical practice guidelines, and may be of use to other healthcare professionals, as improvements in collaboration among healthcare providers may have a positive impact on patient outcomes.

  12. Prevalence of potential drug–drug interactions among internal medicine ward in University of Gondar Teaching Hospital, Ethiopia

    Directory of Open Access Journals (Sweden)

    Akshaya Srikanth Bhagavathula

    2014-05-01

    Conclusion: We have recorded a high rate of prevalence of potential DDI in the internal medicine ward of UOG hospital and a high number of clinically significant DDIs which the most prevalent DDI were of moderate severity. Careful selection of drugs and active pharmaceutical care is encouraged in order to avoid negative consequences of these interactions.

  13. Crisis management on surgical wards: a simulation-based approach to enhancing technical, teamwork, and patient interaction skills.

    Science.gov (United States)

    Arora, Sonal; Hull, Louise; Fitzpatrick, Maureen; Sevdalis, Nick; Birnbach, David J

    2015-05-01

    To establish the efficacy of simulation-based training for improving residents' management of postoperative complications on a surgical ward. Effective postoperative care is a crucial determinant of patient outcome, yet trainees learn this through the Halstedian approach. Little evidence exists on the efficacy of simulation in this safety-critical environment. A pre-/postintervention design was employed with 185 residents from 5 hospitals. Residents participated in 2 simulated ward-based scenarios consisting of a deteriorating postoperative patient. A debriefing intervention was implemented between scenarios. Resident performance was evaluated by calibrated, blinded assessors using the validated Global Assessment Toolkit for Ward Care. This included an assessment of clinical skills (checklist of 35 tasks), team-working skills (score range 1-6 per skill), and physician-patient interaction skills. Excellent interrater reliability was achieved in all assessments (reliability 0.89-0.99, P pre = 73.7% vs post = 94.8%, P pre = 21.1% vs post = 84.2% P pre = 42.1% vs post = 100%, P pre = 36.8% vs post = 89.8%, P pre = 1.75 vs post = 3.43), leadership (pre = 2.43 vs post = 4.20), and decision-making skills (pre = 2.20 vs post = 3.81, P < 0.001). Finally, residents improved in all elements of interaction with patients: empathy, organization, and verbal and nonverbal expression (Ps < 0.001). The study provides evidence for the efficacy of ward-based team training using simulation. Such exercises should be formally incorporated into training curricula to enhance patient safety in the high-risk surgical ward environment.

  14. Psychiatric wards with locked doors--advantages and disadvantages according to nurses and mental health nurse assistants.

    Science.gov (United States)

    Haglund, K; von Knorring, L; von Essen, L

    2006-04-01

    To describe nurses' and mental health nurse assistants' perceptions of advantages and disadvantages about working on a psychiatric ward with a locked entrance door. Psychiatric staff sometimes needs to protect patients from harming themselves or others. To keep the entrance door locked may help staff to achieve this goal. How locked entrance doors at psychiatric wards are experienced by staff, working on these wards, has been investigated to a very limited extent. The study was explorative and descriptive. Audio taped, semi-structured interviews with open-ended questions about advantages and disadvantages about working on a psychiatric ward with a locked entrance door, were conducted with 20 nurses and 20 mental health nurse assistants. Data were analyzed with content analysis. A content analysis revealed eight categories of advantages and 18 categories of disadvantages. Most advantages mentioned by nurses and mental health nurse assistants were categorized as providing staff with control over patients, providing patients with a secure and efficient care and protecting patients and staff against 'the outside'. Most disadvantages mentioned by nurses were categorized as causing extra work for staff, making patients feel confined, making patients feel dependent and creating a non-caring environment. Most disadvantages mentioned by mental health nurse assistants were categorized as causing extra work for staff, making patients feel confined, causing emotional problems for patients, making staff's power obvious and forcing patients to adapt to other patients' needs. Nurses and mental health nurse assistants mentioned more disadvantages than advantages and nurses mentioned more disadvantages than mental health nurse assistants. Nurses and mental health nurse assistants perceive a number of advantages and disadvantages for themselves, patients and significant others with a locked door at a psychiatric ward. Most of these concern patients' experiences. It is important for

  15. Ward's area location, physical activity, and body composition in 8- and 9-year-old boys and girls.

    Science.gov (United States)

    Cardadeiro, Graça; Baptista, Fátima; Zymbal, Vera; Rodrigues, Luís A; Sardinha, Luís B

    2010-11-01

    Bone strength is the result of its material composition and structural design, particularly bone mass distribution. The purpose of this study was to analyze femoral neck bone mass distribution by Ward's area location and its relationship with physical activity (PA) and body composition in children 8 and 9 years of age. The proximal femur shape was defined by geometric morphometric analysis in 88 participants (48 boys and 40 girls). Using dual-energy X-ray absorptiometry (DXA) images, 18 landmarks were digitized to define the proximal femur shape and to identify Ward's area position. Body weight, lean and fat mass, and bone mineral were assessed by DXA, PA by accelerometry, and bone age by the Tanner-Whitehouse III method. Warps analysis with Thin-Plate Spline software showed that the first axis explained 63% of proximal femur shape variation in boys and 58% in girls. Most of this variation was associated with differences in Ward's area location, from the central zone to the superior aspect of the femoral neck in both genders. Regression analysis demonstrated that body composition explained 4% to 7% of the proximal femur shape variation in girls. In boys, body composition variables explained a similar amount of variance, but moderate plus vigorous PA (MVPA) also accounted for 6% of proximal femur shape variation. In conclusion, proximal femur shape variation in children ages 8 and 9 was due mainly to differences in Ward's area position determined, in part, by body composition in both genders and by MVPA in boys. These variables were positively associated with a central Ward's area and thus with a more balanced femoral neck bone mass distribution. © 2010 American Society for Bone and Mineral Research.

  16. Identification of the benefits, enablers and barriers to integrating junior pharmacists into the ward team within one UK-based hospital

    Directory of Open Access Journals (Sweden)

    Hung MY

    2017-11-01

    Full Text Available Man Yui Hung,1 David John Wright,2 Jeanette Blacklock,2 Richard John Needle1,2 1Pharmacy Department, Colchester Hospital University NHS Foundation Trust, Colchester, 2School of Pharmacy, University of East Anglia, Norwich, UK Introduction: A high nurse-vacancy rate combined with high numbers of applications for junior pharmacist roles resulted in Colchester Hospital University National Health System Foundation Trust trial employing junior pharmacists into traditional nursing posts with the aim of integrating pharmacists into the ward team and enhancing local medicines optimization. The aim of the evaluation was to describe the implementation process and practice of the integrated care pharmacists (ICPs in order to inform future innovations of a similar nature.Methods: Four band 6 ward-based ICPs were employed on two wards funded within current ward staffing expenditure. With ethical committee approval, interviews were undertaken with the ICPs and focus groups with ward nurses, senior ward nurses and members of the medical team. Data were analyzed thematically to identify service benefits, barriers and enablers. Routine ward performance data were obtained from the two ICP wards and two wards selected as comparators. Appropriate statistical tests were performed to identify differences in performance.Results: Four ICPs were interviewed, and focus groups were undertaken with three junior nurses, four senior nurses and three medical practitioners. Service enablers were continuous ward time, undertaking drug administration, positive feedback and use of effective communication methods. Barriers were planning, funding model, career development, and interprofessional working and social isolation. ICPs were believed to save nurse time and improve medicines safety. The proportion of patients receiving medicine reconciliation within 24 hours increased significantly in the ICP wards. All ICPs had resigned from their role within 12 months.Discussion: It was

  17. Anomalies in Ward identities revisited. Explicit calculation of the three point functions

    International Nuclear Information System (INIS)

    Dalmolin, Fabricio Tronco

    2007-01-01

    others already performed within the same issue. In particular, in one of such investigation a pioneer and traditional reference has been revisited by using the alternative strategy mentioned above. In such study, a systematic treatment of purely fermionic one, two and three point functions, associated to scalar, pseudo-scalar, vector and axial-vector densities, has done. There, however, only the explicit expressions for one and two point functions were developed. The conclusions pointed out, in a very clear way, that the association between intrinsic ambiguities of the perturbative calculation and violations in symmetry properties is not consistent. At the same time, it was concluded that only in an investigation where the explicit forms for the three point functions involved are considered clean and sound conclusions can be extracted. This is due to the fact that, in the relevant symmetry properties, it is involved three ward identities and a low energy limit. This is precisely the main purpose of the present work: to promote a detailed investigation of the relations among green functions and ward identities, within the context of a model having only one specie of 1/2 spin fermionic field, that consider all the amplitudes having superficial degree of divergence higher than the logarithmic one, in a similar way as that made in the work of Gerstein and Jackiw, taking however the explicit form for the three point functions. This is one to get in the analysis, simultaneously, the ward identities and the low energy limits involved in the anomalous amplitudes as required by the Sutherland-Veltman theorem, in order to get an adequate understanding of the anomaly phenomena. We will show that our final results can be mapped in those found with the use of the Dimensional Regularization, in situation where this technique can be applied, or in those of Gerstein and Jackiw, however with conflicting interpretations. Finally, we will show that in the context of the adopted technique

  18. Feasibility of progressive strength training implemented in the acute ward after hip fracture surgery.

    Directory of Open Access Journals (Sweden)

    Lise Kronborg

    Full Text Available Patients with a hip fracture lose more than 50% knee-extension strength in the fractured limb within one week of surgery. Hence, immediate progressive strength training following hip fracture surgery may be rational, but the feasibility unknown.To examine the feasibility of in-hospital progressive strength training implemented in the acute ward following hip fracture surgery, based on pre-specified criteria for feasibility.A prospective cohort study conducted in an acute orthopedic hip fracture unit at a university hospital. A consecutive sample of 36 patients, 18 with a cervical and 18 with a trochanteric hip fracture (27 women and 9 men, mean (SD age of 79.4 (8.3 years were included between June and December 2012.A daily (on weekdays program of progressive knee-extension strength training for the fractured limb, using ankle weight cuffs in 3 sets of 10 repetition maximum loadings.The primary outcome was the change in training load (kg during the knee-extension strength training. The secondary outcomes were changes in hip fracture-related pain and maximal isometric knee-extension strength.The strength training was commenced at a mean of 2.4 (0.7 days after surgery. The training loads (kilograms lifted increased from 1.6 (0.8 to 4.3 (1.7 kg over 4.3 (2.2 training sessions (P<.001. The maximal isometric knee-extension strength of the fractured limb increased from 0.37 (0.2 to 0.61 (0.3 Nm/kg (P<.001, while the average strength deficit in the fractured limb decreased from 50% to 32% (% non-fractured, P<.001. Only 3 of 212 sessions were not performed because of severe hip fracture-related pain.Progressive knee-extension strength training of the fractured limb commenced in the acute ward seems feasible, and may reduce strength asymmetry between limbs without hip pain interfering. The clinical efficacy needs confirmation in a randomized controlled design.ClinicalTrials.gov ID: NCT01616030.

  19. Patients’ approaches to students’ learning at a clinical education ward-an ethnographic study

    Science.gov (United States)

    2014-01-01

    Background It is well known that patients’ involvement in health care students’ learning is essential and gives students opportunities to experience clinical reasoning and practice clinical skills when interacting with patients. Students encounter patients in different contexts throughout their education. However, looking across the research providing evidence about learning related to patient-student encounters reveals a lack of knowledge about the actual learning process that occurs in encounters between patients and students. The aim of this study was to explore patient-student encounters in relation to students’ learning in a patient-centered health-care setting. Methods An ethnographic approach was used to study the encounters between patients and students. The setting was a clinical education ward for nursing students at a university hospital with eight beds. The study included 10 observations with 11 students and 10 patients. The observer followed one or two students taking care of one patient. During the fieldwork observational and reflective notes were taken. After each observation follow-up interviews were conducted with each patient and student separately. Data were analyzed using an ethnographic approach. Results The most striking results showed that patients took different approaches in the encounters with students. When the students managed to create a good atmosphere and a mutual relationship, the patients were active participants in the students’ learning. If the students did not manage to create a good atmosphere, the relationship became one-way and the patients were passive participants, letting the students practice on their bodies but without engaging in a dialogue with the students. Conclusions Patient-student encounters, at a clinical education ward with a patient-centred pedagogical framework, can develop into either a learning relationship or an attending relationship. A learning relationship is based on a mutual relationship between

  20. A Virtual Ward for Home Hemodialysis Patients – A Pilot Trial

    Directory of Open Access Journals (Sweden)

    Michael J. Raphael

    2015-11-01

    Full Text Available Background: Patients with end-stage renal disease (ESRD have a high rate of hospitalization and are prone to care gaps that may occur during the transition from hospital to home. The virtual ward (VW is an innovative model that provides short-term transitional care to patients upon hospital discharge. The VW may be an effective intervention to address care gaps. Objectives: The primary objective of the pilot study was to assess the feasibility and practicality of implementing the Home Dialysis VW (HDVW on a broader scale. Design: The HDVW Pilot Study enrolled home hemodialysis patients following one of four inclusion criteria: 1. Discharge from hospital, 2. Completion of an in-hospital medical procedure, 3. Prescription of an antibiotic, 4. Completion of home hemodialysis training. Patients were followed in the HDVW for 14 days and during this time were assessed serially with a clinician-led telephone interview for one of three transitional care gaps: 1. Requirement for change in hemodialysis prescription, 2. Requirement for coordination of follow-up care, 3. Requirement for medication change. Setting: The study was conducted in Toronto, Ontario, Canada at a quaternary care academic teaching hospital from 2012–2013. Patients: This study included 52 HDVW admissions among 35 patients selected from the existing home hemodialysis program. Measurements: The primary outcome was the identification of the number of care gaps at each HDVW admission. Secondary outcomes included the identification of potential predictors of care gaps and description of clinical adverse events following HDVW admission (readmissions, emergency department visits, unplanned visits to the home hemodialysis in-center. Results: The implementation and execution of the HDVW Pilot Study proved to be technically feasible and practical. A care gap was identified in 35 (67 % of the HDVW admissions. In total, the cohort experienced 85 care gaps. There were no baseline demographic

  1. Patients' approaches to students' learning at a clinical education ward--an ethnographic study.

    Science.gov (United States)

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

    2014-07-02

    It is well known that patients' involvement in health care students' learning is essential and gives students opportunities to experience clinical reasoning and practice clinical skills when interacting with patients. Students encounter patients in different contexts throughout their education. However, looking across the research providing evidence about learning related to patient-student encounters reveals a lack of knowledge about the actual learning process that occurs in encounters between patients and students. The aim of this study was to explore patient-student encounters in relation to students' learning in a patient-centered health-care setting. An ethnographic approach was used to study the encounters between patients and students. The setting was a clinical education ward for nursing students at a university hospital with eight beds. The study included 10 observations with 11 students and 10 patients. The observer followed one or two students taking care of one patient. During the fieldwork observational and reflective notes were taken. After each observation follow-up interviews were conducted with each patient and student separately. Data were analyzed using an ethnographic approach. The most striking results showed that patients took different approaches in the encounters with students. When the students managed to create a good atmosphere and a mutual relationship, the patients were active participants in the students' learning. If the students did not manage to create a good atmosphere, the relationship became one-way and the patients were passive participants, letting the students practice on their bodies but without engaging in a dialogue with the students. Patient-student encounters, at a clinical education ward with a patient-centred pedagogical framework, can develop into either a learning relationship or an attending relationship. A learning relationship is based on a mutual relationship between patients and students resulting in patients

  2. Workplace learning: an analysis of students' expectations of learning on the ward in the Department of Internal Medicine.

    Science.gov (United States)

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

    2014-01-01

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

  3. Effects of Transferring to the Rehabilitation Ward on Long-Term Mortality Rate of First-Time Stroke Survivors: A Population-Based Study.

    Science.gov (United States)

    Chen, Chien-Min; Yang, Yao-Hsu; Chang, Chia-Hao; Chen, Pau-Chung

    2017-12-01

    To assess the long-term health outcomes of acute stroke survivors transferred to the rehabilitation ward. Long-term mortality rates of first-time stroke survivors during hospitalization were compared among the following sets of patients: patients transferred to the rehabilitation ward, patients receiving rehabilitation without being transferred to the rehabilitation ward, and patients receiving no rehabilitation. Retrospective cohort study. Patients (N = 11,419) with stroke from 2005 to 2008 were initially assessed for eligibility. After propensity score matching, 390 first-time stroke survivors were included. None. Cox proportional hazards regression model was used to assess differences in 5-year poststroke mortality rates. Based on adjusted hazard ratios (HRs), the patients receiving rehabilitation without being transferred to the rehabilitation ward (adjusted HR, 2.20; 95% confidence interval [CI], 1.36-3.57) and patients receiving no rehabilitation (adjusted HR, 4.00; 95% CI, 2.55-6.27) had significantly higher mortality risk than the patients transferred to the rehabilitation ward. Mortality rate of the stroke survivors was affected by age ≥65 years (compared with age stroke (adjusted HR, 1.55), stroke severity (Stroke Severity Index [SSI] score≥20, compared with SSI scorestroke survivors transferred to the rehabilitation ward had a 5-year mortality rate 2.2 times lower than those who received rehabilitation without transfer to the rehabilitation ward and 4 times lower than those who received no rehabilitation. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  4. Comparison of alcohol-dependent patients at a gastroenterological and a psychiatric ward according to the Lesch alcoholism typology: implications for treatment.

    Science.gov (United States)

    Vyssoki, Benjamin; Steindl-Munda, Petra; Ferenci, Peter; Walter, Henriette; Höfer, Peter; Blüml, Victor; Friedrich, Fabian; Kogoj, Dagmar; Lesch, Otto M

    2010-01-01

    To assess the clinical and biological status of alcohol-dependent patients admitted to a psychiatric or a gastroenterological ward, assessing and comparing dimensions important for prescribing treatment for withdrawal and relapse prevention. Eighty patients, alcohol-dependent according to international classification of diseases tenth revision and diagnostic and statistical manual, text revised, version IV, admitted to the Vienna General Hospital between January 2005 and  November 2006, were examined, of whom 44 were admitted to the psychiatric ward and 36 to the gastroenterological ward. Dimensions of alcohol dependence were assessed using a computerized structured interview, the Lesch alcoholism typology (LAT). Biological markers and the model for end-stage liver disease (MELD) score defined the severity of alcohol-related physical disturbances. As might be expected, gastroenterological patients had more advanced physical diseases than psychiatric patients, and affective disorders and suicidal tendencies were significantly commoner among the psychiatric patients. Thus, LAT Type II patients were overrepresented at the gastroenterological ward and LAT Type III patients at the psychiatric ward. The severity of somatic diseases and psychiatric disorders as well as the distribution of the four types according to Lesch differ between alcohol-dependent patients admitted to a psychiatric ward or a gastroenterological ward. Regarding the positive long-term outcome, different evidence-based medical treatment approaches for withdrawal and relapse prevention are needed for these patients.

  5. Lost in hospital: a qualitative interview study that explores the perceptions of NHS inpatients who spent time on clinically inappropriate hospital wards.

    Science.gov (United States)

    Goulding, Lucy; Adamson, Joy; Watt, Ian; Wright, John

    2015-10-01

    Prior research suggests that the placement of patients on clinically inappropriate hospital wards may increase the risk of experiencing patient safety issues. To explore patients' perspectives of the quality and safety of the care received during their inpatient stay on a clinically inappropriate hospital ward. Qualitative study using semi-structured interviews. Nineteen patients who had spent time on at least one clinically inappropriate ward during their hospital stay at a large NHS teaching hospital in England. Patients would prefer to be treated on the correct specialty ward, but it is generally accepted that this may not be possible. When patients are placed on inappropriate wards, they may lack a sense of belonging. Participants commented on potential failings in communication, medical staff availability, nurses' knowledge and the resources available, each of which may contribute to unsafe care. Patients generally acknowledge the need for placement on inappropriate wards due to demand for inpatient beds, but may report dissatisfaction in terms of preference and belonging. Importantly, patients recount issues resulting from this placement that may compromise their safety. Hospital managers should be encouraged to appreciate this insight and potential threat to safe practice and where possible avoid inappropriate ward transfers and admissions. Where such admissions are unavoidable, staff should take action to address the gaps in safety of care that have been identified. © 2013 John Wiley & Sons Ltd.

  6. 'It's a matter of patient safety': understanding challenges in everyday clinical practice for achieving good care on the surgical ward - a qualitative study.

    Science.gov (United States)

    Jangland, Eva; Nyberg, Berit; Yngman-Uhlin, Pia

    2017-06-01

    Surgical care plays an important role in the acute hospital's delivery of safe, high-quality patient care. Although demands for effectiveness are high in surgical wards quality of care and patient safety must also be secured. It is therefore necessary to identify the challenges and barriers linked to quality of care and patient safety with a focus on this specific setting. To explore situations and processes that support or hinder good safe patient care on the surgical ward. This qualitative study was based on a strategic sample of 10 department and ward leaders in three hospitals and six surgical wards in Sweden. Repeated reflective interviews were analysed using systematic text condensation. Four themes described the leaders' view of a complex healthcare setting that demands effectiveness and efficiency in moving patients quickly through the healthcare system. Quality of care and patient safety were often hampered factors such as a shift of care level, with critically ill patients cared for without reorganisation of nurses' competencies on the surgical ward. There is a gap between what is described in written documents and what is or can be performed in clinical practice to achieve good care and safe care on the surgical ward. A shift in levels of care on the surgical ward without reallocation of the necessary competencies at the patient's bedside show consequences for quality of care and patient safety. This means that surgical wards should consider reviewing their organisation and implementing more advanced nursing roles in direct patient care on all shifts. The ethical issues and the moral stress on nurses who lack the resources and competence to deliver good care according to professional values need to be made more explicit as a part of the patient safety agenda in the surgical ward. © 2016 Nordic College of Caring Science.

  7. 'It teaches you what to expect in future . . . ': interprofessional learning on a training ward for medical, nursing, occupational therapy and physiotherapy students.

    Science.gov (United States)

    Reeves, Scott; Freeth, Della; McCrorie, Peter; Perry, David

    2002-04-01

    This paper presents findings from a multimethod evaluation of an interprofessional training ward placement for medical, nursing, occupational therapy and physiotherapy students. Unique in the UK, and following the pioneering work at Linköping, the training ward allowed senior pre-qualification students, under the supervision of practitioners, to plan and deliver interprofessional care for a group of orthopaedic and rheumatology patients. This responsibility enabled students to develop profession-specific skills and competencies in dealing with patients. It also allowed them to enhance their teamworking skills in an interprofessional environment. Student teams were supported by facilitators who ensured medical care was optimal, led reflective sessions and facilitated students' problem solving. Data were collected from all groups of participants involved in the ward: students, facilitators and patients. Methods included questionnaires, interviews and observations. Findings are presented from each participating group, with a particular emphasis placed on the perspective of medicine. The study found that students valued highly the experiential learning they received on the ward and felt the ward prepared them more effectively for future practice. However, many encountered difficulties adopting an autonomous learning style during their placement. Despite enjoying their work on the ward, facilitators were concerned that the demands of their role could result in 'burn-out'. Patients enjoyed their ward experience and scored higher on a range of satisfaction indicators than a comparative group of patients. Participants were generally positive about the training ward. All considered that it was a worthwhile experience and felt the ward should recommence in the near future.

  8. Simulation in undergraduate paediatric nursing curriculum: Evaluation of a complex 'ward for a day' education program.

    Science.gov (United States)

    Gamble, Andree S

    2017-03-01

    Simulation in health education has been shown to increase confidence, psychomotor and professional skills, and thus positively impact on student preparedness for clinical placement. It is recognised as a valuable tool to expose and engage students in realistic patient care encounters without the potential to cause patient harm. Although inherent challenges exist in the development and implementation of simulation, variability in clinical placement time, availability and quality dictates the need to provide students with learning opportunities they may otherwise not experience. With this, and a myriad of other issues providing the impetus for improved clinical preparation, 28 final semester undergraduate nursing students in a paediatric nursing course were involved in an extended multi-scenario simulated clinical shift prior to clinical placement. The simulation focussed on a complex ward experience, giving students the opportunity to demonstrate a variety of psychomotor skills, decision making, leadership, team work and other professional attributes integral for successful transition into the clinical arena. Evaluation data were collected at 3 intermittent points; post-simulation, post clinical placement, and 3 months after commencing employment as a Registered Nurse. Quantitative and qualitative analysis suggested positive impacts on critical nursing concepts and psychomotor skills resulted for participants in both clinical placement and beyond into the first months of employment. Copyright © 2017 Elsevier Ltd. All rights reserved.

  9. Going Mobile: An Empirical Model for Explaining Successful Information Logistics in Ward Rounds.

    Science.gov (United States)

    Esdar, Moritz; Liebe, Jan-David; Babitsch, Birgit; Hübner, Ursula

    2018-01-01

    Medical ward rounds are critical focal points of inpatient care that call for uniquely flexible solutions to provide clinical information at the bedside. While this fact is undoubted, adoption rates of mobile IT solutions remain rather low. Our goal was to investigate if and how mobile IT solutions influence successful information provision at the bedside, i.e. clinical information logistics, as well as to shed light at socio-organizational factors that facilitate adoption rates from a user-centered perspective. Survey data were collected from 373 medical and nursing directors of German, Austrian and Swiss hospitals and analyzed using variance-based Structural Equation Modelling (SEM). The adoption of mobile IT solutions explains large portions of clinical information logistics and is in itself associated with an organizational culture of innovation and end user participation. Results should encourage decision makers to understand mobility as a core constituent of information logistics and thus to promote close end-user participation as well as to work towards building a culture of innovation.

  10. Characteristics of Tornado-Like Vortices Simulated in a Large-Scale Ward-Type Simulator

    Science.gov (United States)

    Tang, Zhuo; Feng, Changda; Wu, Liang; Zuo, Delong; James, Darryl L.

    2018-02-01

    Tornado-like vortices are simulated in a large-scale Ward-type simulator to further advance the understanding of such flows, and to facilitate future studies of tornado wind loading on structures. Measurements of the velocity fields near the simulator floor and the resulting floor surface pressures are interpreted to reveal the mean and fluctuating characteristics of the flow as well as the characteristics of the static-pressure deficit. We focus on the manner in which the swirl ratio and the radial Reynolds number affect these characteristics. The transition of the tornado-like flow from a single-celled vortex to a dual-celled vortex with increasing swirl ratio and the impact of this transition on the flow field and the surface-pressure deficit are closely examined. The mean characteristics of the surface-pressure deficit caused by tornado-like vortices simulated at a number of swirl ratios compare well with the corresponding characteristics recorded during full-scale tornadoes.

  11. [Systematic umbilical cord blood analysis at birth: feasibility and reliability in a French labour ward].

    Science.gov (United States)

    Ernst, D; Clerc, J; Decullier, E; Gavanier, G; Dupuis, O

    2012-10-01

    At birth, evaluation of neonatal well-being is crucial. It is though important to perform umbilical cord blood gas analysis, and then to analyze the samples. We wanted to establish the feasibility and reliability of systematic umbilical cord blood sampling in a French labour ward. Study of systematic umbilical cord blood gas analysis was realized retrospectively from 1000 consecutive deliveries. We first established the feasibility of the samples. Feasibility was defined by the ratio of complete cord acid-base data on the number of deliveries from alive newborns. Afterwards, we established the reliability on the remaining cord samples. Reliability was the ratio of samples that fulfilled quality criteria defined by Westgate et al. and revised by Kro et al., on the number of complete samples from alive newborns. At last, we looked for factors that would influence these results. The systematic umbilical cord blood sample feasibility reached 91.6%, and the reliability reached 80.7%. About the delivery mode, 38.6% of emergency caesarians (IC 95% [30.8-46.3]; Panalysis were significantly less validated during emergency caesarians. Realization of systematic cord blood gas analysis was followed by 8.4% of incomplete samples, and by 19.3% that were uninterpretable. Training sessions should be organized to improve the feasibility and reliability, especially during emergency caesarians. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

  12. Factors Influencing communication between the patients with cancer and their nurses in oncology wards

    Directory of Open Access Journals (Sweden)

    Vahid Zamanzadeh

    2014-01-01

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

  13. Chemical restraint in routine clinical practice: a report from a general hospital psychiatric ward in Greece

    Directory of Open Access Journals (Sweden)

    Papamichael Georgios

    2011-02-01

    Full Text Available Abstract Background There is a dearth of studies regarding chemical restraint in routine clinical psychiatric practice. There may be wide variations between different settings and countries. Methods A retrospective study on chemical restraint was performed in the 11-bed psychiatric ward of the General Hospital of Arta, in northwestern Greece. All admissions over a 2-year-period (from March 2008 to March 2010 were examined. Results Chemical restraint was applied in 33 cases (10.5% of total admissions. From a total of 82 injections, 22 involved a benzodiazepine and/or levomepromazine, whereas 60 injections involved an antipsychotic agent, almost exclusively haloperidol (96.7% of cases, usually in combination with a benzodiazepine (61.7% of cases. In 36.4% of cases the patient was further subjected to restraint or seclusion. Conclusions In our unit, clinicians prefer the combined antipsychotic/benzodiazepine regimen for the management of patients' acute agitation and violent behaviour. Conventional antipsychotics are administrated almost exclusively and in a significant proportion of cases further coercive measures are applied. Studies on the practice of chemical restraint should be regularly performed in clinical settings.

  14. Effects of pharmaceutical counselling on antimicrobial use in surgical wards: intervention study with historical control group.

    Science.gov (United States)

    Grill, Eva; Weber, Alexandra; Lohmann, Stefanie; Vetter-Kerkhoff, Cornelia; Strobl, Ralf; Jauch, Karl-Walter

    2011-07-01

    The objective of this study was to assess the impact of pharmaceutical consulting on the quality of antimicrobial use in a surgical hospital department in a prospective controlled intervention study. Patients receiving pharmaceutical intervention (intervention group, IG, n = 317) were compared with a historical control group (control group, CG, n = 321). During the control period, antimicrobial use was monitored without intervention. During the subsequent intervention period, a clinical pharmacist reviewed the prescriptions and gave advice on medication. Intervention reduced the length of antimicrobial courses (IG = 10 days, CG = 11 days, incidence rate ratio for i.v. versus o.p. = 0.88, 95% confidence interval 0.84 to 0.93) and shortened i.v. administration (IG = 8 days, CG = 10 days, hazard rate = 1.76 in favour of switch from i.v. to p.o., 95% confidence interval 1.23 to 2.52). Intervention also helped to avoid useless combination therapy and reduced total costs for antimicrobials. A clinical pharmacist who reviews prescriptions can promote an increase in efficiency, for example, by shortening the course of treatment. Counselling by ward-based clinical pharmacists was shown to be effective to streamline antimicrobial therapy in surgical units and to increase drug safety. Copyright © 2011 John Wiley & Sons, Ltd.

  15. Nitrogen removal process optimization in New York City WPCPS: a case study of Wards Island WPCP.

    Science.gov (United States)

    Ramalingam, K; Fillos, J; Musabyimana, M; Deur, A; Beckmann, K

    2009-01-01

    The New York City Department of Environmental Protection has been engaged in a continuous process to develop a nitrogen removal program to reduce the nitrogen mass discharge from its water pollution control plants, (WPCPs), from 49,158 kg/d to 20,105 kg/d by the year 2017 as recommended by the Long Island Sound Study. As part of the process, a comprehensive research effort was undertaken involving bench, pilot and full scale studies to identify the most effective way to upgrade and optimize the existing WPCPs. Aeration tank 13 (AT-13) at the Wards Island WPCP was particularly attractive as a full-scale research facility because its aeration tank with its dedicated final settling tanks and RAS pumps could be isolated from the remaining treatment facilities. The nitrogen removal performance of AT-13, which, at the time, was operated as a "basic step feed BNR Facility", was evaluated and concurrently nitrification kinetic parameters were measured using in-situ bench scale experiments. Additional bench scale experiments provided denitrification rates using different sources of carbon and measurement of the maximum specific growth rate of nitrifying bacteria. The combined findings were then used to upgrade AT-13 to a "full" BNR facility with carbon and alkalinity addition. This paper will focus on the combined bench and full scale results that were the basis for the consequent upgrade.

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

    International Nuclear Information System (INIS)

    Hinterbichler, Kurt; Hui, Lam; Khoury, Justin

    2014-01-01

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

  17. [Severe post-partum hemorrhage: descriptive study at the Robert-Debré Hospital maternity ward].

    Science.gov (United States)

    Reyal, F; Deffarges, J; Luton, D; Blot, P; Oury, J F; Sibony, O

    2002-06-01

    To analyze the prevalence, cause, treatment, and risk factors of severe post-partum hemorrhage (transfusion, surgery, radiology) observed at the maternity ward of the Robert-Debré Hospital, Paris. Method. This retrospective cohort was collected from a database including 19182 deliveries from 1992 to 1998. The entire medical file was reviewed in cases of severe hemorrhage. The prevalence of severe post-partum hemorrhage was 23 per 10,000 deliveries (44 patients). Transfusion was performed in 44/44 and hysterectomy in 3/44. Three patients were transferred to the intensive care unit. There were no deaths. At multivariate analysis, risk factors for severe post-partum hemorrhage were: abnormal placental insertion (OR=7.2; 95CI: 2.18-18.3), cesarean (OR=5.8; 95CI: 2.9-11.6), multiple pregnancy (OR=3.2; 95CI: 1.3-7.8), prematurity (OR=3, 95CI: 1.5-6.2), hypertension (OR=2.9; 95CI: 1.3-6.3). Twenty-six percent of the patients had no risk factors. The prevalence of severe pot-partum hemorrhage is low in our experience. The methodology used for this retrospective cohort does not enable an explanation. Intensive obstetrical care is necessary in case of abnormal placenta insertion. In 10 out of 44 cases, severe post-partum hemorrhage occurred in a context of insufficient monitoring, late or erroneous diagnosis, or incorrect treatment.

  18. Systematic Review of Pain assessment scales in newborns under maxillofacial surgery Admitted to the surgical ward

    Directory of Open Access Journals (Sweden)

    Shapour Yaripoor

    2016-10-01

    Full Text Available Having standard tools for measuring pain in infants is essential. The aim of this study is to review the scale of pain in newborns under maxillofacial surgery Admitted to the surgical ward. Integrative review study of articles published from 2000 to 2015, carried out in the following databases: Scopus, PubMed, CINAHL, LILACS, Cochrane, medscape and google scholar. The sample consisted of 17 articles. MeSH headings searched included pain measurement, pain scale, newborn pain, infant pain scale, maxillofacial surgery and pain perception. 16 neonatal pain assessment tools were found. Of the 232 original articles, 17 review articles in the field of pain assessment tools in infant under maxillofacial surgery who had inclusion criteria were selected. The most studied was the Premature Infant Pain Profile (PIPP, The CRIES and the Neonatal Infant Pain Scale (NIPS. Infant pain assessment is not universally standardized. Practitioners may assess pain; however, they may not consistently use the same criteria to do so. The use of Neonatal Facial Coding System, the Neonatal Infant Pain Scale and the Premature Infant Pain Profile Can accurately show the amount of pain in newborns.

  19. Inpatients' attitudes towards the rationale use of drugs at a cardiology ward

    Directory of Open Access Journals (Sweden)

    Ugur Ugrak

    2015-04-01

    Full Text Available AIM: This descriptive survey purposed to evaluate inpatients' attitudes towards the rationale use of drugs at a cardiology ward in GATA. METHODS: Rational Drug Use Questionnaire designed by T.C. Health Ministry was performed. The patients hospitalized during the research period were tried to be reached and 121 inpatients completed the questionnaire. SPSS 15.0 program was used for data evaluation. Descriptive statistics were indicated with mean, standard deviation, frequency. Pearsons Chi-Square Test was used for comparison of groups. Statistical significance at p<0.05 was adopted. RESULTS: Mean age of patient surveyed was 29.3+/-16.4 year and 68.6% of the patients were male. It was seen that 49.6% of the patients reserved residual drugs of a treatment at home to reuse, 87.6% of the patients applied to a physician when drug side effect was seen. 42.1% of female and 36.2% of married participants were seen to use painkiller without prescription. Additionally, significant relationship was observed between attitude of using painkiller without prescription and gender, marital status. CONCLUSION: Our research participants' attitudes towards rational drug use found more positive than previous researches performed in Turkey. It is assessed this difference resulted from participant's high education level and participants' obligation to use drugs for long time because most of them had chronic or congenital heart disease. [TAF Prev Med Bull 2015; 14(2.000: 137-144

  20. Renormalization, conformal ward identities and the origin of a conformal anomaly pole

    Science.gov (United States)

    Corianò, Claudio; Maglio, Matteo Maria

    2018-06-01

    We investigate the emergence of a conformal anomaly pole in conformal field theories in the case of the TJJ correlator. We show how it comes to be generated in dimensional renormalization, using a basis of 13 form factors (the F-basis), where only one of them requires renormalization (F13), extending previous studies. We then combine recent results on the structure of the non-perturbative solutions of the conformal Ward identities (CWI's) for the TJJ in momentum space, expressed in terms of a minimal set of 4 form factors (A-basis), with the properties of the F-basis, and show how the singular behaviour of the corresponding form factors in both basis can be related. The result proves the centrality of such massless effective interactions induced by the anomaly, which have recently found realization in solid state, in the theory of topological insulators and of Weyl semimetals. This pattern is confirmed in massless abelian and nonabelian theories (QED and QCD) investigated at one-loop.

  1. QCD chiral Lagrangian on the lattice, strong coupling expansion, and Ward identities with Wilson fermions

    International Nuclear Information System (INIS)

    Levi, A.R.; Lubicz, V.; Rebbi, C.

    1997-01-01

    We discuss a general strategy to compute the coefficients of the QCD chiral Lagrangian using lattice QCD with Wilson fermions. This procedure requires the introduction of a lattice chiral Lagrangian as an intermediate step in the calculation. The QCD chiral Lagrangian is then obtained by expanding the lattice effective theory in increasing powers of the lattice spacing and the external momenta. In order to investigate the general structure of the lattice effective Lagrangian, we perform an analytical calculation at the leading order of the strong-coupling and large-N expansion. We find that the explicit chiral symmetry breaking, introduced on the lattice by the Wilson term, is reproduced in the effective theory by a set of additional terms, which do not have direct correspondence in the continuum chiral Lagrangian. We argue that these terms can be conveniently reabsorbed by a suitable renormalization procedure. This is shown explicitly at the leading order of the strong-coupling and large-N expansion. In fact, we find that at this order, as is known to be the case in the opposite weak-coupling limit, the vector and axial Ward identities of the continuum theory are reproduced on the lattice provided that the bare quark mass and the lattice operators are properly renormalized. copyright 1997 The American Physical Society

  2. Accuracy and safety of ward based pleural ultrasound in the Australian healthcare system.

    Science.gov (United States)

    Hammerschlag, Gary; Denton, Matthew; Wallbridge, Peter; Irving, Louis; Hew, Mark; Steinfort, Daniel

    2017-04-01

    Ultrasound has been shown to improve the accuracy and safety of pleural procedures. Studies to date have been performed in large, specialized units, where pleural procedures are performed by a small number of highly specialized physicians. There are no studies examining the safety and accuracy of ultrasound in the Australian healthcare system where procedures are performed by junior doctors with a high staff turnover. We performed a retrospective review of the ultrasound database in the Respiratory Department at the Royal Melbourne Hospital to determine accuracy and complications associated pleural procedures. A total of 357 ultrasounds were performed between October 2010 and June 2013. Accuracy of pleural procedures was 350 of 356 (98.3%). Aspiration of pleural fluid was successful in 121 of 126 (96%) of patients. Two (0.9%) patients required chest tube insertion for management of pneumothorax. There were no recorded pleural infections, haemorrhage or viscera puncture. Ward-based ultrasound for pleural procedures is safe and accurate when performed by appropriately trained and supported junior medical officers. Our findings support this model of pleural service care in the Australian healthcare system. © 2016 Asian Pacific Society of Respirology.

  3. Exploring the transition from\\ud staff nurse to\\ud ward sister/manager –\\ud An exploratory case study

    OpenAIRE

    Enterkin, Judith

    2016-01-01

    Background\\ud The ward sister/manager figure has traditionally been considered the ward based\\ud clinical leader. This role has evolved over time in response to professional and\\ud political demands; despite or because of this, reports of role ambiguity exist and\\ud the ward sister/manager position has become increasingly difficult to recruit to,\\ud with nurses arguably looking to roles perceived to have greater influence and\\ud status, but less onerous managerial responsibility. Understandin...

  4. Evaluation of the decision support system for antimicrobial treatment, TREAT, in an acute medical ward of a university hospital

    DEFF Research Database (Denmark)

    Arboe, Bente; Laub, Rasmus Rude; Kronborg, Gitte

    2014-01-01

    OBJECTIVES: TREAT, a decision support system for antimicrobial therapy, was implemented in an acute medical ward. METHODS: Patients admitted on suspicion of infection were included in the study. The evaluation of TREAT was done both retrospectively and prospectively. Coverage of empirical...... antimicrobial treatments was compared to recommendations from TREAT and the optimal use of local guidelines. RESULTS: Five hundred and eleven patients were included, of whom 162 had a microbiologically documented infection. In the retrospective part of the study, TREAT, physician, and guideline antimicrobial.......247). The coverage of TREAT advice for the bacteraemia patients was non-inferior to the physicians (p=1.00). CONCLUSIONS: TREAT can potentially improve the ecological costs of empirical antimicrobial therapy for patients in acute medical wards, but provided lower coverage than local guidelines....

  5. Perbandingan Kinerja Metode Ward Dan K-means Dalam Menentukan Cluster Data Mahasiswa Pemohon Beasiswa (Studi Kasus : STMIK Pringsewu)

    OpenAIRE

    Satria, Fiqih; Aziz, R Z Abdul

    2016-01-01

    This research aims to determine the steps cluster analysis method with Ward method and K-Means method, and compare the results of the analysis of the two methods for clustering student data related decision-making to determine the students are eligible to receive a Peningkatan PrestasiAkademik (PPA) scholarship and Bantuan Biaya Akademik (BBA) scholarship in STMIK Pringsewu. Cluster analysis was performed using IBM SPSS Version 23. Cluster Analysis results of both methods were compared using ...

  6. An ethnographic study exploring the role of ward-based Advanced Nurse Practitioners in an acute medical setting.

    Science.gov (United States)

    Williamson, Susan; Twelvetree, Timothy; Thompson, Jacqueline; Beaver, Kinta

    2012-07-01

    This article is a report of a study that aimed to examine the role of ward-based Advanced Nurse Practitioners and their impact on patient care and nursing practice. Revised doctor/nurse skill mix combined with a focus on improving quality of care while reducing costs has had an impact on healthcare delivery in the western world. Diverse advanced nursing practice roles have developed and their function has varied globally over the last decade. However, roles and expectations for ward-based Advanced Nurse Practitioners lack clarity, which may hinder effective contribution to practice. An ethnographic approach was used to explore the advanced nurse practitioner role. Participant observation and interviews of five ward-based Advanced Nurse Practitioners working in a large teaching hospital in the North West of England during 2009 were complemented by formal and informal interviews with staff and patients. Data were descriptive and broken down into themes, patterns and processes to enable interpretation and explanation. The overarching concept that ran through data analysis was that of Advanced Nurse Practitioners as a lynchpin, using their considerable expertise, networks and insider knowledge of health care not only to facilitate patient care but to develop a pivotal role facilitating nursing and medical practice. Sub-themes included enhancing communication and practice, acting as a role model, facilitating the patients' journey and pioneering the role. Ward-based Advanced Nurse Practitioners are pivotal and necessary for providing quality holistic patient care and their role can be defined as more than junior doctor substitutes. © 2012 Blackwell Publishing Ltd.

  7. [Nosocomial infection/colonization of the respiratory tract caused by Acinetobacter baumannii in an Internal Medicine ward].

    Science.gov (United States)

    Salas Coronas, J; Cabezas Fernández, T; Alvarez-Ossorio García de Soria, R; Rogado González, M C; Delgado Fernández, M; Díez García, F

    2002-10-01

    To present the epidemiology of the outbreak and the description of patients with infection or colonization of the respiratory tract caused by A. baumannii in an Internal Medicine ward. 20 consecutively patients hospitalized in the Internal Medicine ward were studied during 18 months with isolation of multiresistant A. baumanni in respiratory tract specimens with or without clinical signs of infection. Starting on an index case, that was a patient coming from other hospital with diagnosis of nosocomial Acinetobacter pneumonia, we detected 20 patients. The age of the patients ranged from 48 to 95 years, with a mean of 71.4 years. Eighty percent were males. The clinical features were similar: advanced age, with chronic diseases (35 percent diabetics, 45 percent with chronic lung diseases), and use of broad-spectrum antibiotics agents, fundamentally third generation cephalosporin (70 percent), clarithromycin (55 percent) and quinolones (30 percent). 75 percent of patients were in the same ward. Eight (40 percent) of the patients with chronic lung diseases were subjects with COPD, two with asthma and chronic glucocorticoids treatment, and one with a sleep apnea. In four cases the isolation was considered a colonization. The mean stay was 26.15 days, and the mortality 40 percent. The nosocomial infection caused by Acinetobacter baumannii is responsible of a high morbi-mortality between the patients hospitalized in an Internal Medicine ward, and produce an increase in length of stay. It is necessary a combination of control measures to prevent the transmission in the hospital and the outbreak of new multiresistant strains.

  8. Weekly screening supports terminating nosocomial transmissions of vancomycin-resistant enterococci on an oncologic ward – a retrospective analysis

    Directory of Open Access Journals (Sweden)

    Stefanie Kampmeier

    2017-05-01

    Full Text Available Abstract Background To investigate the impact of weekly screening within the bundle of infection control measures to terminate vancomycin-resistant enterococci (VRE transmissions on an oncologic ward. Methods A cluster of 12 VRE colonisation and five infections was detected on an oncologic ward between January and April 2015. Subsequently, the VRE point prevalence was detected and, as part of a the bundle of infection control strategies to terminate the VRE cluster, we isolated affected patients, performed hand hygiene training among staff on ward, increased observations by infection control specialists, intensified surface disinfection, used personal protective equipment and initiated an admission screening in May 2015. After a further nosocomial VRE infection in August 2015, a weekly screening strategy of all oncology patients on the respective ward was established while admission screening was continued. Whole genome sequencing (WGS-based typing was applied to determine the clonal relationship of isolated strains. Results Initially, 12 of 29 patients were VRE colonised; of these 10 were hospital-acquired. During May to August, on average 7 of 40 patients were detected to be VRE colonised per week during the admission screening, showing no significant decline compared to the initial situation. WGS-based typing revealed five different clusters of which three were due to vanB- and two vanA-positive enterococci. After an additional weekly screening was established, the number of colonised patients significantly declined to 1/53 and no further nosocomial cases were detected. Conclusions Weekly screening helped to differentiate between nosocomial and community-acquired VRE cases resulting in earlier infection control strategies on epidemic situations for a successful termination of nosocomial VRE transmissions.

  9. Restoration of supersymmetric Slavnov-Taylor and Ward identities in the presence of soft and spontaneous symmetry breaking

    International Nuclear Information System (INIS)

    Fischer, I.; Hollik, W.; Roth, M.; Stoeckinger, D.

    2004-01-01

    Supersymmetric Slavnov-Taylor and Ward identities are investigated in the presence of soft and spontaneous symmetry breaking. We consider an Abelian model where soft supersymmetry breaking yields a mass splitting between electron and selectron and triggers spontaneous symmetry breaking, and we derive the corresponding identities that relate the electron and selectron masses to the Yukawa coupling. We demonstrate that the identities are valid in dimensional reduction and invalid in dimensional regularization and compute the necessary symmetry-restoring counterterms

  10. Restoration of supersymmetric Slavnov-Taylor and Ward identities in presence of soft and spontaneous symmetry breaking

    International Nuclear Information System (INIS)

    Fischer, I.; Hollik, W.; Roth, M.; Stoeckinger, D.

    2003-12-01

    Supersymmetric Slavnov-Taylor and Ward identities are investigated in presence of soft and spontaneous symmetry breaking. We consider an abelian model where soft supersymmetry breaking yields a mass splitting between electron and selectron and triggers spontaneous symmetry breaking, and we derive corresponding identities that relate the electron and selectron masses with the Yukawa coupling. We demonstrate that the identities are valid in dimensional reduction and invalid in dimensional regularization and compute the necessary symmetry-restoring counterterms. (orig.)

  11. Confidential conversations between supervisor and employee as a means for improving leadership: a quasi-experimental study in hospital wards.

    Science.gov (United States)

    Kivimäki, M

    1996-11-01

    Although yearly confidential conversations between a supervisor and an employee have been recommended as a means for improving leadership, evidence on the actual effects of these conversations has been lacking. The present study therefore investigated whether confidential conversations improve perceptions of goal clarity, sufficiency of feedback and innovativeness, and elicit satisfaction with the supervisor's leadership style within the hospital setting. Nine wards were divided into one experimental group (3 wards) and two control groups (3 + 3 wards). A questionnaire on goal clarity, feedback, innovativeness and satisfaction was administered twice to every group (1st measurement: r = 186, 2nd measurement: n = 163). The experimental group began confidential conversations after the first measurement, control group 1 entered into conversations during both measurements, and control group 2 did not enter into conversations at the time of either measurement. Confidential conversations improved perceived feedback. In both measurements, the sufficiency of feedback was reported to be significantly better in the groups having conversations than in the other groups. In addition, there was a significant positive change in the perceived sufficiency of feedback in the experimental group but not in the other groups. Confidential conversations did not affect the perceptions of goal clarity and innovativeness or elicit satisfaction with the supervisor's management style.

  12. A Systematic Review of Early Warning Systems' Effects on Nurses' Clinical Performance and Adverse Events Among Deteriorating Ward Patients.

    Science.gov (United States)

    Lee, Ju-Ry; Kim, Eun-Mi; Kim, Sun-Aee; Oh, Eui Geum

    2018-04-25

    Early warning systems (EWSs) are an integral part of processes that aim to improve the early identification and management of deteriorating patients in general wards. However, the widespread implementation of these systems has not generated robust data regarding nurses' clinical performance and patients' adverse events. This review aimed to determine the ability of EWSs to improve nurses' clinical performance and prevent adverse events among deteriorating ward patients. The PubMed, CINAHL, EMBASE, and Cochrane Library databases were searched for relevant publications (January 1, 1997, to April 12, 2017). In addition, a grey literature search evaluated several guideline Web sites. The main outcome measures were nurses' clinical performance (vital sign monitoring and rapid response team notification) and patients' adverse events (in-hospital mortality, cardiac arrest, and unplanned intensive care unit [ICU] admission). The search identified 888 reports, although only five studies fulfilled the inclusion criteria. The findings of these studies revealed that EWSs implementation had a positive effect on nurses' clinical performance, based on their frequency of documenting vital signs that were related to the patient's clinical deterioration. In addition, postimplementation reductions were identified for cardiac arrest, unplanned ICU admission, and unexpected death. It seems that EWSs can improve nurses' clinical performance and prevent adverse events (e.g., in-hospital mortality, unplanned ICU admission, and cardiac arrest) among deteriorating ward patients. However, additional high-quality evidence is needed to more comprehensively evaluate the effects of EWSs on these outcomes.

  13. Surgical face masks worn by patients with multidrug-resistant tuberculosis: impact on infectivity of air on a hospital ward.

    Science.gov (United States)

    Dharmadhikari, Ashwin S; Mphahlele, Matsie; Stoltz, Anton; Venter, Kobus; Mathebula, Rirhandzu; Masotla, Thabiso; Lubbe, Willem; Pagano, Marcello; First, Melvin; Jensen, Paul A; van der Walt, Martie; Nardell, Edward A

    2012-05-15

    Drug-resistant tuberculosis transmission in hospitals threatens staff and patient health. Surgical face masks used by patients with tuberculosis (TB) are believed to reduce transmission but have not been rigorously tested. We sought to quantify the efficacy of surgical face masks when worn by patients with multidrug-resistant TB (MDR-TB). Over 3 months, 17 patients with pulmonary MDR-TB occupied an MDR-TB ward in South Africa and wore face masks on alternate days. Ward air was exhausted to two identical chambers, each housing 90 pathogen-free guinea pigs that breathed ward air either when patients wore surgical face masks (intervention group) or when patients did not wear masks (control group). Efficacy was based on differences in guinea pig infections in each chamber. Sixty-nine of 90 control guinea pigs (76.6%; 95% confidence interval [CI], 68-85%) became infected, compared with 36 of 90 intervention guinea pigs (40%; 95% CI, 31-51%), representing a 56% (95% CI, 33-70.5%) decreased risk of TB transmission when patients used masks. Surgical face masks on patients with MDR-TB significantly reduced transmission and offer an adjunct measure for reducing TB transmission from infectious patients.

  14. Smallholder farmers' attitudes toward the provision of drinking water for dairy cows in Kagera, Tanzania.

    Science.gov (United States)

    Forbes, Barbara; Kepe, Thembela

    2015-02-01

    Agriculture's large share of Tanzanian GDP and the large percentage of rural poor engaged in the sector make it a focus for many development projects that see it as an area of attention for reducing rural poverty. This paper uses a case of the Kamachumu community, where a dairy cow loan project was implemented using the heifer-in-trust (HIT) model. This study finds that productivity is limited by how the cows are being managed, particularly with many animals not having ad lib access to drinking water. The paper explores reasons why farmers do or do not provide their cows with unlimited access to drinking water. The study concludes that there are many barriers farmers face, including water accessibility, education and training, infrastructure, simple negligence, and security. These results suggest an increase in extension services and national and local livestock policies that consider the specific realities of small-scale dairy farmers.

  15. The neglected role of distress in pain management: qualitative research on a gastrointestinal ward.

    Science.gov (United States)

    Drake, Gareth; Williams, Amanda C de C

    2018-05-09

    Pain management for hospital inpatients remains suboptimal. Previously identified barriers to optimal pain management include staff communication difficulties, confusion around pain management roles and a lack of suitable resources for clinical staff. The emotional, relational and contextual complexities of gastrointestinal (GI) pain create particular challenges for frontline clinical staff attempting to implement a biopsychosocial approach to its management. The current study took place over 2 years, comprised an ethnographic and a feedback phase, and aimed to examine pain management processes with clinical staff in order to generate hypotheses and initiatives for improvement. This paper focuses on two overarching themes identified in the ethnographic phase of the study, centred on the neglected role of both staff and patient distress in GI pain management. Grounded theory and thematic analysis methods were used as part of action research, which involves collaborative working with clinical staff. The study took place on a 60 bed GI ward in a university hospital in London. Participants were clinical staff who were either ward-based or involved in the care of particular patients. This latter group included doctors, nurses, psychologists and physiotherapists from the Acute and Complex Pain Teams. Qualitative data on pain management processes was gathered from staff interviews, consultation groups, and observations of patient-staff interactions. Recruitment was purposive and collaborative in that early participants suggested targets and staff groups for subsequent enquiry. Following the identification of initial ethnographic themes, further analysis and the use of existing literature led to the identification of two overarching pain management processes. As such the results are divided into three sections: (i) illustration of initial ethnographic themes, (ii) summary of relevant theory used, (iii) exploration of hypothesised overarching processes. Initially, two

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

    Science.gov (United States)

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

    2015-01-01

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

  17. Narcissism in patients admitted to psychiatric acute wards: its relation to violence, suicidality and other psychopathology

    Science.gov (United States)

    Svindseth, Marit F; Nøttestad, Jim Aage; Wallin, Juliska; Roaldset, John Olav; Dahl, Alv A

    2008-01-01

    Background The objective was to examine various aspects of narcissism in patients admitted to acute psychiatric wards and to compare their level of narcissism to that of an age- and gender-matched sample from the general population (NORM). Methods This cross-sectional study interviewed 186 eligible acute psychiatric patients with the Brief Psychiatric Rating Scale (BPRS) and the Global Assessment of Functioning (GAF). The patients filled in the Narcissistic Personality Inventory-21 item version (NPI-21), The Hospital Anxiety and Depression Scale (HADS) and the Rosenberg Self-Esteem Scale. High and low narcissism was defined by the median of the total NPI-21 score. An age- and gender-matched control sample from the general population also scored the NPI-21 (NORM). Results Being male, involuntary admitted, having diagnosis of schizophrenia, higher self-esteem, and severe violence were significantly associated with high narcissism, and so were also low levels of suicidality, depression, anxiety and GAF scores. Severe violence and high self-esteem were significantly associated with high narcissism in multivariable analyses. The NPI-21 and its subscales showed test-retest correlations ≥0.83, while the BPRS and the HADS showed lower correlations, confirming the trait character of the NPI-21. Depression and suicidality were negatively associated with the NPI-21 total score and all its subscales, while positive association was observed with grandiosity. No significant differences were observed between patients and NORM on the NPI-21 total score or any of the NPI subscales. Conclusion Narcissism in the psychiatric patients was significantly associated with violence, suicidality and other symptoms relevant for management and treatment planning. Due to its trait character, use of the NPI-21 in acute psychiatric patients can give important clinical information. The similar level of narcissism found in patients and NORM is in need of further examination. PMID:18304339

  18. N=1 supersymmetry and super quantum electrodynamic in Atiyah-Ward space-time

    International Nuclear Information System (INIS)

    Andrade, M.A. de; Cima, O.M. Del; Magalhaes, M.N.P.

    1994-12-01

    The supersymmetric gauge invariant action for the massive Abelian N=1 super-QED 2+2 in the Atiyah-Ward space-time (D=2+2) is formulated. The questions concerning the scheme of the gauge invariance in D=2+2 by means of gauging the massive N=1 super-QED 2+2 are investigated. It is studied how to ensure the gauge invariance at the expenses of the introduction of a complex vector superfield. It is discussed the Wess-Zumino gauge and thereupon we conclude that in this gauge, only the imaginary part of the complex vector field, B μ , gauges a U(1)-symmetry, whereas its real part gauges a Weyl symmetry. It is build up the gauge invariant massive term by introducing four scalar superfields: a pair of chiral and a pair of anti-chiral superfields; the supermultiplets of each pair have opposite U (1)-changes. It is carried out a dimensional reduction a la Scherk of the massive N=1 super-QED 2+2 action from D=2+2 to D=1+2. Truncations are needed in order to suppress unphysical modes and one ends up with a parity-preserving N=1 super QED 1+2 (rather than N=2) in D=1+2 which spectrum is free from tachyons and ghosts at tree-level. Finally it is show that the N=1 super-QED 1+2 obtained is the supersymmetry version of the φ3 QED. (author). 27 refs

  19. [Community coordination of dental care needs in a home medical care support ward and at home].

    Science.gov (United States)

    Sumi, Yasunori; Ozawa, Nobuyoshi; Miura, Hiroko; Miura, Hisayuki; Toba, Kenji

    2011-01-01

    The purpose of this study was to ascertain the current statuses and problems of dental home care patients by surveying the oral care status and needs of patients in the home medical care support ward at the National Center for Geriatrics and Gerontology. Patients that required continuous oral management even after discharge from the hospital were referred to local dental clinics to receive home dental care. We investigated the suitability and problems associated with such care, and identified the dental care needs of home patients and the status of local care coordination, including those in hospitals. The subjects were 82 patients. We ascertained their general condition and oral status, and also investigated the problems associated with patients judged to need specialized oral care by a dentist during oral treatment. Patients who required continuous specialized oral care after discharge from hospital were referred to dental clinics that could provide regular care, and the problems at the time of referral were identified. Dry mouth was reported by many patients. A large number of patients also needed specialized dental treatment such as the removal of dental calculus or tooth extraction. Problems were seen in oral function, with 38 of the patients (46%) unable to gargle and 23 (28%) unable to hold their mouths open. About half of the patients also had dementia, and communication with these patients was difficult. Of the 43 patients who were judged to need continuing oral care after discharge from hospital, their referral to a dental clinic for regular care was successful for 22 (51%) patients and unsuccessful for 21 (49%) patients. The reasons for unsuccessful referrals included the fact that the family, patient, nurse, or caregiver did not understand the need for specialized oral care. The present results suggest the need for specialized oral treatment in home medical care. These findings also suggest that coordinating seamless dental care among primary physicians

  20. Analysis of Clostridium difficile infections in patients hospitalized at the nephrological ward in Poland

    Directory of Open Access Journals (Sweden)

    Agata Kujawa-Szewieczek

    2016-05-01

    Full Text Available Background: Few studies have evaluated the incidence and risk factors of Clostridium difficile infection (CDI in the adult Polish population, in particular in solid organ recipients hospitalized at the nephrological ward.Aim: The aim of this study was to analyze Clostridium difficile infections (CDI among patients hospitalized in the Department of Nephrology, Transplantation and Internal Medicine, Medical University of Silesia in Katowice.Material/Methods: Thirty-seven patients with Clostridium difficile infection diagnosed between October 2011 and November 2013 (26 months, identified among a total of 3728 patients hospitalized in this department during this period, were included in this retrospective, single-center study. The CDI definition was based on the current recommendations of the European Society of Clinical Microbiology and Infectious Diseases.Results: The observation period was divided into two 13-month intervals. Increased incidence (of borderline significance of CDI in the second period compared to the first period was observed (1.33% vs 0.65% respectively; p=0.057. Patients after kidney (n=11, kidney and pancreas (n=2 and liver (n=5 transplantation represented 48% of the analyzed CDI patients, and in half of these patients (50% CDI symptoms occurred within the first 3 months after transplantation. Clostridium difficile infection leads to irreversible deterioration of graft function in 38% of kidney recipients. Most incidents of CDI (70% were identified as nosocomial infection.Conclusions: 1. Clostridium difficile infection is particularly common among patients in the early period after solid organ transplantation. 2. Clostridium difficile infection may lead to irreversible deterioration of transplanted kidney function.

  1. N=1 supersymmetry and super quantum electrodynamic in Atiyah-Ward space-time

    Energy Technology Data Exchange (ETDEWEB)

    Andrade, M.A. de; Cima, O.M. Del; Magalhaes, M.N.P.

    1994-12-01

    The supersymmetric gauge invariant action for the massive Abelian N=1 super-QED{sub 2+2} in the Atiyah-Ward space-time (D=2+2) is formulated. The questions concerning the scheme of the gauge invariance in D=2+2 by means of gauging the massive N=1 super-QED{sub 2+2} are investigated. It is studied how to ensure the gauge invariance at the expenses of the introduction of a complex vector superfield. It is discussed the Wess-Zumino gauge and thereupon we conclude that in this gauge, only the imaginary part of the complex vector field, B{sub {mu}}, gauges a U(1)-symmetry, whereas its real part gauges a Weyl symmetry. It is build up the gauge invariant massive term by introducing four scalar superfields: a pair of chiral and a pair of anti-chiral superfields; the supermultiplets of each pair have opposite U (1)-changes. It is carried out a dimensional reduction a la Scherk of the massive N=1 super-QED{sub 2+2} action from D=2+2 to D=1+2. Truncations are needed in order to suppress unphysical modes and one ends up with a parity-preserving N=1 super QED{sub 1+2} (rather than N=2) in D=1+2 which spectrum is free from tachyons and ghosts at tree-level. Finally it is show that the N=1 super-QED{sub 1+2} obtained is the supersymmetry version of the {sub {phi}3} QED. (author). 27 refs.

  2. Improving the frequency of visual infusion phlebitis (VIP) scoring on an oncology ward

    Science.gov (United States)

    Tzolos, Evangelos; Salawu, Abdulazeez

    2014-01-01

    Phlebitis from peripheral intravenous infusions is an important potential source of oncology patient morbidity. Important factors found to determine phlebitis incidence include the kind of infusion and dwell time of intravenous cannula. Early studies showed incidence rates of between 25–70% worldwide, and association with up to 10% of S. aureus bacteraemia. The introduction of the visual infusion phlebitis (VIP) score tool for assessment of the early signs of phlebitis, along with prompt removal of peripheral intravenous cannulas, has been very successful in reducing the incidence below the acceptable rate of 5%. However, achieving this goal depends on strict compliance with guidelines for cannula insertion, documentation, and assessment using the VIP tool. This study aimed to increase the use of VIP scoring tool to 100% on an oncology ward during a four to six month period in order to maximise its utility in phlebitis prevention. Three plan-do-study-act (PDSA) cycles were carried out, during which two major interventions were introduced. The first cycle aimed to improve junior doctors’ awareness of VIP scoring using presentations in induction meetings and posters. The second cycle ensured that ready access to the VIP tool was provided in the form of bedside intentional rounding charts. Proportions of intravenous cannulas with proper documentation and VIP assessment were measured before intervention and at nine subsequent bi-weekly time points. Pre-intervention, under 30% of cannulas were properly documented and assessed. This proportion rose to around 80% by the end of the second PDSA cycle and achieved 100% by the end of the third cycle. PMID:26734282

  3. Feasibility of implementing a practice guideline for fall prevention on geriatric wards: a multicentre study.

    Science.gov (United States)

    Milisen, Koen; Coussement, Joke; Arnout, Hanne; Vanlerberghe, Virginie; De Paepe, Leen; Schoevaerdts, Didier; Lambert, Margareta; Van Den Noortgate, Nele; Delbaere, Kim; Boonen, Steven; Dejaeger, Eddy

    2013-04-01

    About 40% of all adverse events in hospital are falls, but only about one in three Belgian hospitals have a fall prevention policy in place. The implementation of a national practice guideline is urgently needed. This multicentre study aimed to determine the feasibility of a previously developed guideline. SETTING, PARTICIPANTS AND METHOD: Seventeen geriatric wards, selected at random out of 40 Belgian hospitals who agreed to take part in the study, evaluated the fall prevention guideline. After the one-month test period, 49 healthcare workers completed a questionnaire on the feasibility of the guideline. At the end of the study, 512 geriatric patients had been assessed using the practice guideline. The average time spent per patient on case finding, multifactorial assessment and initiating a treatment plan was 5.1, 76.1 and 30.6 min, respectively. For most risk assessments and risk modifications, several disciplines considered themselves as being responsible and capable. The majority (more than 69%) of the respondents judged the practice guideline as useful, but only a small majority (62.3%) believed that the guideline could be successfully integrated into their daily practice over a longer period of time. Barriers for implementation included a large time investment (81.1%), lack of communication between the different disciplines (35.8%), lack of motivation of the patient (34.0%), lack of multidisciplinary teamwork (28.3%), and lack of interest from the hospital management (15.4%). Overall, the guideline was found useful, and for each risk factor (except for visual impairment), at least one discipline felt responsible and capable. Towards future implementation of the guideline, following steps should be considered: division of the risk-factor assessment duties and interventions among different healthcare workers; patient education; appointment of a fall prevention coordinator; development of a fall prevention policy with support from the management of the hospital

  4. Narcissism in patients admitted to psychiatric acute wards: its relation to violence, suicidality and other psychopathology

    Directory of Open Access Journals (Sweden)

    Wallin Juliska

    2008-02-01

    Full Text Available Abstract Background The objective was to examine various aspects of narcissism in patients admitted to acute psychiatric wards and to compare their level of narcissism to that of an age- and gender-matched sample from the general population (NORM. Methods This cross-sectional study interviewed 186 eligible acute psychiatric patients with the Brief Psychiatric Rating Scale (BPRS and the Global Assessment of Functioning (GAF. The patients filled in the Narcissistic Personality Inventory-21 item version (NPI-21, The Hospital Anxiety and Depression Scale (HADS and the Rosenberg Self-Esteem Scale. High and low narcissism was defined by the median of the total NPI-21 score. An age- and gender-matched control sample from the general population also scored the NPI-21 (NORM. Results Being male, involuntary admitted, having diagnosis of schizophrenia, higher self-esteem, and severe violence were significantly associated with high narcissism, and so were also low levels of suicidality, depression, anxiety and GAF scores. Severe violence and high self-esteem were significantly associated with high narcissism in multivariable analyses. The NPI-21 and its subscales showed test-retest correlations ≥0.83, while the BPRS and the HADS showed lower correlations, confirming the trait character of the NPI-21. Depression and suicidality were negatively associated with the NPI-21 total score and all its subscales, while positive association was observed with grandiosity. No significant differences were observed between patients and NORM on the NPI-21 total score or any of the NPI subscales. Conclusion Narcissism in the psychiatric patients was significantly associated with violence, suicidality and other symptoms relevant for management and treatment planning. Due to its trait character, use of the NPI-21 in acute psychiatric patients can give important clinical information. The similar level of narcissism found in patients and NORM is in need of further examination.

  5. Factors Predicting Recovery of Oral Intake in Stroke Survivors with Dysphagia in a Convalescent Rehabilitation Ward.

    Science.gov (United States)

    Ikenaga, Yasunori; Nakayama, Sayaka; Taniguchi, Hiroki; Ohori, Isao; Komatsu, Nahoko; Nishimura, Hitoshi; Katsuki, Yasuo

    2017-05-01

    Percutaneous endoscopic gastrostomy may be performed in dysphagic stroke patients. However, some patients regain complete oral intake without gastrostomy. This study aimed to investigate the predictive factors of intake, thereby determining gastrostomy indications. Stroke survivors admitted to our convalescent rehabilitation ward who underwent gastrostomy or nasogastric tube placement from 2009 to 2015 were divided into 2 groups based on intake status at discharge. Demographic data and Functional Independence Measure (FIM), Dysphagia Severity Scale (DSS), National Institutes of Health Stroke Scale, and Glasgow Coma Scale (GCS) scores on admission were compared between groups. We evaluated the factors predicting intake using a stepwise logistic regression analysis. Thirty-four patients recovered intake, whereas 38 achieved incomplete intake. Mean age was lower, mean body mass index (BMI) was higher, and mean time from stroke onset to admission was shorter in the complete intake group. The complete intake group had less impairment in terms of GCS, FIM, and DSS scores. In the stepwise logistic regression analysis, BMI, FIM-cognitive score, and DSS score were significant independent factors predicting intake. The formula of BMI × .26 + FIM cognitive score × .19 + DSS score × 1.60 predicted recovery of complete intake with a sensitivity of 88.2% and a specificity of 84.2%. Stroke survivors with dysphagia with a high BMI and FIM-cognitive and DSS scores tended to recover oral intake. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

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

    Science.gov (United States)

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

    2015-11-01

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

  7. A work-based learning approach for clinical support workers on mental health inpatient wards.

    Science.gov (United States)

    Kemp, Philip; Gilding, Moorene; Seewooruttun, Khooseal; Walsh, Hannah

    2016-09-14

    Background With a rise in the number of unqualified staff providing health and social care, and reports raising concerns about the quality of care provided, there is a need to address the learning needs of clinical support workers. This article describes a qualitative evaluation of a service improvement project that involved a work-based learning approach for clinical support workers on mental health inpatient wards. Aim To investigate and identify insights in relation to the content and process of learning using a work-based learning approach for clinical support workers. Method This was a qualitative evaluation of a service improvement project involving 25 clinical support workers at the seven mental health inpatient units in South London and Maudsley NHS Foundation Trust. Three clinical skills tutors were appointed to develop, implement and evaluate the work-based learning approach. Four sources of data were used to evaluate this approach, including reflective journals, qualitative responses to questionnaires, three focus groups involving the clinical support workers and a group interview involving the clinical skills tutors. Data were analysed using thematic analysis. Findings The work-based learning approach was highly valued by the clinical support workers and enhanced learning in practice. Face-to-face learning in practice helped the clinical support workers to develop practice skills and reflective learning skills. Insights relating to the role of clinical support workers were also identified, including the benefits of face-to-face supervision in practice, particularly in relation to the interpersonal aspects of care. Conclusion A work-based learning approach has the potential to enhance care delivery by meeting the learning needs of clinical support workers and enabling them to apply learning to practice. Care providers should consider how the work-based learning approach can be used on a systematic, organisation-wide basis in the context of budgetary

  8. Spatial distribution of infection risk of SARS transmission in a hospital ward

    Energy Technology Data Exchange (ETDEWEB)

    Qian, Hua; Li, Yuguo [School of Energy and Environment, Southeast University, Nanjing, JiangSu (China); Nielsen, Peter V. [Department of Civil Engineering, Aalborg University, DK-9000 Aalborg (Denmark); Huang, Xinhua [Institute of Refrigeration and Cryogenics Engineering, Shanghai Jiaotong University, Shanghai (China)

    2009-08-15

    The classical Wells-Riley model for predicting risk of airborne transmission of diseases assumes a uniform spatial distribution of the infected cases in an enclosed space. A new mathematical model is developed here for predicting the spatial distribution of infection risk of airborne transmitted diseases by integrating the Wells-Riley equation into computational fluid dynamics. We applied our new integrated model to analyze a large nosocomial SARS outbreak in Hong Kong during the 2003 SARS epidemics, which was studied in the literature with regard to the association between airflow and SARS infection. The predicted numbers of infected cases of medical students in the same cubicle, the adjacent cubicle and the distant cubicle were 6.39, 0.78 and 0.2 respectively while the observed numbers of infected medical students in the three cubicles were 7, 0 and 0 respectively during the morning of March 6th, which was the highest attack period. The predicted numbers of infected cases of inpatients during the morning of March 6th in the same cubicle, the adjacent cubic and the distance cubicle were 7.8, 5.1, and 4.8 respectively which also agree well with the observed distribution of the infected inpatients during the entire infection period. The new developed model provides a new modelling tool for investigating the airborne transmission of diseases in enclosed spaces. The model is applicable when the susceptible stays mostly at the same location in an enclosed space during the infectious period, such as inpatients in a hospital ward, passengers in an airplane etc. (author)

  9. End-of-life care in the general wards of a Singaporean hospital: an Asian perspective.

    Science.gov (United States)

    Phua, Jason; Kee, Adrian Chin-Leong; Tan, Adeline; Mukhopadhyay, Amartya; See, Kay Choong; Aung, Ngu Wah; Seah, Angeline S T; Lim, Tow Keang

    2011-12-01

    Despite international differences in cultural perspectives on end-of-life issues, little is known of the care for the dying in the general wards of acute hospitals in Asia. We performed a retrospective medical chart review of all 683 adult patients who died without intensive care unit (ICU) admission in our Singaporean hospital in 2007. We first evaluated the prevalence of do-not-resuscitate (DNR) orders and orders for or against life-sustaining therapies; second, if such orders were discussed with the patients and/or family members; and third, the actual treatments provided before death. There were DNR orders for 66.2% of patients and neither commitment for DNR nor cardiopulmonary resuscitation (CPR) for 28.1%. Orders to limit life-sustaining therapies, including ICU admission, intubation, and vasopressors/inotropes were infrequent. Only 6.2% of the alert and conversant patients with DNR orders were involved in discussions on these orders. In contrast, such discussions with their family members occurred 82.9% of the time. Interventions in the last 24 hours of life included CPR (9.4%), intubation (6.4%), vasopressors/inotropes (14.8%), tube feeding (24.7%), and antibiotics (44.9%). Analgesia was provided in 29.1% of patients. There was a lack of commitment by doctors on orders for DNR/CPR and to limit life-sustaining therapies, infrequent discussions with patients on end-of-life decisions, and excessive burdensome interventions with inadequate palliative care for the dying. These findings may reflect certain Asian cultural biases. More work is required to improve our quality of end-of-life care.

  10. A Study about The Quality of Nursing Services a Hospitals’ Ward, Mojokerto

    Directory of Open Access Journals (Sweden)

    Abdul Muhith

    2016-09-01

    Full Text Available Introduction: Nowadays, the trend of hospital visits in Mojokerto is declining. It can caused by man (nurses, such as the quality of nursing services hasn’t been conducted optimally. This study was aimed to analyze the quality of nursing services at hospitals’ ward at Mojokerto. Method: This was explanatory research with survey method and cross sectional approach. The population were nurses and patients who undergo hospitalization minimally in three days at RSU. Dr. Wahidin Sudiro Husodo and RS Reksa Waluyo Mojokerto. The data were collected by using questionnaire, and then will be analyzed by using regression statistical test. Result: 1 There was positive significance influence of nurses capability, hospital’s ethic, and leadership to the commitment of nurses; 2 There was significant influence of capability work (identification, significance, autonomy, and feedback to the improvement of nursing services quality; 3 There was significant influence of hospital’s ethics (communication, relatedness with industry, compulsion, and specification to the improvement of nursing services quality; 4 There was significant influence of leadership (challenger risk, socialization in vision and mission, supporter, guiding, and supporting to the improvement of nursing services quality; 5 There was significant influence of nurses’ commitment (sense of belonging, sense of linking, believable leader, and suitability of value to the improvement of nursing services quality. Discussion: It can be concluded that in order to improve the quality of nursing service, management of RSU Dr. Wahidin Sudiro Husodo and RS Rekso Waluyo Mojokerto should improve the ability of nurses, the enforcement of hospital ethics to all employees without exception, and develop hospital ethics that can represent various stakeholder interests, as well as maintain and improve leadership issue. Keywords: nurses, quality, services (tangibility, reliability, responsiveness, assurance

  11. The Effect on mortality of fluconazole or echinocandins treatment in candidemia in internal medicine wards [corrected].

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    Francesco G De Rosa

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

  12. Characterization of colonizing Staphylococcus aureus isolated from surgical wards' patients in a Nigerian university hospital.

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    Deboye O Kolawole

    Full Text Available In contrast to developed countries, only limited data on the prevalence, resistance and clonal structure of Staphylococcus aureus are available for African countries. Since S. aureus carriage is a risk factor for postoperative wound infection, patients who had been hospitalized in surgical wards in a Nigerian University Teaching Hospital were screened for S. aureus carriage. All S. aureus isolates were genotyped (spa, agr and assigned to multilocus sequence types (MLST. Species affiliation, methicillin-resistance, and the possession of pyrogenic toxin superantigens (PTSAg, exfoliative toxins (ETs and Panton-Valentine Leukocidin (PVL were analyzed. Of 192 patients screened, the S. aureus carrier rate was 31.8 % (n = 61. Of these isolates, 7 (11.5% were methicillin-resistant (MRSA. The isolates comprised 24 spa types. The most frequent spa types were t064, t084, t311, and t1931, while the most prevalent MLST clonal complexes were CC5 and CC15. The most frequent PTSAg genes detected were seg/sei (41.0% followed by seb (29.5%, sea (19.7%, seh (14.7% and sec (11.5. The difference between the possession of classical and newly described PTSAg genes was not significant (63.9% versus 59.0% respectively; P = 0.602. PVL encoding genes were found in 39.3% isolates. All MRSA isolates were PVL negative, SCCmec types I and VI in MLST CC 5 and CC 30, respectively. Typing of the accessory gene regulator (agr showed the following distribution: agr group 1 (n = 20, group II (n = 17, group III (n = 14 and group IV (n = 10. Compared to European data, enterotoxin gene seb and PVL-encoding genes were more prevalent in Nigerian methicillin-susceptible S. aureus isolates, which may therefore act as potential reservoir for PVL and PTSAg genes.

  13. Yang-Mills theories in axial and light-cone gauges, analytic regularization and Ward identities

    International Nuclear Information System (INIS)

    Lee, H.C.

    1984-12-01

    The application of the principles of generalization and analytic continuation to the regularization of divergent Feynman integrals is discussed. The technique, or analytic regularization, which is a generalization of dimensional regularization, is used to derive analytic representations for two classes of massless two-point integrals. The first class is based on the principal-value prescription and includes integrals encountered in quantum field theories in the ghost-free axial gauge (n.A=0), reducing in a special case to integrals in the light-cone gauge (n.A=0,n 2 =0). The second class is based on the Mandelstam prescription devised espcially for the light-cone gauge. For some light-cone gauge integrals the two representations are not equivalent. Both classes include as a subclass integrals in the Lorentz covariant 'zeta-gauges'. The representations are used to compute one-loop corrections to the self-energy and the three-vertex in Yang-Mills theories in the axial and light-cone gauges, showing that the two- and three-point Ward identities are satisfied; to illustrate that ultraviolet and infrared singularities, indistinguishable in dimensional regularization, can be separated analytically; and to show that certain tadpole integrals vanish because of an exact cancellation between ultraviolet and infrared singularities. In the axial gauge, the wavefunction and vertex renormalization constants, Z 3 and Z 1 , are identical, so that the β-function can be directly derived from Z 3 the result being the same as that computed in the covariant zeta-gauges. Preliminary results suggest that the light-cone gauge in the Mandelstam prescription, but not in the principal value prescription, has the same renormalization property of the axial gauge

  14. Development of the Huddle Observation Tool for structured case management discussions to improve situation awareness on inpatient clinical wards.

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    Edbrooke-Childs, Julian; Hayes, Jacqueline; Sharples, Evelyn; Gondek, Dawid; Stapley, Emily; Sevdalis, Nick; Lachman, Peter; Deighton, Jessica

    2018-05-01

    'Situation Awareness For Everyone' (SAFE) was a 3-year project which aimed to improve situation awareness in clinical teams in order to detect potential deterioration and other potential risks to children on hospital wards. The key intervention was the 'huddle', a structured case management discussion which is central to facilitating situation awareness. This study aimed to develop an observational assessment tool to assess the team processes occurring during huddles, including the effectiveness of the huddle. A cross-sectional observational design was used to psychometrically develop the 'Huddle Observation Tool' (HOT) over three phases using standardised psychometric methodology. Huddles were observed across four NHS paediatric wards participating in SAFE by five researchers; two wards within specialist children hospitals and two within district general hospitals, with location, number of beds and length of stay considered to make the sample as heterogeneous as possible. Inter-rater reliability was calculated using the weighted kappa and intraclass correlation coefficient. Inter - rater reliability was acceptable for the collaborative culture (weighted kappa=0.32, 95% CI 0.17 to 0.42), environment items (weighted kappa=0.78, 95% CI 0.52 to 1) and total score (intraclass correlation coefficient=0.87, 95% CI 0.68 to 0.95). It was lower for the structure and risk management items, suggesting that these were more variable in how observers rated them. However, agreement on the global score for huddles was acceptable. We developed an observational assessment tool to assess the team processes occurring during huddles, including the effectiveness of the huddle. Future research should examine whether observational evaluations of huddles are associated with other indicators of safety on clinical wards (eg, safety climate and incidents of patient harm), and whether scores on the HOT are associated with improved situation awareness and reductions in deterioration and adverse

  15. Investigation of type and density of bio-aerosols in air samples from educational hospital wards of Kerman city, 2014

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    Mohammad Malakootian

    2016-10-01

    Full Text Available Background: Bio-aerosols in the air of hospital wards have an important role in the development of infections. It is important to make quantitative and qualitative estimations of microorganisms in the air of these wards as an index for environmental hygiene applicable to different hospital wards. The aim of the study was to investigate degrees of diversity and density of bio-aerosols in the education hospitals of Kerman city. Methods: This study applied a descriptive-cross-sectional methodology in the second half of 2014 in the education hospitals of Kerman city, with bed capacity of over 300. As many as 200 samples were collected from the air in different wards of each hospital using the standard method of the National Occupational Health and Safety Institute. Following collection, samples were placed in an incubator for 48 hours and then bio-aerosol detections were made for and resulting data reported as colonies/m3. Results: Results indicated that maximum and minimum degrees of bacterial density were observed in operation rooms and in the intensive care unit (ICU of Shafa hospital. Furthermore, comparison showedthat the operating room at Afzalipour hospital had the lowest level of fungal contamination, while ICU at Bahonar hospital had the highest level of fungal contamination. The emitted fungi of Aspergillus and Penicillium along with the bacteria, staphylococci and Acinetobacter had greater frequencies. The means of bacterial density and fungal density were not equal across the studied hospitals and significant statistical, difference was observed between means of bacterial and fungal density (P ≤ 0.001. Conclusion: Amounts of bacterial and fungal density were greater than those proposed in the American Industrial Health State Conference in 73.3% of the wards in the educational hospitals of Kerman city sampled in this study. Therefore it is suggested that implementation of some, necessary measures for continuous monitoring, promotion of

  16. Differences in antimicrobial consumption, prescribing and isolation rate of multidrug resistant Klebsiella pneumoniae, Pseudomonas aeruginosa and Acinetobacter baumannii on surgical and medical wards.

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    Vladimir Zivanovic

    Full Text Available In order to provide guidance data for clinically rational use of an antibiotics consuption, prescribing and prevalence of multidrug resistant (MDR Klebsiella pneumoniae, Pseudomonas aeruginosa and Acinetobacter baumannii were monitored on the surgical (S and medical (M wards of the University Hospital Center "Dr. Dragisa Misovic-Dedinje" (Belgrade, Serbia, in the study period from 2012 to 2015. Appropriateness of antimicrobial use was evaluated using the Global-Prevalence Survey method designed by the University of Antwerp. The percentages of MDR pathogens relative to the total number of isolates of K. pneumoniae and P. aeruginosa were higher on the S (86.2% and 49.1% than on the M (63.2% and 36.9% wards. The percentage of MDR A. baumannii was not different between S (93.7% and M (79.5% wards. An overall antibiotics consumption (defined daily doses/100 bed-days during study was 369.7 and 261.5 on the S and M wards, respectively. A total of 225 prescriptions of antimicrobials were evaluated in138 adults admitted to wards on the day of the survey. The percentage of antimicrobials prescribed for prophylaxis on the M and S wards were 0% and 25%, respectively. Therapies were more frequently empiric (S, 86.8% and M, 80%. The percentages of medical errors on the S and M wards were 74.6% and 27.3%, respectively. The quality indicators for antibiotic prescribing on the S and M wards were as follows: the incorrect choice of antimicrobials (35.6% vs. 20.0%, inappropriate dose interval (70.6% vs. 16.9% or duration of therapy (72.5% vs. 23.1%, a non-documented stop/review data (73.6% vs. 16.9% and divergence from guidelines (71.9% vs. 23.1%. Treatment based on biomarkers was more common on the M wards as compared to the S wards. The increasing prevalence of MDR pathogens, a very high consumption and incorrect prescribing of antimicrobials need special attention, particularly on the S wards.

  17. Quantification of the diversity among common bean accessions using Ward-MLM strategy Quantificação da diversidade entre acessos de feijoeiro-comum com uso da estratégia Ward-MLM

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    Pablo Diego Silva Cabral

    2010-10-01

    Full Text Available The present work aimed at evaluating the divergence among common bean accessions by their agronomic, morphological and molecular traits, based on the Ward-MLM procedure. A collection of 57 accessions from the gene bank of Universidade Federal do Espírito Santo was used in this study, from which: 31 were landraces belonging to the community Fortaleza, in the municipality of Muqui, ES, Brazil; 20 accessions were provided by Embrapa Trigo; and 6 were commercial cultivars. Five agronomic traits (plant cycle, number of seeds per pod, number of pods per plant, weight of 100 seeds, and grain yield, five morphological traits (growth habit, plant size, seed shape, seed color, and commercial group and 16 microsatellite primers were evaluated. High genetic variability was detected considering morphological, agronomic and molecular traits in the 57 common bean accessions studied. The Ward-MLM procedure showed that the ideal number of groups was five, according to the pseudo F and pseudo t² criteria. The accessions from Andean origin had heavier seeds than others and formed a cluster. The Ward-MLM statistical procedure is a useful technique to detect genetic divergence and to cluster genotypes by simultaneously using morphological, agronomic and molecular data.O objetivo deste trabalho foi avaliar a divergência de acessos de feijoeiro-comum por suas características agronômicas, morfológicas e moleculares, com base no procedimento Ward-MLM. Uma coleção de 57 acessos do banco de germoplasma da Universidade Federal do Espírito Santo foi utilizada neste estudo, dos quais: 31 acessos locais, pertencentes à comunidade Fortaleza, no Município de Muqui, ES; 20 acessos fornecidos pela Embrapa Trigo; e 6 cultivares comerciais. Foram avaliados cinco caracteres agronômicos (ciclo da planta, número de sementes por vagem, número de vagens por planta, peso de 100 grãos e produtividade de grãos, cinco caracteres morfológicos (hábito de crescimento, porte

  18. The impact of a large-scale quality improvement programme on work engagement: preliminary results from a national cross-sectional-survey of the 'Productive Ward'.

    Science.gov (United States)

    White, Mark; Wells, John S G; Butterworth, Tony

    2014-12-01

    Quality improvement (QI) Programmes, like the Productive Ward: Releasing-time-to-care initiative, aim to 'engage' and 'empower' ward teams to actively participate, innovate and lead quality improvement at the front line. However, little is known about the relationship and impact that QI work has on the 'engagement' of the clinical teams who participate and vice-versa. This paper explores and examines the impact of a large-scale QI programme, the Productive Ward, on the 'work engagement' of the nurses and ward teams involved. Using the Utrecht Work Engagement Scale (UWES), we surveyed, measured and analysed work engagement in a representative test group of hospital-based ward teams who had recently commenced the latest phase of the national 'Productive Ward' initiative in Ireland and compared them to a control group of similar size and matched (as far as is possible) on variables such as ward size, employment grade and clinical specialty area. 338 individual datasets were recorded, n=180 (53.6%) from the Productive Ward group, and n=158 (46.4%) from the control group; the overall response rate was 67%, and did not differ significantly between the Productive Ward and control groups. The work engagement mean score (±standard deviation) in the Productive group was 4.33(±0.88), and 4.07(±1.06) in the control group, representing a modest but statistically significant between-group difference (p=0.013, independent samples t-test). Similarly modest differences were observed in all three dimensions of the work engagement construct. Employment grade and the clinical specialty area were also significantly related to the work engagement score (pengagement (the vigour, absorption and dedication) of ward-based teams. The use and suitability of the UWES as an appropriate measure of 'engagement' in QI interventions was confirmed. The engagement of nurses and front-line clinical teams is a major component of creating, developing and sustaining a culture of improvement. Copyright

  19. Therapeutic Body Wraps in Swiss public adult acute inpatient wards. A retrospective descriptive cohort study.

    Science.gov (United States)

    Opsommer, E; Dubois, J; Bangerter, G; Panchaud, R; Martin, D; Skuza, K

    2016-04-01

    WHAT IS KNOWN ON THE SUBJECT?: Various expert opinions reported relational benefits and tranquilizing effects of therapeutic body wraps (TBW) in adults experiencing high anxiety in the context of psychosis. Yet, this tranquilizing effect was never investigated in larger samples and in the context of modern psychopharmacology. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This is the first study to establish descriptive statistics of this mind-body therapy in French-speaking Switzerland where TBWs are routinely used in two public psychiatric hospitals. It brings knowledge on patients nowadays treated with TBW. Moreover, it opens a new area of investigation on the potential of this nursing technique, which may contribute to reduce anxiolytic medication in severely ill patients. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: This study sheds light on a clinical practice in mental health nursing and upon nurses' specific contribution to psychiatric clinic. It investigates a potential for TBWs to reduce the use of anxiolytic medications by patients who agreed to have TBW as part of their treatment. It may help to inform the mental health nursing practice. Introduction Many patients suffering from serious mental illness experience severe anxiety and those with psychosis often report the feeling of their bodies falling apart. While it is believed that these patients benefit from therapeutic body wraps (TBWs), the use of this adjunct therapy has rarely been studied in adult patients. Aims The aim of this study was to obtain descriptive statistics on the clinical, social-demographic and institutional reality of TBW therapy in Swiss public adult inpatient wards. Methods Retrospective data related to a cohort of 172 adult inpatients were retrieved from records of two public hospitals. Correlations between TBW and the prescriptions of lorazepam were explored. Results TBWs were primarily used for patients diagnosed with either schizophrenia, schizotypal, delusional and other non

  20. Experiences During a Psychoeducational Intervention Program Run in a Pediatric Ward: A Qualitative Study

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    Paula Magalhães

    2018-05-01

    Full Text Available Hospitalization, despite its duration, is likely to result in emotional, social, and academic costs to school-age children and adolescents. Developing adequate psychoeducational activities and assuring inpatients' own class teachers' collaboration, allows for the enhancement of their personal and emotional competences and the maintenance of a connection with school and academic life. These educational programs have been mainly designed for patients with long stays and/or chronic conditions, in the format of Hospital Schools, and typically in pediatric Hospitals. However, the negative effects of hospitalization can be felt in internments of any duration, and children hospitalized in smaller regional hospitals should have access to actions to maintain the connection with their daily life. Thus, this investigation aims to present a psychoeducational intervention program theoretically grounded within the self-regulated learning (SRL framework, implemented along 1 year in a pediatric ward of a regional hospital to all its school-aged inpatients, regardless of the duration of their stay. The program counts with two facets: the psychoeducational accompaniment and the linkage to school. All the 798 school-aged inpatients (Mage = 11.7; SDage = 3.71; Mhospital stay = 4 days participated in pedagogical, leisure nature, and SRL activities designed to train transversal skills (e.g., goal-setting. Moreover, inpatients completed assigned study tasks resulting from the linkage between the students' own class teachers and the hospital teacher. The experiences reported by parents/caregivers and class teachers of the inpatients enrolling in the intervention allowed the researchers to reflect on the potential advantages of implementing a psychoeducational intervention to hospitalized children and adolescents that is: individually tailored, focused on leisure playful theoretically grounded activities that allow learning to naturally occur, and designed to facilitate