Indoor air bacterial load and antibiotic susceptibility pattern of isolates in operating rooms and surgical wards at jimma university specialized hospital, southwest ethiopia.

Science.gov (United States)

Genet, Chalachew; Kibru, Gebre; Tsegaye, Wondewosen

2011-03-01

Surgical site infection is the second most common health care associated infection. One of the risk factors for such infection is bacterial contamination of operating rooms' and surgical wards' indoor air. In view of that, the microbiological quality of air can be considered as a mirror of the hygienic condition of these rooms. Thus, the objective of this study was to determine the bacterial load and antibiotic susceptibility pattern of isolates in operating rooms' and surgical wards' indoor air of Jimma University Specialized Hospital. A cross sectional study was conducted to measure indoor air microbial quality of operating rooms and surgical wards from October to January 2009/2010 on 108 indoor air samples collected in twelve rounds using purposive sampling technique by Settle Plate Method (Passive Air Sampling following 1/1/1 Schedule). Sample processing and antimicrobial susceptibility testing were done following standard bacteriological techniques. The data was analyzed using SPSS version 16 and interpreted according to scientifically determined baseline values initially suggested by Fisher. The mean aerobic colony counts obtained in OR-1(46cfu/hr) and OR-2(28cfu/hr) was far beyond the set 5-8cfu/hr acceptable standards for passive room. Similarly the highest mean aerobic colony counts of 465cfu/hr and 461cfu/hr were observed in Female room-1 and room-2 respectively when compared to the acceptable range of 250-450cfu/hr. In this study only 3 isolates of S. pyogenes and 48 isolates of S. aureus were identified. Over 66% of S. aureus was identified in Critical Zone of Operating rooms. All isolates of S. aureus showed 100% and 82.8% resistance to methicillin and ampicillin respectively. Higher degree of aerobic bacterial load was measured from operating rooms' and surgical wards' indoor air. Reducing foot trafficking, improving the ventilation system and routine cleaning has to be made to maintain the aerobic bacteria load with in optimal level.

Surgical face masks worn by patients with multidrug-resistant tuberculosis: impact on infectivity of air on a hospital ward.

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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.

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...

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.

Crisis management on surgical wards: a simulation-based approach to enhancing technical, teamwork, and patient interaction skills.

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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.

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

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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.

Surgical Instrument Sets for Special Operations Expeditionary Surgical Teams.

Science.gov (United States)

Hale, Diane F; Sexton, Justin C; Benavides, Linda C; Benavides, Jerry M; Lundy, Jonathan B

The deployment of surgical assets has been driven by mission demands throughout years of military operations in Iraq and Afghanistan. The transition to the highly expeditious Golden Hour Offset Surgical Transport Team (GHOST- T) now offers highly mobile surgical assets in nontraditional operating rooms; the content of the surgical instrument sets has also transformed to accommodate this change. The 102nd Forward Surgical Team (FST) was attached to Special Operations assigned to southern Afghanistan from June 2015 to March 2016. The focus was to decrease overall size and weight of FST instrument sets without decreasing surgical capability of the GHOST-T. Each instrument set was evaluated and modified to include essential instruments to perform damage control surgery. The overall number of main instrument sets was decreased from eight to four; simplified augmentation sets have been added, which expand the capabilities of any main set. The overall size was decreased by 40% and overall weight decreased by 58%. The cardiothoracic, thoracotomy, and emergency thoracotomy trays were condensed to thoracic set. The orthopedic and amputation sets were replaced with an augmentation set of a prepackaged orthopedic external fixator set). An augmentation set to the major or minor basic sets, specifically for vascular injuries, was created. Through the reorganization of conventional FST surgical instrument sets to maintain damage control capabilities and mobility, the 102nd GHOST-T reduced surgical equipment volume and weight, providing a lesson learned for future surgical teams operating in austere environments. 2017.

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.

Experiences of patients with acute abdominal pain in the ED or acute surgical ward --a qualitative comparative study

DEFF Research Database (Denmark)

Schultz, Helen; Qvist, Niels; Backer Mogensen, Christian

2013-01-01

The Danish health care system is currently establishing emergency departments (EDs) with an observation unit nationwide. The aim of the study was to investigate patients with acute abdominal pain and their experiences upon arrival and stay in an acute surgical ward (ASW) versus an ED with an obse......The Danish health care system is currently establishing emergency departments (EDs) with an observation unit nationwide. The aim of the study was to investigate patients with acute abdominal pain and their experiences upon arrival and stay in an acute surgical ward (ASW) versus an ED...... was that the ED included a multidisciplinary team with nurses, who mainly had interactions with the patients before surgical assessment. In all, it resulted in fragmentation of care and a patient experience of repetition. In ASW, focus was on assessment by a senior physician, only, and the nurses' interaction...... with the patients took place after surgical assessment. In all, patients experienced long waiting times. The study shows a need to define the roles of the professionals in units receiving patients with acute abdominal pain in order to fulfil the medical as well as the experienced needs of the acute patient....

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.

Inadequate environment, resources and values lead to missed nursing care: A focused ethnographic study on the surgical ward using the Fundamentals of Care framework.

Science.gov (United States)

Jangland, Eva; Teodorsson, Therese; Molander, Karin; Muntlin Athlin, Åsa

2018-06-01

To explore the delivery of care from the perspective of patients with acute abdominal pain focusing on the contextual factors at system level using the Fundamentals of Care framework. The Fundamentals of Care framework describes several contextual and systemic factors that can impact the delivery of care. To deliver high-quality, person-centred care, it is important to understand how these factors affect patients' experiences and care needs. A focused ethnographic approach. A total of 20 observations were performed on two surgical wards at a Swedish university hospital. Data were collected using participant observation and informal interviews and analysed using deductive content analysis. The findings, presented in four categories, reflect the value patients place on the caring relationship and a friendly atmosphere on the ward. Patients had concerns about the environment, particularly the high-tempo culture on the ward and its impact on their integrity, rest and sleep, access to information and planning, and need for support in addressing their existential thoughts. The observers also noted that missed nursing care had serious consequences for patient safety. Patients with acute abdominal pain were cared for in the high-tempo culture of a surgical ward with limited resources, unclear leadership and challenges to patients' safety. The findings highlight the crucial importance of prioritising and valuing the patients' fundamental care needs for recovery. Nursing leaders and nurses need to take the lead to reconceptualise the value of fundamental care in the acute care setting. To improve clinical practice, the value of fundamentals of care must be addressed regardless of patient's clinical condition. Providing a caring relationship is paramount to ensure a positive impact on patient's well-being and recovery. © 2017 John Wiley & Sons Ltd.

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....

Infection-free surgery: how to improve hand-hygiene compliance and eradicate methicillin-resistant Staphylococcus aureus from surgical wards.

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Davis, C R

2010-05-01

Healthcare-associated infections cost the UK National Health Service 1 billion UK pounds per annum. Poor hand hygiene is the main route of transmission for methicillin-resistant Staphylococcus aureus (MRSA), leading to increased mortality and morbidity for infected patients. This study aims to quantify MRSA infection rates and compliance of alcohol gel application at the entrance to a surgical ward and assess how a simple intervention affects compliance. Compliance was assessed via a discretely positioned close-surveillance camera at the ward entrance. Footage was reviewed to monitor compliance of all persons entering the ward over a 12-month period. For the initial 6 months, mean alcohol gel compliance was 24% for all persons entering the ward. After this period, a conspicuous strip of bright red tape was positioned along the corridor approaching the ward entrance. The red line continued up the wall to an arrow head pointing to the two alcohol gel dispensers on the wall. Mean compliance over the subsequent 6 months significantly improved to 62% (P porters (21% - 67%, P 0.05). There were two cases of MRSA bacteraemia in the initial 6 months and no cases in the following 6 months with the red line in situ. This study demonstrates how a simple intervention significantly improves hand-hygiene compliance with associated eradication of MRSA.

Microbial Contamination on Used Surgical Masks among Hospital Personnel and Microbial Air Quality in their Working Wards: A Hospital in Bangkok.

Science.gov (United States)

Luksamijarulkul, Pipat; Aiempradit, Natkitta; Vatanasomboon, Pisit

2014-09-01

To assess the relationship of bacterial and fungal contamination on used surgical masks worn by the hospital personnel and microbial air quality in their working wards. This is a cross-sectional study of 230 used surgical masks collected from 214 hospital personnel, and 215 indoor air samples collected from their working wards to culture for bacterial and fungal counts. This study was carried out at the hospital in Bangkok. Group or genus of isolated bacteria and fungi were preliminarily identified by Gram's stain and lacto-phenol cotton blue. Data were analyzed using paired t-test and Pearson's correlation coefficient at the significant level of pcontamination on inside area of the used masks were 47 ± 56 and 15 ± 9 cfu/ml/piece, and on outside area were 166 ± 199 and 34 ± 18 cfu/ml/piece, respectively, pcontamination on used masks from hospital personnel working in the male and female medical wards and out-patient department, as well as the bacterial and fungal counts of the indoor air sample collected from the same area were relatively higher than the other wards. The predominant isolated bacteria and fungi contaminated on inside and outside areas of the used masks and air samples were similar (Staphylococcus spp. and Aspergillus spp.; respectively). For its relationship, results found that bacterial and fungal counts in air samples showed significantly positive correlation with the bacterial contamination load on outside area of the used masks, r=0.16, p=0.018 and r=0.21, p=0.003, respectively. High bacterial contamination on outside area of the used masks was demonstrated, and it showed a significant correlation with microbial air quality of working wards.

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

Microbial Contamination on Used Surgical Masks among Hospital Personnel and Microbial Air Quality in their Working Wards: A Hospital in Bangkok

Directory of Open Access Journals (Sweden)

Pipat Luksamijarulkul

2014-09-01

Full Text Available Objective: To assess the relationship of bacterial and fungal contamination on used surgical masks worn by the hospital personnel and microbial air quality in their working wards. Methods: This is a cross-sectional study of 230 used surgical masks collected from 214 hospital personnel, and 215 indoor air samples collected from their working wards to culture for bacterial and fungal counts. This study was carried out at the hospital in Bangkok. Group or genus of isolated bacteria and fungi were preliminarily identified by Gram’s stain and lacto-phenol cotton blue. Data were analyzed using paired t-test and Pearson’s correlation coefficient at the significant level of p<0.050. Results: Means and standard deviation of bacterial and fungal contamination on inside area of the used masks were 47 ± 56 and 15 ± 9 cfu/ml/piece, and on outside area were 166 ± 199 and 34 ± 18 cfu/ml/piece, respectively, p<0.001. The bacterial and fungal contamination on used masks from hospital personnel working in the male and female medical wards and out-patient department, as well as the bacterial and fungal counts of the indoor air sample collected from the same area were relatively higher than the other wards. The predominant isolated bacteria and fungi contaminated on inside and outside areas of the used masks and air samples were similar (Staphylococcus spp. and Aspergillus spp.; respectively. For its relationship, results found that bacterial and fungal counts in air samples showed significantly positive correlation with the bacterial contamination load on outside area of the used masks, r=0.16, p=0.018 and r=0.21, p=0.003, respectively. Conclusion: High bacterial contamination on outside area of the used masks was demonstrated, and it showed a significant correlation with microbial air quality of working wards.

The difference in pharmacists' interventions across the diverse settings in a children's hospital.

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Hesty Utami Ramadaniati

Full Text Available This study aimed to document and compare the nature of clinical pharmacists' interventions made in different practice settings within a children's hospital.The primary investigator observed and documented all clinical interventions performed by clinical pharmacists for between 35-37 days on each of the five study wards from the three practice settings, namely general medical, general surgical and hematology-oncology. The rates, types and significance of the pharmacists' interventions in the different settings were compared.A total of 982 interventions were documented, related to the 16,700 medication orders reviewed on the five wards in the three practice settings over the duration of the study. Taking medication histories and/or patient counselling were the most common pharmacists' interventions in the general settings; constituting more than half of all interventions. On the Hematology-Oncology Ward the pattern was different with drug therapy changes being the most common interventions (n = 73/195, 37.4% of all interventions. Active interventions (pharmacists' activities leading to a change in drug therapy constituted less than a quarter of all interventions on the general medical and surgical wards compared to nearly half on the specialty Hematology-Oncology Ward. The majority (n = 37/42, 88.1% of a random sample of the active interventions reviewed were rated as clinically significant. Dose adjustment was the most frequent active interventions in the general settings, whilst drug addition constituted the most common active interventions on the Hematology-Oncology Ward. The degree of acceptance of pharmacists' active interventions by prescribers was high (n = 223/244, 91.4%.The rate of pharmacists' active interventions differed across different practice settings, being most frequent in the specialty hematology-oncology setting. The nature and type of the interventions documented in the hematology-oncology were also different

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...

Impact of pharmacists assisting with prescribing and undertaking medication review on oxycodone prescribing and supply for patients discharged from surgical wards.

Science.gov (United States)

Tran, T; Taylor, S E; Hardidge, A; Findakly, D; Aminian, P; Elliott, R A

2017-10-01

Overprescribing of oxycodone is a contributor to the epidemic of prescription opioid misuse and deaths. Practice models to optimize oxycodone prescribing and supply need to be evaluated. We explored the impact of pharmacist-assisted discharge prescribing and medication review on oxycodone prescribing and supply for patients discharged from surgical wards. A retrospective audit was conducted on two surgical inpatient wards following a 16-week prospective pre- and post-intervention study. During the pre-intervention period, discharge prescriptions were prepared by hospital doctors and then reviewed by a ward pharmacist (WP) before being dispensed. Post-intervention, prescriptions were prepared by a project pharmacist in consultation with hospital doctors and then reviewed by a WP and dispensed. Proportion of patients who were prescribed, and proportion supplied, oxycodone on discharge; Median amount (milligrams) of oxycodone prescribed and supplied, for patients who were prescribed and supplied at least one oxycodone-containing preparation, respectively. A total of 320 and 341 patients were evaluated pre- and post-intervention, respectively. Pre-intervention, 75.6% of patients were prescribed oxycodone; after WP review, 60.3% were supplied oxycodone (Psupplied was 100 milligrams/patient. Post-intervention, 68.6% of patients were prescribed oxycodone; after WP review, 57.8% were supplied oxycodone (Psupplied was 50 milligrams/patient (difference in amount prescribed and supplied: 50 milligrams, Psupplied oxycodone but not the amount supplied/patient. Having a pharmacist assist with prescribing reduced the amount of oxycodone supplied. © 2017 John Wiley & Sons Ltd.

Differences in antimicrobial consumption, prescribing and isolation rate of multidrug resistant Klebsiella pneumoniae, Pseudomonas aeruginosa and Acinetobacter baumannii on surgical and medical wards.

Directory of Open Access Journals (Sweden)

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.

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

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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.

Second Order Ideal-Ward Continuity

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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.

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.

Nurse Level of Education, Quality of Care and Patient Safety in the Medical and Surgical Wards in Malaysian Private Hospitals: A Cross-sectional Study.

Science.gov (United States)

Abdul Rahman, Hamzah; Jarrar, Mu'taman; Don, Mohammad Sobri

2015-04-23

Nursing knowledge and skills are required to sustain quality of care and patient safety. The numbers of nurses with Bachelor degrees in Malaysia are very limited. This study aims to predict the impact of nurse level of education on quality of care and patient safety in the medical and surgical wards in Malaysian private hospitals. A cross-sectional survey by questionnaire was conducted. A total 652 nurses working in the medical and surgical wards in 12 private hospitals were participated in the study. Multistage stratified simple random sampling performed to invite nurses working in small size (less than 100 beds), medium size (100-199 beds) and large size (over than 200) hospitals to participate in the study. This allowed nurses from all shifts to participate in this study. Nurses with higher education were not significantly associated with both quality of care and patient safety. However, a total 355 (60.9%) of respondents participated in this study were working in teaching hospitals. Teaching hospitals offer training for all newly appointed staff. They also provide general orientation programs and training to outline the policies, procedures of the nurses' roles and responsibilities. This made the variances between the Bachelor and Diploma nurses not significantly associated with the outcomes of care. Nursing educational level was not associated with the outcomes of care in Malaysian private hospitals. However, training programs and the general nursing orientation programs for nurses in Malaysia can help to upgrade the Diploma-level nurses. Training programs can increase their self confidence, knowledge, critical thinking ability and improve their interpersonal skills. So, it can be concluded that better education and training for a medical and surgical wards' nurses is required for satisfying client expectations and sustaining the outcomes of patient care.

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.

Improving surgical weekend handover.

Science.gov (United States)

Culwick, Caroline; Devine, Chris; Coombs, Catherine

2014-01-01

Effective handovers are vital to patient safety and continuity of care, and this is recognised by several national bodies including the GMC. The existing model at Great Western Hospital (GWH) involved three general surgical teams and a urology team placing their printed patient lists, complete with weekend jobs, in a folder for the on-call team to collect at the weekend. We recognised a need to reduce time searching for patients, jobs and reviews, and to streamline weekend ward rounds. A unified weekend list ordering all surgical patients by ward and bed number was introduced. Discrepancies in the layout of each team's weekday list necessitated the design of a new weekday list to match the weekend list to facilitate the easy transfer of information between the two lists. A colour coding system was also used to highlight specific jobs. Prior to this improvement project only 7.1% of those polled were satisfied with the existing system, after a series of interventions satisfaction increased to 85.7%. The significant increase in overall satisfaction with surgical handover following the introduction of the unified weekend list is promising. Locating patients and identifying jobs is easier and weekend ward rounds can conducted in a more logical and timely fashion. It has also helped facilitate the transition to consultant ward rounds of all surgical inpatients at the weekends with promising feedback from a recent consultants meeting.

Using Google Glass in Surgical Settings: Systematic Review.

Science.gov (United States)

Wei, Nancy J; Dougherty, Bryn; Myers, Aundria; Badawy, Sherif M

2018-03-06

In recent years, wearable devices have become increasingly attractive and the health care industry has been especially drawn to Google Glass because of its ability to serve as a head-mounted wearable device. The use of Google Glass in surgical settings is of particular interest due to the hands-free device potential to streamline workflow and maintain sterile conditions in an operating room environment. The aim is to conduct a systematic evaluation of the literature on the feasibility and acceptability of using Google Glass in surgical settings and to assess the potential benefits and limitations of its application. The literature was searched for articles published between January 2013 and May 2017. The search included the following databases: PubMed MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature, PsycINFO (EBSCO), and IEEE Xplore. Two reviewers independently screened titles and abstracts and assessed full-text articles. Original research articles that evaluated the feasibility, usability, or acceptability of using Google Glass in surgical settings were included. This review was completed following the Preferred Reporting Results of Systematic Reviews and Meta-Analyses guidelines. Of the 520 records obtained, 31 met all predefined criteria and were included in this review. Google Glass was used in various surgical specialties. Most studies were in the United States (23/31, 74%) and all were conducted in hospital settings: 29 in adult hospitals (29/31, 94%) and two in children's hospitals (2/31, 7%). Sample sizes of participants who wore Google Glass ranged from 1 to 40. Of the 31 studies, 25 (81%) were conducted under real-time conditions or actual clinical care settings, whereas the other six (19%) were conducted under simulated environment. Twenty-six studies were pilot or feasibility studies (84%), three were case studies (10%), and two were randomized controlled trials (6%). The majority of studies examined the potential use of

Hospital-acquired acute kidney injury in medical, surgical, and intensive care unit: A comparative study

Directory of Open Access Journals (Sweden)

T B Singh

2013-01-01

Full Text Available Acute kidney injury (AKI is a common complication in hospitalized patients. There are few comparative studies on hospital-acquired AKI (HAAKI in medical, surgical, and ICU patients. This study was conducted to compare the epidemiological characteristics, clinical profiles, and outcomes of HAAKI among these three units. All adult patients (>18 years of either gender who developed AKI based on RIFLE criteria (using serum creatinine, 48 h after hospitalization were included in the study. Patients of acute on chronic renal failure and AKI in pregnancy were excluded. Incidence of HAAKI in medical, surgical, and ICU wards were 0.54%, 0.72%, and 2.2% respectively ( P < 0.0001. There was no difference in age distribution among the groups, but onset of HAAKI was earliest in the medical ward ( P = 0.001. RIFLE-R was the most common AKI in medical (39.2% and ICU (50% wards but in the surgical ward, it was RIFLE-F that was most common (52.6%. Acute tubular necrosis was more common in ICU ( P = 0.043. Most common etiology of HAAKI in medical unit was drug induced (39.2%, whereas in surgical and ICU, it was sepsis (34% and 35.2% respectively. Mortality in ICU, surgical and medical units were 73.5%, 43.42%, and 37.2%, respectively ( P = 0.003. Length of hospital stay in surgical, ICU and medical units were different ( P = 0.007. This study highlights that the characters of HAAKI are different in some aspects among different hospital settings.

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.

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.

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.

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...

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

Prevalence and risk factors of metallo β-lactamase producing Pseudomonas aeruginosa and Acinetobacter species in burns and surgical wards in a tertiary care hospital

Directory of Open Access Journals (Sweden)

Simit H Kumar

2012-01-01

Full Text Available Introduction: The production of Metallo-β-lactamases (MBLs is one of the resistance mechanisms of Pseudomonas aeruginosa and Acinetobacter species. There is not much Indian data on the prevalence of MBLs in burns and surgical wards. Materials and Methods: A total of 145 non-duplicate isolates of carbapenem-resistant Pseudomonas aeruginosa and Acinetobacter species, isolated from pus/wound swabs and endotracheal secretions from burns and surgical wards, were tested for MBL production by modified ethylene diamine tetra acetic acid (EDTA disc synergy and double disc synergy tests. Results: Prevalence of MBLs was 26.9% by both the above tests. All MBL-positive isolates were multidrug resistant. Only 6.06% (2/33 P.aeruginosa and 16.67% (1/06 Acinetobacter species were susceptible to piperacillin-tazobactam and netilmycin, respectively. These patients had multiple risk factors like >8 days hospital stay, catheterization, IV lines, previous antibiotic use, mechanical ventilation, etc. Graft application and surgical intervention were significant risk factors in MBL-positive patients. Overall mortality in MBL-positive patients was 34.21%. Conclusion: Emergence of MBL-producing Pseudomonas aeruginosa and Acinetobacter species in this hospital is alarming, which reflect excessive use of carbapenems and at the same time, pose a therapeutic challenge to clinicians as well as to microbiologists. Therefore, a strict antibiotic policy and implementation of proper infection control practices will go a long way to prevent further spread of MBLs. Detection of MBLs should also become mandatory in all hospitals.

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

Pain management in the outpatient surgical setting

African Journals Online (AJOL)

QuickSilver

2003-05-14

May 14, 2003 ... Pain management in the outpatient surgical setting. Robert S. Wolf MD. American Sports Medicine Institute. Birmingham, AL USA emptive and post-operative setting. These medications inhibit prostaglandin synthesis, promote analgesia, and consequently decrease the post-operative demand for opioids.

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

Detection of Deteriorating Patients on Surgical Wards Outside the ICU by an Automated MEWS-Based Early Warning System With Paging Functionality.

Science.gov (United States)

Heller, Axel R; Mees, Sören T; Lauterwald, Benjamin; Reeps, Christian; Koch, Thea; Weitz, Jürgen

2018-05-16

The establishment of early warning systems in hospitals was strongly recommended in recent guidelines to detect deteriorating patients early and direct them to adequate care. Upon reaching predefined trigger criteria, Medical Emergency Teams (MET) should be notified and directed to these patients. The present study analyses the effect of introducing an automated multiparameter early warning score (MEWS)-based early warning system with paging functionality on 2 wards hosting patients recovering from highly complex surgical interventions. The deployment of the system was accompanied by retrospective data acquisition during 12 months (intervention) using 4 routine databases: Hospital patient data management, anesthesia database, local data of the German Resuscitation Registry, and measurement logs of the deployed system (intervention period only). A retrospective 12-month data review using the same aforementioned databases before the deployment of the system served as control. Control and intervention phases were separated by a 6-month washout period for the installation of the system and for training. Data from 3827 patients could be acquired from 2 surgical wards during the two 12-month periods, 1896 patients in the control and 1931 in the intervention cohorts. Patient characteristics differed between the 2 observation phases. American Society of Anesthesiologists risk classification and duration of surgery as well as German DRG case-weight were significantly higher in the intervention period. However, the rate of cardiac arrests significantly dropped from 5.3 to 2.1 per 1000 admissions in the intervention period (P automated MEWS-based early warning system with paging functionality.

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.

Undergraduate surgical nursing preparation and guided operating room experience: A quantitative analysis.

Science.gov (United States)

Foran, Paula

2016-01-01

The aim of this research was to determine if guided operating theatre experience in the undergraduate nursing curricula enhanced surgical knowledge and understanding of nursing care provided outside this specialist area in the pre- and post-operative surgical wards. Using quantitative analyses, undergraduate nurses were knowledge tested on areas of pre- and post-operative surgical nursing in their final semester of study. As much learning occurs in nurses' first year of practice, participants were re-tested again after their Graduate Nurse Program/Preceptorship year. Participants' results were compared to the model of operating room education they had participated in to determine if there was a relationship between the type of theatre education they experienced (if any) and their knowledge of surgical ward nursing. Findings revealed undergraduates nurses receiving guided operating theatre experience had a 76% pass rate compared to 56% with non-guided or no experience (p nurses achieved a 100% pass rate compared to 53% with non-guided or no experience (p research informs us that undergraduate nurses achieve greater learning about surgical ward nursing via guided operating room experience as opposed to surgical ward nursing experience alone. Copyright © 2015 Elsevier Ltd. All rights reserved.

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.

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 ...

Evaluation of two surveillance methods for surgical site infection

Directory of Open Access Journals (Sweden)

M. Haji Abdolbaghi

2006-08-01

Full Text Available Background: Surgical wound infection surveillance is an important facet of hospital infection control processes. There are several surveillance methods for surgical site infections. The objective of this study is to evaluate the accuracy of two different surgical site infection surveillance methods. Methods: In this prospective cross sectional study 3020 undergoing surgey in general surgical wards of Imam Khomeini hospital were included. Surveillance methods consisted of review of medical records for postoperative fever and review of nursing daily note for prescription of antibiotics postoperatively and during patient’s discharge. Review of patient’s history and daily records and interview with patient’s surgeon and the head-nurse of the ward considered as a gold standard for surveillance. Results: The postoperative antibiotic consumption especially when considering its duration is a proper method for surgical wound infection surveillance. Accomplishments of a prospective study with postdischarge follow up until 30 days after surgery is recommended. Conclusion: The result of this study showed that postoperative antibiotic surveillance method specially with consideration of the antibiotic usage duration is a proper method for surgical site infection surveillance in general surgery wards. Accomplishments of a prospective study with post discharge follow up until 30 days after surgery is recommended.

Surgical Site Infection Rate and Risk Factors among Obstetric Cases ...

African Journals Online (AJOL)

2009-04-01

Among surgical patients in obstetrics, Surgical Site Infections were the most ... for delivery from April 1, 2009 to March 31, 2010 in obstetric ward of the Hospital. ... applying improved surgical techniques and improving infection prevention ...

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...

A primer on standards setting as it applies to surgical education and credentialing.

Science.gov (United States)

Cendan, Juan; Wier, Daryl; Behrns, Kevin

2013-07-01

Surgical technological advances in the past three decades have led to dramatic reductions in the morbidity associated with abdominal procedures and permanently altered the surgical practice landscape. Significant changes continue apace including surgical robotics, natural orifice-based surgery, and single-incision approaches. These disruptive technologies have on occasion been injurious to patients, and high-stakes assessment before adoption of new technologies would be reasonable. We reviewed the drivers for well-established psychometric techniques available for the standards-setting process. We present a series of examples that are relevant in the surgical domain including standards setting for knowledge and skills assessments. Defensible standards for knowledge and procedural skills will likely become part of surgical clinical practice. Understanding the methodology for determining standards should position the surgical community to assist in the process and lead within their clinical settings as standards are considered that may affect patient safety and physician credentialing.

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...

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.

Surgical site infections in an abdominal surgical ward at Kosovo Teaching Hospital.

Science.gov (United States)

Raka, Lul; Krasniqi, Avdyl; Hoxha, Faton; Musa, Ruustem; Mulliqi, Gjyle; Krasniqi, Selvete; Kurti, Arsim; Dervishaj, Antigona; Nuhiu, Beqir; Kelmendi, Baton; Limani, Dalip; Tolaj, Ilir

2008-01-01

Abdominal surgical site infections (SSI) cause substantial morbidity and mortality for patients undergoing operative procedures. We determined the incidence of and risk factors for SSI after abdominal surgery in the Department of Abdominal Surgery at the University Clinical Centre of Kosovo (UCCK). Prospective surveillance of patients undergoing abdominal surgery was performed between December 2005 and June 2006. CDC definitions were followed to detect SSI and study forms were based on Europe Link for Infection Control through Surveillance (HELICS) protocol. A total of 253 surgical interventions in 225 patients were evaluated. The median age of patients was 42 years and 55.1% of them were male. The overall incidence rate of SSI was 12%. Follow-up was achieved for 84.1% of the procedures. For patients with an SSI, the median duration of hospitalization was 9 days compared with 4 days for those without an SSI (p 2, use of antibiotic prophylaxis and NNIS class of > 2 were all significant at p < .001. The SSI rates for the NNIS System risk classes 0, 1 and 2-3 were 4.2%, 46.7% and 100%, respectively. SSI caused considerable morbidity among surgical patients in UCCK. Appropriate active surveillance and infection control measures should be introduced during preoperative, intra-operative, and postoperative care to reduce infection rates.

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.

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

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

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.

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

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.

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)

[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.

Surgical Face Masks Worn by Patients with Multidrug-Resistant Tuberculosis

Science.gov (United States)

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.

2012-01-01

Rationale: 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. Objectives: We sought to quantify the efficacy of surgical face masks when worn by patients with multidrug-resistant TB (MDR-TB). Methods: 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. Measurements and Main Results: 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. Conclusions: Surgical face masks on patients with MDR-TB significantly reduced transmission and offer an adjunct measure for reducing TB transmission from infectious patients. PMID:22323300

Senile anorexia in acute-ward and rehabilitations settings.

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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

Get SET: aligning anatomy demonstrator programmes with Surgical Education and Training selection criteria.

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Rhodes, Danielle; Fogg, Quentin A; Lazarus, Michelle D

2018-05-01

Prevocational doctors aspiring to surgical careers are commonly recruited as anatomy demonstrators for undergraduate and graduate medical programmes. Entry into Surgical Education and Training (SET) is highly competitive and a unique opportunity exists to align anatomy demonstrator programmes with the selection criteria and core competencies of SET programmes. This study used a qualitative approach to (i) determine what criteria applicants for SET are assessed on and (ii) identify criteria that could be aligned with and enhanced by an anatomy demonstrator programme. The selection guidelines of all nine surgical specialties for the 2017 intake of SET trainees were analysed using qualitative content analysis methodology. The Royal Australasian College of Surgeons adopted a holistic approach to trainee selection that assessed both discipline-specific and discipline-independent skills. Qualitative content analysis identified eight categories of key selection criteria: medical expertise, scholarly activity, professional identity, interpersonal skills, integrity, self-management, insight and self-awareness and community involvement. The structured curriculum vitae was heavily weighted towards discipline-specific skills, such as medical expertise and scholarly activity. Insufficient information was available to determine the weighting of selection criteria assessed by the structured referee reports or interviews. Anatomy demonstrator programmes provide prevocational doctors with unique opportunities to develop surgical skills and competencies in a non-clinical setting. Constructively aligned anatomy demonstrator programmes may be particularly beneficial for prevocational doctors seeking to improve their anatomical knowledge, teaching skills or scholarly activity. © 2017 Royal Australasian College of Surgeons.

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...

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...

Clinical Documentation and Data Transfer from Ebola and Marburg Virus Disease Wards in Outbreak Settings: Health Care Workers’ Experiences and Preferences

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Silja Bühler

2014-02-01

Full Text Available Understanding human filovirus hemorrhagic fever (FHF clinical manifestations and evaluating treatment strategies require the collection of clinical data in outbreak settings, where clinical documentation has been limited. Currently, no consensus among filovirus outbreak-response organisations guides best practice for clinical documentation and data transfer. Semi-structured interviews were conducted with health care workers (HCWs involved in FHF outbreaks in sub-Saharan Africa, and with HCWs experienced in documenting and transferring data from high-risk areas (isolation wards or biosafety level 4 laboratories. Methods for data documentation and transfer were identified, described in detail and categorised by requirement for electricity and ranked by interviewee preference. Some methods involve removing paperwork and other objects from the filovirus disease ward without disinfection. We believe that if done properly, these methods are reasonably safe for certain settings. However, alternative methods avoiding the removal of objects, or involving the removal of paperwork or objects after non-damaging disinfection, are available. These methods are not only safer, they are also perceived as safer and likely more acceptable to health workers and members of the community. The use of standardised clinical forms is overdue. Experiments with by sunlight disinfection should continue, and non-damaging disinfection of impregnated paper, suitable tablet computers and underwater cameras should be evaluated under field conditions.

Complex Pulmonary Aspergilloma: Surgical Challenges in a Third World Setting

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Bernadette Ngo Nonga

2018-01-01

Full Text Available Background. Surgery for pulmonary aspergilloma (PA, especially complex forms, is greatly challenging in a resource-poor setting such as Cameroon. We report our experience of surgical management of PA in this environment. Method. We prospectively assessed patients who underwent surgery for PA from January 2012 to May 2015, at the University Hospital Center of Yaoundé. Records were reviewed for demographics, history and physical examinations, radiological findings, surgical procedures, and outcomes. The study has received approval from the institutional ethics committees. Results. In total, 20 patients (17 males and 3 females (sex ratio, 5.66; mean age, 30 years; range, 23–65 years with a past history of tuberculosis were assessed. The median follow-up was 21.5 months. The primary symptom was hemoptysis, followed by cough and chest pain. All patients underwent surgical treatment and lung resection. Postoperative complications (bleeding, air leak, empyema, and severe anemia occurred in 4 patients and 1 patient died. Although 3 patients were lost to follow-up, the survival rate was 80% with improvement of the preoperative symptoms. Conclusion. Although surgery for complex aspergilloma is very challenging in environments such as ours, we believe that it is the best treatment modality for symptomatic diseases in our setting.

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

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.

Unlicensed and off-label use of drugs in pediatric surgical units at tertiary care hospitals of Pakistan.

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Aamir, Muhammad; Khan, Jamshaid Ali; Shakeel, Faisal; Asim, Syed Muhammad

2017-08-01

Background Unlicensed and off-label prescribing practice is global dilemma around the world. This pioneering study was designed to determine unlicensed and off-label use of drug in surgical wards of tertiary care hospitals of Pakistan. Objective To assess unlicensed and off-label use of drugs in pediatric surgical unit at three tertiary care hospitals in Peshawar, Pakistan. Setting Two government and one private tertiary care hospitals in Pakistan. Method Drug profiles of 895 patients from three different clinical settings were evaluated for unlicensed and off-label use of drugs using Micromedex DRUGDEX. Main outcome measure Characteristics of the unlicensed and off-label drug prescriptions. Result Total of 3168 prescribed drugs were analyzed in this study. Indication (38.7%) and dose (34.8%) were the most frequent off-label categories. In comparison with the corresponding reference categories, infants and children, male patients and having less than five prescribed drugs were significant predictors of unlicensed prescriptions. In comparison with the corresponding reference categories, significant predictors of off-label drug prescribing were children younger than two year, children between 2-12 years, patient staying at hospital less than 5 days and patients having less than five prescribed drugs. Conclusion The prevalence of unlicensed and off-label drug prescriptions are high at pediatric surgical ward of tertiary care hospitals. More awareness of the efficacy and safety of drugs are required in pediatrics. In addition, new formulations with advanced dosing for children are also required to minimize the risk of adverse outcomes.

Mixed methods evaluation of a quality improvement and audit tool for nurse-to-nurse bedside clinical handover in ward settings.

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Redley, Bernice; Waugh, Rachael

2018-04-01

Nurse bedside handover quality is influenced by complex interactions related to the content, processes used and the work environment. Audit tools are seldom tested in 'real' settings. Examine the reliability, validity and usability of a quality improvement tool for audit of nurse bedside handover. Naturalistic, descriptive, mixed-methods. Six inpatient wards at a single large not-for-profit private health service in Victoria, Australia. Five nurse experts and 104 nurses involved in 199 change-of-shift bedside handovers. A focus group with experts and pilot test were used to examine content and face validity, and usability of the handover audit tool. The tool was examined for inter-rater reliability and usability using observation audits of handovers across six wards. Data were collected in 2013-2014. Two independent observers for 72 audits demonstrated acceptable inter-observer agreement for 27 (77%) items. Reliability was weak for items examining the handover environment. Seventeen items were not observed reflecting gaps in practices. Across 199 observation audits, gaps in nurse bedside handover practice most often related to process and environment, rather than content items. Usability was impacted by high observer burden, familiarity and non-specific illustrative behaviours. The reliability and validity of most items to audit handover content was acceptable. Gaps in practices for process and environment items were identified. Context specific exemplars and reducing the items used at each handover audit can enhance usability. Further research is needed to develop context specific exemplars and undertake additional reliability testing using a wide range of handover settings. CONTRIBUTION OF THE PAPER. Copyright © 2017 Elsevier Inc. All rights reserved.

A tailored relocation stress intervention programme for family caregivers of patients transferred from a surgical intensive care unit to a general ward.

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Lee, Seul; Oh, HyunSoo; Suh, YeonOk; Seo, WhaSook

2017-03-01

To develop and examine a relocation stress intervention programme tailored for the family caregivers of patients scheduled for transfer from a surgical intensive care unit to a general ward. Family relocation stress syndrome has been reported to be similar to that exhibited by patients, and investigators have emphasised that nurses should make special efforts to relieve family relocation stress to maximise positive contributions to the well-being of patients by family caregivers. A nonequivalent control group, nonsynchronised pretest-post-test design was adopted. The study subjects were 60 family caregivers of patients with neurosurgical or general surgical conditions in the surgical intensive care unit of a university hospital located in Incheon, South Korea. Relocation stress and family burden were evaluated at three times, that is before intervention, immediately after transfer and four to five days after transfer. This relocation stress intervention programme was developed for the family caregivers based on disease characteristics and relocation-related needs. In the experimental group, relocation stress levels significantly and continuously decreased after intervention, whereas in the control group, a slight nonsignificant trend was observed. Family burden levels in the control group increased significantly after transfer, whereas burden levels in the experimental group increased only marginally and nonsignificantly. No significant between-group differences in relocation stress or family burden levels were observed after intervention. Relocation stress levels of family caregivers were significantly decreased after intervention in the experimental group, which indicates that the devised family relocation stress intervention programme effectively alleviated family relocation stress. The devised intervention programme, which was tailored to disease characteristics and relocation-related needs, may enhance the practicality and efficacy of relocation stress

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

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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.

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

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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.

An ethnographic study exploring the role of ward-based Advanced Nurse Practitioners in an acute medical setting.

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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.

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...

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

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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.

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

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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.

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.

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.

Implementing ward based clinical pharmacy services in an Ethiopian University Hospital

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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

Characterization of colonizing Staphylococcus aureus isolated from surgical wards' patients in a Nigerian university hospital.

Directory of Open Access Journals (Sweden)

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.

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.

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

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

Development of a handy-type laser surgical unit

Science.gov (United States)

Abe, Yusuke; Wakamatsu, Koh; Goto, Shigeru

2005-07-01

We proposed a concept of a handy-type laser surgical unit for use in outpatient, in ward and in open-air field. To investigate the possibility of the concept, a handy-type semiconductor laser surgical unit was developed experimentally using 2-watts power laser diode with no built-in electrical cooling unit (Peltier chip) and a small rechargeable battery. The drive circuit was constructed with only current limit and ACC circuits. The laser diode was cooled with heat sink and simple fan. Laser irradiation was set to stop at 30 degree Celsius by monitoring the temperature of laser diode with thermistor temperature sensor. With this system, 1.18 watts of laser power at the end of optical fiber with both 600 and 900mm core diameter, and about 30 minutes of continuous irradiating time with Ni-Cd battery (4.8V 1,500mA/h) could be obtained with no over heating in laser diode. The result showed that the high power semiconductor laser could be driven with small battery when specially designed. In an animal experiment, small bleeding could be managed with contact irradiation method. This kind of simple laser surgical unit is considered to be useful for the management of small bleedings in clinical.

Values and attitudes related to career preference and performance in the surgical clerkship.

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Linn, B S; Zeppa, R

1982-10-01

We investigated the values and attitudes of junior medical students in relation to career preference (particularly surgery), ward behavior, and cognitive performance in the surgical clerkship. Students choosing specialty surgery were more cynical and authoritarian than those selecting general surgery. Those choosing general surgery had more self-esteem, and along with those who selected specialty surgery, more intolerance for ambiguity than other students. None of the values or attitudes were associated with grades, but several were related to ward behavior as judged by faculty and house staff. Students who valued academic achievement more and independence and intellectualism less and those with more submissive authoritarian views and more ego strength were considered better ward performers. This raises the question of whether such values and attitudes should be reinforced in ward performance or whether such students are rated higher simply because they are less disruptive to busy ward routines.

Enabling coordination within medical settings: case of a maternity ward

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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.

[Croatian guidelines for perioperative enteral nutrition of surgical patients].

Science.gov (United States)

Zelić, Marko; Bender, Darija Vranesić; Kelecić, Dina Ljubas; Zupan, Zeljko; Cicvarić, Tedi; Maldini, Branka; Durut, Iva; Rahelić, Velimir; Skegro, Mate; Majerović, Mate; Perko, Zdravko; Sustić, Alan; Madzar, Tomislav; Kovacić, Borna; Kekez, Tihomir; Krznarić, Zeljko

2014-01-01

Nutritional status of patients significantly affects the outcome of surgical treatment, whether it's about being obese or malnutrition with loss of muscle mass. Inadequate nutritional support in the perioperative period compromises surgical procedures even in patients who are adequately nourished. In this paper, particular attention was paid to malnourished patients, and their incidence in population hospitalized in surgical wards can be high up to 30%. Special emphasis was paid to the appropriateness of preoperative fasting and to the acceptance of new knowledge in this area of treatment. The aim of this working group was to make guidelines for perioperative nutritional support with different modalities of enteral nutrition. The development of these guidelines was attended by representatives of Croatian Medical Association: Croatian Society for Digestive Surgery, Croatian Society for Clinical Nutrition, Croatian Society of Surgery, Croatian Society for Endoscopic Surgery, Croatian Trauma Society and the Croatian Society of Anesthesiology and Intensive Care. The guidelines are designed as a set of questions that arise daily in clinical practice when preparing patients for surgery and after the surgical treatment, which relate to the assessment of nutritional status, perioperative nutritional support, duration of preoperative fasting period and the selection of food intake route. Assessment of nutritional status and the use of different modes of enteral nutrition should enter into standard protocols of diagnosis and treatment in the Croatian hospitals.

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...

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

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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.

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

Improving surgical weekend handover

OpenAIRE

Culwick, Caroline; Devine, Chris; Coombs, Catherine

2014-01-01

Effective handovers are vital to patient safety and continuity of care, and this is recognised by several national bodies including the GMC. The existing model at Great Western Hospital (GWH) involved three general surgical teams and a urology team placing their printed patient lists, complete with weekend jobs, in a folder for the on-call team to collect at the weekend. We recognised a need to reduce time searching for patients, jobs and reviews, and to streamline weekend ward rounds. A unif...

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.)

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

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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.

Higher surgical training opportunities in the general hospital setting; getting the balance right.

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Robertson, I; Traynor, O; Khan, W; Waldron, R; Barry, K

2013-12-01

The general hospital can play an important role in training of higher surgical trainees (HSTs) in Ireland and abroad. Training opportunities in such a setting have not been closely analysed to date. The aim of this study was to quantify operative exposure for HSTs over a 5-year period in a single institution. Analysis of electronic training logbooks (over a 5-year period, 2007-2012) was performed for general surgery trainees on the higher surgical training programme in Ireland. The most commonly performed adult and paediatric procedures per trainee, per year were analysed. Standard general surgery operations such as herniae (average 58, range 32-86) and cholecystectomy (average 60, range 49-72) ranked highly in each logbook. The most frequently performed emergency operations were appendicectomy (average 45, range 33-53) and laparotomy for acute abdomen (average 48, range 10-79). Paediatric surgical experience included appendicectomy, circumcision, orchidopexy and hernia/hydrocoele repair. Overall, the procedure most commonly performed in the adult setting was endoscopy, with each trainee recording an average of 116 (range 98-132) oesophagogastroduodenoscopies and 284 (range 227-354) colonoscopies. General hospitals continue to play a major role in the training of higher surgical trainees. Analysis of the electronic logbooks over a 5-year period reveals the high volume of procedures available to trainees in a non-specialist centre. Such training opportunities are invaluable in the context of changing work practices and limited resources.

The Pattern of Surgically Treatable Anorectal Diseases in University ...

African Journals Online (AJOL)

PATIENTS AND METHODS: This is a 4 year retrospective study of all adult patients with anorectal diseases who were admitted into the surgical wards of University of Port Harcourt Teaching Hospital. Relevant data were retrieved and analyzed. RESULTS: One hundred and fifty cases were seen over the 4 year period.

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

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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.

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

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...

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.

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

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

Predictors of surgical site infections among patients undergoing major surgery at Bugando Medical Centre in Northwestern Tanzania

Directory of Open Access Journals (Sweden)

Imirzalioglu Can

2011-08-01

Full Text Available Abstract Background Surgical site infection (SSI continues to be a major source of morbidity and mortality in developing countries despite recent advances in aseptic techniques. There is no baseline information regarding SSI in our setting therefore it was necessary to conduct this study to establish the prevalence, pattern and predictors of surgical site infection at Bugando Medical Centre Mwanza (BMC, Tanzania. Methods This was a cross-sectional prospective study involving all patients who underwent major surgery in surgical wards between July 2009 and March 2010. After informed written consent for the study and HIV testing, all patients who met inclusion criteria were consecutively enrolled into the study. Pre-operative, intra-operative and post operative data were collected using standardized data collection form. Wound specimens were collected and processed as per standard operative procedures; and susceptibility testing was done using disc diffusion technique. Data were analyzed using SPSS software version 15 and STATA. Results Surgical site infection (SSI was detected in 65 (26.0% patients, of whom 56 (86.2% and 9 (13.8% had superficial and deep SSI respectively. Among 65 patients with clinical SSI, 56(86.2% had positive aerobic culture. Staphylococcus aureus was the predominant organism 16/56 (28.6%; of which 3/16 (18.8% were MRSA. This was followed by Escherichia coli 14/56 (25% and Klebsiella pneumoniae 10/56 (17.9%. Among the Escherichia coli and Klebsiella pneumoniae isolates 9(64.3% and 8(80% were ESBL producers respectively. A total of 37/250 (14.8% patients were HIV positive with a mean CD4 count of 296 cells/ml. Using multivariate logistic regression analysis, presence of pre-morbid illness (OR = 6.1, use of drain (OR = 15.3, use of iodine alone in skin preparation (OR = 17.6, duration of operation ≥ 3 hours (OR = 3.2 and cigarette smoking (OR = 9.6 significantly predicted surgical site infection (SSI Conclusion SSI is common

Compliance and Effectiveness of WHO Surgical Safety Check list: A JPMC Audit

OpenAIRE

Anwer, Mariyah; Manzoor, Shahneela; Muneer, Nadeem; Qureshi, Shamim

2016-01-01

Objective: To assess World Health Organization (WHO) Surgical Safety Checklist (SSC), compliance and its effectiveness in reducing complications and final outcome of patients. Methods: This was a prospective study done in Department of General Surgery (Ward 02), Jinnah Postgraduate Medical Centre (JPMC), Karachi. The study included Total 3638 patients who underwent surgical procedure in elective theatre in four years from November 2011 to October 2015 since the SSC was included as part of his...

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.

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

Incidence and risk factors for surgical site infections in obstetric and gynecological surgeries from a teaching hospital in rural India

Directory of Open Access Journals (Sweden)

Ashish Pathak

2017-06-01

Full Text Available Abstract Background Surgical site infections (SSI are one of the most common healthcare associated infections in the low-middle income countries. Data on incidence and risk factors for SSI following surgeries in general and Obstetric and Gynecological surgeries in particular are scare. This study set out to identify risk factors for SSI in patients undergoing Obstetric and Gynecological surgeries in an Indian rural hospital. Methods Patients who underwent a surgical procedure between September 2010 to February 2013 in the 60-bedded ward of Obstetric and Gynecology department were included. Surveillance for SSI was based on the Centre for Disease Control (CDC definition and methodology. Incidence and risk factors for SSI, including those for specific procedure, were calculated from data collected on daily ward rounds. Results A total of 1173 patients underwent a surgical procedure during the study period. The incidence of SSI in the cohort was 7.84% (95% CI 6.30–9.38. Majority of SSI were superficial. Obstetric surgeries had a lower SSI incidence compared to gynecological surgeries (1.2% versus 10.3% respectively. The risk factors for SSI identified in the multivariate logistic regression model were age (OR 1.03, vaginal examination (OR 1.31; presence of vaginal discharge (OR 4.04; medical disease (OR 5.76; American Society of Anesthesia score greater than 3 (OR 12.8; concurrent surgical procedure (OR 3.26; each increase in hour of surgery, after the first hour, doubled the risk of SSI; inappropriate antibiotic prophylaxis increased the risk of SSI by nearly 5 times. Each day increase in stay in the hospital after the surgery increased the risk of contacting an SSI by 5%. Conclusions Incidence and risk factors from prospective SSI surveillance can be reported simultaneously for the Obstetric and Gynecological surgeries and can be part of routine practice in resource-constrained settings. The incidence of SSI was lower for Obstetric surgeries

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

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.

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

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.

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.

Prevalence of malnutrition among older people in medical and surgical wards in hospital and quality of nutritional care: A multicenter, cross-sectional study.

Science.gov (United States)

Bonetti, Loris; Terzoni, Stefano; Lusignani, Maura; Negri, Marina; Froldi, Marco; Destrebecq, Anne

2017-12-01

To determine and compare the prevalence of malnutrition in medical and surgical hospital units; to assess quality of nutritional care and patients' perception about quality of food and nutritional care. Hospital malnutrition in older people leads to increased mortality, length of stay, risk of infections and pressure ulcers. Several studies show that malnutrition is often caused by hospitalisation and related to poor nutritional care. Few studies report data on surgical older patients. A cross-sectional, multicenter study was conducted in 12 hospitals in northern Italy. Malnutrition prevalence was determined according to the Mini Nutritional Assessment full-version. Head nurses were interviewed in 80 units, through a validated questionnaire regarding quality of nutritional care. Semi-structured interviews were administered to a sample of patients, to investigate their perception about quality of food and nutritional care. Two hundred twenty-eight patients of 1,066 were malnourished (21.4%). Medical patients were at higher risk, so were women, patients aged 85 or more, with impaired autonomy, pressure ulcers or taking more than three drugs. The lack of personnel impacts on quality of care: in 55% of the units, no nutritional screening is performed; nutritional history is investigated in 48% only. No protocols for nutritional problems exist in 70% of the wards; hardly ever the intake is measured. Patients are mostly satisfied, even though they report that food has no taste and is not well presented. They remark the need for more personnel. Prevalence was high, as found in other studies. Medical patients were at higher risk. Nutritional care was inadequate, and often no measures were adopted to prevent malnutrition. Staffing should be increased during meals. These findings will provide indications on the strategies needed to overcome such barriers. © 2017 John Wiley & Sons Ltd.

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

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.

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...

Compliance and Effectiveness of WHO Surgical Safety Check list: A JPMC Audit.

Science.gov (United States)

Anwer, Mariyah; Manzoor, Shahneela; Muneer, Nadeem; Qureshi, Shamim

2016-01-01

To assess World Health Organization (WHO) Surgical Safety Checklist (SSC), compliance and its effectiveness in reducing complications and final outcome of patients. This was a prospective study done in Department of General Surgery (Ward 02), Jinnah Postgraduate Medical Centre (JPMC), Karachi. The study included Total 3638 patients who underwent surgical procedure in elective theatre in four years from November 2011 to October 2015 since the SSC was included as part of history sheets in ward. Files were checked to confirm the compliance with regards to filling the three stage checklist properly and complications were noted. In 1st year, out of 840 surgical procedures, SSC was properly marked in 172 (20.4%) cases. In 2nd year, out of 857 surgical procedures 303 (35.3%) cases were marked which increased in 3rd year out of 935 surgical procedures 757 (80.9%) cases and in 4th year out of 932 surgical procedures 838 (89.9%) cases were marked. No significant change in site and side (left or right) complications were noted in all four years. Surgical Site Infection (SSI) was noted in 59 (7.50%), 52 (6.47%), 44 (4.70%) and 20 (2.12%) cases in 1st, 2nd, 3rd and 4th year respectively. SSI in laparoscopic cholecystectomies was 41 (20.8 %), 45 (13%), 20 (5.68%) and 4 (1.12%) in 1st, 2nd, 3rd and 4th year respectively. No significant change in chest complications were noted in all four years. Mortality rate also remained same in all four years. WHO SSC is an effective tool in reducing in-hospital complications thus producing a favorable outcome. Realization its efficacy would improve compliance.

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...

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.

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.

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 ...

The educational value of ward rounds for junior trainees

Directory of Open Access Journals (Sweden)

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.

Surgical site infection following hernia repair in the day care setting of a developing country: a retrospective review

International Nuclear Information System (INIS)

Pardhan, A.; Mazahir, S.; Alvi, A.R.; Murtaza, G.

2013-01-01

Objective: To determine the incidence proportion of surgical site infection following hernia repair in a daycare setting at a tertiary care hospital of a low-income country. Methods: The retrospective audit was done at the Aga Khan University Hospital, Karachi, from June 1, 2008 to May 30, 2009. Patients with age >15 years who underwent Lichenstein's open mesh repair in daycare were included. Surgical Site Infection was labelled if the records revealed any of the following: opening of the wound by the primary surgeon; pain, tenderness and raised temperature of skin; purulent discharge from the wound; if the surgeon had documented it as a surgical site infection. SPSS 16 was used for data analysis. Results: After reviewing the retrieved files, 104 patients were found eligible. Of them, 102 (98%) were males. Overall wound-related complications were found in 13 (12.5%), whereas surgical site infection was found in 8 (7.7%) patients. The mean age of those with infections was 38.7+-18 year, while that of those with no surgical site infection was 47.8+-18 years. Smoking was found significantly associated with surgical site infection with 5.8 times higher incidence as compared to the non-smokers (OR with 95% CI: 5.6 (1.2, 25.3)). Conclusions: The incidence of surgical site infection after hernia repair with mesh in a daycare setting at a tertiary care hospital of a low-income country was higher than internationally reported incidence. Smoking was found to be a significant risk factor. (author)

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

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.

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...

Comprehensive Surgical Coaching Enhances Surgical Skill in the Operating Room: A Randomized Controlled Trial.

Science.gov (United States)

Bonrath, Esther M; Dedy, Nicolas J; Gordon, Lauren E; Grantcharov, Teodor P

2015-08-01

The aim of the study was to determine whether individualized coaching improved surgical technical skill in the operating room to a higher degree than current residency training. Clinical training in the operating room is a valuable opportunity for surgeons to acquire skill and knowledge; however, it often remains underutilized. Coaching has been successfully used in various industries to enhance performance, but its role in surgery has been insufficiently investigated. This randomized controlled trial was conducted at one surgical training program. Trainees undergoing a minimally invasive surgery rotation were randomized to either conventional training (CT) or comprehensive surgical coaching (CSC). CT included ward and operating room duties, and regular departmental teaching sessions. CSC comprised performance analysis, debriefing, feedback, and behavior modeling. Primary outcome measures were technical performance as measured on global and procedure-specific rating scales, and surgical safety parameters, measured by error count. Operative performance was assessed by blinded video analysis of the first and last cases recorded by the participants during their rotation. Twenty residents were randomized and 18 completed the study. At posttraining the CSC group (n = 9) scored significantly higher on a procedure-specific skill scale compared with the CT group (n = 9) [median, 3.90 (interquartile range, 3.68-4.30) vs 3.60 (2.98-3.70), P = 0.017], and made fewer technical errors [10 (7-13) vs 18 (13-21), P = 0.003]. Significant within-group improvements for all skill metrics were only noted in the CSC group. Comprehensive surgical coaching enhances surgical training and results in skill acquisition superior to conventional training.

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.

[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.

Multiple challenges of antibiotic use in a large hospital in Ethiopia - a ward-specific study showing high rates of hospital-acquired infections and ineffective prophylaxis.

Science.gov (United States)

Gutema, Girma; Håkonsen, Helle; Engidawork, Ephrem; Toverud, Else-Lydia

2018-05-03

This project aims to study the use of antibiotics in three clinical wards in the largest tertiary teaching hospital in Ethiopia for a period of 1 year. The specific aims were to assess the prevalence of patients on antibiotics, quantify the antibiotic consumption and identify the main indications of use. The material was all the medical charts (n = 2231) retrieved from three clinical wards (internal medicine, gynecology/obstetrics and surgery) in Tikur Anbessa Specialized Hospital (TASH) in Addis Ababa between September 2013 and September 2014. Data collection was performed manually by four pharmacists. Each medical chart represented one patient. About 60% of the patients were admitted to internal medicine, 20% to each of the other two wards. The number of bed days (BD) was on average 16.5. Antibiotics for systemic use were prescribed to 73.7% of the patients (on average: 2.1 antibiotics/patient) of whom 86.6% got a third or fourth generation cephalosporin (mainly ceftriaxone). The average consumption of antibiotics was 81.6 DDD/100BD, varying from 91.8 in internal medicine and 71.6 in surgery to 47.6 in gynecology/obstetrics. The five most frequently occurring infections were pneumonia (26.6%), surgical site infections (21.5%), neutropenic fever (6.9%), sepsis (6.4%) and urinary tract infections (4.7%). About one fourth of the prescriptions were for prophylactic purposes. Hospital acquired infections occurred in 23.5% of the patients (353 cases of surgical site infection). The prescribing was based on empirical treatment and sensitivity testing was reported in only 3.8% of the cases. In the present study from three wards in the largest tertiary teaching hospital in Ethiopia, three out of four patients were prescribed antibiotics, primarily empirically. The mean antibiotic consumption was 81.6 DDD/100BD. Surgical site infections constituted a large burden of the infections treated in the hospital, despite extensive prescribing of prophylaxis. The findings show

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

Equitable access to comprehensive surgical care: the potential of indigenous private philanthropy in low-income settings.

Science.gov (United States)

Samad, Lubna; Iqbal, Mehreen; Tariq, Ahson; Shahzad, Wasif; Khan, Aamir J

2015-01-01

Equitable access to surgical care is necessary for improving global health. We report on the performance, financial sustainability, and policy impact of a free-of-cost multispecialty surgical delivery program in Karachi, Pakistan built upon local private philanthropy. We evaluated trends in surgical service delivery, expenditures, and philanthropic donations from Indus Hospital's first 5 years of operation (2007-2012), projected these over the hospital's current expansion phase, compared these to publicly accessible records of other philanthropic hospitals providing surgical care, and documented the government's evolving policies toward this model. Between 2007 and 2012, Indus Hospital treated 40,012 in-patients free of cost, 33,606 (84 %) of them for surgical procedures. Surgical procedures increased fivefold to 9,478 during 2011-2012 from 1,838 during 2007-2008. Bed occupancy increased to 91 % from 65 % over the same period. External surgical missions accounted for less than 0.5 % of patients served. Ninety-eight percent (98 %) of all philanthropic donations--totaling USD 26.6 million over 2007-2012--were locally generated. Zakat (obligatory annual religious alms in the Islamic faith) constituted 34 % of all donations, followed by unrestricted funds (24 %) and donations-in-kind (24 %), buildings (12 %), grants (5 %), and return on investments (1 %). Overall, donations received between 2007 and 2012 increased sevenfold, with Zakat increasing 12-fold. During 2013-2014, the Government of Pakistan provided land lease and annual operational grants totaling USD 9 million. Local philanthropy can sustain and grow the provision of free, high-quality surgical care in low-income settings, and encourage the development of hybrid government-philanthropic models of surgical care.

The Relationship between Therapeutic Alliance and Service User Satisfaction in Mental Health Inpatient Wards and Crisis House Alternatives: A Cross-Sectional Study

Science.gov (United States)

Sweeney, Angela; Fahmy, Sarah; Nolan, Fiona; Morant, Nicola; Fox, Zoe; Lloyd-Evans, Brynmor; Osborn, David; Burgess, Emma; Gilburt, Helen; McCabe, Rosemarie; Slade, Mike; Johnson, Sonia

2014-01-01

Background Poor service user experiences are often reported on mental health inpatient wards. Crisis houses are an alternative, but evidence is limited. This paper investigates therapeutic alliances in acute wards and crisis houses, exploring how far stronger therapeutic alliance may underlie greater client satisfaction in crisis houses. Methods and Findings Mixed methods were used. In the quantitative component, 108 crisis house and 247 acute ward service users responded to measures of satisfaction, therapeutic relationships, informal peer support, recovery and negative events experienced during the admission. Linear regressions were conducted to estimate the association between service setting and measures, and to model the factors associated with satisfaction. Qualitative interviews exploring therapeutic alliances were conducted with service users and staff in each setting and analysed thematically. Results We found that therapeutic alliances, service user satisfaction and informal peer support were greater in crisis houses than on acute wards, whilst self-rated recovery and numbers of negative events were lower. Adjusted multivariable analyses suggest that therapeutic relationships, informal peer support and negative experiences related to staff may be important factors in accounting for greater satisfaction in crisis houses. Qualitative results suggest factors that influence therapeutic alliances include service user perceptions of basic human qualities such as kindness and empathy in staff and, at service level, the extent of loss of liberty and autonomy. Conclusions and Implications We found that service users experience better therapeutic relationships and higher satisfaction in crisis houses compared to acute wards, although we cannot exclude the possibility that differences in service user characteristics contribute to this. This finding provides some support for the expansion of crisis house provision. Further research is needed to investigate why acute

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

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.

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.)

The Surgical Nosology In Primary-care Settings (SNIPS): a simple bridging classification for the interface between primary and specialist care

Science.gov (United States)

Gruen, Russell L; Knox, Stephanie; Britt, Helena; Bailie, Ross S

2004-01-01

Background The interface between primary care and specialist medical services is an important domain for health services research and policy. Of particular concern is optimising specialist services and the organisation of the specialist workforce to meet the needs and demands for specialist care, particularly those generated by referral from primary care. However, differences in the disease classification and reporting of the work of primary and specialist surgical sectors hamper such research. This paper describes the development of a bridging classification for use in the study of potential surgical problems in primary care settings, and for classifying referrals to surgical specialties. Methods A three stage process was undertaken, which involved: (1) defining the categories of surgical disorders from a specialist perspective that were relevant to the specialist-primary care interface; (2) classifying the 'terms' in the International Classification of Primary Care Version 2-Plus (ICPC-2 Plus) to the surgical categories; and (3) using referral data from 303,000 patient encounters in the BEACH study of general practice activity in Australia to define a core set of surgical conditions. Inclusion of terms was based on the probability of specialist referral of patients with such problems, and specialists' perception that they constitute part of normal surgical practice. Results A four-level hierarchy was developed, containing 8, 27 and 79 categories in the first, second and third levels, respectively. These categories classified 2050 ICPC-2 Plus terms that constituted the fourth level, and which covered the spectrum of problems that were managed in primary care and referred to surgical specialists. Conclusion Our method of classifying terms from a primary care classification system to categories delineated by specialists should be applicable to research addressing the interface between primary and specialist care. By describing the process and putting the bridging

Prevalence of delirium in hospitalized internal medicine and surgical adult patients in Shohadaye ashayer hospital of Khoram abad

Directory of Open Access Journals (Sweden)

raheleh Asaee

2008-10-01

Full Text Available Asaee R1, Nasari H2,Hoseini S3 1. Assistant professor, Department of Physiology, Faculty of Medicine, Lorestanl University of Medical Sciences, Khorramabad, Iran 1. Assistant professor, Department of Psychiatry, Faculty of Medicine, Lorestanl University of Medical Sciences, Khorramabad, Iran 2. G.P, Khorramabad, Iran Abstract Background: Delirium is common in elderly persons and in hospitalized patients especially after surgical procedures. But many of them are undetected and don’t receive treatment so they involve with increased mortality and morbidity, adverse outcomes, length of hospital stay and mental disability sequels. Unfortunetly , despite the importance of this syndrom , physicians and staff are able to diagnose only one thirth of the patients. Material and methods: In this cross sectional study, 240 inpatiants (120 from surgery ward and 120 from miernal medicine ward from Shohadaye Ashayer hospital of Khorramabad were selected randomly. The diagnostic criteria for delirium were Mini-Mental state examination (MMSE questionnaire, and patients daily examination for 4 days by MMSE. Results: Delirium was observed in 37 (30.8% of the patients of internal medicine ward and 25 (20.8% of the patients of surgery ward. 27 (22.5% of the patients of internal medicine ward and 37 (30.8% of the patients of surgery ward were suspicious for delirium. In age group of 58-77 years in surgery ward and patients over 77 years in internal medicine ward had the most frequency of delirium. There was significant relationship (p=0.01 between two sex in surgery ward. But there was not significant difference (p=0.92 between two sex in internal medicine ward for delirium. Conclusion: Reading the results of this study and frequency of delirum in surgery and internal medicine wards, presence of a psychiatrist in mentioned wards is necessary of early diagnosis and control of delirium.

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

Non-perturbative construction of the Luttinger-Ward functional

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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.

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.

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.

Words in Maternity Wards: An Aproximation to Perinatal Psychology

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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”. 

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

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...

Surgical nurse: his leadership style with nursing auxiliary personnel

OpenAIRE

Galvão, Cristina Maria; Trevizan, Maria Auxiliadora; Okino Sawada, Namie

2008-01-01

This investigation as carried out in order to promote follow-up in the studies concerning nurse`s leadership in the hospital context. Emphasys is given to the nurses that works in surgical ward unities. As a theoretical framework, authors utilized the model of leadership proposed by Hersey na Blanchard, named Situational Leadership. The objective was to analyze the correspondence of opinion between nurses and nursing auxiliary personnel about the leadership style of nurse should adopt in acco...

Healthcare Quality Improvement and 'work engagement'; concluding results from a national, longitudinal, cross-sectional study of the 'Productive Ward-Releasing Time to Care' Programme.

Science.gov (United States)

White, Mark; Butterworth, Tony; Wells, John Sg

2017-08-01

Concerns about patient safety and reducing harm have led to a particular focus on initiatives that improve healthcare quality. However Quality Improvement (QI) initiatives have in the past typically faltered because they fail to fully engage healthcare professionals, resulting in apathy and resistance amongst this group of key stakeholders. Productive Ward: Releasing Time to Care (PW) is a ward-based QI programme created to help ward-based teams redesign and streamline the way that they work; leaving more time to care for patients. PW is designed to engage and empower ward-based teams to improve the safety, quality and delivery of care. The main objective of this study was to explore whether PW sustains the 'engagement' of ward-based teams by examining the longitudinal effect that the national QI programme had on the 'work-engagement' of ward-based teams in Ireland. Utilising the Utrecht Work Engagement Scale questionnaire (UWES-17), we surveyed nine PW (intervention) sites from typical acute Medical/Surgical, Rehabilitation and Elderly services (representing the entire cohort of a national phase of PW implementation in Ireland) and a cohort of matched control sites. The numbers surveyed from the PW group at T1 (up to 3 months after commencing the programme) totalled 253 ward-team members and 249 from the control group. At T2 (12 months later), the survey was repeated with 233 ward-team members from the PW sites and 236 from the control group. Overall findings demonstrated that those involved in the QI initiative had higher 'engagement' scores at T1 and T2 in comparison to the control group. Total 'engagement' score (TES), and its 3 dimensions, were all significantly higher in the PW group at T1, but only the Vigour dimension remained significantly higher at T2 (p = 0.006). Our results lend some support to the assertions of the PW initiative itself and suggest that when compared to a control group, ward-based teams involved in the QI programme are more likely

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

Management experience of surgical complications of dengue fever patients at hameed latif hospital, Lahore

International Nuclear Information System (INIS)

Ahmad, F.

2012-01-01

Objective: This study was designed to determine the frequency, pattern and management of surgical complications among patients with dengue fever. Design: Cross sectional study design was used. Settings: Hameed Latif Hospital, Lahore. Methods: From March - 2009 to December - 2011 total of 875 patients of dengue fever with positive anti-dengue immunoglobulin M (IgM) serology were included in this study. Complete blood count, liver function test, blood urea, serum creatinin, serum amylase were determined in all patients admitted with the diagnosis of dengue fever. All the patients were evaluated for the presence of surgical complications by physical examination and real time ultrasound abdomen. Patient had CT - abdomen and brain where it was required. Patients having surgical complications were managed in dengue ward and ICU with multidisciplinary approach. Data entry and analysis was done by using SPSS 16. Results: Among 875 patients with dengue fever, 491 (43.9%) patients were men and 384 (48.9%) were women with age range (18 - 70) years. Surgical complications were detected in 121 (13.8%) patients: acute cholecystitis in 46 (5.26%); acute pancreatitis in 19 (2.17%); injection abscess in 14 (1.6%); gastrointestinal bleed in 24 (2.74%); forearm compartment syndrome in 3 (0.34%); abdominal compartment syndrome in 2 (0.23%) and acute appendicitis, 4 (0.46%) patients. Cerebral bleed, retroperitoneal hematoma, abdominal wall hematoma and splenic rupture was seen among 3 (0.34%), 2 (0.23%), 3 (0.34%), and 1 (0.11%) patients, respectively. Out of 121 patients surgery was done in 20 (16.5%) patients while rest of 101 (83.5%) patients were managed conservatively. Two patients died. Conclusion: Surgical complications are common and should be suspected in every patient with dengue fever. Majority of surgical manifestations of dengue fever were managed conservatively however surgical intervention was done in certain cases with favorable outcome. (author)

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.

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

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...

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.

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.

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.

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.

Information transfer and communication during the morning rounds in surgical departments: an observational study on the use of SBAR.

NARCIS (Netherlands)

Merten, H.; Langelaan, M.; Wagner, C.

2013-01-01

Objectives: To study the structure and completeness of the information transfer between nurses and physicians during the morning rounds on surgical wards after the implementation of the SBAR-communication tool. Methods: in collaboration with the care professionals, we adjusted the SBAR-tool

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 ...

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.

Anatomy and Physiology. Module Set II: Major Body Systems. Teacher Edition [and] Student Edition. Surgical Technology.

Science.gov (United States)

Hilley, Robert

This document, which is the second part of a two-part set of modules on anatomy and physiology for future surgical technicians, contains the teacher and student editions of an introduction to anatomy and physiology that consists of modules on the following body systems: integumentary system; skeletal system; muscular system; nervous system;…

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.

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.

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 ...

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

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…

Mortality pattern in otorhinolaryngology ward: A 5 years retrospective study at an urban tertiary health care center in India.

Science.gov (United States)

Kumar, Vivek; Kumar, Satish; Chandra Sharma, Naresh; Kumar, Badal

2017-10-01

To recognize deaths in the otorhinolaryngology indoor wards, determine the reason behind the mortalities and recommend modifications for betterment of patient care and surgical outcomes. Data was collected from the mortality register, operation theatre registers, ward registers and case notes of patients declared dead at an urban tertiary health care center in India for a period of 5 years; from January 2012 to December 2016. The data included date of admission, age, sex, educational status, residence, and clinical diagnosis, course of hospital stay and medical cause of death. Data acquired was reviewed and statistically interpreted and presented in graphical and descriptive formats. 6157 admissions were made in otorhinolaryngology (ENT) ward in the 5 year period which included 3969 males and 2188 female patients. 58 deaths were recorded during this period which gives overall death per admission crude mortality rate of 9.42% at an average of about 12 (11.60) deaths per year. The major causes of death were malignancy and septicemia. The significance of health education, aggressive healthcare campaigns, enhancement of healthcare services and wide accessibility of healthcare services to remote areas has been emphasized. Role of structured study and protocols in the management of serious cases is highlighted along with the need for prompt referral and better interdepartmental cooperation. Copyright © 2017 Chang Gung University. Published by Elsevier B.V. All rights reserved.

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...

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…

Factors contributing to fecal incontinence in older people and outcome of routine management in home, hospital and nursing home settings

Directory of Open Access Journals (Sweden)

Asangaedem Akpan

2007-04-01

Full Text Available Asangaedem Akpan1,2,3, Margot A Gosney2, James Barrett3,4, 1Directorate of Medicine and Elderly Care, Warrington Hospital, Warrington, Cheshire, UK; 2School of Food Biosciences, The University of Reading, Whiteknights, Reading, UK; 3Liverpool John Moores University, Liverpool, UK; 4Directorate of Elderly Medicine and Rehabilitation, Clatterbridge Hospital, Merseyside, UKObjective: Fecal loading, cognitive impairment, loose stools, functional disability, comorbidity and anorectal incontinence are recognized as factors contributing to loss of fecal continence in older adults. The objective of this project was to assess the relative distribution of these factors in a variety of settings along with the outcome of usual management. Methods: One hundred and twenty adults aged 65 years and over with fecal incontinence recruited by convenience sampling from four different settings were studied. They were either living at home or in a nursing home or receiving care on an acute or rehabilitation elderly care ward. A structured questionnaire was used to elicit which factors associated with fecal incontinence were present from subjects who had given written informed consent or for whom assent for inclusion in the study had been obtained.Results: Fecal loading (Homes 6 [20%]; Acute care wards 17 [57%]; Rehabilitation wards 19 [63%]; Nursing homes 21 [70%] and functional disability (Homes 5 [17%]; Acute care wards 25 [83%]; Rehabilitation wards 25 [83%]; Nursing homes 20 [67%] were significantly more prevalent in the hospital and nursing home settings than in those living at home (P < 0.01. Loose stools were more prevalent in the hospital setting than in the other settings (Homes 11 [37%]; Acute care wards 20 [67%]; Rehabilitation wards 17 [57%]; Nursing homes 6 [20%] (P < 0.01. Cognitive impairment was significantly more common in the nursing home than in the other settings (Nursing homes 26 [87%], Homes 5 [17%], Acute care wards 13 [43%], Rehabilitation

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.

PRE-OPERATIVE HAIR REMOVAL WITH TRIMMERS AND RAZORS AND ITS IMPACT ON SURGICAL SITE INFECTIONS IN ELECTIVE INGUINAL HERNIA REPAIR

Directory of Open Access Journals (Sweden)

John S. Kurien

2018-02-01

Full Text Available BACKGROUND Despite major advances in infection control interventions, health care-associated infections (HAI remain a major public health problem and patient safety threat worldwide. The global data suggests that the SSI incidence rate varies from 0.5 to 20% depending upon the type of operation and underlying patient status. Several factors preoperative, intraoperative & postoperative, determine the occurrence of surgical site infections, Preoperative hair removal is considered as a risk for the development of surgical site infections. The objective of the study is to find out the difference in the incidence of surgical site infections in patients undergoing pre-operative hair removal by shaving with Razor blades and hair trimmers prior to elective inguinal hernia surgery. MATERIALS AND METHODS Written informed consent from 160 patients with no significant comorbidities planning to undergo elective inguinal hernia surgery at the general surgery wards in Government Medical College Kottayam and who were willing to participate in the study were to be obtained. 80 of them to undergo pre-operative hair removal with hair trimmers and 80 to undergo preoperative hair removal by shaving with razor blades on the day prior to the surgery randomised into two groups. During their stay in the postoperative ward the surgical wounds of the patients were examined daily for the development of erythema, pain, discharge, induration and gaping of the wound. The daily findings were noted down till the patient was discharged from the ward. The patients were again reassessed 2 weeks later, when they came for review in the Surgery OPD after their discharge from the ward; finally the patients were examined on the 30th day post-surgery to look for the clinical features of surgical site infections. RESULTS Out of the total 160 patients who were studied, 29 (18.1% of them had post-operative infection within 30 days, in the form of erythema, induration, discharge and gaping

The evaluation of a framework for measuring the non-technical ward round skills of final year nursing students: An observational study.

Science.gov (United States)

Murray, Kara; McKenzie, Karen; Kelleher, Michael

2016-10-01

The importance of non-technical skills (NTS) to patient outcomes is increasingly being recognised, however, there is limited research into how such skills can be taught and evaluated in student nurses in relation toward rounds. This pilot study describes an evaluation of a NTS framework that could potentially be used to measure ward round skills of student nurses. The study used an observational design. Potential key NTS were identified from existing literature and NTS taxonomies. The proposed framework was then used to evaluate whether the identified NTS were evident in a series of ward round simulations that final year general nursing students undertook as part of their training. Finally, the views of a small group of qualified nurse educators, qualified nurses and general nursing students were sought about whether the identified NTS were important and relevant to practice. The proposed NTS framework included seven categories: Communication, Decision Making, Situational Awareness, Teamwork and Task Management, Student Initiative and Responsiveness to Patient. All were rated as important and relevant to practice. The pilot study suggests that the proposed NTS framework could be used as a means of evaluating student nurse competencies in respect of many non-technical skills required for a successful ward round. Further work is required to establish the validity of the framework in educational settings and to determine the extent to which it is of use in a non-simulated ward round setting. Copyright © 2016 Elsevier Ltd. All rights reserved.

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.

[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.

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.

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 ...

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.

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.

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.

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.

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.

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.

[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.

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.

Feasibility of using the International Classification of Functioning, Disability and Health Core Set for evaluation of fall-related risk factors in acute rehabilitation settings.

Science.gov (United States)

Huang, Shih W; Lin, Li F; Chou, Lin C; Wu, Mei J; Liao, Chun D; Liou, Tsan H

2016-04-01

Previously, we reported the use of an International Classification of Functioning (ICF) core set that can provide a holistic framework for evaluating the risk factors of falls; however, data on the feasibility of applying this core set are lacking. To investigate the feasibility of applying the fall-related ICF risk-factor core set in the case of patients in an acute-rehabilitation setting. A cross-sectional and descriptive correlational design. Acute-rehabilitation ward. A total of 273 patients who experienced fall at acute-rehabilitation ward. The data on falls were collected from the hospital's Nursing Information System (NIS) and the fall-reporting system (Adverse Event Reporting System, AERS) between 2010 and 2013. The relationship of both systems to the fall-related ICF core set was analyzed to assess the feasibility of their clinical application. We evaluated the feasibility of using the fall-related ICF risk-factor core set by using the frequency and the percentage of the fall patients in of the listed categories. The fall-related ICF risk-factor core set category b735 (muscle tone functions) exhibited a high feasibility (85.95%) for clinical application, and the category b730 (muscle power functions) covered 77.11% of the patients. The feasibility of application of the category d410 (change basic body position) was also high in the case of all fall patients (81.69%). In the acute-rehabilitation setting, the feasibility of application of the fall-related ICF risk-factor core set is high. The fall-related ICF risk-factor core set can help multidisciplinary teams develop fall-prevention strategies in acute rehabilitation wards.

The consequences of using advanced physical assessment skills in medical and surgical nursing: A hermeneutic pragmatic study.

Science.gov (United States)

Zambas, Shelaine I; Smythe, Elizabeth A; Koziol-Mclain, Jane

2016-01-01

The aim of this study was to explore the consequences of the nurse's use of advanced assessment skills on medical and surgical wards. Appropriate, accurate, and timely assessment by nurses is the cornerstone of maintaining patient safety in hospitals. The inclusion of "advanced" physical assessment skills such as auscultation, palpation, and percussion is thought to better prepare nurses for complex patient presentations within a wide range of clinical situations. This qualitative study used a hermeneutic pragmatic approach. Unstructured interviews were conducted with five experienced medical and surgical nurses to obtain 13 detailed narratives of assessment practice. Narratives were analyzed using Van Manen's six-step approach to identify the consequences of the nurse's use of advanced assessment skills. The consequences of using advanced assessment skills include looking for more, challenging interpretations, and perseverance. The use of advanced assessment skills directs what the nurse looks for, what she sees, interpretation of the findings, and her response. It is the interpretation of what is seen, heard, or felt within the full context of the patient situation, which is the advanced skill. Advanced assessment skill is the means to an accurate interpretation of the clinical situation and contributes to appropriate diagnosis and medical management in complex patient situations. The nurse's use of advanced assessment skills enables her to contribute to diagnostic reasoning within the acute medical and surgical setting.

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.

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

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Lewin, Simon; Reeves, Scott

2011-05-01

Interprofessional teamwork is widely advocated in health and social care policies. However, the theoretical literature is rarely employed to help understand the nature of collaborative relations in action or to critique normative discourses of teamworking. This paper draws upon Goffman's (1963) theory of impression management, modified by Sinclair (1997), to explore how professionals 'present' themselves when interacting on hospital wards and also how they employ front stage and backstage settings in their collaborative work. The study was undertaken in the general medicine directorate of a large NHS teaching hospital in England. An ethnographic approach was used, including interviews with 49 different health and social care staff and participant observation of ward-based work. These observations focused on both verbal and non-verbal interprofessional interactions. Thematic analysis of the data was undertaken. The study findings suggest that doctor-nurse relationships were characterised by 'parallel working', with limited information sharing or effective joint working. Interprofessional working was based less on planned, 'front stage' activities, such as wards rounds, than on ad hoc backstage opportunistic strategies. These backstage interactions, including corridor conversations, allowed the appearance of collaborative 'teamwork' to be maintained as a form of impression management. These interactions also helped to overcome the limitations of planned front stage work. Our data also highlight the shifting 'ownership' of space by different professional groups and the ways in which front and backstage activities are structured by physical space. We argue that the use of Sinclair's model helps to illuminate the nature of collaborative interprofessional relations within an acute care setting. In such settings, the notion of teamwork, as a form of regular interaction and with a shared team identity, appears to have little relevance. This suggests that interventions to

Improving patient and carer communication, multidisciplinary team working and goal-setting in stroke rehabilitation.

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Monaghan, J; Channell, K; McDowell, D; Sharma, A K

2005-03-01

To determine the extent to which three forms of multidisciplinary team (MDT) care in stroke rehabilitation meet the standards set by the United Kingdom National Service Framework (NSF). Consecutive assessment of the three forms of care was completed. The study included three groups of 25 stroke inpatients on the stroke rehabilitation ward. (1) A standard weekly MDT meeting using a standard form for documentation; (2) a standard MDT meeting using a newly devised form; and (3) a novel MDT ward round using the new form, and attended by doctors. MDT ward rounds result in significantly better consideration of patients' needs (median 7 per patient compared with 0 and 5 in phases one and two), enhanced SMART (specific, measurable, achievable, realistic and time framed) goal-setting (median 3 per patient compared to 1 in phases one and two); greater patient involvement (12 patients compared to 0 and 4 in phases one and two); and improved team working (measured using the team climate inventory) than do MDT meetings. In the present study, standard weekly MDT meetings did not meet the standards set for MDT care by the NSF. The use of a MDT ward round allows these standards to be achieved.

An outbreak of Burkholderia stabilis colonization in a nasal ward.

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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.

Ward Identity and Scattering Amplitudes for Nonlinear Sigma Models

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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.

Automated hand hygiene auditing with and without an intervention.

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Kwok, Yen Lee Angela; Juergens, Craig P; McLaws, Mary-Louise

2016-12-01

Daily feedback from continuous automated auditing with a peer reminder intervention was used to improve compliance. Compliance rates from covert and overt automated auditing phases with and without intervention were compared with human mandatory audits. An automated system was installed to covertly detect hand hygiene events with each depression of the alcohol-based handrub dispenser for 5 months. The overt phase included key clinicians trained to share daily rates with clinicians, set compliance goals, and nudge each other to comply for 6 months. During a further 6 months, the intervention continued without being refreshed. Hand Hygiene Australia (HHA) human audits were performed quarterly during the intervention in accordance with the World Health Organization guidelines. Percentage point (PP) differences between compliance rates were used to determine change. HHA rates for June 2014 were 85% and 87% on the medical and surgical wards, respectively. These rates were 55 PPs and 38 PPs higher than covert automation rates for June 2014 on the medical and surgical ward at 30% and 49%, respectively. During the intervention phase, average compliance did not change on the medical ward from their covert rate, whereas the surgical ward improved compared with the covert phase by 11 PPs to 60%. On average, compliance during the intervention without being refreshed did not change on the medical ward, whereas the average rate on the surgical ward declined by 9 PPs. Automation provided a unique opportunity to respond to daily rates, but compliance will return to preintervention levels once active intervention ceases or human auditors leave the ward, unless clinicians are committed to change. Crown Copyright © 2016. Published by Elsevier Inc. All rights reserved.

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

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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.

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

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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.

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)

The introduction of an acute physiological support service for surgical patients is an effective error reduction strategy.

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Clarke, D L; Kong, V Y; Naidoo, L C; Furlong, H; Aldous, C

2013-01-01

Acute surgical patients are particularly vulnerable to human error. The Acute Physiological Support Team (APST) was created with the twin objectives of identifying high-risk acute surgical patients in the general wards and reducing both the incidence of error and impact of error on these patients. A number of error taxonomies were used to understand the causes of human error and a simple risk stratification system was adopted to identify patients who are particularly at risk of error. During the period November 2012-January 2013 a total of 101 surgical patients were cared for by the APST at Edendale Hospital. The average age was forty years. There were 36 females and 65 males. There were 66 general surgical patients and 35 trauma patients. Fifty-six patients were referred on the day of their admission. The average length of stay in the APST was four days. Eleven patients were haemo-dynamically unstable on presentation and twelve were clinically septic. The reasons for referral were sepsis,(4) respiratory distress,(3) acute kidney injury AKI (38), post-operative monitoring (39), pancreatitis,(3) ICU down-referral,(7) hypoxia,(5) low GCS,(1) coagulopathy.(1) The mortality rate was 13%. A total of thirty-six patients experienced 56 errors. A total of 143 interventions were initiated by the APST. These included institution or adjustment of intravenous fluids (101), blood transfusion,(12) antibiotics,(9) the management of neutropenic sepsis,(1) central line insertion,(3) optimization of oxygen therapy,(7) correction of electrolyte abnormality,(8) correction of coagulopathy.(2) CONCLUSION: Our intervention combined current taxonomies of error with a simple risk stratification system and is a variant of the defence in depth strategy of error reduction. We effectively identified and corrected a significant number of human errors in high-risk acute surgical patients. This audit has helped understand the common sources of error in the general surgical wards and will inform

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

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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...

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

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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

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

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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.

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

[Evaluations by hospital-ward physicians of patient care management quality for patients hospitalized after an emergency department admission].

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Bartiaux, M; Mols, P

2017-01-01

patient management in the acute and sub-acute setting of an Emergency Department is challenging. An assessment of the quality of provided care enables an evaluation of failings. It contributes to the identification of areas for improvement. to obtain an analysis, by hospital-ward physicians, of adult patient care management quality, as well as of the correctness of diagnosis made during emergency admissions. To evaluate the consequences of inadequate patient care management on morbidity, mortality and cost and duration of hospitalization. prospective data analysis obtained between the 1/12/2009 and the 21/12/2009 from physicians using a questionnaire on adult-patient emergency admissions and subsequent hospitalization. questionnaires were completed for 332 patients. Inadequate management of patient care were reported for 73/332 (22 %) cases. Incorrect diagnoses were reported for 20/332 (6 %) cases. 35 cases of inadequate care management (10.5 % overall) were associated with morbidity (34 cases) or mortality (1 case), including 4 cases (1.2 % ) that required emergency intensive-care or surgical interventions. this quality study analyzed the percentage of patient management cases and incorrect diagnoses in the emergency department. The data for serious outcome and wrong diagnosis are comparable with current literature. To improve performance, we consider the process for establishing a diagnosis and therapeutic care.

Workplace learning: an analysis of students' expectations of learning on the ward in the Department of Internal Medicine.

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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

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

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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...

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

Improving clinical handover in a paediatric ward: implications for nursing management.

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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.

Prevalence and Antibiogram of Microbial Agents Causing Nosocomial Urinary Tract Infection in Surgical Ward of Dhaka Medical College Hospital

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Tashmin Afroz Binte Islam

2016-05-01

Full Text Available Background: Nosocomial infections pose substantial risk to patients receiving care in hospitals. In Bangladesh, this problem is aggravated by inadequate infection control due to poor hygiene, resource and structural constraints and lack of awareness regarding nosocomial infections. Objective: We carried out this study to determine the prevalence of different microorganisms from urine in surgery ward and antimicrobial susceptibility pattern against various antibiotics. Materials and Methods: This cross sectional study was carried out in Department of Microbiology, Dhaka Medical College, Dhaka over a period of 12 months from July 2011 to June 2012. A total of 52 urine specimens were collected from catheterized patients admitted in general surgery ward of Dhaka Medical College Hospital (DMCH and incubated in blood agar, MacConkey agar media and the isolates were identified by different biochemical tests – oxidase test and reaction in MIU (motility indole urease and Simmon’s citrate and TSI (triple sugar iron media. ESBL producers were detected by double-disk synergy test (DDST. Results: Bacteria were isolated from 35 specimens and Escherichia coli was the commonest isolate (23, 65.71% followed by Pseudomonas aeruginosa 6 (17.14%, Klebsiella pneumoniae 3 (8.57%, Acinetobacter baumannii 2 (5.72% and Proteus vulgaris 1 (2.86% respectively. Among the isolates, 10 (28.57% ESBL producers were detected and the highest ESBL production was observed in Escherichia coli (8, 22.85% followed by Klebsiella pneumoniae 1 (2.86% and Pseudomonas aeruginosa 1 (2.86%. The isolates were resistant to most of the commonly used antimicrobial agents. Conclusion: The emergence of multi-drug resistant (MDR bacteria poses a difficult task for physicians who have limited therapeutic options. However, the high rate of nosocomial infections and multi-resistant pathogens necessitate urgent comprehensive interventions of infection control.

Rolling out Productive Ward foundation modules across a hospital trust.

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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.

Bush animal attacks: management of complex injuries in a resource-limited setting

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Mitchell Katrina B

2011-12-01

Full Text Available Abstract Introduction Though animal-related injuries and fatalities have been documented throughout the world, the variety of attacks by wild animals native to rural East Africa are less commonly described. Given the proximity of our northwestern Tanzania hospital to Lake Victoria, Lake Tanganyika, and the Serengeti National Park, and presentation of several patients attacked by bush animals and suffering a variety of complex injuries, we sought to report the pattern of attacks and surgical management in a resource-limited setting. Materials and methods Four patients who were admitted to the northwestern Tanzania tertiary referral hospital, Bugando Medical Centre (BMC, in 2010-2011 suffered attacks by different bush animals: hyena, elephant, crocodile, and vervet monkey. These patients were triaged as trauma patients in the Casualty Ward, then admitted for inpatient monitoring and treatment. Their outcomes were followed to discharge. Results The age and gender of the patients attacked was variable, though all but the pediatric patient were participating in food gathering or guarding activities in rural locations at the time of the attacks. All patients required surgical management of their injuries, which included debridement and closure of wounds, chest tube insertion, amputation, and external fixation of an extremity fracture. All patients survived and were discharged home. Discussion Though human injuries secondary to encounters with undomesticated animals such as cows, moose, and camel are reported, they often are indirect traumas resulting from road traffic collisions. Snake attacks are well documented and common. However, this series of unique bush animal attacks describes the initial and surgical management of human injuries in the resource-limited setting of the developing world. Conclusion Animal attacks are common throughout the world, but their pattern may vary in Africa throughout jungle and bush environmental settings. It is

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

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

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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.

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.

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

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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.

SURGICAL TREATMENT OF TROCHANTERIC FRACTURES BY GAMMA3 NAIL

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Aleksandar Vukićević

2010-09-01

Full Text Available Fractures of the greater trochanter rank amongst severe injuries of bone tissue. They occur most frequently in patients over 65 years of age, nearly all of whom are diagnosed with osteoporosis. Non-surgical treatment does not prove to be satisfactory and results in high mortality rate. Surgical treatment is a method of fracture treatment of the trochanteric region, which enables early activation and thus prevents numerous complications in bedridden patients. Gamma3 nails are one of the most state-of-the-art implants for trochanteric fracture fixation. The implant is easy to embed, which does not require a large surgical team. This implant embedding requires the least invasive surgery and complications are rare.This paper describes 47 patients who received surgical treatment and is focused on the first nine months of 2009. The patients were treated at the Orthopaedics Ward of Health Centre Valjevo. They were in their seventies, average age: 72.21 years, with female sex prevailing (63.82%. The outcome was as follows: excellent in 65.96%, good in 17.02% and satisfactory in 4.25% of patients. Surface infections occurred in 6.38% of patients. One implant broke.We had one death outcome in the early post-surgical treatment.Surgical treatment of trochanteric fractures by Gamma3 implants proved very effective as it resulted in few complications and numerous excellent functional and anatomic outcomes. Thus we recommend it as an option when decision on treatment of this type of fractures is made.

Mobile surgical skills education unit: a new concept in surgical training.

Science.gov (United States)

Shaikh, Faisal M; Hseino, Hazem; Hill, Arnold D K; Kavanagh, Eamon; Traynor, Oscar

2011-08-01

Basic surgical skills are an integral part of surgical training. Simulation-based surgical training offers an opportunity both to trainees and trainers to learn and teach surgical skills outside the operating room in a nonpatient, nonstressed environment. However, widespread adoption of simulation technology especially in medical education is prohibited by its inherent higher cost, limited space, and interruptions to clinical duties. Mobile skills laboratory has been proposed as a means to address some of these limitations. A new program is designed by the Royal College of Surgeons in Ireland (RCSI), in an approach to teach its postgraduate basic surgical trainees the necessary surgical skills, by making the use of mobile innovative simulation technology in their own hospital settings. In this article, authors describe the program and students response to the mobile surgical skills being delivered in the region of their training hospitals and by their own regional consultant trainers.

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.

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

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.

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.

Acquiring minimally invasive surgical skills

OpenAIRE

Hiemstra, Ellen

2012-01-01

Many topics in surgical skills education have been implemented without a solid scientific basis. For that reason we have tried to find this scientific basis. We have focused on training and evaluation of minimally invasive surgical skills in a training setting and in practice in the operating room. This thesis has led to an enlarged insight in the organization of surgical skills training during residency training of surgical medical specialists.

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.)

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.)

The da vinci robot system eliminates multispecialty surgical trainees' hand dominance in open and robotic surgical settings.

Science.gov (United States)

Badalato, Gina M; Shapiro, Edan; Rothberg, Michael B; Bergman, Ari; RoyChoudhury, Arindam; Korets, Ruslan; Patel, Trushar; Badani, Ketan K

2014-01-01

Handedness, or the inherent dominance of one hand's dexterity over the other's, is a factor in open surgery but has an unknown importance in robot-assisted surgery. We sought to examine whether the robotic surgery platform could eliminate the effect of inherent hand preference. Residents from the Urology and Obstetrics/Gynecology departments were enrolled. Ambidextrous and left-handed subjects were excluded. After completing a questionnaire, subjects performed three tasks modified from the Fundamentals of Laparoscopic Surgery curriculum. Tasks were performed by hand and then with the da Vinci robotic surgical system (Intuitive Surgical, Sunnyvale, California). Participants were randomized to begin with using either the left or the right hand, and then switch. Left:right ratios were calculated from scores based on time to task completion. Linear regression analysis was used to determine the significance of the impact of surgical technique on hand dominance. Ten subjects were enrolled. The mean difference in raw score performance between the right and left hands was 12.5 seconds for open tasks and 8 seconds for robotic tasks (Probot tasks, respectively (Probotic and open approaches for raw time scores (Phand, prior robotic experience, and comfort level. These findings remain to be validated in larger cohorts. The robotic technique reduces hand dominance in surgical trainees across all task domains. This finding contributes to the known advantages of robotic surgery.

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

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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.

Barriers to implementing the Sepsis Six guidelines in an acute hospital setting.

Science.gov (United States)

Breen, Sarah-Jane; Rees, Sharon

2018-05-10

To identify the barriers to implementation of the Sepsis Six pathway. Research has suggested that compliance with the Sepsis Six pathway remains low. A convenience sample of doctors and nurses from one emergency department, two medical wards and two surgical wards were asked to complete a survey questionnaire. Data from 108 respondents were available for analysis. Doctors and nurses agreed that lack of sepsis recognition during observation rounds and failure to associate sepsis with deranged temperature and blood results acted as barriers to the identification of sepsis. Doctors and nurses agreed that nursing delays and knowledge deficits were the top barriers leading to delay in sepsis treatment. Knowledge deficits, lack of resources and practical issues were barriers identified in this survey. This will inform the educational and process needs of both doctors and nurses in order to improve sepsis care.

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.

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.

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.)

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.

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.

Effect of communication skill training using group psychoeducation method on the stress level of psychiatry ward nurses.

Science.gov (United States)

Ghazavi, Zahra; Lohrasbi, Fatemeh; Mehrabi, Tayebeh

2010-12-01

Nursing is a dynamic and supportive job, with the main role of taking care of patients. Maintaining appropriate communication of the nurse with the patients is particularly known as the main core of care in mental health. However, in spite of the importance of providing communication, one of the main sources of stress in nurses of psychiatry wards is communication with the patients. Some important reasons for inappropriate relationship between the nurse and patient can be lack of necessary skills to communicate with patients because of insufficient training. Although training communication skills is an important part of the education of medical and paramedical students, in recent studies it has been demonstrated that the communication skills learned in theoretical courses would not necessarily be transferred to clinical settings, and proving training in clinical settings is a must. The present study was carried out to determine the effect of training communication skills using psychoeducation method on the stress level of nurses of psychiatry wards in 2010. This is a quasi-experimental study. The participants were 45 nurses; 23 and 22 in the experiment and control groups, respectively, working in psychiatry wards of Noor and Farabi hospitals, Isfahan, Iran. The sampling was carried out by the census method, and then the participants were randomly assigned to the two groups of experiment and control, using random number table. The two groups filled out the demographic data form and also the questionnaire on nurses' occupational stress, designed by the researcher. The questionnaire was filled out three times; before, immediately after, and one month after the training. Training of communication skills was carried out using group psychoeducation method, in six sessions, each lasted for 1.5 hours. The training sessions of the experiment group were held in Farabi Hospital. The findings indicated that before the intervention, the members of the two groups had a high

Every antibiotic, every day: Maximizing the impact of prospective audit and feedback on total antibiotic use.

Science.gov (United States)

Campbell, Tonya J; Decloe, Melissa; Gill, Suzanne; Ho, Grace; McCready, Janine; Powis, Jeff

2017-01-01

The success of antimicrobial stewardship is dependent on how often it is completed and which antimicrobials are targeted. We evaluated the impact of an antimicrobial stewardship program (ASP) in three non-ICU settings where all systemic antibiotics, regardless of spectrum, were targeted on the first weekday after initiation. Prospective audit and feedback (PAAF) was initiated on the surgical, respiratory, and medical wards of a community hospital on July 1, 2010, October 1, 2010, and April 1, 2012, respectively. We evaluated rates of total antibiotic use, measured in days on therapy (DOTs), among all patients admitted to the wards before and after PAAF initiation using an interrupted time series analysis. Changes in antibiotic costs, rates of C. difficile infection (CDI), mortality, readmission, and length of stay were evaluated using univariate analyses. Time series modelling demonstrated that total antibiotic use decreased (± standard error) by 100 ± 51 DOTs/1,000 patient-days on the surgical wards (p = 0.049), 100 ± 46 DOTs/1,000 patient-days on the respiratory ward (p = 0.029), and 91 ± 33 DOTs/1,000 patient-days on the medical wards (p = 0.006) immediately following PAAF initiation. Reductions in antibiotic use were sustained up to 50 months after intervention initiation, and were accompanied by decreases in antibiotic costs. There were no significant changes to patient outcomes on the surgical and respiratory wards following intervention initiation. On the medical wards, however, readmission increased from 4.6 to 5.6 per 1,000 patient-days (p = 0.043), while mortality decreased from 7.4 to 5.0 per 1,000 patient-days (p = 0.001). CDI rates showed a non-significant declining trend after PAAF initiation. ASPs can lead to cost-effective, sustained reductions in total antibiotic use when interventions are conducted early in the course of therapy and target all antibiotics. Shifting to such a model may help strengthen the effectiveness of ASPs in non

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.

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.

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.

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.

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

Leadership set-up

DEFF Research Database (Denmark)

Thude, Bettina Ravnborg; Stenager, Egon; von Plessen, Christian

2018-01-01

. Findings: The study found that the leadership set-up did not have any clear influence on interdisciplinary cooperation, as all wards had a high degree of interdisciplinary cooperation independent of which leadership set-up they had. Instead, the authors found a relation between leadership set-up and leader...... could influence legitimacy. Originality/value: The study shows that leadership set-up is not the predominant factor that creates interdisciplinary cooperation; but rather, leader legitimacy also should be considered. Additionally, the study shows that leader legitimacy can be difficult to establish...... and that it cannot be taken for granted. This is something chief executive officers should bear in mind when they plan and implement new leadership structures. Therefore, it would also be useful to look more closely at how to achieve legitimacy in cases where the leader is from a different profession to the staff....

Examination of acute treatment strategies in 314 patients with putaminal hemorrhage from the view point of functional prognosis in kaifukuki rehabilitation wards

International Nuclear Information System (INIS)

Sakoh, Masaharu; Ohmura, Yuji; Fujii, Ryousuke; Horimi, Hirotsugu; Ishikawa, Makoto; Ishihara, Ken

2010-01-01

We examined the influence of acute treatment strategies for putaminal hemorrhage from the view point of the functional prognosis in Kaifukuki rehabilitation wards. Subjects were 314 patients with putaminal hemorrhage for inpatient rehabilitation in our hospital. For all patients, Functional Independence Measure (FIM), Barthel Index (BI), Independence of Gait (IOG) was measured on admission and discharge, respectively. We examined the functional prognosis, according to method of treatment, age, volume of hematoma, CT classification, side of damage, sex, and hospitalization waiting period. A significant difference was admitted with FIM, BI, and IOG in the age, the volume of hematoma, the hospitalization waiting period, and the CT classification (p<0.05). The functional prognosis was excellent in the conservative treatment than in the surgical treatment. The hospitalization waiting period was significantly a long term in the surgical treatment (p<0.05). In the analysis where the age is arranged the volume of hematoma, the surgical treatment was more excellent than the conservative treatment, in the patients less than 70 years old and the volume of hematoma with 60 ml or more. The functional prognosis of putaminal hemorrhage was excellent in the conservative treatment, but the stereotactic hematoma evacuation is recommended to the limited case as a surgical treatment. Early rehabilitation is a pressing need for the improvement of the functional prognosis. Especially, it is indispensable to shorten the hospitalization waiting period in the surgical treatment. (author)

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.

Incidence and predictors of surgical site infection in Ethiopia: prospective cohort.

Science.gov (United States)

Legesse Laloto, Tamrat; Hiko Gemeda, Desta; Abdella, Sadikalmahdi Hussen

2017-02-03

Surgical site infections are commonest nosocomial infections and responsible for considerable morbidity and mortality as well as increased hospitalizations and treatment cost related to surgical operations. The aim of this study was to determine incidence and predictors of surgical site infections at surgical ward of Hawassa University Referral Hospital, Southern Ethiopia. We performed prospective study involving 105 patients that undergone major surgical procedure at Hawassa University Referral Hospital from March 2 to May 2, 2015. Data were extracted from paper based medical charts, operational and anesthesia note, by direct observation and patients' interview. All patients were followed daily before, during and after operation for 30 days starting from the date of operation. Data were analyzed using Statistical Package for Social Science (SPSS) for window version 20.0 software. Predictors of Surgical site infections were identified using multivariable logistic regression model. P-value less than 0.05 was considered to be statistically significant. We studied 105 patients. Sixty four patients (61%) were males. The mean age of the patients was 30.85 ± 17.72 years. The mean Body Mass Index (BMI) was 21.6 ± 4 kg/m 2 . Twenty patients (19.1%) developed surgical site infections. Age greater than 40 years, AOR = 7.7(95% CI [1.610-40.810 p = 0.016,]), preoperative hospital stay more than 7 days, AOR = 22.4(95% CI [4.544-110.780, p = 0.001]), duration of operation more than 1 hour, AOR = 8.01(95% CI [1.562-41.099, p = 0.013]) and administering antimicrobial prophylaxis before 1 hour of operation, AOR = 11.1 (95% CI [1.269-75.639, p = 0.014]) were independent predictors for surgical site infections. Surgical site infection is relatively high.

Lingual nerve injury following surgical removal of mandibular third molar

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Abduljaleel Azad Samad

2017-12-01

Full Text Available Background and objective: The close proximity of lingual nerve in relation to the lingual cortical bone of the posterior mandibular third molar is clinically important because lingual nerve may be subjected to trauma during surgical removal of the impacted lower third molar. This prospective study aimed to evaluate the incidence of lingual nerve paresthesia following surgical removal of mandibular third molar in College of Dentistry, Hawler Medical University. Methods: A total of 116 third molars surgery were carried out under local anesthesia for 116 patients for removal of lower mandibular teeth Using Terence Ward's incision made in all cases, and after that, the buccal flap was reflected, lingual tissues had been retracted during bone removal with a periosteal elevator. The sensory disturbance was evaluated on the 7th postoperative day by standard questioning the patients: “Do you have any unusual feeling in your tongue, lingual gingiva and mucosa of the floor of the mouth?" Results: One patient experienced sensory disturbance, the lingual nerve paresthesia incidence was 0.9% as a transient sensory disturbance, while no patient of permanent sensory disturbance. Conclusion: The incidence of injury to the lingual nerve can be minimized by careful clinical evaluation, surgeon’s experience, surgical approach and knowledge about anatomical landmarks during surgical removal of an impacted lower third molar tooth.

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

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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.

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

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

The Gap Between Clinical Research and Standard of Care: A Review of Frailty Assessment Scales in Perioperative Surgical Settings.

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Stoicea, Nicoleta; Baddigam, Ramya; Wajahn, Jennifer; Sipes, Angela C; Arias-Morales, Carlos E; Gastaldo, Nicholas; Bergese, Sergio D

2016-01-01

The elderly population in the United States is increasing exponentially in tandem with risk for frailty. Frailty is described by a clinically significant state where a patient is at risk for developing complications requiring increased assistance in daily activities. Frailty syndrome studied in geriatric patients is responsible for an increased risk for falls, and increased mortality. In efforts to prepare for and to intervene in perioperative complications and general frailty, a universal scale to measure frailty is necessary. Many methods for determining frailty have been developed, yet there remains a need to define clinical frailty and, therefore, the most effective way to measure it. This article reviews six popular scales for measuring frailty and evaluates their clinical effectiveness demonstrated in previous studies. By identifying the most time-efficient, criteria comprehensive, and clinically effective scale, a universal scale can be implemented into standard of care and reduce complications from frailty in both non-surgical and surgical settings, especially applied to the perioperative surgical home model. We suggest further evaluation of the Edmonton Frailty Scale for inclusion in patient care.

The Gap Between Clinical Research and Standard of Care: A Review of Frailty Assessment Scales in Perioperative Surgical Settings

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Nicoleta Stoicea

2016-07-01

Full Text Available The elderly population in the United States is increasing exponentially in tandem with risk for frailty. Frailty is described by a clinically significant state where a patient is at risk for developing complications requiring increased assistance in daily activities. Frailty syndrome studied in geriatric patients is responsible for an increased risk for falls, and increased mortality. In efforts to prepare for and to intervene in perioperative complications and general frailty, a universal scale to measure frailty is necessary. Many methods for determining frailty have been developed, yet there remains a need to define clinical frailty and therefore the most effective way to measure it. This article reviews six popular scales for measuring frailty and evaluates their clinical effectiveness demonstrated in previous studies. By identifying the most time-efficient, criteria comprehensive, and clinically effective scale, a universal scale can be implemented into standard of care and reduce complications from frailty in both non-surgical and surgical settings, especially applied to the perioperative surgical home model. We suggest further evaluation of the Edmonton Frailty Scale for inclusion in patient care.

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

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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

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

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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.

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

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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.

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

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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.

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

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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.

Costs analysis of surgical treatment of stress urinary incontinence in a brazilian public hospital, comparing burch and synthetic sling techniques.

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Limberger, Leo Francisco; Faria, Fernanda Pacheco; Campos, Luciana Silveira; Anzolch, Karin Marise Jaeger; Fornari, Alexandre

2018-01-01

Surgical treatment of urinary incontinence progressed significantly with the introduction of synthetic slings. However, in some public Brazilian hospitals, the costs of these materials prevent their routine use. To compare the costs of ambulatory synthetic sling surgery with an historical series of patients submitted to Burch surgery in a Brazilian public hospital. Twenty nine incontinent patients were selected to synthetic sling surgery. Demographic data were prospectively collected and also the costs of the procedure, including drugs and materials, use of surgical and recovery wards, medical staff and hospitalization. These data were compared to the costs of 29 Burch surgeries performed before the introduction of synthetic slings. Demographic data were similar, although median age was lower in the group submitted to Burch surgery (46.3±8.6 versus 56.2±11.3 (pCost was significantly lower in patients submitted to sling in all items, except for time spent in recovery ward. Total value of 29 Burch surgeries was R$ 217.766.12, and of R$ 68.049.92 of 29 patients submitted to sling surgery (pcost of the synthetic sling was considered. Copyright® by the International Brazilian Journal of Urology.

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

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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

THE INFLUENCE OF STRESS CONNECTED WITH PROFESSIONAL WORK ON THE OCCURRENCE OF BURNOUT SYNDROME IN NURSES WORKING IN SURGICAL AND MEDICAL TREATMENT WARDS

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Grażyna Nowak-Starz

2013-11-01

Full Text Available Nursing is one of the professions where chronic stress is an inseparable characteristic and stems from the very nature of the profession itself. The job of a nurse involves particular mental burdens. The source of these is another person, one who has most often found themselves in an extreme situation. A nurse carries out her/his duties in a state of strong and long-lasting emotional strain. Inappropriate coping with stress and a lack of support from others in difficult situations leads to the development of burnout syndrome. This syndrome not only lowers, to a great extent, the quality of performed work but also prevents nurses from further professional development. Aims : The aim of the following paper is to evaluate the influence of stress connected with the professional work of a nurse on the occurrence of burnout syndrome. Material and methodology : Research was conducted on a group of 103 nurses working at eight hospital wards (surgical and medical treatment at the District Hospital in Lipsko. The research tool was a questionnaire of the author’s own devise, which contained 34 questions. Results : Among the examined nurses, 90% concluded that their professional work has a negative impact on their family life and they pointed to their own occupational burnout. Nurses who carried negative emotions over from work to their homes significantly more often showed a lack of satisfaction from their job and signs of occupational burnout. A substantial percentage of the participants considered shift-work and the professional position held to be a detrimental factor in the process of occupational burnout. Conclusion : The nurses were to a large extent exposed to mental burdens having a negative impact on their work. The vast majority of the respondents felt satisfaction from their job but a significant percentage of the respondents admitted to suffering from symptoms of chronic stress and exhaustion, which may indicate a lack of any support from co

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.

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

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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.

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

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)

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

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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.

Fighting surgical site infections in small animals

DEFF Research Database (Denmark)

Verwilghen, Denis; Singh, Ameet

2015-01-01

A diverse array of pathogen-related, patient-related, and caretaker-related issues influence risk and prevention of surgical site infections (SSIs). The entire surgical team involved in health care settings in which surgical procedures are performed play a pivotal role in the prevention of SSIs. ...

The role of the internal medicine specialist in the management of infective complications in general surgical wards

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Patrizia Zoboli

2013-05-01

Full Text Available BACKGROUND Internal medicine specialists are often asked to evaluate a patient before surgery. Perioperative risk evaluation for elderly patients is important, because complications increase with age. The increasing age of the general population increases the probabilities of surgery in the older patients. The manifestation of a surgical problem, is more likely to be severe and complicated in the elderly patients. In fact, emergency surgery treatment occurs more frequently in the elderly (e.g., it is much more common to see intestinal obstruction complicating colorectal cancer in the elderly compared with a younger population. Old age is an independent factor for long hospital stay after surgery. The role of the preoperative medical consultant is to identify and evaluate a patient’s current medical status and provide a clinical risk profile, in order to decide whether further tests are indicated prior to surgery, and to optimise the patient’s medical condition in the attempt of reducing the risk of complications. The medical consultant must know which medical condition could eventually influence the surgery, achieve a good contact and communication between the medical and surgical team, in order to obtain the best management planning. AIM OF THE STUDY This paper focuses on the rational use of antibiotic prophylaxis and on the treatment of the complications of post-surgery infections (e.g., pulmonary complication, peritonitis, intra-abdominal infection. Specific aspects of pre-operative risk evaluation and peri and post-operative management are discussed. CONCLUSIONS The internal medicin specialist in collaboration with the surgical team is necessary in the peri and post-surgery management.

The effect of an interactive follow-up program on ostomy adjustment of inpatients after their discharge from surgical wards of the hospitals affiliated to Isfahan University of Medical Sciences.

Science.gov (United States)

Hamidi, Yaser; Moeini, Mahin; Yousefi, Hojatollah

2018-04-07

Ostomy patients suffer from many physical and mental problems, which can be solved to a large extent with the help of education and follow-up programs. These follow-ups can be done in person or on the telephone by the nurses, or even, by sending a text message that is an easier way for the patients to adapt to their condition. This study aimed to investigate the effect of an interactive follow-up program on the adjustment of ostomy inpatients after being discharged. This study is a clinical trial, conducted on 64 ostomy patients who were discharged from the surgical wards of the hospital affiliated to Isfahan University of Medical Sciences. Subjects in the experimental group participated in a 6-week follow-up program via text message. The information about the patients were collected by Olbrisch Ostomy Adjustment Scale. The obtained results have suggested that 34.4% of the patients in the experimental group and 28.1% of the patients in the control group were female. Before the intervention, comparing the mean score of ostomy adjustment and its dimensions in the two groups showed no significant difference (P > 0.05). However, a significant difference was observed between the two groups immediately after the intervention (P  0.05). The findings of this study suggested that using SMS can be considered as a proper tool or method for following up the ostomy patients.

Environmental scan of infection prevention and control practices for containment of hospital-acquired infectious disease outbreaks in acute care hospital settings across Canada.

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Ocampo, Wrechelle; Geransar, Rose; Clayden, Nancy; Jones, Jessica; de Grood, Jill; Joffe, Mark; Taylor, Geoffrey; Missaghi, Bayan; Pearce, Craig; Ghali, William; Conly, John

2017-10-01

Ward closure is a method of controlling hospital-acquired infectious diseases outbreaks and is often coupled with other practices. However, the value and efficacy of ward closures remains uncertain. To understand the current practices and perceptions with respect to ward closure for hospital-acquired infectious disease outbreaks in acute care hospital settings across Canada. A Web-based environmental scan survey was developed by a team of infection prevention and control (IPC) experts and distributed to 235 IPC professionals at acute care sites across Canada. Data were analyzed using a mixed-methods approach of descriptive statistics and thematic analysis. A total of 110 completed responses showed that 70% of sites reported at least 1 outbreak during 2013, 44% of these sites reported the use of ward closure. Ward closure was considered an "appropriate," "sometimes appropriate," or "not appropriate" strategy to control outbreaks by 50%, 45%, and 5% of participants, respectively. System capacity issues and overall risk assessment were main factors influencing the decision to close hospital wards following an outbreak. Results suggest the use of ward closure for containment of hospital-acquired infectious disease outbreaks in Canadian acute care health settings is mixed, with outbreak control methods varying. The successful implementation of ward closure was dependent on overall support for the IPC team within hospital administration. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

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

events in clinical settings, such as inpatient wards. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

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.

Study protocol for two randomized controlled trials examining the effectiveness and safety of current weekend allied health services and a new stakeholder-driven model for acute medical/surgical patients versus no weekend allied health services.

Science.gov (United States)

Haines, Terry P; O'Brien, Lisa; Mitchell, Deb; Bowles, Kelly-Ann; Haas, Romi; Markham, Donna; Plumb, Samantha; Chiu, Timothy; May, Kerry; Philip, Kathleen; Lescai, David; McDermott, Fiona; Sarkies, Mitchell; Ghaly, Marcelle; Shaw, Leonie; Juj, Genevieve; Skinner, Elizabeth H

2015-04-02

Disinvestment from inefficient or ineffective health services is a growing priority for health care systems. Provision of allied health services over the weekend is now commonplace despite a relative paucity of evidence supporting their provision. The relatively high cost of providing this service combined with the paucity of evidence supporting its provision makes this a potential candidate for disinvestment so that resources consumed can be used in other areas. This study aims to determine the effectiveness, cost-effectiveness and safety of the current model of weekend allied health service and a new stakeholder-driven model of weekend allied health service delivery on acute medical and surgical wards compared to having no weekend allied health service. Two stepped wedge, cluster randomised trials of weekend allied health services will be conducted in six acute medical/surgical wards across two public metropolitan hospitals in Melbourne (Australia). Wards have been chosen to participate by management teams at each hospital. The allied health services to be investigated will include physiotherapy, occupational therapy, speech therapy, dietetics, social work and allied health assistants. At baseline, all wards will be receiving weekend allied health services. Study 1 intervention will be the sequential disinvestment (roll-in) of the current weekend allied health service model from each participating ward in monthly intervals and study 2 will be the roll-out of a new stakeholder-driven model of weekend allied health service delivery. The order in which weekend allied health services will be rolled in and out amongst participating wards will be determined randomly. This trial will be conducted in each of the two participating hospitals at a different time interval. Primary outcomes will be length of stay, rate of unplanned hospital readmission within 28 days and rate of adverse events. Secondary outcomes will be number of complaints and compliments, staff absenteeism

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.

Acquiring minimally invasive surgical skills

NARCIS (Netherlands)

Hiemstra, Ellen

2012-01-01

Many topics in surgical skills education have been implemented without a solid scientific basis. For that reason we have tried to find this scientific basis. We have focused on training and evaluation of minimally invasive surgical skills in a training setting and in practice in the operating room.

Implementation of Releasing Time to Care - the productive ward.

Science.gov (United States)

Wilson, Gwyneth

2009-07-01

experience of the NHS as well as a cultural change for the workforce. Releasing Time to Care, also known as the productive ward, offers a systematic way of delivering safe, high quality care to patients across healthcare settings. The Institute for Innovation and Improvement, have devised a programme of 15 modules based on 'lean' methodology. It has been widely piloted and in January 2008 was rolled out as a national initiative with 50 million pound pump priming money. Evidence shows that the programme can improve patient satisfaction as it enables the provision of an increase in direct patient care by staff and subsequent improved clinical and safety outcomes. The programme has to be implemented in a structured manner in order to assure its success and release the benefits. Core to this success is Board level commitment. Board members need to sign up to and understand the concepts of the programme and their role in supporting the ward staff. The organisation needs to understand the benefits that the programme will bring to the organisation as well as the challenges. The Board needs to understand that the programme is focussed on improving the quality of care for patients and not an opportunity to reduce costs.

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.

Wrong-Site Surgery, Retained Surgical Items, and Surgical Fires : A Systematic Review of Surgical Never Events.

Science.gov (United States)

Hempel, Susanne; Maggard-Gibbons, Melinda; Nguyen, David K; Dawes, Aaron J; Miake-Lye, Isomi; Beroes, Jessica M; Booth, Marika J; Miles, Jeremy N V; Shanman, Roberta; Shekelle, Paul G

2015-08-01

Serious, preventable surgical events, termed never events, continue to occur despite considerable patient safety efforts. To examine the incidence and root causes of and interventions to prevent wrong-site surgery, retained surgical items, and surgical fires in the era after the implementation of the Universal Protocol in 2004. We searched 9 electronic databases for entries from 2004 through June 30, 2014, screened references, and consulted experts. Two independent reviewers identified relevant publications in June 2014. One reviewer used a standardized form to extract data and a second reviewer checked the data. Strength of evidence was established by the review team. Data extraction was completed in January 2015. Incidence of wrong-site surgery, retained surgical items, and surgical fires. We found 138 empirical studies that met our inclusion criteria. Incidence estimates for wrong-site surgery in US settings varied by data source and procedure (median estimate, 0.09 events per 10,000 surgical procedures). The median estimate for retained surgical items was 1.32 events per 10,000 procedures, but estimates varied by item and procedure. The per-procedure surgical fire incidence is unknown. A frequently reported root cause was inadequate communication. Methodologic challenges associated with investigating changes in rare events limit the conclusions of 78 intervention evaluations. Limited evidence supported the Universal Protocol (5 studies), education (4 studies), and team training (4 studies) interventions to prevent wrong-site surgery. Limited evidence exists to prevent retained surgical items by using data-matrix-coded sponge-counting systems (5 pertinent studies). Evidence for preventing surgical fires was insufficient, and intervention effects were not estimable. Current estimates for wrong-site surgery and retained surgical items are 1 event per 100,000 and 1 event per 10,000 procedures, respectively, but the precision is uncertain, and the per

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.

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

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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

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…

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....

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

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.

[The surgical nurse: his/her leadership of auxiliary nursing personnel].

Science.gov (United States)

Galvão, C M; Trevizan, M A; Sawada, N O; Mendes, I A

1997-01-01

This investigation as carried out in order to promote follow-up in the studies concerning nurse's leadership in the hospital context. Emphasys is given to the nurses that works in surgical ward unities. As a theoretical framework, authors utilized the model of leadership proposed by Hersey and Blanchard, named Situational Leadership. The objective was to analyze the correspondence of opinion between nurses and nursing auxiliary personnel about the leadership style of nurse should adopt in accordance with the maturity level of an element of the auxiliary personnel based on six categories of activities that were studied. Authors found out that nurses should adopt the styles of participant leadership, such as E3 (participating) and/or E4 (delegating).

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

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.

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.

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.

Surgical education and training in an outer metropolitan hospital: a qualitative study of surgical trainers and trainees.

Science.gov (United States)

Nestel, Debra; Harlim, Jennifer; Bryant, Melanie; Rampersad, Rajay; Hunter-Smith, David; Spychal, Bob

2017-08-01

The landscape of surgical training is changing. The anticipated increase in the numbers of surgical trainees and the shift to competency-based surgical training places pressures on an already stretched health service. With these pressures in mind, we explored trainers' and trainees' experiences of surgical training in a less traditional rotation, an outer metropolitan hospital. We considered practice-based learning theories to make meaning of surgical training in this setting, in particular Actor-network theory. We adopted a qualitative approach and purposively sampled surgical trainers and trainees to participate in individual interviews and focus groups respectively. Transcripts were made and thematically analysed. Institutional human research ethics approval was obtained. Four surgical trainers and fourteen trainees participated. Almost without exception, participants' report training needs to be well met. Emergent inter-related themes were: learning as social activity; learning and programmatic factors; learning and physical infrastructure; and, learning and organizational structure. This outer metropolitan hospital is suited to the provision of surgical training with the current rotational system for trainees. The setting offers experiences that enable consolidation of learning providing a rich and varied overall surgical training program. Although relational elements of learning were paramount they occurred within a complex environment. Actor-network theory was used to give meaning to emergent themes acknowledging that actors (both people and objects) and their interactions combine to influence training quality, shifting the focus of responsibility for learning away from individuals to the complex interactions in which they work and learn.

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.

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 ...

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.

Recovery orientation in mental health inpatient settings

DEFF Research Database (Denmark)

Waldemar, Anna Kristine; Esbensen, Bente Appel; Korsbek, Lisa

2018-01-01

Offering mental health treatment in line with a recovery-oriented practice has become an objective in the mental health services in many countries. However, applying recovery-oriented practice in inpatient settings seems challenged by unclear and diverging definitions of the concept......-structured interviews were conducted with 14 inpatients from two mental health inpatient wards using an interview guide based on factors from the Recovery Self-Assessment. Qualitative content analysis was applied in the analysis. Six themes covering the participants’ experiences were identified. The participants felt...... accepted and protected in the ward and found comfort in being around other people but missed talking and engaging with health professionals. They described limited choice and influence on the course of their treatment, and low information levels regarding their treatment, which they considered to consist...

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

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

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%) ...

Performance of handheld electrocardiogram devices to detect atrial fibrillation in a cardiology and geriatric ward setting.

Science.gov (United States)

Desteghe, Lien; Raymaekers, Zina; Lutin, Mark; Vijgen, Johan; Dilling-Boer, Dagmara; Koopman, Pieter; Schurmans, Joris; Vanduynhoven, Philippe; Dendale, Paul; Heidbuchel, Hein

2017-01-01

To determine the usability, accuracy, and cost-effectiveness of two handheld single-lead electrocardiogram (ECG) devices for atrial fibrillation (AF) screening in a hospital population with an increased risk for AF. Hospitalized patients (n = 445) at cardiological or geriatric wards were screened for AF by two handheld ECG devices (MyDiagnostick and AliveCor). The performance of the automated algorithm of each device was evaluated against a full 12-lead or 6-lead ECG recording. All ECGs and monitor tracings were also independently reviewed in a blinded fashion by two electrophysiologists. Time investments by nurses and physicians were tracked and used to estimate cost-effectiveness of different screening strategies. Handheld recordings were not possible in 7 and 21.4% of cardiology and geriatric patients, respectively, because they were not able to hold the devices properly. Even after the exclusion of patients with an implanted device, sensitivity and specificity of the automated algorithms were suboptimal (Cardiology: 81.8 and 94.2%, respectively, for MyDiagnostick; 54.5 and 97.5%, respectively, for AliveCor; Geriatrics: 89.5 and 95.7%, respectively, for MyDiagnostick; 78.9 and 97.9%, respectively, for AliveCor). A scenario based on automated AliveCor evaluation in patients without AF history and without an implanted device proved to be the most cost-effective method, with a provider cost to identify one new AF patient of €193 and €82 at cardiology and geriatrics, respectively. The cost to detect one preventable stroke per year would be €7535 and €1916, respectively (based on average CHA 2 DS 2 -VASc of 3.9 ± 2.0 and 5.0 ± 1.5, respectively). Manual interpretation increases sensitivity, but decreases specificity, doubling the cost per detected patient, but remains cheaper than sole 12-lead ECG screening. Using AliveCor or MyDiagnostick handheld recorders requires a structured screening strategy to be effective and cost-effective in a hospital setting

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.

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.

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.

The relation between household income and surgical outcome in the Dutch setting of equal access to and provision of healthcare.

Science.gov (United States)

Ultee, Klaas H J; Tjeertes, Elke K M; Bastos Gonçalves, Frederico; Rouwet, Ellen V; Hoofwijk, Anton G M; Stolker, Robert Jan; Verhagen, Hence J M; Hoeks, Sanne E

2018-01-01

The impact of socioeconomic disparities on surgical outcome in the absence of healthcare inequality remains unclear. Therefore, we set out to determine the association between socioeconomic status (SES), reflected by household income, and overall survival after surgery in the Dutch setting of equal access and provision of care. Additionally, we aim to assess whether SES is associated with cause-specific survival and major 30-day complications. Patients undergoing surgery between March 2005 and December 2006 in a general teaching hospital in the Netherlands were prospectively included. Adjusted logistic and cox regression analyses were used to assess the independent association of SES-quantified by gross household income-with major 30-day complications and long-term postoperative survival. A total of 3929 patients were included, with a median follow-up of 6.3 years. Low household income was associated with worse survival in continuous analysis (HR: 1.05 per 10.000 euro decrease in income, 95% CI: 1.01-1.10) and in income quartile analysis (HR: 1.58, 95% CI: 1.08-2.31, first [i.e. lowest] quartile relative to the fourth quartile). Similarly, low income patients were at higher risk of cardiovascular death (HR: 1.26 per 10.000 decrease in income, 95% CI: 1.07-1.48, first income quartile: HR: 3.10, 95% CI: 1.04-9.22). Household income was not independently associated with cancer-related mortality and major 30-day complications. Low SES, quantified by gross household income, is associated with increased overall and cardiovascular mortality risks among surgical patients. Considering the equality of care provided by this study setting, the associated survival hazards can be attributed to patient and provider factors, rather than disparities in healthcare. Increased physician awareness of SES as a risk factor in preoperative decision-making and focus on improving established SES-related risk factors may improve surgical outcome of low SES patients.

Conflicting priorities: evaluation of an intervention to improve nurse-parent relationships on a Tanzanian paediatric ward

DEFF Research Database (Denmark)

Manongi, Rachel N; Nasuwa, Fortunata R; Mwangi, Rose

2009-01-01

such as the Health Workers for Change initiative have been successful in improving provider-client relationships in various developing country settings, but have not yet been reported in the complex environment of hospital wards. We evaluated the HWC approach for improving the relationship between nurses and parents...... outcome of the intervention was not met. The priorities of the intervention--to improve nurse-parent relationships--did not match the priorities of the nursing staff. Development of awareness and empathy was not enough to provide care that was satisfactory to clients in the context of working conditions...

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)

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

Nonpharmacological Interventions Targeted at Delirium Risk Factors, Delivered by Trained Volunteers (Medical and Psychology Students, Reduced Need for Antipsychotic Medications and the Length of Hospital Stay in Aged Patients Admitted to an Acute Internal Medicine Ward: Pilot Study

Directory of Open Access Journals (Sweden)

Stanislaw Gorski

2017-01-01

Full Text Available Purpose. Effectiveness of nonpharmacological multicomponent prevention delivered by trained volunteers (medical and psychology students, targeted at delirium risk factors in geriatric inpatients, was assessed at an internal medicine ward in Poland. Patients and Methods. Participants were recruited to intervention and control groups at the internal medicine ward (inclusion criteria: age ≥ 75, acute medical condition, basic orientation, and logical contact on admission; exclusion criteria: life expectancy < 24 hours, surgical hospitalization, isolation due to infectious disease, and discharge to other medical wards. Every day trained volunteers delivered a multicomponent standardized intervention targeted at risk factors of in-hospital complications to the intervention group. The control group, selected using a retrospective individual matching strategy (1 : 1 ratio, regarding age, gender, and time of hospitalization, received standard care. Outcome Measures. Hospitalization time, deaths, falls, delirium episodes, and antipsychotic prescriptions were assessed retrospectively from medical documentation. Results. 130 patients (38.4% males participated in the study, with 65 in the intervention group. Antipsychotic medications were initiated less frequently in the intervention group compared to the control group. There was a trend towards a shorter hospitalization time and a not statistically significant decrease in deaths in the intervention group. Conclusion. Nonpharmacological multicomponent intervention targeted at delirium risk factors effectively reduced length of hospitalization and need for initiating antipsychotic treatment in elderly patients at the internal medicine ward.

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, ...

Unusual Complication of Surgical Abortion with Pelvic Extrusion of Fetal Head: A Case Report.

Science.gov (United States)

Begum, Jasmina; Samal, Sunita; Ghose, Seetesh

2015-11-01

Unsafe abortion is one of the causes of maternal mortality and morbidity in developing countries. The complications mostly results following unsafe abortion procedure done by unskilled provider with or without minimal medical knowledge in rural part of developing countries. These complications can endanger the life of mother if proper medical or surgical interventions are not offered in time. A majority of these complications remains confidential. The uterine perforation is one of the serious but preventable complications of surgical abortion. A 21-year-old woman G4P2L2A1, presented in the emergency ward with complaints of lower abdominal pain for four days after attempting twice surgical termination of pregnancy at 19 weeks of gestation for an unwanted pregnancy. Transabdominal sonography and MRI revealed uterine rent with pelvic extrusion of fetal head. Emergency laparotomy with removal of fetal head and uterine rent repair was done. This case illustrates the importance of maintaining a high index of suspicion by the gynaecologist for uterine perforation in patient presenting with abdominal pain a few days after undergoing surgical abortion, also shows the complementary role of sonography and MRI in evaluation of the similar patient and this case also highlights the rampant illegal unsafe abortion procedure in rural India despite of legalization of abortion act.

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…

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)

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.

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.

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

Big Data and Machine Learning in Plastic Surgery: A New Frontier in Surgical Innovation.

Science.gov (United States)

Kanevsky, Jonathan; Corban, Jason; Gaster, Richard; Kanevsky, Ari; Lin, Samuel; Gilardino, Mirko

2016-05-01

Medical decision-making is increasingly based on quantifiable data. From the moment patients come into contact with the health care system, their entire medical history is recorded electronically. Whether a patient is in the operating room or on the hospital ward, technological advancement has facilitated the expedient and reliable measurement of clinically relevant health metrics, all in an effort to guide care and ensure the best possible clinical outcomes. However, as the volume and complexity of biomedical data grow, it becomes challenging to effectively process "big data" using conventional techniques. Physicians and scientists must be prepared to look beyond classic methods of data processing to extract clinically relevant information. The purpose of this article is to introduce the modern plastic surgeon to machine learning and computational interpretation of large data sets. What is machine learning? Machine learning, a subfield of artificial intelligence, can address clinically relevant problems in several domains of plastic surgery, including burn surgery; microsurgery; and craniofacial, peripheral nerve, and aesthetic surgery. This article provides a brief introduction to current research and suggests future projects that will allow plastic surgeons to explore this new frontier of surgical science.

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

National survey of surgeons\\' attitudes to laparoscopic surgical ...

African Journals Online (AJOL)

Aim. Laparoscopic surgery forms an integral component of modern surgical practice. The perception exists that laparoscopic training in South Africa has been unplanned and under-resourced. This study set out to assess the opinions of surgeons and surgical trainees with regard to the various facets of laparoscopic surgical ...

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...

Natural History of Multi-Drug Resistant Organisms in a New Military Medical Facility

Science.gov (United States)

2012-10-01

Sink  Staphylococcus schleiferi ssp  coagulans   Surgical Ward  06.316  Room Sink  Acinetobacter baumannii  Surgical Ward  06.316  Toilet seat...Telephone  Bacillus  megaterium  Maternity Ward  05.326  Call box  Pantoea agglomerans  Maternity Ward  05.326  Toilet rail  Staphylococcus aureus

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.

[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.

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.

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)

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)

Surgically Assisted Rapid Maxillary Expansion: surgical and orthodontic aspects

NARCIS (Netherlands)

M.J. Koudstaal (Maarten)

2008-01-01

textabstractThe scope of this thesis is to shed more light, from a number of perspectives, on surgically assisted rapid maxillary expansion (SARME). The primary questions this thesis set out to answer were; ‘is there a difference in stability between bone-borne and tooth-borne distraction?’ and ‘can

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.

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....

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

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. 

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...

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.

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.

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.

Optimized positioning of autonomous surgical lamps

Science.gov (United States)

Teuber, Jörn; Weller, Rene; Kikinis, Ron; Oldhafer, Karl-Jürgen; Lipp, Michael J.; Zachmann, Gabriel

2017-03-01

We consider the problem of finding automatically optimal positions of surgical lamps throughout the whole surgical procedure, where we assume that future lamps could be robotized. We propose a two-tiered optimization technique for the real-time autonomous positioning of those robotized surgical lamps. Typically, finding optimal positions for surgical lamps is a multi-dimensional problem with several, in part conflicting, objectives, such as optimal lighting conditions at every point in time while minimizing the movement of the lamps in order to avoid distractions of the surgeon. Consequently, we use multi-objective optimization (MOO) to find optimal positions in real-time during the entire surgery. Due to the conflicting objectives, there is usually not a single optimal solution for such kinds of problems, but a set of solutions that realizes a Pareto-front. When our algorithm selects a solution from this set it additionally has to consider the individual preferences of the surgeon. This is a highly non-trivial task because the relationship between the solution and the parameters is not obvious. We have developed a novel meta-optimization that considers exactly this challenge. It delivers an easy to understand set of presets for the parameters and allows a balance between the lamp movement and lamp obstruction. This metaoptimization can be pre-computed for different kinds of operations and it then used by our online optimization for the selection of the appropriate Pareto solution. Both optimization approaches use data obtained by a depth camera that captures the surgical site but also the environment around the operating table. We have evaluated our algorithms with data recorded during a real open abdominal surgery. It is available for use for scientific purposes. The results show that our meta-optimization produces viable parameter sets for different parts of an intervention even when trained on a small portion of it.

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.

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.

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.

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...

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.

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

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.

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

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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.

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...

[Nosocomial urinary tract and surgical site infection rates in the Maternity Ward at the General Referral Hospital in Katuba, Lubumbashi, Democratic Republic of the Congo].

Science.gov (United States)

Lukuke, Hendrick Mbutshu; Kasamba, Eric; Mahuridi, Abdulu; Nlandu, Roger Ngatu; Narufumi, Suganuma; Mukengeshayi, Abel Ntambue; Malou, Vicky; Makoutode, Michel; Kaj, Françoise Malonga

2017-01-01

In Intertropical Africa hospitalized patients are exposed to a risk of nosocomial infections. The dearth of published data on this subject limits the descriptive analysis of the situation. This study aimed to determine the incidence, the germs responsible for these infections and the risk factors of nosocomial infections in the Maternity Ward at the General Referral Hospital in Katuba, Lubumbashi, Democratic Republic of the Congo. We conducted a descriptive, longitudinal study from 1 October 2014 to 1 January 2015. Our study population consisted of 207 women who had been hospitalized in the Maternity Ward at the General Referral Hospital in Katuba. We carried out a comprehensive data collection. Nosocomial infection rate accounted for 15.5%. Parturient women who had been hospitalized for more than three days were three times more likely to develop a nosocomial infection (p=0.003), while those who had had a complicated delivery were four times more likely to be at risk of developing nosocomial infection (p = 0.000). Escherichia coli was the most isolated causative agent (38.1%), followed by Citrobacter freundi (23.8%), Acinobacter baumani (.18, 2%), Staphylococcus aureus (18.2%), Enterococcus aureus (14.3%) and Pseudomonas aeroginosa (9.1%). Ampicillin was the most prescribed antibiotic, to which isolated microbes were resistant. It is necessary to improve hospital hygiene and to conduct further study to examine the similarity between germs strains in the environment and those in biological fluids.

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...

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.

The role of rewards and demands in burnout among surgical nurses

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Beata A. Basińska

2013-08-01

Full Text Available Objective: Job rewards have both, an intrinsic and an extrinsic motivational potential, and lead to employees' development as well as help them to achieve work goals. Rewards can balance job demands and protect from burnout. Due to changes on the labour market, new studies are needed. The aim of our study was to examine the role of demands and individual rewards (and their absence in burnout among surgical nurses. Materials and Methods: The study was conducted in 2009 and 2010 with 263 nurses who worked in surgical wards and clinics in hospitals in Southern Poland. The hypotheses were tested by the use of measures of demands and rewards (Effort-Reward Imbalance Questionnaire by Siegrist and burnout syndrome (Maslach Burnout Inventory. A cross-sectional, correlational study design was applied. Results: Nurses experienced the largest deficiencies in salary and prestige. Exhaustion was explained by stronger demands and lack of respect (large effect. Depersonalization was explained by stronger demands, lack of respect and greater job security (medium effect. Reduced personal achievement was explained by more demands and greater job security (small effect. Conclusions: Excessive demands and lack of esteem are key reasons for burnout among surgical nurses. Job security can increase burnout when too many resources are invested and career opportunities do not appear. These results may help to improve human resource management in the healthcare sector.

The role of rewards and demands in burnout among surgical nurses.

Science.gov (United States)

Basińska, Beata A; Wilczek-Rużyczka, Ewa

2013-08-01

Job rewards have both, an intrinsic and an extrinsic motivational potential, and lead to employees' development as well as help them to achieve work goals. Rewards can balance job demands and protect from burnout. Due to changes on the labour market, new studies are needed. The aim of our study was to examine the role of demands and individual rewards (and their absence) in burnout among surgical nurses. The study was conducted in 2009 and 2010 with 263 nurses who worked in surgical wards and clinics in hospitals in Southern Poland. The hypotheses were tested by the use of measures of demands and rewards (Effort-Reward Imbalance Questionnaire by Siegrist) and burnout syndrome (Maslach Burnout Inventory). A cross-sectional, correlational study design was applied. Nurses experienced the largest deficiencies in salary and prestige. Exhaustion was explained by stronger demands and lack of respect (large effect). Depersonalization was explained by stronger demands, lack of respect and greater job security (medium effect). Reduced personal achievement was explained by more demands and greater job security (small effect). Excessive demands and lack of esteem are key reasons for burnout among surgical nurses. Job security can increase burnout when too many resources are invested and career opportunities do not appear. These results may help to improve human resource management in the healthcare sector.

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.

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.)

DEVELOPMENT OF GEOSPATIAL MAP BASED PORTAL FOR DELIMITATION OF MCD WARDS

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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.

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

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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.

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

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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.

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

Higher third-generation cephalosporin prescription proportion is associated with lower probability of reducing carbapenem use: a nationwide retrospective study

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Allison Muller

2018-01-01

Full Text Available Abstract Background The ongoing extended spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE pandemic has led to an increasing carbapenem use, requiring release of guidelines for carbapenem usage in France in late 2010. We sought to determine factors associated with changes in carbapenem use in intensive care units (ICUs, medical and surgical wards between 2009 and 2013. Methods This ward-level multicentre retrospective study was based on data from French antibiotic and multidrug-resistant bacteria surveillance networks in healthcare facilities. Antibiotic use was expressed in defined daily doses per 1000 patient-days. Factors associated with the reduction in carbapenem use (yes/no over the study period were determined from random-effects logistic regression model (493 wards nested within 259 healthcare facilities: ward characteristics (type, size…, ward antibiotic use (initial antibiotic use [i.e., consumption of a given antibiotic in 2009], initial antibiotic prescribing profile [i.e., proportion of a given antibiotic in the overall antibiotic consumption in 2009] and reduction in the use of a given antibiotic between 2009 and 2013 and regional ESBL-PE incidence rate in acute care settings in 2011. Results Over the study period, carbapenem consumption in ICUs (n = 85, medical (n = 227 and surgical wards (n = 181 was equal to 73.4, 6.2 and 5.4 defined daily doses per 1000 patient-days, respectively. Release of guidelines was followed by a significant decrease in carbapenem use within ICUs and medical wards, and a slowdown in use within surgical wards. The following factors were independently associated with a higher probability of reducing carbapenem use: location in Eastern France, higher initial carbapenem prescribing profile and reductions in consumption of fluoroquinolones, glycopeptides and piperacillin/tazobactam. In parallel, factors independently associated with a lower probability of reducing carbapenem use were

Staff perceptions of leadership during implementation of task-shifting in three surgical units.

Science.gov (United States)

Henderson, Amanda; Paterson, Karyn; Burmeister, Liz; Thomson, Bernadette; Young, Louise

2013-03-01

Registered nurses are difficult to recruit and retain. Task shifting, which involves reallocation of delegation, can reduce demand for registered nurses. Effective leadership is needed for successful task shifting. This study explored leadership styles of three surgical nurse unit managers. Staff completed surveys before and after the implementation of task shifting. Task shifting involved the introduction of endorsed enrolled nurses (licensed nurses who must practise under registered nurse supervision) to better utilize registered nurses. Implementation of task shifting occurred over 4 months in a 700-bed tertiary hospital, in southeast Queensland, Australia. A facilitator assisted nurse unit managers during implementation. The impact was assessed by comparison of data before (n = 49) and after (n = 72) task shifting from registered nurses and endorsed enrolled nurses (n = 121) who completed the Ward Organization Features Survey. Significant differences in leadership and staff organization subscales across the settings suggest that how change involving task shifting is implemented influences nurses' opinions of leadership. Leadership behaviours of nurse unit managers is a key consideration in managing change such as task shifting. Consistent and clear messages from leaders about practice change are viewed positively by nursing staff. In the short term, incremental change possibly results in staff maintaining confidence in leadership. © 2012 Blackwell Publishing Ltd.

Alcohol skin preparation causes surgical fires.

Science.gov (United States)

Rocos, B; Donaldson, L J

2012-03-01

Surgical fires are a rare but serious preventable safety risk in modern hospitals. Data from the US show that up to 650 surgical fires occur each year, with up to 5% causing death or serious harm. This study used the National Reporting and Learning Service (NRLS) database at the National Patient Safety Agency to explore whether spirit-based surgical skin preparation fluid contributes to the cause of surgical fires. The NRLS database was interrogated for all incidents of surgical fires reported between 1 March 2004 and 1 March 2011. Each report was scrutinised manually to discover the cause of the fire. Thirteen surgical fires were reported during the study period. Of these, 11 were found to be directly related to spirit-based surgical skin preparation or preparation soaked swabs and drapes. Despite manufacturer's instructions and warnings, surgical fires continue to occur. Guidance published in the UK and US states that spirit-based skin preparation solutions should continue to be used but sets out some precautions. It may be that fire risk should be included in pre-surgical World Health Organization checklists or in the surgical training curriculum. Surgical staff should be aware of the risk that spirit-based skin preparation fluids pose and should take action to minimise the chance of fire occurring.

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,.

A RANDOMIZED CONTROLLED STUDY OF RISK FACTORS AND ROLE OF PROPHYLACTIC ANTIBIOTICS IN PREVENTION OF SURGICAL SITE INFECTIONS

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Avijeet Mukherjee, Naveen N

2015-01-01

Full Text Available Background and Objectives: Surgical site infection (SSI is the most common nosocomial infection encountered in post operative surgical wards. The use of prophylactic antibiotic in clean elective surgical cases is still a subject of controversy to surgeons. The objective of the study is to identify the need for using prophylactic antibiotics in clean surgeries, prevalence of organisms in patients who are not given prophylactic antibiotics and to study whether the presence of risk factors increase the incidence of surgical site infection. Methodology: The comparative study consists of 100 cases admitted under two groups of 50 each: Group A was given prophylactic antibiotic and Group B didn’t receive any. All surgeries other than clean surgical cases were excluded from the study. Results: Out of 50 patients in group B who were not given prophylactic antibiotic, 2 patients had more than one risk factor for development of SSI and both of them developed SSI. Of the 50 patients who received prophylactic antibiotic, none developed SSI. The rate of infection in group A was nil and in Group B was 4%. Conclusion: Prophylactic antibiotics are not recommended for clean elective surgical cases as there is no statistically significant change in the infection rate seen in patients not receiving prophylactic antibiotic(P=0.4952. Meticulous surgical technique and correcting risk factors prior to surgery is a must for reducing incidence of SSI.

Remote Video Auditing in the Surgical Setting.

Science.gov (United States)

Pedersen, Anne; Getty Ritter, Elizabeth; Beaton, Megan; Gibbons, David

2017-02-01

Remote video auditing, a method first adopted by the food preparation industry, was later introduced to the health care industry as a novel approach to improving hand hygiene practices. This strategy yielded tremendous and sustained improvement, causing leaders to consider the potential effects of such technology on the complex surgical environment. This article outlines the implementation of remote video auditing and the first year of activity, outcomes, and measurable successes in a busy surgery department in the eastern United States. A team of anesthesia care providers, surgeons, and OR personnel used low-resolution cameras, large-screen displays, and cell phone alerts to make significant progress in three domains: application of the Universal Protocol for preventing wrong site, wrong procedure, wrong person surgery; efficiency metrics; and cleaning compliance. The use of cameras with real-time auditing and results-sharing created an environment of continuous learning, compliance, and synergy, which has resulted in a safer, cleaner, and more efficient OR. Copyright © 2017 AORN, Inc. Published by Elsevier Inc. All rights reserved.

A reflection on choosing practice development as a framework to explore music as a therapeutic method to reduce anxiety in patients living with dementia in a ward setting

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Alasdair Pithie

2016-05-01

Full Text Available Background: As a student nurse I chose to write my fourth year dissertation on the use of music as a therapeutic method to reduce anxiety in patients living with dementia. Music has been shown to have a positive effect on patients’ anxiety levels and improve their quality of life. A music therapy intervention could be beneficial but I realised I would need a framework that would enable me to implement the intervention in a ward setting, while offering practitioners and other participants a reasonable level of control and ownership. Discussion: Practice development was chosen because it is a person-centred framework, encouraging the learning of all those involved as well as those facilitating. It is inclusive and allows staff to adapt to the way new practices are introduced in a project. Change management theory was also considered as a framework but lacked many of the person-centred qualities required. Conclusions and implications for practice: Practice development provides the required characteristics for a project to introduce music into a care setting. Given that the methods of the project rely heavily on the involvement of staff and patients’ families, it is important to offer them a sense of ownership and control as an encouragement to take an interest and pride in its success. Furthermore, student nurses can benefit from being introduced to practice development because it will offer them a change theory that is person centred and inclusive.

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.

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

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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.

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...

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...

EMPYEMA THORACIS IN CHILDREN- EARLY SURGICAL TREATMENT IS BETTER

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Shyam Bihari Sharma

2016-11-01

Full Text Available BACKGROUND Prolonged intercostal drainage for empyema thoracis in children is difficult to manage by parents at home and at the same time prolonged stay at hospital increases the financial burden on them. Hence, aim of this study is to get rid of intercostal drainage earliest by performing surgery thereby decreasing the morbidity and mortality. This is a prospective study done in infant and children below age of 12 at Paediatric Surgery Department, National Institute of Medical Science, Jaipur-Delhi Highway, Jaipur, from May 2012 to April 2016. Total number of cases in which surgical intervention done were 13 out which 2 required lobectomy whereas in 11 cases decortication and removing of peel was done. MATERIALS AND METHODS Out of all thirteen patients, the age ranging from 6 months to 10 years, a proforma was made and kept in OPD and ward filling with investigation, symptomatology, treatment and follow up. RESULTS Out of all 13 cases, lung expansion was complete and all are symptom free, follow up 3 years to 1 month was there. CONCLUSION Early surgical intervention of empyema thoracis is beneficial in children as prolonged intercostal drainage increase the misery of the patients as well as their parents.

Study of nosocomial isolates of Staphylococcus aureus with special reference to methicillin resistant S. aureus in a tertiary care hospital in Nepal.

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Shrestha, B; Pokhrel, B; Mohapatra, T

2009-06-01

To find out the prevalence of Staphylococcus aureus nosocomial infection and methicillin resistant S. aureus (MRSA), clinical samples from nosocomially infected patients were processed by following standard methodology in microbiology laboratory, Tribhuvan University Teaching Hospital, Kathmandu, Nepal. Of 149 S. aureus isolates, skin infection isolates contributed a major part 72.5% making nosocomial infection by S. aureus most prevalent in skin infection followed by lower respiratory tract infection 11.41% and urinary tract infection 8.7%. Overall MRSA prevalence was 45.0%. MRSA prevalence was 42.6% in skin infection, 82.3% in lower respiratory tract infection and 30.8% in urinary tract infection. MRSA infection was found associated with lower respiratory tract infection only. Highest occurrence of nosocomial infection was observed in female surgical ward, surgical out patient department, orthopedic ward, male surgical ward and maternity ward. MRSA isolation was high from lower respiratory tract of patients admitted in intensive care unit, coronary care unit, Sub-acute intensive care unit, intermediate coronary care unit, neurology ward and post-operative ward. Whereas methicillin sensitive S. aureus (MSSA) occurrence was higher in patients admitted in orthopedic, Surgical out patient department, and female surgical ward. The occurrence of MRSA did not differ with age but MRSA was found associated with male patients and MSSA was associated with female patients. Since MRSA prevalence was high, regular surveillance of MRSA and nosocomial infections should be done and universal precautions to control nosocomial infections should be followed.

High Resolution Manometry - an underappreciated tool for examination of dysphagia in a surgical setting

DEFF Research Database (Denmark)

Jensen, Jonas Sanberg

Introduction Examination of dysphagia in Danish surgical departments, rely primarily on upper gastrointestinal endoscopy. When no visible or histological cause can be detected, esophageal motility disorders are important differential diagnosis. In examining these disorders and in evaluating...... gastroesophageal reflux disorder (GERD), High Resolution Esophageal Manometry (HRM), provide valuable insights. The purpose of this study was to examine referrals and final diagnosis from HRM in a surgical center specializing in esophageal disorders. Methods and Procedures All patients referred to HRM at our.......1% based on 10419 endoscopies. Conclusion HRM is an important diagnostic tool and supplements upper gastrointestinal endoscopy in examination of dysphagia as well as GERD, with significant differences in patterns of motility disorders. Knowledge and availability of HRM increases use at a surgical center...

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

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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.

Implementing lean in a surgical ward

DEFF Research Database (Denmark)

Edwards, Kasper; Nielsen, Anders Paarup; Jacobsen, Peter

be planned (in detail) in advance. The remaining operating rooms are allocated to this flow and there have been no significant changes to the organization of work in these theaters. Lean management is derived from the Toyota production system and is a comprehensive system of tools and techniques...

Observations on BI from N=2 supergravity and the general Ward identity

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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.

Managing competing demands through task-switching and multitasking: a multi-setting observational study of 200 clinicians over 1000 hours.

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Walter, Scott R; Li, Ling; Dunsmuir, William T M; Westbrook, Johanna I

2014-03-01

To provide a detailed characterisation of clinicians' work management strategies. 1002.3 h of observational data were derived from three previous studies conducted in a teaching hospital in Sydney, Australia, among emergency department (ED) doctors (n=40), ward doctors (n=57) and ward nurses (n=104). The rates of task-switching (pausing a task to handle an incoming task) and multitasking (adding a task in parallel to an existing task) were compared in each group. Random intercepts logistic regression was used to determine factors significantly associated with clinicians' use of task-switching over multitasking and to quantify variation between individual clinicians. Task-switching rates were higher among ED doctors (6.0 per hour) than ward staff (2.2 and 1.8 per hour for doctors and nurses, respectively) and vice versa for multitasking rates (9.2 vs 17.3 and 14.1 per hour). Clinicians' strategy use was significantly related to the nature and complexity of work and to the person they were working with. In some settings, time of day, day of the week or previous chosen strategy affected a clinician's strategy. Independent of these factors, there was significant variation between individual clinicians in their use of strategies in a given situation (ED doctors p=0.04, ward staff p=0.03). Despite differences in factors associated with work management strategy use among ED doctors, ward doctors and ward nurses, clinicians in all settings appeared to prioritise certain types of tasks over others. Documentation was generally given low priority in all groups, while the arrival of direct care tasks tended to be treated with high priority. These findings suggest that considerations of safety may be implicit in task-switching and multitasking decisions. Although these strategies have been cast in a negative light, future research should consider their role in optimising competing quality and efficiency demands.

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

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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.

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.

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 .

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%

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...

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

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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.

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

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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?

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

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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.

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

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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.

The A-test: Assessment of functional recovery during early rehabilitation of patients in an orthopedic ward - content, criterion and construct validity

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Vukomanović Aleksandra

2014-01-01

Full Text Available Background/Aim. The A-test was designed for assessment of functional recovery during early rehabilitation of patients in an orthopedic ward. This performance-based test consists of 10 items for assessing basic activities by a six level ordinal scale (0-5. Total scores can range from 0 to 50, i.e. from inability to perform any activity despite the help of therapists to complete independence and safety in performing all activities. The aim of this study was to examine the A-test validity. Methods. This prospective study was conducted in an orthopedic ward and included 120 patients [60 patients with hip osteoarthritis that underwent arthroplasty and 60 surgically treated patients with hip fracture (HF] during early inpatient rehabilitation (1st-5th day. Validity was examined through 3 aspects: content validity - floor and ceiling effect, range, skewness; criterion validity - concurrent validity [correlation with the University of Iowa Level of Assistance Scale (ILAS for patients with hip osteoarthritis, and with the Cumulated Ambulation Score (CAS for patients with HF, Spearman rank correlation] and predictive validity [the New Mobility Score (NMS 4 weeks after surgery, Mann-Whitney U test]; construct validity - 4 hypotheses: 1 on the fifth day of rehabilitation in patients underwent arthroplasty due to hip osteoarthritis, the A-test results will strongly correlate with those of ILAS, while the correlation with the Harris hip score will be less strong; 2 in patients with HF, the A-test results will be significantly better in those with allowed weight bearing as compared to patients whom weight bearing is not allowed while walking; 3 results of the A-test will be significantly better in patients with hip osetoarthritis than in those with HF; 4 the A-test results will be significantly better in patients younger than 65 years than in those aged 65 years and older. Results. The obtained results were: low floor (1% and ceiling (2% effect, range 0

Preoperative learning goals set by surgical residents and faculty.

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Pernar, Luise I M; Breen, Elizabeth; Ashley, Stanley W; Peyre, Sarah E

2011-09-01

The operating room (OR) remains the main teaching venue for surgical trainees. The OR is considered a pure-discovery learning environment; the downsides of this can be putatively overcome when faculty and trainee arrive at a shared understanding of learning. This study aimed to better understand preoperative learning goals to identify areas of commonalities and potential barrier to intraoperative teaching. Brief, structured preoperative interviews were conducted outside the OR with the resident and faculty member who were scheduled to operate together. Answers were analyzed and grouped using grounded theory. Twenty-seven resident-faculty pairs were interviewed. Nine residents (33.3%) were junior (PGY 1 and 2) and 18 (66.7%) were senior (PGY 3 through 5). Learning goal categories that emerged from the response analysis were anatomy, basic and advanced surgical skills, general and specific procedural tasks, technical autonomy, and pre-, intra-, and postoperative considerations. Residents articulated fewer learning goals than faculty (1.5 versus 2.4; P = 0.024). The most frequently identified learning goal by both groups was one classifiable under general procedural tasks; the greatest divergence was seen regarding perioperative considerations, which were identified frequently by faculty members but rarely by residents. Faculty articulate significantly more learning goals for the residents they will operate with than residents articulate for themselves. Our data suggest that residents and faculty align on some learning goals for the OR but residents tend to be more limited, focusing predominantly on technical aspects of the operation. Faculty members tend to hold a broader view of the learning potential of the OR. These discrepancies may present barriers to effective intraoperative teaching. Copyright © 2011 Elsevier Inc. All rights reserved.

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

Impact of antimicrobial wipes compared with hypochlorite solution on environmental surface contamination in a health care setting: A double-crossover study.

Science.gov (United States)

Siani, Harsha; Wesgate, Rebecca; Maillard, Jean-Yves

2018-05-11

Antimicrobial wipes are increasingly used in health care settings. This study evaluates, in a clinical setting, the efficacy of sporicidal wipes versus a cloth soaked in a 1,000 ppm chlorine solution. A double-crossover study was performed on 2 different surgical and cardiovascular wards in a 1,000-bed teaching hospital over 29 weeks. The intervention period that consisted of surface decontamination with the preimpregnated wipe or cloth soaked in chlorine followed a 5-week baseline assessment of microbial bioburden on surfaces. Environmental samples from 11 surfaces were analyzed weekly for their microbial content. A total of 1,566 environmental samples and 1,591 ATP swabs were analyzed during the trial. Overall, there were significant differences in the recovery of total aerobic bacteria (P < .001), total anaerobic bacteria (P < .001), and ATP measurement (P < .001) between wards and between the different parts of the crossover study. Generally, the use of wipes produced the largest reduction in the total aerobic and anaerobic counts when compared with the baseline data or the use of 1,000 ppm chlorine. Collectively, the introduction of training plus daily wipe disinfection significantly reduced multidrug-resistant organisms recovered from surfaces. Reversion to using 1,000 ppm chlorine resulted in the number of sites positive for multidrug-resistant organisms rising again. This double-crossover study is the first controlled field trial comparison of using preimpregnated wipes versus cotton cloth dipped into a bucket of hypochlorite to decrease surface microbial bioburden. The results demonstrate the superiority of the preimpregnated wipes in significantly decreasing microbial bioburden from high-touch surfaces. Copyright © 2018 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

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

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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.

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 ...

'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.

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

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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.

Surgical Emphysema: A Rare Complication of a Simple Surgical Dental Extraction Without the Use of an Air-Driven Rotor.

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Gowans, Keegan; Patel, Muneer; Lewis, Khari

2017-03-01

Surgical emphysema is a rare complication of dental extractions, often associated with the use of high-speed air rotors. This report describes a case of extensive surgical emphysema following a simple surgical extraction of a LL6 under local anaesthetic. There was no use of air-driven handpieces during the procedure. The patient developed extensive surgical emphysema bi-laterally in both cervical neck and facial planes. After prophylactic antibiotics with careful monitoring in a secondary care setting, the patient made a full unremarkable recovery. Clinical relevance: Simple extraction of teeth is a procedure carried out daily by most general dental practitioners. However, the risk of surgical emphysema without the use of high-speed air rotors or instruments using pressurized air/water is not well known or documented.

Nursing ward managers' perceptions of pain prevalence at the aged-care facilities in Japan: a nationwide survey.

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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.

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

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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.

Applying Mathematical Models to Surgical Patient Planning

NARCIS (Netherlands)

J.M. van Oostrum (Jeroen)

2009-01-01

textabstractOn a daily basis surgeons, nurses, and managers face cancellation of surgery, peak demands on wards, and overtime in operating rooms. Moreover, the lack of an integral planning approach for operating rooms, wards, and intensive care units causes low resource utilization and makes patient

Micro-spatial distribution of malaria cases and control strategies at ward level in Gwanda district, Matabeleland South, Zimbabwe.

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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

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

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, 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...

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

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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.

Design and validation of a questionnaire to assess organizational culture in French hospital wards.

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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

Comparison of alcohol-dependent patients at a gastroenterological and a psychiatric ward according to the Lesch alcoholism typology: implications for treatment.

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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.

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

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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.

Povidone-iodine induced post-surgical irritant contact dermatitis localized outside of the surgical incision area. Report of 27 cases and a literature review.

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Borrego, Leopoldo; Hernández, Noelia; Hernández, Zaida; Peñate, Yeray

2016-05-01

Povidone-iodine solution is an antiseptic that is used worldwide as surgical paint and is considered to have a low irritant potential. Post-surgical severe irritant dermatitis has been described after the misuse of this antiseptic in the surgical setting. Between January 2011 and June 2013, 27 consecutive patients with post-surgical contact dermatitis localized outside of the surgical incision area were evaluated. Thirteen patients were also available for patch testing. All patients developed dermatitis the day after the surgical procedure. Povidone-iodine solution was the only liquid in contact with the skin of our patients. Most typical lesions were distributed in a double lumbar parallel pattern, but they were also found in a random pattern or in areas where a protective pad or an occlusive medical device was glued to the skin. The patch test results with povidone-iodine were negative. Povidone-iodine-induced post-surgical dermatitis may be a severe complication after prolonged surgical procedures. As stated in the literature and based on the observation that povidone-iodine-induced contact irritant dermatitis occurred in areas of pooling or occlusion, we speculate that povidone-iodine together with occlusion were the causes of the dermatitis epidemic that occurred in our surgical setting. Povidone-iodine dermatitis is a problem that is easily preventable through the implementation of minimal routine changes to adequately dry the solution in contact with the skin. © 2015 The International Society of Dermatology.

Surgical simulation in orthopaedic skills training.

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Atesok, Kivanc; Mabrey, Jay D; Jazrawi, Laith M; Egol, Kenneth A

2012-07-01

Mastering rapidly evolving orthopaedic surgical techniques requires a lengthy period of training. Current work-hour restrictions and cost pressures force trainees to face the challenge of acquiring more complex surgical skills in a shorter amount of time. As a result, alternative methods to improve the surgical skills of orthopaedic trainees outside the operating room have been developed. These methods include hands-on training in a laboratory setting using synthetic bones or cadaver models as well as software tools and computerized simulators that enable trainees to plan and simulate orthopaedic operations in a three-dimensional virtual environment. Laboratory-based training offers potential benefits in the development of basic surgical skills, such as using surgical tools and implants appropriately, achieving competency in procedures that have a steep learning curve, and assessing already acquired skills while minimizing concerns for patient safety, operating room time, and financial constraints. Current evidence supporting the educational advantages of surgical simulation in orthopaedic skills training is limited. Despite this, positive effects on the overall education of orthopaedic residents, and on maintaining the proficiency of practicing orthopaedic surgeons, are anticipated.

Design and implementation of a PC-based image-guided surgical system.

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Stefansic, James D; Bass, W Andrew; Hartmann, Steven L; Beasley, Ryan A; Sinha, Tuhin K; Cash, David M; Herline, Alan J; Galloway, Robert L

2002-11-01

In interactive, image-guided surgery, current physical space position in the operating room is displayed on various sets of medical images used for surgical navigation. We have developed a PC-based surgical guidance system (ORION) which synchronously displays surgical position on up to four image sets and updates them in real time. There are three essential components which must be developed for this system: (1) accurately tracked instruments; (2) accurate registration techniques to map physical space to image space; and (3) methods to display and update the image sets on a computer monitor. For each of these components, we have developed a set of dynamic link libraries in MS Visual C++ 6.0 supporting various hardware tools and software techniques. Surgical instruments are tracked in physical space using an active optical tracking system. Several of the different registration algorithms were developed with a library of robust math kernel functions, and the accuracy of all registration techniques was thoroughly investigated. Our display was developed using the Win32 API for windows management and tomographic visualization, a frame grabber for live video capture, and OpenGL for visualization of surface renderings. We have begun to use this current implementation of our system for several surgical procedures, including open and minimally invasive liver surgery.

Quantity and quality of interaction between staff and older patients in UK hospital wards: A descriptive study.

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Barker, Hannah Ruth; Griffiths, Peter; Mesa-Eguiagaray, Ines; Pickering, Ruth; Gould, Lisa; Bridges, Jackie

2016-10-01

The quality of staff-patient interactions underpins the overall quality of patient experience and can affect other important outcomes. However no studies have been identified that comprehensively explore both the quality and quantity of interactions in general hospital settings. To quantify and characterise the quality of staff-patient interactions and to identify factors associated with negative interaction ratings. Data were gathered at two acute English NHS hospitals between March and April 2015. Six wards for adult patients participated including medicine for older people (n=4), urology (n=1) and orthopaedics (n=1). Eligible patients on participating wards were randomly selected for observation. Staff-patient interactions were observed using the Quality of Interactions Schedule. 120h of care were observed with each 2h observation session determined from a balanced random schedule (Monday-Friday, 08:00-22:00h). Multilevel logistic regression models were used to determine factors associated with negative interactions. 1554 interactions involving 133 patients were observed. The median length of interaction was 36s with a mean of 6 interactions per patient per hour. Seventy three percent of interactions were categorized as positive, 17% neutral and 10% negative. Forty percent of patients had at least one negative interaction (95% confidence interval 32% to 49%). Interactions initiated by the patient (adjusted Odds Ratio [OR] 5.30), one way communication (adjusted OR 10.70), involving two or more staff (adjusted OR 5.86 for 2 staff, 6.46 for 3+ staff), having a higher total number of interactions (adjusted OR 1.09 per unit increase), and specific types of interaction content were associated with increased odds of negative interaction (pinteraction was associated with increased odds of negative interaction in a reduced model. There was no significant association with gender, age or cognitive impairment. There was substantially more variation at ward level (variance

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

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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.

Effects of Frequent Glove Change on Outcomes of Orthopaedic Surgical Procedures - A Multicenter Study on Surgical Gloves

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Nishit Palo

2017-10-01

Full Text Available Introduction: Intact surgical gloves are a barrier to microorganisms migration between surgical team members and the patient. The surgical gloves are changed at various junctures but the effects of changing gloves during surgical procedures on various surgical parameters or clinical outcomes are not established. Aim: To determine rationale of glove change during orthopaedic procedures, differences amongst surgical parameters with and without changing the surgical gloves and whether frequent glove change affected surgical parameters or clinical outcomes. Materials and Methods: A prospective multicenter study conducted at three centers from January 2014 to January 2016. A 250 patients were divided into 2 groups (n=125 each in Group 1, surgical team operated with regular changing of gloves. In Group 2, only 1 set of double gloves were worn throughout the procedure. Surgical parameters or clinical outcomes were assessed for both the groups. Statistical analyses included the median, mode, range, Interquartile Range (IQR and sample standard deviation (s and independent-samples t-test. Bacterial counts were expressed as median with (IQR. Results: Surgical Timing Difference was 10 (S.D.- 4.2 minutes more in Group-1 (<0.05, Surgical Cost was higher in Group-1 by Rs.150-450 (<0.05. Outer glove micro-perforation rate was 5.85% and 8.15% in group-1 and 2 respectively with no inner glove perforation or Surgical Site Infections. Outer glove micro perforations were proportional to duration of surgery; operations lasting 120-210 and 61-120 minutes had 66.6% and 37.2% micro perforation rates respectively (p<0.05. Conclusion: Under standard operating conditions, procedures performed without glove change are shorter and cost effective than procedures performed with regular glove change with similar surgical and functional results. Judicious use of surgical gloves is a patient and environment friendly option, thereby reducing the hospital’s biomedical waste load.

The background scale Ward identity in quantum gravity

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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.)

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

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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.

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

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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.

Methicillin-resistant Staphylococcus aureus and Acinetobacter baumannii on computer interface surfaces of hospital wards and association with clinical isolates

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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.

Robotic surgical training.

Science.gov (United States)

Ben-Or, Sharon; Nifong, L Wiley; Chitwood, W Randolph

2013-01-01

In July 2000, the da Vinci Surgical System (Intuitive Surgical, Inc) received Food and Drug Administration approval for intracardiac applications, and the first mitral valve repair was done at the East Carolina Heart Institute in May 2000. The system is now approved and used in many surgical specialties. With this disruptive technology and accepted use, surgeons and hospitals are seeking the most efficacious training pathway leading to safe use and responsible credentialing.One of the most important issues related to safe use is assembling the appropriate team of professionals involved with patient care. Moreover, proper patient selection and setting obtainable goals are also important.Creation and maintenance of a successful program are discussed in the article focusing on realistic goals. This begins with a partnership between surgeon leaders, hospital administrators, and industry support. Through this partnership, an appropriate training pathway and clinical pathway for success can be outlined. A timeline can then be created with periods of data analysis and adjustments as necessary. A successful program is attainable by following this pathway and attending to every detail along the journey.

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.

[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.

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

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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.

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

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

Lost in hospital: a qualitative interview study that explores the perceptions of NHS inpatients who spent time on clinically inappropriate hospital wards.

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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.

Utilizing distributional analytics and electronic records to assess timeliness of inpatient blood glucose monitoring in non-critical care wards

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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

Assessment of post-operative pain management among acutely and electively admitted patients - a Swedish ward perspective.

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Magidy, Mahnaz; Warrén-Stomberg, Margareta; Bjerså, Kristofer

2016-04-01

Swedish health care is regulated to involve the patient in every intervention process. In the area of post-operative pain, it is therefore important to evaluate patient experience of the quality of pain management. Previous research has focused on mapping this area but not on comparing experiences between acutely and electively admitted patients. Hence, the aim of this study was to investigate the experiences of post-operative pain management quality among acutely and electively admitted patients at a Swedish surgical department performing soft-tissue surgery. A survey study design was used as a method based on a multidimensional instrument to assess post-operative pain management: Strategic and Clinical Quality Indicators in Postoperative Pain Management (SCQIPP). Consecutive patients at all wards of a university hospital's surgical department were included. Data collection was performed at hospital discharge. In total, 160 patients participated, of whom 40 patients were acutely admitted. A significant difference between acutely and electively admitted patients was observed in the SCQIPP area of environment, whereas acute patients rated the post-operative pain management quality lower compared with those who were electively admitted. There may be a need for improvement in the areas of post-operative pain management in Sweden, both specifically and generally. There may also be a difference in the experience of post-operative pain quality between acutely and electively admitted patients in this study, specifically in the area of environment. In addition, low levels of the perceived quality of post-operative pain management among the patients were consistent, but satisfaction with analgesic treatment was rated as good. © 2015 John Wiley & Sons, Ltd.

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.)

Wearable Technology for Global Surgical Teleproctoring.

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Datta, Néha; MacQueen, Ian T; Schroeder, Alexander D; Wilson, Jessica J; Espinoza, Juan C; Wagner, Justin P; Filipi, Charles J; Chen, David C

2015-01-01

In underserved communities around the world, inguinal hernias represent a significant burden of surgically-treatable disease. With traditional models of international surgical assistance limited to mission trips, a standardized framework to strengthen local healthcare systems is lacking. We established a surgical education model using web-based tools and wearable technology to allow for long-term proctoring and assessment in a resource-poor setting. This is a feasibility study examining wearable technology and web-based performance rating tools for long-term proctoring in an international setting. Using the Lichtenstein inguinal hernia repair as the index surgical procedure, local surgeons in Paraguay and Brazil were trained in person by visiting international expert trainers using a formal, standardized teaching protocol. Surgeries were captured in real-time using Google Glass and transmitted wirelessly to an online video stream, permitting real-time observation and proctoring by mentoring surgeon experts in remote locations around the world. A system for ongoing remote evaluation and support by experienced surgeons was established using the Lichtenstein-specific Operative Performance Rating Scale. Data were collected from 4 sequential training operations for surgeons trained in both Paraguay and Brazil. With continuous internet connectivity, live streaming of the surgeries was successful. The Operative Performance Rating Scale was immediately used after each operation. Both surgeons demonstrated proficiency at the completion of the fourth case. A sustainable model for surgical training and proctoring to empower local surgeons in resource-poor locations and "train trainers" is feasible with wearable technology and web-based communication. Capacity building by maximizing use of local resources and expertise offers a long-term solution to reducing the global burden of surgically-treatable disease. Copyright © 2015 Association of Program Directors in Surgery

clinical outcome of burns in hiv positive patients at the university

African Journals Online (AJOL)

Esem

Hospital (UTH), Lusaka, Zambia, Male and Female. Surgical Admission Wards and all General Surgical. Wards with burns patients from November 2009 to. November 2010. Study Design. This study was a Prospective Observational Cohort. Study. Case Definition. In this study, a case referred to a patient with recent burns,.

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

Factors influencing incident reporting in surgical care.

Science.gov (United States)

Kreckler, S; Catchpole, K; McCulloch, P; Handa, A

2009-04-01

To evaluate the process of incident reporting in a surgical setting. In particular: the influence of event outcome on reporting behaviour; staff perception of surgical complications as reportable events. Anonymous web-based questionnaire survey. General Surgical Department in a UK teaching hospital. Of 203 eligible staff, 55 (76.4%) doctors and 82 (62.6%) nurses participated. Knowledge and use of local reporting system; propensity to report incidents which vary by outcome (harm, no harm, harm prevented); propensity to report surgical complications; practical and psychological barriers to reporting. Nurses were significantly more likely to know of the local reporting system and to have recently completed a report than doctors. The level of harm (F(1.8,246) = 254.2, pvs 53%, z = 4.633, psystems.

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

Influence of Parental Encouragement towards Health Care of Their Wards

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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…

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 ...

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.

Improving Escalation of Care: Development and Validation of the Quality of Information Transfer Tool.

Science.gov (United States)

Johnston, Maximilian J; Arora, Sonal; Pucher, Philip H; Reissis, Yannis; Hull, Louise; Huddy, Jeremy R; King, Dominic; Darzi, Ara

2016-03-01

To develop and provide validity and feasibility evidence for the QUality of Information Transfer (QUIT) tool. Prompt escalation of care in the setting of patient deterioration can prevent further harm. Escalation and information transfer skills are not currently measured in surgery. This study comprised 3 phases: the development (phase 1), validation (phase 2), and feasibility analysis (phase 3) of the QUIT tool. Phase 1 involved identification of core skills needed for successful escalation of care through literature review and 33 semistructured interviews with stakeholders. Phase 2 involved the generation of validity evidence for the tool using a simulated setting. Thirty surgeons assessed a deteriorating postoperative patient in a simulated ward and escalated their care to a senior colleague. The face and content validity were assessed using a survey. Construct and concurrent validity of the tool were determined by comparing performance scores using the QUIT tool with those measured using the Situation-Background-Assessment-Recommendation (SBAR) tool. Phase 3 was conducted using direct observation of escalation scenarios on surgical wards in 2 hospitals. A 7-category assessment tool was developed from phase 1 consisting of 24 items. Twenty-one of 24 items had excellent content validity (content validity index >0.8). All 7 categories and 18 of 24 (P validity. The correlation between the QUIT and SBAR tools used was strong indicating concurrent validity (r = 0.694, P information transfer skills than nurses when faced with a deteriorating patient. A validated tool to assess information transfer for deteriorating surgical patients was developed and tested using simulation and real-time clinical scenarios. It may improve the quality and safety of patient care on the surgical ward.

Orthodontic-orthognathic interventions in orthognathic surgical cases: "Paper surgery" and "model surgery" concepts in surgical orthodontics

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Narayan H Gandedkar

2016-01-01

Full Text Available Thorough planning and execution is the key for successful treatment of dentofacial deformity involving surgical orthodontics. Presurgical planning (paper surgery and model surgery are the most essential prerequisites of orthognathic surgery, and orthodontist is the one who carries out this procedure by evaluating diagnostic aids such as crucial clinical findings and radiographic assessments. However, literature pertaining to step-by-step orthognathic surgical guidelines is limited. Hence, this article makes an attempt to provide an insight and nuances involved in the planning and execution. The diagnostic information revealed from clinical findings and radiographic assessments is integrated in the "paper surgery" to establish "surgical-plan." Furthermore, the "paper surgery" is emulated in "model surgery" such that surgical bite-wafers are created, which aid surgeon to preview the final outcome and make surgical movements that are deemed essential for the desired skeletal and dental outcomes. Skeletal complexities are corrected by performing "paper surgery" and an occlusion is set up during "model surgery" for the fabrication of surgical bite-wafers. Further, orthodontics is carried out for the proper settling and finishing of occlusion. Article describes the nuances involved in the treatment of Class III skeletal deformity individuals treated with orthognathic surgical approach and illustrates orthodontic-orthognathic step-by-step procedures from "treatment planning" to "execution" for successful management of aforementioned dentofacial deformity.

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

Glycemic control and the outcomes of Hispanic patients with diabetes admitted to the general ward of a community hospital in Puerto Rico.

Science.gov (United States)

Torres-Torres, Nancy; Maldonado-Rodríguez, Miguel A; Pérez-López, Shirley; Sierra-Martínez, Kassandra; García, Astrid J

2011-06-01

Uncontrolled glucose, present in 40% of diabetic patients admitted to United States hospitals, has been associated with prolonged length of stay and poorer general outcomes in critically ill and surgical patients. However, past studies of general ward patients have shown there to be no consistent benefits of strict glucose control, and the Hispanic population has been underrepresented in such studies. This work evaluated the association between glycemic control and the outcomes of hospitalized Hispanics with diabetes and to describe physicians' interventions in the treatment of diabetes. This is a retrospective chart review of all patients with diabetes admitted over a period of six months in the general ward of a community hospital in Puerto Rico. We evaluated glucose levels during the first 72 hours, length of stay, and reported complications during admission. Outcomes were evaluated with crude odds ratios and multivariate logistic regression. Uncontrolled blood glucose was observed in 59.1% of the 875 patients whose records were revised; of that 59.1%, treatment modification was not prescribed for 43.2%. Patients with poorly controlled glucose were more likely to develop acute coronary syndrome (corrected OR: 11.46; 95% CI = 1.48-88.50) as a complication and less likely to develop hypoglycemia (corrected OR: 0.57; 95% = CI 0.37-0.88). Our results suggest that hospitalized but non-critically ill Hispanic patients with diabetes are prone to poor outcomes secondary to uncontrolled glucose levels; in addition, those results support the creation of standardized protocols for the management of diabetes in this population.

Clostridium Difficile Infection in the Nephrology Ward

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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.

Exploring staff perceptions and experiences of volunteers and visitors on the hospital ward at mealtimes using an ethnographic approach.

Science.gov (United States)

Ottrey, Ella; Palermo, Claire; Huggins, Catherine E; Porter, Judi

2018-04-01

To explore multiple perspectives and experiences of volunteer and visitor involvement and interactions at hospital mealtimes. In addition, to understand how the volunteer and visitor role at mealtimes is perceived within the hospital system. Mealtime assistance can improve patients' food intake and mealtime experience. Barriers to providing mealtime assistance include time pressures, staff availability and inadequate communication. Volunteers and visitors can encourage and assist patients at mealtimes. There is a lack of evidence on the relationship between hospital staff, volunteers and visitors. A qualitative, ethnographic approach. Sixty-seven hours of fieldwork were conducted on two subacute wards within an Australian healthcare network in 2015. Mealtime practices and interactions of hospital staff, volunteers and visitors were observed. Sixty-one staff, volunteers and visitors were interviewed in 75 ethnographic and semi-structured interviews. Data were inductively and thematically analysed. Three key themes emerged as follows: "help"-volunteers and visitors were considered helpful when they assisted patients at mealtimes, supported well-being and aided staff-patient communication; "hindrance"-staff perceived visitors as negative presences when they inhibited patient progress and impacted staff work practices; and "reality of practice"-visiting hours, visitor engagement in patient therapy and communication between staff, volunteers and visitors were important practical considerations of mealtime involvement. The findings show how and why volunteers and visitors can be helpful and unhelpful at hospital mealtimes on subacute wards. More research on the role and contribution of volunteers and visitors on hospital wards will inform future practice in healthcare settings. This healthcare organisation should continue to encourage volunteer and visitor involvement at hospital mealtimes. More effort is needed to educate visitors about patients' therapeutic goals and

[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.

Current Status of Surgical Planning for Orthognathic Surgery: Traditional Methods versus 3D Surgical Planning

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Jeffrey A. Hammoudeh, MD, DDS

2015-02-01

Conclusions: It is our opinion that virtual model surgery will displace and replace traditional model surgery as it will become cost and time effective in both the private and academic setting for practitioners providing orthognathic surgical care in cleft and noncleft patients.

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.

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...

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

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Louise S van Galen

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

The opinion of Greek parents on the advantages and disadvantages of the outpatient pediatric oncology setting.

Science.gov (United States)

Matziou, Vasiliki; Servitzoglou, Marina; Vlahioti, Efrosini; Deli, Haralampia; Matziou, Theodora; Megapanou, Efstathia; Perdikaris, Pantelis

2013-12-01

The aim of this study was to assess parental opinions on the advantages and disadvantages of a pediatric oncology outpatient setting in comparison to the inpatient oncology ward. The sample of the study consisted of 104 parents whose children were diagnosed and treated for pediatric cancer. The survey took place at the Pediatric Oncology Wards, as well as their respective outpatient settings of the two General Children's Hospitals in Athens, Greece from May 2010 to August 2010. According to parents' view the outpatient setting was preferable due to the maintenance keeping of their daily routine (x(2) = 75.9, p = 0.000), maintaining the family life (x(2) = 90.1, p = 0.000) and young patients' participation in activities (x(2) = 25.6, p = 0.000). Moreover, young patients were more happy, less anxious and less scared when they were attending in the daily clinic (x(2) = 25.9, p = 0.000). According to parents' view, the outpatient setting has many advantages. The judgment of children and parents on the services offered by the Pediatric Oncology Unit overall, in both inpatient and outpatient setting can give the necessary feedback to improve the qualitative provided care. Copyright © 2013 Elsevier Ltd. All rights reserved.

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

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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.

Análise da aplicabilidade de três instrumentos de avaliação de dor em distintas unidades de atendimento: ambulatório, enfermaria e urgência Analysis of the applicability of different pain questionnaires in three hospital settings: outpatient clinic, ward and emergency unit

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José Eduardo Martinez

2011-08-01

Full Text Available OBJETIVO: Avaliar a aplicabilidade dos instrumentos de avaliação de dor em três ambientes hospitalares. METODOLOGIA: Foram estudados 60 pacientes com dor musculoesquelética atendidos no Conjunto Hospitalar de Sorocaba: enfermaria da Ortopedia, ambulatório de Reumatologia e Unidade Regional de Emergência (Pronto-socorro. QUESTIONÁRIOS: Inventário breve de dor (BPI; questionário McGill de Dor (MPQ; escala visual analógica para dor (EVA. RESULTADOS: Na urgência, houve um predomínio do gênero masculino com média de idade de 35 anos. No ambulatório, foram entrevistados 18 homens com idade média de 42 anos e duas mulheres com idade média de 55 anos. Na enfermaria, predominavam os homens com idade média de 30,7 anos. No pronto-socorro e na enfermaria, a duração foi menor para a EVA e maior para o MPQ. A duração para a EVA foi menor e não diferiu com relação aos locais. Na enfermaria e no pronto-socorro, a preferência dos pacientes recaiu pelo BPI sendo que, na enfermaria, a EVA foi segunda opção. No ambulatório, a preferência dos pacientes recaiu sobre o BPI (80% seguido do MPQ e os entrevistadores se dividiram igualmente entre esses mesmos questionários. No pronto-socorro, a preferência dos entrevistadores foi pelo BPI (40%, os restantes foram divididos igualmente. Houve uma prevalência maior de concordância do que de discordância das preferências entre pacientes e entrevistadores. CONCLUSÃO: Os instrumentos multidimensionais para avaliação da dor têm limitações em sua aplicabilidade no cotidiano da assistência hospitalar à saúdeOBJECTIVE: To assess the applicability of pain assessment instruments in three hospital settings. METHODOLOGY: This study comprised 60 patients with musculoskeletal pain cared for at the Conjunto Hospitalar de Sorocaba: orthopedic ward, Rheumatology outpatient clinic, and orthopedic emergency unit. QUESTIONNAIRES: Brief Pain Inventory (BPI; McGill Pain Questionnaire (MPQ; Visual

The impact of a large-scale quality improvement programme on work engagement: preliminary results from a national cross-sectional-survey of the 'Productive Ward'.

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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

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...

Lifshitz anomalies, Ward identities and split dimensional regularization

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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.

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.

The Full Ward-Takahashi Identity for Colored Tensor Models

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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.

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.)

Cost-Effectiveness Analysis of an Automated Medication System Implemented in a Danish Hospital Setting.

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Risør, Bettina Wulff; Lisby, Marianne; Sørensen, Jan

To evaluate the cost-effectiveness of an automated medication system (AMS) implemented in a Danish hospital setting. An economic evaluation was performed alongside a controlled before-and-after effectiveness study with one control ward and one intervention ward. The primary outcome measure was the number of errors in the medication administration process observed prospectively before and after implementation. To determine the difference in proportion of errors after implementation of the AMS, logistic regression was applied with the presence of error(s) as the dependent variable. Time, group, and interaction between time and group were the independent variables. The cost analysis used the hospital perspective with a short-term incremental costing approach. The total 6-month costs with and without the AMS were calculated as well as the incremental costs. The number of avoided administration errors was related to the incremental costs to obtain the cost-effectiveness ratio expressed as the cost per avoided administration error. The AMS resulted in a statistically significant reduction in the proportion of errors in the intervention ward compared with the control ward. The cost analysis showed that the AMS increased the ward's 6-month cost by €16,843. The cost-effectiveness ratio was estimated at €2.01 per avoided administration error, €2.91 per avoided procedural error, and €19.38 per avoided clinical error. The AMS was effective in reducing errors in the medication administration process at a higher overall cost. The cost-effectiveness analysis showed that the AMS was associated with affordable cost-effectiveness rates. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Ward's area location, physical activity, and body composition in 8- and 9-year-old boys and girls.

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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.

Combat surgical workload in Operation Iraqi Freedom and Operation Enduring Freedom: The definitive analysis.

Science.gov (United States)

Turner, Caryn A; Stockinger, Zsolt T; Gurney, Jennifer M

2017-07-01

Relatively few publications exist on surgical workload in the deployed military setting. This study analyzes US military combat surgical workload in Iraq and Afghanistan to gain a more thorough understanding of surgical training gaps and personnel requirements. A retrospective analysis of the Department of Defense Trauma Registry was performed for all Role 2 (R2) and Role 3 (R3) military treatment facilities from January 2001 to May 2016. International Classification of Diseases, Ninth Revision, Clinical Modification procedure codes were grouped into 18 categories based on functional surgical skill sets. The 189,167 surgical procedures identified were stratified by role of care, month, and year. Percentiles were calculated for the number of procedures for each skill set. A literature search was performed for publications documenting combat surgical workload during the same period. A total of 23,548 surgical procedures were performed at R2 facilities, while 165,619 surgical procedures were performed at R3 facilities. The most common surgical procedures performed overall were soft tissue (37.5%), orthopedic (13.84%), abdominal (13.01%), and vascular (6.53%). The least common surgical procedures performed overall were cardiac (0.23%), peripheral nervous system (0.53%), and spine (0.34%).Mean surgical workload at any point in time clearly underrepresented those units in highly kinetic areas, at times by an order of magnitude or more. The published literature always demonstrated workloads well in excess of the 50th percentile for the relevant time period. The published literature on combat surgical workload represents the high end of the spectrum of deployed surgical experience. These trends in surgical workload provide vital information that can be used to determine the manpower needs of future conflicts in ever-changing operational tempo environments. Our findings provide surgical types and surgical workload requirements that will be useful in surgical training and

The usefulness of the surgical knowledge and skills acquired via the university curriculum for doctors' medical practice several years after graduation.

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Zyluk, Andrzej; Puchalski, Piotr; Szlosser, Zbigniew

2015-01-01

Teaching surgery during university curriculum comprises transferring theoretical knowledge traditionally and simultaneously acquiring manual skills, i.e., suturing, stitch removal, limb immobilization, catheterization, and assisting operations. Observations of doctors several years after graduation led to the reflection that teachers' ideas about surgical knowledge and skills that are useful in daily practice frequently fail to meet the facts of the case. The objective of this study was to determine which part of the surgical knowledge and skills taught via the university surgical curriculum proved to be useful in the daily practice of young doctors. A custom-made questionnaire was designed and mailed to 200 randomly chosen doctors who had graduated from the medical faculty at the authors' university 5 to 6 years previously. The questionnaire comprised 9 items concerning the knowledge and skills that proved to be the most useful in participants' daily practice, regardless of their specialty. A total of 64 completed questionnaires were returned (32% of 200 sent) and were the subject of analysis. The most useful knowledge in daily practice was that acquired from general surgery, followed by oncological and vascular surgery. The most useful was knowledge about the rational interpretation of clinical symptoms and signs acquired from examination of the patient, followed by arriving at an accurate diagnosis through logical analysis, and next developing "oncological sensitivity" to diagnosing neoplasms. The most effective teaching model was specialized outpatient clinic rounds, followed by training manual skills on a model and classical ward-round teaching. The most frequently learned (acquired) manual skills were removal of stitches, rectal examination, and examination of the abdomen. Of these skills, the most useful in daily practice appeared to be removal of stitches, catheterization of the urinary bladder, and wound suturing. Learning and practicing manual skills

A Literature Review of Renal Surgical Anatomy and Surgical Strategies for Partial Nephrectomy.

Science.gov (United States)

Klatte, Tobias; Ficarra, Vincenzo; Gratzke, Christian; Kaouk, Jihad; Kutikov, Alexander; Macchi, Veronica; Mottrie, Alexandre; Porpiglia, Francesco; Porter, James; Rogers, Craig G; Russo, Paul; Thompson, R Houston; Uzzo, Robert G; Wood, Christopher G; Gill, Inderbir S

2015-12-01

A detailed understanding of renal surgical anatomy is necessary to optimize preoperative planning and operative technique and provide a basis for improved outcomes. To evaluate the literature regarding pertinent surgical anatomy of the kidney and related structures, nephrometry scoring systems, and current surgical strategies for partial nephrectomy (PN). A literature review was conducted. Surgical renal anatomy fundamentally impacts PN surgery. The renal artery divides into anterior and posterior divisions, from which approximately five segmental terminal arteries originate. The renal veins are not terminal. Variations in the vascular and lymphatic channels are common; thus, concurrent lymphadenectomy is not routinely indicated during PN for cT1 renal masses in the setting of clinically negative lymph nodes. Renal-protocol contrast-enhanced computed tomography or magnetic resonance imaging is used for standard imaging. Anatomy-based nephrometry scoring systems allow standardized academic reporting of tumor characteristics and predict PN outcomes (complications, remnant function, possibly histology). Anatomy-based novel surgical approaches may reduce ischemic time during PN; these include early unclamping, segmental clamping, tumor-specific clamping (zero ischemia), and unclamped PN. Cancer cure after PN relies on complete resection, which can be achieved by thin margins. Post-PN renal function is impacted by kidney quality, remnant quantity, and ischemia type and duration. Surgical renal anatomy underpins imaging, nephrometry scoring systems, and vascular control techniques that reduce global renal ischemia and may impact post-PN function. A contemporary ideal PN excises the tumor with a thin negative margin, delicately secures the tumor bed to maximize vascularized remnant parenchyma, and minimizes global ischemia to the renal remnant with minimal complications. In this report we review renal surgical anatomy. Renal mass imaging allows detailed delineation of the