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  1. Assessment of Delirium in Intensive Care Unit Patients: Educational Strategies.

    Science.gov (United States)

    Smith, Judith M; Van Aman, M Nancy; Schneiderhahn, Mary Elizabeth; Edelman, Robin; Ercole, Patrick M

    2017-05-01

    Delirium is an acute brain dysfunction associated with poor outcomes in intensive care unit (ICU) patients. Critical care nurses play an important role in the prevention, detection, and management of delirium, but they must be able to accurately assess for it. The Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) instrument is a reliable and valid method to assess for delirium, but research reveals most nurses need practice to use it proficiently. A pretest-posttest design was used to evaluate the success of a multimodal educational strategy (i.e., online learning module coupled with standardized patient simulation experience) on critical care nurses' knowledge and confidence to assess and manage delirium using the CAM-ICU. Participants (N = 34) showed a significant increase (p assess and manage delirium following the multimodal education. No statistical change in knowledge of delirium existed following the education. A multimodal educational strategy, which included simulation, significantly added confidence in critical care nurses' performance using the CAM-ICU. J Contin Nurs Educ. 2017;48(5):239-244. Copyright 2017, SLACK Incorporated.

  2. Perspectives of patients with acute abdominal pain in an emergency department observation unit and a surgical assessment unit

    DEFF Research Database (Denmark)

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

    2014-01-01

    AIMS AND OBJECTIVES: To investigate the patient perspective when admitted with acute abdominal pain to an emergency department observation unit compared with the perspective when admitted to a surgical assessment unit. BACKGROUND: An increase in emergency department observation units has led...... to more short-term admissions and has changed the patient journey from admission to specialised wards staffed by specialist nurses to stays in units staffed by emergency nurses. DESIGN: A comparative field study. METHODS: The study included 21 patients. Participant observation and qualitative interviews...... were performed, and the analyses were phenomenological-hermeneutic. RESULTS: Emergency department observation unit patients had extensive interaction with health professionals, which could create distrust. Surgical assessment unit patients experienced lack of interaction with nurses, also creating...

  3. Assessment of Sedation and Analgesia in Mechanically Ventilated Patients in Intensive Care Unit

    OpenAIRE

    2008-01-01

    Post traumatic stress resulting from an intensive care unit(ICU) stay may be prevented by adequate level of sedation and analgesia. Aims of the study were reviewing the current practices of sedation and analgesia in our ICU setup and to assess level of sedation and analgesia to know the requirement of sedative and analgesics in mechani-cally ventilated ICU patients. This prospective observational study was conducted on 50 consecutive mechanically ventilated patients in ICU over a period of 6 ...

  4. Assessment of Sedation and Analgesia in Mechanically Ventilated Patients in Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Udita Naithani

    2008-01-01

    Full Text Available Post traumatic stress resulting from an intensive care unit(ICU stay may be prevented by adequate level of sedation and analgesia. Aims of the study were reviewing the current practices of sedation and analgesia in our ICU setup and to assess level of sedation and analgesia to know the requirement of sedative and analgesics in mechani-cally ventilated ICU patients. This prospective observational study was conducted on 50 consecutive mechanically ventilated patients in ICU over a period of 6 months. Patient′s sedation level was assessed by Ramsay Sedation Scale (RSS = 1 : Agitated; 2,3 : Comfortable; 4,5,6 : Sedated and pain intensity by Behavioural Pain Scale (BPS = 3 :No pain, to 16 : Maximum pain. BPS, mean arterial pressure(MAP and heart rate(HR were assessed before and after painful stimulus (tracheal suction. Although no patient had received sedative and analgesics, mean Ramsay score was 3.52±1.92 with 30% patients categorized as ′agitated′, 12% as ′comfortable′ and 58% as ′sedated′ because of depressed consciousness level. Mean BPS at rest was 4.30±1.28 revealing background pain that further increased to 6.18±1.88 after painful stimulus. There was significant rise in HR (10.30%, MAP (7.56% and BPS (40.86% after painful stimulus, P< 0.0001. The correlation between BPS and Ramsay Score was negative and significant (P< 0.01. We conclude that there should be regular definition of the appropriate level of sedation and analgesia as well as monitoring of the desired level, using sedation and pain scales as a part of the total care for mechanically ventilated patients.

  5. Assessment of a Hospital Palliative Care Unit (HPCU) for Cancer Patients; A Conceptual Framework

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    Rouhollahi, Mohammad Reza; Saghafinia, Masoud; Zandehdel, Kazem; Motlagh, Ali Ghanbari; Kazemian, Ali; Mohagheghi, Mohammad Ali; Tahmasebi, Mamak

    2015-01-01

    Introduction: The first hospital palliative care unit (HPCU) in Iran (FARS-HPCU) has been established in 2008 in the Cancer Institute, which is the largest referral cancer center in the country. We attempted to assess the performance of the HPCU based on a comprehensive conceptual framework. The main aim of this study was to develop a conceptual framework for assessment of the HPCU performances through designing a value chain in line with the goals and the main processes (core and support). Materials and Methods: We collected data from a variety of sources, including international guidelines, international best practices, and expert opinions in the country and compared them with national policies and priorities. We also took into consideration the trend of the HPCU development in the Cancer Institute of Iran. Through benchmarking the gap area with the performance standards, some recommendations for better outcome are proposed. Results: The framework for performance assessment consisted of 154 process indicators (PIs), based on which the main stakeholders of the HPCU (including staff, patients, and families) offered their scoring. The outcome revealed the state of the processes as well as the gaps Conclusion: Despite a significant improvement in many processes and indicators, more development in the comprehensive and integrative aspects of FARS-HPCU performance is required. Consideration of all supportive and palliative requirements of the patients through interdisciplinary and collaborative approaches is recommended. PMID:26600701

  6. [Epidemiological characteristics of patients evaluated with fibromyalgia in the Assessment of Disability Unit of Madrid].

    Science.gov (United States)

    Regal Ramos, R J

    To determine the epidemiological characteristics of patients with fibromyalgia requiring assessment of incapacity for work. A descriptive study was conducted on the patients evaluated in the Medical Unit of the National Institute of Social Security in Madrid in the period from 2005 to 2014 with the diagnosis of fibromyalgia. A study was made on the variables: age, sex, marital status, comorbidity (hypothyroidism, neck pain, psychiatric disorders, and carpal tunnel syndrome), professional occupation, level of education, and type of affiliation to the National Institute of Social Security. The total number of patients studied was 5,501. The median age was 53 years. Compared to the general working population in our area there were 47% more women, 12% less married people, 25% less workers with higher education, and 23% more unskilled occupations. As regards the working population in our area, there is a markedly increased prevalence of neck pain (prevalence ratio: 2.0), hypothyroidism (prevalence ratio 2.4), and carpal tunnel syndrome (prevalence ratio: 3.0). More than half (58%) of the sample presented with psychiatric disorders. It can be concluded that the profile of the patient with fibromyalgia assessed in the UMEVI is a woman, aged 46-60 years, mostly with a relatively unskilled job, and with primary level education. More than half of the cases had associated psychiatric disorders, and often associated with neck pain diagnoses, carpal tunnel syndrome, and hypothyroidism. Copyright © 2016 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.

  7. Assessment of Dietary Practice Among Diabetic Patients in the United Arab Emirates

    Science.gov (United States)

    Al-Kaabi, Juma; Al-Maskari, Fatma; Saadi, Hussein; Afandi, Bachar; Parkar, Hasratali; Nagelkerke, Nicolaas

    2008-01-01

    OBJECTIVES: The aim of this study was to assess dietary practices and risk profile (hypertension, obesity, lipid profile and glycemic control) among people with diabetes in Al-Ain District, United Arab Emirates (UAE). METHODS: During 2006, we performed a cross-sectional study of diabetic patients attending diabetic outpatient clinics at Tawam Hospital and primary health care centers in Al-Ain District. Subjects completed an interviewer-administered questionnaire, blood pressure, body mass index, percentage body fat and abdominal circumference were measured and recorded and the most recent HbA1c levels and fasting lipid profile were identified. RESULTS: A sample of 409 diabetic patients was recruited, 50% of whom were illiterate. Only 24% read food labeling. 76% reported being unable to distinguish clearly between low and high carbohydrate index food items and no one reported counting calorie intake. 46% reported that they had never been seen by dietician since their diagnosis. Their overall risk profile, notably body weight, lipid profile and blood pressure, was very unfavorable; more than half of the study sample had uncontrolled hypertension and uncontrolled lipid profile and the majority was overweight (36%) or obese (45%). Abdominal obesity was particularly common (59%). Only 31% had an HbA1c of less than 7%. CONCLUSIONS: The dietary practices of diabetic patients in the UAE are inadequate and need improvement. PMID:18795213

  8. Motor unit properties in the biceps brachii of chronic stroke patients assessed with high-density surface EMG

    NARCIS (Netherlands)

    Kallenberg, L.A.C.; Hermens, Hermanus J.

    2009-01-01

    Motor unit properties of the biceps brachii and Fugl-Meyer score were assessed in stroke patients and healthy controls during passive and active elbow flexion and extension contractions. The level of motor recovery as assessed with the Fugl-Meyer was correlated with the ration of the size of the

  9. Motor unit properties of biceps brachii in chronic stroke patients assessed with high-density surface EMG

    NARCIS (Netherlands)

    Kallenberg, L.A.C.; Hermens, Hermanus J.

    2009-01-01

    The aim of this study was to investigate motor unit (MU) characteristics of the biceps brachii in post-stroke patients, using high-density surface electromyography (sEMG). Eighteen chronic hemiparetic stroke patients took part. The Fugl-Meyer score for the upper extremity was assessed. Subjects

  10. Assessment and Treatment of Pain in Adult Intensive Care Unit Patients

    Directory of Open Access Journals (Sweden)

    Jun Mo Park

    2014-08-01

    Because pain is quite subjective, the accurate assessment of pain is very difficult in the patients with impaired communication ability. The current most valid and reliable behavioral pain scales used to assess pain in adult ICU patients are the Behavioral Pain Scale and the Critical-Care Pain Observation Tool. Once pain has been accurately assessed using these methods, various pharmacologic and non-pharmacologic therapies should be performed by the multidisciplinary care team. Accurate assessment and proper treatment of pain in adult ICU patients will improve patients outcome, which reduces the stress response and decreases the risk of post-traumatic stress disorder.

  11. Using rapid assessment to evaluate noise on an in-patient unit.

    Science.gov (United States)

    Deitrick, Lynn M; Kennedy, Paulette; Cyriax, Carol; Davies-Hathen, Nancy

    2009-01-01

    Rapid assessment was used to evaluate a noise problem on a busy, high-traffic, high-acuity medical/surgical telemetry unit over a 4-week period. Six sources of environmental noise were identified including conversational noise, noise from doors, noise from housekeeping activities, noise from the pneumatic message tube station, hallway noise, and miscellaneous noise. Our study also demonstrates the value of rapid-assessment methodology for the evaluation of clinical problems such as noise.

  12. Nursing assessment of continuous vital sign surveillance to improve patient safety on the medical/surgical unit.

    Science.gov (United States)

    Watkins, Terri; Whisman, Lynn; Booker, Pamela

    2016-01-01

    Evaluate continuous vital sign surveillance as a tool to improve patient safety in the medical/surgical unit. Failure-to-rescue is an important measure of hospital quality. Patient deterioration is often preceded by changes in vital signs. However, continuous multi-parameter vital sign monitoring may decrease patient safety with an abundance of unnecessary alarms. Prospective observational study at two geographically disperse hospitals in a single hospital system. A multi-parameter vital sign monitoring system was installed in a medical/surgical unit in Utah and one in Alabama providing continuous display of SpO2, heart rate, blood pressure and respiration rate on a central station. Alarm thresholds and time to alert annunciations were set based on prior analysis of the distribution of each vital sign. At the end of 4 weeks, nurses completed a survey on their experience. An average alert per patient, per day was determined retrospectively from the saved vital signs data and knowledge of the alarm settings. Ninety-two per cent of the nurses agreed that the number of alarms and alerts were appropriate; 54% strongly agreed. On average, both units experienced 10·8 alarms per patient, per day. One hundred per cent agreed the monitor provided valuable patient data that increased patient safety; 79% strongly agreed. Continuous, multi-parameter patient monitoring could be performed on medical/surgical units with a small and appropriate level of alarms. Continuous vital sign assessment may have initiated nursing interventions that prevented failure-to-rescue events. Nurses surveyed unanimously agreed that continuous vital sign surveillance will help enhance patient safety. Nursing response to abnormal vital signs is one of the most important levers in patient safety, by providing timely recognition of early clinical deterioration. This occurs through diligent nursing surveillance, involving assessment, interpretation of data, recognition of a problem and meaningful

  13. Risk assessment study of the pressure ulcers in intensive care unit patients.

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    Terekeci, Hakan; Kucukardali, Yasar; Top, Cihan; Onem, Yalçin; Celik, Serkan; Oktenli, Cağatay

    2009-07-01

    In this research, we studied the incidence of pressure ulcer and risk factors and screening of the patients for pressure ulcers at intensive care unit on the first day of admission in 142 patients. All patients were evaluated according to National Pressure Ulcer Advisory Panel during the ICU period strictly. Pressure ulcer risk evaluation was performed according to Norton Scale. Nutritional state was evaluated according to nutritional risk screening 2002. Age, hospitalization period, mean arterial pressure, pressure ulcer degree, hemoglobin and albumin levels, body mass index, APACHE-II scores and comorbidities were evaluated. In the following parameters, first value represents PU (+) cases, and second value represents PU (-) cases. On the admittance: 14 (9.8%) patients had PU (prevalence). NRS-2002: 5.4+/-1.9 and 4.3+/-2.1 (p0.05). Mean pressure ulcer degree was 2.15. On the discharge: first values represent new developed PU (+) patients and second values represent PU (-) cases. 25 (17.6%) patients had PU. Incidence was 7.8%. NRS-2002: 6.4 and 3.6 (p0.05). Two or more co morbidity, neurophyschiatric disorders, infections and medications were more prevalent in PU (+) group (pmalnutrition and hypoalbuminemia were significant in patients with PU; however, BMI and hemoglobin were not significant. The studies focusing on the relation between the effect of optimization of these parameters from the first day of admittance and pressure ulcer are required.

  14. Nurses' Knowledge and Responsibility toward Nutritional Assessment for Patients in Intensive Care Units

    Directory of Open Access Journals (Sweden)

    Mahmoud Al Kalaldeh

    2014-09-01

    Full Text Available Introduction: Nutritional assessment is a prerequisite for nutritional delivery. Patients in intensive care suffer from under-nutrition and nutritional failure due to poor assessment. Nursing ability to early detect nutritional failure is the key for minimizing imparities in practice and attaining nutritional goals. Aim of this article is to examine the ability of Jordanian ICU nurses to assess the nutritional status of critically ill patients, considering biophysical and biochemical measures.Methods: This cross sectional study recruited nurses from different health sectors in Jordan. ICU nurses from the governmental sector (two hospitals and private sectors (two hospitals were surveyed using a self-administered questionnaire. Nurses' knowledge and responsibility towards nutritional assessment were examined.Results: A total of 220 nurses from both sectors have completed the questionnaire. Nurses were consistent in regard to knowledge, responsibility, and documentation of nutritional assessment. Nurses in the governmental hospitals inappropriately perceived the application of aspiration reduction measures. However, they scored higher in applying physical examination and anthropometric assessment.  Although both nurses claimed higher use of biochemical measurements, biophysical measurements were less frequently used. Older nurses with longer clinical experience exhibited better adherence to biophysical measurement than younger nurses.Conclusion: Nursing nutritional assessment is still suboptimal to attain nutritional goals. Assessment of body weight, history of nutrition intake, severity of illness, and function of gastrointestinal tract should be considered over measuring albumin and pre-albumin levels.  A well-defined evidence-based protocol as well as a multidisciplinary nutritional team for nutritional assessment is the best to minimize episodes of under-nutrition.

  15. Assessment and risk classification protocol for patients in emergency units1

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    Silva, Michele de Freitas Neves; Oliveira, Gabriela Novelli; Pergola-Marconato, Aline Maino; Marconato, Rafael Silva; Bargas, Eliete Boaventura; Araujo, Izilda Esmenia Muglia

    2014-01-01

    Objective to develop, validate the contents and verify the reliability of a risk classification protocol for an Emergency Unit. Method the content validation was developed in a University Hospital in a country town located in the state of Sao Paulo and was carried out in two stages: the first with the individual assessment of specialists and the second with the meeting between the researchers and the specialists. The use of the protocol followed a specific guide. Concerning reliability, the concordance or equivalent method among observers was used. Results the protocol developed showed to have content validity and, after the suggested changes were made, there were excellent results concerning reliability. Conclusion the assistance flow chart was shown to be easy to use, and facilitate the search for the complaint in each assistance priority. PMID:26107828

  16. Quality of life assessment in advanced cancer patients treated at home, an inpatient unit, and a day care center

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    Leppert W

    2014-05-01

    Full Text Available Wojciech Leppert,1 Mikolaj Majkowicz,2 Maria Forycka,1 Eleonora Mess,3 Agata Zdun-Ryzewska2 1Department of Palliative Medicine, Poznan University of Medical Sciences, Poznan, Poland; 2Department of Quality of Life Research, Gdansk Medical University, Gdansk, Poland; 3Palliative Care Nursing Department, Wroclaw Medical University, Wroclaw, Poland Aim of the study: To assess quality of life (QoL in cancer patients treated at home, at an in-patient palliative care unit (PCU, and at a day care center (DCC. Patients and methods: QoL was assessed in advanced cancer patients at baseline and after 7 days of symptomatic treatment using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 15-Palliative Care (EORTC QLQ-C15-PAL, the Edmonton Symptom Assessment System (ESAS, and the Karnofsky Performance Status (KPS scale. Results: A total of 129 patients completed the study, with 51 patients treated at home, 51 patients treated at the PCU, and 27 patients at DCC. In the EORTC QLQ-C15-PAL, improvement in functional and symptom scales was observed except in physical functioning and fatigue levels; patients at DCC had a better physical functioning, global QoL, appetite, and fatigue levels. In the ESAS, improvement in all items was found except for drowsiness levels, which was stable in patients treated at DCC and deteriorated in home and PCU patients. Higher activity, better appetite and well-being, and less drowsiness were observed in patients treated at DCC. KPS was better in DCC patients compared to those treated at home and at the PCU; the latter group deteriorated. Conclusions: QoL improved in all patient groups, with better results in DCC patients and similar scores in those staying at home and at the PCU. Along with clinical assessment, baseline age, KPS, physical and emotional functioning may be considered when assigning patients to care at a DCC, PCU, or at home. Keywords: oncology, patient care

  17. Is the acute care of frail elderly patients in a comprehensive geriatric assessment unit superior to conventional acute medical care?

    Science.gov (United States)

    Ekerstad, Niklas; Karlson, Björn W; Dahlin Ivanoff, Synneve; Landahl, Sten; Andersson, David; Heintz, Emelie; Husberg, Magnus; Alwin, Jenny

    2017-01-01

    Objective The aim of this study was to investigate whether the acute care of frail elderly patients in a comprehensive geriatric assessment (CGA) unit is superior to the care in a conventional acute medical care unit. Design This is a clinical, prospective, randomized, controlled, one-center intervention study. Setting This study was conducted in a large county hospital in western Sweden. Participants The study included 408 frail elderly patients, aged ≥75 years, in need of acute in-hospital treatment. The patients were allocated to the intervention group (n=206) or control group (n=202). Mean age of the patients was 85.7 years, and 56% were female. Intervention This organizational form of care is characterized by a structured, systematic interdisciplinary CGA-based care at an acute elderly care unit. Measurements The primary outcome was the change in health-related quality of life (HRQoL) 3 months after discharge from hospital, measured by the Health Utilities Index-3 (HUI-3). Secondary outcomes were all-cause mortality, rehospitalizations, and hospital care costs. Results After adjustment by regression analysis, patients in the intervention group were less likely to present with decline in HRQoL after 3 months for the following dimensions: vision (odds ratio [OR] =0.33, 95% confidence interval [CI] =0.14–0.79), ambulation (OR =0.19, 95% CI =0.1–0.37), dexterity (OR =0.38, 95% CI =0.19–0.75), emotion (OR =0.43, 95% CI =0.22–0.84), cognition (OR = 0.076, 95% CI =0.033–0.18) and pain (OR =0.28, 95% CI =0.15–0.50). Treatment in a CGA unit was independently associated with lower 3-month mortality adjusted by Cox regression analysis (hazard ratio [HR] =0.55, 95% CI =0.32–0.96), and the two groups did not differ significantly in terms of hospital care costs (P>0.05). Conclusion Patients in an acute CGA unit were less likely to present with decline in HRQoL after 3 months, and the care in a CGA unit was also independently associated with lower mortality

  18. Implementing Best Practice Guidelines in Pain Assessment and Management on a Women's Psychiatric Inpatient Unit: Exploring Patients' Perceptions.

    Science.gov (United States)

    Rolin-Gilman, Cheryl; Fournier, Bonnie; Cleverley, Kristin

    2017-06-01

    Assessing and managing chronic pain in women with histories of interpersonal trauma, mood disorders and co-morbid addiction is complex. The aim of this paper is to report on the findings from a quality improvement project exploring women's experiences who have co-occurring mental health issues, addiction and chronic pain. Exploring perceptions was an initial step in implementing the Registered Nurses' Association of Ontario (RNAO) Best Practice Guideline (BPG) on the Assessment and Management of Pain. Focus group discussions were conducted using an exploratory design with 10 women who were hospitalized in an acute psychiatric unit. Our findings suggest that these women view their pain as complex and often feel powerless within an acute psychiatric setting resorting to coping through self management. The women expressed the importance of therapeutic relationships with clinicians in assessing and managing their pain. The implications of this study suggest that patients have a key role in informing the implementation and applicability of best practice guidelines. Validating the patient's personal pain management experience and particular psychological and physical therapies were suggested as strategies to enhance the patient's quality of life. Many clinicians working in mental health are knowledgeable about these therapies, but may not be aware of the application to managing physical pain. Copyright © 2017 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

  19. Performance assessment of the SOFA, APACHE II scoring system, and SAPS II in intensive care unit organophosphate poisoned patients.

    Science.gov (United States)

    Kim, Yong Hwan; Yeo, Jung Hoon; Kang, Mun Ju; Lee, Jun Ho; Cho, Kwang Won; Hwang, SeongYoun; Hong, Chong Kun; Lee, Young Hwan; Kim, Yang Weon

    2013-12-01

    This study assessed the ability of the Sequential Organ Failure Assessment (SOFA) and Acute Physiology, Chronic Health Evaluation (APACHE) II scoring systems, as well as the Simplified Acute Physiology Score (SAPS) II method to predict group mortality in intensive care unit (ICU) patients who were poisoned with organophosphate. The medical records of 149 organophosphate poisoned patients admitted to the ICU from September 2006 to December 2012 were retrospectively examined. The SOFA, APACHE II, and SAPS II were calculated based on initial laboratory data in the Emergency Department, and during the first 24 hr of ICU admission. The probability of death was calculated for each patient based on the SOFA score, APACHE II score, and SAPS II equations. The ability to predict group mortality by the SOFA score, APACHE II score, and SAPS II method was assessed using two by two decision matrices and receiver operating characteristic (ROC) curve analysis. A total of 131 patients (mean age, 61 yr) were enrolled. The sensitivities, specificities, and accuracies were 86.2%, 82.4%, and 83.2% for the SOFA score, respectively; 65.5%, 68.6%, and 67.9% for the APACHE II scoring system, respectively; and 86.2%, 77.5%, and 79.4% for the SAPS II, respectively. The areas under the curve in the ROC curve analysis for the SOFA score, APACHE II scoring system, and SAPS II were 0.896, 0.716, and 0.852, respectively. In conclusion, the SOFA, APACHE II, and SAPS II have different capability to discriminate and estimate early in-hospital mortality of organophosphate poisoned patients. The SOFA score is more useful in predicting mortality, and easier and simpler than the APACHE II and SAPS II.

  20. Is the acute care of frail elderly patients in a comprehensive geriatric assessment unit superior to conventional acute medical care?

    Directory of Open Access Journals (Sweden)

    Ekerstad N

    2016-12-01

    Full Text Available Niklas Ekerstad,1,2 Björn W Karlson,3 Synneve Dahlin Ivanoff,4 Sten Landahl,5 David Andersson,6 Emelie Heintz,7 Magnus Husberg,2 Jenny Alwin2 1Department of Cardiology, NU (NÄL-Uddevalla Hospital Group, Trollhattan, 2Division of Health Care Analysis, Department of Medical and Health Sciences, Linköping University, Linköping, 3Department of Molecular and Clinical Medicine, Institute of Medicine, 4Centre for Ageing and Health, AGECAP, Department of Health and Rehabilitation, 5Department of Geriatrics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, 6Division of Economics, Department of Management and Engineering, Linköping University, Linköping, 7Health Outcomes and Economic Evaluation Research Group, Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden Objective: The aim of this study was to investigate whether the acute care of frail elderly patients in a comprehensive geriatric assessment (CGA unit is superior to the care in a conventional acute medical care unit. Design: This is a clinical, prospective, randomized, controlled, one-center intervention study. Setting: This study was conducted in a large county hospital in western Sweden. Participants: The study included 408 frail elderly patients, aged ≥75 years, in need of acute in-hospital treatment. The patients were allocated to the intervention group (n=206 or control group (n=202. Mean age of the patients was 85.7 years, and 56% were female. Intervention: This organizational form of care is characterized by a structured, systematic interdisciplinary CGA-based care at an acute elderly care unit. Measurements: The primary outcome was the change in health-related quality of life (HRQoL 3 months after discharge from hospital, measured by the Health Utilities Index-3 (HUI-3. Secondary outcomes were all-cause mortality, rehospitalizations, and hospital care costs. Results: After adjustment by

  1. Motor unit properties in the biceps brachii of stroke patients assessed with surface array EMG

    NARCIS (Netherlands)

    Kallenberg, L.A.C.; Hermens, Hermanus J.

    2007-01-01

    As a consequence of a stroke, both motor control as well as motor unit (MU) characteristics may change, e.g. MU size has been reported to increase due to reinnervation. The aim of the present study was to investigate how differences between the affected and unaffected side of hemiparetic stroke

  2. Undiagnosed chronic obstructive pulmonary diseases in patients admittet to an acute assessment unit

    DEFF Research Database (Denmark)

    Eikhof, Karin Dam; Olsen, Kristine R; Wrengler, NCH

    2017-01-01

    % were offered follow-up visit after 6 weeks. Results: Of the 1145 admitted patients, 46% were eligible: 28% of those had an abnormal spirometry. The offered follow-up visit was attended by 51% and in this group 17% were diagnosed with lung disease. COPD was the most prevalent diagnosis (73%), and 2......Introduction: Chronic obstructive pulmonary disease (COPD) is very prevalent worldwide, yet underdiagnosed. Aim: This study investigates feasibility of performing spirometry in patients in need of acute hospital admission as well as the prevalence of undiagnosed COPD in the same cohort. Methods...

  3. Measuring patient safety culture: an assessment of the clustering of responses at unit level and hospital level

    NARCIS (Netherlands)

    Smits, M.; Wagner, C.; Spreeuwenberg, P.; Wal, van der G.

    2009-01-01

    OBJECTIVES: To test the claim that the Hospital Survey on Patient Safety Culture (HSOPS) measures patient safety culture instead of mere individual attitudes and to determine the most appropriate level (individual, unit or hospital level) for interventions aimed at improving the culture of patient s

  4. Measuring patient safety culture : an assessment of the clustering of responses at unit level and hospital level

    NARCIS (Netherlands)

    Smits, M.; Wagner, C.; Spreeuwenberg, P.; Wal, G. van der; Groenewegen, P.P.

    2009-01-01

    Objectives: To test the claim that the Hospital Survey on Patient Safety Culture (HSOPS) measures patient safety culture instead of mere individual attitudes and to determine the most appropriate level (individual, unit or hospital level) for interventions aimed at improving the culture of patient s

  5. Psychometric properties of the patient assessment of chronic illness care measure: acceptability, reliability and validity in United Kingdom patients with long-term conditions

    Directory of Open Access Journals (Sweden)

    Rick Jo

    2012-08-01

    Full Text Available Abstract Background The Patient Assessment of Chronic Illness Care (PACIC is a US measure of chronic illness quality of care, based on the influential Chronic Care Model (CCM. It measures a number of aspects of care, including patient activation; delivery system design and decision support; goal setting and tailoring; problem-solving and contextual counselling; follow-up and coordination. Although there is developing evidence of the utility of the scale, there is little evidence about its performance in the United Kingdom (UK. We present preliminary data on the psychometric performance of the PACIC in a large sample of UK patients with long-term conditions. Method We collected PACIC, demographic, clinical and quality of care data from patients with long-term conditions across 38 general practices, as part of a wider longitudinal study. We assess rates of missing data, present descriptive and distributional data, assess internal consistency, and test validity through confirmatory factor analysis, and through associations between PACIC scores, patient characteristics and related measures. Results There was evidence that rates of missing data were high on PACIC (9.6% - 15.9%, and higher than on other scales used in the same survey. Most PACIC sub-scales showed reasonable levels of internal consistency (alpha = 0.68 – 0.94, responses did not demonstrate high skewness levels, and floor effects were more frequent (up to 30.4% on the follow up and co-ordination subscale than ceiling effects (generally Conclusion The importance of improving care for long-term conditions means that the development and validation of measures is a priority. The PACIC scale has demonstrated potential utility in this regard, but further assessment is required to assess low levels of completion of the scale, and to explore the performance of the scale in predicting outcomes and assessing the effects of interventions.

  6. Assessment in multisite randomized clinical trials of patients with autistic disorder: the Autism RUPP Network. Research Units on Pediatric Psychopharmacology.

    Science.gov (United States)

    Arnold, L E; Aman, M G; Martin, A; Collier-Crespin, A; Vitiello, B; Tierney, E; Asarnow, R; Bell-Bradshaw, F; Freeman, B J; Gates-Ulanet, P; Klin, A; McCracken, J T; McDougle, C J; McGough, J J; Posey, D J; Scahill, L; Swiezy, N B; Ritz, L; Volkmar, F

    2000-04-01

    Assessment of autistic disorder (autism) symptoms, primary and secondary, poses more challenging problems than ordinarily found in multisite randomized clinical trial (RCT) assessments. For example, subjects may be uncommunicative and extremely heterogeneous in problem presentation, and current pharmacological treatments are not likely to alter most core features of autism. The Autism Research Units on Pediatric Psychopharmacology (RUPP Autism Network) resolved some of these problems during the design of a risperidone RCT in children/adolescents. The inappropriateness of the usual anchors for a Clinical Global Impression of Severity (CGI-S) was resolved by defining uncomplicated autism without secondary symptoms as a CGI-S of 3, mildly ill. The communication problems, compromising use of the patient as an informant, were addressed by several strategies, including careful questioning of care providers, rating scales, laboratory tests, and physical exams. The broad subject heterogeneity requires outcome measures sensitive to individual change over a wide spectrum of treatment response and side effects. The problems of neuropsychologically testing nonverbal, lower functioning, sometimes noncompliant subjects requires careful instrument selection/adaptation and flexible administration techniques. The problems of assessing low-end IQs, neglected by most standardized test developers, was resolved by an algorithm of test hierarchy. Scarcity of other autism-adapted cognitive and neuropsychological tests and lack of standardization required development of a new, specially adapted battery. Reliability on the Autism Diagnostic Interview (currently the most valid diagnostic instrument) and other clinician instruments required extensive cross-site training (in-person, videotape, and teleconference sessions). Definition of a treatment responder required focus on individually relevant target symptoms, synthesis of possible modest improvements in many domains, and acceptance of

  7. Discharge from an emergency department observation unit and a surgical assessment unit

    DEFF Research Database (Denmark)

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

    2014-01-01

    To investigate the experiences of patients with acute abdominal pain at discharge from an emergency department observation unit compared with discharge from a surgical assessment unit.......To investigate the experiences of patients with acute abdominal pain at discharge from an emergency department observation unit compared with discharge from a surgical assessment unit....

  8. Physical functional outcome assessment of patients with major burns admitted to a UK Burn Intensive Care Unit.

    Science.gov (United States)

    Smailes, Sarah T; Engelsman, Kayleen; Dziewulski, Peter

    2013-02-01

    Determining the discharge outcome of burn patients can be challenging and therefore a validated objective measure of functional independence would assist with this process. We developed the Functional Assessment for Burns (FAB) score to measure burn patients' functional independence. FAB scores were taken on discharge from ICU (FAB 1) and on discharge from inpatient burn care (FAB 2) in 56 patients meeting the American Burn Association criteria for major burn. We retrospectively analysed prospectively collected data to measure the progress of patients' physical functional outcomes and to evaluate the predictive validity of the FAB score for discharge outcome. Mean age was 38.6 years and median burn size 35%. Significant improvements were made in the physical functional outcomes between FAB 1 and FAB 2 scores (ppatients were discharged home, 8 of these with social care. 8 patients were transferred to another hospital for further inpatient rehabilitation. FAB 1 score (≤ 9) is strongly associated with discharge outcome (pburn patients.

  9. Cardiometry: pioneering experience in assessment of the heart performance and evaluation of fatal arrhythmia risks in intensive care unit patients

    Directory of Open Access Journals (Sweden)

    Vladimir V. Chepenko

    2014-05-01

    Full Text Available In the paper presented is an application study of the heart performance phase mechanism with the use of the Cardiocode analyzer based on principles of cardiometry for evaluating iatrogenic complications caused by antiarrhythmic therapy and monitoring the quality of treatment of hemodynamic disorders in inhospital intensive care units. The aim of the study is a thorough estimation of the diagnostic and functional quality of the performance of the Cardiocode device and developing a new methodology of its application under the conditions of the intensive care units, when predicting fatal arrhythmia progression. 50 patients with true cardiogenic shock of different degrees of severity have been examined with Cardiocode. As a result, it is established that the application of the heart cycle phase analysis in diagnostics, hemodynamics evaluation and management with the medication and infusion therapy supported by the Cardiocode device allows reducing the mortality rate by 32 ± 3.4%.

  10. Patient Assessment File (PAF)

    Data.gov (United States)

    Department of Veterans Affairs — The Patient Assessment File (PAF) database compiles the results of the Patient Assessment Instrument (PAI) questionnaire filled out for intermediate care Veterans...

  11. Development of stress ulcers assessed by gastric electrical potential difference, pH of gastric juice, and endoscopy in patients in the intensive care unit

    DEFF Research Database (Denmark)

    Rubinstein, E; Gjørup, I; Schulze, S

    1992-01-01

    OBJECTIVE: To assess measurement of gastric electrical potential difference, pH of gastric mucosa, and endoscopic findings in patients in intensive care units who are at risk of developing stress ulcers. DESIGN: Open comparison with age- and sex-matched control subjects. SETTING: Herlev Hospital...... which any lesions that were found were scored according to severity, the gastric potential difference, and the pH of gastric juice were measured. OUTCOME MEASURES: Correlation between the incidence of stress ulceration found at endoscopy, gastric potential difference, and gastric pH. RESULTS: Gastric...... potential difference was significantly reduced and gastric pH significantly increased in the patients in the intensive care unit (p less than 0.05 in both cases), all of whom had stress ulcers in more than one gastric segment. Nine of the patients had gastric pH readings of greater than 4. CONCLUSION...

  12. Unit Performance Assessment System Development

    Science.gov (United States)

    1994-08-01

    Overview of the enhanced UPAS ...... . 57 xiv UNIT PERFORMANCE ASSESSMENT SYSTEM DEVELOPMENT Introduccion The networking of combat vehicle simulators...converting SIMNET terrain data from the UNIX format to a DOS format as part of their work on the development of Intelligent Semi-Automated Forces. The...and Social Sciences. (AD A226 956). LB&M Associates (1992). Phase I Small Business Innovative Research (SBIR) Program for Simulation Networkinc Training

  13. [Assessment of socio-demographic factors in alcohol-addicted patients recurrently treated in a detoxification unit].

    Science.gov (United States)

    Chrostek Maj, Jan; Kamenczak, Aleksandra; Bock, Romana; Polewka, Andrzej; Krawczyk, Elzbieta

    2005-01-01

    The aim of the presented study was the assessment some socio-demographic factors of alcohol dependent patients more times hospitalized in Department of Toxicology in Kraków in the years 1999-2004. The repeatedly hospitalization of 334 patients (298 men and 36 women), aged from 17 to 71 years (mean 45.1 years) due the alcohol problem on the basis of clinic documentation were established. The following socio-demographics traits were taken in analysis: age, sex, marital status, place of living, education, kind of jobs, employment and others sources of money. The patients were admitted from 2 or more 29 times during 6 years. Medical history of addiction of mentioned patients was from 1 to 40 years, mean 25 years. 43.7% persons live single and 53.6% was married. The most patients live in Kraków (80%) and others near the town. The education of them: 15.0% ended high school, 28.7% "medium", 30.5% "low professional" and elementary school--13.8% of them. This factor was similar like regional data. Amount mentioned persons 25.8% worked for salary, 11.7% had own business, and 25.4% was retired, and 29.0% was unemployed. This last factor was worse liked similar from mentioned region. The kind of jobs of persons on the aspect of "social safety" was described. Among the mentioned chronic alcohol addicted persons about 18.8% of them with machines in traffic was worked (bus drivers i.e.) and 7.5% described persons in special jobs was worked (policemen, physician i.e.). The authors were suggested that mentioned factors due health services cost in Poland and propose integration of treatment of alcohol-addicted patients.

  14. Clinical swallowing assessment in intensive care unit.

    Science.gov (United States)

    Padovani, Aline Rodrigues; Moraes, Danielle Pedroni; Sassi, Fernanda Chiarion; Andrade, Claudia Regina Furquim de

    2013-01-01

    To report the results of the full clinical swallowing assessment in acute-care population in a large Brazilian teaching hospital. A prospective, descriptive clinical study was conducted during three months in a 30-bed adult clinical emergency ICU from a large Brazilian teaching hospital. Thirty-five patients consecutively referred to the Speech-Language Pathology Service according to our standard clinical practice were included. A full clinical swallowing assessment was completed and includes a Preliminary Assessment Protocol (PAP), a Dysphagia Risk Evaluation Protocol (DREP) and an Oral Feeding Transition Protocol (OFTP). In this study, the prevalence of OD in the ICU setting was of 63%, most of which were classified as moderate and moderate-severe (39%). Patients submitted to orotracheal intubation were very frequently referred to swallowing assessment (74%). The results of the statistical analyses revealed clinical indicators that could correctly classify patients as either having or not having OD on clinical tests. These include cough strength, coordination between breathing and speaking, dysphonia severity, and laryngeal elevation. Twenty six patients (74%) completed all protocols. Of these total, 38% were able to eat a regular diet. The practice with standardized protocols adds an important option for the management of oropharyngeal dysphagia in intensive care unit.

  15. Peripheral venous blood gas analysis: An alternative to arterial blood gas analysis for initial assessment and resuscitation in emergency and intensive care unit patients.

    Science.gov (United States)

    Awasthi, Shilpi; Rani, Raka; Malviya, Deepak

    2013-01-01

    Arterial blood gas (ABG) analysis is the gold standard method for assessment of oxygenation and acid base analysis, yielding valuable information about a variety of disease process. This study is aimed to determine the extent of correlation between arterial and peripheral venous samples for blood gases and acid base status in critically ill and emergency department patients and to evaluate if venous sample may be a better alternative for initial assessment and resuscitation. The prospective study was conducted on 45 patients of either sex in the age group of 15-80 years of intensive care unit and emergency ward. Relevant history, presenting complaints, vital signs, and indication for testing were recorded. Arterial and peripheral venous samples were drawn simultaneously in a pre-heparinized syringe and analyzed immediately for blood gases and acid base status. Mean difference and Pearson's product moment correlation coefficient was used to compare the result. After statistical evaluation, the present study shows minimal mean difference and good correlation (r > 0.9) between arterial and peripheral venous sample for blood gases and acid base status. Correlation in PO2 measurement was poor (r blood may be a useful alternative to arterial blood during blood gas analysis obviating the need for arterial puncture in difficult clinical situation especially trauma patients, for initial emergency department assessment and early stages of resuscitation.

  16. World Assessment Unit Geological Characterizations, 2000 World Petroleum Assessment

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This shapfile includes arcs and polygons that describe U.S. Geological Survey defined petroleum resource Assessment Units of the World. Each assessment unit is...

  17. National Assessment of Oil and Gas Project - Yukon Flats Assessment Area (002) Assessment Units

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — The Assessment Unit is the fundamental unit used in the National Assessment Project for the assessment of undiscovered oil and gas resources. The Assessment Unit is...

  18. Radial artery applanation tonometry for continuous non-invasive arterial pressure monitoring in intensive care unit patients: comparison with invasively assessed radial arterial pressure.

    Science.gov (United States)

    Meidert, A S; Huber, W; Müller, J N; Schöfthaler, M; Hapfelmeier, A; Langwieser, N; Wagner, J Y; Eyer, F; Schmid, R M; Saugel, B

    2014-03-01

    Radial artery applanation tonometry technology can be used for continuous non-invasive measurement of arterial pressure (AP). The purpose of this study was to evaluate this AP monitoring technology in intensive care unit (ICU) patients in comparison with invasive AP monitoring using a radial arterial catheter. In 24 ICU patients (German university hospital), AP values were simultaneously recorded on a beat-to-beat basis using radial artery applanation tonometry (T-Line system; Tensys Medical, San Diego, CA, USA) and a radial arterial catheter (contralateral arm). The primary endpoint of the study was to investigate the accuracy and precision of the non-invasively assessed AP measurements with the Bland-Altman method based on averaged 10 beat AP epochs (n=2993 10 beat epochs). For mean AP (MAP), systolic AP (SAP), and diastolic AP (DAP), we observed a bias (±standard deviation of the bias; 95% limits of agreement; percentage error) of +2 mm Hg (±6; -11 to +15 mm Hg; 15%), -3 mm Hg (±15; -33 to +27 mm Hg; 23%), and +5 mm Hg (±7; -9 to +19 mm Hg; 22%), respectively. In ICU patients, MAP and DAP measurements obtained using radial artery applanation tonometry show clinically acceptable agreement with invasive AP determination with a radial arterial catheter. While the radial artery applanation tonometry technology also allows SAP measurements with high accuracy, its precision for SAP measurements needs to be further improved.

  19. Assessment of Motor Units in Neuromuscular Disease.

    Science.gov (United States)

    Henderson, Robert D; McCombe, Pamela A

    2017-01-01

    The motor unit comprises the anterior horn cell, its axon, and the muscle fibers that it innervates. Although the true number of motor units is unknown, the number of motor units appears to vary greatly between different muscles and between different individuals. Assessment of the number and function of motor units is needed in diseases of the anterior horn cell and other motor nerve disorders. Amyotrophic lateral sclerosis is the most important disease of anterior horn cells. The need for an effective biomarker for assessing disease progression and for use in clinical trials in amyotrophic lateral sclerosis has stimulated the study of methods to measure the number of motor units. Since 1970 a number of different methods, including the incremental, F-wave, multipoint, and statistical methods, have been developed but none has achieved widespread applicability. Two methods (MUNIX and the multipoint incremental method) are in current use across multiple centres and are discussed in detail in this review, together with other recently published methods. Imaging with magnetic resonance and ultrasound is increasingly being applied to this area. Motor unit number estimates have also been applied to other neuromuscular diseases such as spinal muscular atrophy, compression neuropathies, and prior poliomyelitis. The need for an objective measure for the assessment of motor units remains tantalizingly close but unfulfilled in 2016.

  20. Patient caries risk assessment

    DEFF Research Database (Denmark)

    Twetman, Svante; Fontana, Margherita

    2009-01-01

    Risk assessment is an essential component in the decision-making process for the correct prevention and management of dental caries. Multiple risk factors and indicators have been proposed as targets in the assessment of risk of future disease, varying sometimes based on the age group at which...... for prediction purposes, as measured until now in the literature, is at best questionable in schoolchildren, adolescents and adults. That is not to say these additional factors should not be assessed to help understand the strength of their associations with the disease experience in a particular patient......, and aid in the development of an individualized and targeted preventive and management plan....

  1. ICU患者疼痛评估工具研究进展%Research progress of pain assessment tools for Intensive Care Unit patients

    Institute of Scientific and Technical Information of China (English)

    陈杰; 路潜; 张海燕

    2014-01-01

    Appropriate pain management in critically ill patients greatly depends on a clinician’s ability to perform reliable and valid pain assessment. Subjective pain assessment tools are available to clinicians when patients are able to complete self-report tools, the“gold standard”of pain assessment;however, objective pain assessment tools may be appropriate when patients are not capable of adequate communication because of sedation or mechanical ventilation. The pain assessment tools for critically ill patients were elaborated in this article to provide reference for improving the process of pain assessment and management.%疼痛是ICU患者的常见问题,有效的评估是疼痛管理的基础。由于镇静或其他原因,ICU患者的疼痛评估往往比较复杂。能获得患者主诉时可以使用主观疼痛评估工具,不能获得患者主诉时宜使用客观疼痛评估工具。本文就ICU患者常用的主观和客观疼痛评估工具进行综述,为完善ICU患者的疼痛评估和疼痛管理流程提供科学的依据。

  2. Assessing the Performance of Business Unit Managers

    NARCIS (Netherlands)

    Bouwens, J.F.M.G.; van Lent, L.A.G.M.

    2006-01-01

    Using a sample of 140 managers, we investigate the use of various performance metrics in determining the periodic assessment, bonus decisions, and career paths of business unit managers.We show that the weight on accounting return measures is associated with the authority of these managers, and we d

  3. Assessment of risk factors related to healthcare-associated methicillin-resistant Staphylococcus aureus infection at patient admission to an intensive care unit in Japan

    Directory of Open Access Journals (Sweden)

    Ogura Hiroshi

    2011-11-01

    Full Text Available Abstract Background Healthcare-associated methicillin-resistant Staphylococcus aureus (HA-MRSA infection in intensive care unit (ICU patients prolongs ICU stay and causes high mortality. Predicting HA-MRSA infection on admission can strengthen precautions against MRSA transmission. This study aimed to clarify the risk factors for HA-MRSA infection in an ICU from data obtained within 24 hours of patient ICU admission. Methods We prospectively studied HA-MRSA infection in 474 consecutive patients admitted for more than 2 days to our medical, surgical, and trauma ICU in a tertiary referral hospital in Japan. Data obtained from patients within 24 hours of ICU admission on 11 prognostic variables possibly related to outcome were evaluated to predict infection risk in the early phase of ICU stay. Stepwise multivariate logistic regression analysis was used to identify independent risk factors for HA-MRSA infection. Results Thirty patients (6.3% had MRSA infection, and 444 patients (93.7% were infection-free. Intubation, existence of open wound, treatment with antibiotics, and steroid administration, all occurring within 24 hours of ICU admission, were detected as independent prognostic indicators. Patients with intubation or open wound comprised 96.7% of MRSA-infected patients but only 57.4% of all patients admitted. Conclusions Four prognostic variables were found to be risk factors for HA-MRSA infection in ICU: intubation, open wound, treatment with antibiotics, and steroid administration, all occurring within 24 hours of ICU admission. Preemptive infection control in patients with these risk factors might effectively decrease HA-MRSA infection.

  4. Exploring the opinion of hemodialysis patients about their dialysis unit.

    Science.gov (United States)

    Donia, Ahmed Farouk; Elhadedy, Mohamed Ahmed; El-Maghrabi, Hanzada Mohamed; Abbas, Mohamed Hamed; Foda, Mohamed Ashraf

    2015-01-01

    Hemodialysis (HD) patients are subjected to a number of physical and mental stresses. Physicians might be unaware of some of these problems. We assessed our patients' opinion about the service provided at the dialysis unit. Our unit has 89 patients on HD. A questionnaire exploring our patients' opinion relative to the service provided was prepared. The patients were asked to fill-in the questionnaire in a confidential manner. Questionnaires were then collected and examined while unaware of patient identities. Sixty-nine patients (77.5%) responded to the questionnaire. Eight patients (11.6%) revealed their names on the questionnaire. According to the questionnaire, the patients were asked to assess the service of each service by choosing one of the following grades: "excellent," "mediocre" or "bad." For the whole group of contributing patients, there were 563 "excellent," 85 "mediocre" and five "bad" choices in addition to 37 blank "no comment" choices. Food service had the least percentage (68%) of evaluation as "excellent," while doctor' performance got the highest excellent evaluation (85.5%). Thirty-five patients (50.7%) added further comment(s). An audit meeting was conducted to discuss these results. Exploring the opinion of patients on HD might uncover some areas of dissatisfaction and help in improving the provided service. We recommend widespread usage of questionnaires to assess patient satisfaction as well as to assess other health-care aspects.

  5. National Assessment of Oil and Gas Project - Montana Thrust Belt Province (027) Assessment Units

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — The Assessment Unit is the fundamental unit used in the National Assessment Project for the assessment of undiscovered oil and gas resources. The Assessment Unit is...

  6. National Assessment of Oil and Gas Project - Florida Peninsula Province (050) Assessment Units

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — The Assessment Unit is the fundamental unit used in the National Assessment Project for the assessment of undiscovered oil and gas resources. The Assessment Unit is...

  7. National Assessment of Oil and Gas Project - Southwestern Wyoming Province (037) Assessment Units

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — The Assessment Unit is the fundamental unit used in the National Assessment Project for the assessment of undiscovered oil and gas resources. The Assessment Unit is...

  8. National Assessment of Oil and Gas Project - Wyoming Thrust Belt Province (036) Assessment Units

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — The Assessment Unit is the fundamental unit used in the National Assessment Project for the assessment of undiscovered oil and gas resources. The Assessment Unit is...

  9. National Assessment of Oil and Gas Project - Western Oregon-Washington Province (004) Assessment Units

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — The Assessment Unit is the fundamental unit used in the National Assessment Project for the assessment of undiscovered oil and gas resources. The Assessment Unit is...

  10. National Assessment of Oil and Gas Project - San Joaquin Basin Province (010) Assessment Units

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — The Assessment Unit is the fundamental unit used in the National Assessment Project for the assessment of undiscovered oil and gas resources. The Assessment Unit is...

  11. National Assessment of Oil and Gas Project - San Juan Basin Province (022) Assessment Units

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — The Assessment Unit is the fundamental unit used in the National Assessment Project for the assessment of undiscovered oil and gas resources. The Assessment Unit is...

  12. National Assessment of Oil and Gas Project Anadarko Basin Province (058) Assessment Units

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — The Assessment Unit is the fundamental unit used in the National Assessment Project for the assessment of undiscovered oil and gas resources. The Assessment Unit is...

  13. National Assessment of Oil and Gas Project - Hanna, Laramie, Shirley Basins Province (030) Assessment Units

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — The Assessment Unit is the fundamental unit used in the National Assessment Project for the assessment of undiscovered oil and gas resources. The Assessment Unit is...

  14. National Assessment of Oil and Gas Project - Paradox Basin (021) Assessment Units

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — The Assessment Unit is the fundamental unit used in the National Assessment Project for the assessment of undiscovered oil and gas resources. The Assessment Unit is...

  15. National Assessment of Oil and Gas Project - Michigan Basin Province (063) Assessment Units

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — The Assessment Unit is the fundamental unit used in the National Assessment Project for the assessment of undiscovered oil and gas resources. The Assessment Unit is...

  16. National Assessment of Oil and Gas Project - Illinois Basin Province (064) Assessment Units

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — The Assessment Unit is the fundamental unit used in the National Assessment Project for the assessment of undiscovered oil and gas resources. The Assessment Unit is...

  17. National Assessment of Oil and Gas Project - Powder River Basin Province (033) Assessment Units

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — The Assessment Unit is the fundamental unit used in the National Assessment Project for the assessment of undiscovered oil and gas resources. The Assessment Unit is...

  18. National Assessment of Oil and Gas Project - Black Warrior Province (065) Assessment Units

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — The Assessment Unit is the fundamental unit used in the National Assessment Project for the assessment of undiscovered oil and gas resources. The Assessment Unit is...

  19. National Assessment of Oil and Gas Project - Williston Basin Province (031) Assessment Units

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — The Assessment Unit is the fundamental unit used in the National Assessment Project for the assessment of undiscovered oil and gas resources. The Assessment Unit is...

  20. USGS National Assessment of Oil and Gas Project - Unconventional Assessment Units from 2000 to 2011

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — The Assessment Unit is the fundamental unit used in the National Assessment Project for the assessment of undiscovered oil and gas resources. The Assessment Unit is...

  1. National Assessment of Oil and Gas Project - Uinta-Piceance Province (020) Assessment Units

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — The Assessment Unit is the fundamental unit used in the National Assessment Project for the assessment of undiscovered oil and gas resources. The Assessment Unit is...

  2. National Assessment of Oil and Gas Project - Denver Basin Province (039) Assessment Units

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — The Assessment Unit is the fundamental unit used in the National Assessment Project for the assessment of undiscovered oil and gas resources. The Assessment Unit is...

  3. USGS National Assessment of Oil and Gas Project - Cherokee Platform Province Assessment Units

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — The Assessment Unit is the fundamental unit used in the National Assessment Project for the assessment of undiscovered oil and gas resources. The Assessment Unit is...

  4. USGS National Assessment of Oil and Gas Project - Uinta-Piceance Province, Mancos Formation Assessment Units

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — The Assessment Unit is the fundamental unit used in the National Assessment Project for the assessment of undiscovered oil and gas resources. The Assessment Unit is...

  5. USGS National Assessment of Oil and Gas Project - Uteland Butte Assessment Units

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — The Assessment Unit is the fundamental unit used in the National Assessment Project for the assessment of undiscovered oil and gas resources. The Assessment Unit is...

  6. National Assessment of Oil and Gas Project - Eastern Great Basin (019) Assessment Units

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — The Assessment Unit is the fundamental unit used in the National Assessment Project for the assessment of undiscovered oil and gas resources. The Assessment Unit is...

  7. National Assessment of Oil and Gas Project - Cotton Valley Assessment Units

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — The Assessment Unit is the fundamental unit used in the National Assessment Project for the assessment of undiscovered oil and gas resources. The Assessment Unit is...

  8. Exploring the opinion of hemodialysis patients about their dialysis unit

    Directory of Open Access Journals (Sweden)

    Ahmed Farouk Donia

    2015-01-01

    Full Text Available Hemodialysis (HD patients are subjected to a number of physical and mental stresses. Physicians might be unaware of some of these problems. We assessed our patients′ opinion about the service provided at the dialysis unit. Our unit has 89 patients on HD. A questionnaire exploring our patients′ opinion relative to the service provided was prepared. The patients were asked to fill-in the questionnaire in a confidential manner. Questionnaires were then collected and examined while unaware of patient identities. Sixty-nine patients (77.5% responded to the questionnaire. Eight patients (11.6% revealed their names on the questionnaire. According to the questionnaire, the patients were asked to assess the service of each service by choosing one of the following grades: "excellent," "mediocre" or "bad." For the whole group of contributing patients, there were 563 "excellent," 85 "mediocre" and five "bad" choices in addition to 37 blank "no comment" choices. Food service had the least percentage (68% of evaluation as "excellent," while doctor′ performance got the highest excellent evaluation (85.5%. Thirty-five patients (50.7% added further comment(s. An audit meeting was conducted to discuss these results. Exploring the opinion of patients on HD might uncover some areas of dissatisfaction and help in improving the provided service. We recommend widespread usage of questionnaires to assess patient satisfaction as well as to assess other health-care aspects.

  9. Modeling Units of Assessment for Sharing Assessment Process Information: towards an Assessment Process Specification

    NARCIS (Netherlands)

    Miao, Yongwu; Sloep, Peter; Koper, Rob

    2009-01-01

    Miao, Y., Sloep, P. B., & Koper, R. (2008). Modeling Units of Assessment for Sharing Assessment Process Information: towards an Assessment Process Specification. Presentation at the ICWL 2008 conference. August, 20, 2008, Jinhua, China.

  10. [Guidelines for specialized nutritional and metabolic support in the critically-ill patient. Update. Consensus of the Spanish Society of Intensive Care Medicine and Coronary Units-Spanish Society of Parenteral and Enteral Nutrition (SEMICYUC-SENPE): nutritional assessment].

    Science.gov (United States)

    Ruiz-Santana, S; Arboleda Sánchez, J A; Abilés, J

    2011-11-01

    Current parameters to assess nutritional status in critically-ill patients are useful to evaluate nutritional status prior to admission to the intensive care unit. However, these parameters are of little utility once the patient's nutritional status has been altered by the acute process and its treatment. Changes in water distribution affect anthropometric variables and biochemical biomarkers, which in turn are affected by synthesis and degradation processes. Increased plasma levels of prealbumin and retinol -proteins with a short half-life- can indicate adequate response to nutritional support, while reduced levels of these proteins indicate further metabolic stress. The parameters used in functional assessment, such as those employed to assess muscular or immune function, are often altered by drugs or the presence of infection or polyneuropathy. However, some parameters can be used to monitor metabolic response and refeeding or can aid prognostic evaluation.

  11. Psychometric assessment of the Family Satisfaction in the Intensive Care Unit questionnaire in the United Kingdom.

    Science.gov (United States)

    Harrison, David A; Ferrando-Vivas, Paloma; Wright, Stephen E; McColl, Elaine; Heyland, Daren K; Rowan, Kathryn M

    2017-04-01

    To establish the psychometric properties of the Family Satisfaction in the Intensive Care Unit 24-item (FS-ICU-24) questionnaire in the United Kingdom. The Family-Reported Experiences Evaluation study recruited family members of patients staying at least 24 hours in 20 participating intensive care units. Questionnaires were evaluated for nonresponse, floor/ceiling effects, redundancy, and construct validity. Internal consistency was evaluated with item-to-own scale correlations and Cronbach α. Confirmatory and exploratory factor analyses were used to explore the underlying structure. Twelve thousand three hundred forty-six family members of 6380 patients were recruited and 7173 (58%) family members of 4615 patients returned a completed questionnaire. One family member per patient was included in the psychometric assessment. Six items had greater than 10% nonresponse; 1 item had a ceiling effect; and 11 items had potential redundancy. Internal consistency was high (Cronbach α, overall .96; satisfaction with care, .94; satisfaction with decision making, .93). The 2-factor solution was not a good fit. Exploratory factor analysis indicated that satisfaction with decision making encompassed 2 constructs-satisfaction with information and satisfaction with the decision-making process. The Family Satisfaction in the Intensive Care Unit 24-item questionnaire demonstrated good psychometric properties in the United Kingdom setting. Construct validity could be improved by use of 3 domains and some scope for further improvement was identified. Copyright © 2016 Elsevier Inc. All rights reserved.

  12. Parental satisfaction of an assessment unit for autistic spectrum disorders.

    Science.gov (United States)

    Ben Amor, Arwa; Halayem, Soumeyya; Touati, Maissa; Belhadj, Ahlem; Gouider, Riadh; Mrad, Ridha; Bouden, Asma

    2016-06-01

    Background - Based on the recognized principles of assessment of autistic disorders, the child and adolescent psychiatry department in Razi Hospital developed an assessment unit with diagnostic as well as therapeutic roles. The aim of this work was to examine its functioning and to analyze the parents' perceptions about the unit services. Methods - We gathered the parental satisfaction about the unit by the means of a hetero-questionnaire. Results - Fifty-two parents of children evaluated within the unit were included.  Patients had received the diagnosis of Autistic Disorder, Pervasive Developmental Disorders Not Otherwise Specified and Asperger Syndrome in accordance with DSM IV criteria, and than that of Autism Spectrum Disorder after DSM 5 publication. The overall satisfaction rate was 63%. Most parents (84.6%) rated the Psycho Educative Profile examination positively, 75% appreciated the neurological examination and the final report steps, 55.8% appreciated step of the Autism Diagnostic Interview revised and 42.3% the genetic exploration. 67% of the parents reported an improvement of their child following the evaluation. This improvement was attributed to the unit in 57.7% of cases. Parents whose children did not have associated disorders such as intellectual disability (p = 0.02), aggressive behavior (p = 0.04), affective disorder (p = 0.01) and sleep-related disorders (p = 0.03) were the most satisfied. Parents of children with epilepsy comorbidity were the least satisfied (p <10-3). 96% of parents suggested repeating the assessment once a year. Conclusion - Assessment units are based on international recommendations. However, it would be interesting to adapt assessments and orientation to the parents' expectations.

  13. Discomfort and factual recollection in intensive care unit patients

    NARCIS (Netherlands)

    van de Leur, JP; van der Schans, CP; Loef, BG; Deelman, BG; Geertzen, JHB; Zwaveling, JH

    2004-01-01

    Introduction A stay in the intensive care unit (ICU), although potentially life-saving, may cause considerable discomfort to patients. However, retrospective assessment of discomfort is difficult because recollection of stressful events may be impaired by sedation and severe illness during the ICU

  14. Discomfort and factual recollection in intensive care unit patients

    NARCIS (Netherlands)

    van de Leur, JP; van der Schans, CP; Loef, BG; Deelman, BG; Geertzen, JHB; Zwaveling, JH

    2004-01-01

    Introduction A stay in the intensive care unit (ICU), although potentially life-saving, may cause considerable discomfort to patients. However, retrospective assessment of discomfort is difficult because recollection of stressful events may be impaired by sedation and severe illness during the ICU s

  15. A Markov model assessing the impact on primary care practice revenues and patient's health when using mid-level providers, lesson learned from the United Kingdom.

    Science.gov (United States)

    Hill, Harry; Macey, Richard; Brocklehurst, Paul

    2017-03-08

    To evaluate the cost-effectiveness of using mid-level providers for dental "check-up" examinations and the treatment of caries in different NHS settings in the United Kingdom. Mid-level providers are a broad category that describes non-dentist members of dental teams. This study focused on the potential use of Dental Hygiene Therapists undertaking dental "check-up" examinations and simple restorative treatment, instead of dentists. A Markov model was used to construct the natural history of caries development in adults that visit a dental practice every six months over a five-year period. Three cost perspectives are taken: those borne to dental healthcare providers in England and Wales, Northern Ireland and Scotland. These represent three separate forms of retrospective payment system that are currently in use in the United Kingdom. The cost outcome was the average amount of retained practice earnings required to provide healthcare per patient visit. The health outcome was the average length of time in a cavity-free state and the cost-effectiveness outcome was incremental cost for six months in a cavity-free state. No statistical difference was found between dentists and mid-level providers in the length of time in a cavity-free state but the use of the latter saved money in all three NHS health system jurisdictions. This ranged from £7.85 (England and Wales) to £9.16 (Northern Ireland) per patient visit ($10.20 to $11.90, respectively) meaning the incremental cost for six month in a cavity-free state ranged from £261.67 ($339.93) in England and Wales to £305.33 ($369.68) in Northern Ireland. Further, changes in baseline assumptions and parameter values did not change mid-level providers being the dominant service intervention. In a time of limited funds for dental services, these results suggest that resources in public funded systems could be saved using mid-level providers in dental practices, without any health risk to patients or capital investment.

  16. [Prisoners in units for difficult patients].

    Science.gov (United States)

    Bouchard, Jean-Pierre; Brulin-Solignac, Diane; Lodetti, Célia

    2016-01-01

    Prisoners, on remand or convicted, can be placed for a variable amount of time in a unit for difficult patients if their pathological mental state so requires. For the most part, their therapeutic care does not depend on their status as prisoner. The treatments provided are those indicated for their psychological pathologies and their potential or known dangerousness. However, some administrative measures make a distinction between their treatment and that of non-prisoner patients placed in these secure psychiatric units. Copyright © 2016. Published by Elsevier Masson SAS.

  17. Assessment of Diet and Physical Activity in Paediatric Non-Alcoholic Fatty Liver Disease Patients: A United Kingdom Case Control Study

    Directory of Open Access Journals (Sweden)

    Philippa S. Gibson

    2015-11-01

    Full Text Available Non-alcoholic fatty liver disease (NAFLD is the most common cause of chronic liver disease in children, with prevalence rising alongside childhood obesity rates. This study aimed to characterise the habitual diet and activity behaviours of children with NAFLD compared to obese children without liver disease in the United Kingdom (UK. Twenty-four biopsy-proven paediatric NAFLD cases and eight obese controls without biochemical or radiological evidence of NAFLD completed a 24-h dietary recall, a Physical Activity Questionnaire (PAQ, a Dutch Eating Behavior Questionnaire (DEBQ and a 7-day food and activity diary (FAD, in conjunction with wearing a pedometer. Groups were well matched for age and gender. Obese children had higher BMI z-scores (p = 0.006 and BMI centiles (p = 0.002 than participants with NAFLD. After adjusting for multiple hypotheses testing and controlling for differences in BMI, no differences in macro- or micronutrient intake were observed as assessed using either 24-h recall or 7-day FAD (p > 0.001. Under-reporting was prevalent (NAFLD 75%, Obese Control 87%: p = 0.15. Restrained eating behaviours were significantly higher in the NAFLD group (p = 0.005, who also recorded more steps per day than the obese controls (p = 0.01. In conclusion, this is the first study to assess dietary and activity patterns in a UK paediatric NAFLD population. Only a minority of cases and controls were meeting current dietary and physical activity recommendations. Our findings do not support development of specific dietary/ physical activity guidelines for children with NAFLD; promoting adherence with current general paediatric recommendations for health should remain the focus of clinical management.

  18. Assessment of Diet and Physical Activity in Paediatric Non-Alcoholic Fatty Liver Disease Patients: A United Kingdom Case Control Study.

    Science.gov (United States)

    Gibson, Philippa S; Lang, Sarah; Gilbert, Marianne; Kamat, Deepa; Bansal, Sanjay; Ford-Adams, Martha E; Desai, Ashish P; Dhawan, Anil; Fitzpatrick, Emer; Moore, J Bernadette; Hart, Kathryn H

    2015-11-26

    Non-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in children, with prevalence rising alongside childhood obesity rates. This study aimed to characterise the habitual diet and activity behaviours of children with NAFLD compared to obese children without liver disease in the United Kingdom (UK). Twenty-four biopsy-proven paediatric NAFLD cases and eight obese controls without biochemical or radiological evidence of NAFLD completed a 24-h dietary recall, a Physical Activity Questionnaire (PAQ), a Dutch Eating Behavior Questionnaire (DEBQ) and a 7-day food and activity diary (FAD), in conjunction with wearing a pedometer. Groups were well matched for age and gender. Obese children had higher BMI z-scores (p = 0.006) and BMI centiles (p = 0.002) than participants with NAFLD. After adjusting for multiple hypotheses testing and controlling for differences in BMI, no differences in macro- or micronutrient intake were observed as assessed using either 24-h recall or 7-day FAD (p > 0.001). Under-reporting was prevalent (NAFLD 75%, Obese Control 87%: p = 0.15). Restrained eating behaviours were significantly higher in the NAFLD group (p = 0.005), who also recorded more steps per day than the obese controls (p = 0.01). In conclusion, this is the first study to assess dietary and activity patterns in a UK paediatric NAFLD population. Only a minority of cases and controls were meeting current dietary and physical activity recommendations. Our findings do not support development of specific dietary/ physical activity guidelines for children with NAFLD; promoting adherence with current general paediatric recommendations for health should remain the focus of clinical management.

  19. Assessment methods in surgical training in the United Kingdom

    Directory of Open Access Journals (Sweden)

    Evgenios Evgeniou

    2013-02-01

    Full Text Available A career in surgery in the United Kingdom demands a commitment to a long journey of assessment. The assessment methods used must ensure that the appropriate candidates are selected into a programme of study or a job and must guarantee public safety by regulating the progression of surgical trainees and the certification of trained surgeons. This review attempts to analyse the psychometric properties of various assessment methods used in the selection of candidates to medical school, job selection, progression in training, and certification. Validity is an indicator of how well an assessment measures what it is designed to measure. Reliability informs us whether a test is consistent in its outcome by measuring the reproducibility and discriminating ability of the test. In the long journey of assessment in surgical training, the same assessment formats are frequently being used for selection into a programme of study, job selection, progression, and certification. Although similar assessment methods are being used for different purposes in surgical training, the psychometric properties of these assessment methods have not been examined separately for each purpose. Because of the significance of these assessments for trainees and patients, their reliability and validity should be examined thoroughly in every context where the assessment method is being used.

  20. Delirium in Prolonged Hospitalized Patients in the Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Vahedian Azimi

    2015-05-01

    Full Text Available Background Prolonged hospitalization in the intensive care unit (ICU can impose long-term psychological effects on patients. One of the most significant psychological effects from prolonged hospitalization is delirium. Objectives The aim of this study was to assess the effect of prolonged hospitalization of patients and subsequent delirium in the intensive care unit. Patients and Methods This conventional content analysis study was conducted in the General Intensive Care Unit of the Shariati Hospital of Tehran University of Medical Sciences, from the beginning of 2013 to 2014. All prolonged hospitalized patients and their families were eligible participants. From the 34 eligible patients and 63 family members, the final numbers of actual patients and family members were 9 and 16, respectively. Several semi-structured interviews were conducted face-to-face with patients and their families in a private room and data were gathered. Results Two main themes from two different perspectives emerged, 'patients' perspectives' (experiences during ICU hospitalization and 'family members' perspectives' (supportive-communicational experiences. The main results of this study focused on delirium, Patients' findings were described as pleasant and unpleasant, factual and delusional experiences. Conclusions Family members are valuable components in the therapeutic process of delirium. Effective use of family members in the delirium caring process can be considered to be one of the key non-medical nursing components in the therapeutic process.

  1. Acoustic assessment of speech privacy curtains in two nursing units.

    Science.gov (United States)

    Pope, Diana S; Miller-Klein, Erik T

    2016-01-01

    Hospitals have complex soundscapes that create challenges to patient care. Extraneous noise and high reverberation rates impair speech intelligibility, which leads to raised voices. In an unintended spiral, the increasing noise may result in diminished speech privacy, as people speak loudly to be heard over the din. The products available to improve hospital soundscapes include construction materials that absorb sound (acoustic ceiling tiles, carpet, wall insulation) and reduce reverberation rates. Enhanced privacy curtains are now available and offer potential for a relatively simple way to improve speech privacy and speech intelligibility by absorbing sound at the hospital patient's bedside. Acoustic assessments were performed over 2 days on two nursing units with a similar design in the same hospital. One unit was built with the 1970s' standard hospital construction and the other was newly refurbished (2013) with sound-absorbing features. In addition, we determined the effect of an enhanced privacy curtain versus standard privacy curtains using acoustic measures of speech privacy and speech intelligibility indexes. Privacy curtains provided auditory protection for the patients. In general, that protection was increased by the use of enhanced privacy curtains. On an average, the enhanced curtain improved sound absorption from 20% to 30%; however, there was considerable variability, depending on the configuration of the rooms tested. Enhanced privacy curtains provide measureable improvement to the acoustics of patient rooms but cannot overcome larger acoustic design issues. To shorten reverberation time, additional absorption, and compact and more fragmented nursing unit floor plate shapes should be considered.

  2. Effectiveness of Self Instructional Module on Knowledge and Skills Regarding Use of Glasgow Coma Scale in Neurological Assessment of Patients among Nurses Working in Critical Care Units of KLE Dr. Prabhakar Kore Hospital and Medical Research Centre, Belgaum

    Directory of Open Access Journals (Sweden)

    Milka Madhale

    2013-01-01

    Full Text Available Background: The brain is the central unit that controls all the functions of our body. The brain cannot function all by its self without the neurons. The proper functioning of the brain and its relationship with the world is known as consciousness. The level of consciousness is the sensitive and reliable indicator of the patient’s neurological status. The alteration in the consciousness helps to determine if there is any damage in the nervous system that can occur even without visible damage to the head. There are numerous tools used to determine level of consciousness. The most common tool used to determine level of consciousness is the Glasgow Coma Scale (GCS. It was used with ease and helped to standardize clinical observations of the patients with impaired consciousness. A proper neurological assessment using the Glasgow Coma Scale is the essential part of nursing care. It is very essential for the nurse to have knowledge and skills about neurological assessment and the Glasgow Coma Scale.Hence the present study to evaluate the effectiveness of Self Instructional Module (SIM on knowledge and skill regarding Glasgow Coma Scale was undertaken. Aim and Objectives: 1]To assess the knowledge and skills regarding the use of Glasgow Coma Scale in neurological assessment of patients among the staff nurses. 2] To determine the effectiveness of the Self Instructional Module on knowledge and skills regarding the GCS in neurological assessment of patients. 3] To find association between the pre test knowledge and skills scores and demographic variables. 4] To find the correlation between the knowledge score sand the skills scores regarding the GCS in neurological assessment of patients. Material and Methods: The study was evaluative in nature. A purposive sampling technique was used for the study. A total of 55 staff nurses working in Critical Care Units of KLES Hospital and MRC,Belgaum were selected for the study. A structured questionnaire and an

  3. Key role of staff competencies for patient and donor safety in a bone marrow transplantation unit: design and implementation of an accredited training and self-assessment program.

    Science.gov (United States)

    Lamanna, C; Baroni, M; Bisin, S; Gianassi, S; Bambi, F; Caselli, D; Aricò, M

    2010-01-01

    Human resources represent at the moment the most critical factor in an hospital setting characterized by a high rate of staff turnover. It is important to ensure a consistent level of expertise and knowledge of professionals who work in health care facilities to provide quality services and simultaneously support the implementation of strategies for patient safety. Unfortunately, the development of effective interventions for training newly added staff and self-evaluation of skills possessed by trained staff are closely related to understanding critical aspects of the organization. At the new Center for Bone Marrow Transplantation and Blood Transfusion Service in Meyer Hospital, during the last year, a group of professional nurses and technicians completed a specific plan to train new staff and, at the same time, a program of self-assessment of skills for experienced staff. The main purpose of this project was to promote skills development by newly added as well as experienced staff, to identify areas of weaknesses, and to correct them with training (organized by the hospital, departmental, or individual) designed to improve performance. Copyright 2010 Elsevier Inc. All rights reserved.

  4. Acoustic assessment of speech privacy curtains in two nursing units

    Directory of Open Access Journals (Sweden)

    Diana S Pope

    2016-01-01

    Full Text Available Hospitals have complex soundscapes that create challenges to patient care. Extraneous noise and high reverberation rates impair speech intelligibility, which leads to raised voices. In an unintended spiral, the increasing noise may result in diminished speech privacy, as people speak loudly to be heard over the din. The products available to improve hospital soundscapes include construction materials that absorb sound (acoustic ceiling tiles, carpet, wall insulation and reduce reverberation rates. Enhanced privacy curtains are now available and offer potential for a relatively simple way to improve speech privacy and speech intelligibility by absorbing sound at the hospital patient′s bedside. Acoustic assessments were performed over 2 days on two nursing units with a similar design in the same hospital. One unit was built with the 1970s′ standard hospital construction and the other was newly refurbished (2013 with sound-absorbing features. In addition, we determined the effect of an enhanced privacy curtain versus standard privacy curtains using acoustic measures of speech privacy and speech intelligibility indexes. Privacy curtains provided auditory protection for the patients. In general, that protection was increased by the use of enhanced privacy curtains. On an average, the enhanced curtain improved sound absorption from 20% to 30%; however, there was considerable variability, depending on the configuration of the rooms tested. Enhanced privacy curtains provide measureable improvement to the acoustics of patient rooms but cannot overcome larger acoustic design issues. To shorten reverberation time, additional absorption, and compact and more fragmented nursing unit floor plate shapes should be considered.

  5. Clinical risk assessment in intensive care unit

    Directory of Open Access Journals (Sweden)

    Saeed Asefzadeh

    2013-01-01

    Full Text Available Background: Clinical risk management focuses on improving the quality and safety of health care services by identifying the circumstances and opportunities that put patients at risk of harm and acting to prevent or control those risks. The goal of this study is to identify and assess the failure modes in the ICU of Qazvin′s Social Security Hospital (Razi Hospital through Failure Mode and Effect Analysis (FMEA. Methods: This was a qualitative-quantitative research by Focus Discussion Group (FDG performed in Qazvin Province, Iran during 2011. The study population included all individuals and owners who are familiar with the process in ICU. Sampling method was purposeful and the FDG group members were selected by the researcher. The research instrument was standard worksheet that has been used by several researchers. Data was analyzed by FMEA technique. Results: Forty eight clinical errors and failure modes identified, results showed that the highest risk probability number (RPN was in respiratory care "Ventilator′s alarm malfunction (no alarm" with the score 288, and the lowest was in gastrointestinal "not washing the NG-Tube" with the score 8. Conclusions: Many of the identified errors can be prevented by group members. Clinical risk assessment and management is the key to delivery of effective health care.

  6. Evaluation of cytomegalovirus (CMV)-specific T-cell immunity for the assessment of the risk of active CMV infection in non-immunosuppressed surgical and trauma intensive care unit patients.

    Science.gov (United States)

    Clari, María A; Aguilar, Gerardo; Benet, Isabel; Belda, Javier; Giménez, Estela; Bravo, Dayana; Carbonell, José A; Henao, Liliana; Navarro, David

    2013-10-01

    The current study was designed to assess the predictive value of the evaluation of cytomegalovirus (CMV)-specific T-cell immunity early following admission to the intensive care unit for inferring the risk of active CMV infection in non-immunosuppressed surgical and trauma patients. A total of 31 CMV-seropositive patients were included. Patients were screened for the presence of CMV DNA in plasma and in tracheal aspirates by real-time PCR. Enumeration of CMV pp65 and IE-1-specific IFN-γ CD8(+) and CD4(+) T cells was performed by flow cytometry for intracellular cytokine staining. Virological and immunological monitoring was conducted once or twice a week. Active CMV infection occurred in 17 out of 31 patients. Undetectable levels of pp65 and IE-1-specific IFN-γ CD8(+) and CD4(+) T-cell subsets cells were observed in 10 patients who developed active CMV infection and in one who did not (at a median of 2 days following ICU admission). Peak CMV DNA loads in both tracheal aspirates and plasma were substantially higher (P = 0.018 and P = 0.091, respectively) in patients with undetectable IFN-γ T-cell responses than in patients with detectable responses. The expansion of both CMV-specific T-cell subsets following detection of active CMV infection was demonstrated in 9 out of 14 patients with active CMV infection. In conclusion, the evaluation of CMV pp65 and IE-1-specific IFN-γ-producing CD8(+) and CD4(+) T cells early following ICU admission may allow the identification of patients most at risk of either having or developing an episode of active CMV infection, particularly those associated with high-level virus replication.

  7. Modeling Units of Assessment for Sharing Assessment Process Information: towards an Assessment Process Specification

    NARCIS (Netherlands)

    Miao, Yongwu; Sloep, Peter; Koper, Rob

    2008-01-01

    Miao, Y., Sloep, P. B., & Koper, R. (2008). Modeling Units of Assessment for Sharing Assessment Process Information: towards an Assessment Process Specification. In F. W. B. Li, J. Zhao, T. K. Shih, R. W. H. Lau, Q. Li & D. McLeod (Eds.), Advances in Web Based Learning - Proceedings of the 7th

  8. What Does a Hospital Survey on Patient Safety Reveal About Patient Safety Culture of Surgical Units Compared With That of Other Units?

    Science.gov (United States)

    Shu, Qin; Cai, Miao; Tao, Hong-Bing; Cheng, Zhao-Hui; Chen, Jing; Hu, Yin-Huan; Li, Gang

    2015-07-01

    The objective of this study was to examine the strengths and weaknesses of surgical units as compared with other units, and to provide an opportunity to improve patient safety culture in surgical settings by suggesting targeted actions using Hospital Survey on Patient Safety Culture (HSOPSC) investigation.A Hospital Survey on Patient Safety questionnaire was conducted to physicians and nurses in a tertiary hospital in Shandong China. 12 patient safety culture dimensions and 2 outcome variables were measured.A total of 23.5% of respondents came from surgical units, and 76.5% worked in other units. The "overall perceptions of safety" (48.1% vs 40.4%, P < 0.001) and "frequency of events reported" (63.7% vs 60.7%, P = 0.001) of surgical units were higher than those of other units. However, the communication openness (38.7% vs 42.5%, P < 0.001) of surgical units was lower than in other units. Medical workers in surgical units reported more events than those in other units, and more respondents in the surgical units assess "patient safety grade" to be good/excellent. Three dimensions were considered as strengths, whereas 5 other dimensions were considered to be weaknesses in surgical units. Six dimensions have potential to aid in improving events reporting and patient safety grade. Appropriate working times will also contribute to ensuring patient safety. Medical staff with longer years of experience reported more events.Surgical units outperform the nonsurgical ones in overall perception of safety and the number of events reported but underperform in the openness of communication. Four strategies, namely deepening the understanding about patient safety of supervisors, narrowing the communication gap within and across clinical units, recruiting more workers, and employing the event reporting system and building a nonpunitive culture, are recommended to improve patient safety in surgical units in the context of 1 hospital.

  9. [Operational units for health risk management (patient safety)].

    Science.gov (United States)

    Pardo Hernández, A; Claveria Fontán, A; García Urbaneja, M; López Barba, J

    2008-12-01

    In 1995 INSALUD began to develop performance measures in the field of risk management, and following transfer of powers to the regions, these led to the development of operational units in individual healthcare centres. These units, which consist of a group of health professionals, including managers, aim to identify, evaluate, analyse and deal with health risks, to enhance patient safety. Their organisational structure can vary in accordance with the needs, resources and philosophy of each individual organisation. This paper presents the experience of the risk management units developed in four Spanish regions: Madrid, the Basque Country, Galicia and INGESA (Ceuta and Melilla). It also includes reflections on assessment of their impact and on their future role in improving safety in healthcare services.

  10. National Assessment of Oil and Gas - Neogene System Assessment Units of the Gulf Coast (Provinces 047, 048 and 049)

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — The Assessment Unit is the fundamental unit used in the National Assessment Project for the assessment of undiscovered oil and gas resources. The Assessment Unit is...

  11. National Assessment of Oil and Gas Project - Raton Basin-Sierra Grande Uplift Province (041) Assessment Units

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — The Assessment Unit is the fundamental unit used in the National Assessment Project for the assessment of undiscovered oil and gas resources. The Assessment Unit is...

  12. USGS National and Global Oil and Gas Assessment Project-Gulf Coast Mesozoic Province, Haynesville Formation Assessment Units

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — The Assessment Unit is the fundamental unit used in the National Assessment Project for the assessment of undiscovered oil and gas resources. The Assessment Unit is...

  13. USGS National and Global Oil and Gas Assessment Project-Gulf Coast Mesozoic Province, Bossier Formation Assessment Units

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — The Assessment Unit is the fundamental unit used in the National Assessment Project for the assessment of undiscovered oil and gas resources. The Assessment Unit is...

  14. National Assessment of Oil and Gas Project - Northern Alaska Gas Hydrate Total Petroleum System, Northern Alaska Province (001) Assessment Units

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — The Assessment Unit is the fundamental unit used in the National Assessment Project for the assessment of undiscovered oil and gas resources. The Assessment Unit is...

  15. National Assessment of Oil and Gas Project Bend Arch-Fort Worth Basin Province (045) Assessment Units

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — The Assessment Unit is the fundamental unit used in the National Assessment Project for the assessment of undiscovered oil and gas resources. The Assessment Unit is...

  16. National Assessment of Oil and Gas Project Devonian Marcellus Shale of the Appalachian Basin Province (067) Assessment Units

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — The Assessment Unit is the fundamental unit used in the National Assessment Project for the assessment of undiscovered oil and gas resources. The Assessment Unit is...

  17. USGS National and Global Oil and Gas Assessment Project-Permian Basin Province, Val Verde Basin, Canyon Sandstones Assessment Units

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — The Assessment Unit is the fundamental unit used in the National Assessment Project for the assessment of undiscovered oil and gas resources. The Assessment Unit is...

  18. National Assessment of Oil and Gas Project - Brookian Coalbed Gas Composite Total Petroleum System, Northern Alaska Province (001) Assessment Units

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — The Assessment Unit is the fundamental unit used in the National Assessment Project for the assessment of undiscovered oil and gas resources. The Assessment Unit is...

  19. National Assessment of Oil and Gas - Upper Cretaceous Taylor and Navarro Group Assessment Units, Western Gulf Province (047)

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — The Assessment Unit is the fundamental unit used in the National Assessment Project for the assessment of undiscovered oil and gas resources. The Assessment Unit is...

  20. USGS National and Global Oil and Gas Assessment Project-Permian Basin Province, Midland Basin, Wolfcamp Shale Assessment Units

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — The Assessment Unit is the fundamental unit used in the National Assessment Project for the assessment of undiscovered oil and gas resources. The Assessment Unit is...

  1. USGS National Assessment of Oil and Gas Project - Mississippian Barnett Shale, Bend Arch-Fort Worth Basin Province Assessment Units

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — The Assessment Unit is the fundamental unit used in the National Assessment Project for the assessment of undiscovered oil and gas resources. The Assessment Unit is...

  2. Bruce Unit 1 and 2 preheater condition assessment and refurbishment

    Energy Technology Data Exchange (ETDEWEB)

    King, P.; Machowski, C.; McGillivray, R. [Babcock and Wilcox Canada Ltd., Cambridge, ON (Canada); Durance, D. [Bruce Power, Tiverton, ON (Canada)

    2008-07-01

    Bruce Units 1 to 4 were shut down during the 1990s, largely as a consequence of tube degradation resulting from inappropriate steam generator secondary side water chemistries. Following a condition assessment, Bruce Power restarted Units 3 and 4 and is currently refurbishing Units 1 and 2. In order to assess the condition of the Unit 1 and Unit 2 preheaters and determine their suitability for extended operation, inspection, maintenance and assessment activities have been conducted. Eddy current and visual inspection have revealed vessels in generally good condition. Secondary side internals appear largely undergraded. Some tube to support fretting has been observed, and a number of tubes have been removed from service because of debris fretting concerns. To prepare for return to service, the primary side divider plates have been replaced and the tubes have been ID cleaned to restore the preheater to its original condition. This paper summarizes the inspection planning, findings, assessment for extended operation and maintenance activities undertaken. (author)

  3. Communication of mechanically ventilated patients in intensive care units

    Science.gov (United States)

    Martinho, Carina Isabel Ferreira; Rodrigues, Inês Tello Rato Milheiras

    2016-01-01

    Objective The aim of this study was to translate and culturally and linguistically adapt the Ease of Communication Scale and to assess the level of communication difficulties for patients undergoing mechanical ventilation with orotracheal intubation, relating these difficulties to clinical and sociodemographic variables. Methods This study had three stages: (1) cultural and linguistic adaptation of the Ease of Communication Scale; (2) preliminary assessment of its psychometric properties; and (3) observational, descriptive-correlational and cross-sectional study, conducted from March to August 2015, based on the Ease of Communication Scale - after extubation answers and clinical and sociodemographic variables of 31 adult patients who were extubated, clinically stable and admitted to five Portuguese intensive care units. Results Expert analysis showed high agreement on content (100%) and relevance (75%). The pretest scores showed a high acceptability regarding the completion of the instrument and its usefulness. The Ease of Communication Scale showed excellent internal consistency (0.951 Cronbach's alpha). The factor analysis explained approximately 81% of the total variance with two scale components. On average, the patients considered the communication experiences during intubation to be "quite hard" (2.99). No significant correlation was observed between the communication difficulties reported and the studied sociodemographic and clinical variables, except for the clinical variable "number of hours after extubation" (p < 0.05). Conclusion This study translated and adapted the first assessment instrument of communication difficulties for mechanically ventilated patients in intensive care units into European Portuguese. The preliminary scale validation suggested high reliability. Patients undergoing mechanical ventilation reported that communication during intubation was "quite hard", and these communication difficulties apparently existed regardless of the

  4. Bank Units. Assessment and Development Tendencies

    Directory of Open Access Journals (Sweden)

    Adam Szafarczyk

    2008-01-01

    Full Text Available There are new trends in development banking sector especially concerning branches. The e-banking has diminished impact the old fashion branches as main tool finance activity. Now we have units (departments localised at supermarkets and in other strange places. Due to some researches mortgages and insurance polices ought to be sold in traditional branches according to clients preferences. Lafferty Agency researched quality of banking service condition in the UK. Base on this methodology similar case studies were done in Poland.

  5. Assessment of delirium in the intensive care unit

    African Journals Online (AJOL)

    Delirium is a prevalent problem in the intensive care unit (ICU),1–4 with an associated ... central nervous system; assessment of delirium impaired by lack of verbal ..... processed by the South Africa National Health Laboratory Service. Table 4: ...

  6. Assessment units of northern Afghanistan (auafg.shp)

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This shapefile includes polygons and regions that describe U.S. Geological Survey defined petroleum resource Assessment Units of northern Afghanistan. Each...

  7. Patient trajectories in a Norwegian unit of municipal emergency beds

    OpenAIRE

    Nilsen, Heidi; Hunskaar, Steinar; Ruths, Sabine

    2017-01-01

    Objective The Coordination reform was implemented in Norway from 2012, aiming at seamless patient trajectories. All municipalities are required to establish emergency care beds (MEBs) to avoid unnecessary hospital admissions. We aimed to examine occupancy rate, patient characteristics, diagnoses and discharge level of municipal care in a small MEB unit. Design Cross-sectional, observational study. Setting A two-bed emergency care unit. Subjects All patients admitted to the unit during one yea...

  8. [Standardised pain assessment in cognitively impaired nursing home residents: Comparing the use of assessment tools in dementia care units and in integrated care units].

    Science.gov (United States)

    Palm, Rebecca; Sirsch, Erika; Holle, Bernhard; Bartholomeyczik, Sabine

    2017-05-01

    median percentage of residents with severe cognitive impairments who were assessed with a self-rating instrument was below 10 %; in integrated care units it was 51 %. The differences were statistically significant. A mixed regression model confirmed the results. In the majority of dementia care units a single pain assessment tool was used for all residents; in 18 of 30 dementia care units this was a proxy-rated observational instrument. The results indicate that pain assessment in cognitively impaired patients is suboptimal in many integrated care units because the nurses use inappropriate instruments. Also, they confirm the results of previous studies by demonstrating that instruments are used in clinical practice that are not recommended because their German-language versions are not validated. Since valid pain assessment is a prerequisite to appropriate pain treatment, we may assume that in many residents this is also not carried out as recommended. Especially in integrated units, a defined and consented method of pain assessment is important because of the differences in their residents' cognitive and verbal abilities. Appropriate education may help to improve this process. Copyright © 2017. Published by Elsevier GmbH.

  9. Nutritional Assessment in Critically Ill Patients

    Directory of Open Access Journals (Sweden)

    Najmeh Hejazi

    2016-05-01

    Full Text Available Background: Malnutrition is an important factor in the survival of critically ill patients. The purpose of the present study was to assess the nutritional status of patients in the intensive care unit (ICU on the days of admission and discharge via a detailed nutritional assessment. Methods: Totally, 125 patients were followed up from admission to discharge at 8ICUs in Shiraz, Iran. The patients’ nutritional status was assessed using subjective global assessment (SGA, anthropometric measurements, biochemical indices, and body composition indicators. Diet prescription and intake was also evaluated. Results: Malnutrition prevalence significantly increased on the day of discharge (58.62% compared to the day of admission (28.8% according to SGA (P<0.001. The patients’ weight, mid-upper-arm circumference, mid-arm muscle circumference, triceps skinfold thickness, and calf circumference decreased significantly as well (P<0.001. Lean mass weight and body cell mass also decreased significantly (P<0.001. Biochemical indices showed no notable changes except for magnesium, which decreased significantly (P=0.013. A negative significant correlation was observed between malnutrition on discharge day and anthropometric measurements. Positive and significant correlations were observed between the number of days without enteral feeding, days delayed from ICU admission to the commencement of enteral feeding, and the length of ICU stay and malnutrition on discharge day. Energy and protein intakes were significantly less than the prescribed diet (26.26% and 26.48%, respectively. Conclusion: Malnutrition on discharge day increased in the patients in the ICU according to SGA. Anthropometric measurements were better predictors of the nutritional outcome of our critically ill patients than were biochemical tests.

  10. 2016 Offshore Wind Energy Resource Assessment for the United States

    Energy Technology Data Exchange (ETDEWEB)

    Musial, Walt [National Renewable Energy Lab. (NREL), Golden, CO (United States); Heimiller, Donna [National Renewable Energy Lab. (NREL), Golden, CO (United States); Beiter, Philipp [National Renewable Energy Lab. (NREL), Golden, CO (United States); Scott, George [National Renewable Energy Lab. (NREL), Golden, CO (United States); Draxl, Caroline [National Renewable Energy Lab. (NREL), Golden, CO (United States)

    2016-09-01

    This report, the 2016 Offshore Wind Energy Resource Assessment for the United States, was developed by the National Renewable Energy Laboratory, and updates a previous national resource assessment study, and refines and reaffirms that the available wind resource is sufficient for offshore wind to be a large-scale contributor to the nation's electric energy supply.

  11. Clinical utility of the Hopkins Competency Assessment Test on an inpatient geropsychiatry unit.

    Science.gov (United States)

    Wilkins, Kirsten M; Lund, Brian C; McAdams, Jimmie D; Yates, William R

    2009-01-01

    This study examined the clinical use of routine administration of the Hopkins Competency Assessment Test on an inpatient geropsychiatry unit. The purpose was to determine whether the Hopkins Competency Assessment Test results influenced the psychiatrist's capacity assessment or confidence in that determination. The test was administered to all patients admitted voluntarily during an 18-week period. The attending psychiatrist determined treatment consent capacity and rated confidence in that determination, before and after review of the test results. Fifty seven patients were assessed. After review of the test results, the psychiatrist's capacity rating changed in only 2 (3.5%) cases. However, the test increased the psychiatrist's confidence ratings, particularly among the patients with cognitive impairment. The Hopkins Competency Assessment Test is not suited for routine administration among geropsychiatry inpatients. However, the test may serve a role as a supplementary tool for assessing treatment consent capacity among patients with evidence of cognitive impairment.

  12. Map of assessed shale gas in the United States, 2012

    Science.gov (United States)

    ,; Biewick, Laura R. H.

    2013-01-01

    The U.S. Geological Survey has compiled a map of shale-gas assessments in the United States that were completed by 2012 as part of the National Assessment of Oil and Gas Project. Using a geology-based assessment methodology, the U.S. Geological Survey quantitatively estimated potential volumes of undiscovered gas within shale-gas assessment units. These shale-gas assessment units are mapped, and square-mile cells are shown to represent proprietary shale-gas wells. The square-mile cells include gas-producing wells from shale intervals. In some cases, shale-gas formations contain gas in deeper parts of a basin and oil at shallower depths (for example, the Woodford Shale and the Eagle Ford Shale). Because a discussion of shale oil is beyond the scope of this report, only shale-gas assessment units and cells are shown. The map can be printed as a hardcopy map or downloaded for interactive analysis in a Geographic Information System data package using the ArcGIS map document (file extension MXD) and published map file (file extension PMF). Also available is a publications access table with hyperlinks to current U.S. Geological Survey shale gas assessment publications and web pages. Assessment results and geologic reports are available as completed at the U.S. Geological Survey Energy Resources Program Web Site, http://energy.usgs.gov/OilGas/AssessmentsData/NationalOilGasAssessment.aspx. A historical perspective of shale gas activity in the United States is documented and presented in a video clip included as a PowerPoint slideshow.

  13. USGS National Assessment of Oil and Gas Project - Shale Gas Assessment Units

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — The U.S. Geological Survey has compiled a map of shale gas assessments in the United States that were completed by 2012, such assessments having been included as...

  14. NUTRITIONAL ASSESSMENT OF CAPD PATIENTS

    Directory of Open Access Journals (Sweden)

    Hong Ren

    2012-06-01

    Full Text Available Appearance and progressive development of malnutrition significantly influence the efficacy and treatment outcome in chronic renal failure (CRF patients receiving continuous ambulatory peritoneal dialysis (CAPD therapy. The aim of the present investigation was estimation of incidence and risk factors of the malnutrition development in CRF patients treated with CAPD. Nutritional status was studied in 244 PD patients (97 women, 146 men; age 59.58±16.55 years being under CAPD during 1-104 (median 30 months. Anthropometric (body mass index, dermato-fatty fold over 3-headed muscle, Subjective Global Assessment SGA, normalized protein catabolic rate nPCR and biochemical indices (hemoglobin Hb, serum albumin SALB, serum pre-albumin Spre-ALB, serum cholesterol SChol were used for nutritional status estimation. The overall mean body mass index was 28.18±47.11. The mean level of hemoglobin was 101.30±23.81 g/L, Scr was 857.28±336.17 umol/L, KT/V was 2.25±0.73. The overall mean SALB was 30.67±5.58 g/L, 74.2% patients on low SALB (SALB <35 g/L. The mean level of Spre-ALB was 331.63±91.43 mg/L, 35.66% patients on low Spre-ALB (Spre-ALB <300 mg/L. The mean level of PCR was 0.93±0.24 g/kg.d, 59.01% patients on low level PCR (PCR <1 g/kg.d. The mean dermato-fatty fold over 3-headed muscle was 13.42 mm. 25% patients had a SGA score of 1-4(malnutrition range. The prevalence of malnutrition was 18.03%. The main cause (44.6% of death is infection in our study, and the majority of these patients were complicated with different level of malnutrition. In conclusion, the results indicate that malnutrition is quite common and plays an important role in mortality in CAPD patients independent of dialysis efficacy and prevention or treatment of malnutrition by suitable means is necessary to improve clinical outcomes in CAPD patients.

  15. Pain Assessment in INTensive care (PAINT): an observational study of physician-documented pain assessment in 45 intensive care units in the United Kingdom.

    Science.gov (United States)

    Kemp, H I; Bantel, C; Gordon, F; Brett, S J; Laycock, H C

    2017-06-01

    Pain is a common and distressing symptom experienced by intensive care patients. Assessing pain in this environment is challenging, and published guidelines have been inconsistently implemented. The Pain Assessment in INTensive care (PAINT) study aimed to evaluate the frequency and type of physician pain assessments with respect to published guidelines. This observational service evaluation considered all pain and analgesia-related entries in patients' records over a 24-h period, in 45 adult intensive care units (ICUs) in London and the South-East of England. Data were collected from 750 patients, reflecting the practice of 362 physicians. Nearly two-thirds of patients (n = 475, 64.5%, 95%CI 60.9-67.8%) received no physician-documented pain assessment during the 24-h study period. Just under one-third (n = 215, 28.6%, 95%CI 25.5-32.0%) received no nursing-documented pain assessment, and over one-fifth (n = 159, 21.2%, 95%CI 19.2-23.4)% received neither a doctor nor a nursing pain assessment. Two of the 45 ICUs used validated behavioural pain assessment tools. The likelihood of receiving a physician pain assessment was affected by the following factors: the number of nursing assessments performed; whether the patient was admitted as a surgical patient; the presence of tracheal tube or tracheostomy; and the length of stay in ICU. Physician-documented pain assessments in the majority of participating ICUs were infrequent and did not utilise recommended behavioural pain assessment tools. Further research to identify factors influencing physician pain assessment behaviour in ICU, such as human factors or cultural attitudes, is urgently needed. © 2017 The Authors. Anaesthesia published by John Wiley & Sons Ltd on behalf of Association of Anaesthetists of Great Britain and Ireland.

  16. Patient education in Europe: united differences.

    NARCIS (Netherlands)

    Visser, S.; Deccache, A.; Bensing, J.

    2001-01-01

    This issue of Patient Education and Counseling presents the state of the art of patient education in several European countries. It is based on papers presented at a meeting in Paris on the evolution and development of patient education in western, central and eastern Europe (May 1999). Also patient

  17. Patient education in Europe: united differences

    NARCIS (Netherlands)

    Visser, Adriaan; Deccache, A.; Bensing, J.

    2001-01-01

    This issue of Patient Education and Counseling presents the state of the art of patient education in several European countries. It is based on papers presented at a meeting in Paris on the evolution and development of patient education in western, central and eastern Europe (May 1999). Also patient

  18. Patient education in Europe: united differences.

    NARCIS (Netherlands)

    Visser, S.; Deccache, A.; Bensing, J.

    2001-01-01

    This issue of Patient Education and Counseling presents the state of the art of patient education in several European countries. It is based on papers presented at a meeting in Paris on the evolution and development of patient education in western, central and eastern Europe (May 1999). Also patient

  19. Randomized trial of a patient-centered hospital unit.

    Science.gov (United States)

    Martin, D P; Diehr, P; Conrad, D A; Davis, J H; Leickly, R; Perrin, E B

    1998-06-01

    Patient-centered hospital units have grown out of the national trend to greater consumerism, but few of these units have been evaluated rigorously. We used a randomized controlled trial to compare patient outcomes on the Planetree Model Hospital Unit with other medical-surgical units in the hospital. Planetree patients were significantly more satisfied than controls with their hospital stay, the unit's environment and nursing care, but did not differ in ratings of physician care. Planetree patients reported more involvement in their care while hospitalized and higher satisfaction with the education they received. There were few differences between Planetree and controls in health behaviors. While Planetree patients reported better mental health status and role functioning after discharge, their health status was similar to controls after 3 to 6 months. There were no differences in length of stay and charges for the index hospitalization, readmissions or outpatient care during the following year.

  20. Patient education in Europe: united differences.

    Science.gov (United States)

    Visser, A; Deccache, A; Bensing, J

    2001-07-01

    This issue of Patient Education and Counseling presents the state of the art of patient education in several European countries. It is based on papers presented at a meeting in Paris on the evolution and development of patient education in western, central and eastern Europe (May 1999). Also patient education in the US is presented in this issue. Patient education is defined as all the educational activities directed to patients, including aspects of therapeutic education, health education and clinical health promotion. Five important factors are identified in the development of patient education: (1) research and evidence based standards; (2) the organization of care; (3) training and methodological support; (4) professional values; and (5) acknowledgment, funding and place of patient education in health policy. Several of the discussed common orientations and priorities in the patient education in the reviewed countries are highlighted in this issue. And finally, an example of the possible integrated international practice in patient education in the field of diabetes is described in this issue. Several conclusions are drawn concerning future development of communication in health care within the framework of patient education in Europe.

  1. Valoración de la actividad de una Unidad de Dolor Agudo Postoperatorio por los cuidadores del paciente quirúrgico Assessment of the activity of an Acute Postoperative Pain Unit by the staff taking care of surgical patients

    Directory of Open Access Journals (Sweden)

    F. Caba

    2004-12-01

    al 19% de los facultativos; p=0,01. El aspecto mejor valorado de la UDAP fue la mejora en el control del dolor postoperatorio; el peor, la comunicación entre los profesionales y, la sugerencia más referida, la de intentar mejorarla. Conclusiones: El papel de la UDAP es muy bien comprendido en nuestro hospital por los cuidadores del paciente quirúrgico y aunque su actividad es unánimemente percibida como útil y necesaria, existen problemas de integración y comunicación, especialmente con la enfermería de planta. La identificación de situaciones como esta mediante estudios de opinión sobre su actividad, puede ser útil para dirigir mejoras en el funcionamiento de las Unidades de Dolor Agudo con modelos organizativos similares al nuestro.Objective: An Acute Postoperative Pain Unit (APPU staffed by nurses and supervised by the Service of Anesthesiology was created in our center in 2.000. The aim of this study was to assess how the staff taking care of surgical patients perceive its activity. Material and method: The Service of Anesthesiology and Resuscitation and the Post-Anesthetic Recovery Unit (PARU maintain an APPU staffed by nurses that provides planned and protocolized management of postoperative pain to more than 1.000 patients/year undergoing the most aggressive and painful surgical procedures in a second-level hospital. Nurses and doctors taking care of the patients were requested to anonymously and voluntarily answer a written questionnaire with 15 questions (12 close-ended questions grouped in 4 categories and 3 open-ended questions that assessed several aspects of their activity. Results: Out of 168 questionnaires handed out, 87 questionnaires returned were considered (52%, 48 from doctors and 39 from nurses. The role of the APPU was well or very well understood by 97% of the responders and its activity was perceived rather unanimously as useful, effective and necessary by 98, 93 and 97%, respectively. Treatment indications were considered

  2. Assessment of atmospheric microbial contamination in a mobile dental unit

    Directory of Open Access Journals (Sweden)

    Shivakumar K

    2007-01-01

    Full Text Available Introduction: Bioaerosols are important considerations in infection control as well as in occupational health. Bioaerosols may carry potentially hazardous microbes, viruses, fungi, allergens, and other toxic substances that may harm the dental operator, patient, and the dental assistant by causing nosocomial infections. Objective: To assess the level of atmospheric microbial contamination before, during, and after dental treatment procedures in the dental operatory of a mobile dental unit (MDU. Materials and Methods: The study included three treatment sessions on different working days, with an interval of one month. The MDU was fumigated before the start of the study. Brain Heart Infusion Agar with 5% sheep blood was used to collect the gravitometric settling of aerosols produced before, during, and after dental treatment procedures. The agar plates were sent for aerobic and anaerobic culture. Results: The results showed that atmospheric microbial contamination (CFUs/plate was 4 times higher during working sessions as compared to the levels before the working sessions. At the end of the working day, aerosols decreased by almost 3 times that seen during work. Conclusion: The aerosols increased during and after work sessions. This shows the increased risk of transmission of infectious agents to the dentists who work in the MDU. Hence, all necessary preventive measures should be advised and need to be followed strictly.

  3. [Medical short stay unit for geriatric patients in the emergency department: clinical and healthcare benefits].

    Science.gov (United States)

    Pareja, Teresa; Hornillos, Mercedes; Rodríguez, Miriam; Martínez, Javier; Madrigal, María; Mauleón, Coro; Alvarez, Bárbara

    2009-01-01

    To evaluate the impact of comprehensive geriatric assessment and management of high-risk elders in a medical short stay unit located in the emergency department of a general hospital. We performed a descriptive, prospective study of patients admitted to the medical short stay unit for geriatric patients of the emergency department in 2006. A total of 749 patients were evaluated, with a mean (standard deviation) stay in the unit of 37 (16) h. The mean age was 86 (7) years; 57% were women, and 50% had moderate-severe physical impairment and dementia. Thirty-five percent lived in a nursing home. The most frequent reason for admission was exacerbation of chronic cardiopulmonary disease. Multiple geriatric syndromes were identified. The most frequent were immobility, pressure sores and behavioral disorders related to dementia. Seventy percent of the patients were discharged to home after being stabilized and were followed-up by the geriatric clinic and day hospital (39%), the home care medical team (11%), or the nursing home or primary care physician (20%). During the month after discharge, 17% were readmitted and 7.7% died, especially patients with more advanced age or functional impairment. After the unit was opened, admissions to the acute geriatric unit fell by 18.2%. Medical short stay units for geriatric patients in emergency departments may be useful for geriatric assessment and treatment of exacerbations of chronic diseases. These units can help to reduce the number of admissions and optimize the care provided in other ambulatory and domiciliary geriatric settings.

  4. An environmental assessment of United States drinking water watersheds

    Science.gov (United States)

    James Wickham; Timothy Wade; Kurt Riitters

    2011-01-01

    Abstract There is an emerging recognition that natural lands and their conservation are important elements of a sustainable drinking water infrastructure. We conducted a national, watershed-level environmental assessment of 5,265 drinking water watersheds using data on land cover, hydrography and conservation status. Approximately 78% of the conterminous United States...

  5. Life cycle assessment analysis of supercritical coal power units

    Science.gov (United States)

    Ziębik, Andrzej; Hoinka, Krzysztof; Liszka, Marcin

    2010-09-01

    This paper presents the Life Cycle Assessment (LCA) analysis concerning the selected options of supercritical coal power units. The investigation covers a pulverized power unit without a CCS (Carbon Capture and Storage) installation, a pulverized unit with a "post-combustion" installation (MEA type) and a pulverized power unit working in the "oxy-combustion" mode. For each variant the net electric power amounts to 600 MW. The energy component of the LCA analysis has been determined. It describes the depletion of non-renewable natural resources. The energy component is determined by the coefficient of cumulative energy consumption in the life cycle. For the calculation of the ecological component of the LCA analysis the cumulative CO2 emission has been applied. At present it is the basic emission factor for the LCA analysis of power plants. The work also presents the sensitivity analysis of calculated energy and ecological factors.

  6. Observational study of admission and triage decisions for patients referred to a regional intensive care unit.

    Science.gov (United States)

    Howe, D C

    2011-07-01

    The objectives of this study were to identify factors associated with decisions concerning triage and admission to the intensive care unit and to describe the outcome of patients referred to intensive care unit for admission. The study was a single-centre, prospective, observational study. It was performed in the general intensive care unit of a tertiary regional hospital, over the period of February to June 2009. The patients were non-elective, acute medical in-patients. For 100 patients referred, only 36 were admitted to the intensive care unit. The remaining 64 were declined admission: nine were declined admission because they were assessed as too sick to benefit, 41 were declined admission because they were assessed as too well to benefit and 14 were deemed to potentially benefit from intensive care unit admission but were not admitted ('triage'). Patients most likely to receive triage decisions were medical in-patients who had expressed wishes about end-of-life care, who were functionally limited with co-morbid conditions affecting their performance status. Patients referred by Resident Medical Officers were also more likely to receive a triage decision. Age, gender Aboriginal and Torres Strait Islander status, diagnostic category and reason for referral did not impact on admission or triage decisions. Bed status in intensive care unit at the time of referral affected neither admission nor triage decisions. Hospital mortality in patients deemed too well to benefit from intensive care unit was 7.3%, suggesting that all patients referred for consideration of admission to intensive care unit should be classified as 'high risk'.

  7. Modeling Safety Outcomes on Patient Care Units

    Science.gov (United States)

    Patil, Anita; Effken, Judith; Carley, Kathleen; Lee, Ju-Sung

    In its groundbreaking report, "To Err is Human," the Institute of Medicine reported that as many as 98,000 hospitalized patients die each year due to medical errors (IOM, 2001). Although not all errors are attributable to nurses, nursing staff (registered nurses, licensed practical nurses, and technicians) comprise 54% of the caregivers. Therefore, it is not surprising, that AHRQ commissioned the Institute of Medicine to do a follow-up study on nursing, particularly focusing on the context in which care is provided. The intent was to identify characteristics of the workplace, such as staff per patient ratios, hours on duty, education, and other environmental characteristics. That report, "Keeping Patients Safe: Transforming the Work Environment of Nurses" was published this spring (IOM, 2004).

  8. Simulation-based patient flow analysis in an endoscopy unit

    DEFF Research Database (Denmark)

    Koo, Pyung-Hoi; Nielsen, Karl Brian; Jang, Jaejin

    2010-01-01

    One of the major elements in improving efficiency of healthcare services is patient flow. Patients require a variety of healthcare resources as they receive healthcare services. Poor management of patient flow results in long waiting time of patients, under/over utilization of medical resources......, low quality of care and high healthcare cost. This article addresses patient flow problems at a Gastrointestinal endoscopy unit. We attempt to analyze the main factors that contribute to the inefficient patient flow and process bottlenecks and to propose efficient patient scheduling and staff...

  9. Circum-Arctic Resource Appraisal (north of the Arctic Circle) Assessment Units

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — The Assessment Unit is the fundamental unit used in the World Petroleum Resources Project. The Assessment Unit is defined within the context of the higher-level...

  10. Patient trajectories in a Norwegian unit of municipal emergency beds.

    Science.gov (United States)

    Nilsen, Heidi; Hunskaar, Steinar; Ruths, Sabine

    2017-06-01

    The Coordination reform was implemented in Norway from 2012, aiming at seamless patient trajectories. All municipalities are required to establish emergency care beds (MEBs) to avoid unnecessary hospital admissions. We aimed to examine occupancy rate, patient characteristics, diagnoses and discharge level of municipal care in a small MEB unit. Cross-sectional, observational study. A two-bed emergency care unit. All patients admitted to the unit during one year. Patients' age and gender, comorbidity, main diagnoses and municipal care level on admission and discharge, diagnostic and therapeutic initiatives, occupancy rate. Sixty admissions were registered, with total bed occupancy 194 days, and an occupancy rate of 0.27. The patients (median age 83 years, 57% women) had mostly infections, musculoskeletal symptoms or undefined conditions. Some 48% of the stays exceeded three days and 43% of the patients were subsequently transferred to nursing homes or hospitals. Occupancy rate was low. Patient selection was not according to national standards, and stays were longer. Many patients were transferred to nursing homes, indicating that the unit was an intermediate pathway or a short cut to institutional care. It is unclear whether the unit avoided hospital admissions.

  11. New psych unit eases patient burden in ED.

    Science.gov (United States)

    2008-06-01

    Creating a special unit for psychiatric patients frees up beds in your ED, ensures better care for that patient population, and improves the atmosphere in the main department for the rest of your patients. Consider these suggestions: The creation of a psych unit can be extremely costly. Be prepared to demonstrate projected savings when pitching the idea to administration. Make sure an ED physician has overall responsibility for each patient at all times. Keep a regular group of nurses in rotation. This setup will help ensure smooth handoffs.

  12. Assessment of teamwork during structured interdisciplinary rounds on medical units.

    Science.gov (United States)

    O'Leary, Kevin J; Boudreau, Yvonne N; Creden, Amanda J; Slade, Maureen E; Williams, Mark V

    2012-01-01

    Interdisciplinary rounds (IDR) provide a means to assemble hospital team members and improve collaboration. Little is known about teamwork during IDR. To evaluate and characterize teamwork during IDR. Cross-sectional observational study. Six medical units which had implemented structured interdisciplinary rounds (SIDR). We adapted the Observational Teamwork Assessment for Surgery (OTAS) tool, a behaviorally anchored rating scale shown to be reliable and valid in surgical settings. OTAS provides scores ranging from 0 to 6 (0 = problematic behavior; 6 = exemplary behavior) across 5 domains (communication, coordination, cooperation/backup behavior, leadership, and monitoring/situational awareness) and for prespecified subteams. Two researchers conducted direct observations using the adapted OTAS tool. We conducted 7-8 independent observations for each unit (total = 44) and 20 joint observations. Inter-rater reliability was excellent at the unit level (Spearman's rho = 0.75), and good across domains (rho = 0.53-0.68) and subteams (rho = 0.53-0.76) with the exception of the physician subteam, for which it was poor (rho = 0.35). Though teamwork scores were generally high, we found differences across units, with a median (interquartile range [IQR]) 4.5 (3.9-4.9) for the lowest and 5.4 (5.3-5.5) for the highest performing unit (P teamwork during SIDR across units, domains, and most subteams. Variation in performance suggests a need to improve consistency of teamwork and emphasizes the importance of leadership. Copyright © 2012 Society of Hospital Medicine.

  13. Discrete Event Simulation of Patient Admissions to a Neurovascular Unit

    Directory of Open Access Journals (Sweden)

    S. Hahn-Goldberg

    2014-01-01

    Full Text Available Evidence exists that clinical outcomes improve for stroke patients admitted to specialized Stroke Units. The Toronto Western Hospital created a Neurovascular Unit (NVU using beds from general internal medicine, Neurology and Neurosurgery to care for patients with stroke and acute neurovascular conditions. Using patient-level data for NVU-eligible patients, a discrete event simulation was created to study changes in patient flow and length of stay pre- and post-NVU implementation. Varying patient volumes and resources were tested to determine the ideal number of beds under various conditions. In the first year of operation, the NVU admitted 507 patients, over 66% of NVU-eligible patient volumes. With the introduction of the NVU, length of stay decreased by around 8%. Scenario testing showed that the current level of 20 beds is sufficient for accommodating the current demand and would continue to be sufficient with an increase in demand of up to 20%.

  14. Sleep and delirium in unsedated patients in the intensive care unit

    DEFF Research Database (Denmark)

    Boesen, H C; Andersen, J H; Bendtsen, A O

    2016-01-01

    BACKGROUND: Sleep deprivation and delirium are major problems in the ICU. We aimed to assess the sleep quality by polysomnography (PSG) in relation to delirium in mechanically ventilated non-sedated ICU patients. METHODS: Interpretation of 24-h PSG and clinical sleep assessment in 14 patients....... Delirium assessment was done using the confusion assessment method for the intensive care unit (CAM-ICU). RESULTS: Of four patients who were delirium free, only one had identifiable sleep on PSG. Sleep was disrupted with loss of circadian rhythm, and diminished REM sleep. In the remaining three patients...... the PSGs were atypical, meaning that no sleep signs were found, and sleep could not be quantified from the PSGs. Clinical total sleep time (ClinTST) ranged from 2.0-13.1 h in patients without delirium. Six patients with delirium all had atypical PSGs, so sleep could not be quantified. Short periods of REM...

  15. Care of the Patient with Chest Pain in the Observation Unit.

    Science.gov (United States)

    Borawski, Joseph B; Graff, Louis G; Limkakeng, Alexander T

    2017-08-01

    Care of the patient presenting to an emergency department (ED) with chest pain remains a common yet challenging aspect of emergency medicine. Acute coronary syndrome presents in nonspecific fashion. The development and evolution of the ED-based observation unit has helped to safely assess and diagnose those most at risk for an adverse cardiac event. Furthermore, there are several provocative testing modalities to help assess for coronary artery disease. This article serves to describe and discuss the modern ED-based observation unit approach to patients with chest pain and/or angina equivalents presenting to an ED. Copyright © 2017 Elsevier Inc. All rights reserved.

  16. Hypertension in Intensive Care Unit Patients.

    Directory of Open Access Journals (Sweden)

    ilhan Kurultak

    2016-06-01

    data regarding HT are particularly about the outpatients, who have variety of cardiovascular risks and it had remained limited in ICU patients. The ignoring of HT involuntary by health professionals who fight with the more complicated life threatening problems, the existence of different medical conditions of patients and variety of each individual needs can lead this situation. Despite of these difficulties, it is expected that the clinician should be successful to do correct action completely in management of HT like in a lot of the other medical conditions. In this review, the evaluation and treatment of HT in ICU is examined in light of recent data. [J Contemp Med 2016; 6(2.000: 126-136

  17. Intake of Dietary Supplements and Malnutrition in Patients in Intensive Care Unit

    OpenAIRE

    2016-01-01

    Background: Malnutrition is prevalent among patients hospitalized in Intensive Care Units (ICUs) and causes various complications. Dietary supplementation to provide appropriate nutritional support may reduce the malnutrition and complications through improvement in nutritional status. This study was carried out to assess the association between dietary supplementation and malnutrition among patients in ICUs. Methods: A case-control study was conducted on 180 male patients aged 20-60 year...

  18. [Patient safety in antibiotics administration: Risk assessment].

    Science.gov (United States)

    Maqueda Palau, M; Pérez Juan, E

    To determine the level of risk in the preparation and administration of antibiotics frequently used in the Intensive Care Unit using a risk matrix. A study was conducted using situation analysis and literature review of databases, protocols and good practice guidelines on intravenous therapy, drugs, and their administration routes. The most used antibiotics in the ICU registered in the ENVIN-HELICS program from 1 April to 30 June 2015 were selected. In this period, 257 patients received antimicrobial treatment and 26 antibiotics were evaluated. Variables studied: A risk assessment of each antibiotic using the scale Risk Assessment Tool, of the National Patient Safety Agency, as well as pH, osmolarity, type of catheter recommended for administration, and compatibility and incompatibility with other antibiotics studied. Almost two-thirds (65.3%) of antibiotics had more than 3 risk factors (represented by a yellow stripe), with the remaining 34.7% of antibiotics having between 0 and 2 risk factors (represented by a green stripe). There were no antibiotics with 6 or more risk factors (represented by a red stripe). Most drugs needed reconstitution, additional dilution, and the use of part of the vial to administer the prescribed dose. More than half of the antibiotics studied had a moderate risk level; thus measures should be adopted in order to reduce it. The risk matrix is a useful tool for the assessment and detection of weaknesses associated with the preparation and administration of intravenous antibiotics. Copyright © 2016 SECA. Publicado por Elsevier España, S.L.U. All rights reserved.

  19. Assessment of patient safety culture: what tools for medical students?

    Science.gov (United States)

    Chaneliere, M; Jacquet, F; Occelli, P; Touzet, S; Siranyan, V; Colin, C

    2016-09-29

    The assessment of patient safety culture refers mainly to surveys exploring the perceptions of health professionals in hospitals. These surveys have less relevance when considering the assessment of the patient safety culture of medical students, especially at university or medical school. They are indeed not fully integrated in care units and constitute a heterogeneous population. This work aimed to find appropriate assessment tools of the patient safety culture of medical students. Systematic review of the literature. Surveys related to a care unit were excluded. A typology of the patient safety culture of medical students was built from the included surveys. Eighteen surveys were included. In our typology of patient safety culture of medical students (15 dimensions), the number of dimensions explored by survey (n) ranged from 1 to 12, with 6 "specialized" tools (n ≤ 4) and 12 "global" tools (N ≥ 5). These surveys have explored: knowledge about patient safety, acknowledgment of the inevitability of human error, the lack of skills as the main source of errors, the errors reporting systems, disclosure of medical errors to others health professionals or patients, teamwork and patient involvement to improve safety in care. We recommend using Wetzel's survey for making an overall assessment of the patient safety culture of medical students at university. In a specific purpose-e.g. to assess an educational program on medical error disclosure-the authors recommend to determine which dimensions of patient safety will be taught, to select the best assessment tool. Learning on patient safety should however be considered beyond the university. International translations of tools are required to create databases allowing comparative studies.

  20. Psychiatric Comorbidity in Patients from the Addictive Disorders Assistance Units of Galicia: The COPSIAD Study.

    Directory of Open Access Journals (Sweden)

    César Pereiro

    Full Text Available The objective of this study is to assess the prevalence of psychiatric comorbidity in patients under treatment within the addictive disorders assistance units of Galicia (Spain.A total of 64 healthcare professionals performed clinical diagnosis of mental disorders (on DSM IV-TR criteria in 2300 patients treated throughout March 2010 in 21 addictive disorders assistance units.56.3% of patients with substance abuse/dependency also showed some other mental disorder, 42.2% of patients suffering from at least an Axis I condition and 20.2% from some Axis II condition. Mood and anxiety disorders and borderline and antisocial personality disorders were the most frequent disorders in both axes.A high comorbidity was found between mental and substance use disorders (SUD in patients seen at the addictive disorders assistance units of Galicia.

  1. Low caspofungin exposure in patients in the Intensive Care Unit

    NARCIS (Netherlands)

    van der Elst, Kim C M; Veringa, Anette; Zijlstra, Jan G; Beishuizen, Albertus; Klont, Rob; Brummelhuis-Visser, Petra; Uges, Donald R A; Touw, Daan J; Kosterink, Jos G W; van der Werf, Tjip S; Alffenaar, Jan-Willem C

    2016-01-01

    In critically ill patients, drug exposure may be influenced by altered drug distribution and clearance. Earlier studies showed that the variability in caspofungin exposure was high in Intensive Care Unit (ICU) patients. The primary objective of this study was to determine if the standard dose of cas

  2. Modeling the effect of short stay units on patient admissions

    NARCIS (Netherlands)

    Zonderland, Maartje E.; Boucherie, Richard J.; Carter, Michael W.; Stanford, David A.

    2015-01-01

    Two purposes of Short Stay Units (SSU) are the reduction of Emergency Department crowding and increased urgent patient admissions. At an SSU urgent patients are temporarily held until they either can go home or transferred to an inpatient ward. In this paper we present an overflow model to evaluate

  3. Patient health questionnaire. Using a patient-focused assessment tool.

    OpenAIRE

    Mitchell, J. D.

    1996-01-01

    A patient health questionnaire was developed for use in family practice to help identify lifestyle risk factors, assess health care needs, and better understand patients. This article discusses the questionnaire's development and practical application.

  4. Nurse-Patient Communication Interactions in the Intensive Care Unit

    Science.gov (United States)

    Happ, Mary Beth; Garrett, Kathryn; Thomas, Dana DiVirgilio; Tate, Judith; George, Elisabeth; Houze, Martin; Radtke, Jill; Sereika, Susan

    2011-01-01

    Background The inability to speak during critical illness is a source of distress for patients, yet nurse-patient communication in the intensive care unit has not been systematically studied or measured. Objectives To describe communication interactions, methods, and assistive techniques between nurses and nonspeaking critically ill patients in the intensive care unit. Methods Descriptive observational study of the nonintervention/usual care cohort from a larger clinical trial of nurse-patient communication in a medical and a cardiothoracic surgical intensive care unit. Videorecorded interactions between 10 randomly selected nurses (5 per unit) and a convenience sample of 30 critically ill adults (15 per unit) who were awake, responsive, and unable to speak because of respiratory tract intubation were rated for frequency, success, quality, communication methods, and assistive communication techniques. Patients self-rated ease of communication. Results Nurses initiated most (86.2%) of the communication exchanges. Mean rate of completed communication exchange was 2.62 exchanges per minute. The most common positive nurse act was making eye contact with the patient. Although communication exchanges were generally (>70%) successful, more than one-third (37.7%) of communications about pain were unsuccessful. Patients rated 40% of the communication sessions with nurses as somewhat difficult to extremely difficult. Assistive communication strategies were uncommon, with little to no use of assistive communication materials (eg, writing supplies, alphabet or word boards). Conclusions Study results highlight specific areas for improvement in communication between nurses and nonspeaking patients in the intensive care unit, particularly in communication about pain and in the use of assistive communication strategies and communication materials. PMID:21362711

  5. The geriatric patient: use of acute geriatrics units in the emergency care of elderly patients in France.

    Science.gov (United States)

    Somme, D; Lazarovici, C; Dramé, M; Blanc, P; Lang, P O; Gauvain, J B; Voisin, T; Gonthier, R; De Wazières, B; Jeandel, C; Couturier, P; Blanchard, F; Saint-Jean, O

    2011-01-01

    We studied the factors influencing the choice of admission to Geriatrics units, instead of other acute hospital units after an emergency visit. We report the results from a cohort of 1283 randomly selected patients aged >75 years hospitalized in emergency and representative of the French University hospital system. All patients underwent geriatric assessment. Baseline characteristics of patients admitted to Geriatrics and other units were compared. A center effect influencing the use of Geriatrics units during emergencies was also investigated. Admission to a Geriatrics unit during the acute care episode occurred in 499 cases (40.3%). By multivariate analysis, 4 factors were related to admission to a Geriatrics unit: cognitive disorder: odds ratio (OR)=1.79 (1.38-2.32) (95% confidence interval=95% CI); "failure to thrive" syndrome OR=1.54 (1.01-2.35), depression: OR=1.42 (1.12-1.83) or loss of Activities of Daily Living (ADL): OR=1.35 (1.04-1.75). The emergency volume of the hospital was inversely related to the use of Geriatrics units, with high variation that could be explained by other unstudied factors. In the French University Emergency Healthcare system, the "geriatrics patient" is defined by the existence of cognitive disorder, psychological symptoms or installed loss of autonomy. Nevertheless, considerable nation-wide variation was observed underlining the need to clarify and reinforce this discipline in the emergency healthcare system. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

  6. Multimethod and Interpersonal Assessment in Medical Settings: A Case Study from the Dermatology Unit

    Directory of Open Access Journals (Sweden)

    Chiara Vari

    2014-01-01

    Full Text Available Psoriasis is a chronic skin disease with multifactorial aetiology. The psychological impact of skin diseases is increasingly recognised, but only scant attention has been given to the possible role of couple relationships as protective factors for dermatology patients. This article presents a multimethod assessment conducted along with physical examination at a Dermatology Unit. Specifically, the assessment includes measures of emotion regulation and attachment. The first aim of the article is to support an integrated assessment of dermatological and psychological factors together. The second aim is to highlight the possible role of couple relationships in the management of skin diseases.

  7. The value of colonoscopy to assess rectal bleeding in patients referred from Primary Care Units Utilidad de la colonoscopia en pacientes derivados desde Atención Primaria por rectorragia

    Directory of Open Access Journals (Sweden)

    A. Sánchez

    2005-12-01

    Full Text Available Objectives: rectal bleeding is very common in the general population. It is produced mainly because of benign disease originating in the anus and the rectum. Our aim was to evaluate the need for colonoscopy in patients presenting with rectal bleeding. Patients and methods: patients referred from Primary Care Units and complaining of rectal bleeding were included prospectively in a three-month study. All patients underwent a careful medical history along with physical examination, laboratory tests, and colonoscopy. Results: 126 patients with a mean age of 49.2 years (range: 19-80 were studied. Rectal digital examination was abnormal in 75 cases (59.5%. Severe disease was encountered in 22 patients (neoplasm, angiodysplasia, and inflammatory bowel disease; 10 patients had polyps, 6 had colorectal cancer, and 6 had inflammatory bowel disease. Out of 63 patients younger than 50 years, 5 had severe disease, all of them in the form of inflammatory bowel disease. Conclusions: a neoplasm of the rectum and colon in patients younger than 50 years is a rare event. A colonoscopy must be performed in this group of patients to rule out inflammatory bowel disease.Objetivos: la rectorragia es frecuente en la población general. En la mayoría de las ocasiones está producida por patología anorrectal benigna. Nuestro objetivo era determinar la necesidad de realizar pruebas endoscópicas en pacientes con rectorragia. Pacientes y métodos: se incluyeron de forma prospectiva durante tres meses todos los pacientes que eran derivados desde la Atención Primaria por rectorragia. En todos los pacientes se realizó historia clínica y exploración física que incluía tacto rectal, analítica básica y una colonoscopia. Resultados: se incluyeron 126 pacientes con una edad media de 49,2 años (19-80. El tacto rectal fue anormal en 75 (59,5%. En 22 pacientes se encontró patología severa o positiva (lesiones neoplásicas, angiodisplasias y enfermedad inflamatoria

  8. Aggregation of carbon dioxide sequestration storage assessment units

    Science.gov (United States)

    Blondes, Madalyn S.; Schuenemeyer, John H.; Olea, Ricardo A.; Drew, Lawrence J.

    2013-01-01

    The U.S. Geological Survey is currently conducting a national assessment of carbon dioxide (CO2) storage resources, mandated by the Energy Independence and Security Act of 2007. Pre-emission capture and storage of CO2 in subsurface saline formations is one potential method to reduce greenhouse gas emissions and the negative impact of global climate change. Like many large-scale resource assessments, the area under investigation is split into smaller, more manageable storage assessment units (SAUs), which must be aggregated with correctly propagated uncertainty to the basin, regional, and national scales. The aggregation methodology requires two types of data: marginal probability distributions of storage resource for each SAU, and a correlation matrix obtained by expert elicitation describing interdependencies between pairs of SAUs. Dependencies arise because geologic analogs, assessment methods, and assessors often overlap. The correlation matrix is used to induce rank correlation, using a Cholesky decomposition, among the empirical marginal distributions representing individually assessed SAUs. This manuscript presents a probabilistic aggregation method tailored to the correlations and dependencies inherent to a CO2 storage assessment. Aggregation results must be presented at the basin, regional, and national scales. A single stage approach, in which one large correlation matrix is defined and subsets are used for different scales, is compared to a multiple stage approach, in which new correlation matrices are created to aggregate intermediate results. Although the single-stage approach requires determination of significantly more correlation coefficients, it captures geologic dependencies among similar units in different basins and it is less sensitive to fluctuations in low correlation coefficients than the multiple stage approach. Thus, subsets of one single-stage correlation matrix are used to aggregate to basin, regional, and national scales.

  9. Assessing the spiritual needs of patients.

    Science.gov (United States)

    Timmins, Fiona; Caldeira, Sílvia

    2017-03-15

    Assessing spirituality and the spiritual needs of patients is fundamental to providing effective spiritual care. This article, the second in a series of three, discusses the assessment of patients' spirituality and spiritual needs in healthcare settings. Several formal spiritual assessment tools are available to assist nurses to identify patients' spiritual needs and to determine whether they are experiencing spiritual distress. However, it may be more appropriate to assess patients' spirituality informally, by asking open questions about their spiritual beliefs and needs. It is important for nurses to be aware of the limits of their competence in undertaking spiritual assessment and providing spiritual care, and to refer patients to the healthcare chaplain or other spiritual support personnel where necessary. The third and final article in this series will discuss spiritual care nursing interventions.

  10. Critically ill obstetric patients in the intensive care unit.

    Science.gov (United States)

    Demirkiran, O; Dikmen, Y; Utku, T; Urkmez, S

    2003-10-01

    We aimed to determine the morbidity and mortality among obstetric patients admitted to the intensive care unit. In this study, we analyzed retrospectively all obstetric admissions to a multi-disciplinary intensive care unit over a five-year period. Obstetric patients were identified from 4733 consecutive intensive care unit admissions. Maternal age, gestation of newborns, mode of delivery, presence of coexisting medical problems, duration of stay, admission diagnosis, specific intensive care interventions (mechanical ventilation, continuous veno-venous hemofiltration, central venous catheterization, and arterial cannulation), outcome, maternal mortality, and acute physiology and chronic health evaluation (APACHE) II score were recorded. Obstetric patients (n=125) represented 2.64% of all intensive care unit admissions and 0.89% of all deliveries during the five-year period. The overall mortality of those admitted to the intensive care unit was 10.4%. Maternal age and gestation of newborns were similar in survivors and non-survivors. There were significant differences in length of stay and APACHE II score between survivors and non-survivors P intensive care unit admission was preeclampsia/eclampsia (73.6%) followed by post-partum hemorrhage (11.2%). Intensive care specialists should be familiar with these complications of pregnancy and should work closely with obstetricians.

  11. [Pain assessment in the premature newborn in Intensive Care Unit].

    Science.gov (United States)

    Santos, Luciano Marques; Pereira, Monick Piton; dos Santos, Leandro Feliciano Nery; de Santana, Rosana Castelo Branco

    2012-01-01

    This study aimed to analyze the process of pain identification in premature by the professional staff of the Neonatal Intensive Care Unit of a public hospital in the interior of Bahia, Brazil. This is a quantitative descriptive exploratory study that was made through a form applied to twenty-four health professional of a Neonatal Intensive Care Unit. The data were analyzed in the Statistical Package for Social Sciences. The results showed 100% of professionals believed that newborns feel pain, 83.3% knew the pain as the fifth vital sign to be evaluated; 54,8% did not know the pain assessment scales; 70.8% did not use scales and highlighted behavioral and physiological signs of the newborn as signs suggestive of pain. Thus, it is important that professionals understand the pain as a complex phenomenon that demands early intervention, ensuring the excellence of care.

  12. Acute medical assessment units: an efficient alternative to in-hospital acute medical care.

    LENUS (Irish Health Repository)

    Watts, M

    2011-02-01

    Acute Medical Assessment Units (AMAUs) are being proposed as an alternative to congested Emergency Departments (EDs for the assessment of patients with a range of acute medical problems. We retrospectively reviewed the discharge destination of patients referred to a newly established AMAU during a six-month period. During the same period we contrasted activity in the ED for a similar group of patients. 1,562 patients were assessed in the AMAU. 196 (12.5%) were admitted to an in-patient bed and 1,148 (73.5%) were entered into specific diagnosis-driven out-patient pathways. 1,465 patients attended the ED and 635 (43.3%) were admitted. Out-patient alternatives to expensive in-patient care need to be provided at the \\'coal face" of acute referral. The AMAU provides this, and as a consequence admission rates are relatively low. This is achieved by directly communicating with GPs, accessing senior clinical decision makers, and providing immediate access to diagnostically driven outpatient pathways.

  13. Respiratory syncytial virus rhinosinusitis in intensive care unit patients

    Directory of Open Access Journals (Sweden)

    Alexandre Rodrigues da Silva

    2007-02-01

    Full Text Available This study reported a case of rhinosinusitis for Respiratory Syncytial Virus in Intensive Care Unit patient. The settings were Intensive Care Unit at Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil. One female HIV-infected patient with respiratory failure and circulatory shock due to splenic and renal abscesses, who developed rhinosinusitis caused by RSV and bacteria. Respiratory viruses can play a pathogenic role in airways infection allowing secondary bacterial overgrowth.

  14. Professional attitudes toward patient safety culture in a bone marrow transplant unit.

    Science.gov (United States)

    Fermo, Vivian Costa; Radünz, Vera; Rosa, Luciana Martins da; Marinho, Monique Mendes

    2016-03-01

    Objective To identify the attitude of health professionals toward the patient safety culture at a bone marrow transplant unit. Methods Quantitative research approach, cross-sectional survey conducted at a bone marrow transplant unit in Santa Catarina, Brazil. Data were collected using a Safety Attitudes Questionnaire with 33 health professionals in August and September of 2013. A total of 37 attitudes were assessed according to six safety dimensions of patient safety culture. Data were analysed by applying descriptive and inferential statistics, ANOVA and the Kruskal-Wallis test with a p value equal to or under 0.05. Results Attitudes regarding the dimension "job satisfaction" were positive for the patient safety culture, and there was a significant difference between the professionals in this dimension (p-value 0.05). The other dimensions were not assessed positively. Conclusion The attitudes of health professionals toward patient safety must be strengthened.

  15. Routine functional assessment for hip fracture patients

    DEFF Research Database (Denmark)

    Pedersen, Tonny J; Lauritsen, Jens M

    2016-01-01

    Background and purpose - Pre-fracture functional level has been shown to be a consistent predictor of rehabilitation outcomes in older hip fracture patients. We validated 4 overall pre-fracture functional level assessment instruments in patients aged 65 or more, used the prediction of outcome at 4...... months post-fracture, and assessed cutoff values for decision making in treatment and rehabilitation. Patients and methods - 165 consecutive patients with acute primary hip fracture were prospectively included in the study. Pre-fracture Barthel-20, Barthel-100, cumulated ambulation score, and new...... investigation of usage for guidance of clinical and rehabilitation decisions concerning hip fracture patients is warranted....

  16. Hospital Related Stress Among Patients Admitted to a Psychiatric In-patient Unit in India

    Directory of Open Access Journals (Sweden)

    Latha KS

    2011-04-01

    Full Text Available The psychiatric patient’s attitudes towards hospitalization have found an association between patient perceptions of the ward atmosphere and dissatisfaction. The aim of the study was to determine the aspects of stress related to hospitalization in inpatients admitted to a psychiatric facility. Fifty in-patients of both sexes admitted consecutively to a psychiatric unit in a General Hospital were asked to rate the importance of, and their satisfaction with, 38 different aspects of in-patient care and treatment. Results showed that the major sources of stress were related to having a violent patient near to his/her bed; being away from family; having to stay in closed wards; having to eat cold and tasteless food; losing income or job due to illness, being hospitalized away from home; not able to understand the jargons used by the clinical staff and not getting medication for sleep. A well-differentiated assessment of stress and satisfaction has implications for the evaluation of the quality of psychiatric care and for the improvement of in-patient psychiatric care.

  17. Identifying and assessing strategies for evaluating the impact of mobile eye health units on health outcomes.

    Science.gov (United States)

    Fu, Shiwan; Turner, Angus; Tan, Irene; Muir, Josephine

    2017-08-14

    To identify and assess strategies for evaluating the impact of mobile eye health units on health outcomes. Systematic literature review. Worldwide. Peer-reviewed journal articles that included the use of a mobile eye health unit. Journal articles were included if outcome measures reflected an assessment of the impact of a mobile eye health unit on health outcomes. Six studies were identified with mobile services offering diabetic retinopathy screening (three studies), optometric services (two studies) and orthoptic services (one study). This review identified and assessed strategies in existing literature used to evaluate the impact of mobile eye health units on health outcomes. Studies included in this review used patient outcomes (i.e. disease detection, vision impairment, treatment compliance) and/or service delivery outcomes (i.e. cost per attendance, hospital transport use, inappropriate referrals, time from diabetic retinopathy photography to treatment) to evaluate the impact of mobile eye health units. Limitations include difficulty proving causation of specific outcome measures and the overall shortage of impact evaluation studies. Variation in geographical location, service population and nature of eye care providers limits broad application. © 2017 National Rural Health Alliance Inc.

  18. Attitudes of patients and staff to research in a specialist palliative care unit.

    Science.gov (United States)

    Ross, Catriona; Cornbleet, Mike

    2003-09-01

    Many randomized trials in specialist palliative care (SPC) have failed to recruit sufficient numbers of patients. A questionnaire was designed to assess the attitudes of inpatients of a SPC unit to taking part in research. Only 50% of patients were considered physically and mentally fit for interview. Forty patients and 13 nurses were asked to indicate their willingness to take part, or for their patients to take part, in research in general and then in three hypothetical trials. Reasons for their responses were analysed. The patients were generally agreeable to trial participation (66% 'quite happy' or 'very happy'). The nurses were strongly in favour of research participation for the same group of patients (92% 'quite happy' or 'very happy'). The most invasive study involving venepuncture and random drug allocation had the least favourable response (46% of patients and 54% of nurses 'quite happy' or 'very happy'). A trial of reflexology attracted 77% of patients, while 62% were happy to take part in a study involving mood assessment and interview. Factors deterring willingness to participate included the need for record keeping by the patient and concern about potential emotional strain. The nurses correctly identified some of the factors deterring patients, but often their willingness for trial participation did not match that of the patient. Although there is support for research among the small number of potential trial entrants in specialist palliative care units, their limited physical and emotional reserves make careful attention to appropriate trial design essential to the success of future studies.

  19. Emergency Department Observation Units and the Older Patient

    Science.gov (United States)

    Moseley, Mark G.; Hawley, Miles P.; Caterino, Jeffrey M.

    2013-01-01

    Synopsis An increasing number of emergency departments (EDs) are providing extended care and monitoring of patients in ED observation units (EDOUs). EDOUs can be particularly useful for older adults both as an alternative to hospitalization in appropriately selected patients and as a means to risk-stratify older adults with unclear presentations. They can also provide a period of therapeutic intervention and reassessment for older patients in whom the appropriateness and safety of immediate outpatient care is unclear. They offer the opportunity for more comprehensive evaluation of many characteristics of particular importance to the care of older adults which cannot be accomplished during a short ED stay. The manuscript first discusses the general characteristics of EDOUs. Next, it reviews appropriate entry and exclusion criteria for older adults in EDOU including specific focus on several of the most common observation unit protocols, focusing on their relevance to older adults. Finally, it briefly discusses regulatory implications of observation status for patients with Medicare. PMID:23177601

  20. [Nitrogen balance assessment in burn patients].

    Science.gov (United States)

    Beça, Andreia; Egipto, Paula; Carvalho, Davide; Correia, Flora; Oliveira, Bruno; Rodrigues, Acácio; Amarante, José; Medina, J Luís

    2010-01-01

    The burn injury probably represents the largest stimulus for muscle protein catabolism. This state is characterized by an accelerated catabolism of the lean or skeletal mass that results in a clinical negative balance of nitrogen and muscle wasting. The determination of an appropriate value for protein intake is essential, since it is positively related to the nitrogen balance (NB) and accordingly several authors argue that a positive NB is the key parameter associated with nutritional improvement of a burn patient. Evaluation of the degree of protein catabolism by assessment of the Nitrogen Balance; Defining of nutritional support (protein needs) to implement in patients with burned surface area (BSA) = 10%. We prospectively evaluated the clinical files and scrutinized the clinical variables of interest. The NB was estimated according to three formulae. Each gram of nitrogen calculated by the NB was then converted into grams of protein, subtracted or added to protein intake (or administered enteric or parenterically) and divided by kg of reference Weight (kg Rweight), in an attempt to estimate the daily protein needs. The cohort consisted of 10 patients, 6 females, with average age of 58(23) years old, a mean of BSA of 21.4(8.4)%, ranging from a minimum of 10.0% and máximum of 35.0%. On average, patients were 58 (23) years old. The average number of days of hospitalization in the burn unit was 64.8(36.5) days. We observed significant differences between the 3 methods used for calculating the NB (p = 0.004), on average the NB was positive. When the formula A was used the average value of NB was higher. Regarding the attempt to estimate the needs of g prot/kg Rweight/day most of the values did not exceed, on average, 2.6 g Prot/kg Rweight/day and no significant differences between patients with a BSA% of 10-20% and with BSA% > 20% were found. Despite being able to estimate the protein catabolism through these formulas and verifying that most values were above zero

  1. [patient Profile And Nursing Workload At The Nephrology Unit].

    OpenAIRE

    Trepichio,Priscilla Branco; Guirardello,Edinêis de Brito; Duran,Erika Christiane Marocco; de Brito, Ana Paula

    2015-01-01

    Chronic kidney failure (CKF), which is frequently silent, can lead to considerable changes in the lives of patients. Depending on the stage, hospitalization and hours of nursing care are required to ensure medical and surgical treatment. The aim of this descriptive and quantitative study is to measure nursing workload at a nephrology unit based on daily application of the Nursing Activities Score (NAS) for 47 consecutive days. Patients were mostly young male adults in the chronic stage of the...

  2. Validation and Evaluation of Two Observational Pain Assessment Tools in a Trauma and Neurosurgical Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Jane Topolovec-Vranic

    2013-01-01

    Full Text Available BACKGROUND: Studies have demonstrated that patients in the intensive care unit experience high levels of pain. While many of these patients are nonverbal at some point during their stay, there are few valid tools available to assess pain in this group.

  3. National Assessment of Oil and Gas Project - East Coast Mesozoic Basins of the Piedmont, Blue Ridge Thrust Belt, Atlantic Coastal Plain, and New England Provinces Assessment Units

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — The Assessment Unit is the fundamental unit used in the National Assessment Project for the assessment of undiscovered oil and gas resources. The Assessment Unit is...

  4. National Assessment of Oil and Gas in Jurassis-Cretaceous Strata Gulf Coast, 2010 (Provinces 047, 048 and 049) Assessment Units

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — The Assessment Unit is the fundamental unit used in the National Assessment Project for the assessment of undiscovered oil and gas resources. The Assessment Unit is...

  5. National Assessment of Oil and Gas - Paleogene System and Cretaceous-Tertiary Coalbed Assessment Units of the Gulf Coast (Provinces 047, 048 and 049)

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — The Assessment Unit is the fundamental unit used in the National Assessment Project for the assessment of undiscovered oil and gas resources. The Assessment Unit is...

  6. Patient safety culture at neonatal intensive care units: perspectives of the nursing and medical team

    Directory of Open Access Journals (Sweden)

    Andréia Tomazoni

    2014-10-01

    Full Text Available OBJECTIVE: to verify the assessment of the patient safety culture according to the function and length of experience of the nursing and medical teams at Neonatal Intensive Care Units.METHOD: quantitative survey undertaken at four Neonatal Intensive Care Units in Florianópolis, Brazil. The sample totaled 141 subjects. The data were collected between February and April 2013 through the application of the Hospital Survey on Patient Safety Culture. For analysis, the Kruskal-Wallis and Chi-Square tests and Cronbach's Alpha coefficient were used. Approval for the research project was obtained from the Ethics Committee, CAAE: 05274612.7.0000.0121.RESULTS: differences in the number of positive answers to the Hospital Survey on Patient Safety Culture, the safety grade and the number of reported events were found according to the professional characteristics. A significant association was found between a shorter Length of work at the hospital and Length of work at the unit and a larger number of positive answers; longer length of experience in the profession represented higher grades and less reported events. The physicians and nursing technicians assessed the patient safety culture more positively. Cronbach's alpha demonstrated the reliability of the instrument.CONCLUSION: the differences found reveal a possible relation between the assessment of the safety culture and the subjects' professional characteristics at the Neonatal Intensive Care Units.

  7. [Pathway of a patient within a healthcare unit].

    Science.gov (United States)

    Haegeman, Nicolas; Béziat, Olivier; Cavero, Laure; Biau, Audrey

    2016-01-01

    Care in prison must be based as much as possible on the model used for the general population. The system of psychiatric care in prisons comprises three levels of provision. The presentation of the pathway of a young patient with severe mental disorders shows the possibilities and the difficulties involved in caring within a healthcare unit.

  8. Intensive care unit research ethics and trials on unconscious patients.

    Science.gov (United States)

    Gillett, G R

    2015-05-01

    There are widely acknowledged ethical issues in enrolling unconscious patients in research trials, particularly in intensive care unit (ICU) settings. An analysis of those issues shows that, by and large, patients are better served in units where research is actively taking place for several reasons: i) they do not fall prey to therapeutic prejudices without clear evidential support, ii) they get a chance of accessing new and potentially beneficial treatments, iii) a climate of careful monitoring of patients and their clinical progress is necessary for good clinical research and affects the care of all patients and iv) even those not in the treatment arm of a trial of a new intervention must receive best current standard care (according to international evidence-based treatment guidelines). Given that we have discovered a number of 'best practice' regimens of care that do not optimise outcomes in ICU settings, it is of great benefit to all patients (including those participating in research) that we are constantly updating and evaluating what we do. Therefore, the practice of ICU-based clinical research on patients, many of whom cannot give prospective informed consent, ticks all the ethical boxes and ought to be encouraged in our health system. It is very important that the evaluation of protocols for ICU research should not overlook obvious (albeit probabilistic) benefits to patients and the acceptability of responsible clinicians entering patients into well-designed trials, even though the ICU setting does not and cannot conform to typical informed consent procedures and requirements.

  9. Morbidity and mortality predictivity of nutritional assessment tools in the postoperative care unit.

    Science.gov (United States)

    Özbilgin, Şule; Hanc, Volkan; Ömür, Dilek; Özbilgin, Mücahit; Tosun, Mine; Yurtlu, Serhan; Küçükgüçlü, Semih; Arkan, Atalay

    2016-10-01

    The aim was to evaluate the nutritional situation of patients admitted to the Postoperative Acute Care Unit using classic methods of objective anthropometry, systemic evaluation methods, and Nutrition Risk in Critically Ill (NUTRIC) score, and to compare them as a predictor of morbidity and mortality.At admission to the postoperative care unit, patients undergoing various surgeries were assessed for the following items: Subjective Global Assessment (SGA), Nutritional Risk Index (NRI), Nutritional Risk Screening (NRS)-2002, Mini Nutritional Assessment (MNA), Charlson comorbidity index (CCI), and NUTRIC score, anthropometric measurements, serum total protein, serum albumin, and lymphocyte count. Patients were monitored for postoperative complications until death or discharge. Correlation of complications with these parameters was also analyzed.A total of 152 patients were included in the study. In this study a positive correlation was determined between mortality and NRS-2002, SGA, CCI, Acute Physiology and Chronic Health Evaluation , Sepsis-related Organ Failure Assessment, and NUTRIC score, whereas a negative correlation was determined between mortality and NRI. There was a correlation between NUTRIC score and pneumonia, development of atrial fibrillation, delirium, renal failure, inotrope use, and duration of mechanical ventilation. In our study group of postoperative patients, MNA had no predictive properties for any complication, whereas SGA had no predictive properties for any complications other than duration of hospital stay and mortality.The NUTRIC score is an important indicator of mortality and morbidity in postoperative surgical patients. NRI correlated with many postoperative complications, and though SGA and NRS were correlated with mortality, they were not correlated with the majority of complications. MNA was determined not to have any correlation with any complication, mortality, and duration of hospital stay in our patient group.

  10. Patient safety culture: the nursing unit leader's role.

    Science.gov (United States)

    Sammer, Christine Elizabeth; James, Barbara R

    2011-09-30

    Discussions about a culture of patient safety abound, yet nurse leaders continue to struggle to achieve such a culture in today's complex and fast-paced healthcare environment. In this article the authors discuss the concept of a patient safety culture, present a fictional scenario describing what happened in a hospital that lacked a culture of patient safety, and explain what should have happened in the above scenario. This discussion is offered within a framework consisting of seven driving factors of patient safety. These factors include leadership, evidence-based practice, teamwork, communication, and a learning, just, and patient-centered culture. Throughout, an emphasis is placed on leadership at the unit level. Nurse managers will find practical examples illustrating how leaders can help their teams establish a culture that offers the patient quality care in a safe environment.

  11. Patient access to medical records on a psychiatric inpatient unit.

    Science.gov (United States)

    Stein, E J; Furedy, R L; Simonton, M J; Neuffer, C H

    1979-03-01

    The authors studied the effects of patient access to medical records during hospitalization in a psychiatric unit of a community general hospital. Questionnaires were completed by about 20 staff and 88 patients, and records were compared with those from an earlier period to note any changes in the written record. Patients reported feeling better informed and more involved in their treatment, and staff said that they became more thoughtful about their notes in the chart. The availability of staff seems crucial to this process and facilitates the working alliance.

  12. [Approach to the patient in the ambulatory surgery unit].

    Science.gov (United States)

    Cordero-Ponce, Montserrat; Romero-Sánchez, Isabel María; López-Barea, José; Martínez-Ramos, Pablo

    2008-01-01

    Ambulatory surgery aims to improve the quality of care, provide services in an environment closer to users' normal surroundings, reduce the risk of nosocomial infection and release hospital beds for other uses demanded by the population, thus reducing health costs. Nursing activity in these units should aim to restore health and aid the rapid recovery of patients in their homes. To achieve this, an effective health education program is required. Such programs should be simple and, at the same time, cover the care that these patients will require during the recovery period at home. The unit covers patients in the Virgen de Rocío University Hospital, The Fleming Peripheral Center for Specialties and the Virgen de los Reyes Peripheral Center for Specialties in Seville, Spain and the the specialties included are plastic surgery, otorhinolaryngology, orthopedic surgery, urology, and general surgery. The duration of the education program will be at most 14-17 h.

  13. Assessing climate-sensitive ecosystems in the southeastern United States

    Science.gov (United States)

    Costanza, Jennifer; Beck, Scott; Pyne, Milo; Terando, Adam; Rubino, Matthew J.; White, Rickie; Collazo, Jaime

    2016-08-11

    Climate change impacts ecosystems in many ways, from effects on species to phenology to wildfire dynamics. Assessing the potential vulnerability of ecosystems to future changes in climate is an important first step in prioritizing and planning for conservation. Although assessments of climate change vulnerability commonly are done for species, fewer have been done for ecosystems. To aid regional conservation planning efforts, we assessed climate change vulnerability for ecosystems in the Southeastern United States and Caribbean.First, we solicited input from experts to create a list of candidate ecosystems for assessment. From that list, 12 ecosystems were selected for a vulnerability assessment that was based on a synthesis of available geographic information system (GIS) data and literature related to 3 components of vulnerability—sensitivity, exposure, and adaptive capacity. This literature and data synthesis comprised “Phase I” of the assessment. Sensitivity is the degree to which the species or processes in the ecosystem are affected by climate. Exposure is the likely future change in important climate and sea level variables. Adaptive capacity is the degree to which ecosystems can adjust to changing conditions. Where available, GIS data relevant to each of these components were used. For example, we summarized observed and projected climate, protected areas existing in 2011, projected sea-level rise, and projected urbanization across each ecosystem’s distribution. These summaries were supplemented with information in the literature, and a short narrative assessment was compiled for each ecosystem. We also summarized all information into a qualitative vulnerability rating for each ecosystem.Next, for 2 of the 12 ecosystems (East Gulf Coastal Plain Near-Coast Pine Flatwoods and Nashville Basin Limestone Glade and Woodland), the NatureServe Habitat Climate Change Vulnerability Index (HCCVI) framework was used as an alternative approach for assessing

  14. OBSTETRIC PATIENTS IN MULTIDISIPLINARY INTENSIVE CARE UNIT: RETROSPECTIVE ANALYSIS

    Directory of Open Access Journals (Sweden)

    Semih ARICI

    2014-03-01

    The aim of this study is to retrospectively evaluate the obstetric cases who referred to intensive care unit, and define the frequency, cause and clinic outcomes of the patients. Demographic data, causes of reference, interventions in the intensive care and the outcomes of 15 obstetric cases in the pregnancy and postpartum period, whose referred to Gaziosmanpasa University Hospital Intensive Care Unit between 2007 and 2013 were included and retrospectively evaluated. The frequency of patients who referred from another center to our intensive care unit was 10 (%66.6. The mean age of the patients was 28.80 +/- 5.74. The mean hospital stay time was 3.20 +/- 2.51. The most cause to refer into intensive care unit was postpartum hemorrhage. One of the cases was resulted in death. The mortality ratio was found as %6.7. In conclusion, the frequent cause of intensive care requirement of the obstetric cases were obstetric bleeding and uncontrolled hypertension. The maternal morbidity and mortality will be substantially decreased with advanced treatment modalities and maternal care before pregnancy. [J Contemp Med 2014; 4(1.000: 14-17

  15. The impact of a surgical assessment unit on numbers of general surgery outliers.

    Science.gov (United States)

    Jacobson, Alexandra; Poole, Garth; Hill, Andrew G; Biggar, Magdalena

    2016-12-02

    Patient care and efficiency outcomes are improved if acute patients admitted to non-specialty (outlier) wards are minimised.1 Assessment units may help to reduce numbers of outlier patients.2 A surgical assessment unit (SAU) was recently established at Middlemore Hospital. We aimed to determine the impact of its introduction on numbers of general surgery outliers on post-acute ward rounds. A 10-bed SAU was introduced in July 2015, coinciding with the closure of 20 beds on the general surgical wards. The numbers and locations of patients on post-acute ward rounds before and after the establishment of the SAU were compared. A student two-tailed t-test was used for statistical comparisons, with poutlier wards after the introduction of the SAU (mean 1.7 before vs 0.8 after, p=0.04). Despite a net reduction in general surgery beds and no change in the overall number of post-acute patients, the establishment of a SAU was associated with a reduction in outliers.

  16. Patient-generated subjective global assessment

    NARCIS (Netherlands)

    Dr Harriët Jager-Wittenaar; Martine J. Sealy; Suzanne Kasenic; Elizabeth Isenring; Faith D. Ottery; Susan P. DeBolt

    2015-01-01

    Purpose: The Patient-Generated Subjective Global Assessment (PG-SGA), including the PG-SGA Short Form (SF, aka ‘abridged’), was originally developed in the mid 1990’s as a scored, patient self-report, paperbased instrument and has been widely validated. The PG-SGA (SF) has been used for screening,

  17. Psychological assessment of patients with Meniere's disease

    NARCIS (Netherlands)

    van Cruijsen, N.; Jaspers, J. P. C.; van de Wiel, H. B. M.; Wit, H. P.; Albers, F. W. J.

    2006-01-01

    The objective of this study was to evaluate daily stressors, coping, personality, physical and mental health, and quality of life in Meniere patients. 110 consecutive patients with definite Meniere's disease were assessed using the Dutch Daily Hassles List, Coping Inventory for Stressful Situations

  18. Patient-generated subjective global assessment

    NARCIS (Netherlands)

    Dr Harriët Jager-Wittenaar; Martine J. Sealy; Suzanne Kasenic; Elizabeth Isenring; Faith D. Ottery; Susan P. DeBolt

    2015-01-01

    Purpose: The Patient-Generated Subjective Global Assessment (PG-SGA), including the PG-SGA Short Form (SF, aka ‘abridged’), was originally developed in the mid 1990’s as a scored, patient self-report, paperbased instrument and has been widely validated. The PG-SGA (SF) has been used for screening, a

  19. [Assessing motivation to smoking cessation in hospitalized patients].

    Science.gov (United States)

    Sepúlveda-Sánchez, Juana María; Canca-Sánchez, José Carlos; Rivas-Ruiz, Francisco; Martín-García, Mónica; Lorente Márquez, Celia; Timonet-Andreu, Eva María

    2017-01-07

    To assess motivation to quit smoking in patients admitted to an acute care hospital, determine predictors of readiness to change, and identify a risk group that requires targeted motivational interviewing. A cross-sectional descriptive study. A retrospective study was performed on the medical records of 248 patients aged >18 years with smoking habits admitted to the medical and surgery units of a district hospital between May 2014 and April 2015. The data collected included sociodemographic data, data on respiratory function, number of cigarettes smoked per day, motivation to quit smoking, patient-reported readiness to quit, history of respiratory diseases and previous admissions. The Richmond test revealed that 54% of patients (n=134) were poorly motivated to quit smoking vs. 11.74% (n=29) who reported to be highly motivated. The group of patients who reported to be willing to receive support (n=77) was prevailingly composed of men (p=.009) admitted to a medical care unit (p=.026) -mainly the Unit of Cardiology (51%)- who smoked 11/29 cigarettes/day (p=.015). Dyspnoea at admission, a history of respiratory disease and previous admissions for respiratory problems were not predictors of readiness to quit. This study identifies a risk group of patients with respiratory disease, low motivation to quit smoking and poor readiness to receive smoke cessation support, that should be the target of motivational approaches to behavior change. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

  20. Evaluating the quality of patient leaflets about renal replacement therapy across UK renal units.

    Science.gov (United States)

    Winterbottom, Anna; Conner, Mark; Mooney, Andrew; Bekker, Hilary L

    2007-08-01

    Enhancing patient participation is a priority for renal services. Good quality information is fundamental to facilitate patient involvement, but in other health contexts it has been found to be sub-optimal. This research aims to audit the provision of patient information by renal units and charities and to assess the quality of written information about dialysis treatment options. All UK renal units were sent a questionnaire about the patient information they provided. Renal units and charities that provided dialysis leaflets were asked to forward copies. Leaflet quality and content were assessed by a coding frame informed by information and decision aid checklists. Out of 105, 67 completed questionnaires were returned. Services provide patients with large amounts of information in several media (leaflets, meetings with nurses and patients, videos); computers were not used frequently. Out of 47, 32 units forwarded leaflets about dialysis, and 31 different leaflets. Most leaflets were difficult to understand and rarely included risk information or treatment limitations. No leaflets included techniques to assist patient involvement or decision-making; their primary goal was to inform. These data suggest an unsystematic pattern of information provision across the UK. Vast resources have been spent on providing information to patients that is difficult to comprehend and incomplete. Research needs to identify which resources are effective in meeting patient needs and at what point in their illness. A centralized system to guide renal services in the design and development of information resources may help meet the differing goals of education, choice facilitation and preparation for self-management.

  1. Mobility decline in patients hospitalized in an intensive care unit

    Science.gov (United States)

    de Jesus, Fábio Santos; Paim, Daniel de Macedo; Brito, Juliana de Oliveira; Barros, Idiel de Araujo; Nogueira, Thiago Barbosa; Martinez, Bruno Prata; Pires, Thiago Queiroz

    2016-01-01

    Objective To evaluate the variation in mobility during hospitalization in an intensive care unit and its association with hospital mortality. Methods This prospective study was conducted in an intensive care unit. The inclusion criteria included patients admitted with an independence score of ≥ 4 for both bed-chair transfer and locomotion, with the score based on the Functional Independence Measure. Patients with cardiac arrest and/or those who died during hospitalization were excluded. To measure the loss of mobility, the value obtained at discharge was calculated and subtracted from the value obtained on admission, which was then divided by the admission score and recorded as a percentage. Results The comparison of these two variables indicated that the loss of mobility during hospitalization was 14.3% (p < 0.001). Loss of mobility was greater in patients hospitalized for more than 48 hours in the intensive care unit (p < 0.02) and in patients who used vasopressor drugs (p = 0.041). However, the comparison between subjects aged 60 years or older and those younger than 60 years indicated no significant differences in the loss of mobility (p = 0.332), reason for hospitalization (p = 0.265), SAPS 3 score (p = 0.224), use of mechanical ventilation (p = 0.117), or hospital mortality (p = 0.063). Conclusion There was loss of mobility during hospitalization in the intensive care unit. This loss was greater in patients who were hospitalized for more than 48 hours and in those who used vasopressors; however, the causal and prognostic factors associated with this decline need to be elucidated. PMID:27410406

  2. Primary immunodeficiency investigation in patients during and after hospitalization in a pediatric Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Erica Suavinho

    2014-03-01

    Full Text Available Objective: To analyze whether the patients with severe infections, admitted in the Pediatric Intensive Care Unit of the Hospital de Clínicas of the Universidade Federal de Uberlândia, underwent the active screening for primary immunodeficiencies (PID. Methods: Retrospective study that assessed the data records of patients with any severe infections admitted in the Pediatric Intensive Care Unit, covering a period from January 2011 to January 2012, in order to confirm if they performed an initial investigation for PID with blood count and immunoglobulin dosage. Results: In the studied period, 53 children were hospitalized with severe infections in the Pediatric Intensive Care Unit, and only in seven (13.2% the initial investigation of PID was performed. Among these patients, 3/7 (42.8% showed quantitative alterations in immunoglobulin G (IgG levels, 1/7 (14.3% had the diagnosis of cyclic neutropenia, and 1/7 (14.3% presented thrombocytopenia and a final diagnosis of Wiskott-Aldrich syndrome. Therefore, the PID diagnosis was confirmed in 5/7 (71.4% of the patients. Conclusions: The investigation of PID in patients with severe infections has not been routinely performed in the Pediatric Intensive Care Unit. Our findings suggest the necessity of performing PID investigation in this group of patients.

  3. Readability assessment of online urology patient education materials.

    Science.gov (United States)

    Colaco, Marc; Svider, Peter F; Agarwal, Nitin; Eloy, Jean Anderson; Jackson, Imani M

    2013-03-01

    The National Institutes of Health, American Medical Association, and United States Department of Health and Human Services recommend that patient education materials be written at a fourth to sixth grade reading level to facilitate comprehension. We examined and compared the readability and difficulty of online patient education materials from the American Urological Association and academic urology departments in the Northeastern United States. We assessed the online patient education materials for difficulty level with 10 commonly used readability assessment tools, including the Flesch Reading Ease Score, Flesch-Kincaid Grade Level, Simple Measure of Gobbledygook, Gunning Frequency of Gobbledygook, New Dale-Chall Test, Coleman-Liau index, New Fog Count, Raygor Readability Estimate, FORCAST test and Fry score. Most patient education materials on the websites of these programs were written at or above the eleventh grade reading level. Urological online patient education materials are written above the recommended reading level. They may need to be simplified to facilitate better patient understanding of urological topics. Copyright © 2013 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  4. Using the braden and glasgow scales to predict pressure ulcer risk in patients hospitalized at intensive care units

    OpenAIRE

    Luciana Magnani Fernandes; Maria Helena Larcher Caliri

    2008-01-01

    Pressure ulcers remain a major health issue for critical patients. The purpose of this descriptive and exploratory study was to analyze the risk factors for the development of pressure ulcers in patients hospitalized at an intensive care unit of a university hospital. Patients were assessed through the Braden scale to determine the risk for the development of pressure ulcers and to identify individual risks, and the Glasgow scale was used to assess their consciousness. It was found that the r...

  5. Eye injury treatment in intensive care unit patients

    Directory of Open Access Journals (Sweden)

    L. K. Moshetova

    2015-01-01

    Full Text Available Aim. To describe eye injuries in intensive care unit (ICU patients with multitrauma, to study conjunctival microflora in these patients, and to develop etiologically and pathogenically targeted treatment and prevention of wound complications.Materials and methods. Study group included 50 patients (54 eyes with combined mechanical cerebral and eye injury. All patients underwent possible ophthalmological examination (biomicroscopy, ophthalmoscopy and ocular fundus photographing with portative fundus camera, tonometry, cranial CT and MRT, and bacteriological study of conjunctival smears. Results. Modern methods of ophthalmological examination of ICU patients provided correct diagnosis and prediction of wound healing. Eye injury treatment schedule provided maximum possible results in all ICU patients. Hospitalacquired infection results in asymptomatic dissemination of pathogenic microbes on ocular surface. Conclusions. 14-day topical treatment with antimicrobials, steroids, and NSAIDs reduces posttraumatic inflammation caused by mechanical eye injuries in ICU patients. Bacteriological studies of conjunctival smears demonstrate the presence of pathogenic flora in ICU patients. In these patients, the most effective antibacterial agents are third-generation fluoroquinolones. 

  6. Eye injury treatment in intensive care unit patients

    Directory of Open Access Journals (Sweden)

    L. K. Moshetova

    2015-03-01

    Full Text Available Aim. To describe eye injuries in intensive care unit (ICU patients with multitrauma, to study conjunctival microflora in these patients, and to develop etiologically and pathogenically targeted treatment and prevention of wound complications.Materials and methods. Study group included 50 patients (54 eyes with combined mechanical cerebral and eye injury. All patients underwent possible ophthalmological examination (biomicroscopy, ophthalmoscopy and ocular fundus photographing with portative fundus camera, tonometry, cranial CT and MRT, and bacteriological study of conjunctival smears. Results. Modern methods of ophthalmological examination of ICU patients provided correct diagnosis and prediction of wound healing. Eye injury treatment schedule provided maximum possible results in all ICU patients. Hospitalacquired infection results in asymptomatic dissemination of pathogenic microbes on ocular surface. Conclusions. 14-day topical treatment with antimicrobials, steroids, and NSAIDs reduces posttraumatic inflammation caused by mechanical eye injuries in ICU patients. Bacteriological studies of conjunctival smears demonstrate the presence of pathogenic flora in ICU patients. In these patients, the most effective antibacterial agents are third-generation fluoroquinolones. 

  7. [Perception of night-time sleep by the surgical patients in an intensive care unit].

    Science.gov (United States)

    Nicolás, A; Aizpitarte, E; Iruarrizaga, A; Vázquez, M; Margall, M A; Asiain, M C

    2002-01-01

    Night-time rest of the patients hospitalized in Intensive Care is a very important feature within the health/disease process since it has a direct repercussion on their adequate recovery. The objectives of this investigation are: 1) describe how the surgical patients perceive their night-time sleep in the Polyvalent Intensive Care Unit: 2) compare the subjective perception of the patients with the nursing record in the care plan and analyze the degree of agreement between both assessments. Night-time sleep has been studied in 104 patients; surgery patients from emergencies, patients who are intubated, with previous psychiatric treatment, sleep apnea, drinking habit or impossibility of adequate communication were not included. To measure the patient's perception, the five item sleep questionnaire of Richards-Campbell and the assessment of sleep by the nurse, as well as the remaining variables included in a computerized care plan, were used. The total mean score of the sleep on the first post-operative night was 51.42 mm. When the scores obtained in each one of the questionnaire items are analyzed, it is seen that the sleep profile of these patients has been characterized by being light sleep, with frequent wakenings and generally with little difficulty to go back to sleep when woke op or were awakened. The assessment of the night-time sleep performed by the nurse coincides with the perception of the patients on many occasions, and when there is discrepancy, the nurse has overestimated the patient's sleep.

  8. Exposure assessment of electromagnetic fields near electrosurgical units.

    Science.gov (United States)

    Wilén, Jonna

    2010-10-01

    Electrosurgical units (ESU) are widely used in medical health services. By applying sinusoidal or pulsed voltage in the frequency range of 0.3-5 MHz to the electrode tip, the desired mixture of coagulation and cutting are achieved. Due to the high voltage and current in the cable, strong electromagnetic fields appear near the ESU. The surgeon and others inside the operating room such as nurses, anesthesiologists, etc., will be highly exposed to these fields. The stray fields surrounding the ESU have previously been measured, but now a deeper analysis has been made of the curve shape of the field and the implication of this when assessing exposure from a commonly used ESU in accordance with the International Commission on Non-Ionizing Radiation Protection (ICNIRP) guidelines. The result showed that for some of the modes, especially those using high-pulsed voltage with only a few sinusoidal periods, the E-field close to the cable could reach linear spatially averaged values of 20 kV/m compared to the 2.1 kV/m stated in ICNIRP guidelines. Assessing the E- and B-field from ESU is not straightforward since in this frequency range, both induced current density and specific absorption rate are restricted by the ICNIRP guidelines. Nevertheless, work needs to be done to reduce the stray fields from ESU.

  9. [Patient profile and nursing workload at the nephrology unit].

    Science.gov (United States)

    Trepichio, Priscilla Branco; Guirardello, Edinêis de Brito; Duran, Erika Christiane Marocco; de Brito, Ana Paula

    2013-06-01

    Chronic kidney failure (CKF), which is frequently silent, can lead to considerable changes in the lives of patients. Depending on the stage, hospitalization and hours of nursing care are required to ensure medical and surgical treatment. The aim of this descriptive and quantitative study is to measure nursing workload at a nephrology unit based on daily application of the Nursing Activities Score (NAS) for 47 consecutive days. Patients were mostly young male adults in the chronic stage of the disease or admitted for kidney transplant. A total of 833 observations were obtained from 62 patients. The resulting NAS workload upon admission was 52%, corresponding to 12.5 hours of care per patient for 24 hours, which is similar to the workload found in intensive care units. This profile allows calculation of nursing work hours required for each patient and is a valuable tool for nursing managers when determining the number of staff members required to ensure assistance. Other studies should be conducted for clinical validation.

  10. METHODOLOGICAL APPROACHES TO ASSESSING THE EFFICIENCY OF THE INTEGRATION UNITS

    Directory of Open Access Journals (Sweden)

    I. P. Bogomolova

    2014-01-01

    Full Text Available The article examines the scientific and methodological apparatus assessment, built on the basis of the categories of «effectiveness» and «optimality», will allow, on the one hand, to establish the efficiency of functioning of associations in prior periods, on the other - to identify the parameters conditioning condition and results of integrated production in the future. Taking into account the results of these studies, we developed a methodology of integrated assessment of efficiency of functioning of the agro-industrial units. Its essence consists in the determination of the integral coefficient of efficiency on the basis of two complementary groups of settings: performance, expressed in the system of relative indicators, and optimality, the quantitative characteristics of which used the limit values. As the distinctive features of the proposed methodology, determining its scientific novelty and practical significance, it should be noted: enabling the assessment of the effectiveness in using existing and advanced involved in production resources; the use of a unified system of criteria and performance measures and to determine the level of optimality of meat production, built in accordance with the sequence of stages of the reproduction process; universality settlement mechanism, used for the analysis of efficiency of managing the links of the production chain (agriculture, processing, trade and overall integration. The technique involves the execution of the aggregate calculation and analytical operations, grouped by us in the framework of interrelated stages. The result can be identified priority directions of development of the Association, the necessity to optimize the composition of participants and proportions of the process chain, development and implementation of innovative programs, development of new technologies and management methods.

  11. TEAR SUBSTITUTES PREVENT OPHTHALMIC COMPLICATIONS IN INTENSIVE CARE UNIT PATIENTS

    Directory of Open Access Journals (Sweden)

    S. A. Kochergin

    2015-01-01

    Full Text Available Aim. To study the effects of Cationorm for the prevention of ophthalmic complications in intensive care unit (ICU patients and to compare the efficacy of ocular surface lubricants used in ICU. Patients and methods. 50 ICU patients (100 eyes with bilateral lagophthalmos (2 mm or more were enrolled in the study. Study group and control group each included 25 patients (50 eyes who were on deep sedation and ventilator. Before and after the treatment, general examination, biomicroscopy, tonometry, ophthalmoscopy, Schirmer’s test and Norn’s test (with fluorescein were performed. Results. Cationorm significantly improves tear film stability without any corneal epithelial defects (100 % of patients. In 7 controls (14 eyes, 28 %, initial signs of corneal xerosis and exposure keratitis were revealed. Conclusions. ICU patients are at high risk of complications due to hypodynamia and reduced innervation of the eye and its appendages. Bilateral lagophthalmos develops in 16.67 % of ICU patients who are on deep sedation and ventilator (up to 3 days. In the abscence of preventive therapy, lagophthalmos results in complications, i.e., keratitis and, occasionally, corneal ulceration and perforation. ICU patients require ophthalmological examination and tear substitutes. Regular instillations of Cationorm minimize ophthalmic complications due to intensive therapy. Cationorm restores tear firm architectonics and may be considered as a first-line choice for such disorders. 

  12. 42 CFR 494.80 - Condition: Patient assessment.

    Science.gov (United States)

    2010-10-01

    ... Patient Care § 494.80 Condition: Patient assessment. The facility's interdisciplinary team consists of, at... care. (a) Standard: Assessment criteria. The patient's comprehensive assessment must include, but is... maintenance (for example, arteriovenous fistulas, arteriovenous grafts, and peritoneal catheters)....

  13. Characteristics and mortality of elderly patients admitted to the Intensive Care Unit of a district hospital

    Directory of Open Access Journals (Sweden)

    José Carlos Llamas Reyes

    2016-01-01

    Full Text Available Aim: To study all the elderly patients (≥75 years who were admitted in an Intensive Care Unit (ICU of a Spanish hospital and identify factors associated with mortality. Patients and Methods: A retrospective, observational data collected prospectively in patients ≥75 years recruited from the ICU in the period of January 2004 to December 2010. Results: During the study period, 1661 patients were admitted to our unit, of whom 553 (33.3% were older than 75 years. The mean age was 79.9 years, 317 (57.3% were male, and the overall in-hospital mortality was 94 patients (17% confidence interval 14-20.3%. When comparing patients who survived to those who died, we found significant differences in mean age (P = 0.001, Acute Physiologic Assessment and Chronic Health Evaluation II and Simplified Acute Physiology Scoring II (SAPS II on admission (P 75 years was not significant (P = 0.1390. Conclusions: The percentage of elderly patients in our unit is high, with low mortality rates. The age itself is not the sole determinant for admission to the ICU and other factors should be taken into account.

  14. National Water-Quality Assessment (NAWQA) Study-Unit Investigations in the conterminous United States 2001-2012

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This is a coverage of the boundaries and codes used for the U.S. Geological Survey's National Water-Quality Assessment (NAWQA) Program Study-Unit investigations in...

  15. National Water-Quality Assessment (NAWQA) Study-Unit Investigations in the conterminous United States 1991-2001

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This is a coverage of the boundaries and codes used for the U.S. Geological Survey's National Water-Quality Assessment (NAWQA) Program Study-Unit investigations in...

  16. Quadrennial review of a paediatric emergency assessment unit.

    Science.gov (United States)

    Aitken, Penny; Birch, Simon; Cogman, Genevieve; Glasper, Edward A; Wiltshire, Maureen

    The primary aim of this article is to report on one aspect of a quadrennial study designed to explore the appropriateness and impact of the development of a paediatric emergency assessment unit (PEAU) as a response to increases in paediatric emergencies presenting to a south-western regional child health unit. In particular, this article will present the findings of a prospective audit of admissions to the PEAU over a 1-month period during the latter part of 2002. The primary method of data collection utilized a structured survey instrument developed using a design and automatic data computer software package, completed by the nursing staff. Anonymized descriptive data were obtained from 223 children admitted to the PEAU during one calendar moth and authorized by the appropriate clinical directorate audit committee as part of its ongoing commitment to the full implementation of clinical governance. The data presented primarily relate to children admitted during the official opening times of the PEAU, and those presenting out of hours. The data analysis demonstrates a reduction in the number of children staying overnight in hospital since the opening of the PEAU, with the majority of children being referred by their own family doctor. Only one child in the sample was readmitted to the PEAU within 24 hours, and two within 24 hours of discharge as inpatients. Although thought to be pertinent, only one child admitted after official closing of the PEAU and out of hours was described as being admitted for social reasons. The International Classification of Diagnosis (ICD) 10 (World Health Organization (WHO), 1994) classifications of the children admitted to the PEAU reflect those found in other similar studies. Overall, the results of this investigation demonstrate that a PEAU can offer an efficient service to GPs, families and others as a route of referral, thus mitigating unnecessary overnight stays for individual children.

  17. Assessing Interprofessional Teamwork in Inpatient Medical Oncology Units.

    Science.gov (United States)

    Weaver, A Charlotta; Callaghan, Mary; Cooper, Abby L; Brandman, James; O'Leary, Kevin J

    2015-01-01

    Teamwork is important to providing safe and effective care for hospitalized patients with cancer; however, few studies have evaluated teamwork in this setting. We surveyed all nurses, residents, hospitalists, and oncology physicians in oncology units at a large urban teaching hospital from September to November 2012. Respondents rated teamwork using a validated instrument (Safety Attitudes Questionnaire; scale, 0 to 100) and rated the quality of collaboration they had experienced with other professionals using a 5-point ordinal response scale (1, very low quality; 5, very high quality). Respondents also rated potential barriers to collaboration using a 4-point ordinal response scale (1, not at all a barrier; 4, major barrier). We compared ratings by professionals using analysis of variance (ANOVA). Overall, 129 (67%) of 193 eligible participants completed the survey. Teamwork scores differed across professional types, with nurses providing the lowest ratings (69.7) and residents providing the highest (81.9; ANOVA P = .01). Ratings of collaboration with nurses were high across all types of professionals. Ratings of collaboration with physicians varied significantly by professional type (P ≤ .02), with nurses giving lower ratings of collaboration with all physician types. Similarly, perceived barriers to collaboration differed by professional type, with nurses perceiving the biggest barrier to be negative attitudes regarding the importance of communication. Oncologists did not perceive any of the listed options as major barriers to collaboration. In inpatient oncology units, discrepancies exist between nurses' and physicians' ratings of teamwork and collaboration. Oncologists seem to be unaware that teamwork is suboptimal in this setting. Copyright © 2015 by American Society of Clinical Oncology.

  18. Mortality among Patients Admitted to Strained Intensive Care Units

    Science.gov (United States)

    Gabler, Nicole B.; Ratcliffe, Sarah J.; Wagner, Jason; Asch, David A.; Rubenfeld, Gordon D.; Angus, Derek C.

    2013-01-01

    Rationale: The aging population may strain intensive care unit (ICU) capacity and adversely affect patient outcomes. Existing fluctuations in demand for ICU care offer an opportunity to explore such relationships. Objectives: To determine whether transient increases in ICU strain influence patient mortality, and to identify characteristics of ICUs that are resilient to surges in capacity strain. Methods: Retrospective cohort study of 264,401 patients admitted to 155 U.S. ICUs from 2001 to 2008. We used logistic regression to examine relationships of measures of ICU strain (census, average acuity, and proportion of new admissions) near the time of ICU admission with mortality. Measurements and Main Results: A total of 36,465 (14%) patients died in the hospital. ICU census on the day of a patient’s admission was associated with increased mortality (odds ratio [OR], 1.02 per standardized unit increase; 95% confidence interval [CI]: 1.00, 1.03). This effect was greater among ICUs employing closed (OR, 1.07; 95% CI: 1.02, 1.12) versus open (OR, 1.01; 95% CI: 0.99, 1.03) physician staffing models (interaction P value = 0.02). The relationship between census and mortality was stronger when the census was composed of higher acuity patients (interaction P value < 0.01). Averaging strain over the first 3 days of patients’ ICU stays yielded similar results except that the proportion of new admissions was now also associated with mortality (OR, 1.04 for each 10% increase; 95% CI: 1.02, 1.06). Conclusions: Several sources of ICU strain are associated with small but potentially important increases in patient mortality, particularly in ICUs employing closed staffing models. Although closed ICUs may promote favorable outcomes under static conditions, they are susceptible to being overwhelmed by patient influxes. PMID:23992449

  19. Patient satisfaction with nursing staff in bone marrow transplantation and hematology units.

    Science.gov (United States)

    Piras, A; Poddigue, M; Angelucci, E

    2010-01-01

    Several validated questionnaires for assessment of hospitalized patient satisfaction have been reported in the literature. Many have been designed specifically for patients with cancer. User satisfaction is one indicator of service quality and benefits. Thus, we conducted a small qualitative survey managed by nursing staff in our Bone Marrow Transplantation Unit and Acute Leukemia Unit, with the objectives of assessing patient satisfaction, determining critical existing problems, and developing required interventions. The sample was not probabilistic. A questionnaire was developed using the Delphi method in a pilot study with 30 patients. Analysis of the data suggested a good level of patient satisfaction with medical and nursing staffs (100%), but poor satisfaction with food (48%), services (38%), and amenities (31%). Limitations of the study were that the questionnaire was unvalidated and the sample was small. However, for the first time, patient satisfaction was directly measured at our hospital. Another qualitative study will be conducted after correction of the critical points that emerged during this initial study, in a larger sample of patients.

  20. Nurses' Patient-Centeredness and Perceptions of Care among Medicaid Patients in Hospital Obstetrical Units.

    Science.gov (United States)

    Aragon, Stephen J; Richardson, Liana J; Lawrence, Wanda; Gesell, Sabina B

    2013-01-01

    Objective. This study examined to what degree patient-centeredness-measured as an underlying ability of obstetrical nurses-influenced Medicaid patients' satisfaction with care in hospital obstetrical units. Design. Multigroup structural equation modeling design, using three cross-sectional random samples (n = 300 each) from the 2003 Press Ganey National Inpatient Database. Setting. Self-administered mail surveys. Participants. 900 Medicaid recipients recently discharged from inpatient hospital obstetrical units across the United States. Methods. Multigroup structural equation modeling was used to test the goodness of fit between a hypothesized model based on the Primary Provider Theory and patients' ratings of nurses. Results. The model fitted the data well, was stable across three random samples, and was sustained when compared to a competing model. The patient-centeredness of nurses significantly influenced overall patient satisfaction and explained 66% of its variability. When nurses' patient-centeredness increased by one standard deviation, patients' satisfaction increased by 0.80 standard deviation. Conclusion. This study offers a novel approach to the measurement of the patient-centeredness of nurses and a paradigm for increasing it and its influence on Medicaid patients' satisfaction in hospital obstetrical units.

  1. Nurses' Patient-Centeredness and Perceptions of Care among Medicaid Patients in Hospital Obstetrical Units

    Science.gov (United States)

    Aragon, Stephen J.; Richardson, Liana J.; Lawrence, Wanda; Gesell, Sabina B.

    2013-01-01

    Objective. This study examined to what degree patient-centeredness—measured as an underlying ability of obstetrical nurses—influenced Medicaid patients' satisfaction with care in hospital obstetrical units. Design. Multigroup structural equation modeling design, using three cross-sectional random samples (n = 300 each) from the 2003 Press Ganey National Inpatient Database. Setting. Self-administered mail surveys. Participants. 900 Medicaid recipients recently discharged from inpatient hospital obstetrical units across the United States. Methods. Multigroup structural equation modeling was used to test the goodness of fit between a hypothesized model based on the Primary Provider Theory and patients' ratings of nurses. Results. The model fitted the data well, was stable across three random samples, and was sustained when compared to a competing model. The patient-centeredness of nurses significantly influenced overall patient satisfaction and explained 66% of its variability. When nurses' patient-centeredness increased by one standard deviation, patients' satisfaction increased by 0.80 standard deviation. Conclusion. This study offers a novel approach to the measurement of the patient-centeredness of nurses and a paradigm for increasing it and its influence on Medicaid patients' satisfaction in hospital obstetrical units. PMID:24027634

  2. Intravenous lipids in adult intensive care unit patients.

    Science.gov (United States)

    Hecker, Matthias; Mayer, Konstantin

    2015-01-01

    Malnutrition of critically ill patients is a widespread phenomenon in intensive care units (ICUs) worldwide. Lipid emulsions (LEs) are able to provide sufficient caloric support and essential fatty acids to correct the energy deficit and improve outcome. Furthermore, components of LEs might impact cell and organ function in an ICU setting. All currently available LEs for parenteral use are effective in providing energy and possess a good safety profile. Nevertheless, soybean oil-based LEs have been associated with an elevated risk of adverse outcomes, possibly due to their high content of omega-6 fatty acids. More newly developed emulsions partially replace soybean oil with medium-chain triglycerides, fish oil or olive oil in various combinations to reduce its negative effects on immune function and inflammation. The majority of experimental studies and smaller clinical trials provide initial evidence for a beneficial impact of these modern LEs on critically ill patients. However, large, well-designed clinical trials are needed to evaluate which LE offers the greatest advantages concerning clinical outcome. Lipid emulsions (LEs) are a powerful source of energy that can help to adjust the caloric deficit of intensive care unit (ICU) patients. LEs possess various biological activities, but their subsequent impact on critically ill patients awaits further investigations.

  3. Condition of cleanliness of surfaces close to patients in an intensive care unit

    OpenAIRE

    Ferreira,Adriano Menis; Andrade,Denise de; Rigotti, Marcelo Alessandro; Ferreira, Maria Verônica Ferrareze

    2011-01-01

    ABSTRACT - Surface cleaning is a well-known control procedure against the dissemination of microorganisms in the hospital environment. This prospective study, carried out in an intensive care unit over the course of 14 days, describes the cleaning/disinfection conditions of four surfaces near patients. In total, 100 assessments of the surfaces were carried out after they were cleaned. Three methods were used to evaluate cleanliness: a visual inspection, an adenosine triphosphate (ATP) biolumi...

  4. Nutritional assessment in patients with cirrhosis

    Directory of Open Access Journals (Sweden)

    Sabrina Alves Fernandes

    2012-03-01

    Full Text Available CONTEXT: Malnutrition in cirrhotic patients with end-stage disease is common, and the degree of nutritional debilitation can play an important role in the pathogenesis of complications and cause a negative impact on prognosis. However, it involves difficulties and controversies regarding the identification of the best nutritional assessment method. OBJECTIVE: To identify a method that provides a safe and effective nutritional diagnosis. METHODS: Cross-sectional study with 129 cirrhotic patients. Anthropometric measurements, subjective global assessment, hand grip strength and bioelectrical impedance. RESULTS: Through phase angle of bioelectrical impedance analysis (BIA method, significant associations with Child-Pugh (P = 0.008, age group and gender were observed. The ROC (receiver operator characteristic curve was generated to determine the best cutoff point of the phase angle of cirrhotic patients, serving as one of the reference parameters for the nutritional assessment with bioimpedance in this study, considering the classification through Child-Pugh score as the reference standard for the clinical conditions of patients with cirrhosis. CONCLUSIONS: The assessment through bioelectrical impedance presented a statistically significant correlation with Child-Pugh score. The identification of phase angle of 5.44º is the new parameter suggested for the classification of the nutritional conditions of cirrhotic patients.

  5. Assessment of patients with chronic pain.

    Science.gov (United States)

    Dansie, E J; Turk, D C

    2013-07-01

    Chronic pain is a public health concern affecting 20-30% of the population of Western countries. Although there have been many scientific advances in the understanding of the neurophysiology of pain, precisely assessing and diagnosing a patient's chronic pain problem is not straightforward or well-defined. How chronic pain is conceptualized influences how pain is evaluated and the factors considered when making a chronic pain diagnosis. There is no one-to-one relationship between the amount or type of organic pathology and pain intensity, but instead, the chronic pain experience is shaped by a myriad of biomedical, psychosocial (e.g. patients' beliefs, expectations, and mood), and behavioural factors (e.g. context, responses by significant others). Assessing each of these three domains through a comprehensive evaluation of the person with chronic pain is essential for treatment decisions and to facilitate optimal outcomes. This evaluation should include a thorough patient history and medical evaluation and a brief screening interview where the patient's behaviour can be observed. Further assessment to address questions identified during the initial evaluation will guide decisions as to what additional assessments, if any, may be appropriate. Standardized self-reported instruments to evaluate the patient's pain intensity, functional abilities, beliefs and expectations, and emotional distress are available, and can be administered by the physician, or a referral for in depth evaluation can be made to assist in treatment planning.

  6. Serologic prevalence of amoeba-associated microorganisms in intensive care unit pneumonia patients.

    Directory of Open Access Journals (Sweden)

    Sabri Bousbia

    Full Text Available BACKGROUND: Patients admitted to intensive care units are frequently exposed to pathogenic microorganisms present in their environment. Exposure to these microbes may lead to the development of hospital-acquired infections that complicate the illness and may be fatal. Amoeba-associated microorganisms (AAMs are frequently isolated from hospital water networks and are reported to be associated to cases of community and hospital-acquired pneumonia. METHODOLOGY/PRINCIPAL FINDINGS: We used a multiplexed immunofluorescence assay to test for the presence of antibodies against AAMs in sera of intensive care unit (ICU pneumonia patients and compared to patients at the admission to the ICU (controls. Our results show that some AAMs may be more frequently detected in patients who had hospital-acquired pneumonia than in controls, whereas other AAMs are ubiquitously detected. However, ICU patients seem to exhibit increasing immune response to AAMs when the ICU stay is prolonged. Moreover, concomitant antibodies responses against seven different microorganisms (5 Rhizobiales, Balneatrix alpica, and Mimivirus were observed in the serum of patients that had a prolonged ICU stay. CONCLUSIONS/SIGNIFICANCE: Our work partially confirms the results of previous studies, which show that ICU patients would be exposed to water amoeba-associated microorganisms, and provides information about the magnitude of AAM infection in ICU patients, especially patients that have a prolonged ICU stay. However, the incidence of this exposure on the development of pneumonia remains to assess.

  7. Cardiac Risk Assessment, Morbidity Prediction, and Outcome in the Vascular Intensive Care Unit.

    LENUS (Irish Health Repository)

    Dover, Mary

    2013-09-17

    Objectives: The aim of this study is to examine the predictive value of the Lee revised cardiac risk index (RCRI) for a standard vascular intensive care unit (ICU) population as well as assessing the utility of transthoracic echocardiography and the impact of prior coronary artery disease (CAD) and coronary revascularization on patient outcome. Design: This is a retrospective review of prospectively maintained Vascubase and prospectively collected ICU data. Materials and Methods: Data from 363 consecutive vascular ICU admissions were collected. Findings were used to calculate the RCRI, which was then correlated with patient outcomes. All patients were on optimal medical therapy (OMT) in the form of cardioselective β-blocker, aspirin, statin, and folic acid. Results: There was no relationship found between a reduced ejection fraction and patient outcome. Mortality was significantly increased for patients with left ventricular hypertrophy (LVH) as identified on echo (14.9% vs 6.5%, P = .028). The overall complication rates were significantly elevated for patients with valvular dysfunction. Discrimination for the RCRI on receiver-operating characteristic analysis was poor, with an area under the receiver-operating characteristic curve of .621. Model calibration was reasonable with an Hosmer-Lemeshow Ĉ statistic of 2.726 (P = .256). Of those with known CAD, 41.22% of the patients receiving best medical treatment developed acute myocardial infarction (AMI) compared to 35.3% of those who previously underwent percutaneous cardiac intervention and 23.5% of those who had undergone coronary artery bypass grafting. There was 3-fold increase in major adverse clinical events in patients with troponin rise and LVH. Conclusions: The RCRI\\'s discriminatory capacity is low, and this raises difficulties in assessing cardiac risk in patients undergoing vascular intervention. The AMI is highest in the OMT group without prior cardiac intervention, which mandates protocols to

  8. Nurses' and physicians' perceptions of Confusion Assessment Method for the intensive care unit for delirium detection

    DEFF Research Database (Denmark)

    Oxenbøll-Collet, Marie; Egerod, Ingrid; Christensen, Vibeke;

    2017-01-01

    of this study was to identify nurses' and physicians' perceived professional barriers to using the CAM-ICU in Danish ICUs. METHODS: This study uses a qualitative explorative multicentre design using focus groups and a semi-structured interview guide. Five focus groups with nurses (n = 20) and four...... with physicians (n = 14) were conducted. Strategic sampling was used to include participants with varying CAM-ICU experience at units, with variable implementation of the tool. RESULTS: Using a hermeneutical approach, three main themes and nine sub-themes emerged. The main themes were (1) Professional role issues......: CAM-ICU screening affected nursing care, clinical judgment and professional integrity; (2) Instrument reliability: nurses and physicians expressed concerns about CAM-ICU assessment in non-sedated patients, patients with multi-organ failure or patients influenced by residual sedatives/opioids; and (3...

  9. An observational study of patient care outcomes sensitive to handover quality in the Post-Anaesthetic Care Unit.

    Science.gov (United States)

    Lillibridge, Nichole; Botti, Mari; Wood, Beverley; Redley, Bernice

    2017-05-19

    To identify patient care outcome indicators sensitive to the quality of interprofessional handover between the anaesthetist and the Post-Anaesthetic Care Unit nurse. The relationship between interprofessional clinical handover when patients are transferred from the operating theatre to the Post-Anaesthetic Care Unit and patient outcomes of subsequent patient care delivery is not well understood. Naturalistic, exploratory descriptive design using observation. Observations of 31 patient journeys through Post-Anaesthetic Care Units across three public and private hospitals. Characteristics of interprofessional handover on arrival in the Post-Anaesthetic Care Unit, the trajectory of patient care activities in Post-Anaesthetic Care Unit and patient outcomes were observed. Of the 821 care activities observed across 31 "patient journeys" in the Post-Anaesthetic Care Unit, observations (assessments and vital signs) (52.5 %), communication (15.8 %) and pain management (assessment of pain and analgesic administration) (10.3%) were most common. Examination of patterns in handover communications and subsequent trajectories of patient care activities revealed three patient trajectory typologies and two patient outcome indicators expected to be sensitive to the quality of interprofessional handover communication in the Post-Anaesthetic Care Unit: pain on discharge from the Post-Anaesthetic Care Unit and timely response to clinical deterioration. An additional process indicator, seeking missing information, was also identified. Patient's pain on discharge from Post-Anaesthetic Care Unit, escalation of care in response to early signs of deterioration and the need for nurses to seek out missing information to deliver care are indicators expected to be sensitive to the quality of interprofessional handover communication in the Post-Anaesthetic Care Unit. Future research should test these indicators. Patient outcomes sensitive to the quality of interprofessional handover on patient

  10. Candida colonization in intensive care unit patients' urine

    Directory of Open Access Journals (Sweden)

    Xisto Sena Passos

    2005-12-01

    Full Text Available The objective of this study was to identify possible predisposing factors for candiduria in intensive care unit (ICU patients from Hospital das Clínicas, Universidade Federal de Goiás, Goiânia, Brazil, during one year. Urine samples from 153 ICU patients were obtained by catheterization on admission day and every seven days. Data such as sex, age, antifungal therapy, and variables as antibiotics, underlying diseases or comorbid conditions and stay in the hospital, were collected from patients who had at least one urine culture that yielded > 10³ yeast colonies/ml. Candiduria was recovered in 68 patients and the commonest predisposing factors were antibiotic therapy (100% and indwelling urinary catheter (92.6%. The percentage of Candida spp. isolation increased during the extended periods in which patients remained in the ICU. C. albicans was isolated in 69.1%, and the other species non-albicans as C. glabrata, C. kefyr, C. parapsilosis, C. famata, C. guilliermondii, C. krusei, and C. tropicalis were isolated in lower percentage. The high frequency of candiduria and the possible predisposing factors found in ICU patients show that candiduria surveillance should be performed to help reducing nosocomial infections.

  11. Focus assessed transthoracic echocardiography for preoperative assessment in patients scheduled for acute surgery

    DEFF Research Database (Denmark)

    Bøtker, Morten Thingemann; Frederiksen, C.A.; Lauridsen Vang, M.K.

    2013-01-01

    Introduction: Unexpected cardiopulmonary complications are a well-known and feared entity during surgery and anaesthesia, acknowledged in previous reports. Focus Assessed Transthoracic Echocardiography (FATE) has proven to be feasible in intensive care units and perioperatively for evaluation...... were recorded. After the routine preoperative assessment these were reported to the anaesthetist responsible for the anaesthesia.Whether or not this led to changes in the perioperative management was registered. Results: 112 patients scheduled for acute surgery were included. Mean age was 62 years (57...

  12. Low Caspofungin Exposure in Patients in Intensive Care Units.

    Science.gov (United States)

    van der Elst, Kim C M; Veringa, Anette; Zijlstra, Jan G; Beishuizen, Albertus; Klont, Rob; Brummelhuis-Visser, Petra; Uges, Donald R A; Touw, Daan J; Kosterink, Jos G W; van der Werf, Tjip S; Alffenaar, Jan-Willem C

    2017-02-01

    In critically ill patients, drug exposure may be influenced by altered drug distribution and clearance. Earlier studies showed that the variability in caspofungin exposure was high in intensive care unit (ICU) patients. The primary objective of this study was to determine if the standard dose of caspofungin resulted in adequate exposure in critically ill patients. A multicenter prospective study in ICU patients with (suspected) invasive candidiasis was conducted in the Netherlands from November 2013 to October 2015. Patients received standard caspofungin treatment, and the exposure was determined on day 3 of treatment. An area under the concentration-time curve from 0 to 24 h (AUC0-24) of 98 mg · h/liter was considered adequate exposure. In case of low exposure (i.e., caspofungin dose was increased and the exposure reevaluated. Twenty patients were included in the study, of whom 5 had a positive blood culture. The median caspofungin AUC0-24 at day 3 was 78 mg · h/liter (interquartile range [IQR], 69 to 97 mg · h/liter). A low AUC0-24 (caspofungin dose in mg/kg/day (P = 0.011). The median AUC0-24 with a caspofungin dose of 1 mg/kg was estimated using a pharmacokinetic model and was 114.9 mg · h/liter (IQR, 103.2 to 143.5 mg · h/liter). In conclusion, the caspofungin exposure in ICU patients in this study was low compared with that in healthy volunteers and other (non)critically ill patients, most likely due to a larger volume of distribution. A weight-based dose regimen is probably more suitable for patients with substantially altered drug distribution. (This study has been registered at ClinicalTrials.gov under registration no. NCT01994096.).

  13. Patients assessing students' assignments; making the patient experience real.

    Science.gov (United States)

    Munro, Jane; Whyte, Fiona; Stewart, Jim; Letters, Andrew

    2012-02-01

    The care of patients with inflammatory bowel disease (IBD) frequently falls short of the highest standards. This is noted in several publications, including national standards, despite nursing students being taught the importance of listening to and understanding patients. Teaching staff at the University of Glasgow primarily responsible for teaching third year undergraduate nursing students undertook a radical rethink of the planning, delivery and assessment of lectures on IBD. The subject had previously been delivered in a modified lecture format. Although the topic could be included in the end-of-year exams, there was little evidence to show whether this traditional teaching method had any effect on students' clinical practice. In a novel approach to learning and assessment, students were invited to research and produce an information leaflet for newly diagnosed patients with IBD. The leaflets were then assessed and grades awarded by an expert panel of patients and carers. Such enquiry based learning (EBL) intended to demonstrate in practice, the key role patients can play in both undergraduate nurse education and in service planning and delivery in the National Health Service (NHS). The panel found the exercise both interesting and insightful, while the students reported being invigorated and felt the expert assessment meant they were forced to achieve a higher level of work. Copyright © 2011 Elsevier Ltd. All rights reserved.

  14. Precast concrete unit assessment through GPR survey and FDTD modelling

    Science.gov (United States)

    Campo, Davide

    2017-04-01

    Precast concrete elements are widely used within United Kingdom house building offering ease in assembly and added values as structural integrity, sound and thermal insulation; most common concrete components include walls, beams, floors, panels, lintels, stairs, etc. The lack of respect of the manufacturer instruction during assembling, however, may induce cracking and short/long term loss of bearing capacity. GPR is a well-established not destructive technique employed in the assessment of structural elements because of real-time imaging, quickness of data collecting and ability to discriminate finest structural details. In this work, GPR has been used to investigate two different precast elements: precast reinforced concrete planks constituting the roof slab of a school and precast wood-cement blocks with insulation material pre-fitted used to build a perimeter wall of a private building. Visible cracks affected both constructions. For the assessment surveys, a GSSI 2.0 GHz GPR antenna has been used because of the high resolution required and the small size of the antenna case (155 by 90 by 105mm) enabling scanning up to 45mm from any obstruction. Finite Difference Time Domain (FDTD) numerical modelling was also performed to build a scenario of the expected GPR signal response for a preliminary real-time interpretation and to help solve uncertainties due to complex reflection patterns: simulated radargrams were built using Reflex Software v. 8.2, reproducing the same GPR pulse used for the surveys in terms of wavelet, nominal frequency, sample frequency and time window. Model geometries were derived from the design projects available both for the planks and the blocks; the electromagnetic properties of the materials (concrete, reinforcing bars, air-filled void, insulation and wooden concrete) were inferred from both values reported in literature and a preliminary interpretation of radargrams where internal layer interfaces were clearly recognizable and

  15. Computer-delivered patient simulations in the United States Medical Licensing Examination (USMLE).

    Science.gov (United States)

    Dillon, Gerard F; Clauser, Brian E

    2009-01-01

    To obtain a full and unrestricted license to practice medicine in the United States, students and graduates of the MD-granting US medical schools and of medical schools located outside of the United States must take and pass the United States Medical Licensing Examination. United States Medical Licensing Examination began as a series of paper-and-pencil examinations in the early 1990s and converted to computer-delivery in 1999. With this change to the computerized format came the opportunity to introduce computer-simulated patients, which had been under development at the National Board of Medical Examiners for a number of years. This testing format, called a computer-based case simulation, requires the examinee to manage a simulated patient in simulated time. The examinee can select options for history-taking and physical examination. Diagnostic studies and treatment are ordered via free-text entry, and the examinee controls the advance of simulated time and the location of the patient in the health care setting. Although the inclusion of this format has brought a number of practical, psychometric, and security challenges, its addition has allowed a significant expansion in ways to assess examinees on their diagnostic decision making and therapeutic intervention skills and on developing and implementing a reasonable patient management plan.

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

    Science.gov (United States)

    Evans, Jennie; Reyers, Evelyn

    2014-01-01

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

  17. Assessing the Implementation of Ghana's Patient Charter

    Science.gov (United States)

    Abekah-Nkrumah, Gordon; Manu, Abubakar; Atinga, Roger Ayimbillah

    2010-01-01

    Purpose: This paper seeks to assess the implementation of Ghana's Patients' Charter by investigating the level of awareness and knowledge of the Charter's content, some socio-demographic factors that may influence awareness and knowledge of the Charter and how providers have discharged their responsibilities under the Charter.…

  18. [Preoperative assessment of patients with diabetes mellitus].

    Science.gov (United States)

    Takeda, Kiyoshi

    2010-07-01

    The perioperative morbidity of diabetic patients is related to preoperative end-organ damage. Due to the microvascular pathology, autonomic neuropathy is common and cardiovascular abnormalities such as hypertension, painless myocardial ischemia, and orthostatic hypotension may predispose patients to perioperative cardiovascular instability. Autonomic dysfunction also contributes to delayed gastric emptying, and preoperative administration of a histamine antagonist and a gastric emptying agent is needed. Chronic hyperglycemia leads to glycosylation of tissue proteins and the accumulation of abnormal collagen can cause stiff joint syndrome resulting in difficult tracheal intubation. The primary goal of pre and intraoperative blood glucose control is to avoid hypoglycemia and ketosis. Moreover, the tight glycemic control has been reported to improve survival in critically ill patients who were treated in the intensive care unit.

  19. Medication reconciliation in patients hospitalized in a cardiology unit.

    Science.gov (United States)

    Magalhães, Gabriella Fernandes; Santos, Gláucia Noblat de Carvalho; Santos, Gláucia Beisl Noblat de Carvalho; Rosa, Mário Borges; Noblat, Lúcia de Araújo Costa Beisl

    2014-01-01

    To compare drugs prescribed on hospital admission with the list of drugs taken prior to admission for adult patients admitted to a cardiology unit and to identify the role of a pharmacist in identifying and resolving medication discrepancies. This study was conducted in a 300 bed university hospital in Brazil. Clinical pharmacists taking medication histories and reconciling medications prescribed on admission with a list of drugs used prior to admission. Discrepancies were classified as justified (e.g., based on the pharmacotherapeutic guidelines of the hospital studied) or unintentional. Treatments were reviewed within 48 hours following hospitalization. Unintentional discrepancies were further classified according to the categorization of medication error severity. Pharmacists verbally contacted the prescriber to recommend actions to resolve the discrepancies. A total of 181 discrepancies were found in 50 patients (86%). Of these discrepancies, 149 (82.3%) were justified changes to the patient's home medication regimen; however, 32 (17.7%) discrepancies found in 24 patients were unintentional. Pharmacists made 31 interventions and 23 (74.2%) were accepted. Among unintentional discrepancies, the most common was a different medication dose on admission (42%). Of the unintentional discrepancies 13 (40.6%) were classified as error without harm, 11 (34.4%) were classified as error without harm but which could affect the patient and require monitoring, 3 (9.4%) as errors could have resulted in harm and 5 (15.6%) were classified as circumstances or events that have the capacity to cause harm. The results revealed a high number of unintentional discrepancies and the pharmacist can play an important role by intervening and correcting medication errors at a hospital cardiology unit.

  20. Medication reconciliation in patients hospitalized in a cardiology unit.

    Directory of Open Access Journals (Sweden)

    Gabriella Fernandes Magalhães

    Full Text Available To compare drugs prescribed on hospital admission with the list of drugs taken prior to admission for adult patients admitted to a cardiology unit and to identify the role of a pharmacist in identifying and resolving medication discrepancies.This study was conducted in a 300 bed university hospital in Brazil. Clinical pharmacists taking medication histories and reconciling medications prescribed on admission with a list of drugs used prior to admission. Discrepancies were classified as justified (e.g., based on the pharmacotherapeutic guidelines of the hospital studied or unintentional. Treatments were reviewed within 48 hours following hospitalization. Unintentional discrepancies were further classified according to the categorization of medication error severity. Pharmacists verbally contacted the prescriber to recommend actions to resolve the discrepancies.A total of 181 discrepancies were found in 50 patients (86%. Of these discrepancies, 149 (82.3% were justified changes to the patient's home medication regimen; however, 32 (17.7% discrepancies found in 24 patients were unintentional. Pharmacists made 31 interventions and 23 (74.2% were accepted. Among unintentional discrepancies, the most common was a different medication dose on admission (42%. Of the unintentional discrepancies 13 (40.6% were classified as error without harm, 11 (34.4% were classified as error without harm but which could affect the patient and require monitoring, 3 (9.4% as errors could have resulted in harm and 5 (15.6% were classified as circumstances or events that have the capacity to cause harm.The results revealed a high number of unintentional discrepancies and the pharmacist can play an important role by intervening and correcting medication errors at a hospital cardiology unit.

  1. Family Perspectives of Traumatically Brain-Injured Patient Pain Behaviors in the Intensive Care Unit.

    Science.gov (United States)

    Vanderbyl, Brandy L; Gélinas, Céline

    2017-08-01

    Behavioral scales allow for the pain assessment of vulnerable critically ill patients who are unable to self-report. However, validity of the use of such scales is limited in traumatic brain injury patients with an altered level of consciousness as a result of the different way that these patients express pain. Family participation is considered as an important component of pain assessment for those unable to self-report, but research in this area is minimal so far. This study aimed to describe what behaviors family caregivers deemed relevant to pain for patients with a traumatic brain injury with an altered level of consciousness in the intensive care unit. Using a mixed-method descriptive design, semistructured interviews were conducted and behaviors' relevance was quantitatively rated by seven family caregivers of nonverbal patients with traumatic brain injury in the intensive care unit of a tertiary trauma center in Montreal, Canada. Family caregivers were able to provide rich descriptions of a number of behaviors they observed in their loved ones that were perceived to be relevant indicators of pain, such as muscle tension and key facial expressions and body movements. Several factors influenced how behaviors were interpreted by family, including personal medical beliefs and intimate knowledge of the patient's history. The pain behaviors determined by family caregivers can be useful in the pain assessment process of traumatic brain injury patients with an altered level of consciousness. Their input could also be helpful in further development of pain assessment tools. Copyright © 2017 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

  2. Assessing functional ability in older patients

    DEFF Research Database (Denmark)

    Nielsen, Louise Møldrup; Maribo, Thomas; Nielsen, Hanne Grethe

    2014-01-01

    different settings: the local hospital and the municipality. Results: Focus group interviews showed that health professionals in the hospital and the municipality expressed the need for an observation-based tool to predict and guide decisions about the rehabilitation needs of older patients. Participants...... from the hospital expressed a need for a fast and simple screening tool to identify those in need of further rehabilitation and care after discharge. Participants from the municipality expressed a need for a more detailed assessment tool to capture information about patients’ ability to perform daily...... to administer, to assess the quality of functional ability and predict the need for rehabilitation. The different context (hospital or primary care) seems to influence the way health professionals perceive the need for assessment of functional ability in older patients....

  3. Functional level at admission is a predictor of survival in older patients admitted to an acute geriatric unit

    DEFF Research Database (Denmark)

    Matzen, Lars E; Jepsen, Ditte B; Ryg, Jesper

    2012-01-01

    ABSTRACT: BACKGROUND: Functional decline is associated with increased risk of mortality in geriatric patients.Assessment of activities of daily living (ADL) with the Barthel Index (BI) at admission wasstudied as a predictor of survival in older patients admitted to an acute geriatric unit. METHODS...... to an acute geriatricunit. These data suggest that assessment of ADL may have a potential role in decisionmaking for the clinical management of frail geriatric inpatients....

  4. Hazard assessment of United Arab Emirates (UAE) incense smoke.

    Science.gov (United States)

    Cohen, Rebecca; Sexton, Kenneth G; Yeatts, Karin B

    2013-08-01

    Incense burning inside the home, a common practice in Arabian Gulf countries, has been recognized as a potentially modifiable source of indoor air pollution. To better understand potential adverse effects of incense burning in exposed individuals, we conducted a hazard assessment of incense smoke exposure. The goals of this study were first to characterize the particles and gases emitted from Arabian incense over time when burned, and secondly to examine in vitro human lung cells responses to incense smoke. Two types of incense (from the United Arab Emirates) were burned in a specially designed indoor environmental chamber (22 m(3)) to simulate the smoke concentration in a typical living room and the chamber air was analyzed. Both particulate (PM) concentrations and sizes were measured, as were gases carbon monoxide (CO), sulfur dioxide (SO2), oxides of nitrogen (NOx), formaldehyde (HCHO), and carbonyls. During the burn, peak concentrations were recorded for PM (1.42 mg/m(3)), CO (122 pm), NOx (0.3 ppm), and HCHO (85 ppb) along with pentanal (71.9 μg/m(3)), glyoxal (84.8 μg/m(3)), and several other carbonyls. Particle sizes ranged from 20 to 300 nm with count median diameters ranging from 65 to 92 nm depending on time post burn-out. PM, CO, and NOx time-weighted averages exceeded current government regulation values and emissions seen previously from environmental tobacco smoke. Charcoal emissions were the main contributor to both the high CO and NOx concentrations. A significant cell inflammatory response was observed in response to smoke components formed from incense burning. Our hazard evaluation suggests that incense burning contributes to indoor air pollution and could be harmful to human health.

  5. Assessing the problem of counterfeit medications in the United Kingdom.

    Science.gov (United States)

    Jackson, G; Patel, S; Khan, S

    2012-03-01

    Counterfeit medicines pose an ever-increasing threat to public health, although precise tracking of illegal counterfeit prescription drug activity is difficult. Available data indicate that all types of medications have been targeted. Adverse health effects, including death, have resulted from using counterfeit medications; consumers who self-medicate without appropriate interactions with the healthcare system rarely receive adequate healthcare. The Internet provides a large, convenient route for counterfeiters to reach potential buyers with unregulated, often dangerous, products. The majority of medicines purchased via unverified Internet sites are counterfeit; often, these products lack the purported drug compound or have variable concentrations of active ingredients and sometimes contain dangerous toxins. Although many consumers acknowledge some degree of risk with purchasing medications via the Internet, speed, convenience and cost often prompt these purchases. Counterfeit medications also have been detected in the legitimate supply chain, but represent a significantly smaller proportion of sales than those purchased via the Internet. Pilot programmes in Europe have demonstrated that product verification systems prevent penetration of counterfeit products into the legitimate supply chain. Significant EU legislation, including stronger penalties for counterfeiting, is in development. In the United Kingdom, the Medicines and Healthcare Products Regulatory Agency (MHRA) launched an initiative against counterfeit medication. Healthcare professionals should report suspected cases of counterfeit medication to the MHRA, be alert to threats to the medicine supply, and provide practical advice to patients about ordering medications online, including avoiding unregulated Internet pharmacies, and being suspicious of sites offering substantial discounts and prescription-only medication without a prescription. © 2011 Blackwell Publishing Ltd.

  6. Assessing functional ability in older patients

    DEFF Research Database (Denmark)

    Nielsen, Louise Møldrup; Maribo, Thomas; Nielsen, Hanne Grethe

    2014-01-01

    Aim: This study aimed to develop an understanding of how primary and secondary care health professionals perceive current practice and challenges in assessing older patients’ functional abilities. A secondary aim was to gain insight into how these professionals perceive the need for generic tools...... for assessing functional ability among older patients. Method: A qualitative design was used to explore health professionals’ perspectives on the assessment of older patients’ functional ability. Two groups of health professionals participated in focus group interviews, with one group for each of the two...... from the hospital expressed a need for a fast and simple screening tool to identify those in need of further rehabilitation and care after discharge. Participants from the municipality expressed a need for a more detailed assessment tool to capture information about patients’ ability to perform daily...

  7. Reliability assessment of a hospital quality measure based on rates of adverse outcomes on nursing units.

    Science.gov (United States)

    Staggs, Vincent S

    2015-12-31

    The purpose of this study was to develop methods for assessing the reliability of scores on a widely disseminated hospital quality measure based on nursing unit fall rates. Poisson regression interactive multilevel modeling was adapted to account for clustering of units within hospitals. Three signal-noise reliability measures were computed. Squared correlations between the hospital score and true hospital fall rate averaged 0.52 ± 0.18 for total falls (0.68 ± 0.18 for injurious falls). Reliabilities on the other two measures averaged at least 0.70 but varied widely across hospitals. Parametric bootstrap data reflecting within-unit noise in falls were generated to evaluate percentile-ranked hospital scores as estimators of true hospital fall rate ranks. Spearman correlations between bootstrap hospital scores and true fall rates averaged 0.81 ± 0.01 (0.79 ± 0.01). Bias was negligible, but ranked hospital scores were imprecise, varying across bootstrap samples with average SD 11.8 (14.9) percentiles. Across bootstrap samples, hospital-measure scores fell in the same decile as the true fall rate in about 30% of cases. Findings underscore the importance of thoroughly assessing reliability of quality measurements before deciding how they will be used. Both the hospital measure and the reliability methods described can be adapted to other contexts involving clustered rates of adverse patient outcomes. © The Author(s) 2015.

  8. Visual unit analysis: a descriptive approach to landscape assessment

    Science.gov (United States)

    R. J. Tetlow; S. R. J. Sheppard

    1979-01-01

    Analysis of the visible attributes of landscapes is an important component of the planning process. When landscapes are at regional scale, economical and effective methodologies are critical. The Visual Unit concept appears to offer a logical and useful framework for description and evaluation. The concept subdivides landscape into coherent, spatially-defined units....

  9. Assessing Unit-Price Related Remifentanil Choice in Rhesus Monkeys

    Science.gov (United States)

    Galuska, Chad M.; Winger, Gail; Woods, James H.; Hursh, Steven R.

    2006-01-01

    Given a commodity available at different prices, a unit-price account of choice predicts preference for the cheaper alternative. This experiment determined if rhesus monkeys preferred remifentanil (an ultra-short-acting [mu]-opioid agonist) delivered at a lower unit price over a higher-priced remifentanil alternative (Phases 1 and 3). Choice…

  10. Environmental Assessment: Interim Western United States C-17 Landing Zone

    Science.gov (United States)

    2008-05-01

    RESEARCH STATE CLEARINGHOUSE AND PLANNING UNIT ARNOLD SCHWARZENEGGER GOVERNOR January 7, 2008 Doug Allbright U.S. Air Force Headquarters Air...STATE OF CALIFORNIA GoVERNOR’S OFFICE of PLANNING AND RESEARCH STATE CLEARINGHOUSE AND PLANNING UNIT ARNOLD SCHWARZENBGGER. CYNTHJABRYANT DIRECTOR

  11. Experience from multidisciplinary follow-up on critically ill patients treated in an intensive care unit.

    Science.gov (United States)

    Fonsmark, Lise; Rosendahl-Nielsen, Mette

    2015-05-01

    International literature describes that former intensive care unit (ICU) patients suffer considerable physical and neuropsychological complications. Systematic data on Danish ICU survivors are scarce as standardised follow-up after intensive care has yet to be described. This article describes and evaluates the knowledge gained from outpatient follow-up at a tertiary intensive care unit at Rigshospitalet, Copenhagen, during a three-year period. A total of 101 adult former ICU patients attended the outpatient clinic over a three-year period. Patients included were medical and surgical patients with a length of stay exceeding four days. Patients attended the clinic after discharge from hospital and for a minimum of two months from their discharge from the ICU. The patients were assessed for physical, neuropsychological and psychological problems and, if necessary, further treatment or rehabilitation was initiated. Reduced physical ability was seen in 82%. A total of 89% suffered a substantial weight loss. 83.2% had signs indicating acute brain dysfunction during the ICU stay, and approximately half of the patients still had cognitive problems. A total of 66 interventions were initiated. Our data confirmed that a large proportion of ICU survivors suffer considerable long-term physical and neuropsychological sequelae. Intensive care follow-up may contribute to address these specific problems and to initiate the needed interventions. Research is needed to determine whether specialised rehabilitation is required. not relevant. not relevant.

  12. Body Hair Transplant by Follicular Unit Extraction: My Experience With 122 Patients

    Science.gov (United States)

    Umar, Sanusi

    2016-01-01

    Background Body hair shafts from the beard, trunk, and extremities can be used to treat baldness when patients have inadequate amounts of scalp donor hair, but reports in the literature concerning use of body hair to treat baldness are confined to case reports. Objectives This study aimed to assess the outcome of body hair transplanted to bald areas of the scalp in selected patients. Methods From 2005 through 2011, 122 patients preselected for adequate body hair had donor hair transplanted from the beard, trunk, and the extremities to the scalp by follicular unit extraction (FUE) by the author at a single center. All patients were emailed surveys to assess surgical outcomes and overall satisfaction. Results Seventy-nine patients (64.8%) responded with a mean time of 2.9 years between date of last surgery and time of survey. Patients were generally very satisfied with results of their procedure, giving mean scores of at least a 7.8 on a Likert-like scale of 0 to 10 for their healing status, hair growth in recipient areas, and overall satisfaction with their surgeries. These scores were comparable to mean scores provided by patients whose transplants included scalp donor sources. Conclusions FUE using body hair can be an effective hair transplantation method for a select patient population of hirsute individuals who suffer from severe baldness or have inadequate scalp donor reserve. Level of Evidence: 4 Therapeutic PMID:27241361

  13. Assessing the Quality of Diabetic Patients Care

    Directory of Open Access Journals (Sweden)

    Belkis Vicente Sánchez

    2012-12-01

    Full Text Available Background: to improve the efficiency and effectiveness of the actions of family doctors and nurses in this area is an indispensable requisite in order to achieve a comprehensive health care. Objective: to assess the quality of health care provided to diabetic patients by the family doctor in Abreus health area. Methods: a descriptive and observational study based on the application of tools to assess the performance of family doctors in the treatment of diabetes mellitus in the five family doctors consultation in Abreus health area from January to July 2011 was conducted. The five doctors working in these consultations, as well as the 172 diabetic patients were included in the study. At the same time, 172 randomly selected medical records were also revised. Through observation, the existence of some necessary material resources and the quality of their performance as well as the quality of medical records were evaluated. Patient criteria served to assess the quality of the health care provided. Results: scientific and technical training on diabetes mellitus has been insufficient; the necessary equipment for the appropriate care and monitoring of patients with diabetes is available; in 2.9% of medical records reviewed, interrogation appears in its complete form including the complete physical examination in 12 of them and the complete medical indications in 26. Conclusions: the quality of comprehensive medical care to diabetic patients included in the study is compromised. Doctors interviewed recognized the need to be trained in the diagnosis and treatment of diabetes in order to improve their professional performance and enhance the quality of the health care provided to these patients.

  14. Assessment of the nutritional state of dialysis patients.

    Science.gov (United States)

    Kerr, P G; Strauss, B J; Atkins, R C

    1996-01-01

    The importance of the nutritional state of our dialysis patients has been stressed for many years. Although the calculation of the protein catabolic rate has become common practice in many dialysis units, there are several problems with this measurement. In addition, the serum albumin level is subject to multiple influences making its interpretation in individual patients difficult. This paper examines a different approach to nutritional assessment-that of using longer term measures of nutrition. Several techniques for measuring body composition are explored and their use in end-stage renal disease (ESRD) examined. Total body nitrogen measurement is a gold standard technique which has been validated in renal patients, unfortunately it is not widely available. Of the alternatives, dual energy X-ray absorptiometry scanning for assessment of fat-free mass appears to be the best technique with the narrowest limits of agreement compared to gold standard techniques. Whilst bioelectrical impedance is reasonable for body water assessment, it is not reliable in ESRD patients for lean-body mass estimation.

  15. Metabolic assessment in patients with urinary lithiasis

    Directory of Open Access Journals (Sweden)

    Carmen R. Amaro

    2005-02-01

    Full Text Available INTRODUCTION: Metabolic investigation in patients with urinary lithiasis is very important for preventing recurrence of disease. The objective of this work was to diagnose and to determine the prevalence of metabolic disorders, to assess the quality of the water consumed and volume of diuresis as potential risk factors for this pathology. PATIENTS AND METHODS: We studied 182 patients older than 12 years. We included patients with history and/or imaging tests confirming at least 2 stones, with creatinine clearance > 60 mL/min and negative urine culture. The protocol consisted in the collection of 2, 24-hour urine samples, for dosing Ca, P, uric acid, Na, K, Mg, Ox and Ci, glycemia and serum levels of Ca, P, Uric acid, Na, K, Cl, Mg, U and Cr, urinary pH and urinary acidification test. RESULTS: 158 patients fulfilled the inclusion criteria. Among these, 151 (95.5% presented metabolic changes, with 94 (62.2% presenting isolated metabolic change and 57 (37.8% had mixed changes. The main disorders detected were hypercalciuria (74%, hypocitraturia (37.3%, hyperoxaluria (24.1%, hypomagnesuria (21%, hyperuricosuria (20.2%, primary hyperparathyroidism (1.8% secondary hyperparathyroidism (0.6% and renal tubular acidosis (0.6. CONCLUSION: Metabolic change was diagnosed in 95.5% of patients. These results warrant the metabolic study and follow-up in patients with recurrent lithiasis in order to decrease the recurrence rate through specific treatments, modification in alimentary and behavioral habits.

  16. Nurses’ Patient-Centeredness and Perceptions of Care among Medicaid Patients in Hospital Obstetrical Units

    Directory of Open Access Journals (Sweden)

    Stephen J. Aragon

    2013-01-01

    Full Text Available Objective. This study examined to what degree patient-centeredness—measured as an underlying ability of obstetrical nurses—influenced Medicaid patients’ satisfaction with care in hospital obstetrical units. Design. Multigroup structural equation modeling design, using three cross-sectional random samples (n=300 each from the 2003 Press Ganey National Inpatient Database. Setting. Self-administered mail surveys. Participants. 900 Medicaid recipients recently discharged from inpatient hospital obstetrical units across the United States. Methods. Multigroup structural equation modeling was used to test the goodness of fit between a hypothesized model based on the Primary Provider Theory and patients’ ratings of nurses. Results. The model fitted the data well, was stable across three random samples, and was sustained when compared to a competing model. The patient-centeredness of nurses significantly influenced overall patient satisfaction and explained 66% of its variability. When nurses’ patient-centeredness increased by one standard deviation, patients’ satisfaction increased by 0.80 standard deviation. Conclusion. This study offers a novel approach to the measurement of the patient-centeredness of nurses and a paradigm for increasing it and its influence on Medicaid patients’ satisfaction in hospital obstetrical units.

  17. Incidence of violent behavior among patients in Psychiatric Intensive Care Units

    Directory of Open Access Journals (Sweden)

    Valentina C. Iversen

    2016-03-01

    Full Text Available Background and Objectives: Both psychiatric acute units and psychiatric intensive care units (PICUs focus on acute treatment of behavioral disturbances such as violence and aggressive threats and acts. The aim of the present study is to describe the frequency of violent behavior; such as verbal or physical threats and physical attacks, among patients admitted to psychiatric intensive care unit (PICU. In addition the relationship between the episodes of threats and/or attacks in relation to time of the day, days of the week, and their seasonal variations was explored. Methods: All violent behavior was continuously assessed at the psychiatric emergency department. Data were collected during the period from May 2010 to May 2012. Results: Patients with only one hospitalization were less violent than those who have had two hospitalizations. There was a statistically significant difference in violence among patients without formal secondary education and those who have not formal education. Violent behavior showed two peaks during the day; the first occurring at 1 pm and the second at 8 pm. In regard to seasonality, summer had a higher incidence of violence. The most peaceful seasons of the year were spring and autumn. Conclusions: Violent behavior shows variation in daytime, days of the week and season in acute psychiatric intensive care. Daytime variation shows two peaks of violence at 1 pm and 8 pm, Sundays and Wednesdays being the quietest days regarding violence both in winter and summer. Patient's level of education and hospitalization status partially explain the variation.

  18. Psychiatric Assessment and Rehabilitation of Burn Patients

    Directory of Open Access Journals (Sweden)

    Süleyman Akarsu

    2017-03-01

    Full Text Available Objective: Psychiatric rehabilitation has gained significance owing to improved healthcare facilities for burn injuries and decreased mortality/ morbidity rates. Burn traumas may result in psychiatric signs such as denial, anger, guilt, confusion, disgrace, anxiety, distress, and nervousness. Psychiatric disorders such as delirium, depression, anxiety, post-traumatic stress disorder, and sexual problems can also be encountered. Therefore, it is necessary to look for these signs and disorders through regular sessions with burn patients and appropriate psychometric tests. This study aims at examining the process of psychological rehabilitation for burn patients in light of the current literature. Material and Methods: This study has been carried out in the light of the main and current literature review. The study intends to put forth the data observed in the course of the psychological diagnosis, treatment and rehabilitation of burn patients. The study has been conducted in accordance with the Helsinki Declaration Guidelines. Results: Treatment and rehabilitation process requires a multidisciplinary teamwork that consists of physicians, dieticians, psychologists, social service specialists, and other healthcare workers who can meet the needs of burn patients and their families. It is necessary for the team to contribute both to the hospitalization process and the social environment of the patients and their families. Conclusion: It is observed that the quality of life of these patients can be considerably improved with the effective assessment of psychiatric signs that occur during or after the injury and with appropriate treatment methods.

  19. Health Technology Assessment and patient safety

    Directory of Open Access Journals (Sweden)

    Andrew Mulcahy

    2005-12-01

    Full Text Available

    Health Technology Assessment (HTA is a process used to evaluate the clinical effectiveness and costeffectiveness of health technologies by a systematic review of clinical, economic, and utilization research.

    Despite widespread investment in patient safety technologies in the U.K., U.S., and elsewhere, little HTA has been done to establish the clinical or cost-effectiveness of these technologies. The HTA and patient safety literature suggests there are four categories of patient safety HTA, including HTA for existing safety technologies, underutilized safety technologies, emerging safety technologies, as well as safety aspects of technologies with a non-safety primary purpose.

    Recent HTA and other research, including a 2002 evidencebased evaluation of patient safety technologies from the U.S. Agency for Health Research and Quality, provide an important foundation for a more comprehensive approach to patient safety HTA. However, HTA programs must address prioritization, methodology, and dissemination challenges introduced by patient safety technologies before significant progress can Te made.

  20. Satisfaction in the Intensive Care Unit (ICU). Patient opinion as a cornerstone.

    Science.gov (United States)

    Holanda Peña, M S; Talledo, N Marina; Ots Ruiz, E; Lanza Gómez, J M; Ruiz Ruiz, A; García Miguelez, A; Gómez Marcos, V; Domínguez Artiga, M J; Hernández Hernández, M Á; Wallmann, R; Llorca Díaz, J

    2017-03-01

    To study the agreement between the level of satisfaction of patients and their families referred to the care and attention received during admission to the ICU. A prospective, 5-month observational and descriptive study was carried out. ICU of Marqués de Valdecilla University Hospital, Santander (Spain). Adult patients with an ICU stay longer than 24h, who were discharged to the ward during the period of the study, and their relatives. Instrument: FS-ICU 34 for assessing family satisfaction, and an adaptation of the FS-ICU 34 for patients. The Cohen kappa index was calculated to assess agreement between answers. An analysis was made of the questionnaires from one same family unit, obtaining 148 pairs of surveys (296 questionnaires). The kappa index ranged between 0.278-0.558, which is indicative of mild to moderate agreement. The families of patients admitted to the ICU cannot be regarded as good proxies, at least for competent patients. In such cases, we must refer to these patients in order to obtain first hand information on their feelings, perceptions and experiences during admission to the ICU. Only when patients are unable to actively participate in the care process should their relatives be consulted. Copyright © 2016 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

  1. Evaluation of the Utility of the Edmonton Symptom Assessment System (revised) Scale on a Tertiary Palliative Care Unit.

    Science.gov (United States)

    Beddard-Huber, Elizabeth; Jayaraman, Jyothi; White, Laura; Yeomans, Wendy

    2015-01-01

    The aim of this study was to evaluate the utility of the Edmonton Symptom Assessment System (ESAS-r) Scale on a tertiary palliative care unit. There were 92 admitted patients who participated in the study; the scale was administered to those able to participate on day 1 (n = 35, 38 percent), on day 4 (n = 20, 21 percent), and weekly. Patient comfort level with the ESAS-r tool was assessed using a 5-point Likert scale (strongly disagree to strongly agree) on day 4. Nurses' and physicians' perceptions of clinical assessment pre- and postimplementation of the scale were surveyed using a 5-point Likert scale. Of the participating physicians, 75 percent (n = 3) found that the ESAS-r Scale did not enhance clinical assessment; the proportion of nurses with that response was 37.5 percent (n = 6). Among these care providers, 50 percent of the physicians (n = 2) and 62 percent of the nurses (n = 10) thought that the scale was burdensome to patients; but 60 percent of the patients who were able to complete the comfort-level survey (n = 12) indicated that they did not find the scale burdensome. Patient acuity, team expertise, perceived burden to patients, and time commitment all influenced staff's recommendation not to implement the ESAS-r tool on the palliative care unit.

  2. 28 CFR 505.4 - Calculation of assessment by unit staff.

    Science.gov (United States)

    2010-07-01

    ... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Calculation of assessment by unit staff. 505.4 Section 505.4 Judicial Administration BUREAU OF PRISONS, DEPARTMENT OF JUSTICE GENERAL MANAGEMENT AND ADMINISTRATION COST OF INCARCERATION FEE § 505.4 Calculation of assessment by unit...

  3. USGS National and Global Oil and Gas Assessment Project-Burgos, Tampico-Misantla, and Sabinas Provinces, Northeast Mexico, Assessment Unit Boundaries

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — The Assessment Unit is the fundamental unit used in the National and Global Petroleum Assessment Project for the assessment of undiscovered oil and gas resources....

  4. Fluid resuscitation protocols for burn patients at intensive care units of the United Kingdom and Ireland.

    Science.gov (United States)

    Al-Benna, Sammy

    2011-01-01

    The objective of this study was to determine the thermal injury fluid resuscitation protocols at intensive care units (ICUs) in the United Kingdom and Ireland. A telephone questionnaire was designed to survey the fluid resuscitation protocols of ICUs at all hospitals with plastic/burn surgery departments in the British Isles in 2010. The feedback from the questionnaire was from the senior nurse in charge of the ICUs. 32/64 (50%) of these ICUs had provided care to burns patients. A 100% response from these 32 units was obtained. 71.4% commence fluid resuscitation at 15% total body surface area burn (TBSA), 21.4% at 20% TBSA and 7.1% at 10% TBSA in adults. The estimated resuscitation volume was most often calculated using the Parkland/Modified Parkland formula (87.5%) or the Muir and Barclay formula (12.5%). Interestingly, of the ICUs using formulae, two had recently moved from using the Muir and Barclay formula to Parkland formula and one had recently moved from using the Parkland formula to Muir and Barclay formula. Despite this, 37.5% of ICUs using a formula did not rigidly follow it exactly. The most commonly used resuscitation fluid was Ringer's lactate solution (46.9%) and Human Albumin Solution was used in 12.5%. No ICU used red cell concentrate as a first line fluid. 18.8% used a central line. 40.6% ICUs considered changing the IV solution during resuscitation. 78.1% ICUs consider urine output to be the most important factor in modifying resuscitation volumes. 59.4% ICUs calculate a maintenance fluid rate after completion of resuscitation. The endpoint for resuscitation was at 24 h in 46.9% ICUs and at 36 h in 9.4%. 5/32 (16%) felt their protocol gave too little and 6/32 (19%) felt their protocol gave too much. 59.3% ICUs gave oral/enteral fluids by naso-gastric or naso-jejenal tubes. 21.9% felt that oral/enteral resuscitation worked. Exactly half of the units believed that the formula that they used provided approximately the right amount of fluid, with 25

  5. The direct healthcare costs associated with ankylosing spondylitis patients attending a UK secondary care rheumatology unit.

    Science.gov (United States)

    Ara, R M; Packham, J C; Haywood, K L

    2008-01-01

    To explore the direct healthcare resources associated with ankylosing spondylitis (AS) in the UK. A secondary objective was to establish if resources, and thus healthcare costs, vary by disease severity. Medical records of 147 sequential AS patients attending a UK secondary care rheumatology unit were examined to assess the direct healthcare resources used over the previous 12 months. Starting with a detailed inventory and measurement of resources consumed, unit cost multipliers were applied to the quantity of each type of resource consumed. The mean cost per patient was estimated using the total cost divided by the number of patients included. The mean (median) annual cost per patient was 1852 pounds sterling (892 pounds sterling). The distribution of cost data was skewed, with 11% of patients incurring 50% of the total costs. The three most relevant cost domains were physiotherapy, hospitalization and medication costs at 32, 21 and 20% of the total costs, respectively. Twenty percent of the patients received physiotherapy, 13% received inpatient care and almost all incurred medication costs. Thirty-four percent of patients were prescribed disease-modifying anti-rheumatic drugs and 85% non-steroidal anti-inflammatory drugs. Over 50% of patients had at least one comorbidity. Direct costs accelerate steeply with disease activity (Bath Ankylosing Spondylitis Disease Activity Index >6.0) and increasing loss of function (Bath Ankylosing Spondylitis Functional Index >6.0) in patients with AS. The most severely affected patients incur 50% of the total costs, and physiotherapy accounts for 32% of the total healthcare costs in the UK.

  6. Severe acidosis does not predict fatal outcomes in intensive care unit patients: a retrospective analysis.

    Science.gov (United States)

    Paz, Yoav; Zegerman, Alexander; Sorkine, Patrick; Matot, Idit

    2014-04-01

    Severe acidosis is a potentially life-threatening acid-base imbalance. The outcome of patients with severe acidosis has only been anecdotally described. We therefore assessed the discharge rate of such patients from the intensive care unit (ICU) and survival time after the event. A retrospective evaluation of medical records of patients admitted to the ICU of Tel Aviv Medical Center between 2005 and 2010, in whom arterial blood pH less than 6.8 was documented during their ICU stay, was performed. Twenty-eight patients were suitable for study entry. Septic shock was the most common underlying medical condition (33%). Nine (32.1%) patients were either discharged alive or survived for at least 30 days in the ICU after their arterial blood pH measurement was less than 6.8. More than a quarter of the patients with life-threatening acidosis (n = 8; 28.6%) were discharged home and returned to their prehospitalization daily activity. Mean follow-up period for these patients was 132 ± 111 weeks. Multivariate analysis identified hyperkalemia, Acute Physiology and Chronic Health Evaluation II score, and Glasgow Coma Scale as determinants for ICU death after severe acidosis. A significant number of patients can outlast severe acidosis and return to their prehospitalization status. Larger studies are needed to define the patient population most likely to benefit from aggressive resuscitation efforts during severe acidosis. Copyright © 2014 Elsevier Inc. All rights reserved.

  7. Unconventional Assessment Units in Burgos Basin Province, Sabinas Basin Province, Tampico-Misantla Basin Province, Northeast Mexico

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — The Assessment Unit is the fundamental unit used in the National and Global Petroleum Assessment Project for the assessment of undiscovered oil and gas resources....

  8. Eielson Air Force Base Operable Unit 2 baseline risk assessment

    Energy Technology Data Exchange (ETDEWEB)

    Lewis, R.E.; Jarvis, T.T.; Jarvis, M.R.; Whelan, G.

    1994-10-01

    Operable Unit 2 at Eielson Air Force Base (AFB) near Fairbanks, is one of several operable units characterized by petroleum, oil, and lubricant contamination, and by the presence of organic products floating at the water table, as a result of Air Force operations since the 1940s. The base is approximately 19,270 acres in size, and comprises the areas for military operations and a residential neighborhood for military dependents. Within Operable Unit 2, there are seven source areas. These source areas were grouped together primarily because of the contaminants released and hence are not necessarily in geographical proximity. Source area ST10 includes a surface water body (Hardfill Lake) next to a fuel spill area. The primary constituents of concern for human health include benzene, toluene, ethylbenzene, and xylenes (BTEX). Monitored data showed these volatile constituents to be present in groundwater wells. The data also showed an elevated level of trace metals in groundwater.

  9. For what reasons do patients file a complaint? A retrospective study on patient rights units' registries.

    Science.gov (United States)

    Önal, Gülsüm; Civaner, M Murat

    2015-01-01

    In 2004, Patient Rights Units were established in all public hospitals in Turkey to allow patients to voice their complaints about services. To determine what violations are reflected into the complaint mechanism, the pattern over time, and patients' expectations of the services. Descriptive study. A retrospective study performed using the complaint database of the Istanbul Health Directorate, from 2005 to 2011. The results indicate that people who are older than 40 years, women, and those with less than high school education are the most common patients in these units. A total of 218,186 complaints were filed. Each year, the number of complaints increased compared to the previous year, and nearly half of the applications were made in 2010 and 2011 (48.9%). The three most frequent complaints were "not benefiting from services in general" (35.4%), "not being treated in a respectable manner and in comfortable conditions" (17.8%), and "not being properly informed" (13.5%). Two-thirds of the overall applications were found in favour of the patients (63.3%), and but this rate has decreased over the years. Patients would like to be treated in a manner that respects their human dignity. Educating healthcare workers on communication skills might be a useful initiative. More importantly, health policies and the organisation of services should prioritise patient rights. It is only then would be possible to exercise patient rights in reality.

  10. Environmental Impact Assessment for Olkiluoto 4 Nuclear Power Plant Unit in Finland

    Energy Technology Data Exchange (ETDEWEB)

    Dersten, Riitta; Gahmberg, Sini; Takala, Jenni [Teollisuuden Voima Oyj, Olkiluoto, FI-27160 Eurajoki (Finland)

    2008-07-01

    In order to improve its readiness for constructing additional production capacity, Teollisuuden Voima Oyj (TVO) initiated in spring 2007 the environmental impact assessment procedure (EIA procedure) concerning a new nuclear power plant unit that would possibly be located at Olkiluoto. When assessing the environmental impacts of the Olkiluoto nuclear power plant extension project, the present state of the environment was first examined, and after that, the changes caused by the projects as well as their significance were assessed, taking into account the combined impacts of the operations at Olkiluoto. The environmental impact assessment for the planned nuclear power plant unit covers the entire life cycle of the plant unit. (authors)

  11. [What non invasive haemodynamic assessment in paediatric intensive care unit in 2009?].

    Science.gov (United States)

    Brissaud, O; Guichoux, J; Villega, F; Orliaguet, G

    2010-03-01

    The haemodynamic assessment of the patients is a daily activity in paediatric intensive care unit. It completes and is guided by the clinical examination. The will to develop the least invasive possible coverage of the patients is a constant concern. The haemodynamic monitoring, all the more if it is invasive, ceaselessly has to put in balance the profit and the risk of beginning this technique at a fragile patient. In the last three decades, numerous non-invasive haemodynamic tools were developed. The ideal one must be reliable, reproducible, with a time of fast, easily useful answer, with a total harmlessness, cheap and allowing a monitoring continues. Among all the existing tools (oesophageal Doppler ultrasound method, transthoracic echocardiography, NICO, thoracic impedancemetry, plethysmography, sublingual capnography), no one allies all these qualities. We can consider that the transthoracic echocardiography gets closer to most of these objectives. We shall blame it for its cost and for the fact that it is an intermittent monitoring but both in the diagnosis and in the survey, it has no equal among the non-invasive tools of haemodynamic assessment from part the quality and the quantity of the obtained information. The learning of the basic functions (contractility evaluation, cardiac output, cardiac and the vascular filling) useful for the start of a treatment is relatively well-to-do. We shall miss the absence of training in this tool in France in its paediatric and neonatal specificity within the university or interuniversity framework.

  12. [Improving patient safety: Usefulness of safety checklists in a neonatal unit].

    Science.gov (United States)

    Arriaga Redondo, María; Sanz López, Ester; Rodríguez Sánchez de la Blanca, Ana; Marsinyach Ros, Itziar; Collados Gómez, Laura; Díaz Redondo, Alicia; Sánchez Luna, Manuel

    2017-01-27

    Due to the complexity and characteristics of their patients, neonatal units are risk areas for the development of adverse events (AE). For this reason, there is a need to introduce and implement some tools and strategies that will help to improve the safety of the neonatal patient. Safety check-lists have shown to be a useful tool in other health areas but they are not sufficiently developed in Neonatal Units. A quasi-experimental prospective study was conducted on the design and implementation of the use of a checklist and evaluation of its usefulness for detecting incidents. The satisfaction of the health professionals on using the checklist tool was also assessed. The compliance rate in the neonatal intensive care unit (NICU) was 56.5%, with 4.03 incidents per patient being detected. One incident was detected for every 5.3 checklists used. The most frequent detected incidents were those related to medication, followed by inadequate alarm thresholds, adjustments of the monitors, and medication pumps. The large majority (75%) of the NICU health professionals considered the checklist useful or very useful, and 68.75% considered that its use had managed to avoid an AE. The overall satisfaction was 83.33% for the professionals with less than 5 years working experience, and 44.4% of the professionals with more than 5 years of experience were pleased or very pleased. The checklists have shown to be a useful tool for the detection of incidents, especially in NICU, with a positive assessment from the health professionals of the unit. Copyright © 2016. Publicado por Elsevier España, S.L.U.

  13. Neuropsychological assessment of patients with dementing illness.

    Science.gov (United States)

    Fields, Julie A; Ferman, Tanis J; Boeve, Bradley F; Smith, Glenn E

    2011-11-01

    Neuropsychological assessment has a distinct role in the detection and monitoring of cognitive and functional changes associated with dementing illness. Molecular, structural and functional neuroimaging studies have advanced our understanding of the anatomy and physiology underlying neurodegenerative disease; however, the overlap in pathological features of different dementia-associated diseases limits the information that can be obtained by these methods. Incorporation of information obtained from multiple sources can help to increase diagnostic and prognostic accuracy. Neuropsychological test findings provide unique value as biomarkers of dementia, as differentiators of disease topography and in the estimation of disease risk and trajectory. However, psychometric test properties--such as construct validity, stability and the use of appropriate norms--must be understood, because they influence both the application of neuropsychological tests and the interpretation of their results. Finally, measurement of cognitive strengths and weaknesses in patients at risk of dementia can be helpful to predict changes in functional abilities, design appropriate and effective interventions, and assist family and health-care providers in the planning of the patient's future care needs. This Review describes the key characteristics of neuropsychological testing in the assessment of patients at risk of dementia.

  14. Thopaz Portable Suction Systems in Thoracic Surgery: An end user assessment and feedback in a tertiary unit

    Directory of Open Access Journals (Sweden)

    Cantlin Teresa

    2011-04-01

    Full Text Available Abstract Background Thoracic surgical patients have chest drains inserted to enable re-expansion of lungs, to clear contents from the pleural cavity which sometimes require negative suction. Suction impedes mobility, may have variable suction delivery and increases risk of infection. Assessment of air-leak in conventional drains is not scientific and is subjective. Thopaz chest drain system is a portable suction unit which allows mobilization of the patient, with scientific digital flow recordings and an in built alarm system. Methods We evaluated the utility, staff and patient feedback of this device in a pilot evaluation in a regional thoracic unit in a structured format over a period of two months. Staff responses were graded on a scale of 1 to 6 [1 Excellent to 6 Poor]. Results 120 patients who underwent elective bullectomy/pleurectomy, VATS lung biopsies, VATS metastectomy and lung resections were evaluated. The staff feedback forms were positive. The staff liked the system as it was more scientific and accurately recordable. It made nursing and physiotherapy easier as they could mobilise patients early. The patients liked the compact design, weightlessness and the silence. It enabled mobilisation of the patients and scientific removal of chest drain. Conclusions Thopaz digital suction units were found to be user friendly and were liked by the staff and patients. The staff feedback stated the devices to be objective and scientific in making decisions about removal and enabled mobilisation.

  15. Thopaz Portable Suction Systems in Thoracic Surgery: An end user assessment and feedback in a tertiary unit

    Science.gov (United States)

    2011-01-01

    Background Thoracic surgical patients have chest drains inserted to enable re-expansion of lungs, to clear contents from the pleural cavity which sometimes require negative suction. Suction impedes mobility, may have variable suction delivery and increases risk of infection. Assessment of air-leak in conventional drains is not scientific and is subjective. Thopaz chest drain system is a portable suction unit which allows mobilization of the patient, with scientific digital flow recordings and an in built alarm system. Methods We evaluated the utility, staff and patient feedback of this device in a pilot evaluation in a regional thoracic unit in a structured format over a period of two months. Staff responses were graded on a scale of 1 to 6 [1 Excellent to 6 Poor]. Results 120 patients who underwent elective bullectomy/pleurectomy, VATS lung biopsies, VATS metastectomy and lung resections were evaluated. The staff feedback forms were positive. The staff liked the system as it was more scientific and accurately recordable. It made nursing and physiotherapy easier as they could mobilise patients early. The patients liked the compact design, weightlessness and the silence. It enabled mobilisation of the patients and scientific removal of chest drain. Conclusions Thopaz digital suction units were found to be user friendly and were liked by the staff and patients. The staff feedback stated the devices to be objective and scientific in making decisions about removal and enabled mobilisation. PMID:21510897

  16. National Assessment of Oil and Gas Project - Wind River Basin Province (035) Assessment Units Quarter-Mile Cells

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — Cell maps for each oil and gas assessment unit were created by the USGS to illustrate the degree of exploration, type of production, and distribution of production...

  17. Global Motor Unit Number Index sum score for assessing the loss of lower motor neurons in amyotrophic lateral sclerosis.

    Science.gov (United States)

    Grimaldi, Stephan; Duprat, Lauréline; Grapperon, Aude-Marie; Verschueren, Annie; Delmont, Emilien; Attarian, Shahram

    2017-02-06

    Introduction Our objective was to propose a motor unit number index (MUNIX) global sum score in amyotrophic lateral sclerosis (ALS) to estimate the loss of functional motor units. Methods MUNIX was assessed for 18 ALS patients and 17 healthy controls in seven muscles: the abductor pollicis brevis (APB), abductor digiti minimi (ADM), tibialis anterior (TA), deltoid, trapezius, submental complex (SMC) and orbicularis oris. Results MUNIX was significantly lower in ALS patients than in healthy controls for the APB, ADM, TA and the trapezius muscles. The MUNIX sum score of 4 muscles (ADM + APB + Trapezius + TA) was lower in ALS patients (P = 0.01) and was correlated with clinical scores. Discussion The global MUNIX sum score proposed in this study estimates the loss of lower motor neurons in several body regions including the trapezius, and is correlated with clinical impairment in ALS patients. This article is protected by copyright. All rights reserved.

  18. [Diabetic foot risk in patients with type II diabetes mellitus in a family medicine unit].

    Science.gov (United States)

    Márquez-Godínez, S A; Zonana-Nacach, A; Anzaldo-Campos, M C; Muñoz-Martínez, J A

    2014-01-01

    To determine the risk of diabetic foot in patients with type II diabetes mellitus (DM) seen in a Family Medicine Unit. The study included type II DM patients with a disease duration ≥ 5 years seen in a Family Medicine Unit, Tijuana, Mexico, during September-December 2011. Neuropathy was assessed with the Diabetic Neuropathy Symptom questionnaire, and pressure sensation using a 10-g Semmes-Weinstein monofilament. A patient had a high risk of diabetic foot if there was sensitivity loss, foot deformities, and non-palpable pedal pulses. We studied 205 patients with an average (± SD) age and DM duration of 59 ± 10 years and 10.7 ± 6.7 years, respectively. Ninety one patients (44%) had a high risk of developing diabetic foot, and it was associated with; an education of less than 6 years (OR 2.3; 95%CI: 1-1-4.1), DM disease duration ≥ 10 years (OR 5.1; 95%CI: 2.8-9.4), female gender (OR 2.0; 95%CI: 1.1-3.6), monthly familiar income diabetic neuropathy, since they have a high risk of diabetic foot. Copyright © 2013 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España. All rights reserved.

  19. The effect of Echinacea mouthwash on ventilator associated pneumonia in patients in intensive care units

    Directory of Open Access Journals (Sweden)

    Gholami Mehrabadi M

    2015-11-01

    Full Text Available Background and Objective: Ventilator associated pneumonia (VAP is one of the most prevalent hospital infections in intensive care units. Mouthwash is one of the caring procedures which can be effective in decreasing the rate of VAP. The present study was conducted to determine the effect of Echinacea mouthwash on prevalence of ventilator associated pneumonia in intensive care units. Materials and Method: In this clinical trial study, population was the intubated patients in intensive care units of educational hospitals in Arak in 2014. 70 patients were selected purposively and then were randomly allocated into two intervention and control groups, In intervention group, mouthwash with Echinacea and in control group with normal saline was done twice daily. The rate of VAP was assessed by Clinical Pulmonary Infection Scale (CPIS, before and on the fifth day of intervention. Data were analyzed by Chi square, independent T-test and fisher’s exact test through using SPSS16. Results: prevalence of Ventilator associated pneumonia was 60 percent in normal saline and 51.4 percent in Echinacea group buth the Chi square test didn’t show significant difference between two groups. Conclusion: According to results, Echinacea can relatively decrease the rate of VAP in ventilated patients, but more investigations in this area are essential.

  20. The United States National Climate Assessment - Alaska Technical Regional Report

    Science.gov (United States)

    Markon, Carl J.; Trainor, Sarah F.; Chapin, F. Stuart; Markon, Carl J.; Trainor, Sarah F.; Chapin, F. Stuart

    2012-01-01

    The Alaskan landscape is changing, both in terms of effects of human activities as a consequence of increased population, social and economic development and their effects on the local and broad landscape; and those effects that accompany naturally occurring hazards such as volcanic eruptions, earthquakes, and tsunamis. Some of the most prevalent changes, however, are those resulting from a changing climate, with both near term and potential upcoming effects expected to continue into the future. Alaska's average annual statewide temperatures have increased by nearly 4°F from 1949 to 2005, with significant spatial variability due to the large latitudinal and longitudinal expanse of the State. Increases in mean annual temperature have been greatest in the interior region, and smallest in the State's southwest coastal regions. In general, however, trends point toward increases in both minimum temperatures, and in fewer extreme cold days. Trends in precipitation are somewhat similar to those in temperature, but with more variability. On the whole, Alaska saw a 10-percent increase in precipitation from 1949 to 2005, with the greatest increases recorded in winter. The National Climate Assessment has designated two well-established scenarios developed by the Intergovernmental Panel on Climate Change (Nakicenovic and others, 2001) as a minimum set that technical and author teams considered as context in preparing portions of this assessment. These two scenarios are referred to as the Special Report on Emissions Scenarios A2 and B1 scenarios, which assume either a continuation of recent trends in fossil fuel use (A2) or a vigorous global effort to reduce fossil fuel use (B1). Temperature increases from 4 to 22°F are predicted (to 2070-2099) depending on which emissions scenario (A2 or B1) is used with the least warming in southeast Alaska and the greatest in the northwest. Concomitant with temperature changes, by the end of the 21st century the growing season is expected

  1. [Sedation and analgesia assessment tools in ICU patients].

    Science.gov (United States)

    Thuong, M

    2008-01-01

    Sedative and analgesic treatment administered to critically ill patients need to be regularly assessed to ensure that predefinite goals are well achieved as the risk of complications of oversedation is minimized. In most of the cases, which are lightly sedation patients, the goal to reach is a calm, cooperative and painless patient, adapted to the ventilator. Recently, eight new bedside scoring systems to monitor sedation have been developed and mainly tested for reliability and validity. The choice of a sedation scale measuring level of consciousness, could be made between the Ramsay sedation scale, the Richmond Agitation Sedation scale (RASS) and the Adaptation to The Intensive Care Environment scale-ATICE. The Behavioral Pain Scale (BPS) is a behavioral pain scale. Two of them have been tested with strong evidence of their clinimetric properties: ATICE, RASS. The nurses'preference for a convenient tool could be defined by the level of reliability, the level of clarity, the variety of sedation and agitation states represented user friendliness and speed. In fine, the choice between a simple scale easy to use and a well-defined and complex scale has to be discussed and determined in each unit. Actually, randomized controlled studies are needed to assess the potential superiority of one scale compared with others scales, including evaluation of the reliability and the compliance to the scale. The usefulness of the BIS in ICU for patients lightly sedated is limited, mainly because of EMG artefact, when subjective scales are more appropriated in this situation. On the other hand, subjective scales are insensitive to detect oversedation in patients requiring deep sedation. The contribution of the BIS in deeply sedation patients, patients under neuromuscular blockade or barbiturates has to be proved. Pharmacoeconomics studies are lacking.

  2. Nutritional assessment in cirrhotic patients with hepaticencephalopathy

    Institute of Scientific and Technical Information of China (English)

    2015-01-01

    Hepatic encephalopathy (HE) is one of the worstcomplications of liver disease and can be greatly influencedby nutritional status. Ammonia metabolism, inflammationand muscle wasting are relevant processes inHE pathophysiology. Malnutrition worsens the prognosisin HE, requiring early assessment of nutritional statusof these patients. Body composition changes inducedby liver disease and limitations superimposed by HEhamper the proper accomplishment of exams in thispopulation, but evidence is growing that assessmentof muscle mass and muscle function is mandatory dueto the role of skeletal muscles in ammonia metabolism.In this review, we present the pathophysiologicalaspects involved in HE to support further discussionabout advantages and drawbacks of some methods forevaluating the nutritional status of cirrhotic patients withHE, focusing on body composition.

  3. Healing gardens and cognitive behavioral units in the management of Alzheimer's disease patients: the Nancy experience.

    Science.gov (United States)

    Rivasseau Jonveaux, Therese; Batt, Martine; Fescharek, Reinhard; Benetos, Athanase; Trognon, Alain; Bah Chuzeville, Stanislas; Pop, Alina; Jacob, Christel; Yzoard, Manon; Demarche, Laetitia; Soulon, Laure; Malerba, Gabriel; Bouvel, Bruno

    2013-01-01

    The French Alzheimer Plan 2008-2012 anticipates the implementation of new Units specialized in cognitive rehabilitation and psycho-behavioral therapy of Alzheimer's disease (AD) patients. Conceived for AD and other dementia patients of all ages, their objectives are to propose a cognitive rehabilitation program, to prevent or treat psycho-behavioral crises, and to provide support and educational therapy to the family and professional caregivers, in order to ease the patient's return to his or her previous way of life. Studies on green spaces and healing gardens in health-care settings have revealed objective and measurable improvements in the patient's well-being. The Plan officially stipulates for the first time the need to make healing gardens an integral part of these Units, but it does not provide specific recommendations or criteria for implementing such gardens. Although green spaces and gardens are available in many French Care Units, they are rarely specifically adapted to the needs of AD patients. In Nancy, the Art, Memory and Life garden, a specific concept guided by a neuropsychological approach, was developed and complemented by an artistic vision based on cultural invariants. The main objective of this article is to describe the various steps of the process that led to the creation of this garden: the collection of experiences and information by a pilot group, surveys of patients, visitors, and caregivers before and after establishment of the garden, and implementation of a multi-professional group project. The specifications, the organizational criteria, the therapeutic project, and the criteria for the conception of such a garden stemming from our clinical experience with the Art, Memory and Life garden in Nancy, are described herein. We also present the first assessment following the implementation of the project.

  4. Prognostic Assessment in Patients with Hepatic Encephalopathy

    Directory of Open Access Journals (Sweden)

    Rita García-Martínez

    2011-01-01

    Full Text Available Hepatic encephalopathy (HE is a common complication of liver failure that is associated with poor prognosis. However, the prognosis is not uniform and depends on the underlying liver disease. Acute liver failure is an uncommon cause of HE that carries bad prognosis but is potentially reversible. There are several prognostic systems that have been specifically developed for selecting patients for liver transplantation. In patients with cirrhosis the prognosis of the episode of HE is usually dictated by the underlying precipitating factor. Acute-on-chronic liver failure is the most severe form of decompensation of cirrhosis, the prognosis depends on the number of associated organ failures. Patients with cirrhosis that have experienced an episode of HE should be considered candidates for liver transplant. The selection depends on the underlying liver function assessed by the Model for End-stage Liver Disease (MELD index. There is a subgroup that exhibits low MELD and recurrent HE, usually due to the coexistence of large portosystemic shunts. The recurrence of HE is more common in patients that develop progressive deterioration of liver function and hyponatremia. The bouts of HE may cause sequels that have been shown to persist after liver transplant.

  5. Utility of electroencephalogram in altered states of consciousness in intensive care unit patients

    Directory of Open Access Journals (Sweden)

    Kapadia F

    2005-01-01

    Full Text Available BACKGROUND: EEG is an investigative tool for assessing cerebral activity. Although certain EEG patterns may have a specific diagnostic or prognostic inference, they may not be precise for any sole etiology in majority of cases and may need clinical correlation. OBJECTIVE: Aim of this study was to assess the severity and prognosis of cerebral dysfunction in patients admitted to Intensive Care Unit (ICU and to evaluate the incidence of non-convulsive status epilepticus (NCSE. DESIGN: A prospective study, wherein we analyzed EEG characteristics in a series of 70 patients. SETTING: A tertiary care hospital in Mumbai, India. PATIENTS: EEG characteristics of 70 patients admitted in ICU over a period of 9 months were comprehensively analyzed. These patients were clinically examined and a questionnaire was completed without knowledge of the EEG findings. EEGs were requested for by neurologist or intensivist and our inclusion criteria were (i patients with altered sensorium of varying etiology, (ii unconscious patients at risk for non-convulsive status epilepticus (those with a history of epilepsy, and (iii unconscious patients with involuntary jerky eye movements. RESULTS: Of the various clinical presentations on ICU admission, there were 20 patients with seizures, 15 with metabolic disorders, 13 with infective causes, 9 with hypoxia, 9 with cerebro-vascular accident on presentation, 1 patient with alcohol/drug overdose, 2 with intra-cerebral space occupying lesion and 1 with ambiguous etiology on admission (there being an overlap among the presentation. Mean duration from presentation to performing EEG was 13 hours. 64 (91.42% patients had abnormal EEGs. 32(50% patients had EEG slowing and 4(6.25% patient had electro cerebral inactivity. Eleven (21.87% patients had epileptiform activity on the EEG of which seven did not have overt seizures (NCSE. Follow-up EEGs of these patients showed resolution of the epileptiform activity. CONCLUSIONS: EEG is useful

  6. Assessment of across-muscle coherence using multi-unit vs. single-unit recordings.

    Science.gov (United States)

    Johnston, Jamie A; Formicone, Gabriele; Hamm, Thomas M; Santello, Marco

    2010-12-01

    Coherence between electromyographic (EMG) signals has been used to identify correlated neural inputs to motor units (MUs) innervating different muscles. Simulations using a motor-unit model (Fuglevand et al. 1992) were performed to determine the ability of coherence between two multi-unit EMGs (mEMG) to detect correlated MU activity and the range of correlation strengths in which mEMG coherence can be usefully employed. Coherence between motor-unit and mEMG activities in two muscles was determined as we varied the strength of a 30-Hz periodic common input, the number of correlated MU pairs and variability of MU discharge relative to the common input. Pooled and mEMG coherence amplitudes positively and negatively accelerated, respectively, toward the strongest and most widespread correlating inputs. Furthermore, the relation between pooled and mEMG coherence was also nonlinear and was essentially the same whether correlation strength varied by changing common input strength or its distribution. However, the most important finding is that while the mEMG coherence saturates at the strongest common input strengths, this occurs at common input strengths greater than found in most physiological studies. Thus, we conclude that mEMG coherence would be a useful measure in many experimental conditions and our simulation results suggest further guidelines for using and interpreting coherence between mEMG signals.

  7. Development of a questionnaire for assessing work unit performance

    Directory of Open Access Journals (Sweden)

    H. H. Spangenberrg

    2004-10-01

    Full Text Available The aim of this study was to develop a generic work unit performance measure that can be utilised in private, public and non-profit work units. Development of such a questionnaire, called the Performance Index (PI comprised three steps, namely deciding on a baseline structure for the model; verifying the model and dimensions through subject expert feedback; and consolidating the model and refining the questionnaire. The sample consisted of 60 units rated on a 360 basis by 257 respondents. Item and dimensionality analysis, followed by confirmatory factor analysis utilising LISREL produced acceptable model fit. Overall, results provided reasonable psychometric support for the Performance Index. Opsomming Die doel van die studie was om ’n generiese werkeenheid- prestasiemeting te ontwikkel wat in privaat, openbare en nie-winsgerigte organisasies gebruik kan word. Die ontwikkeling van die vraelys, die Prestasie-Indeks (PI het drie stappe behels, naamlik om te besluit op ’n onderliggende struktuur vir die model; om die model en dimensies deur middel van ekspert-beoordeling te verifieer; en om die model te konsolideer en die vraelys af te rond. Die steekproef het bestaan uit 60 eenhede wat op ’n 360-basis deur 257 respondente beoordeel is. Item- en dimensionaliteitsontledings, gevolg deur Lisrel-gedrewe bevestigende faktorontleding het gedui op aanvaarbare modelpassing. In geheel beslou het resultate redelike psigometriese ondersteuning aan die Prestasie-Indeks verleen.

  8. Alaska maritime national wildlife refuge - Bearing Sea unit contaminant assessment

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — The purpose of the Contaminant Assessment Process (CAP) is to compile and summarize known past, present, and potential contaminant issues on National Wildlife...

  9. Sustainability Assessment Using a Unit-based Sustainability ...

    African Journals Online (AJOL)

    Sustainability Assessment Tool (USAT) and was guided by systems thinking and the ... Universities, through their mission of teaching, research and community service ..... could be 'World Heritage Sites, national, provincial, urban and privately ...

  10. Assessment of delirium in the intensive care unit

    African Journals Online (AJOL)

    Southern African Journal of Anaesthesia and Analgesia is co-published by Medpharm Publications, NISC (Pty) Ltd and Informa UK Limited ..... Management of Pain, Agitation, and Delirium in Adult Patients in ..... Korean J Anesthesiol. 2013 ...

  11. Associations of patient safety outcomes with models of nursing care organization at unit level in hospitals.

    Science.gov (United States)

    Dubois, Carl-Ardy; D'amour, Danielle; Tchouaket, Eric; Clarke, Sean; Rivard, Michèle; Blais, Régis

    2013-04-01

    To examine the associations of four distinct nursing care organizational models with patient safety outcomes. Cross-sectional correlational study. Using a standardized protocol, patients' records were screened retrospectively to detect occurrences of patient safety-related events. Binary logistic regression was used to assess the associations of those events with four nursing care organizational models. Twenty-two medical units in 11 hospitals in Quebec, Canada, were clustered into 4 nursing care organizational models: 2 professional models and 2 functional models. Two thousand six hundred and ninety-nine were patients hospitalized for at least 48 h on the selected units. Composite of six safety-related events widely-considered sensitive to nursing care: medication administration errors, falls, pneumonia, urinary tract infection, unjustified restraints and pressure ulcers. Events were ultimately sorted into two categories: events 'without major' consequences for patients and events 'with' consequences. After controlling for patient characteristics, patient risk of experiencing one or more events (of any severity) and of experiencing an event with consequences was significantly lower, by factors of 25-52%, in both professional models than in the functional models. Event rates for both functional models were statistically indistinguishable from each other. Data suggest that nursing care organizational models characterized by contrasting staffing, work environment and innovation characteristics may be associated with differential risk for hospitalized patients. The two professional models, which draw mainly on registered nurses (RNs) to deliver nursing services and reflect stronger support for nurses' professional practice, were associated with lower risks than are the two functional models.

  12. RELIABILITY ASSESSMENT OF ENTROPY METHOD FOR SYSTEM CONSISTED OF IDENTICAL EXPONENTIAL UNITS

    Institute of Scientific and Technical Information of China (English)

    Sun Youchao; Shi Jun

    2004-01-01

    The reliability assessment of unit-system near two levels is the most important content in the reliability multi-level synthesis of complex systems. Introducing the information theory into system reliability assessment, using the addible characteristic of information quantity and the principle of equivalence of information quantity, an entropy method of data information conversion is presented for the system consisted of identical exponential units. The basic conversion formulae of entropy method of unit test data are derived based on the principle of information quantity equivalence. The general models of entropy method synthesis assessment for system reliability approximate lower limits are established according to the fundamental principle of the unit reliability assessment. The applications of the entropy method are discussed by way of practical examples. Compared with the traditional methods, the entropy method is found to be valid and practicable and the assessment results are very satisfactory.

  13. Preoperative anxiety in surgical patients - experience of a single unit.

    Science.gov (United States)

    Matthias, Anne Thushara; Samarasekera, Dharmanbandhu Nandadeva

    2012-03-01

    Preoperative anxiety has a significant effect on the outcome of anesthesia and surgery. At present, there is no published data on the preoperative anxiety levels in Sri Lankan patients. In the West, several validated questionnaires such as The Amsterdam Preoperative Anxiety and Information Scale (APAIS) and State Trait Anxiety Inventory (STAI) are used. To measure the preoperative anxiety levels in patients using APAIS and to analyze the factors affecting anxiety and the role played by the anesthetist in allaying anxiety. One hundred patients scheduled for elective surgery were prospectively studied using the APAIS. The internal consistency was checked using Cronbach's alpha. The ages varied 25 to 72 years (mean=48.7 years, SD=13.6). Reliability of the APAIS was high; Cronbach's alpha=0.864 in the overall component and 0.84, 0.73 and 0.97 in the anxiety related to surgery, anesthesia and in the information desire components, respectively. Females were more anxious than males (p=0.02) and those who had never sustained surgery were more anxious than those who previously had surgery (p=0.05). An anesthetist's visit and premedication reduced total anxiety scores (Z=-3.07, p=0.002) and anesthesia related anxiety scores (Z=-3.45, p=0.001). The prevalence of anxiety is high among Sri Lankan patients. Females are more anxious than males and those who have never had surgery are more anxious than those who have had surgery. The anesthetist's visit could reduce anxiety. Sinhala version of the APAIS is highly reliable in assessing the preoperative anxiety levels. Copyright © 2012. Published by Elsevier B.V.

  14. Primary care units in Emilia-Romagna, Italy: an assessment of organizational culture.

    Science.gov (United States)

    Pracilio, Valerie P; Keith, Scott W; McAna, John; Rossi, Giuseppina; Brianti, Ettore; Fabi, Massimo; Maio, Vittorio

    2014-01-01

    This study investigates the organizational culture and associated characteristics of the newly established primary care units (PCUs)-collaborative teams of general practitioners (GPs) who provide patients with integrated health care services-in the Emilia-Romagna Region (RER), Italy. A survey instrument covering 6 cultural dimensions was administered to all 301 GPs in 21 PCUs in the Local Health Authority (LHA) of Parma, RER; the response rate was 79.1%. Management style, organizational trust, and collegiality proved to be more important aspects of PCU organizational culture than information sharing, quality, and cohesiveness. Cultural dimension scores were positively associated with certain characteristics of the PCUs including larger PCU size and greater proportion of older GPs. The presence of female GPs in the PCUs had a negative impact on collegiality, organizational trust, and quality. Feedback collected through this assessment will be useful to the RER and LHAs for evaluating and guiding improvements in the PCUs.

  15. Physical Therapy Observation and Assessment in the Neonatal Intensive Care Unit

    Science.gov (United States)

    Byrne, Eilish; Campbell, Suzann K.

    2013-01-01

    This article presents the elements of the Observation and Assessment section of the Infant Care Path for Physical Therapy in the Neonatal Intensive Care Unit (NICU). The types of physical therapy assessments presented in this path are evidence-based and the suggested timing of these assessments is primarily based on practice knowledge from expert…

  16. Speech Language Assessments in Te Reo in a Primary School Maori Immersion Unit

    Science.gov (United States)

    Naidoo, Kershni

    2012-01-01

    This research originated from the need for a speech and language therapy assessment in te reo Maori for a particular child who attended a Maori immersion unit. A Speech and Language Therapy te reo assessment had already been developed but it needed to be revised and normative data collected. Discussions and assessments were carried out in a…

  17. 1.8 K Refrigeration Units for the LHC: Performance Assessment of Pre-series Units

    CERN Document Server

    Claudet, S; Millet, F; Tavian, L; 20th International Cryogenic Engineering Conference (ICEC20)

    2005-01-01

    The cooling capacity below 2 K for the superconducting magnets of the Large Hadron Collider (LHC), at CERN, will be provided by eight refrigeration units of 2400 W at 1.8 K, each of them coupled to a 4.5 K refrigerator. The two selected vendors have proposed cycles based on centrifugal cold compressors combined with volumetric screw compressors with sub-atmospheric suction, as previously identified by CERN as “reference cycle”. The supply of the series units was linked to successful testing and acceptance of the pre-series temporarily installed in a dedicated test station. The global capacity, the performance of cold compressors and some process specificities have been thoroughly tested and will be presented.

  18. Reproducibility of mandibular third molar assessment comparing two cone beam CT units in a matched pairs design.

    Science.gov (United States)

    Matzen, L H; Hintze, H; Spin-Neto, R; Wenzel, A

    2013-01-01

    The aim of this study was to evaluate the reproducibility of the third molar assessment, comparing five observers and two cone beam CT (CBCT) units. 28 patients, each with two impacted mandibular third molars, were included. Each patient was randomly examined with a Scanora(®) 3D (Soredex, Helsinki, Finland) CBCT unit in one mandibular third molar region and with a Cranex(®) 3D (Soredex) CBCT unit in the other region. Five observers with varying CBCT experience assessed all third molars and recorded the following variables: number and morphology of the roots, relation to the mandibular canal in two directions, shape of the canal and whether there was a direct contact between the roots of the molar and the mandibular canal. The radiographic assessments were compared pairwise among all observers for all variables. Wilcoxon's signed-rank test was used to test the differences in observer accordance percentages among the recorded variables in the images from the two units, and kappa statistics expressed interobserver reproducibility. The mean percentages for observer accordance ranged from 65.4 to 92.9 for Scanora 3D and 60.3 to 94.8 for Cranex 3D. There was no significant difference between the observer accordance in the two CBCT units (p > 0.05), except for assessing root flex in the mesiodistal direction, for which the observer accordance was higher for Scanora 3D (p third molar assessment. Observer variation existed, and experienced radiologists demonstrated the highest interobserver reproducibility for canal-related variables.

  19. Functional Recovery in Patients With and Without Intensive Care Unit-Acquired Weakness.

    Science.gov (United States)

    Dettling-Ihnenfeldt, Daniela Susanne; Wieske, Luuk; Horn, Janneke; Nollet, Frans; van der Schaaf, Marike

    2017-04-01

    The aim of this work was to compare the patient-reported functional health status with regard to physical, psychological, and social functioning of intensive care unit (ICU) survivors with and without ICU-acquired weakness (ICU-AW). Single-center prospective study in ICU patients who were mechanically ventilated for more than 2 days and who survived to ICU discharge. Functional health status was assessed at 3, 6, and 12 months after ICU discharge, using the Sickness Impact Profile 68 (SIP68). The independent effect of ICU-AW on impaired functional status (SIP68 scores > 20) was analyzed using a multivariable logistic regression model. A total of 133 patients were included, 60 with ICU-AW. Intensive care unit-acquired weakness was an independent predictor for impaired functional health status at 3 months after ICU discharge (odds ratio, 0.27; 95% confidence interval, 0.08-0.94; P = 0.04) but not at 6 and 12 months. Physical functioning was significantly more impaired in patients with ICU-AW at 3 and 12 months. Psychological functioning and social functioning were comparable between the groups, with little restrictions in psychological functioning, and severe long-lasting restrictions in social functioning. The findings of this study urge the need to develop interdisciplinary rehabilitation interventions for ICU survivors, which should be continued after hospital discharge.

  20. Assessment of geothermal resources of the United States, 1978

    Energy Technology Data Exchange (ETDEWEB)

    Muffler, L.J.P. (ed.)

    1979-01-01

    The geothermal resource assessment presented is a refinement and updating of USGS Circular 726. Nonproprietary information available in June 1978 is used to assess geothermal energy in the ground and, when possible, to evaluate the fraction that might be recovered at the surface. Five categories of geothermal energy are discussed: conduction-dominated regimes, igneous-related geothermal systems, high-temperature (> 150/sup 0/C) and intermediate-temperature (90 to 150/sup 0/C) hydrothermal convection systems, low-temperature (< 90/sup 0/C) geothermal waters, and geopressured-geothermal energy (both thermal energy and energy from dissolved methane). Assessment data are presented on three colored maps prepared in cooperation with the National Oceanic and Atmospheric Administration. Separate abstracts were prepared for papers on these five categories.

  1. Piloting yoga and assessing outcomes in a residential behavioural health unit.

    Science.gov (United States)

    McIlvain, S J; Miller, B; Lawhead, B A; Barbosa-Leiker, C; Anderson, A

    2015-04-01

    measures were tracked over 8 weeks. Adolescents participated in yoga, with a higher participation rate for girls compared with boys. The TEIQue-ASF assessment detected changes in total score over 8 weeks. Increased yoga participation was related to higher values of the TEIQue-ASF subdomain of sociability, increase in weekly point card totals, and a decrease in combined behavioural interventions at various time points throughout the programme. This study was relevant because it was conducted on an adolescent inpatient unit. Further studies are needed to determine if changes can be attributed to yoga or other behavioural-based interventions. If supported by further studies, yoga has the potential to be a complimentary therapy that can be integrated into the multidisciplinary treatment approach for mental health patients.

  2. Oral care in patients on mechanical ventilation in intensive care unit: literature review

    Directory of Open Access Journals (Sweden)

    Selma Atay

    2014-06-01

    Full Text Available intensive care patients needs to oral assessment and oral care for avoid complications caused by orafarengeal bacteria. In this literature review, it is aimed to determine the practice over oral hygiene in mechanical ventilator patients in intensive care unit. For the purpose of collecting data, Medline/pub MED and EBSCO HOST databases were searched with the keywords and lsquo;oral hygiene, oral hygiene practice, mouth care, mouth hygiene, intubated, mechanical ventilation, intensive care and critical care and rdquo; between the years of 2000- 2012. Inclusion criteria for the studies were being performed in adult intensive care unit patients on mechanical ventilation, published in peer-reviewed journals in English between the years of 2000-2012, included oral care practice and presence of a nurse among researchers. A total of 304 articles were identified. Six descriptive evaluation studies, three randomised controlled trials, four literature reviews, three meta-Analysis randomized clinical trials, one qualitative study and one semi-experimental study total 18 papers met all of the inclusion criteria. Oral care is emphasized as an infection control practice for the prevention of Ventilator-Associated Pneumonia (VAP. In conclusion, we mention that oral care is an important nursing practice to prevent VAP development in intensive care unit patients; however, there is no standard oral evaluation tool and no clarity on oral care practice frequency, appropriate solution and appropriate material. It can be recommended that the study projects on oral care in intensive care patients to have high proof level and be experimental, and longitudinal. [Int J Res Med Sci 2014; 2(3.000: 822-829

  3. Map of assessed continuous (unconventional) oil resources in the United States, 2014

    Science.gov (United States)

    ,; Biewick, Laura R. H.

    2015-01-01

    The U.S. Geological Survey (USGS) conducts quantitative assessments of potential oil and gas resources of the onshore United States and associated coastal State waters. Since 2000, the USGS has completed assessments of continuous (unconventional) resources in the United States based on geologic studies and analysis of well-production data and has compiled digital maps of the assessment units classified into four categories: shale gas, tight gas, coalbed gas, and shale oil or tight oil (continuous oil). This is the fourth digital map product in a series of USGS unconventional oil and gas resource maps; its focus being shale-oil or tight-oil (continuous-oil) assessments. The map plate included in this report can be printed in hardcopy form or downloaded in a Geographic Information System (GIS) data package, which includes an ArcGIS ArcMap document (.mxd), geodatabase (.gdb), and a published map file (.pmf). Supporting geologic studies of total petroleum systems and assessment units, as well as studies of the methodology used in the assessment of continuous-oil resources in the United States, are listed with hyperlinks in table 1. Assessment results and geologic reports are available at the USGS websitehttp://energy.usgs.gov/OilGas/AssessmentsData/NationalOilGasAssessment.aspx.

  4. Assessing the Caprini Score for Risk Assessment of Venous Thromboembolism in Hospitalized Medical Patients

    Science.gov (United States)

    Chopra, Vineet; Bernstein, Steven J.; Hofer, Timothy P.; Flanders, Scott A.

    2017-01-01

    Background The optimal approach to assess risk of venous thromboembolism (VTE) in hospitalized medical patients is unknown. We examined how well the Caprini risk assessment model (RAM) predicts VTE in hospitalized medical patients. Methods Between January 2011 and March 2014, VTE events and risk factors were collected from non-intensive care unit (ICU) medical patients hospitalized in facilities across Michigan. Following calculation of the Caprini score for each patient, mixed logistic spline regression was used to determine the predicted probabilities of 90-day VTE by receipt of pharmacologic prophylaxis across the Caprini risk continuum. Results A total of 670 (1.05%) of 63,548 eligible patients experienced a VTE event within 90 days of hospital admission. The mean Caprini risk score was 4.94 (range 0 - 28). Predictive modeling revealed a consistent linear increase in VTE for Caprini scores between 1-10; estimates beyond a score of 10 were unstable. Receipt of pharmacologic prophylaxis resulted in a modest decrease in VTE risk (odds ratio=0.85; 95% confidence interval 0.72 - 0.99, p = 0.04). However, the low overall incidence of VTE led to large estimates of numbers needed to treat in order to prevent a single VTE event. A Caprini cut-point demonstrating clear benefit of prophylaxis was not detected. Conclusions Although a linear association between the Caprini RAM and risk of VTE was noted, an extremely low incidence of VTE events in non-ICU medical patients was observed. The Caprini RAM was unable to identify a subset of medical patients who benefit from pharmacologic prophylaxis. PMID:26551977

  5. Undiscovered gas resources assessment unit boundaries for Bangladesh (au8bg)

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This coverage includes arcs, polygons, and polygon labels that describe the undiscovered natural gas resources assessment unit boundaries of the Bangladesh. This...

  6. Final Environmental Assessment : Livestock Grazing Management Seven Blackfeet Habitat Unit : Charles M. Russell National Wildlife Refuge

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — Final environmental assessment for the grazing management within the Seven Blackfeet Habitat Unit of the Charles M. Russell National Wildlife Refuge, in relation to...

  7. Environmental Assessment for the Reestablishment of Water Control Unit 2: Prime Hook National Wildlife Refuge: 1986

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — An environmental assessment for reestablishment of water control in Unit II of the Prime Hook National Wildlife Refuge was prepared in November, 1985. The Fish and...

  8. ASSESSMENT OF MALNUTRITION IN AN INCENTRE HAEMODIALYSIS UNIT- SINGLE CENTRE EXPERIENCE

    Directory of Open Access Journals (Sweden)

    Meri Manafi

    2012-06-01

    In conclusion there is discrepancy in the rate of malnutrition when assessed according to different tools. MIS has been shown to be a better predictor of survival in dialysis patients. We need interventional studies to assess the utility of MIS in improving patient outcome and survival in dialysis patients

  9. Managing acute medical admissions: a survey of acute medical services and medical assessment and planning units in New Zealand.

    Science.gov (United States)

    Providence, C; Gommans, J; Burns, A

    2012-01-01

    To determine the current provision of acute medical services, including the development of medical assessment and planning units (MAPUs), by district health boards (DHBs) throughout New Zealand (NZ). A questionnaire-based survey about organisation of acute medical services and establishment of MAPUs was sent to all 21 DHBs in NZ. All 21 DHBs responded. Seven DHBs serving 42% of the population have established MAPUs since 2003 and a further six have plans to do so over the next 3 years, potentially expanding service to 73% of the NZ population. All seven current MAPUs are in close proximity to and accept patients directly from emergency departments. Each MAPU has a documented target length of stay, four units have referral protocols, five provide guidelines for management of common medical emergencies and five routinely audit unit performance. Five MAPUs have cardiac monitored beds and isolation rooms. Rapid access is available to computed tomography scanning (six units), ultrasound (five) and echocardiography (four). Two units have no nominated physician leadership and two lack dedicated therapy resources. General physicians are involved in provision of acute medical services in 20 of 21 DHBs. Medical assessment and planning units have become an important component of acute medical service provision in NZ. The established units largely comply with Australasian recommendations, although important deficiencies exist. Training of physicians must combine the needs of acute medical patients and clinical roles of physicians within MAPUs with local DHB requirements for services to be most effective. © 2010 The Authors. Internal Medicine Journal © 2010 Royal Australasian College of Physicians.

  10. Knowledge, attitude and practices of diabetic patients in the United Arab Emirates.

    Directory of Open Access Journals (Sweden)

    Fatma Al-Maskari

    Full Text Available INTRODUCTION: Diabetes self-management education is a cornerstone of diabetes care. However, many diabetics in the United Arab Emirates (UAE lack sufficient knowledge about their disease due to illiteracy. Thus, before considering any possible intervention it was imperative to assess present knowledge, attitudes, and practices of patients towards the management of diabetes. METHODS: A random sample of 575 DM patients was selected from diabetes outpatient's clinics of Tawam and Al-Ain hospitals in Al-Ain city (UAE during 2006-2007, and their knowledge attitude and practice assessed using a questionnaire modified from the Michigan Diabetes Research Training Center instrument. RESULTS: Thirty-one percent of patients had poor knowledge of diabetes. Seventy-two had negative attitudes towards having the disease and 57% had HbA(1c levels reflecting poor glycemic control. Only seventeen percent reported having adequate blood sugar control, while 10% admitted non-compliance with their medications. Knowledge, practice and attitude scores were all statistically significantly positively, but rather weakly, associated, but none of these scores was significantly correlated with HbA(1c. CONCLUSIONS: The study showed low levels of diabetes awareness but positive attitudes towards the importance of DM care and satisfactory diabetes practices in the UAE. Programs to increase patients' awareness about DM are essential for all diabetics in the UAE in order to improve their understanding, compliance and management and, thereby, their ability to cope with the disease.

  11. Knowledge, Attitude and Practices of Diabetic Patients in the United Arab Emirates

    Science.gov (United States)

    Al-Maskari, Fatma; El-Sadig, Mohamed; Al-Kaabi, Juma M.; Afandi, Bachar; Nagelkerke, Nicolas; Yeatts, Karin B.

    2013-01-01

    Introduction Diabetes self-management education is a cornerstone of diabetes care. However, many diabetics in the United Arab Emirates (UAE) lack sufficient knowledge about their disease due to illiteracy. Thus, before considering any possible intervention it was imperative to assess present knowledge, attitudes, and practices of patients towards the management of diabetes. Methods A random sample of 575 DM patients was selected from diabetes outpatient's clinics of Tawam and Al-Ain hospitals in Al-Ain city (UAE) during 2006–2007, and their knowledge attitude and practice assessed using a questionnaire modified from the Michigan Diabetes Research Training Center instrument. Results Thirty-one percent of patients had poor knowledge of diabetes. Seventy-two had negative attitudes towards having the disease and 57% had HbA1c levels reflecting poor glycemic control. Only seventeen percent reported having adequate blood sugar control, while 10% admitted non-compliance with their medications. Knowledge, practice and attitude scores were all statistically significantly positively, but rather weakly, associated, but none of these scores was significantly correlated with HbA1c. Conclusions The study showed low levels of diabetes awareness but positive attitudes towards the importance of DM care and satisfactory diabetes practices in the UAE. Programs to increase patients' awareness about DM are essential for all diabetics in the UAE in order to improve their understanding, compliance and management and, thereby, their ability to cope with the disease. PMID:23341913

  12. Retrospective Assessment of Follicular Unit Density in Asian Men With Androgenetic Alopecia.

    Science.gov (United States)

    Ortega-Castillejos, Dell Kristie A; Pathomvanich, Damkerng

    2017-05-01

    Hair density, together with hair diameter has a tremendous impact on the cosmetic outcome of hair transplantation surgery. This retrospective study aims to assess the average number of follicular unit (FU) grafts in the donor area of Asian men with androgenetic alopecia. Seventy patients (ages 24-65 years old) with virgin scalp who had their first hair transplantation were included. During the harvesting procedure, a 2- to 3-cm-wide area of the donor site was shaved from ear to ear with 5 specific areas assigned as reference points for the study namely the central occipital area, left and right parietal and temporal areas. A video microscope was used to capture the field of each reference point. Follicular units in each area were counted and the number of 1-hair, 2-hair, and 3-hair follicular groupings was recorded. East and Southeast Asians had an average of 61.1 FU/cm (111.2 hairs/cm); West Asians had an average density of 63.6 FU/cm (126.8 hairs/cm); South Asians were noted to have an average density of 63.5 FU/cm (126.8 hairs/cm). Asian hair density has slight variations in the number of FU grafts in each donor area.

  13. Risk assessment of tuberculosis in immunocompromised patients

    DEFF Research Database (Denmark)

    Sester, Martina; van Leth, Frank; Bruchfeld, Judith

    2014-01-01

    of TST and IGRAs in five different groups of immunocompromised patients, and evaluated their ability to identify those at risk for development of tuberculosis. METHODS: Immunocompromised patients with HIV infection, chronic renal failure, rheumatoid arthritis, solid-organ or stem-cell transplantation......, and healthy control subjects were evaluated head-to-head by the TST, QuantiFERON-TB-Gold in-tube test (ELISA), and T-SPOT.TB test (enzyme-linked immunospot) at 17 centers in 11 European countries. Development of tuberculosis was assessed during follow-up. MEASUREMENTS AND MAIN RESULTS: Frequencies of positive...... test results varied from 8.7 to 15.9% in HIV infection (n = 768), 25.3 to 30.6% in chronic renal failure (n = 270), 25.0% to 37.2% in rheumatoid arthritis (n = 199), 9.0 to 20.0% in solid-organ transplant recipients (n = 197), 0% to 5.8% in stem-cell transplant recipients (n = 103), and 11.2 to 15...

  14. Thermal Storage Systems Assessment for Energy Sustainability in Housing Units

    Directory of Open Access Journals (Sweden)

    Tania I. Lagunes Vega

    2016-04-01

    Full Text Available In order to achieve greater enhancements in energy sustainability for housing, the function and efficiency of two different passive cooling systems were studied: encapsulated water in recycled bottles of Polyethylene terephthalate (PET and polystyrene plates, in comparison with standard concrete slab systems, which are customarily used in housing. Experiments were placed over a tile surface, in which temperature changes were monitored for a period of 20 days from 08:00 to 20:00. The efficiency of passive thermal storage systems was endorsed through statistical analysis using the “SPSS” software. This resulted in a 17% energy saving, thus promoting energy sustainability in housing units, which reduces the use of electrical appliances required to stabilize conditions to achieve optimum thermal comfort for the human body inside a house, therefore, reducing electrical power consumption, CO2 emissions to the atmosphere and generating savings. Due to the complexity of a system with temperature changes, a fractal analysis was performed for each experimental system, using the “Benoit” software (V.1.3 with self-compatible tools of rescaled range (R/S and a wavelets method, showing that the thermal fluctuations on the tiles with the thermal storage system adapt to the rescaled range analysis and the regular tiles adapt to the wavelets method.

  15. Low HDL levels in sepsis versus trauma patients in intensive care unit.

    Science.gov (United States)

    Tanaka, Sébastien; Labreuche, Julien; Drumez, Elodie; Harrois, Anatole; Hamada, Sophie; Vigué, Bernard; Couret, David; Duranteau, Jacques; Meilhac, Olivier

    2017-12-01

    The protective cardiovascular effect of high-density lipoproteins (HDLs) is considered to chiefly rely on reverse cholesterol transport from peripheral tissues back to the liver. However, HDL particles display pleiotropic properties, including anti-inflammatory, anti-apoptotic or antioxidant functions. Some studies suggest that HDL concentration decreases during sepsis, and an association was reported between low HDL levels and a poor outcome. Like sepsis, trauma is also associated with a systemic inflammatory response syndrome. However, no study has yet explored changes in lipid profiles during trauma. We sought to compare lipid profiles between sepsis and trauma patients in intensive care unit (ICU). In septic patients, we analyzed the association between lipid profile, severity and prognosis. A prospective, observational, single-centered study was conducted in a surgical ICU. For each patient, total cholesterol, HDL, triglyceride and low-density lipoprotein cholesterol levels were assessed at admission. Short-term prognosis outcome was prospectively assessed. Seventy-five consecutive patients were admitted (50 sepsis and 25 trauma). There was no difference in SOFA and SAPSII scores between the two groups. Patients with sepsis had lower total cholesterol levels than patients with trauma. Regarding the lipoprotein profile, only HDLs differed significantly between the two groups (median [IQR] = 0.33 mmol/l [0.17-0.78] in sepsis patients versus median [IQR] = 0.99 mmol/l [0.74-1.28] in trauma patients; P HDL concentration and the length of ICU stay (r = -0.35; P = 0.03) in the group of survivor septic patients at ICU discharge. In addition, poor outcome defined as death or a SOFA score >6 at day 3 was associated with lower HDL levels (median [IQR] = 0.20 mmol/l [0.11-0.41] vs. 0.35 mmol/l [0.19-0.86] in patients with poor outcome versus others; P = 0.03). Lipid profile was totally different between sepsis and trauma in ICU patients: HDL levels were

  16. Perceived quality in a dementia unit: patients' caregivers as information providers.

    Science.gov (United States)

    López-Picazo, J J; de Dios Cánovas-García, J; Antúnez, C; Marín, J; Antequera, M M; Vivancos, L; Martínez, B; Legaz, A; Navarro, D; Leal, M

    2016-10-22

    Dementia units (DU) provide comprehensive and specialised care to patients with dementia. However, assessment in these units normally focuses on patient management. The aim of this study was to determine satisfaction of the caregivers of patients managed in a DU and how they rated DU care. We created a self-administered questionnaire which was completed by 236 caregivers visiting the DU in 2015. The questionnaire included 6 dimensions (accessibility, organisation, professionalism, relationship with staff, information, and facilities); data were analysed using problem rates. A total of 53.4% caregivers completed the questionnaire; most were women, patients' spouses, or first-degree relatives. The overall problem rates was 15.0% (95% CI, 13.9-16.1), with sizeable differences between dimensions: from 0.1% (95% CI, 0.0-0.4) for 'relationship with staff' and 'professionalism' to 49.3% (95% CI, 45.4-53.2) for 'information'. Waiting times over 30minutes were perceived as excessive. Information problems were not directly related to patient management. Satisfaction was scored 8.29/10 (median 8; SD 1.45); 77.3% (95% CI, 69.8-74.8) of respondents were highly satisfied. Ninety-nine percent of the caregivers stated that they would recommend the DU. This questionnaire provides interesting data on care quality as perceived by patients' caregivers. Our results have allowed us to identify problems and implement corrective actions. Our questionnaire has proved to be a useful tool for evaluating and improving care quality in DUs. Copyright © 2016 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

  17. Oral care practices for patients in Intensive Care Units: A pilot survey

    Directory of Open Access Journals (Sweden)

    Alexandre Franco Miranda

    2016-01-01

    Full Text Available Objective: To assess the level of knowledge and difficulties concerning hospitalized patients regarding preventive oral health measures among professionals working in Intensive Care Units (ICUs. Study Population and Methods: A cross-sectional survey was conducted among 71 health professionals working in the ICU. A self-administered questionnaire was used to determine the methods used, frequency, and attitude toward oral care provided to patients in Brazilian ICUs. The variables were analyzed using descriptive statistics (percentages. A one-sample t-test between proportions was used to assess significant differences between percentages. t-statistics were considered statistically significant for P < 0.05. Bonferroni correction was applied to account for multiple testing. Results: Most participants were nursing professionals (80.3% working 12-h shifts in the ICU (70.4%; about 87.3% and 66.2% reported having knowledge about coated tongue and nosocomial pneumonia, respectively (P < 0.05. Most reported using spatulas, gauze, and toothbrushes (49.3% or only toothbrushes (28.2% with 0.12% chlorhexidine (49.3% to sanitize the oral cavity of ICU patients (P < 0.01. Most professionals felt that adequate time was available to provide oral care to ICU patients and that oral care was a priority for mechanically ventilated patients (80.3% and 83.1%, respectively, P < 0.05. However, most professionals (56.4% reported feeling that the oral cavity was difficult to clean (P < 0.05. Conclusion: The survey results suggest that additional education is necessary to increase awareness among ICU professionals of the association between dental plaque and systemic conditions of patients, to standardize oral care protocols, and to promote the oral health of patients in ICUs.

  18. Assessment of Geothermal Resources of the United States--1975

    Energy Technology Data Exchange (ETDEWEB)

    White, D.E.; Williams, D.L. [eds.

    1975-01-01

    This is the first of two significant assessments of the geological energy potential of the U.S. The second one is U.S.G.S. Circular 790. Systems analyzed include: Hydrothermal convection systems (with estimates of potential for many specific sites in the West), Igneous related systems (related to current or recent volcanism), Estimates of the conductive transport of heat in most areas of CONUS, Recovery of heat from molten igneous systems (magma), and Geopressured geothermal energy in the Gulf Coast area. The significance of this report is that it began to give policy makers a first handle on the quantities and qualities of geothermal energy in the ground in much of the U.S. Economics (costs and revenues) are not considered. (DJE - 2005)

  19. Integrated risk assessment for multi-unit NPP sites—A comparison

    Energy Technology Data Exchange (ETDEWEB)

    Kumar, C. Senthil, E-mail: cskumar@igcar.gov.in [AERB-Safety Research Institute, Kalpakkam (India); Hassija, Varun; Velusamy, K. [Reactor Design Group, Indira Gandhi Centre for Atomic Research, Kalpakkam (India); Balasubramaniyan, V. [AERB-Safety Research Institute, Kalpakkam (India)

    2015-11-15

    Highlights: • Framework for integrated risk assessment for multi-unit NPP sites. • Categorization of external and internal events. • Modelling of key issues: mission time, cliff-edge, common cause failures, etc. • Safety goals for multi-unit NPP sites. • Comparison of site core damage frequency in one, two, three and four unit sites. - Abstract: Most of the nuclear power producing sites in the world houses multiple units. Such sites are faced with hazards generated from external events: earthquake, tsunami, flood, etc. and can threaten the safety of nuclear power plants. Further, risk from a multiple unit site and its impact on the public and environment was evident during the Fukushima nuclear disaster in March 2011. It is therefore important to evolve a methodology to systematically assess the risk from multi-unit site. For a single unit site, probabilistic risk assessment technique identifies the potential accident scenarios, their consequences, and estimates the core damage frequency that arise due to internal and external hazards. This challenging task becomes even more complex for a multiple unit site, especially when the external hazards that has the potential to generate one or more correlated hazards or a combination of non-correlated hazards are to be modelled. This paper presents an approach to evaluate risk for multiple NPP sites and also compare the risk for sites housing single, double and multiple nuclear plants.

  20. Guiding principles for good practices in hospital-based health technology assessment units

    DEFF Research Database (Denmark)

    Sampietro-Colom, Laura; Lach, Krzysztof; Pasternack, Iris

    2015-01-01

    OBJECTIVES: Health technology assessment (HTA) carried out for policy decision making has well-established principles unlike hospital-based HTA (HB-HTA), which differs from the former in the context characteristics and ways of operation. This study proposes principles for good practices in HB....... In total, 385 people from twenty countries have participated in defining the principles for good practices in HB-HTA units. RESULTS: Fifteen guiding principles for good practices in HB-HTA units are grouped in four dimensions. Dimension 1 deals with principles of the assessment process aimed at providing......- and long-term impact of the overall performance of HB-HTA units. Finally, nine core guiding principles were selected as essential requirements for HB-HTA units based on the expertise of the HB-HTA units participating in the project. CONCLUSIONS: Guiding principles for good practices set up a benchmark...

  1. The prevalence of macrovascular complications among diabetic patients in the United Arab Emirates

    Directory of Open Access Journals (Sweden)

    Norman John N

    2007-09-01

    Full Text Available Abstract Background Diabetes Mellitus (DM is a major public health problem in the UAE with a prevalence rate reaching 24% in national citizens and 17.4% in expatriates. The aim of this study was to determine the prevalence and risk factors of macrovascular complications among diabetic patients in the Al-Ain district of the United Arab Emirates (UAE. Methods The study was part of a general cross-sectional survey carried out to assess the prevalence of diabetes (DM complications among known diabetic patients in Al-Ain District, UAE. Patients were randomly selected during 2003/2004. Patients completed an interviewer-administered questionnaire carried out by treating doctors and underwent a complete medical assessment including measurement of height, weight, blood pressure and examination for evidence of macrovascular complications. A standard ECG was recorded and blood samples were taken to document fasting blood sugar, glycosylated haemoglobin (HbA1C and lipid profile. Results A sample of 513 diabetic patients was selected with a mean age of 53 years (SD ± 13.01. Overall, 29.5% of DM patients had evidence of macrovascular complications: 11.6% (95% CI: 8.8–14.4 of patients had peripheral vascular disease (PVD, 14.4% (95% CI: 11.3–17.5 had a history of coronary artery disease (CAD and 3.5% (95% CI: 1.9–5.1% had cerebrovascular disease (CVD. Of the total population surveyed 35% (95%CI: 30.8–39 had hypertension. The analysis showed that macrovascular complications in diabetic patients were more common among males, increased with age, were more common among hypertensive patients and its prevalence increased steadily with duration of DM. Conclusion Our data revealed a significant association between hypertension and presence of macrovascular disease among diabetic patients. However, the risk of CAD in the UAE was relatively low compared to that seen in patients in other geographical settings. In addition, a lack of correlation between

  2. Functional assessment of feet of patients with type II diabetes

    Directory of Open Access Journals (Sweden)

    Vinicius Saura Cardoso

    2014-09-01

    Full Text Available Objective: To evaluate the incidence of functional changes and risk of developing ulcers in type II diabetic patients seen in Primary Healthcare Units (Unidades Básicas de Saúde- UBS. Methods: A cross-sectional, quantitative and descriptive study comprising 80patients with type II diabetes mellitus (DM aged between 41 to 85 years and attended inthe UBS in the city of Parnaíba-PI. Volunteers responded to the identification form and theMichigan Neuropathy Screening Instrument (MNSI, followed by an evaluation of the lowerlimbs, as follows: achilles and patellar reflex, palpation of arterial pulses (dorsalis pedis and posterior tibial, tactile sensitivity (Monofilament 10g and vibration sensitivity (128Hz tuning fork; identification of the presence of changes such as ingrown toenails, calluses,claw toes and hair loss. Finally, using the information acquired from the assessment, subjects were classified according to the risk of developing wounds. Results: The sample consisted of 76 diabetic patients, with average age of 63.8 ± 10.4 years, 63 (82.8% were female, mean diagnostic time 8.8 ± 7.2 years, average body mass index (BMI 28.2 ± 5.4 kg/m2, with 15.7% of the sample being smokers. The myotatic reflexes and arterial pulses were reduced. Tactile sensitivity was identified in 81.5% and 13.1% did not feel the vibration of the tuning fork. The most dominant changes identified were calluses, 76.3% (n = 58. Risk level 2 of developing ulcers stood out, 52.6% (n = 40. Conclusion: Functional changes were detected in the sample and a classification of risk 2 for developing wounds was found in more than 50% of the assessed patients. doi:http://dx.doi.org/10.5020/18061230.2013.p563

  3. Materials Assessment of Components of the Extravehicular Mobility Unit

    Science.gov (United States)

    Olivas, John D.; Barrera, Enrique V.

    1996-01-01

    Current research interests for Extravehicular Mobility Unit (EMU) design and development are directed toward enhancements of the Shuttle EMU, implementation of the Mark 3 technology for Shuttle applications, and development of a next generation suit (the X suit) which has applications for prolonged space flight, longer extravehicular activity (EVA), and Moon and Mars missions. In this research project two principal components of the EMU were studied from the vantage point of the materials and their design criteria. An investigation of the flexible materials which make up the lay-up of materials for abrasion and tear protection, thermal insulation, pressure restrain, etc. was initiated. A central focus was on the thermal insulation. A vacuum apparatus for measuring the flexibility of the materials was built to access their durability in vacuum. Plans are to include a Residual Gas Analyzer on the vacuum chamber to measure volatiles during the durability testing. These tests will more accurately simulate space conditions and provide information which has not been available on the materials currently used on the EMU. Durability testing of the aluminized mylar with a nylon scrim showed that the material strength varied in the machine and transverse directions. Study of components of the EMU also included a study of the EMU Bearing Assemblies as to materials selection, engineered materials, use of coatings and flammability issues. A comprehensive analysis of the performance of the current design, which is a stainless steel assembly, was conducted and use of titanium alloys or engineered alloy systems and coatings was investigated. The friction and wear properties are of interest as are the general manufacturing costs. Recognizing that the bearing assembly is subject to an oxygen environment, all currently used materials as well as titanium and engineered alloys were evaluated as to their flammability. An aim of the project is to provide weight reduction since bearing

  4. Reasons for exclusion from intravenous thrombolysis in stroke patients admitted to the Stroke Unit.

    Science.gov (United States)

    Cappellari, Manuel; Bosco, Mariachiara; Forlivesi, Stefano; Tomelleri, Giampaolo; Micheletti, Nicola; Carletti, Monica; Bovi, Paolo

    2016-11-01

    Intravenous (IV) thrombolysis is the treatment in ischemic stroke, but only the minority of patients receive this medication. The primary objective of this study was to explore the reasons associated with the decision not to offer IV thrombolysis to stroke patients admitted to the Stroke Unit (SU). We conducted a retrospective analysis based on data collected from 876 consecutive stroke patients admitted to the SU 4.5 h (p = 0.001) and unknown time of onset (or stroke present on awakening) (p = 0.004) were reasons listed in the current SPC of Actilyse reasons for exclusion even they occurred singly, whereas mild deficit (or rapidly improving symptoms) (p exclusion even when it occurred singly, whereas early CT hypodensity (p exclusion, early CT hypodensity was associated with decision not offer IV thrombolysis in patients with mild deficit (p 80 years (p 4.5 h (p = 0.005), and unknown time of onset (p = 0.037), while severe pre-stroke disability (p = 0.025) and admission under non-stroke specialist neurologist assessment (p = 0.018) in patients with age >80 years. There are often unjustified reasons for exclusion from IV thrombolysis in SU.

  5. Quality of life in dialysis patients from the United Arab Emirates

    Directory of Open Access Journals (Sweden)

    Abdelbasit M Ayoub

    2013-01-01

    Full Text Available Background: The quality of life (QOL has emerged as an important parameter for evaluating the quality of health-care for patients with renal failure. The literature suggests that many factors impact QOL. The QOL of dialysis patients in the United Arab Emirates (UAE has not been studied before. This research examined the QOL of patients in the UAE on dialysis using two QOL tools. Materials and Methods: A descriptive comparative survey design was used to study 161 dialysis patients. The participants completed the 36-Item Short Form Health Survey (SF-36 and the QOL index dialysis version tool. Comparative analyses of the results for both tools were done using descriptive statistics. Multiple linear regression analysis determines the effect of the variables on the QOL scores. Results: The questionnaires return rate was 93%. The overall QOL for dialysis patients was rated low when self-assessed using the SF-36 (58.9 compared to QOL index (77.2. The multiple regression analysis revealed that having a chronic illness had the strongest impact on the total scores of both tools. The comparison between the statistically significant variables for both samples revealed contradictory results from the two tools used. This meant that the two tools measured QOL differently. Conclusion: The two QOL tools scores impacted very differently on most socio-demographic variables on the two samples. More studies are required to explore the concept of QOL in the Arab dialysis population.

  6. Assessing the quality of interdisciplinary rounds in the intensive care unit

    NARCIS (Netherlands)

    Ten Have, Elsbeth C. M.; Hagedoorn, Mariet; Holman, Nicole D.; Nap, Raoul E.; Sanderman, Robbert; Tulleken, Jaap E.

    2013-01-01

    Purpose: Interdisciplinary rounds (IDRs) in the intensive care unit (ICU) are increasingly recommended to support quality improvement, but uncertainty exists about assessing the quality of IDRs. We developed, tested, and applied an instrument to assess the quality of IDRs in ICUs. Materials and Meth

  7. The Impacts of Climate Change on Human Health in the United States: A Scientific Assessment

    Science.gov (United States)

    This assessment strengthens and expands our understanding of climate-related health impacts by providing a more definitive description of climate-related health burdens in the United States. It builds on the 2014 USGCRP National Climate Assessment and reviews and synthesizes key ...

  8. Pain Assessment Scale for Patients With Disorders of Consciousness

    DEFF Research Database (Denmark)

    Poulsen, Ingrid; Brix, Pia; Andersen, Sylvia;

    2016-01-01

    and sensitivity to change over time of an assessment scale developed for the evaluation of pain in severely brain-injured patients with disorders of consciousness. METHODS: We developed a pain assessment scale based on scientific literature and clinical experience with severely brain-injured patients. It consists......BACKGROUND: Patients with acquired brain injury undergoing rehabilitation are often unable to verbalize pain because of disorders of consciousness. Hence, observational pain assessment instruments are warranted for these patients. AIM: The aim of this study was to study interrater agreement...... and validated scale for the assessment of pain in patients with disorders of consciousness....

  9. Assessment of Environmental Contamination and Environmental Decontamination Practices within an Ebola Holding Unit, Freetown, Sierra Leone.

    Directory of Open Access Journals (Sweden)

    Daniel Youkee

    Full Text Available Evidence to inform decontamination practices at Ebola holding units (EHUs and treatment centres is lacking. We conducted an audit of decontamination procedures inside Connaught Hospital EHU in Freetown, Sierra Leone, by assessing environmental swab specimens for evidence of contamination with Ebola virus by RT-PCR. Swabs were collected following discharge of Ebola Virus Disease (EVD patients before and after routine decontamination. Prior to decontamination, Ebola virus RNA was detected within a limited area at all bedside sites tested, but not at any sites distant to the bedside. Following decontamination, few areas contained detectable Ebola virus RNA. In areas beneath the bed there was evidence of transfer of Ebola virus material during cleaning. Retraining of cleaning staff reduced evidence of environmental contamination after decontamination. Current decontamination procedures appear to be effective in eradicating persistence of viral RNA. This study supports the use of viral swabs to assess Ebola viral contamination within the clinical setting. We recommend that regular refresher training of cleaning staff and audit of environmental contamination become standard practice at all Ebola care facilities during EVD outbreaks.

  10. Assessment of Environmental Contamination and Environmental Decontamination Practices within an Ebola Holding Unit, Freetown, Sierra Leone.

    Science.gov (United States)

    Youkee, Daniel; Brown, Colin S; Lilburn, Paul; Shetty, Nandini; Brooks, Tim; Simpson, Andrew; Bentley, Neil; Lado, Marta; Kamara, Thaim B; Walker, Naomi F; Johnson, Oliver

    2015-01-01

    Evidence to inform decontamination practices at Ebola holding units (EHUs) and treatment centres is lacking. We conducted an audit of decontamination procedures inside Connaught Hospital EHU in Freetown, Sierra Leone, by assessing environmental swab specimens for evidence of contamination with Ebola virus by RT-PCR. Swabs were collected following discharge of Ebola Virus Disease (EVD) patients before and after routine decontamination. Prior to decontamination, Ebola virus RNA was detected within a limited area at all bedside sites tested, but not at any sites distant to the bedside. Following decontamination, few areas contained detectable Ebola virus RNA. In areas beneath the bed there was evidence of transfer of Ebola virus material during cleaning. Retraining of cleaning staff reduced evidence of environmental contamination after decontamination. Current decontamination procedures appear to be effective in eradicating persistence of viral RNA. This study supports the use of viral swabs to assess Ebola viral contamination within the clinical setting. We recommend that regular refresher training of cleaning staff and audit of environmental contamination become standard practice at all Ebola care facilities during EVD outbreaks.

  11. Assessment of satisfaction with care among family members of survivors in a neuroscience intensive care unit.

    Science.gov (United States)

    Hwang, David Y; Yagoda, Daniel; Perrey, Hilary M; Tehan, Tara M; Guanci, Mary; Ananian, Lillian; Currier, Paul F; Cobb, J Perren; Rosand, Jonathan

    2014-04-01

    Many prior nursing studies regarding family members specifically of neuroscience intensive care unit (neuro-ICU) patients have focused on identifying their primary needs. A concept related to identifying these needs and assessing whether they have been met is determining whether families explicitly report satisfaction with the care that both they and their loved ones have received. The objective of this study was to explore family satisfaction with care in an academic neuro-ICU and compare results with concurrent data from the same hospital's medical ICU (MICU). Over 38 days, we administered the Family Satisfaction-ICU instrument to neuro-ICU and MICU patients' families at the time of ICU discharge. Those whose loved ones passed away during ICU admission were excluded. When asked about the respect and compassion that they received from staff, 76.3% (95% CI [66.5, 86.1]) of neuro-ICU families were completely satisfied, as opposed to 92.7% in the MICU (95% CI [84.4, 101.0], p = .04). Respondents were less likely to be completely satisfied with the courtesy of staff if they reported participation in zero formal family meeting. Less than 60% of neuro-ICU families were completely satisfied by (1) frequency of physician communication, (2) inclusion and (3) support during decision making, and (4) control over the care of their loved ones. Parents of patients were more likely than other relatives to feel very included and supported in the decision-making process. Future studies may focus on evaluating strategies for neuro-ICU nurses and physicians to provide better decision-making support and to implement more frequent family meetings even for those patients who may not seem medically or socially complicated to the team. Determining satisfaction with care for those families whose loved ones passed away during their neuro-ICU admission is another potential avenue for future investigation.

  12. The United States National Climate Assessment - Alaska Technical Regional Report

    Science.gov (United States)

    Markon, Carl J.; Trainor, Sarah F.; Chapin, F. Stuart; Markon, Carl J.; Trainor, Sarah F.; Chapin, F. Stuart

    2012-01-01

    The Alaskan landscape is changing, both in terms of effects of human activities as a consequence of increased population, social and economic development and their effects on the local and broad landscape; and those effects that accompany naturally occurring hazards such as volcanic eruptions, earthquakes, and tsunamis. Some of the most prevalent changes, however, are those resulting from a changing climate, with both near term and potential upcoming effects expected to continue into the future. Alaska's average annual statewide temperatures have increased by nearly 4°F from 1949 to 2005, with significant spatial variability due to the large latitudinal and longitudinal expanse of the State. Increases in mean annual temperature have been greatest in the interior region, and smallest in the State's southwest coastal regions. In general, however, trends point toward increases in both minimum temperatures, and in fewer extreme cold days. Trends in precipitation are somewhat similar to those in temperature, but with more variability. On the whole, Alaska saw a 10-percent increase in precipitation from 1949 to 2005, with the greatest increases recorded in winter. The National Climate Assessment has designated two well-established scenarios developed by the Intergovernmental Panel on Climate Change (Nakicenovic and others, 2001) as a minimum set that technical and author teams considered as context in preparing portions of this assessment. These two scenarios are referred to as the Special Report on Emissions Scenarios A2 and B1 scenarios, which assume either a continuation of recent trends in fossil fuel use (A2) or a vigorous global effort to reduce fossil fuel use (B1). Temperature increases from 4 to 22°F are predicted (to 2070-2099) depending on which emissions scenario (A2 or B1) is used with the least warming in southeast Alaska and the greatest in the northwest. Concomitant with temperature changes, by the end of the 21st century the growing season is expected

  13. National Assessment of Oil and Gas - Cotton Valley Group and Travis Peak-Hosston Formation Assessment Units, Western Gulf and East Texas Basin and Louisiana-Mississippi Salt Basins Provinces (047, 048 and 049)

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — The Assessment Unit is the fundamental unit used in the National Assessment Project for the assessment of undiscovered oil and gas resources. The Assessment Unit is...

  14. Comparison of dietetics service delivery (demand and determinants within two Australian Medical Assessment and Planning Units

    Directory of Open Access Journals (Sweden)

    Angela P Vivanti

    2017-03-01

    Full Text Available Aims Assessment and Planning Units have increased globally however, models of care literature is limited. With high malnutrition prevalence amongst ageing populations, this case report identifies demands for dietetic services. Methods Descriptive data compared and contrasted two service including medical models, eligibility criteria, malnutrition screening, dietetic services, clinical follow-up, and team composition. Results High malnutrition prevalence (17 per cent, 31 per cent was evident with different screening approaches successfully implemented. Both units favoured rapid assessment and intervention. Conclusion Dietetic expertise was required for malnutrition assessment, and ongoing management in acute or community setting as determined by differing health-care system arrangements

  15. The Richmond Agitation-Sedation Scale: validity and reliability in adult intensive care unit patients.

    Science.gov (United States)

    Sessler, Curtis N; Gosnell, Mark S; Grap, Mary Jo; Brophy, Gretchen M; O'Neal, Pam V; Keane, Kimberly A; Tesoro, Eljim P; Elswick, R K

    2002-11-15

    Sedative medications are widely used in intensive care unit (ICU) patients. Structured assessment of sedation and agitation is useful to titrate sedative medications and to evaluate agitated behavior, yet existing sedation scales have limitations. We measured inter-rater reliability and validity of a new 10-level (+4 "combative" to -5 "unarousable") scale, the Richmond Agitation-Sedation Scale (RASS), in two phases. In phase 1, we demonstrated excellent (r = 0.956, lower 90% confidence limit = 0.948; kappa = 0.73, 95% confidence interval = 0.71, 0.75) inter-rater reliability among five investigators (two physicians, two nurses, and one pharmacist) in adult ICU patient encounters (n = 192). Robust inter-rater reliability (r = 0.922-0.983) (kappa = 0.64-0.82) was demonstrated for patients from medical, surgical, cardiac surgery, coronary, and neuroscience ICUs, patients with and without mechanical ventilation, and patients with and without sedative medications. In validity testing, RASS correlated highly (r = 0.93) with a visual analog scale anchored by "combative" and "unresponsive," including all patient subgroups (r = 0.84-0.98). In the second phase, after implementation of RASS in our medical ICU, inter-rater reliability between a nurse educator and 27 RASS-trained bedside nurses in 101 patient encounters was high (r = 0.964, lower 90% confidence limit = 0.950; kappa = 0.80, 95% confidence interval = 0.69, 0.90) and very good for all subgroups (r = 0.773-0.970, kappa = 0.66-0.89). Correlations between RASS and the Ramsay sedation scale (r = -0.78) and the Sedation Agitation Scale (r = 0.78) confirmed validity. Our nurses described RASS as logical, easy to administer, and readily recalled. RASS has high reliability and validity in medical and surgical, ventilated and nonventilated, and sedated and nonsedated adult ICU patients.

  16. Scoring system for the selection of high-risk patients in the intensive care unit

    NARCIS (Netherlands)

    Iapichino, G; Mistraletti, G; Corbella, D; Bassi, G; Borotto, E; Miranda, DR; Morabito, A

    2006-01-01

    Objective. Patients admitted to the intensive care unit greatly differ in severity and intensity of care. We devised a system for selecting high-risk patients that reduces bias by excluding low-risk patients and patients with an early death irrespective of the treatment. Design: A posteriori analysi

  17. Holistic approach to multi-unit site risk assessment: Status and Issues

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Inn Seock; Jang, Mi Suk; Kim, Seoung Rae [Nuclear Engineering Service and Solution Company (NESS), Daejeon Business Agency, Daejeon (Korea, Republic of)

    2017-03-15

    The events at the Fukushima Daiichi Nuclear Power Station in March 2011 point out, among other matters, that concurrent accidents at multiple units of a site can occur in reality. Although site risk has been deterministically considered to some extent in nuclear power plant siting and design, potential occurrence of multi-unit accident sequences at a site was not investigated in sufficient detail thus far in the nuclear power community. Therefore, there is considerable worldwide interest and research effort directed toward multi-unit site risk assessment, especially in the countries with high-density nuclear-power-plant sites such as Korea. As the technique of probabilistic safety assessment (PSA) has been successfully applied to evaluate the risk associated with operation of nuclear power plants in the past several decades, the PSA having primarily focused on single-unit risks is now being extended to the multi-unit PSA. In this paper we first characterize the site risk with explicit consideration of the risk associated with spent fuel pools as well as the reactor risks. The status of multi-unit risk assessment is discussed next, followed by a description of the emerging issues relevant to the multi-unit risk evaluation from a practical standpoint.

  18. Assessing the level of healthcare information technology adoption in the United States: a snapshot

    Directory of Open Access Journals (Sweden)

    Middleton Blackford

    2006-01-01

    Full Text Available Abstract Background Comprehensive knowledge about the level of healthcare information technology (HIT adoption in the United States remains limited. We therefore performed a baseline assessment to address this knowledge gap. Methods We segmented HIT into eight major stakeholder groups and identified major functionalities that should ideally exist for each, focusing on applications most likely to improve patient safety, quality of care and organizational efficiency. We then conducted a multi-site qualitative study in Boston and Denver by interviewing key informants from each stakeholder group. Interview transcripts were analyzed to assess the level of adoption and to document the major barriers to further adoption. Findings for Boston and Denver were then presented to an expert panel, which was then asked to estimate the national level of adoption using the modified Delphi approach. We measured adoption level in Boston and Denver was graded on Rogers' technology adoption curve by co-investigators. National estimates from our expert panel were expressed as percentages. Results Adoption of functionalities with financial benefits far exceeds adoption of those with safety and quality benefits. Despite growing interest to adopt HIT to improve safety and quality, adoption remains limited, especially in the area of ambulatory electronic health records and physician-patient communication. Organizations, particularly physicians' practices, face enormous financial challenges in adopting HIT, and concerns remain about its impact on productivity. Conclusion Adoption of HIT is limited and will likely remain slow unless significant financial resources are made available. Policy changes, such as financial incentivesto clinicians to use HIT or pay-for-performance reimbursement, may help health care providers defray upfront investment costs and initial productivity loss.

  19. Community-acquired pneumonia and survival of critically ill acute exacerbation of COPD patients in respiratory intensive care units

    Science.gov (United States)

    Lu, Zhiwei; Cheng, Yusheng; Tu, Xiongwen; Chen, Liang; Chen, Hu; Yang, Jian; Wang, Jinyan; Zhang, Liqin

    2016-01-01

    Purpose The aim of this study was to appraise the effect of community-acquired pneumonia (CAP) on inhospital mortality in critically ill acute exacerbation of COPD (AECOPD) patients admitted to a respiratory intensive care unit. Patients and methods A retrospective observational study was performed. Consecutive critically ill AECOPD patients receiving treatment in a respiratory intensive care unit were reviewed from September 1, 2012, to August 31, 2015. Categorical variables were analyzed using chi-square tests, and continuous variables were analyzed by Mann–Whitney U-test. Kaplan–Meier analysis was used to assess the association of CAP with survival of critically ill AECOPD patients for univariate analysis. Cox’s proportional hazards regression model was performed to identify risk factors for multivariate analysis. Results A total of 80 consecutive eligible individuals were reviewed. These included 38 patients with CAP and 42 patients without CAP. Patients with CAP had a higher inhospital rate of mortality than patients without CAP (42% vs 33.3%, Pcritically ill AECOPD patients (CAP: hazard ratio, 5.29; 95% CI, 1.50–18.47, Pcritically ill AECOPD patients. PMID:27563239

  20. Currently used dosage regimens of vancomycin fail to achieve therapeutic levels in approximately 40% of intensive care unit patients

    Science.gov (United States)

    Obara, Vitor Yuzo; Zacas, Carolina Petrus; Carrilho, Claudia Maria Dantas de Maio; Delfino, Vinicius Daher Alvares

    2016-01-01

    Objective This study aimed to assess whether currently used dosages of vancomycin for treatment of serious gram-positive bacterial infections in intensive care unit patients provided initial therapeutic vancomycin trough levels and to examine possible factors associated with the presence of adequate initial vancomycin trough levels in these patients. Methods A prospective descriptive study with convenience sampling was performed. Nursing note and medical record data were collected from September 2013 to July 2014 for patients who met inclusion criteria. Eighty-three patients were included. Initial vancomycin trough levels were obtained immediately before vancomycin fourth dose. Acute kidney injury was defined as an increase of at least 0.3mg/dL in serum creatinine within 48 hours. Results Considering vancomycin trough levels recommended for serious gram-positive infection treatment (15 - 20µg/mL), patients were categorized as presenting with low, adequate, and high vancomycin trough levels (35 [42.2%], 18 [21.7%], and 30 [36.1%] patients, respectively). Acute kidney injury patients had significantly greater vancomycin trough levels (p = 0.0055, with significance for a trend, p = 0.0023). Conclusion Surprisingly, more than 40% of the patients did not reach an effective initial vancomycin trough level. Studies on pharmacokinetic and dosage regimens of vancomycin in intensive care unit patients are necessary to circumvent this high proportion of failures to obtain adequate initial vancomycin trough levels. Vancomycin use without trough serum level monitoring in critically ill patients should be discouraged. PMID:28099635

  1. Patient recall in advanced education in prosthodontics programs in the United States.

    Science.gov (United States)

    Afshari, Fatemeh S; Koslow, Alyson H; Knoernschild, Kent L; Sukotjo, Cortino

    2010-06-01

    This study surveyed program directors of Advanced Education Programs in Prosthodontics (AEPP) in the United States to determine the extent, type, incidence, and perceived effectiveness of implemented recall systems. Surveys were sent to AEPP directors across the United States to assess their program's recall protocol. This survey first identified whether an active recall program existed. For programs with recall systems, rigor in promoting ongoing oral health was surveyed by focusing on recall frequency, patient tracking protocol, involved personnel, interaction with other university departments, provided clinical procedures, and therapy completion protocol. Whether the directors perceived that their recall system was successful was also investigated. Thirty-three of 46 programs responded, giving a response rate of 72%. Of these 33 programs, only 21 (64%) had an active recall system, although 30 (91%) believed recall to be important. Twelve (57%) directors with recall programs considered their system to be effective. Prosthodontic program directors felt their program's recall effectiveness could be improved. Due to the numerous potential benefits of an active recall system, AEPPs should consider implementing or enhancing their recall programs. Further studies are indicated to determine specific criteria that describe an effective recall system for prosthodontic programs within the context of patient health promotion, program curriculum, and financial ramifications.

  2. Patient characteristics and comorbidities associated with cerebrovascular accident following acute myocardial infarction in the United States.

    Science.gov (United States)

    Naderi, Nassim; Masoomi, Hossein; Mozaffar, Tahseen; Malik, Shaista

    2014-08-01

    Although cerebrovascular accident (CVA) is a relatively infrequent complication of acute myocardial infarction (AMI), the occurrence of CVA in patients with AMI is associated with increased morbidity and mortality. We wanted to assess post-AMI CVA rate in the United States and identify the associated patient characteristics, comorbidities, type of AMI, and utilization of invasive procedures. This is an observational study from the Nationwide Inpatient Sample, 2006-2008. Using multivariate regression models, we assessed predictive risk factors for post-AMI CVA among patients admitted for AMI. Among the 1,924,413 patients admitted for AMI, the overall rate of CVA was 2% (ischemic stroke: 1.47%, transient ischemic attack [TIA]: 0.35% and hemorrhagic stroke: 0.21%). In this sample of AMI patient, higher incidence of CVA was associated with: CHF (adjusted odds ratio [AOR] 1.71; 95% confidence interval [CI], 1.58-1.84,), age over 65 AOR, 1.65; 95% CI, 1.60-1.70, alcohol abuse AOR, 1.60; 95% CI, 1.49-1.73, cocaine use AOR, 1.48; 95% CI, 1.29-1.70, atrial fibrillation AOR, 1.43; 95% CI, 1.39-1.46, Black race AOR, 1.35; 95% CI, 1.30-1.40, female gender AOR, 1.32; 95% CI, 1.29-1.35, peripheral vascular disease [PVD] AOR, 1.26; 95% CI, 1.22-1.30, coronary artery bypass graft (CABG) AOR, 1.22; 95% CI, 1.17-1.27, PCVA post-AMI. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  3. Organizational culture and climate for patient safety in Intensive Care Units.

    Science.gov (United States)

    Santiago, Thaiana Helena Roma; Turrini, Ruth Natalia Teresa

    2015-02-01

    Objective To assess the perception of health professionals about patient safety climate and culture in different intensive care units (ICUs) and the relationship between scores obtained on the Hospital Survey on Patient Safety Culture (HSOPSC) and the Safety Attitudes Questionnaire (SAQ). Method A cross-sectional study conducted at a teaching hospital in the state of São Paulo, Brazil, in March and April 2014. As data gathering instruments, the HSOPSC, SAQ and a questionnaire with sociodemographic and professional information about the staff working in an adult, pediatric and neonatal ICU were used. Data analysis was conducted with descriptive statistics. Results The scales presented good reliability. Greater weaknesses in patient safety were observed in the Working conditions andPerceptions of management domains of the SAQ and in the Nonpunitive response to error domain of the HSOPSC. The strengths indicated by the SAQ wereTeamwork climate and Job satisfactionand by the HSOPC, Supervisor/manager expectations and actions promoting safety and Organizational learning-continuous improvement. Job satisfaction was higher among neonatal ICU workers when compared with the other ICUs. The adult ICU presented lower scores for most of the SAQ and HSOPSC domains. The scales presented moderate correlation between them (r=0.66). Conclusion There were differences in perception regarding patient safety among ICUs, which corroborates the existence of local microcultures. The study did not demonstrate equivalence between the SAQ and the HSOPSC.

  4. Patients with hematological disorders requiring admission to medical intensive care unit: Characteristics, survival and prognostic factors

    Directory of Open Access Journals (Sweden)

    Subhash H

    2003-01-01

    Full Text Available Background: This retrospective chart review assessed the characteristics and outcome of patients with hematological disorders who required admission to medical intensive care unit over a 4 year period (January 1998 to December 2001. Results: There were a total of 104 patients, 67 (64% male, 37 (36% female subjects, with a mean age of 36.3 ± 15.3 years (range 10 to 65 years. The mean duration from hospital admission to ICU transfer was 11 days. Sixty-nine (66% had malignant and 35 (34% had non-malignant conditions. Respiratory distress was the commonest reason for ICU admission 58 (56%. The other indications were hemodynamic instability 38 (36%, low sensorium 22 (21%, following cardio-pulmonary arrest 12 (11.5% and generalized tonic-clonic seizures 5 (5%. Forty-three (42% patients had absolute neutophil count (ANC less than 500, 48 (47.5% had platelet count < 20000. The mean duration of ICU stay was 4 days (range < 24 hours to 28 days. Sixty-nine (66% patients required mechanical ventilation, 61 (59% required hemodynamic support. Pneumonia or sepsis was diagnosed in 71 (68%. Twenty-five (24% survived ICU stay and 20 (19% survived to hospital discharge. ICU admission following cardio-pulmonary arrest, advanced malignancy, requirement of mechanical ventilation, vasopressor support, ANC count < 500 and platelet count < 20000 were the predictors of adverse outcome. Associated organ dysfunction further increases the mortality.

  5. Evaluation of Waste Anesthetic Gas in the Postanesthesia Care Unit within the Patient Breathing Zone

    Science.gov (United States)

    Hiller, Kenneth N.; Altamirano, Alfonso V.; Cai, Chunyan; Tran, Stephanie F.; Williams, George W.

    2015-01-01

    Potential health hazards from waste anesthetic gases (WAGs) have been a concern since the introduction of inhalational anesthetics into clinical practice. The potential to exceed recommended exposure levels (RELs) in the postanesthesia care unit (PACU) exists. The aim of this pilot study was to assess sevoflurane WAG levels while accounting for factors that affect inhalational anesthetic elimination. In this pilot study, 20 adult day surgery patients were enrolled with anesthesia maintained with sevoflurane. Following extubation, exhaled WAG from the patient breathing zone was measured 8 inches from the patient's mouth in the PACU. Maximum sevoflurane WAG levels in the patient breathing zone exceeded National Institute for Occupational Safety and Health (NIOSH) RELs for every 5-minute time interval measured during PACU Phase I. Observed WAGs in our study were explained by inhalational anesthetic pharmacokinetics. Further analysis suggests that the rate of washout of sevoflurane was dependent on the duration of anesthetic exposure. This study demonstrated that clinically relevant inhalational anesthetic concentrations result in sevoflurane WAG levels that exceed current RELs. Evaluating peak and cumulative sevoflurane WAG levels in the breathing zone of PACU Phase I and Phase II providers is warranted to quantify the extent and duration of exposure. PMID:26693222

  6. Educational Needs of Nurses in Intensive Care Unit for Poisoned Patients

    Directory of Open Access Journals (Sweden)

    Dadpour B

    2013-10-01

    Full Text Available Objectives: Poisoned patients are at risk of impaired ventilation in many situations. The purpose of this descriptive study was to investigate the impact of educational workshops on nurses' knowledge, confidence, and attitude in taking care of poisoned patients. Materials and Methods: This descriptive study was performed on 60 nursing staff in the intensive care unit (ICU for poisoned patients in Imam Reza (p hospital, Mashhad, Iran. Data was gathered by a researcher-designed questionnaire. Studied scales included perceived importance and novelty of educational meeting, matching with professional and educational needs, illustration of practical and knowledge weaknesses and strength and finally satisfaction in holding regular workshops annually. Two, half day workshops were held and various items were taught with various methods. The knowledge of participants was assessed by pretests and post-tests consisting of 12 items related to workshop topics. The impact of these educational meetings was evaluated and the results were analyzed by the SPSS software. Results: According to the results, workshops improved awareness of nurses about their weakness and strength points, professional knowledge and their interest and attention; likewise all participants had the same opinion about a strong need to hold similar workshops more than once and preferably 2 to 3 times annually. Conclusion: It seems that short educational courses in small groups for reviewing the old data and recent findings in the context of critical care are useful in order to promote the knowledge and skills of ICU staff in taking care of poisoned patients

  7. Effects of nursing care and staff skill mix on patient outcomes within acute care nursing units.

    Science.gov (United States)

    Hart, Patricia; Davis, Nancy

    2011-01-01

    This article presents the findings from a study that evaluates the relationships between staffing indicators and patient outcomes at the hospital unit level. Nursing administrators should not only evaluate the impact staffing decisions have on patient outcomes at the hospital level but also examine these relationships at the unit level. The findings from this study have implications for nursing practice in the areas of staff orientation, education, and patient outcome monitoring.

  8. Needs Assessment for cancer patients and their families

    OpenAIRE

    Gustafson David H; Wen Kuang-Yi

    2004-01-01

    Abstract Background The assessment of needs for cancer care is a critical step in providing high quality care and achieving cancer patients' and families' satisfaction. Instruments can be used to assess needs and guide cancer care planning. This study discusses the importance of the needs assessment, relationships between needs, satisfaction and quality of life; and reviews the assessment instruments of needs experienced by cancer patients and their families. Methods A systematic search was c...

  9. Map of assessed coalbed-gas resources in the United States, 2014

    Science.gov (United States)

    ,; Biewick, Laura R. H.

    2014-01-01

    This report presents a digital map of coalbed-gas resource assessments in the United States as part of the U.S. Geological Survey’s (USGS) National Assessment of Oil and Gas Project. Using a geology-based assessment methodology, the USGS quantitatively estimated potential volumes of undiscovered, technically recoverable natural gas resources within coalbed-gas assessment units (AUs). This is the third digital map product in a series of USGS unconventional oil and gas resource maps. The map plate included in this report can be printed in hardcopy form or downloaded in a Geographic Information System (GIS) data package, including an ArcGIS ArcMap document (.mxd), geodatabase (.gdb), and published map file (.pmf). In addition, the publication access table contains hyperlinks to current USGS coalbed-gas assessment publications and web pages.

  10. Assessment of physical work load at visual display unit workstations : Ergonomic applications and gender aspects

    OpenAIRE

    Karlqvist, Lena

    1997-01-01

    From the department of Occupational Health, Karolinska Hospital, Stockholm, Department of Ergonomics, National Institute for Working Life, Solna, and the Department of Surgical Sciences K3, Section for Rehabilitation Medicine, Karolinska Institute, Stockholm. Assessment of physical work load at visual display unit workstations Ergonomic applications and gender aspects Lena Karlqvist Arbete och Hälsa I997:9 .Local physical workload at visual display unit(VDU) wor...

  11. A Preliminary Assessment of Mouflon Abundance at the Kahuku Unit of Hawaii Volcanoes National Park

    Science.gov (United States)

    2006-01-01

    Garel M., J.-M. Cugnasse, A. Loison, J.-M. Gaillard, C. Vuiton, and D.Maillard. 2005. Monitoring the abundance of mouflon in south France. European ...of Mouflon Abundance at the Kahuku Unit of Hawaii Volcanoes National Park Report Documentation Page Form ApprovedOMB No. 0704-0188 Public reporting...Preliminary Assessment of Mouflon Abundance at the Kahuku Unit of Hawaii Volcanoes National Park 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM

  12. Assessment of Economic Efficiency Pertaining to Application of Energy Storage Units in Power System

    Directory of Open Access Journals (Sweden)

    A. Chernetsky

    2013-01-01

    Full Text Available The paper considers some aspects pertaining to an application of technologies for energy storage in electric power. Review of technical and cost characteristics of energy storage units has been given in the paper. The review reflects data of the energy storage units which are available and which are under development. The paper proposes an approach that permits to assess boundaries of economically reasonable application of energy storage systems in order to balance daily load curve of a power system.

  13. Predictive validity and reliability of the Braden scale for risk assessment of pressure ulcers in an intensive care unit.

    Science.gov (United States)

    Lima-Serrano, M; González-Méndez, M I; Martín-Castaño, C; Alonso-Araujo, I; Lima-Rodríguez, J S

    2017-02-15

    Contribution to validation of the Braden scale in patients admitted to the ICU, based on an analysis of its reliability and predictive validity. An analytical, observational, longitudinal prospective study was carried out. Intensive Care Unit, Hospital Virgen del Rocío, Seville (Spain). Patients aged 18years or older and admitted for over 24hours to the ICU were included. Patients with pressure ulcers upon admission were excluded. A total of 335 patients were enrolled in two study periods of one month each. None. The presence of gradei-iv pressure ulcers was regarded as the main or dependent variable. Three categories were considered (demographic, clinical and prognostic) for the remaining variables. The incidence of patients who developed pressure ulcers was 8.1%. The proportion of gradei andii pressure ulcer was 40.6% and 59.4% respectively, highlighting the sacrum as the most frequently affected location. Cronbach's alpha coefficient in the assessments considered indicated good to moderate reliability. In the three evaluations made, a cutoff point of 12 was presented as optimal in the assessment of the first and second days of admission. In relation to the assessment of the day with minimum score, the optimal cutoff point was 10. The Braden scale shows insufficient predictive validity and poor precision for cutoff points of both 18 and 16, which are those accepted in the different clinical scenarios. Copyright © 2017 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

  14. Poor concurrence between disabilities as described by patients and established assessment tools three months after stroke

    DEFF Research Database (Denmark)

    Tistad, Malin; Ytterberg, Charlotte; Tham, Kerstin

    2012-01-01

    Extended Index of ADL (KI); Barthel Index (BI) and Stroke Impact Scale (SIS) represented assessed problems. Items/domains in the assessment tools that corresponded to the categories of felt problems were identified and comparisons performed. RESULT: The category Fatigue had the largest number of felt...... stroke and to explore the concurrence between felt problems and assessed problems. METHOD: The patients (n=203) received care in the stroke units at Karolinska University Hospital, Sweden. Felt problems, drawn from an open question, were categorized. Results from established assessment tools: Katz...

  15. Qualitative risk assessment for the 100-HR-3 groundwater operable unit

    Energy Technology Data Exchange (ETDEWEB)

    Vukelich, S.E. [Golder Associates, Inc., Richland, WA (United States)

    1994-09-22

    This report provides the qualitative risk assessment for the 100-HR-3 operable unit on the Hanford Reservation. 100-HR-3 is a ground water unit. The purpose of the QRA at the 100-HR-3 operable unit is to focus on a predefined set of human and environmental exposure scenarios in order to provides sufficient information that will assist the Tri-Party signatories (Washington State Department of Ecology, EPA and US DOE) in making defensible decisions on the necessity of Interim Remedial Measures. Frequent- and occasional-use exposure scenarios are evaluated in the human health risk assessment to provide bounding estimates of risk. The ecological risk assessment consists of an evaluation of the risks to riparian and aquatic receptors which live in or near the Columbia River.

  16. U.S. Geological Survey assessment of reserve growth outside of the United States

    Science.gov (United States)

    Klett, Timothy R.; Cook, Troy A.; Charpentier, Ronald R.; Tennyson, Marilyn E.; Le, Phuong A.

    2015-12-21

    The U.S. Geological Survey estimated volumes of potential additions to oil and gas reserves for the United States by reserve growth in discovered accumulations. These volumes were derived by using a new methodology developed by the U.S. Geological Survey and reviewed by the American Association of Petroleum Geologists Committee on Resource Evaluation. This methodology was used to assess reserve growth in individual accumulations (reservoirs, groups of reservoirs, or fields). Selected, large, well-studied, conventional accumulations in the United States that are estimated to contribute most to reserve growth were assessed using analysis of geology and engineering practices. Potential additions to oil and gas reserves for large, discovered, conventional accumulations outside of the United States due to reserve growth were assessed using the U.S. accumulations as analogs. Potential oil and gas volumes were assumed to be added to proven plus probable reserves.

  17. ASSESSMENT OF PAIN IN VENTILATED ICU PATIENTS USING BEHAVIORAL PAIN SCALE

    Directory of Open Access Journals (Sweden)

    Nidhin

    2015-12-01

    Full Text Available Systematic assessment of pain is difficult in intensive care units, because most of the patients are non-communicative and are unable to self-report pain. The Behavioral Pain Scale (BPS is one of the assessment tools for uncommunicative and sedated intensive care unit patients. This study is to assess and evaluate the efficacy and reliability of BPS scale in mechanically ventilated patients. MATERIALS AND METHODS Prospective observational study in 71 mechanically ventilated medical ICU patients who were unable to report pain was assessed with BPS. RESULTS Post procedure there was a significant difference in the percentage of patients with an increased BPS score for repositioning, but not for oral care. CONCLUSIONS This study showed that the BPS is reliable and valid for use in sedated ICU patients. We conclude that pain scales should be incorporated into pain management as protocols to target the desired levels of analgesia in order to optimize inter-professional practices and to achieve better patient outcomes

  18. Surveys from inside: An assessment of unit nonresponse bias with internal criteria

    Directory of Open Access Journals (Sweden)

    Ulrich Kohler

    2007-06-01

    Full Text Available The article uses the so called “internal criteria of representativeness” to assess the unit nonresponse bias in five European comparative survey projects. It then goes on investigating several ideas why unit nonresponse bias might vary between surveys and countries. It is proposed that unit nonresponse bias is either caused by country characteristics or survey methodology. The empirical evidence presented speaks more in favour of the latter than of the former. Among the survey characteristics the features that strengthen the leverage to control interviewers’ behaviour have top priority

  19. The Magnitude and Time Course of Muscle Cross-section Decrease in Intensive Care Unit Patients.

    Science.gov (United States)

    Ten Haaf, Dianne; Hemmen, Bea; van de Meent, Henk; BovendʼEerdt, Thamar J H

    2017-09-01

    Bedriddenness and immobilization of patients at an intensive care unit may result in muscle atrophy and devaluation in quality of life. The exact effect of immobilization on intensive care unit patients is not known. The aim of this study was to investigate the magnitude and time course of muscle cross-section decrease in acute critically ill patients admitted to the intensive care unit. An observational pilot study was performed in intensive care unit patients. Data of bilateral ultrasound muscle cross-section measurements of the knee extensors and the elbow flexors were collected. Thirty-four intensive care unit patients were included in this study; data are presented from 14 patients who were measured at least three times. Repeated measures analysis of variance shows a significant decrease in muscle cross-section over time (F1,13 = 80.40, P ≤ 0.001).The decrease in muscle cross-section of the arms was significantly higher (F1,13 = 5.38, P = 0.037) than the decrease of the legs. Four weeks after intensive care unit admission, the muscle cross-section decrease had not reached an asymptote yet. The muscle cross-section decrease in bedridden intensive care unit patients is significant for a time of 2 to 4 weeks. The decrease in muscle cross-section of the arms is greater than the decrease of the legs.

  20. Unilateral gynecomastia: The assessment of 23 patients

    Directory of Open Access Journals (Sweden)

    Salih Onur Basat

    2016-12-01

    Results: 11 patients were treated by strictly gland excision, four patients with only liposuction and eight patients with gland excision combined with liposuction. Gynecomastia was seen on the left side of the chest in 13 patients and on the right side in 10 patients. There were no complications. The specimens did not reveal any malignant causes. Conclusion: Although most cases gynecomastia are idiopathic and bilateral, there are instances that require special at- tention and should be given unilateral status. Detailed evaluation including physical examination, history of drug use and concomitant medical disorders should be considered. [Arch Clin Exp Surg 2016; 5(4.000: 206-210

  1. USGS National and Global Oil and Gas Assessment Project-Burgos, Tampico-Misantla, and Sabinas Provinces, northeast Mexico, assessment unit boundaries

    Science.gov (United States)

    Schenk, Christopher J.

    2016-01-01

    The Assessment Unit is the fundamental unit used in the National and Global Petroleum Assessment Project for the assessment of undiscovered oil and gas resources. The Assessment Unit is defined within the context of the higher-level Total Petroleum System. The Assessment Unit is shown herein as a geographic boundary interpreted, defined, and mapped by the geologist responsible for the province and incorporates a set of known or postulated oil and (or) gas accumulations sharing similar geologic, geographic, and temporal properties within the Total Petroleum System, such as source rock, timing, migration pathways, trapping mechanism, and hydrocarbon type. The Assessment Unit boundary is defined geologically as the limits of the geologic elements that define the Assessment Unit, such as limits of reservoir rock, geologic structures, source rock, and seal lithologies.

  2. Comprehensive geriatric assessment on an acute medical unit: a qualitative study of older people's and informal carer's perspectives of the care and treatment received.

    Science.gov (United States)

    Darby, Janet; Williamson, Tracey; Logan, Pip; Gladman, John

    2017-01-01

    This qualitative study was imbedded in a randomized controlled trial evaluating the addition of geriatricians to usual care to enable the comprehensive geriatric assessment process with older patients on acute medical units. The qualitative study explored the perspectives of intervention participants on their care and treatment. A constructivist study incorporating semi-structured interviews that were conducted in patients' homes within six weeks of discharge from the acute medical unit. These interviews were recorded, transcribed, and analysed using thematic analysis. An acute medical unit in the United Kingdom. Older patients ( n = 18) and their informal carers ( n = 6) discharged directly home from an acute medical unit, who had been in the intervention group of the randomized controlled trial. Three core themes were constructed: (1) perceived lack of treatment on the acute medical unit; (2) nebulous grasp of the role of the geriatrician; and (3) on-going health and activities of daily living needs postdischarge. These needs impacted upon the informal carers, who either took over, or helped the patients to complete their activities of daily living. Despite the help received with activities of daily living, a lot of the patients voiced a desire to complete these activities themselves. The participants perceived they were just monitored and observed on the acute medical unit, rather than receiving active treatment, and spoke of on-going unresolved health and activity of daily living needs following discharge, despite receiving the additional intervention of a geriatrician.

  3. Assessment of the Status of Measles Elimination in the United States, 2001-2014.

    Science.gov (United States)

    Gastañaduy, Paul A; Paul, Prabasaj; Fiebelkorn, Amy Parker; Redd, Susan B; Lopman, Ben A; Gambhir, Manoj; Wallace, Gregory S

    2017-04-01

    We assessed the status of measles elimination in the United States using outbreak notification data. Measles transmissibility was assessed by estimation of the reproduction number, R, the average number of secondary cases per infection, using 4 methods; elimination requires maintaining R at measles transmission is maintained in the United States. A suggested increase in measles transmissibility since elimination warrants continued monitoring and emphasizes the importance of high measles vaccination coverage throughout the population. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health 2017. This work is written by (a) US Government employee(s) and is in the public domain in the US.

  4. Qualitative risk assessment for the 100-KR-4 groundwater operable unit

    Energy Technology Data Exchange (ETDEWEB)

    Biggerstaff, R.L.

    1994-06-30

    This report provides the qualitative risk assessment (QRA) for the 100-KR-4 groundwater operable unit at the US Department of Energy`s (DOE) Hanford Site in southeastern Washington State. The extent of the groundwater beneath the 100 K Area is defined in the Remedial Investigation/Feasibility Study Work Plan for the 100-KR-4 Operable Unit (DOE-RL 1992a). The QRA is an evaluation or risk using a limited amount of data and a predefined set of human and environmental exposure scenarios and is not intended to replace or be a substitute for a baseline risk assessment.

  5. Increased reliability through assessment of standard components with life cycle units

    Energy Technology Data Exchange (ETDEWEB)

    Buchholz, A.; Seliger, G. [Inst. fuer Werkzeugmaschinen und Fabrikbetrieb, Fachgebiet Montagetechnik und Fabrikbetrieb - PTZ 2, Berlin (Germany); Middendorf, A.; Reichl, H. [Research Center for Microperipheric Technologies of the TU-Berlin, Berlin (Germany); Ray, P.

    2004-07-01

    Products and their components underlie constant devaluation by their usage which sooner or later leads to a failure. As manufacturers of complex technical products are confronted with increasing demands regarding product availability and reliability, the assessment of the product's condition is desirable. Existing microelectronic technology enables a constant supervision of standard components in their usage to initiate timely adaptation processes like maintenance and repair. The Life Cycle Unit is presented as a modular microelectronic system for product supervision and assessment. Life Cycle Units have been prototypically implemented in various application examples using SMD technology and microsystem technology. (orig.)

  6. Family satisfaction with patient care in critical care units in Pakistan: a descriptive cross-sectional study.

    Science.gov (United States)

    Ahtisham, Younas; Subia, Parveen; Gideon, Victor

    2016-11-23

    To assess family satisfaction with care provided to patients in critical care units in Islamabad. A descriptive cross-sectional study was conducted in 11 medical and surgical critical care units at two private hospitals in Islamabad, Pakistan. The purposive sample consisted of 323 immediate family members and other relatives and friends (referred to as family members in this article) of 323 patients admitted to the critical care units for at least 24 hours. The revised Critical Care Family Satisfaction Survey was used for data collection. Descriptive statistics were used for data analysis. A total of 149/323 (46%) family members were 'very satisfied' with the honesty (openness) of staff in explaining the patient's condition, and 137/323 (42%) family members were 'very satisfied' with the nurses' availability to speak to them. A total of 143/323 (44%) family members were 'satisfied' with the honesty (openness) of staff in explaining the patient's condition, and 131/323 (41%) were 'satisfied' with the nurses' availability to speak to them. A few family members (21/323, 6%) were 'very dissatisfied' with the flexibility of the visiting hours and a few (20/323, 6%) were 'very dissatisfied' with the noise level in the critical care units. Some family members (38/323, 12%) were 'not satisfied' with the flexibility of the visiting hours, and some (18/323, 6%) were 'not satisfied' with the noise level in the critical care units. The majority of family members (244/323, 75%) were 'satisfied' or 'very satisfied' that their relatives' needs were being met in the critical care units. However, qualitative data indicate that most family members wanted greater involvement in decision making. These findings should be considered by staff working in critical care settings to ensure high-quality patient care.

  7. Validity and reliability of the Thai version of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU

    Directory of Open Access Journals (Sweden)

    Pipanmekaporn T

    2014-05-01

    Full Text Available Tanyong Pipanmekaporn,1 Nahathai Wongpakaran,2 Sirirat Mueankwan,3 Piyawat Dendumrongkul,2 Kaweesak Chittawatanarat,3 Nantiya Khongpheng,3 Nongnut Duangsoy31Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; 2Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; 3Division of Surgical Critical Care and Trauma, Department of Surgery, Chiang Mai University Hospital, Chiang Mai, ThailandPurpose: The purpose of this study was to determine the validity and reliability of the Thai version of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU, when compared to the diagnoses made by delirium experts.Patients and methods: This was a cross-sectional study conducted in both surgical intensive care and subintensive care units in Thailand between February–June 2011. Seventy patients aged 60 years or older who had been admitted to the units were enrolled into the study within the first 48 hours of admission. Each patient was randomly assessed as to whether they had delirium by a nurse using the Thai version of the CAM-ICU algorithm (Thai CAM-ICU or by a delirium expert using the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision.Results: The prevalence of delirium was found to be 18.6% (n=13 by the delirium experts. The sensitivity of the Thai CAM-ICU’s algorithms was found to be 92.3% (95% confidence interval [CI] =64.0%-99.8%, while the specificity was 94.7% (95% CI =85.4%-98.9%. The instrument displayed good interrater reliability (Cohen’s κ=0.81; 95% CI =0.64-0.99. The time taken to complete the Thai CAM-ICU was 1 minute (interquatile range, 1-2 minutes.Conclusion: The Thai CAM-ICU demonstrated good validity, reliability, and ease of use when diagnosing delirium in a surgical intensive care unit setting. The use of this diagnostic tool should be encouraged for daily, routine use, so as to promote the early detection

  8. Assessing patient awareness of proper hand hygiene.

    Science.gov (United States)

    Busby, Sunni R; Kennedy, Bryan; Davis, Stephanie C; Thompson, Heather A; Jones, Jan W

    2015-05-01

    The authors hypothesized that patients may not understand the forms of effective hand hygiene employed in the hospital environment. Multiple studies demonstrate the importance of hand hygiene in reducing healthcare-associated infections (HAIs). Extensive research about how to improve compliance has been conducted. Patients' perceptions of proper hand hygiene were evaluated when caregivers used soap and water, waterless hand cleaner, or a combination of these. No significant differences were observed, but many patients reported they did not notice whether their providers cleaned their hands. Educating patients and their caregivers about the protection afforded by proper, consistent hand hygiene practices is important. Engaging patients to monitor healthcare workers may increase compliance, reduce the spread of infection, and lead to better overall patient outcomes. This study revealed a need to investigate the effects of patient education on patient perceptions of hand hygiene. Results of this study appear to indicate a need to focus on patient education and the differences between soap and water versus alcohol-based hand sanitizers as part of proper hand hygiene. Researchers could be asking: "Why have patients not been engaged as members of the healthcare team who have the most to lose?"

  9. Assessment of land use change in the coterminous United States and Alaska for global assessment of forest loss conducted by the food and agricultural organization of the United Nations

    Science.gov (United States)

    Tanushree Biswas; Mike Walterman; Paul Maus; Kevin A. Megown; Sean P. Healey; Kenneth. Brewer

    2012-01-01

    The Food and Agricultural Organization (FAO) of the United Nations conducted a global assessment for forest change in 2010 using satellite imagery from 1990, 2000, and 2005. The U.S. Forest Service was responsible for assessing forest change in the United States. A polygon-based, stratified sampling design developed by FAO was used to assess change in forest area...

  10. The influence of impression management scales on the Personality Assessment Inventory in the epilepsy monitoring unit.

    Science.gov (United States)

    Purdom, Catherine L; Kirlin, Kristin A; Hoerth, Matthew T; Noe, Katherine H; Drazkowski, Joseph F; Sirven, Joseph I; Locke, Dona E C

    2012-12-01

    The Somatic Complaints scale (SOM) and Conversion subscale (SOM-C) of the Personality Assessment Inventory perform best in classifying psychogenic non-epileptic seizures (PNES) from epileptic seizures (ES); however, the impact of positive impression management (PIM) and negative impression management (NIM) scales on SOM and SOM-C classification has not been examined. We studied 187 patients from an epilepsy monitoring unit with confirmed PNES or ES. On SOM, the best cut score was 72.5 T when PIM was elevated and 69.5 T when there was no bias. On SOM-C, when PIM was elevated, the best cut score was 67.5 T and 76.5 T when there was no bias. Negative impression management elevations (n=9) were too infrequent to analyze separately. Despite similarities in classification accuracy, there were differences in sensitivity and specificity with and without PIM, impacting positive and negative predictive values. The presence of PIM bias generally increases positive predictive power of SOM and SOM-C but decreases negative predictive power.

  11. Síndrome de latigazo cervical: Características epidemiológicas de los pacientes evaluados en la Unidad Médica de Valoración de Incapacidades de Madrid Whiplash: Epidemiological characteristics of patients evaluated in the Assessment of Disability Unit of Madrid

    Directory of Open Access Journals (Sweden)

    Raúl Jesús Regal Ramos

    2011-12-01

    Full Text Available El Síndrome de Latigazo cervical (SLC es una patología muy frecuente en las consultas de Atención Primaria y también en las de los médicos evaluadores de discapacidades. Objetivo: Conocer las características epidemiológicas de los pacientes con SLC que, pese a no tener alteraciones anatómicas relevantes, han tenido una evolución tan desfavorable que acaban requiriendo la valoración de una incapacidad laboral Método: Se realizó un estudio descriptivo en el que se recogieron todos los pacientes evaluados en el Equipo de Valoración de Incapacidades (EVI de la Dirección Provincial del Instituto Nacional de la Seguridad Social de Madrid en el período comprendido entre el 1 de enero 2006 al 31 de diciembre de 2010 con el diagnóstico de SLC. Con el fin de excluir los casos más graves se descartaron aquellos con alteraciones anatómicas relevantes, los que habían requerido intervención quirúrgica y los que presentaban afectación moderada-severa en el estudio neurofisiológico. Con la finalidad de minimizar la influencia de otras patologías, se excluyeron también los pacientes que asociaban otros diagnósticos importantes desde el punto de vista de la valoración de incapacidades. Estudiamos las variables edad, sexo, ocupación profesional, estado civil, régimen de afiliación a la SS, contingencia común o laboral, presencia de clínica ansioso-depresiva y /o fibromialgia. Resultado: El total de pacientes estudiados fue de 203. Respecto a la población general ocupada de nuestro entorno con el mismo rango de edad, observamos un 15% más de mujeres (p: 0,015, razón de prevalencia =1,37, un 23% más de no casados (p Whiplash Syndrome (SLC is a very common disease in primary care centers and in disability assessment units. Objetive: To determine the epidemiological characteristics of patients with SLC that, despite having no relevant anatomical changes, have had an unfavorable development that requires the assessment of disability

  12. Experience and Satisfaction With a Multidisciplinary Care Unit for Patients With Psoriasis and Psoriatic Arthritis.

    Science.gov (United States)

    Urruticoechea-Arana, Ana; Serra Torres, Marta; Hergueta Diaz, Mercedes; González Guerrero, María Eugenia; Fariñas Padron, Leslie; Navarro Martín, Sara; Vargas Osorio, Kelly; Palacios Abufón, Andrés; García de Yébenes, María Jesús; Loza, Estíbaliz

    2017-08-24

    To describe patient's characteristics, the activity and patient's satisfaction with a multidisciplinary care unit in patients with psoriasis and psoriatic arthritis (PsA). A retrospective medical records review of patients with psoriasis or PsA attended in a multidisciplinary care unit was performed. Included patients were contacted to fulfill a satisfaction questionnaire. A specific electronic database was set up. Data regarding to patients and their baseline characteristics and the activity of the unit were collected. Descriptive analysis were performed. A total of 112 patients with 154 visits were included in almost 3 years, 54% women, with a mean age of 51 years, 43.7% presented hyperlipidemia and 30.4% arterial hypertension. Half of patients were referred due to diagnostic doubts and the other half for therapeutic problems. After the evaluation of the patients, 66 patients (58.9%) met diagnostic criteria for PsA, and 13 (11.6%) of an inflammatory disease other than PsA, and 95% came back to their usual physician. The most ordered test were laboratory tests (75.6% of patients), followed by X-rays in 57 patients (51.3%). In general the number of patients with different treatments increased, and 55.4% and 42% of patients changed their topic and systemic treatments respectively. The level of satisfaction was very high and all of patients considered that their disease was better controlled in this multidisciplinary care unit. This multidisciplinary care unit has improved the care and satisfaction of patients with psoriasis or PsA, and increased collaboration between rheumatology and dermatology departments. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.

  13. Enteral nutritional therapy in septic patients in the intensive care unit: compliance with nutritional guidelines for critically ill patients

    OpenAIRE

    Pasinato, Valeska Fernandes; Berbigier, Marina Carvalho; Rubin, Bibiana de Almeida; Castro, Kamila; Moraes,Rafael Barberena; Perry, Ingrid Dalira Schweigert

    2013-01-01

    Objective Evaluate the compliance of septic patients' nutritional management with enteral nutrition guidelines for critically ill patients. Methods Prospective cohort study with 92 septic patients, age ≥18 years, hospitalized in an intensive care unit, under enteral nutrition, evaluated according to enteral nutrition guidelines for critically ill patients, compliance with caloric and protein goals, and reasons for not starting enteral nutrition early or for discontinuing it. Prognostic scores...

  14. Healthcare professionals’ views of feedback on patient safety culture assessment.

    NARCIS (Netherlands)

    Zwijnenberg, N.C.; Hendriks, M.; Hoogervorst-Schilp, J.; Wagner, C.

    2016-01-01

    Background: By assessing patient safety culture, healthcare providers can identify areas for improvement in patient safety culture. To achieve this, these assessment outcomes have to be relevant and presented clearly. The aim of our study was to explore healthcare professionals’ views on the feedbac

  15. Is the Frontal Assessment Battery reliable in ALS patients?

    NARCIS (Netherlands)

    J. Raaphorst; E. Beeldman; B. Jaeger; B. Schmand; L.H. van den Berg; J.G. Weikamp; H.J. Schelhaas; M. de Visser; R.J. de Haan

    2013-01-01

    The assessment of frontal functions in ALS patients is important because of the overlap with the behavioural variant of frontotemporal dementia (bvFTD). We investigated the applicability and reliability of the Frontal Assessment Battery (FAB) within a cohort of predominantly prevalent ALS patients.

  16. Myasthenic crisis patients who require intensive care unit management.

    Science.gov (United States)

    Sakaguchi, Hideya; Yamashita, Satoshi; Hirano, Teruyuki; Nakajima, Makoto; Kimura, En; Maeda, Yasushi; Uchino, Makoto

    2012-09-01

    The purpose of this report was to investigate predictive factors that necessitate intensive care in myasthenic crisis (MC). We retrospectively reviewed MC patients at our institution and compared ICU and ward management groups. Higher MG-ADL scale scores, non-ocular initial symptoms, infection-triggered findings, and higher MGFA classification were observed more frequently in the ICU group. In patients with these prognostic factors, better outcomes may be obtained with early institution of intensive care.

  17. Obstetric patients in a surgical intensive care unit: prognostic factors and outcome.

    Science.gov (United States)

    Mjahed, K; Hamoudi, D; Salmi, S; Barrou, L

    2006-07-01

    The objective of this study was to assess the incidence, prognostic factors and the outcome of obstetric patients admitted in a surgical intensive care unit (SICU) during the ante-partum or postpartum period (within 6 weeks of delivery). Between 1995 and 2002, the patients transferred from the department of obstetrics were retrospectively included into the study. Demographics included: obstetric data, medical and surgical histories, diagnosis, simplified acute physiology score (SAPS II), acute physiology and chronic health evaluation system APACHE II score; and the occurrence of organ failure, therapeutic interventions, length of stay in the SICU and outcome were recorded. During the study period, 364 obstetric patients were admitted to the SICU. Obstetric admissions to the SICU represented 0.6% of all deliveries and the SICU utilisation rate was 14.96%. The main indications for admission were eclampsia (70.6%) and postpartum haemorrhage (16.2%). The overall mortality rate was 16.7% (n = 61). In a logistic regression model, risk factors for death included organ system failure (odds ratio (OR) = 3.95 confidence interval (CI) [1.84 - 8.48], bilirubin >12 mg/l (OR = 1.017 CI [1.00 - 1.03]), and prolonged prothrombin time (OR = 0.97 CI [0.95 - 0.99]). Median length of stay was longer in non- survivors (6.5 +/- 7.3 vs 5.5 +/- 4.6 days). Maternal condition on admission and associated complications are the major determinant of maternal outcome.

  18. Distance between residence and the dialysis unit does not impact self-perceived outcomes in hemodialysis patients

    Directory of Open Access Journals (Sweden)

    Santos Paulo

    2012-08-01

    Full Text Available Abstract Background Patients have to travel long distances to undergo hemodialysis (HD in some regions. We aimed to search for an association of the distance between patients’ residence and the dialysis unit with quality of life, depression and coping among end-stage renal disease (ESRD patients undergoing maintenance HD. Methods We studied 161 ESRD patients undergoing HD during April 2009. Quality of life, depression and coping were assessed by the SF-36, the 10-item CES-D and the Jalowiec Coping Scale, respectively. The sample was stratified in three groups: I-patients residing in Sobral (where the dialysis unit is located; II-patients residing in towns up to 100 km from Sobral; and III-patients residing in towns distant greater than 100 km from Sobral. Analysis of variance was used to detect differences in quality of life and coping scores between the groups. Logistic regression was used to test distance as a predictor of depression. Results There were 47 (29.2% patients residing in Sobral, 46 (28.6% up to 100 km away and 68 (42.2% greater than 100 km from Sobral. There were no differences related to quality of life and coping scores between the groups. Distance was not a predictor of depression. Conclusions Social and cultural factors may explain the lack of differences. Studies from other regions are needed to clarify the distance effects on self-perceived outcomes among HD patients.

  19. [Preoperative assessment of lung disease patients.].

    Science.gov (United States)

    Ramos, Gilson; Ramos Filho, José; Pereira, Edísio; Junqueira, Marcos; Assis, Carlos Henrique C

    2003-02-01

    Lung complications are the most frequent causes of postoperative morbidity-mortality, especially in lung disease patients. So, those patients should be preoperatively carefully evaluated and prepared, both clinically and laboratorially. This review aimed at determining surgical risk and at establishing preoperative procedures to minimize peri and postoperative morbidity-mortality in lung disease patients. Major anesthetic-surgical repercussions in lung function have already been described. Similarly, we tried to select higher-risk patients, submitted or not to lung resection. To that end, clinical and laboratorial propedeutics were used. Finally, a proposal of a preoperative algorithm was presented for procedures with lung resection. Lung disease patients, especially those with chronic evolution, need to be preoperatively thoroughly evaluated. ASA physical status and Goldmans cardiac index are important risk forecasting factors for lung disease patients not candidates for lung resection. Adding to these criteria, estimated postoperative max VO2, FEV1 and diffusion capacity are mandatory for some patients submitted to lung resection. beta2-agonists and steroids should be considered in the preoperative period of these patients.

  20. Qualitative Assessment for Toxoplasma gondii Exposure Risk Associated with Meat Products in the United States.

    Science.gov (United States)

    Guo, Miao; Buchanan, Robert L; Dubey, Jitender P; Hill, Dolores E; Lambertini, Elisabetta; Ying, Yuqing; Gamble, H Ray; Jones, Jeffrey L; Pradhan, Abani K

    2015-12-01

    Toxoplasma gondii is a global protozoan parasite capable of infecting most warm-blooded animals. Although healthy adult humans generally have no symptoms, severe illness does occur in certain groups, including congenitally infected fetuses and newborns, immunocompromised individuals including transplant patients. Epidemiological studies have demonstrated that consumption of raw or undercooked meat products is one of the major sources of infection with T. gondii. The goal of this study was to develop a framework to qualitatively estimate the exposure risk to T. gondii from various meat products consumed in the United States. Risk estimates of various meats were analyzed by a farm-to-retail qualitative assessment that included evaluation of farm, abattoir, storage and transportation, meat processing, packaging, and retail modules. It was found that exposure risks associated with meats from free-range chickens, nonconfinement-raised pigs, goats, and lamb are higher than those from confinement-raised pigs, cattle, and caged chickens. For fresh meat products, risk at the retail level was similar to that at the farm level unless meats had been frozen or moisture enhanced. Our results showed that meat processing, such as salting, freezing, commercial hot air drying, long fermentation times, hot smoking, and cooking, are able to reduce T. gondii levels in meat products. whereas nitrite and/or nitrate, spice, low pH, and cold storage have no effect on the viability of T. gondii tissue cysts. Raw-fermented sausage, cured raw meat, meat that is not hot-air dried, and fresh processed meat were associated with higher exposure risks compared with cooked meat and frozen meat. This study provides a reference for meat management control programs to determine critical control points and serves as the foundation for future quantitative risk assessments.

  1. The Risk of Achilles Tendon Rupture in the Patients with Achilles Tendinopathy: Healthcare Database Analysis in the United States

    Directory of Open Access Journals (Sweden)

    Youichi Yasui

    2017-01-01

    Full Text Available Introduction. Disorders of the Achilles tendon can be broadly classified into acute and chronic entities. Few studies have established chronic Achilles tendinopathy as a precursor to acute Achilles ruptures. In this study, we assessed the relationship between Achilles tendinopathy and rupture, clarifying the incidence of rupture in the setting of underlying tendinopathy. Methods. The United Healthcare Orthopedic Dataset from the PearlDiver Patient Record Database was used to identify patients with ICD-9 codes for Achilles rupture and/or Achilles tendinopathy. The number of patients with acute rupture, chronic tendinopathy, and rupture following a prior diagnosis of tendinopathy was assessed. Results. Four percent of patients with an underlying diagnosis of Achilles tendinopathy went on to sustain a rupture (7,232 patients. Older patients with tendinopathy were most vulnerable to subsequent rupture. Conclusions. The current study demonstrates that 4.0% of patients who were previously diagnosed with Achilles tendinopathy sustained an Achilles tendon rupture. Additionally, older patients with Achilles tendinopathy were most vulnerable. These findings are important as they can help clinicians more objectively council patients with Achilles tendinopathy.

  2. The Risk of Achilles Tendon Rupture in the Patients with Achilles Tendinopathy: Healthcare Database Analysis in the United States

    Science.gov (United States)

    Shimozono, Yoshiharu; Kawano, Hirotaka

    2017-01-01

    Introduction. Disorders of the Achilles tendon can be broadly classified into acute and chronic entities. Few studies have established chronic Achilles tendinopathy as a precursor to acute Achilles ruptures. In this study, we assessed the relationship between Achilles tendinopathy and rupture, clarifying the incidence of rupture in the setting of underlying tendinopathy. Methods. The United Healthcare Orthopedic Dataset from the PearlDiver Patient Record Database was used to identify patients with ICD-9 codes for Achilles rupture and/or Achilles tendinopathy. The number of patients with acute rupture, chronic tendinopathy, and rupture following a prior diagnosis of tendinopathy was assessed. Results. Four percent of patients with an underlying diagnosis of Achilles tendinopathy went on to sustain a rupture (7,232 patients). Older patients with tendinopathy were most vulnerable to subsequent rupture. Conclusions. The current study demonstrates that 4.0% of patients who were previously diagnosed with Achilles tendinopathy sustained an Achilles tendon rupture. Additionally, older patients with Achilles tendinopathy were most vulnerable. These findings are important as they can help clinicians more objectively council patients with Achilles tendinopathy. PMID:28540301

  3. Economics of immunization information systems in the United States: assessing costs and efficiency

    Directory of Open Access Journals (Sweden)

    Urquhart Gary A

    2006-08-01

    Full Text Available Abstract Background One of the United States' national health objectives for 2010 is that 95% of children aged Methods Data were collected from a national sampling frame of the 56 states/cities that received federal immunization grants under U.S. Public Health Service Act 317b and completed the federal 1999 Immunization Registry Annual Report. The sampling frame was stratified by IIS functional status, children's enrollment in the IIS, and whether the IIS had been developed as an independent system or was integrated into a larger system. These sites self-reported IIS developmental and operational program costs for calendar years 1998–2002 using a standardized data collection tool and underwent on-site interviews to verify reported data with information from the state/city financial management system and other financial records. A parametric cost-per-patient-record (CPR model was estimated. The model assessed the impact of labor and non-labor resources used in development and operations tasks, as well as the impact of information technology, local providers' participation and compliance with federal IIS performance standards (e.g., ensuring the confidentiality and security of information, ensure timely vaccination data at the time of patient encounter, and produce official immunization records. Given the number of records minimizing CPR, the additional amount of resources needed to meet national health goals for the year 2010 was also calculated. Results Estimated CPR was as high as $10.30 and as low as $0.09 in operating IIS. About 20% of IIS had between 2.9 to 3.2 million records and showed CPR estimates of $0.09. Overall, CPR was highly sensitive to local providers' participation. To achieve the 2010 goals, additional aggregated costs were estimated to be $75.6 million nationwide. Conclusion Efficiently increasing the number of records in IIS would require additional resources and careful consideration of various strategies to minimize CPR

  4. Effect of intensive care unit organizational model and structure on outcomes in patients with acute lung injury.

    Science.gov (United States)

    Treggiari, Miriam M; Martin, Diane P; Yanez, N David; Caldwell, Ellen; Hudson, Leonard D; Rubenfeld, Gordon D

    2007-10-01

    Prior studies supported an association between intensive care unit (ICU) organizational model or staffing patterns and outcome in critically ill patients. To examine the association of closed versus open models with patient mortality across adult ICUs in King County (WA). Cohort study of patients with acute lung injury (ALI). ICU structure, organization, and patient care practices were assessed using self-administered mail questionnaires completed by the medical director and nurse manager. We defined closed ICUs as units that required patient transfer to or mandatory patient comanagement by an intensivist and open ICUs as those relying on other organizational models. Outcomes were obtained from the King County Lung Injury Project, a population-based cohort of patients with ALI. The main endpoint was hospital mortality. Of 24 eligible ICUs, 13 ICUs were designated closed and 11 open. Complete survey data were available for 23 (96%) ICUs. Higher physician and nurse availability was reported in closed versus open ICUs. A total of 684 of 1,075 (63%) of patients with ALI were cared for in closed ICUs. After adjusting for potential confounders, patients with ALI cared for in closed ICUs had reduced hospital mortality (adjusted odds ratio, 0.68; 95% confidence interval, 0.53, 0.89; P = 0.004). Consultation by a pulmonologist in open ICUs was not associated with improved mortality (adjusted odds ratio, 0.94; 95% confidence interval, 0.74, 1.20; P = 0.62). These findings were robust for varying assumptions about the study population definition. Patients with ALI cared for in a closed-model ICU have reduced mortality. These data support recommendations to implement structured intensive care in the United States.

  5. [Assessment of diagnostic methods for the catheter-related bloodstream infections in intensive care units].

    Science.gov (United States)

    Ataman Hatipoğlu, Ciğdem; Ipekkan, Korhan; Oral, Behiç; Onde, Ufuk; Bulut, Cemal; Demiröz, Ali Pekcan

    2011-01-01

    The majority of catheter-related bloodstream infections (CR-BSI) are associated with central venous catheters (CVCs) and most of them develop in patients staying at intensive care units (ICUs). The aim of this study was to assess the performance of different methods for the diagnosis of CR-BSI in neurology and neurosurgery ICUs of our hospital. This prospective study was carried out between January 2007 and January 2008 and all of the patients were followed daily for CR-BSI after the insertion of CVCs. Blood cultures were taken simultaneously from the catheter lumen and from at least one peripheral vein when there was a suspicion of CR-BSI. Additionally, from patients whose CVCs were removed, catheter tip cultures were taken and from patients with exit site infection, cultures of the skin surrounding the catheter entrance were taken. Catheter tip cultures were done by using quantitative and semiquantitative culture methods. Blood cultures taken from the catheter lumen and peripheral vein were incubated in the BACTEC 9050 (Becton Dickinson, USA) automated blood culture system. Gram and acridine orange (AO) staining were used for the smears prepared from the catheter tips and blood cultures. To evaluate the value of culture and staining methods in the diagnosis of CR-BSI; sensitivity, specificity, positive and negative predictive values (PPV and NPV, respectively) of each method were determined. A total of 148 patients (66 male, 82 female; age range: 1-94 years, mean age: 58.7 ± 21.8 years) were included in the study, of whom 67 (45.3%) were from neurology and 81 (54.7%) were from neurosurgery ICUs. One hundred ninety-nine CVC application performed in 148 patients were evaluated. Mean duration of catheterization was 8.5 ± 5.2 days. Thirty-two episodes of CR-BSI among 199 catheterizations (16%) in 29 patients among a total of 148 patients (19.6%) were determined. The most frequently isolated microorganisms were methicillin-resistant coagulase-negative staphylococci

  6. Preventive medicine in the older patient: A United Kingdom perspective

    Directory of Open Access Journals (Sweden)

    Puneet Kakar

    2012-01-01

    Full Text Available Preventive Medicine in the elderly is often regarded as a redundant concept and pre-existing opinions are barriers in the provision of this service. This article explores the concepts of preventive medicine in the elderly from a United Kingdom perspective and examines current trends, opinions and sets out a path for the future. In particular it focusses on the theories of morbidity associated with ageing, economic viability of providing preventive medicine care for the older person and attempts to seek redress for the current situation.

  7. [Comparative assessment of conservative treatment of chronic prostatitis with application of complex unit andro-gin].

    Science.gov (United States)

    Golubchikova, V A; Alekseev, M Ia; Sitnikov, N V; Kochetov, A G; Podgornyĭ, V F

    2000-01-01

    The Andro-Gin unit used in combined treatment of 78 patients with chronic prostatitis (CP) and 16 women with chronic interstitial cystitis with inflammation in the internal genitalia (56.5% of the patients had sexual and spermatogenesis disorders) employed effects of simultaneous exposure to local magnetic field, electrostimulation of the small pelvis organs and prostate with introduction of contact rectal electrode, neurostimulation of pathogenic zones, low-intensity laser and light-diode radiator and color impulse therapy. Control group consisted of 85 patients with CP who received conventional physiotherapy. The comparative analysis has shown high efficiency of the unit Andro-Gin in the treatment of CP and its complications. Laboratory and clinical convalescence and persistent remission was registered in 98% of the patients of the study group. Combined treatment using Andro-Gin is twice more effective than other treatments.

  8. Candiduria in catheterized intensive care unit patients : Emerging microbiological trends

    Directory of Open Access Journals (Sweden)

    Manisha Jain

    2011-01-01

    Full Text Available Objectives: Urinary tract infection (UTI as a result of Candida spp. is becoming increasingly common in hospitalized setting. Clinicians face dilemma in differentiating colonization from true infection and whether to treat candiduria or not. The objective of the present study was to look into the significance of candiduria in catheterized patients admitted in the ICUs and perform microbiological characterization of yeasts to guide treatment protocols. Materials and Methods: One hundred consecutive isolates of Candida spp. from the urine sample of 70 catheterized patients admitted in the ICU were collected and stocked for further characterization. A proforma was maintained containing demographic and clinical details. Blood cultures were obtained from all these 70 patients and processed. Species identification of yeasts was done on VITEK. Results: Candiduria was more common at extremes of age. The mean duration of catheter days was 11.1 ± 6 days. Other associated risk factors such as diabetes mellitus and antibiotic usage were seen in 38% and 100% of our study group. Concomitant candidemia was seen in 4.3% of cases. Non-albicans Candida spp. (71.4% emerged as the predominant pathogen causing nosocomial UTI. Conclusion: The present study reiterates the presence of candiduria in catheterized patients, especially in the presence of diabetes and antibiotic usage. Non-albicans Candida spp. are replacing Candida albicans as the predominant pathogen for nosocomial UTI. Hence, we believe that surveillance for nosocomial candiduria should be carried out in hospitalized patients.

  9. Patient perception of pain care in hospitals in the United States

    Directory of Open Access Journals (Sweden)

    Anita Gupta

    2009-11-01

    Full Text Available Anita Gupta1, Sarah Daigle2, Jeffrey Mojica3, Robert W Hurley41Pain Management Division, Department of Anesthesiology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA; 2Department of Anesthesiology and Critical Care, 3Department of Anesthesiology and Critical Care, Division of Pain Medicine, University of Pennsylvania, Philadelphia, PA, USA; 4Medical Director of the Johns Hopkins Pain Treatment Center, Division of Pain Medicine, Deparment of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USAStudy objective: Assessment of patients’ perception of pain control in hospitals in the United States.Background: Limited data are available regarding the quality of pain care in the hospitalized patient. This is particularly valid for data that allow for comparison of pain outcomes from one hospital to another. Such data are critical for numerous reasons, including allowing patients and policy-makers to make data-driven decisions, and to guide hospitals in their efforts to improve pain care. The Hospital Quality Alliance was recently created by federal policy makers and private organizations in conjunction with the Centers for Medicare and Medicare Services to conduct patient surveys to evaluate their experience including pain control during their hospitalization.Methods: In March 2008, the results of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS survey was released for review for health care providers and researchers. This survey includes a battery of questions for patients upon discharge from the hospital including pain-related questions and patient satisfaction that provide valuable data regarding pain care nationwide. This study will review the results from the pain questions from this available data set and evaluate the performance of these hospitals in pain care in relationship to patient satisfaction. Furthermore, this analysis will be providing valuable

  10. Implementation of unit-based interventions to improve teamwork and patient safety on a medical service.

    Science.gov (United States)

    O'Leary, Kevin J; Creden, Amanda J; Slade, Maureen E; Landler, Matthew P; Kulkarni, Nita; Lee, Jungwha; Vozenilek, John A; Pfeifer, Pamela; Eller, Susan; Wayne, Diane B; Williams, Mark V

    2015-01-01

    In a prior study involving 2 medical units, Structured Interdisciplinary Rounds (SIDRs) improved teamwork and reduced adverse events (AEs). SIDR was implemented on 5 additional units, and a pre- versus postintervention comparison was performed. SIDR combined a structured format for communication with daily interprofessional meetings. Teamwork was assessed using the Safety Attitudes Questionnaire (score range = 0-100), and AEs were identified using queries of information systems confirmed by 2 physician researchers. Paired analyses for 82 professionals completing surveys both pre and post implementation revealed improved teamwork (mean 76.8 ± 14.3 vs 80.5 ± 11.6; P = .02), which was driven mainly by nurses (76.4 ± 14.1 vs 80.8 ± 10.4; P = .009). The AE rate was similar across study periods (3.90 vs 4.07 per 100 patient days; adjusted IRR = 1.08; P = .60). SIDR improved teamwork yet did not reduce AEs. Higher baseline teamwork scores and lower AE rates than the prior study may reflect a positive cultural shift that began prior to the current study. © The Author(s) 2014.

  11. Cardiac arrhythmias in stroke unit patients. Evaluation of the cardiac monitoring data.

    Science.gov (United States)

    Fernández-Menéndez, S; García-Santiago, R; Vega-Primo, A; González Nafría, N; Lara-Lezama, L B; Redondo-Robles, L; Montes-Montes, M; Riveira-Rodríguez, M C; Tejada-García, J

    2016-06-01

    Cardiac arrhythmias are frequent in acute stroke. Stroke units are widely equipped with cardiac monitoring systems. Pre-existing heart diseases and heart-brain interactions may be implicated in causing cardiac arrhythmias in acute stroke. This article analyses cardiac arrhythmias detected in patients hospitalised in a stroke unit. Prospective observational study of consecutive patients admitted to a stroke unit with cardiac monitoring. We collected clinical data from patients and the characteristics of their cardiac arrhythmias over a 1-year period (2013). Time of arrhythmia onset, associated predisposing factors, and the therapeutic decisions made after detection of arrhythmia were examined. All patients underwent continuous cardiac monitoring during no less than 48hours. Of a total of 332 patients admitted, significant cardiac arrhythmias occurred in 98 patients (29.5%) during their stay in the stroke unit. Tachyarrhythmia (ventricular tachyarrhythmias, supraventricular tachyarrhythmias, complex ventricular ectopy) was present in 90 patients (27.1%); bradyarrhythmia was present in 13 patients (3.91%). Arrhythmias were independently associated with larger size of brain lesion and older age. In 10% of the patient total, therapeutic actions were taken after detection of significant cardiac arrhythmias. Most events occurred within the first 48hours after stroke unit admission. Systematic cardiac monitoring in patients with acute stroke is useful for detecting clinically relevant cardiac arrhythmias. Incidence of arrhythmia is higher in the first 48hours after stroke unit admission. Age and lesion size were predicted appearance of arrhythmias. Detection of cardiac arrhythmias in a stroke unit has important implications for treatment. Copyright © 2014 Sociedad Española de Neurología. Published by Elsevier España, S.L.U. All rights reserved.

  12. [Return to work of the cardiac patient: work fitness evaluation in Occupational Medicine Division including an Occupational Cardiology Unit and Work-Physiology Lab in Bergamo].

    Science.gov (United States)

    Borleri, D; Seghizzi, P; Manfredini, F; Mosconi, G

    2012-01-01

    Cardiovascular disease in working age still represent a major cause of morbidity and account for a number of fitness to work certificates expressing several limitations and prescriptions. To present the medical assessment conducted in an Occupational Medicine Division including an Occupational Cardiology Unit and work-physiology lab. It is described the history and the structure of the Occupational Cardiology Unit. Our almost forty years long-lasting experience allow us to point out the precious contribution of the Occupational Cardiology Unit to the Occupational Medicine Division, due to a highly specialised and qualified assessment of cardiac patients.

  13. The Status of Genetics Curriculum in Higher Education in the United States: Goals and Assessment

    Science.gov (United States)

    McElhinny, Teresa L.; Dougherty, Michael J.; Bowling, Bethany V.; Libarkin, Julie C.

    2014-01-01

    We review the state of genetics instruction in the United States through the lens of backward design, with particular attention to the goals and assessments that inform curricular practice. An analysis of syllabi and leading textbooks indicates that genetics instruction focuses most strongly on foundations of DNA and Mendelian genetics. At the…

  14. The Status of Genetics Curriculum in Higher Education in the United States: Goals and Assessment

    Science.gov (United States)

    McElhinny, Teresa L.; Dougherty, Michael J.; Bowling, Bethany V.; Libarkin, Julie C.

    2014-01-01

    We review the state of genetics instruction in the United States through the lens of backward design, with particular attention to the goals and assessments that inform curricular practice. An analysis of syllabi and leading textbooks indicates that genetics instruction focuses most strongly on foundations of DNA and Mendelian genetics. At the…

  15. German Studies in the United States: Assessment and Outlook. Monatshefte Occasional Volume Number 1.

    Science.gov (United States)

    Lohnes, Walter F. W., Ed.; Nollendorfs, Valters, Ed.

    This volume focuses on two principal aspects of German studies in the United States: (1) an assessment of the German-teaching profession from primary to graduate school, with attention to its "raison d'etre" in the present academic, social, and cultural situation, as well as its structures, aims, and personnel; and (2) strategies for survival and…

  16. Impacts of Climate Change on Human Health in the United States: A Scientific Assessment

    Science.gov (United States)

    Climate change threatens human health and well-being in the United States. To address this growing threat, the Interagency Group on Climate Change and Human Health (CCHHG), a working group of the U.S. Global Change Research Program’s (USGCRP), has developed this assessment as par...

  17. 77 FR 51071 - Indiana Michigan Power Company, Donald C. Cook Nuclear Plant, Unit 2, Environmental Assessment...

    Science.gov (United States)

    2012-08-23

    ..., operational, or storing processes). The fuel storage and handling, radioactive waste, and other systems which... From the Federal Register Online via the Government Publishing Office NUCLEAR REGULATORY COMMISSION Indiana Michigan Power Company, Donald C. Cook Nuclear Plant, Unit 2, Environmental Assessment and...

  18. Nutritional assessment and treatment of patients with liver cirrhosis.

    Science.gov (United States)

    Moctezuma-Velázquez, Carlos; García-Juárez, Ignacio; Soto-Solís, Rodrigo; Hernández-Cortés, Juan; Torre, Aldo

    2013-01-01

    Prevalence of chronic liver diseases, including liver cirrhosis, is increasing worldwide. The nutritional state assessment in these patients is complicated, and besides anthropometry is based on several other tools in order to be more accurate. Specific dietary recommendations are needed in patients with chronic liver diseases in order to help prevent and treat liver decompensation because malnutrition is an independent predictor of mortality. This review focuses on essential aspects in the nutritional assessment of cirrhotic patients and some general recommendations for their treatment.

  19. Profile of hemogram and transaminases in dengue-suspected patients at a first-aid health unit

    Directory of Open Access Journals (Sweden)

    Érica Maria da Silva

    2015-04-01

    Full Text Available Current retrospective analysis describes the laboratorial profile of patients hypothetically diagnosed with dengue at a First-Aid Health Unit in Recife, Pernambuco State, Brazil. Results of hemograms were assessed by counting platelets and transaminase dosages, in the first half of 2012. Further, 394 patients (252 females or 64% and 142 males or 34% were listed, mostly during March and April. Hemograms with platelet counting was undertaken with 210 patients (53.3% and hemogram plus transaminases dosages with 184 patients (46.7%. Thrombocytopenia, neutropenia and atypical lymphocytes occurred in both genders. Hematocrits were highest in males and transaminases were more altered in females. Patients attended at the health unit with clinical symptoms of classical dengue had a laboratory profile of non-specific exams which is a feature of infection by the dengue virus. Diagnosis could not be confirmed and the need of a fast test in the health unit services was mandatory. The above avoids dengue cases not being notified and treated or overestimated.

  20. Place of the Post-Anesthesia Care Unit in Patient Care after Anesthesia

    OpenAIRE

    Güvenç Doğan; Çakır E2 , Kılıç I; Akdur F; Ornek D; Selçuk Akçaboy ZN; Nermin G

    2017-01-01

    Aim: The aim of this study is to emphasize that the post-anesthesia care unit provides good quality service and is an important place for treatment of patients at high risk of postoperative complications. Material And Methods: Patients admitted to the post-anesthesia care unit with ASA II, III, IV, and V risk group during the postoperative period between 1 March 2013 and 30 September 2013 in Ankara Numune Training and Research Hospital were retrospectively evaluated for data relating to age, ...

  1. Mental Capacity Assessments Among Inpatients Referred to the Consultation-Liaison Psychiatry Unit at a University Hospital in Bangkok, Thailand.

    Science.gov (United States)

    Pariwatcharakul, Pornjira; Singhakant, Supachoke

    2017-03-01

    Clinicians routinely assess patients' mental capacity on a daily basis, but a more thorough assessment may be needed in complex cases. We aimed to identify the characteristics of inpatients in a general hospital, who were referred to a liaison psychiatry service for mental capacity assessment, reasons for the referrals, and the factors associated with their mental capacity. A 6-year retrospective study (2008-2013) was conducted using data collected routinely (e.g., age, gender, diagnosis, Thai Mental State Examination score, reasons for the referral, and the outcome of capacity assessment) on referrals for mental capacity assessment to a Consultation-liaison Psychiatry Unit at a university hospital in Thailand. Among 6194 consecutive referrals to the liaison-psychiatry services, only 0.6 % [n = 37, mean age (SD), 59.83 (20.42)] were referred for capacity assessment, 43.24 % of which lacked mental capacity. The most common requests from referring physicians were for assessment of testamentary capacity (15 assessed, 53.33 % lacking capacity), financial management capacity (14 assessed, 50 % lacking capacity), and capacity to consent to treatment (9 assessed, 22.22 % lacking capacity). Delirium, rather than dementia or other mental disorders, was associated with mental incapacity (p < 0.001) and being more dependent during the admission (p = 0.048). There were no significant differences for mean age (p = 0.257) or Thai Mental State Examination score (p = 0.206). The main request from referring clinicians was to assess testamentary capacity. Delirium and being more dependent during the admission were associated with lack of mental capacity, whereas age and dementia were not.

  2. Assessing Sexual Abuse/Attack Histories with Bariatric Surgery Patients

    Science.gov (United States)

    Mahony, David

    2010-01-01

    This study assessed sexual abuse/attack histories in 537 bariatric surgery patients using the PsyBari. The prevalence rates found were lower (15.5%, 19.3% of women, 5.2% of men) than other studies that used bariatric surgery patients but consistent with studies that used nonbariatric obese subjects. Furthermore, bariatric surgery patients who…

  3. Assessing Sexual Abuse/Attack Histories with Bariatric Surgery Patients

    Science.gov (United States)

    Mahony, David

    2010-01-01

    This study assessed sexual abuse/attack histories in 537 bariatric surgery patients using the PsyBari. The prevalence rates found were lower (15.5%, 19.3% of women, 5.2% of men) than other studies that used bariatric surgery patients but consistent with studies that used nonbariatric obese subjects. Furthermore, bariatric surgery patients who…

  4. Assessing learning styles: practical tips for patient education.

    Science.gov (United States)

    Inott, Theresa; Kennedy, Betsy B

    2011-09-01

    Nurses must facilitate and support patient and family decision-making and improvement in health outcomes using instructional skills. Complex patient needs and nursing responsibilities necessitate thoughtful consideration for maximizing the effectiveness of patient teaching encounters. This article reviews assessment of patient learning styles in combination with context for an individualized approach, as well as motivation for adult learners as a framework for organization of patient teaching. Methods and modes of patient teaching are discussed as well as tips for overcoming barriers to planning and implementing patient teaching.

  5. Treatment Adherence of Tuberculosis Patients Attending Two Reference Units in Equatorial Guinea.

    Science.gov (United States)

    Fagundez, Gabriela; Perez-Freixo, Hugo; Eyene, Juan; Momo, Juan Carlos; Biyé, Lucia; Esono, Teodoro; Ondó Mba Ayecab, Marcial; Benito, Agustín; Aparicio, Pilar; Herrador, Zaida

    2016-01-01

    Equatorial Guinea has one of the highest burden of tuberculosis (TB) in Africa. Incomplete adherence to TB treatment has been identified as one of the most serious remaining problem in tuberculosis control. The following study is aimed at determining the adherence to anti-tuberculosis treatment in Equatorial Guinea and its determinants, as well as at assessing the knowledge of the people about the disease. In this cross-sectional study, participants were recruited by non-probabilistic consecutive sampling amongst patients who attended the reference units for TB in Bata and Malabo between March and July 2015. Socio-demographic and clinical data were collected. Adherence to treatment and knowledge about TB were assessed by Morisky-Green-Levine and Batalla tests and a questionnaire on adherence related factors specifically prepared for this research. Descriptive statistics were computed to summarize the data and bivariate analyses by adherence profile were performed with χ2 test for categorical data. A total of 98 patients with TB were interviewed. 63.27% of interviewees had good knowledge about TB (Batalla test) while 78.57% of respondents were adherent according to the Morisky-Green-Levine test. A low educational level, lack of family support and lack of medical advice about the disease were significantly associated to lower adherence level. Patients with re-infection (due to relapse or treatment failure) and those who have suffered from drug shortages were also less adherents. The National Programme for TB Control should consider improving the early diagnosis and follow-up of TB cases, as well as the implementation of all components of DOTS (Directly observed Treatment, short-course) strategy all over the country.

  6. Delirium Frequency and Risk Factors Among Patients With Cancer in Palliative Care Unit.

    Science.gov (United States)

    Şenel, Gülcin; Uysal, Neşe; Oguz, Gonca; Kaya, Mensure; Kadioullari, Nihal; Koçak, Nesteren; Karaca, Serife

    2017-04-01

    Introductıon: Delirium is a complex but common disorder in palliative care with a prevalence between 13% and 88% but a particular frequency at the end of life yet often remains insufficiently diagnosed and managed. The aim of our study is to determine the frequency of delirium and identify factors associated with delirium at palliative care unit. Two hundred thirteen consecutive inpatients from October 1, 2012, to March 31, 2013, were studied prospectively. Age, gender, Palliative Performance Scale (PPS), Palliative Prognostic Index (PPI), length of stay in hospital, and delirium etiology and subtype were recorded. Delirium was diagnosed with using Delirium Rating Scale (DRS) and Diagnostic and Statistical Manual of Mental Disorders, 4th Edition Text Revision ( DSM-IV TR) criteria. The incidence of delirium among the patients with cancer was 49.8%. Mean age was 60.3 ± 14.8 (female 41%, male 59%, PPS 39.8%, PPI 5.9 ± 3.0, length of stay in hospital 8.6 ± 6.9 days). Univariate logistic regression analysis indicated that use of opioids, anticonvulsants, benzodiazepines, steroids, polypharmacy, infection, malnutrition, immobilization, sleep disturbance, constipation, hyperbilirubinemia, liver/renal failure, pulmonary failure/hypoxia, electrolyte imbalance, brain cancer/metastases, decreased PPS, and increased PPI were risk factors. Subtypes of delirium included hypoactive 49%, mixed 41%, and hyperactive 10%. The communicative impediments associated with delirium generate distress for the patient, their family, and health care practitioners who might have to contend with agitation and difficulty in assessing pain and other symptoms. To manage delirium in patients with cancer, clinicians must be able to diagnose it accurately and undertake appropriate assessment of underlying causes.

  7. Treatment Adherence of Tuberculosis Patients Attending Two Reference Units in Equatorial Guinea

    Science.gov (United States)

    Eyene, Juan; Momo, Juan Carlos; Biyé, Lucia; Esono, Teodoro; Ondó Mba Ayecab, Marcial; Benito, Agustín; Aparicio, Pilar

    2016-01-01

    Equatorial Guinea has one of the highest burden of tuberculosis (TB) in Africa. Incomplete adherence to TB treatment has been identified as one of the most serious remaining problem in tuberculosis control. The following study is aimed at determining the adherence to anti-tuberculosis treatment in Equatorial Guinea and its determinants, as well as at assessing the knowledge of the people about the disease. In this cross-sectional study, participants were recruited by non-probabilistic consecutive sampling amongst patients who attended the reference units for TB in Bata and Malabo between March and July 2015. Socio-demographic and clinical data were collected. Adherence to treatment and knowledge about TB were assessed by Morisky-Green-Levine and Batalla tests and a questionnaire on adherence related factors specifically prepared for this research. Descriptive statistics were computed to summarize the data and bivariate analyses by adherence profile were performed with χ2 test for categorical data. A total of 98 patients with TB were interviewed. 63.27% of interviewees had good knowledge about TB (Batalla test) while 78.57% of respondents were adherent according to the Morisky-Green-Levine test. A low educational level, lack of family support and lack of medical advice about the disease were significantly associated to lower adherence level. Patients with re-infection (due to relapse or treatment failure) and those who have suffered from drug shortages were also less adherents. The National Programme for TB Control should consider improving the early diagnosis and follow-up of TB cases, as well as the implementation of all components of DOTS (Directly observed Treatment, short-course) strategy all over the country. PMID:27622461

  8. Assessment of Medical-Surgical Patients' Perception of Hospital Noises and Reported Ability to Rest.

    Science.gov (United States)

    Locke, Christine L; Pope, Diana S

    The purpose was to determine if an enhanced privacy curtain (1) impacted ability to rest while hospitalized in the acute care setting and (2) improved patient satisfaction associated with environmental noise. The project evaluated a privacy curtain designed to increase speech privacy and intelligibility and reduce reverberation time (echo). The curtain was similar to the existing privacy curtain with 2 exceptions: the curtain panel had pocket inserts that absorbed sound, and curtain panels could be zipped together to reduce sound transmission through gaps. Curtains were evaluated on 2 medical-surgical units. Patients with at least 2 nights' stay and were alert and oriented without behavioral concerns were asked to complete a 12-item restful environment assessment. The project demonstrated some impact on ability to rest. One unit saw an increase in the patient experience sleep measure score and demonstrated a small increase in the patient's self- reported ability to rest during the day and night when using the enhanced curtain. Patients on medical-surgical units were bothered by the noises typically heard in those units. Small improvements in patient experience with the enhanced curtain were outweighed by cost and increased housekeeping and laundry staff workload.

  9. EuroQoL in assessment of the effect of pulmonary rehabilitation COPD patients

    DEFF Research Database (Denmark)

    Ringbaek, Thomas; Brøndum, Eva; Martinez, Gerd;

    2008-01-01

    BACKGROUND: The effect of pulmonary rehabilitation on EuroQol in COPD patients has not been investigated previously. METHODS/MATERIALS: Two hundred and twenty nine consecutive COPD patients who had completed a 7-week pulmonary rehabilitation programme were assessed with EuroQol five-dimension que......BACKGROUND: The effect of pulmonary rehabilitation on EuroQol in COPD patients has not been investigated previously. METHODS/MATERIALS: Two hundred and twenty nine consecutive COPD patients who had completed a 7-week pulmonary rehabilitation programme were assessed with EuroQol five...... scale. At completion of the programme, statistical significant improvements were seen for ESWT 157.3s; ptotal score -2.8units; p....1%). CONCLUSIONS: In COPD patients receiving rehabilitation, responsiveness of EQ-5D utility was poor. One explanation might be a "ceiling effect" of this instrument....

  10. Stressors in the relatives of patients admitted to an intensive care unit

    Science.gov (United States)

    Barth, Angélica Adam; Weigel, Bruna Dorfey; Dummer, Claus Dieter; Machado, Kelly Campara; Tisott, Taís Montagner

    2016-01-01

    Objective To identify and stratify the main stressors for the relatives of patients admitted to the adult intensive care unit of a teaching hospital. Methods Cross-sectional descriptive study conducted with relatives of patients admitted to an intensive care unit from April to October 2014. The following materials were used: a questionnaire containing identification information and demographic data of the relatives, clinical data of the patients, and 25 stressors adapted from the Intensive Care Unit Environmental Stressor Scale. The degree of stress caused by each factor was determined on a scale of values from 1 to 4. The stressors were ranked based on the average score obtained. Results The main cause of admission to the intensive care unit was clinical in 36 (52.2%) cases. The main stressors were the patient being in a state of coma (3.15 ± 1.23), the patient being unable to speak (3.15 ± 1.20), and the reason for admission (3.00 ± 1.27). After removing the 27 (39.1%) coma patients from the analysis, the main stressors for the relatives were the reason for admission (2.75 ± 1.354), seeing the patient in the intensive care unit (2.51 ± 1.227), and the patient being unable to speak (2.50 ± 1.269). Conclusion Difficulties in communication and in the relationship with the patient admitted to the intensive care unit were identified as the main stressors by their relatives, with the state of coma being predominant. By contrast, the environment, work routines, and relationship between the relatives and intensive care unit team had the least impact as stressors. PMID:27737424

  11. Assessing the energy efficiency of pumps and pump units background and methodology

    CERN Document Server

    Bernd Stoffel, em Dr-Ing

    2015-01-01

    Assessing the Energy Efficiency of Pumps and Pump Units, developed in cooperation with Europump, is the first book available providing the background, methodology, and assessment tools for understanding and calculating energy efficiency for pumps and extended products (pumps+motors+drives). Responding to new EU requirements for pump efficiency, and US DOE exploratory work in setting pump energy efficiency guidelines, this book provides explanation, derivation, and illustration of PA and EPA methods for assessing energy efficiency. It surveys legislation related to pump energy eff

  12. Systematic Suicide Risk Assessment for Patients With Schizophrenia

    DEFF Research Database (Denmark)

    Gjørup Pedersen, Charlotte; Wallenstein Jensen, Signe Olrik; Gradus, Jaimie;

    2014-01-01

    Objectives: Systematic suicide risk assessment is recommended for patients with schizophrenia; however, little is known about the implementation of suicide risk assessment in routine clinical practice. The study aimed to determine the use of systematic suicide risk assessment at discharge...... and predictors of suicide attempt among hospitalized patients with schizophrenia in Denmark. Methods: A one-year follow-up study was conducted of 9,745 patients with schizophrenia who were discharged from psychiatric wards and registered in a national population-based schizophrenia registry between 2005 and 2009....... Results: The proportion of patients receiving suicide risk assessment at discharge from a psychiatric ward increased from 72% (95% confidence interval [CI]=71%-74%) in 2005, when the national monitoring began, to 89% (CI.89%-90%) in 2009. Within one year after discharge, 1% of all registered patients had...

  13. Generalized boundaries of the National Water-Quality Assessment (NAWQA) Study-Unit Investigations in the conterminous United States 2001-2012

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This is a GENERALIZED version of the boundaries and codes used for the U.S. Geological Survey's National Water-Quality Assessment (NAWQA) Program Study-Unit...

  14. Generalized boundaries of the National Water-Quality Assessment (NAWQA) Study-Unit Investigations in the conterminous United States 1991-2001

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This is a GENERALIZED version of the boundaries and codes used for the U.S. Geological Survey's National Water-Quality Assessment (NAWQA) Program Study-Unit...

  15. Searching for predictors of surgical complications in critically ill surgery patients in the intensive care unit: a review.

    Science.gov (United States)

    Meyer, Zainna C; Schreinemakers, Jennifer M J; de Waal, Ruud A L; van der Laan, Lijckle

    2015-09-01

    We reviewed the use of the levels of C-reactive protein, lactate and procalcitonin and/or the Sequential Organ Failure Assessment score to determine their diagnostic accuracy for predicting surgical complications in critically ill general post-surgery patients. Included were all studies published in PubMed from inception to July 2013 that met the following inclusion criteria: evaluation of the above parameters, describing their diagnostic accuracy and the risk stratification for surgical complications in surgical patients admitted to an intensive care unit. No difference in the Sequential Organ Failure Assessment scores was seen between patients with or without complications. The D-lactate levels were significantly higher in those who developed colonic ischemic complications after a ruptured abdominal aortic aneurysm. After gastro-intestinal surgery, contradictory data were reported, with both positive and negative use of C-reactive protein and procalcitonin in the diagnosis of septic complications. However, in trauma patients, the C-reactive protein levels may help to discriminate between those with and without infectious causes. We conclude that the Sequential Organ Failure Assessment score, lactate concentration and C-reactive protein level have no significant predictive value for early postoperative complications in critically ill post-surgery patients. However, procalcitonin seems to be a useful parameter for diagnosing complications in specific patient populations after surgery and/or after trauma.

  16. Outcomes of patients with cirrhosis undergoing non-hepatic surgery: Risk assessment and management

    Institute of Scientific and Technical Information of China (English)

    Farida Millwala; Geoffrey C Nguyen; Paul J Thuluvath

    2007-01-01

    The reported mortality rates in patients with cirrhosis undergoing various non-transplant surgical procedures range from 8.3% to 25%. This wide range of mortality rates is related to severity of liver disease, type of surgery, demographics of patient population, expertise of the surgical, anesthesia and intensive care unit team and finally, reporting bias. In this article, we will review the pathophysiology, morbidity and mortality associated with non-hepatic surgery in patients with cirrhosis, and then recommend an algorithm for risk assessment and evidence based management strategy to optimize postsurgical outcomes.

  17. Professional nursing practice in critical units: assessment of work environment characteristics

    Science.gov (United States)

    Maurício, Luiz Felipe Sales; Okuno, Meiry Fernanda Pinto; Campanharo, Cássia Regina Vancini; Lopes, Maria Carolina Barbosa Teixeira; Belasco, Angélica Gonçalves Silva; Batista, Ruth Ester Assayag

    2017-01-01

    ABSTRACT Objective: assess the autonomy, control over environment, and organizational support of nurses' work process and the relationships between physicians and nurses in critical care units. Method: cross-sectional study conducted with 162 nurses working in the intensive care units and emergency service of a university hospital. The workers' satisfaction with their work environment was assessed using Brazilian Nursing Work Index - Revised, translated and adapted for the Brazilian culture. Results: average age was 31.6 ± 3.9 years; 80.2% were women; 68.5% Caucasians and 71.6% worked in intensive care units. The nurses considered autonomy (2.38 ± 0.64) and their relationship with physicians (2.24 ± 0.62) to be characteristics of the work environment that favored professional practice. Control over environment (2.78 ± 0.62) and organizational support (2.51 ± 0.54), however, were considered to be unfavorable. No statistically significant differences were found between the units based on the scores obtained by the professionals on the Brazilian Nursing Work Index - Revised. Conclusion: autonomy, relationship between physicians and nurses, and organizational support were considered by the units to be characteristics that favored nurses' professional practices. On the other hand, control over environment and organizational support were considered unfavorable. PMID:28301034

  18. [NIC as a tool for assessing competences of nursing students in clinical placement at surgical units].

    Science.gov (United States)

    Celma Vicente, Matilde; Ajuria-Imaz, Eloisa; Lopez-Morales, Manuel; Fernandez-Marín, Pilar; Menor-Castro, Alicia; Cano-Caballero Galvez, Maria Dolores

    2015-01-01

    This paper shows the utility of a NIC standardized language to assess the extent of nursing student skills at Practicum in surgical units To identify the nursing interventions classification (NIC) that students can learn to perform in surgical units. To determine the level of difficulty in learning interventions, depending on which week of rotation in clinical placement the student is. Qualitative study using Delphi consensus technique, involving nurses with teaching experience who work in hospital surgical units, where students undertake the Practicum. The results were triangulated through a questionnaire to tutors about the degree of conformity. A consensus was reached about the interventions that students can achieve in surgical units and the frequency in which they can be performed. The level of difficulty of each intervention, and the amount of weeks of practice that students need to reach the expected level of competence was also determined. The results should enable us to design better rotations matched to student needs. Knowing the frequency of each intervention that is performed in each unit determines the chances of learning it, as well as the indicators for its assessment. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

  19. Damodar Valley Corporation, Chandrapura Unit 2 Thermal Power Station Residual Life Assessment Summary report

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1995-02-01

    The BHEL/NTPC/PFC/TVA teams assembled at the DVC`s Chadrapura station on July 19, 1994, to assess the remaining life of Unit 2. The workscope was expanded to include major plant systems that impact the unit`s ability to sustain generation at 140 MW (Units 1-3 have operated at average rating of about 90 MW). Assessment was completed Aug. 19, 1994. Boiler pressure parts are in excellent condition except for damage to primary superheater header/stub tubes and economizer inlet header stub tubes. The turbine steam path is in good condition except for damage to LP blading; the spar rotor steam path is in better condition and is recommended for Unit 2. Nozzle box struts are severely cracked from the flame outs; the cracks should not be repaired. HP/IP rotor has surface cracks at several places along the steam seal areas; these cracks are shallow and should be machined out. Detailed component damage assessments for above damaged components have been done. The turbine auxiliary systems have been evaluated; cooling tower fouling/blockage is the root cause for the high turbine back pressure. The fuel processing system is one of the primary root causes for limiting unit capacity. The main steam and hot reheat piping systems were conservatively designed and have at least 30 years left;deficiencies needing resolution include restoration of insulation, replacement of 6 deformed hanger clamp/bolts, and adjustment of a few hanger settings. The cold reheat piping system is generally in good condition; some areas should be re-insulated and the rigid support clamps/bolts should be examined. The turbine extraction piping system supports all appeared to be functioning normally.

  20. Systemic Assessment of Patients Undergoing Dental Implant ...

    African Journals Online (AJOL)

    Background: Procedure‑related and patient‑related factors influence the prognosis of dental implants ... Results: Out of 51, 29 patients were males while 22 were females, with ratio of 1.32:1. ... difference of average STAI‑State subscore before and after the surgery was ... bleeding, swelling, bruising, pain, and tenderness to.

  1. Assessing Bleeding Risk in Patients Taking Anticoagulants

    Science.gov (United States)

    Shoeb, Marwa; Fang, Margaret C.

    2013-01-01

    Anticoagulant medications are commonly used for the prevention and treatment of thromboembolism. Although highly effective, they are also associated with significant bleeding risks. Numerous individual clinical factors have been linked to an increased risk of hemorrhage, including older age, anemia, and renal disease. To help quantify hemorrhage risk for individual patients, a number of clinical risk prediction tools have been developed. These risk prediction tools differ in how they were derived and how they identify and weight individual risk factors. At present, their ability to effective predict anticoagulant-associated hemorrhage remains modest. Use of risk prediction tools to estimate bleeding in clinical practice is most influential when applied to patients at the lower spectrum of thromboembolic risk, when the risk of hemorrhage will more strongly affect clinical decisions about anticoagulation. Using risk tools may also help counsel and inform patients about their potential risk for hemorrhage while on anticoagulants, and can identify patients who might benefit from more careful management of anticoagulation. PMID:23479259

  2. Enhancing rehabilitation of mechanically ventilated patients in the intensive care unit: a quality improvement project.

    Science.gov (United States)

    McWilliams, David; Weblin, Jonathan; Atkins, Gemma; Bion, Julian; Williams, Jenny; Elliott, Catherine; Whitehouse, Tony; Snelson, Catherine

    2015-02-01

    Prolonged periods of mechanical ventilation are associated with significant physical and psychosocial adverse effects. Despite increasing evidence supporting early rehabilitation strategies, uptake and delivery of such interventions in Europe have been variable. The objective of this study was to evaluate the impact of an early and enhanced rehabilitation program for mechanically ventilated patients in a large tertiary referral, mixed-population intensive care unit (ICU). A new supportive rehabilitation team was created within the ICU in April 2012, with a focus on promoting early and enhanced rehabilitation for patients at high risk for prolonged ICU and hospital stays. Baseline data on all patients invasively ventilated for at least 5 days in the previous 12 months (n = 290) were compared with all patients ventilated for at least 5 days in the 12 months after the introduction of the rehabilitation team (n = 292). The main outcome measures were mobility level at ICU discharge (assessed via the Manchester Mobility Score), mean ICU, and post-ICU length of stay (LOS), ventilator days, and in-hospital mortality. The introduction of the ICU rehabilitation team was associated with a significant increase in mobility at ICU discharge, and this was associated with a significant reduction in ICU LOS (16.9 vs 14.4 days, P = .007), ventilator days (11.7 vs 9.3 days, P rehabilitation within this European ICU improved levels of mobility at critical care discharge, and this was associated with reduced ICU and hospital LOS and reduced days of mechanical ventilation. Copyright © 2014 The Authors. Published by Elsevier Inc. All rights reserved.

  3. RIFLE classification in geriatric patients with acute kidney injury in the intensive care unit.

    Science.gov (United States)

    Shin, Min Ji; Rhee, Harin; Kim, Il Young; Song, Sang Heon; Lee, Dong Won; Lee, Soo Bong; Kwak, Ihm Soo; Seong, Eun Young

    2016-06-01

    The RIFLE classification is widely used to assess the severity of acute kidney injury (AKI), but its application to geriatric AKI patients complicated by medical problems has not been reported. We investigated 256 geriatric patients (≥65 years old; mean age, 74.4 ± 6.3 years) who developed AKI in the intensive care unit (ICU) according to the RIFLE classification. Etiologic, clinical, and prognostic variables were analyzed. They were categorized into RIFLE-R (n = 53), RIFLE-I (n = 102), and RIFLE-F (n = 101) groups. The overall in-hospital mortality was 39.8 %. There were no significant differences in RIFLE category between survivors and non-survivors. Survivors had significantly less needs for a ventilator and vasopressor, and lower number of failing organs. Survivors had higher systolic blood pressure, hemoglobin level, and serum albumin levels. We performed a logistic regression analysis to identify the independent predictors of in-hospital mortality. In a univariate analysis, hypertension, chronic kidney disease, RIFLE classification, number of failing organs, need for a ventilator and vasopressor, systolic blood pressure, hemoglobin level, and serum albumin levels were identified as prognostic factors of in-hospital mortality. However, in a multivariate analysis, hypertension, chronic kidney disease, number of failing organs, and serum albumin levels were independent risk factors, with no significant difference for in-hospital mortality with the RIFLE classification. The RIFLE classification might not be associated with mortality in geriatric AKI patients in the ICU. In geriatric patients with AKI, various factors besides severity of AKI should be considered to predict mortality.

  4. Reactor units for power supply to the Russian Arctic regions: Priority assessment of nuclear energy sources

    Directory of Open Access Journals (Sweden)

    Mel'nikov N. N.

    2017-03-01

    Full Text Available Under conditions of competitiveness of small nuclear power plants (SNPP and feasibility of their use to supply power to remote and inaccessible regions the competition occurs between nuclear energy sources, which is caused by a wide range of proposals for solving the problem of power supply to different consumers in the decentralized area of the Russian Arctic power complex. The paper suggests a methodological approach for expert assessment of the priority of small power reactor units based on the application of the point system. The priority types of the reactor units have been determined based on evaluation of the unit's conformity to the following criteria: the level of referentiality and readiness degree of reactor units to implementation; duration of the fuel cycle, which largely determines an autonomy level of the nuclear energy source; the possibility of creating a modular block structure of SNPP; the maximum weight of a transported single equipment for the reactor unit; service life of the main equipment. Within the proposed methodological approach the authors have performed a preliminary ranking of the reactor units according to various criteria, which allows quantitatively determining relative difference and priority of the small nuclear power plants projects aimed at energy supply to the Russian Arctic. To assess the sensitivity of the ranking results to the parameters of the point system the authors have observed the five-point and ten-point scales under variations of importance (weights of different criteria. The paper presents the results of preliminary ranking, which have allowed distinguishing the following types of the reactor units in order of their priority: ABV-6E (ABV-6M, "Uniterm" and SVBR-10 in the energy range up to 20 MW; RITM-200 (RITM-200M, KLT-40S and SVBR-100 in the energy range above 20 MW.

  5. [How do family members of haemodialysis patients with dementia experience nursing care on a haemodialysis unit: a qualitative study].

    Science.gov (United States)

    Rütti, Gisela; Huynh-Do, Uyen; Spichiger, Elisabeth

    2014-12-01

    Up to 70 % of dialysis patients over 55 years suffer from some degree of dementia. For a patient with dementia eventually agitated, staying at rest during the whole haemodialysis session could be difficult, which represents a real challenge for the haemodialysis team. Although relatives of patients with dementia or haemodialysis patients were described as care experts because of their support in everyday life, the perspective of relatives of haemodialysis patients with dementia has not yet been researched. The purpose of this qualitative study was to explore the experience of nursing care of relatives of haemodialysis patients with dementia in a haemodialysis unit. Data were collected through eight interviews with relatives. Content analysis was used to analyse data. Relatives knew that the patients were in good hands with their nurses. Their own attendance of the dialysis sessions was of variable duration, frequency and regularity, and they were hardly involved in the care. Relatives and nurses rarely communicated regarding the patients' situation. Although relatives described symptoms of dementia, it was important for them to attest that the patients were still "mentally all right". Relatives of patients with dementia have diverse needs concerning their attendance during the therapy and the exchange of information with clinicians. Nurses should approach relatives and assess their individual needs to achieve a better collaboration.

  6. First Step for Improving Phototherapy Quality: Patient Impressions and Feedback Regarding the Phototherapy Unit

    Directory of Open Access Journals (Sweden)

    Ekin Şavk

    2010-03-01

    Full Text Available Objective: We aimed to learn about patients’ feelings and thoughts regarding phototherapy/photochemotherapy. Methods: Patients treated at our phototherapy unit between 2000-2006 were asked to fill out a questionnaire including 20 questions. Fifty-two of 78 patients contacted answered it.Results: Twenty-six were women and 26 were men, aged between 5 and 76 (mean age 42.1±15.9. Majority of patients had been treated for psoriasis (55.8% and vitiligo (26.9%. Most commonly used modalities were narrow band UVB (65%, local PUVA (23% and PUVA (6%. Majority of patients (73% reported that they “always” experienced a favorable atmosphere and had a fair reception in the phototherapy unit. The unit was described as “congested”, “crowded”, but also a place which was found to be “promising improvement of skin disease”. Most frequently mentioned difficulties of phototherapy were trips to the unit, use of photosensitizing medication and the relatively high cost of treatment. 76%stated that they would prefer phototherapy rather than other treatment alternatives. The attending physician of the phototherapy unit was found to be the factor most in need of improvement. Conclusion: Although unfavorable physical conditions of the phototherapy unit exist, the first step in improving treatment quality should be geared towards the more human component of treatment, namely the physician patient interaction.

  7. HEAT EXPOSURE ASSESSMENT IN THE WORKING ENVIRONMENT OF A GLASS MANUFACTURING UNIT

    Directory of Open Access Journals (Sweden)

    M. Pourmahabadian, M. Adelkhah, K. Azam

    2008-04-01

    Full Text Available Heat stress is a common health problem throughout industry. Any heat stress evaluation requires some exposure assessment of climatic conditions, especially air temperature, humidity, and speed, along with the average temperature of the solid surroundings. In this paper workplace environmental climatic parameters were measured and then evaluated by Wet Bulb Globe Temperature, Corrected Effective Temperature, Heat Stress Index, and Allowable Exposure Time indices among 40 workers in a glass manufacturing unit in Tehran. Also, the effect of available heat control devices on heat stress indices was investigated. The results of this study showed that the obtained heat stress index in individual section and press units is exceeded from 100 (in individual section unit: 302.6, in press unit: 283.6. Also, it is found that the mean average of allowable exposure time in individual section and press units were 13.15 and 12.26 minutes exposure for one hour, respectively. No significant relationship was found between environmental parameters in three parts of body regions (height of head, abdomen and ankle except for measured air velocity in both units (P<0.007. Positive correlation was found between wet bulb globe temperature, corrected effective temperature and heat stress index indices, but negative correlation was found between allowable exposure time and other indices. Mann Whitney non-parametric test revealed significant relationships in wet bulb globe temperature, corrected effective temperature, heat stress index and allowable exposure time indices when metallic shield was used as heat absorber.

  8. Use of CAHPS patient experience surveys to assess the impact of health care innovations.

    Science.gov (United States)

    Weinick, Robin M; Quigley, Denise D; Mayer, Lauren A; Sellers, Clarissa D

    2014-09-01

    The Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys are the standard for collecting information about patient experience of care in the United States. However, despite their widespread use, including in pay-for-performance and public reporting efforts and various provisions of the Affordable Care Act, knowledge about the use of CAHPS in assessing the impact of quality improvement efforts is limited. A study was conducted to examine the use of patient experience surveys in assessing the impact of innovations implemented in health care settings. Innovation profiles identified on the Agency for Healthcare Research and Quality (AHRQ) Health Care Innovations Exchange website that included patient experience (including patient satisfaction) as an outcome (N = 201), were analyzed with a variety of qualitative analysis methods. Fewer than half of the innovations used a patient experience measure, most commonly employing global measures such as an overall rating. Most innovations assessed patient experience at a single time point, with only one third using techniques such as pre-post comparisons, time trends, or comparisons to control groups. Ten domains of measures addressed reports of patient experience, all of which could be assessed by existing CAHPS instruments. Similarly, CAHPS measures are available to assess all of the organizational processes that are addressed by innovations in the profiles and for which patients are the best source of information. While 120 of the innovations that use patient experience measures report using surveys to collect these data, only 6 reported using a CAHPS measure. Although innovations targeting quality improvement are often evaluated using surveys, there is considerable untapped potential for using CAHPS measures or surveys to assess their effectiveness.

  9. Introducing the Comprehensive Unit-based Safety Program for mechanically ventilated patients in Saudi Arabian Intensive Care Units

    Science.gov (United States)

    Khan, Raymond M.; Aljuaid, Maha; Aqeel, Hanan; Aboudeif, Mohammed M.; Elatwey, Shaimaa; Shehab, Rajeh; Mandourah, Yasser; Maghrabi, Khalid; Hawa, Hassan; Khalid, Imran; Qushmaq, Ismael; Latif, Asad; Chang, Bickey; Berenholtz, Sean M.; Tayar, Sultan; Al-Harbi, Khloud; Yousef, Amin; Amr, Anas A.; Arabi, Yaseen M.

    2017-01-01

    Over the past decade, there have been major improvements to the care of mechanically ventilated patients (MVPs). Earlier initiatives used the concept of ventilator care bundles (sets of interventions), with a primary focus on reducing ventilator-associated pneumonia. However, recent evidence has led to a more comprehensive approach: The ABCDE bundle (Awakening and Breathing trial Coordination, Delirium management and Early mobilization). The approach of the Comprehensive Unit-based Safety Program (CUSP) was developed by patient safety researchers at the Johns Hopkins Hospital and is supported by the Agency for Healthcare Research and Quality to improve local safety cultures and to learn from defects by utilizing a validated structured framework. In August 2015, 17 Intensive Care Units (ICUs) (a total of 271 beds) in eight hospitals in the Kingdom of Saudi Arabia joined the CUSP for MVPs (CUSP 4 MVP) that was conducted in 235 ICUs in 169 US hospitals and led by the Johns Hopkins Armstrong Institute for Patient Safety and Quality. The CUSP 4 MVP project will set the stage for cooperation between multiple hospitals and thus strives to create a countrywide plan for the management of all MVPs in Saudi Arabia. PMID:28197216

  10. Introducing the Comprehensive Unit-based Safety Program for mechanically ventilated patients in Saudi Arabian Intensive Care Units

    Directory of Open Access Journals (Sweden)

    Raymond M Khan

    2017-01-01

    Full Text Available Over the past decade, there have been major improvements to the care of mechanically ventilated patients (MVPs. Earlier initiatives used the concept of ventilator care bundles (sets of interventions, with a primary focus on reducing ventilator-associated pneumonia. However, recent evidence has led to a more comprehensive approach: The ABCDE bundle (Awakening and Breathing trial Coordination, Delirium management and Early mobilization. The approach of the Comprehensive Unit-based Safety Program (CUSP was developed by patient safety researchers at the Johns Hopkins Hospital and is supported by the Agency for Healthcare Research and Quality to improve local safety cultures and to learn from defects by utilizing a validated structured framework. In August 2015, 17 Intensive Care Units (ICUs (a total of 271 beds in eight hospitals in the Kingdom of Saudi Arabia joined the CUSP for MVPs (CUSP 4 MVP that was conducted in 235 ICUs in 169 US hospitals and led by the Johns Hopkins Armstrong Institute for Patient Safety and Quality. The CUSP 4 MVP project will set the stage for cooperation between multiple hospitals and thus strives to create a countrywide plan for the management of all MVPs in Saudi Arabia.

  11. Improving pain assessment and managment in stroke patients.

    Science.gov (United States)

    Nesbitt, Julian; Moxham, Sian; Ramadurai, Gopinath; Williams, Lucy

    2015-01-01

    Stroke patients can experience a variety of pain. Many stroke patients have co-morbidities such as osteoporosis, arthritis or diabetes causing diabetic neuropathy. As well as pain from other long term conditions, stroke patients can experience central post-stroke pain, headaches, and musculoskeletal issues such as hypertonia, contractures, spasticity, and subluxations. These stroke patients can also have communication difficulties in the form of expressive dysphasia and/or global aphasia. Communication difficulties can result in these patients not expressing their pain and therefore not having it assessed, leading to inadequate pain relief that could impact their rehabilitation and recovery. By implementing an observational measurement of pain such as the Abbey pain scale, patients with communication difficulties can have their pain assessed and recorded. Initially 30% of patients on the acute stroke ward did not have their pain assessed and adequately recorded and 15% of patients had inadequate pain relief. The patient was assessed if they were in pain and therefore not receiving adequate pain relief by measuring their pain on the Abbey pain scale. After introducing the Abbey pain scale and creating a nurse advocate, an improvement was shown such that only 5% of patients did not have their pain recorded and all had adequate pain relief.

  12. The Development and Evaluation of Delirium Assessment and Nursing Care Decision-Making Assistant Mobile Application for Intensive Care Unit.

    Science.gov (United States)

    Yang, Fangyu; Ji, Meihua; Ding, Shu; Wu, Ying; Chang, Polun; Lin, Chiawei; Yang, Xin

    2016-01-01

    Delirium is a common complication among patients in ICU settings. Although it has been repeatedly confirmed that Confusion Assessment Model for Intensive Care Unit (CAM-ICU), one of the most commonly used ICU delirium assessment tool, is highly accurate in validation studies, it's sensitivity and specificity is relatively low during routine practice among bedside nurses. The aim of this study is to develop a mobile application (app) to detect delirium and to test its reliability and validity both by research nurses and among ICU bedside nurses. The app was programmed with Java and installed on a mobile device with Android system. After completion of reliability and validity testing, the app will be integrated into the existing Hospital Information System in order to automatically retrieve essential information for risk factor identification and formulation of care plan accordingly to prevent or manage ICU delirium.

  13. Assessment of patient-reported symptoms of anxiety

    Science.gov (United States)

    Rose, Matthias; Devine, Janine

    2014-01-01

    Patient self-reported symptoms are of crucial importance to identify anxiety disorders, as well as to monitor their treatment in clinical practice and research. Thus, for evidence-based medicine, a precise, reliable, and valid (ie, “objective”) assessment of the patient's reported “subjective” symptoms is warranted. There is a plethora of instruments available, which can provide psychometrically sound assessments of anxiety, but there are several limitations of current tools that need to be carefully considered for their successful use. Nevertheless, the empirical assessment of mental health status is not as accepted in medicine as is the assessment of biomarkers. One reason for this may be that different instruments assessing the same psychological construct use different scales. In this paper we present some new developments that promise to provide one common metric for the assessment of anxiety, to facilitate the general acceptance of mental health assessments in the future. PMID:25152658

  14. Borrelia miyamotoi Infection in Patients from Upper Midwestern United States, 2014-2015.

    Science.gov (United States)

    Jobe, Dean A; Lovrich, Steven D; Oldenburg, Darby G; Kowalski, Todd J; Callister, Steven M

    2016-08-01

    We confirmed Borrelia miyamotoi infection in 7 patients who had contracted an illness while near La Crosse, Wisconsin, USA, an area where Ixodes scapularis ticks are endemic. B. miyamatoi infection should now be considered among differential diagnoses for patients from the midwestern United States who have signs and symptoms suggestive of tickborne illness.

  15. Evaluation of vitamin D level in patients from neurosurgical intensive care unit

    Institute of Scientific and Technical Information of China (English)

    Ho Jun Yi; Je Hoon Jeong; Eun-Sun Jin; Il Young Shin; Hyung Sik Hwang; Seung-Myung Moon

    2013-01-01

    Vitamin D plays an important role in maintaining normal bone metabolism. Recent studies have suggested that vitamin D influences many other physiological processes, including muscle function, cardiovascular homeostasis, nerve function, and immune response. Furthermore, accumulated evidence suggests that vitamin D also mediates the immune system response to infection. Critical neurosurgical patients have higher infection and mortality rates. To correlate vitamin D deficiency to the immunological status of neurosurgical intensive care unit patients, we detected serum vitamin D level in 15 patients with clinically suspected infection and 10 patients with confirmed infection. Serum level of 25-hydroxyvitamin D, the primary circulating form of vitamin D, was significantly decreased in patients with suspected or confirmed infection after a 2-week neurosurgical intensive care unit hospitalization, while serum level of 1,25-dihydroxyvitamin D, the active form of vitamin D, was significantly decreased in patients after a 4-week neurosurgical intensive care unit hospitalization. These findings suggest that vitamin D deficiency is linked to the immunological status of neurosurgical intensive care unit patients and vitamin D supplementation can improve patient's immunological status.

  16. Influence of Patients' "Sense of Coherence" on Main Postoperative Variables in the Postanesthesia Care Unit

    DEFF Research Database (Denmark)

    Hasfeldt, Dorthe; Maindal, Helle Terkildsen; Toft, Palle

    2015-01-01

    The objective of this study was to investigate whether patients' sense of coherence (SOC)--ability to comprehend their whole situation and their capacity to use available resources--influences acute postoperative complications in the postanesthesia care unit (PACU). We hypothesized that patients...... with a stronger SOC experienced significantly less pain (P nurse anesthetists...

  17. Influence of Patients' "Sense of Coherence" on Main Postoperative Variables in the Postanesthesia Care Unit

    DEFF Research Database (Denmark)

    Hasfeldt, Dorthe; Maindal, Helle Terkildsen; Toft, Palle;

    2015-01-01

    The objective of this study was to investigate whether patients' sense of coherence (SOC)--ability to comprehend their whole situation and their capacity to use available resources--influences acute postoperative complications in the postanesthesia care unit (PACU). We hypothesized that patients...

  18. Access to Care for Methadone Maintenance Patients in the United States

    Science.gov (United States)

    Hettema, Jennifer E.; Sorensen, James L.

    2009-01-01

    This policy commentary addresses a significant access to care issue that faces methadone maintenance patients seeking residential treatment in the United States. Methadone maintenance therapy (MMT) has demonstrated strong efficacy in the outpatient treatment of opiate dependence. However, many opiate dependent patients are also in need of more…

  19. New trends in nutritional status assessment of cancer patients.

    Science.gov (United States)

    Andreoli, A; De Lorenzo, A; Cadeddu, F; Iacopino, L; Grande, M

    2011-05-01

    Nutritional status assessment and support should be considered a valuable measure within the overall oncology strategy. Despite extensive research in the field of clinical nutrition, definite guidelines to base rational nutritional assessment and support in cancer patients are still debated. This review examines different approaches to nutritional status in cancer patients. The assessment of nutritional status is usually based on anthropometric measures, biochemical or laboratory tests, clinical indicators and dietary assessment. At present, body composition (BC) is rarely measured in the clinical setting because it is thought to be too unmanageable and time-consuming. However, using new technologies, the estimation of fat, lean and body fluids, that is significant in the management of nutrition therapies in oncology, has become easy. The present study evaluates the different methods of nutrition assessment today available, especially body composition (BC) measurements. Furthermore, nutrition assessment, relevance of nutritional support and choice of nutritional strategy, in surgical patients, are discussed. Given the clinical relevance of nutritional intervention in patients' quality of life, the nutritional status assessment has a key role in oncological and surgical practice and should include BC assessment in order to tailor nutritional treatment to patients' individual requirements. Furthermore, administration of the supplemented diet before and after surgery seemed to be the best strategy to reduce complications and length of hospital stay.

  20. Consciousness levels one week after admission to a palliative care unit improve survival prediction in advanced cancer patients.

    Science.gov (United States)

    Tsai, Jaw-Shiun; Chen, Chao-Hsien; Wu, Chih-Hsun; Chiu, Tai-Yuan; Morita, Tatsuya; Chang, Chin-Hao; Hung, Shou-Hung; Lee, Ya-Ping; Chen, Ching-Yu

    2015-02-01

    Consciousness is an important factor of survival prediction in advanced cancer patients. However, effects on survival of changes over time in consciousness in advanced cancer patients have not been fully explored. This study evaluated changes in consciousness after admission to a palliative care unit and their correlation with prognosis in terminal cancer patients. This is a prospective observational study. From a palliative care unit in Taiwan, 531 cancer patients (51.8% male) were recruited. Consciousness status was assessed at admission and one week afterwards and recorded as normal or impaired. The mean age was 65.28±13.59 years, and the average survival time was 23.41±37.69 days. Patients with normal consciousness at admission (n=317) had better survival than those with impaired consciousness at admission (n=214): (17.0 days versus 6.0 days, pconsciousness at admission had a higher percentage of survival than the impaired (78.9% versus 44.3%, pconsciousness levels: (1) normal at admission and one week afterwards, (2) impaired at admission but normal one week afterwards, (3) normal at admission but impaired one week afterwards, and (4) impaired both at admission and one week afterwards. The former two groups had significantly better survival than the latter two groups: (median survival counted from day 7 after admission), 25.5, 27.0, 7.0, and 7.0 days, respectively. Consciousness levels one week after admission should be integrated into survival prediction in advanced cancer patients.

  1. Assessment of surfactant use in preterm infants as a marker of neonatal intensive care unit quality

    Directory of Open Access Journals (Sweden)

    Lorch Scott A

    2011-01-01

    Full Text Available Abstract Background Proposed neonatal quality measures have included structural measures such as average daily census, and outcome measures such as mortality and rates of complications of prematurity. However, process measures have remained largely unexamined. The objective of this research was to examine variation in surfactant use as a possible process measure of neonatal quality. Methods We obtained data on infants 30 to 34 weeks gestation admitted with respiratory distress syndrome (RDS within 48 hours of birth to 16 hospitals participating in the Pediatric Health Information Systems database from 2001-2006. Models were developed to describe hospital variation in surfactant use and identify patient and hospital predictors of use. Another cohort of all infants admitted within 24 hours of birth was used to obtain adjusted neonatal intensive care unit (NICU mortality rates. To assess the construct validity of surfactant use as a quality metric, adjusted hospital rates of mortality and surfactant use were compared using Kendall's tau. Results Of 3,633 infants, 46% received surfactant. For individual hospitals, the adjusted odds of surfactant use varied from 2.2 times greater to 5.9 times less than the hospital with the median adjusted odds of surfactant use. Increased annual admissions of extremely low birth weight infants to the NICU were associated with greater surfactant use (OR 1.80, 95% CI 1.02-3.19. The correlation between adjusted hospital rates of surfactant use and in-hospital mortality was 0.37 (Kendall's tau p = 0.051. Conclusions Though results were encouraging, efforts to examine surfactant use in infants with RDS as a process measure reflecting quality of care revealed significant challenges. Difficulties related to adequate measurement including defining RDS using administrative data, accounting for care received prior to transfer, and adjusting for severity of illness will need to be addressed to improve the utility of this

  2. An outbreak of hepatitis C virus in a haemodialysis unit: molecular evidence of patient-to-patient transmission.

    Science.gov (United States)

    Ansaldi, F; Bruzzone, B; de Florentiis, D; Marasso, P; Gota, F; Mofferdin, A; Campello, C; Crovari, P; Icardi, G

    2003-01-01

    Hepatitis C virus (HCV) infection remains a major problem in haemodialysis units despite the risk decrease provided by anti-HCV screening of blood. The exact mode of transmission of HCV in the dialysis units remains unclear. To identify the route of the virus and the mechanisms of transmission an investigation into the outbreak of HCV infection in a haemodialysis unit on a molecular level was held: 12 newly infected patients and 14 already infected were investigated by sequencing the 5' untranslated region of the viral genome. The results showed that 3 strains infected new cases and these strains matched those sequenced in already infected patients. Transmission occurred between patients treated on the same shift and also between different rooms. Console and blood or blood product contamination was excluded. Our study gave molecular evidence of patient-to-patient transmission of HCV in a haemodialysis unit. Our data underline the importance of the strict enforcement of standard precautions to prevent HCV transmission and failure of the isolation of anti-HCV positive patients as preventive measure.

  3. Entrustment Decisions: Bringing the Patient Into the Assessment Equation.

    Science.gov (United States)

    Ten Cate, Olle

    2017-06-01

    With the increased interest in the use of entrustable professional activities (EPAs) in undergraduate medical education (UME) and graduate medical education (GME) come questions about the implications for assessment. Entrustment assessment combines the evaluation of learners' knowledge, skills, and behaviors with the evaluation of their readiness to be entrusted to perform critical patient care responsibilities. Patient safety, then, should be an explicit component of educational assessments. The validity of these assessments in the clinical workplace becomes the validity of the entrustment decisions.Modern definitions of the validity of educational assessments stress the importance of the purpose of the test and the consequences of the learner's score. Thus, if the learner is a trainee in a clinical workplace and entrusting her or him to perform an EPA is the focus of the assessment, the validity argument for that assessment should include a patient safety component.While the decision to allow a learner to practice unsupervised is typically geared toward GME, similar decisions are made in UME regarding learners' readiness to perform EPAs with indirect supervision (i.e., without a supervisor present in the room). Three articles in this issue address implementing EPAs in UME.The author of this Commentary discusses the possibility of implementing true entrustment decisions in UME. He argues that bringing the patient into the educational assessment equation is marrying educational and health care responsibilities. Building trust in learners from early on, gradually throughout the continuum of medical education, may reframe our vision on assessment in the workplace.

  4. Managing burn patients in a fire disaster: Experience from a burn unit in Bangladesh.

    Science.gov (United States)

    Mashreky, S R; Bari, S; Sen, S L; Rahman, A; Khan, T F; Rahman, F

    2010-09-01

    Although burn disaster is not a frequent event, with urbanisation and industrialisation, burn disaster is becoming an emerging problem in Bangladesh. On 3 June 2010, a fire disaster killed 124 people in Neemtali, Dhaka, Bangladesh. This paper narrates the management of burn patients of this disaster in the burn unit of Dhaka Medical College Hospital. The burn unit managed 192 burn victims of the disaster. Forty-two victims were admitted and 150 of them received primary care at the emergency room and were sent back home. Ten patients among 42 in-patients died. The in-patient mortality was 23.8%. Burn unit in Dhaka Medical College Hospital is the only burn management centre in Bangladesh. Proper planning and coordinated effort by all sectors and persons concerned were the key elements in this successful management.

  5. Managing burn patients in a fire disaster: Experience from a burn unit in Bangladesh

    Directory of Open Access Journals (Sweden)

    Mashreky S

    2010-10-01

    Full Text Available Although burn disaster is not a frequent event, with urbanisation and industrialisation, burn disaster is becoming an emerging problem in Bangladesh. On 3 June 2010, a fire disaster killed 124 people in Neemtali, Dhaka, Bangladesh. This paper narrates the management of burn patients of this disaster in the burn unit of Dhaka Medical College Hospital. The burn unit managed 192 burn victims of the disaster. Forty-two victims were admitted and 150 of them received primary care at the emergency room and were sent back home. Ten patients among 42 in-patients died. The in-patient mortality was 23.8%. Burn unit in Dhaka Medical College Hospital is the only burn management centre in Bangladesh. Proper planning and coordinated effort by all sectors and persons concerned were the key elements in this successful management.

  6. Assessment and management of patients with varicose veins.

    Science.gov (United States)

    Allen, Louise

    Varicose veins are enlarged superficial veins found in the legs. This article explores the anatomy and physiology of the venous system to assist nurses to assess, manage and treat patients with varicose veins.

  7. New Guidelines for Assessment of Malnutrition in Adults: Obese Critically Ill Patients.

    Science.gov (United States)

    Mauldin, Kasuen; O'Leary-Kelley, Colleen

    2015-08-01

    Recently released recommendations for detection and documentation of malnutrition in adults in clinical practice define 3 types of malnutrition: starvation related, acute disease or injury related, and chronic disease related. The first 2 are more easily recognized, but the third may be more often unnoticed, particularly in obese patients. Critical care patients tend to be at high risk for malnutrition and thus require a thorough nutritional assessment. Compared with patients of earlier times, intensive care unit patients today tend to be older, have more complex medical and comorbid conditions, and often are obese. Missed or delayed detection of malnutrition in these patients may contribute to increases in hospital morbidity and longer hospital stays. Critical care nurses are in a prime position to screen patients at risk for malnutrition and to work with members of the interprofessional team in implementing nutritional intervention plans.

  8. The terrain signatures of administrative units: a tool for environmental assessment.

    Science.gov (United States)

    Miliaresis, George Ch

    2009-03-01

    The quantification of knowledge related to the terrain and the landuse/landcover of administrative units in Southern Greece (Peloponnesus) is performed from the CGIAR-CSI SRTM digital elevation model and the CORINE landuse/landcover database. Each administrative unit is parametrically represented by a set of attributes related to its relief. Administrative units are classified on the basis of K-means cluster analysis in an attempt to see how they are organized into groups and cluster derived geometric signatures are defined. Finally each cluster is parametrically represented on the basis of the occurrence of the Corine landuse/landcover classes included and thus, landcover signatures are derived. The geometric and the landuse/landcover signatures revealed a terrain dependent landuse/landcover organization that was used in the assessment of the forest fires impact at moderate resolution scale.

  9. [Assessment of nutritional status in patients with primary lung cancer].

    Science.gov (United States)

    Chermiti Ben Abdallah, Fatma; Ben Saïd, Hanène; Chamkhi, Najiba; Ferchichi, Marwa; Chtourou, Amel; Taktak, Sofia; Ben Kheder, Ali

    2013-10-01

    Lung cancer is the leading cause of cancer-related mortality worldwide. Malnutrition is a common problem among patients with cancer, affecting up to 85% of patients with certain cancers and represents a risk factor for poor prognosis. aim: evaluate nutritional status in patients with lung cancer before and during treatment using nutritional risk index. it's a prospective study conducted in pneumology IV department in Abderahman Mami hospital, from January to May 2011. 30 male patients with a lung cancer were included. Nutritional status was assessed before and during treatment based on anthropometric measures, biological markers and nutritional risk index (NRI). Mean age of patients was 58 ± 12 years, ranging from 19 to 82 years. 29 patients had non small cell lung cancer and one patient had small cell cancer. Malnutrition was noted in 14 patients (47%) before treatment according to the NRI. It was noted in 23 patients (77%) after three cycles of chemotherapy with severe malnutrition in 8 patients. Relationship between body mass index (BMI) and the NRI was linear, but NRI tends to evaluate more objectively risk of malnutrition in patients with lung cancer. Nutritional assessment in patient with lung cancer should be performed systematically, early and repeatedly. Several markers can be used such as BMI and NRI. Nutritional support will reduce morbidity and improve quality of life in patients with lung cancer.

  10. Physician offices marketing: assessing patients' views of office visits.

    Science.gov (United States)

    Emmett, Dennis; Chandra, Ashish

    2010-01-01

    Physician offices often lack the sense of incorporating appropriate strategies to make their facilities as marketer of their services. The patient experience at a physician's office not only incorporates the care they receive from the physician but also the other non-healthcare related aspects, such as the behavior of non-health professionals as well as the appearance of the facility itself. This paper is based on a primary research conducted to assess what patients assess from a physician office visit.

  11. Recent Advances in Pulmonary Rehabilitation for Patients in the Intensive Care Unit (ICU)

    OpenAIRE

    SATO, Ryuhei; Ebihara, Satoru; Kohzuki, Masahiro

    2017-01-01

    Pulmonary rehabilitation is important to prevent complications in critically ill patients in the intensive care unit (ICU) who are on mechanical ventilation. However, the effectiveness and adverse events related to pulmonary rehabilitation for patients in the ICU are largely unclear because of the diversity of diseases and various levels of severity in this situation. This review aims to clarify the evidence currently available for pulmonary rehabilitation in critically ill adult patients req...

  12. Patients' characterization, hospital course and clinical outcomes in five Italian respiratory intensive care units.

    Science.gov (United States)

    Polverino, Eva; Nava, Stefano; Ferrer, Miquel; Ceriana, Piero; Clini, Enrico; Spada, Elisa; Zanotti, Ercole; Trianni, Ludovico; Barbano, Luca; Fracchia, Claudio; Balbi, Bruno; Vitacca, Michele

    2010-01-01

    Respiratory intensive care units (RICU) dedicated to weaning could be suitable facilities for clinical management of "post-ICU" patients. We retrospectively analyzed the time course of patients' characteristics, clinical outcomes and medical staff utilization in five Italian RICUs by comparing three periods of 5 consecutive years (from 1991 to 2005). A total of 3,106 patients (age 76 +/- 4 years; 72% males) were analyzed. The number of co-morbidities per patient (from 1.8 to 3.0, p = 0.05) and the previous intensive care unit (ICU) stay (from 25 to 32 days, p = 0.002) increased over time. The doctor-to-patient ratio significantly decreased over time (from 1:3 to 1:5, p rehabilitative units (from 70 to 75%). The mortality rate increased over time (from 9 to 15%). Significant correlations between the doctor-to-patient ratio and the rates of weaning success (r = 0.679, p = 0.005), home discharge (r = 0.722, p = 0.002) and the RICU length of stay (LOS) (r = -0.683, p = 0.005) were observed. The clinical outcomes of our units worsened over 15 years, likely as consequence of admitting more severely ill patients. The potential further negative influence of reduced medical staff availability on weaning success, home discharge and LOS warrants future prospective investigations.

  13. Field Test of the Unit Equal Opportunity Training Diagnosis and Assessment System (TDAS)

    Science.gov (United States)

    1980-02-01

    problem areas identified; and 3. evaluate the extent to which training has been successful in addressing and eliminating the problems initially identified...The system was viewed as having three major components: an instrument or set of instruments for acquiring assessment and evaluation data; an...report. The Ana~ysis Prgram Conversion of data from punchcard form to a final, unit-specific feedback report of the type described above requires the use

  14. Current Conditions Risk Assessment for the 300-FF-5 Groundwater Operable Unit

    Energy Technology Data Exchange (ETDEWEB)

    Miley, Terri B.; Bunn, Amoret L.; Napier, Bruce A.; Peterson, Robert E.; Becker, James M.

    2007-11-01

    This report updates a baseline risk assessment for the 300 Area prepared in 1994. The update includes consideration of changes in contaminants of interest and in the environment that have occurred during the period of interim remedial action, i.e., 1996 to the present, as well as the sub-regions, for which no initial risk assessments have been conducted. In 1996, a record of decision (ROD) stipulated interim remedial action for groundwater affected by releases from 300 Area sources, as follows: (a) continued monitoring of groundwater that is contaminated above health-based levels to ensure that concentrations continue to decrease, and (b) institutional controls to ensure that groundwater use is restricted to prevent unacceptable exposure to groundwater contamination. In 2000, the groundwater beneath the two outlying sub-regions was added to the operable unit. In 2001, the first 5-year review of the ROD found that the interim remedy and remedial action objectives were still appropriate, although the review called for additional characterization activities. This report includes a current conditions baseline ecological and human health risk assessment using maximum concentrations in the environmental media of the 300-FF-5 Operable Unit and downstream conditions at the City of Richland, Washington. The scope for this assessment includes only current measured environmental concentrations and current use scenarios. Future environmental concentrations and future land uses are not considered in this assessment.

  15. Characterization of Patients with Acinetobacter baumannii Ventilator-associated Pneumonia in Progressive Care Units

    Directory of Open Access Journals (Sweden)

    Leonardo Maikel Gómez Carcassés

    2016-08-01

    Full Text Available Background: Acinetobacter baumannii has become one of the most important nosocomial pathogens. Objective: to characterize the patients diagnosed with ventilator-associated pneumonia due to Acinetobacter baumannii in the Progressive Care Units. Methods: a case series study of patients diagnosed with ventilator-associated pneumonia due to Acinetobacter baumannii was conducted in the Progressive Care Units of the Dr. Gustavo Aldereguía Lima Hospital of Cienfuegos from December 2013 through December 2014. The study variables included: age, sex, comorbid conditions, cause of admission, duration of ventilation, length of stay, antibiotic used, and status at discharge. Results: a total of 39 patients were studied, which accounted for 69.2% of the patients in Progressive Care Units. The mean age was 55.7 years. Males predominated. Sixty four point two percent of patients reported one or more past illnesses. Most admissions to emergency services were due to clinical reasons (51.3%. Sixty nine point two percent of patients received mechanical ventilation for 3 to 21 days. The average stay was 14.7 days. Seventy one point eight percent received a combined antimicrobial treatment and most of them were discharged alive (64.1%. Overall mortality was 35.9%. Conclusions: there was a predominance of males, patients over 60 years of age and clinical cases. The study patients needed mechanical ventilation for a medium length of time and combined antimicrobial treatment. Most patients were discharged alive, and mortality was within the range of that reported in the scientific literature.

  16. Neonatal Mortality Risk Assessment in a Neonatal Intensive Care Unit (NICU

    Directory of Open Access Journals (Sweden)

    Babak Eshrati

    2007-09-01

    Full Text Available Objective: This study aims to assess the utility of a scoring system as predictor of neonatal mortality rate among the neonates admitted within one year to the neonatal intensive care unit (NICU of the Childrens Medical Center in Tehran, Iran.Material & Methods: Data were gathered from 213 newborns admitted to the NICU from September 2003 to August 2004. In addition to demographic data, Apgar scores at 1 minute and 5 minutes, history and duration of previous hospitalization, initial diagnosis and final diagnosis, and scoring system by using the score for the neonatal acute physiology-perinatal extension II (SNAP-PE II were carried out within 12 hours after admission to the NICU. All of the parameters were prospectively applied to the admitted newborns. The exclusion criteria were discharge or death in less than 24 hours after NICU admission.Findings: 198 newborn infants met the inclusion criteria. The mean and standard deviation (SD of the variables including postnatal age, birth weight, SNAP, and finally Apgar scores at 1 minute and 5 minutes of neonates under this study were 7.6 (0.5 days, 2479.8 (29.4 grams, 21.6 (1.1, 7.47 0.08(, and 7.71 (0.06, respectively. Twenty five of the 198 patients died (12.6%. Gestational age (P=0.03, birth weight (P=0.02, Apgar score at 5 minutes (0.001, and SNAP-PE II (P=0.04 were significantly related to the mortality rate. By Analyzing through logistic regression to evaluate the predictive value of these variables in relation to the risk of mortality, it was shown that only SNAP-PE II and Apgar score at 5 minutes could significantly predict the neonatal mortality.Conclusion: According to this study SNAP-PE II and Apgar score at 5 minutes can be used to predict mortality among the NICU patients. SNAP-PE II score had the best performance in predicting mortality in this study. More studies with larger samples are suggested to evaluate all of the above-mentioned parameters among neonates who are admitted to NICUs

  17. Assessing the Executive Function Deficits of Patients with Parkinsons Disease

    Science.gov (United States)

    Culbertson, William; Moberg, Paul; Duda, John; Stern, Matthew; Weintraub, Daniel

    2004-01-01

    The aim of the study was to investigate the utility of the Tower of London-Drexel (TOL DX ) in assessing the executive deficits associated with Parkinsons disease (PD). We sought to determine whether the TOL DX would differentiate between (a) patients with PD and healthy control participants (HCP), (b) demented and nondemented patients, and (c)…

  18. Language Assessment in Hindi-English Bilingual Patients with Dementia

    Science.gov (United States)

    Pauranik, Apoorva

    2010-01-01

    The paper provides detailed assessment of a multilingual dementia patients using Boston Diagnostic Aphasia Examination (BDAE) adapted into Hindi by the author. After providing a brief review of literature on Dementia as understood in the west, the responses of the patient under different components of the BDAE are presented. The latter part of…

  19. The assessment and care of patients with hepatic encephalopathy

    DEFF Research Database (Denmark)

    Bager, Palle

    2017-01-01

    This article provides an overview of the metabolic brain dysfunction hepatic encephalopathy (HE). HE is caused by severe liver cirrhosis and patients will often be treated in a liver unit, but patients with symptoms of HE may require nursing care anywhere in the healthcare system. Therefore...... it is beneficial for all nurses to have a basic knowledge of HE and this article explains the symptoms and treatment. Possible differential diagnoses are presented, as well as factors that can trigger episodes of HE. Both patients' and relatives' experiences are examined. Finally, the nurse's role in caring...

  20. Assessment and treatment of dizzy patients in primary health care.

    OpenAIRE

    Ekvall-Hansson, Eva

    2006-01-01

    Dizziness is a common reason for visits to primary health care, especially among elderly patients. From a physiotherapeutic perspective, this thesis aims to study the assessment and treatment of dizzy patients in primary health care. Interventions in papers I, III and IV comprised a vestibular rehabilitation programme. In paper I, patients with multisensory dizziness were randomized to intervention group or control group. At follow-up after six weeks and three months, the intervention ...

  1. Incidence of dehydration encephalopathy among patients with disturbed consciousness at a hospital emergency unit

    Directory of Open Access Journals (Sweden)

    Emina Ogawa

    2011-03-01

    Full Text Available Systemic dehydration and diffuse central nervous system signs without any other illness is referred to as dehydration encephalopathy (DE. However, the incidence of DE at emergency units remains uncertain. We investigated the incidence of DE among persons with disturbed consciousness who visited the emergency unit. We reviewed the medical case records of the emergency unit at our university hospital during a 6-month period. Among them, 132 patients presented with disturbed consciousness as the sole initial manifestation on arrival. They were 75 men, 47 women; mean age 68 years (16-95 years. After carefully excluding other etiologies, the incidence of DE was 2% among all persons in the emergency unit and 4% among persons older than 68 years.In conclusion, the incidence of DE in our emergency unit was not common. Nevertheless, recognition of DE is extremely important in order to avoid unnecessary medication in elderly subjects.

  2. British Cardiovascular Intervention Society Registry for audit and quality assessment of percutaneous coronary interventions in the United Kingdom.

    Science.gov (United States)

    Ludman, Peter F

    2011-08-01

    To create an inclusive and accurate registry of all percutaneous coronary intervention (PCI) procedures performed in the UK for audit to assess quality of care, drive improvements in this care and to provide data for research. Feedback to PCI centres with 'live' online data analysis and structured monthly and quarterly reports of PCI activity, including process of care measures and assessment of risk-adjusted outcome. Annual national reports focused on the structure of the provision of PCI across the UK, the appropriateness and process of its delivery and outcomes. All hospitals performing PCI in the UK. 1994 to present. Consecutive patients treated by PCI. Approximately 80,000 new procedures each year in recent years. All attempts to perform a PCI procedure. This is defined as when any coronary device is used to approach, probe or cross one or more coronary lesions, with the intention of performing a coronary intervention. 113 variables defining patient demographic features, indications for PCI, procedural details and outcomes up to time of hospital discharge. Data entry into local software systems by caregivers and data clerks, with subsequent encryption and internet transfer to central data servers. Local validation, range checks and consistency assessments during upload. No external validation. Feedback of data completeness to all units. Available for research by application to British Cardiovascular Intervention Society using a data sharing agreement which can be obtained at http://www.bcis.org.uk.

  3. Variation exists in rates of admission to intensive care units for heart failure patients across hospitals in the United States

    Science.gov (United States)

    Safavi, Kyan C.; Dharmarajan, Kumar; Kim, Nancy; Strait, Kelly M.; Li, Shu-Xia; Chen, Serene I.; Lagu, Tara; Krumholz, Harlan M.

    2013-01-01

    Background Despite increasing attention on reducing relatively costly hospital practices while maintaining the quality of care, few studies have examined how hospitals use the intensive care unit (ICU), a high-cost setting, for patients admitted with heart failure (HF). We characterized hospital patterns of ICU admission for patients with HF and determined their association with the use of ICU-level therapies and patient outcomes. Methods and Results We identified 166,224 HF discharges from 341 hospitals in the 2009–10 Premier Perspective® database. We excluded hospitals with transfers. We defined ICU as including medical ICU, coronary ICU, and surgical ICU. We calculated the percent of patients admitted directly to an ICU. We compared hospitals in the top-quartile (high ICU admission) with the remaining quartiles. The median percentage of ICU admission was 10% (Interquartile Range 6% to 16%; range 0% to 88%). In top-quartile hospitals, treatments requiring an ICU were used less often: percentage of ICU days receiving mechanical ventilation (6% top quartile versus 15% others), non-invasive positive pressure ventilation (8% versus 19%), vasopressors and/or inotropes (9% versus 16%), vasodilators (6% versus 12%), and any of these interventions (26% versus 51%). Overall HF in-hospital risk standardized mortality was similar (3.4% versus 3.5%; P = 0.2). Conclusions ICU admission rates for HF varied markedly across hospitals and lacked association with in-hospital risk-standardized mortality. Greater ICU use correlated with fewer patients receiving ICU interventions. Judicious ICU use could reduce resource consumption without diminishing patient outcomes. PMID:23355624

  4. Evaluating Infection Prevention Strategies in Out-Patient Dialysis Units Using Agent-Based Modeling.

    Directory of Open Access Journals (Sweden)

    Joanna R Wares

    Full Text Available Patients receiving chronic hemodialysis (CHD are among the most vulnerable to infections caused by multidrug-resistant organisms (MDRO, which are associated with high rates of morbidity and mortality. Current guidelines to reduce transmission of MDRO in the out-patient dialysis unit are targeted at patients considered to be high-risk for transmitting these organisms: those with infected skin wounds not contained by a dressing, or those with fecal incontinence or uncontrolled diarrhea. Here, we hypothesize that targeting patients receiving antimicrobial treatment would more effectively reduce transmission and acquisition of MDRO. We also hypothesize that environmental contamination plays a role in the dissemination of MDRO in the dialysis unit. To address our hypotheses, we built an agent-based model to simulate different treatment strategies in a dialysis unit. Our results suggest that reducing antimicrobial treatment, either by reducing the number of patients receiving treatment or by reducing the duration of the treatment, markedly reduces overall colonization rates and also the levels of environmental contamination in the dialysis unit. Our results also suggest that improving the environmental decontamination efficacy between patient dialysis treatments is an effective method for reducing colonization and contamination rates. These findings have important implications for the development and implementation of future infection prevention strategies.

  5. Nursing students’ experiences of professional patient care encounters in a hospital unit

    DEFF Research Database (Denmark)

    Kaldal, Maiken Holm; Kristiansen, Jette; Uhrenfeldt, Lisbeth

    2015-01-01

    REVIEW QUESTION / OBJECTIVE The objective of this systematic review is to identify, appraise and synthesize the best available evidence on nursing students’ experiences of professional patient care encounters in a hospital unit. More specifically the research questions are: How do nursing students...... describe their experiences of professional patient care in a hospital unit? What kinds of experiences do nursing students have in professional patient care encounters? INCLUSION CRITERIA Types of participants This review will consider studies that include undergraduate and postgraduate nursing students...... experiences of professional patient care encounters where students engage with patients and provide nursing care within the basic principles of nursing care relating to the patients’ physiological and psychological needs. Studies that reflect nursing students’ comprehension of or attitudes towards nursing...

  6. Assessing and Managing Sleep Disturbance in Patients with Chronic Pain.

    Science.gov (United States)

    Cheatle, Martin D; Foster, Simmie; Pinkett, Aaron; Lesneski, Matthew; Qu, David; Dhingra, Lara

    2016-06-01

    Chronic pain is associated with symptoms that may impair a patient's quality of life, including emotional distress, fatigue, and sleep disturbance. There is a high prevalence of concomitant pain and sleep disturbance. Studies support the hypothesis that sleep and pain have a bidirectional and reciprocal relationship. Clinicians who manage patients with chronic pain often focus on interventions that relieve pain, and assessing and treating sleep disturbance are secondary or not addressed. This article reviews the literature on pain and co-occurring sleep disturbance, describes the assessment of sleep disturbance, and outlines nonpharmacologic and pharmacologic treatment strategies to improve sleep in patients with chronic pain.

  7. Assessing the Invasion Risk of Eucalyptus in the United States Using the Australian Weed Risk Assessment

    Directory of Open Access Journals (Sweden)

    Doria R. Gordon

    2012-01-01

    Full Text Available Many agricultural species have undergone selection for traits that are consistent with those that increase the probability that a species will become invasive. However, the risk of invasion may be accurately predicted for the majority of plant species tested using the Australian Weed Risk Assessment (WRA. This system has been tested in multiple climates and geographies and, on average, correctly identifies 90% of the major plant invaders as having high invasion risk, and 70% of the noninvaders as having low risk. We used this tool to evaluate the invasion risk of 38 Eucalyptus taxa currently being tested and cultivated in the USA for pulp, biofuel, and other purposes. We predict 15 taxa to have low risk of invasion, 14 taxa to have high risk, and 9 taxa to require further information. In addition to a history of naturalization and invasiveness elsewhere, the traits that significantly contribute to a high invasion risk conclusion include having prolific seed production and a short generation time. Selection against these traits should reduce the probability that eucalypts cultivated in the USA will become invasive threats to natural areas and agricultural systems.

  8. The influence of volume and intensive care unit organization on hospital mortality in patients admitted with severe sepsis: a retrospective multicentre cohort study.

    NARCIS (Netherlands)

    Peelen, L.; Keizer, N.F. de; Peek, N.; Scheffer, G.J.; Voort, P.H. van der; Jonge, E. de

    2007-01-01

    INTRODUCTION: The aim of the study was to assess the influence of annual volume and factors related to intensive care unit (ICU) organization on in-hospital mortality among patients admitted to the ICU with severe sepsis. METHODS: A retrospective cohort study was conducted using the database of the

  9. Geriatric assessment in elderly patients with prostate cancer.

    Science.gov (United States)

    Terret, Catherine; Albrand, Gilles; Droz, Jean Pierre

    2004-03-01

    As a result of demographic evolution, oncologists will treat more and more elderly patients with prostate cancer. Aging is frequently associated with the coexistence of several medical complications that can increase the complexity of cancer treatment decision-making. Unfortunately, clinical oncologists need to be more familiar with the multidimensional assessment of elderly patients. To acquire this skill, we implemented a multidimensional geriatric assessment program at our cancer center. This instrument prospectively assessed 60 elderly patients with prostate cancer. Herein, we describe geriatric aspects detected in our patient sample and report treatment options proposed to elderly patients with prostate cancer at different disease stages. The minimal comprehensive geriatric assessment (mini-CGA) procedure revealed that 66% of our patient population was dependent in one or more of the Katz Activities of Daily Living and 87% were dependent in 1 or more of the Lawton Instrumental Activities of Daily Living; all patients had significant comorbidity according to the Cumulative Illness Rating Scale-Geriatrics, 75% having at least one severe comorbidity. We identified 19 cases of drug interaction. We also observed that half of these patients had a risk of falling and some physical disability; 45% had cognitive disorders requiring more investigation; one third had depressive symptoms. Finally, 65% of the patients were either malnourished or at risk of malnutrition. Many of these problems were unknown before the mini-CGA processing and may interfere with cancer and cancer treatment. Thus, the correct management of elderly patients with cancer requires comprehensive geriatric assessment as well as relevant disease staging at diagnosis. This approach will help us to propose the most appropriate treatment with the main aim of preserving quality of life.

  10. Assessment of Online Patient Education Materials from Major Dermatologic Associations.

    Science.gov (United States)

    John, Ann M; John, Elizabeth S; Hansberry, David R; Lambert, William Clark

    2016-09-01

    Objective: Patients increasingly use the internet to find medical information regarding their conditions and treatments. Physicians often supplement visits with written education materials. Online patient education materials from major dermatologic associations should be written at appropriate reading levels to optimize utility for patients. The purpose of this study is to assess online patient education materials from major dermatologic associations and determine if they are written at the fourth to sixth grade level recommended by the American Medical Association and National Institutes of Health. Design: This is a descriptive and correlational design. Setting: Academic institution. Participants/measurements: Patient education materials from eight major dermatology websites were downloaded and assessed using 10 readability scales. A one-way analysis of variance and Tukey's Honestly Statistically Different post hoc analysis were performed to determine the difference in readability levels between websites. Results: Two hundred and sixty patient education materials were assessed. Collectively, patient education materials were written at a mean grade level of 11.13, with 65.8 percent of articles written above a tenth grade level and no articles written at the American Medical Association/National Institutes of Health recommended grade levels. Analysis of variance demonstrated a significant difference between websites for each reading scale (pdermatologic association websites are written well above recommended reading levels. Associations should consider revising patient education materials to allow more effective patient comprehension. (J ClinAesthet Dermatol. 2016;9(9):23-28.).

  11. Invasive fungal infection among hematopoietic stem cell transplantation patients with mechanical ventilation in the intensive care unit

    Directory of Open Access Journals (Sweden)

    Hung Chen-Yiu

    2012-02-01

    Full Text Available Abstract Background Invasive fungal infection (IFI is associated with high morbidity and high mortality in hematopoietic stem cell transplantation (HSCT patientsThe purpose of this study was to assess the characteristics and outcomes of HSCT patients with IFIs who are undergoing MV at a single institution in Taiwan. Methods We performed an observational retrospective analysis of IFIs in HSCT patients undergoing mechanical ventilation (MV in an intensive care unit (ICU from the year 2000 to 2009. The characteristics of these HSCT patients and risk factors related to IFIs were evaluated. The status of discharge, length of ICU stay, date of death and cause of death were also recorded. Results There were 326 HSCT patients at the Linkou Chang-Gung Memorial Hospital (Taipei, Taiwan during the study period. Sixty of these patients (18% were transferred to the ICU and placed on mechanical ventilators. A total of 20 of these 60 patients (33% had IFIs. Multivariate analysis indicated that independent risk factors for IFI were admission to an ICU more than 40 days after HSCT, graft versus host disease (GVHD, and high dose corticosteroid (p p = 0.676. Conclusion There was a high incidence of IFIs in HSCT patients requiring MV in the ICU in our study cohort. The independent risk factors for IFI are ICU admission more than 40 days after HSCT, GVHD, and use of high-dose corticosteroid.

  12. Current Practices in Assessing Professionalism in United States and Canadian Allopathic Medical Students and Residents

    Science.gov (United States)

    Nittur, Nandini

    2017-01-01

    Professionalism is a critically important competency that must be evaluated in medical trainees but is a complex construct that is hard to assess. A systematic review was undertaken to give insight into the current best practices for assessment of professionalism in medical trainees and to identify new research priorities in the field. A search was conducted on PubMed for behavioral assessments of medical students and residents among the United States and Canadian allopathic schools in the last 15 years. An initial search yielded 594 results, 28 of which met our inclusion criteria. Our analysis indicated that there are robust generic definitions of the major attributes of medical professionalism. The most commonly used assessment tools are survey instruments that use Likert scales tied to attributes of professionalism. While significant progress has been made in this field in recent years, several opportunities for system-wide improvement were identified that require further research. These include a paucity of information about assessment reliability, the need for rater training, a need to better define competency in professionalism according to learner level (preclinical, clerkship, resident etc.) and ways to remediate lapses in professionalism. Student acceptance of assessment of professionalism may be increased if assessment tools are shifted to better incorporate feedback. Tackling the impact of the hidden curriculum in which students may observe lapses in professionalism by faculty and other health care providers is another priority for further study. PMID:28652951

  13. Effect of the full moon on mortality among patients admitted to the intensive care unit.

    Science.gov (United States)

    Nadeem, Rashid; Nadeem, Amin; Madbouly, Essam Mohamed; Molnar, Janos; Morrison, Jeanette Levine

    2014-02-01

    To determine the lunar effect on mortality among patients admitted to the intensive care unit. The retrospective study conducted at Rosalind Franklin University of Medicine and Science, North Chicago, and comprised data of 4387 patients in intensive care unit from December 2002 to November 2004. The subjects were divided into two groups: patients who died on full moon days (the 14th, 15th, and 16th days of the lunar month); and patients who died on the other days of the month. The mortality rates were calculated for patients in both groups. Parameters including patients' age, gender, acute physiology and chronic health evaluation scores, predicted mortality rates, type of intensive care unit, and actual mortality were compared, and non-parametric tests were performed to determine whether there were any differences between the groups. Of the 4387 patients who were followed for 23 months, 297 patients died, including 31 on full moon days and 266 patients on the other days of the month. Both groups were similar in terms of mean age (73.6 +/- 14.59 vs. 71.07 +/- 16.13 years; p = 0.599), acute physiology and chronic health evalutation scores (82.06 +/- 24.19 vs. 76.52 +/- 27.42; p = 0.258), and predicted mortality (0.405 +/- 0.249 vs. 0.370 +/- 0.268; p = 0.305). There was no difference in the frequency of death between the full moon days and the other days (10.33 +/- 0.58 vs. 9.8 +/- 3.46; p = 0.845). The full moon does not affect the mortality of the patients in intensive care unit.

  14. Yield of routine provocative cardiac testing among patients in an emergency department-based chest pain unit.

    Science.gov (United States)

    Hermann, Luke K; Newman, David H; Pleasant, W Andrew; Rojanasarntikul, Dhanadol; Lakoff, Daniel; Goldberg, Scott A; Duvall, W Lane; Henzlova, Milena J

    2013-06-24

    The American Heart Association recommends routine provocative cardiac testing in accelerated diagnostic protocols for coronary ischemia. The diagnostic and therapeutic yield of this approach are unknown. To assess the yield of routine provocative cardiac testing in an emergency department-based chest pain unit. We examined a prospectively collected database of patients evaluated for possible acute coronary syndrome between March 4, 2004, and May 15, 2010, in the emergency department-based chest pain unit of an urban academic tertiary care center. Patients with signs or symptoms of possible acute coronary syndrome and without an ischemic electrocardiography result or a positive biomarker were enrolled in the database. All patients were evaluated by exercise stress testing or myocardial perfusion imaging. Demographic and clinical features, results of routine provocative cardiac testing and angiography, and therapeutic interventions were recorded. Diagnostic yield (true-positive rate) was calculated, and the potential therapeutic yield of invasive therapy was assessed through blinded, structured medical record review using American Heart Association designations (class I, IIa, IIb, or lower) for the potential benefit from percutaneous intervention. In total, 4181 patients were enrolled in the study. Chest pain was initially reported in 93.5%, most (73.2%) were at intermediate risk for coronary artery disease, and 37.6% were male. Routine provocative cardiac testing was positive for coronary ischemia in 470 (11.2%), of whom 123 underwent coronary angiography. Obstructive disease was confirmed in 63 of 123 (51.2% true positive), and 28 (0.7% overall) had findings consistent with the potential benefit from revascularization (American Heart Association class I or IIa). In an emergency department-based chest pain unit, routine provocative cardiac testing generated a small therapeutic yield, new diagnoses of coronary artery disease were uncommon, and false-positive results

  15. Nutritional risk assessment in critically ill cancer patients: systematic review

    Science.gov (United States)

    Fruchtenicht, Ana Valéria Gonçalves; Poziomyck, Aline Kirjner; Kabke, Geórgia Brum; Loss, Sérgio Henrique; Antoniazzi, Jorge Luiz; Steemburgo, Thais; Moreira, Luis Fernando

    2015-01-01

    Objective To systematically review the main methods for nutritional risk assessment used in critically ill cancer patients and present the methods that better assess risks and predict relevant clinical outcomes in this group of patients, as well as to discuss the pros and cons of these methods according to the current literature. Methods The study consisted of a systematic review based on analysis of manuscripts retrieved from the PubMed, LILACS and SciELO databases by searching for the key words “nutritional risk assessment”, “critically ill” and “cancer”. Results Only 6 (17.7%) of 34 initially retrieved papers met the inclusion criteria and were selected for the review. The main outcomes of these studies were that resting energy expenditure was associated with undernourishment and overfeeding. The high Patient-Generated Subjective Global Assessment score was significantly associated with low food intake, weight loss and malnutrition. In terms of biochemical markers, higher levels of creatinine, albumin and urea were significantly associated with lower mortality. The worst survival was found for patients with worse Eastern Cooperative Oncologic Group - performance status, high Glasgow Prognostic Score, low albumin, high Patient-Generated Subjective Global Assessment score and high alkaline phosphatase levels. Geriatric Nutritional Risk Index values Nutritional Index score was associated with abnormal nutritional status in critically ill cancer patients. Among the reviewed studies that examined weight and body mass index alone, no significant clinical outcome was found. Conclusion None of the methods reviewed helped to define risk among these patients. Therefore, assessment by a combination of weight loss and serum measurements, preferably in combination with other methods using scores such as Eastern Cooperative Oncologic Group - performance status, Glasgow Prognostic Score and Patient-Generated Subjective Global Assessment, is suggested given that

  16. Antidepressant or Antipsychotic Overdose in the Intensive Care Unit - Identification of Patients at Risk

    DEFF Research Database (Denmark)

    Borg, Linda; Julkunen, Anna; Madsen, Kristian Rørbaek

    2016-01-01

    adverse signs at hospital admission that turned out to need intensive care treatment. The effect of the antidepressants overdose risk assessment (ADORA) system was evaluated in patients with antidepressant as well as antipsychotic overdose. Our hypothesis was that patients with low ADORA do not need...... intensive care treatment. This retrospective study was conducted in adult patients admitted to the ICU at Odense University Hospital after an overdose with AP and/or AD between 1 January 2009 and 1 September 2014. Patients with predefined adverse signs in the emergency department were excluded due...... to obvious need of intensive care. Of the 157 patients included, 12 patients (8%) developed events during the ICU stay. Only 3 patients received intubation, vasoactive drugs and/or dialysis. None developed ventricular dysrhythmias. There were no fatalities. All the patients with low-risk assessment by ADORA...

  17. Assessment of the early effectiveness of a stroke unit in comparison to the general ward

    Institute of Scientific and Technical Information of China (English)

    马锐华; 王拥军; 曲辉; 杨中华

    2004-01-01

    Background Stroke unit is the most effective treatment method to benefit stroke patients. Our study is to evaluate the early effectiveness of a hospital stroke unit (SU). Methods Three hundred and ninety-two patients who had suffered from acute strokes and who were admitted to our hospital between December 2001 and January 2003 were recruited for this controlled study. All patients were sent at random to either the SU or the general ward (GW) for treatment. The following indices were measured by: Barthel Index (BI), National Institute of Health Stroke Scale (NIHSS), Oxford Handicap Scale (OHS). Results The mean change in BI score between the day of admission and the day of discharge was 20.00±24.36 for the SU group and 10.63±23.59 for the GW group. A difference that is statistically significant (P=0.000). The mean change in NIHSS score was -2.01±6.61 for the SU group and 0.55±7.44 for the GW group. A difference that is also statistically significant (P=0.000). Finally, the mean change in OHS score was -0.74±1.04 for the SU group and -0.28±0.98 for the GW group, also a statistically significant difference (P=0.000). Among SU patients, patient satisfaction was higher (P=0.000), the rehabilitation success rate was higher (P=0.000), and there were fewer complications (P=0.000).Conclusion Compared to GW patients, stroke patients treated in a special SU were able to return to normal daily activities earlier, with better social abilities, and have reduced neurological defects, without increasing the overall economic burden.

  18. A qualitative study using the Theoretical Domains Framework to investigate why patients were or were not assessed for rehabilitation after stroke.

    Science.gov (United States)

    Lynch, Elizabeth A; Luker, Julie A; Cadilhac, Dominique A; Fryer, Caroline E; Hillier, Susan L

    2017-07-01

    To explore the factors perceived to affect rehabilitation assessment and referral practices for patients with stroke. Qualitative study using data from focus groups analysed thematically and then mapped to the Theoretical Domains Framework. Eight acute stroke units in two states of Australia. Health professionals working in acute stroke units. Health professionals at all sites had participated in interventions to improve rehabilitation assessment and referral practices, which included provision of copies of an evidence-based decision-making rehabilitation Assessment Tool and pathway. Eight focus groups were conducted (32 total participants). Reported rehabilitation assessment and referral practices varied markedly between units. Continence and mood were not routinely assessed (4 units), and people with stroke symptoms were not consistently referred to rehabilitation (4 units). Key factors influencing practice were identified and included whether health professionals perceived that use of the Assessment Tool would improve rehabilitation assessment practices (theoretical domain 'social and professional role'); beliefs about outcomes from changing practice such as increased equity for patients or conversely that changing rehabilitation referral patterns would not affect access to rehabilitation ('belief about consequences'); the influence of the unit's relationships with other groups including rehabilitation teams ('social influences' domain) and understanding within the acute stroke unit team of the purpose of changing assessment practices ('knowledge' domain). This study has identified that health professionals' perceived roles, beliefs about consequences from changing practice and relationships with rehabilitation service providers were perceived to influence rehabilitation assessment and referral practices on Australian acute stroke units.

  19. The use of finger-stick blood to assess lactate in critically ill surgical patients.

    Science.gov (United States)

    Sabat, Joseph; Gould, Scott; Gillego, Ezra; Hariprashad, Anita; Wiest, Christine; Almonte, Shailyn; Lucido, David J; Gave, Asaf; Leitman, I Michael; Eiref, Simon D

    2016-09-01

    Using finger-stick capillary blood to assess lactate from the microcirculation may have utility in treating critically ill patients. Our goals were to determine how finger-stick capillary lactate correlates with arterial lactate levels in patients from the surgical intensive care unit, and to compare how capillary and arterial lactate trend over time in patients undergoing resuscitation for shock. Capillary whole blood specimens were obtained from finger-sticks using a lancet, and assessed for lactate via a handheld point-of-care device as part of an "investigational use only" study. Comparison was made to arterial blood specimens that were assessed for lactate by standard laboratory reference methods. 40 patients (mean age 68, mean APACHEII 18, vasopressor use 62%) were included. The correlation between capillary and arterial lactate levels was 0.94 (p < 0.001). Capillary lactate measured slightly higher on average than paired arterial values, with a mean difference 0.99 mmol/L. In patients being resuscitated for septic and hemorrhagic shock, capillary and arterial lactate trended closely over time: rising, peaking, and falling in tandem. Clearance of capillary and arterial lactate mirrored clinical improvement, normalizing in all patients except two that expired. Finger-stick capillary lactate both correlates and trends closely with arterial lactate in critically ill surgical patients, undergoing resuscitation for shock.

  20. [Predictive variables for mental retardation in a Pediatric Epilepsy Monitoring Unit. Neuropsychological assessment].

    Science.gov (United States)

    López-Sala, A; Palacio-Navarro, A; Donaire, A; García, G; Colomé, R; Boix, C; Sans, A; Campistol, J; Sanmartí, F X

    2010-03-03

    We sought to describe the epidemiological and clinical data from our patients in the Pediatric Epilepsy Monitoring Unit (PEMU) of the Sant Joan de Deu Hospital of Barcelona, and determine the variables of risk for mental retardation. A retrospective review of PEMU reports and hospital discharge summaries from March 2005 to December 2008 was conducted. The data from patients with intelligence quotient (IQ) estimated, older than 3 years of age and with epileptic electroencephalography (EEG) activity was analyzed in 158 patients (8.8 +/- 5.2 years; 55.1% boys). Of those pediatric patients, 63 had IQ less than 70 and 47 an IQ greater than or equal to 70. Intractable epilepsy was present in all of them. The percentage of the patients with mental retardation is significantly higher in patients with onset of epilepsy before 24 months (68.3%) than patients with later onset (27.7%). Onset of seizures, EEG findings and epilepsy etiology are significant risk factors for mental retardation. Early age at seizure, multifocal epilepsy and cryptogenic etiology are factors of worse prognosis to normal development of cognitive functions in pediatric intractable epilepsy.

  1. Patient Safety Culture in Nephrology Nurse Practice Settings: Results by Primary Work Unit, Organizational Work Setting, and Primary Role.

    Science.gov (United States)

    Ulrich, Beth; Kear, Tamara

    2015-01-01

    Patient safety culture is critical to the achievement of patient safety. In 2014, a landmark national study was conducted to investigate patient safety culture in nephrology nurse practice settings. In this secondary analysis of data from that study, we report the status of patient safety culture by primary work unit (chronic hemodialysis unit, acute hemodialysis unit, peritoneal dialysis unit) and organizational work setting (for-profit organization, not-for-profit organization), and compare the perceptions of direct care nurses and managers/administrators on components of patient safety culture.

  2. Assessment of Arbovirus Surveillance 13 Years after Introduction of West Nile Virus, United States.

    Science.gov (United States)

    Hadler, James L; Patel, Dhara; Nasci, Roger S; Petersen, Lyle R; Hughes, James M; Bradley, Kristy; Etkind, Paul; Kan, Lilly; Engel, Jeffrey

    2015-07-01

    Before 1999, the United States had no appropriated funding for arboviral surveillance, and many states conducted no such surveillance. After emergence of West Nile virus (WNV), federal funding was distributed to state and selected local health departments to build WNV surveillance systems. The Council of State and Territorial Epidemiologists conducted assessments of surveillance capacity of resulting systems in 2004 and in 2012; the assessment in 2012 was conducted after a 61% decrease in federal funding. In 2004, nearly all states and assessed local health departments had well-developed animal, mosquito, and human surveillance systems to monitor WNV activity and anticipate outbreaks. In 2012, many health departments had decreased mosquito surveillance and laboratory testing capacity and had no systematic disease-based surveillance for other arboviruses. Arboviral surveillance in many states might no longer be sufficient to rapidly detect and provide information needed to fully respond to WNV outbreaks and other arboviral threats (e.g., dengue, chikungunya).

  3. Safety Aspects of Postanesthesia Care Unit Discharge without Motor Function Assessment after Spinal Anesthesia

    DEFF Research Database (Denmark)

    Aasvang, Eske Kvanner; Jørgensen, Christoffer Calov; Laursen, Mogens Berg

    2017-01-01

    BACKGROUND: Postanesthesia care unit (PACU) discharge without observation of lower limb motor function after spinal anesthesia has been suggested to significantly reduce PACU stay and enhance resource optimization and early rehabilitation but without enough data to allow clinical recommendations....... METHODS: A multicenter, semiblinded, noninferiority randomized controlled trial of discharge from the PACU with or without assessment of lower limb motor function after elective total hip or knee arthroplasty under spinal anesthesia was undertaken. The primary outcome was frequency of a successful fast.......70 to 1.35). Adverse events in the ward during the first 24 h occurred in 5.8% versus 7.4% with or without motor function assessment, respectively (OR, 0.77; 95% CI, 0.5 to 1.19, P = 0.24). CONCLUSIONS: PACU discharge without assessment of lower limb motor function after spinal anesthesia for total hip...

  4. Assessment of Arbovirus Surveillance 13 Years after Introduction of West Nile Virus, United States1

    Science.gov (United States)

    Patel, Dhara; Nasci, Roger S.; Petersen, Lyle R.; Hughes, James M.; Bradley, Kristy; Etkind, Paul; Kan, Lilly; Engel, Jeffrey

    2015-01-01

    Before 1999, the United States had no appropriated funding for arboviral surveillance, and many states conducted no such surveillance. After emergence of West Nile virus (WNV), federal funding was distributed to state and selected local health departments to build WNV surveillance systems. The Council of State and Territorial Epidemiologists conducted assessments of surveillance capacity of resulting systems in 2004 and in 2012; the assessment in 2012 was conducted after a 61% decrease in federal funding. In 2004, nearly all states and assessed local health departments had well-developed animal, mosquito, and human surveillance systems to monitor WNV activity and anticipate outbreaks. In 2012, many health departments had decreased mosquito surveillance and laboratory testing capacity and had no systematic disease-based surveillance for other arboviruses. Arboviral surveillance in many states might no longer be sufficient to rapidly detect and provide information needed to fully respond to WNV outbreaks and other arboviral threats (e.g., dengue, chikungunya). PMID:26079471

  5. USGS mineral-resource assessment of Sagebrush Focal Areas in the western United States

    Science.gov (United States)

    Frank, David G.; Frost, Thomas P.; Day, Warren C.; ,

    2016-10-04

    U.S. Geological Survey (USGS) scientists have completed an assessment of the mineral-resource potential of nearly 10 million acres of Federal and adjacent lands in Idaho, Montana, Nevada, Oregon, Utah, and Wyoming. The assessment of these lands, identified as Sagebrush Focal Areas, was done at the request of the Bureau of Land Management. The assessment results will be used in the decision-making process that the Department of the Interior is pursuing toward the protection of large areas of contiguous sagebrush habitat for the greater sage-grouse (Centrocercus urophasianus) in the Western United States. The detailed results of this ambitious study are published in the five volumes of USGS Scientific Investigations Report 2016–5089 and seven accompanying data releases.

  6. Pre-treatment clinical assessment in head and neck cancer: United Kingdom National Multidisciplinary Guidelines.

    Science.gov (United States)

    Robson, A; Sturman, J; Williamson, P; Conboy, P; Penney, S; Wood, H

    2016-05-01

    This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. This paper provides recommendations on the pre-treatment clinical assessment of patients presenting with head and neck cancer. Recommendations • Comorbidity data should be collected as it is important in the analysis of survival, quality of life and functional outcomes after treatment as well as for comparing results of different treatment regimens and different centres. (R) • Patients with hypertension of over 180/110 or associated target organ damage, should have antihypertensive medication started pre-operatively as per British Hypertension Society guidelines. (R) • Rapidly correcting pre-operative hypertension with beta blockade appears to cause higher mortality due to stroke and hypotension and should not be used. (R) • Patients with poorly controlled or unstable ischaemic heart disease should be referred for cardiology assessment pre-operatively. (G) • Patients within one year of drug eluting stents should be discussed with the cardiologist who was responsible for their percutaneous coronary intervention pre-operatively with regard to cessation of antiplatelet medication due to risk of stent thrombosis. (G) • Patients with multiple recent stents should be managed in a centre with access to interventional cardiology. (G) • Surgery after myocardial infarction should be delayed if possible to reduce mortality risk. (R) • Patients with critical aortic stenosis (AS) should be considered for pre-operative intervention. (G) • Clopidogrel should be discontinued 7 days pre-operatively; warfarin should be discontinued 5 days pre-operatively. (R) • Patients with thromboembolic disease or artificial heart valves require heparin therapy to bridge peri-operative warfarin cessation, this should start 2 days after last warfarin dose. (R) • Cardiac drugs other than angotensin-converting enzyme inhibitors and angiotensin

  7. Elevation of a patient's trunk and legs does not influence length of stay in the post-anesthesia care unit

    Directory of Open Access Journals (Sweden)

    Otávio Omati

    Full Text Available CONTEXT: Patient recovery time after anesthesia depends on problem-oriented monitoring and individual assessment. OBJECTIVE: To investigate the influence of patient positioning on post-anesthesia recovery time. TYPE OF STUDY: Retrospective. SETTING: Post-anesthesia care unit, Hospital das Clínicas, São Paulo. METHODS: Data were obtained from patients recovering from anesthesia in a supine horizontal position or with their trunk and legs elevated at 30 degrees. Data were recorded every 30 minutes. The start time was considered to be the admission to the unit, and the final measurement was taken when the patient reached an Aldrete-Kroulik index of 10. The length of time until discharge was recorded. RESULTS: 442 patients recovering after general (n = 274 or regional anesthesia (n = 168 were assigned to be kept in a supine position or with their trunk and legs elevated. There was no difference in the medians for non-parametric results, between supine position (75 min, n = 229 and trunk and legs elevated (70 min, n = 213; p = 0.729. Patients recovered faster from regional anesthesia with trunk and legs elevated (70 min than in the supine position (84.5 min, although not significantly (p = 0.097. There was no difference between patients recovering from general anesthesia, no matter the positioning (70 min; p = 0.493. DISCUSSION: Elevated legs may supposedly improve venous return and cardiac output since spinal anesthesia blocks sympathetic system and considering leg-raising has been shown to improve cardiac output from hipovolemia. Our findings did not support this hypothesis. Some limitations included a retrospective collection of data that did not allow randomization for recovery position and the unregistered duration of the exposure to the anesthetic drugs. CONCLUSIONS: There was no difference in anesthesia recovery time in relation to positioning patients supinely or with trunk and legs elevated.

  8. Informational support to family members of intensive care unit patients: the perspectives of families and nurses.

    Science.gov (United States)

    Gaeeni, Mina; Farahani, Mansoureh A; Seyedfatemi, Naima; Mohammadi, Nooredin

    2014-09-25

    The receiving information about the patients hospitalized in the intensive care unit is classified among the most important needs of the family members of such patients. Meeting the informational needs of families is a major goal for intensive care workers. Delivering honest, intelligible and effective information raises specific challenges in the stressful setting of the intensive care unit (ICU). The aim of this qualitative study was to explain perspectives of families of Intensive Care Unit patients and nurses about informational support. Using a conventional content analysis approach, semi-structured interviews were conducted with participants to explore their perspectives of providing informational support to families of ICU patients. A purposeful sampling method was used to recruit nineteen family members of thirteen patients hospitalized in the ICU and twelve nurses from three teaching hospitals. In general, 31 persons participated in this study. Data collection continued to achieve data saturation. A conventional content analysis of the data produced three categories and seven sub-categories. The three main categories were as followed, a) providing information, b) handling information and c) using information. Providing information had three sub-categories consisting of "receiving admission news", "receiving truthful and complete information" and receiving general information. Handling information had two sub-categories consisting "keeping information" and "gradual revelation". Lastly, using information has two sub-categories consisting of "support of patient" and "support of family members". The results of this study revealed perspectives of families of Intensive Care Unit patients and nurses about informational support. It also determines the nurses' need to know more about the influence of their supportive role on family's ICU patients informing. In addition, the results of present study can be used as a basis for further studies and for offering

  9. Radiation dose to patients and radiologists during transcatheter arterial embolization: comparison of a digital flat-panel system and conventional unit.

    Science.gov (United States)

    Suzuki, Shigeru; Furui, Shigeru; Kobayashi, Ikuo; Yamauchi, Teiyu; Kohtake, Hiroshi; Takeshita, Koji; Takada, Koichi; Yamagishi, Masafumi

    2005-10-01

    The objective of our study was to evaluate the exposure doses to patients and radiologists during transcatheter arterial embolization (TAE) for hepatocellular carcinoma (HCC) using a new angiographic unit with a digital flat-panel system. Doses were assessed for 24 procedures: 12 using a new unit with a digital flat-panel system and 12 using a conventional unit. Doses to patients' skin were evaluated with thermoluminescent dosimeters behind the left, middle, and right portions of the liver. The doses to the radiologists were measured by an electronic personal dosimeter placed on the chest outside a lead protector. The maximal skin doses to the patients and the dose equivalents, Hp(0.07), to the radiologists were compared between the two procedure groups with each angiographic unit. For procedures with the new unit, the mean maximal skin dose to the patients was 284 +/- 127 (SD) mGy (range, 130-467 mGy), and Hp(0.07) to the radiologists was 62.8 +/- 17.4 muSv. For procedures with the conventional unit, the maximal skin dose to the patients was 1,068 +/- 439 mGy (range, 510-1,882 mGy), and Hp(0.07) to the radiologists was 68.4 +/- 25.7 muSv. The maximal skin dose to the patients was significantly lower with the new unit than with the conventional unit (p < 0.0005). There was no significant difference in the Hp(0.07) to the radiologists between the two procedure groups. The new digital flat-panel system for angiographic imaging can reduce the radiation dose to patients' skin during TAE for HCC as compared with the conventional system.

  10. Self-assessment in cancer patients referred to palliative care

    DEFF Research Database (Denmark)

    Strömgren, Annette S; Goldschmidt, Dorthe; Groenvold, Mogens

    2002-01-01

    the symptomatology of participating patients and examines differences in symptomatology between patients in three palliative care functions: inpatient, outpatient, and palliative home care. RESULTS: Of 267 eligible patients who were referred to a department of palliative medicine, initial self......-assessment questionnaires were obtained from 176 patients (65.9%). The 91 nonparticipants were older and had lower Karnofsky Performance status (KPS) values than the participants. Almost all participating patients suffered from impaired role function and physical function and had high levels of pain, fatigue, and other...... symptoms. According to the HADS, 47% of patients suffered from depression. Outpatients had better scores than inpatients and patients in palliative home care for physical function, role function, cognitive function, depression, and inactivity. CONCLUSIONS: It is possible to carry out a questionnaire...

  11. A Study of the Patients Admitted to the Clinical Decision Unit over One Year.

    Science.gov (United States)

    O'Shea, E; Cusack, S; O'Sullivan, I

    2016-06-10

    Clinical decision units (CDUs) are areas within an emergency department (ED) providing care for the patient who may benefit from an extended observation period, usually for a maximum of twenty-four hours. A retrospective patient record audit was performed to determine the characteristics of patients admitted to the Cork University Hospital (CUH) CDU over 12 months. The average length of stay of a patient in the CDU was 29 hours. The most common diagnoses admitted to the CDU were chest pain (9.5%) and headache (7.2%). The research implies that the CDU provided a means for CUH to save approximately €2 million annually.

  12. Economic assessment of greenhouse-cucumber production units in Birjand Township

    Directory of Open Access Journals (Sweden)

    M. R. Bakhshi

    2011-12-01

    Full Text Available The objective of this study was economic assessment of greenhouse-cucumber production units in Birjand Township and investigation of factors influencing it. Statistical population of this research consisted of all the greenhouse owners in Birjand (50 units. For economic assessment, the profitability index (TR/TC and discriminative analysis were used. Based on the TR/TC index and cluster analysis with –K mean method, the considered society was divided into two groups of successful and less-successful units. The median of this index was more than 1.49 in the successful group and less than1.49 in the other group. After dividing the groups by discriminative analysis, the variables distinguishing the groups were determined. Results showed that the most important variables which influence the TR/TC index and distinguish these two groups are amount of applied micronutrients, greenhouse area, number of irrigations, amount of the applied manure, educational-extension films, and visiting other greenhouse-owners’ activities.

  13. Assessing palatal mobility in post-tonsillectomy patients

    Directory of Open Access Journals (Sweden)

    Eman Mostafa

    2016-07-01

    Full Text Available Objectives: To assess palatal mobility in post-tonsillectomy patients. Material and methods: This study was conducted in one year duration in Sohag University Hospital and consisted of 100 patients with ages ranging from 4 to 21 years. Inclusion criteria: history with previous tonsillectomy at least since 6 months or more. Exclusion criteria: any neurological deficit, muscular disorder or structural defects of the palate such as cleft palate or submucous cleft palate. All patients had undergone ear, nose and throat examination. Palatal mobility was assessed through oral examination. Further assessing palatal mobility by endoscopic examination and videofluoroscopy was done for those who have poor palatal mobility detected by intraoral examination. Result: Forty patients (23 males, 17 females had poor palatal mobility on oral examination. Fourteen patients (8 males, 6 females had definite poor palatal mobility on endoscopic examination. On Auditory Perceptual Assessment, 12 patients had closed nasality and 2 patients had mixed nasality. On endoscopic examination, 14 patients had a large adenoid. In 12 patients, the velopharyngeal orifice closure was veloadenoidal closure while in the other 2 patients there was slight velopharyngeal incompetence (coronal closure. Conclusion: Poor palatal mobility may be caused by malpractice of tonsillectomy or it may be a sign that was present and missed by the otolaryngologist. Pre-tonsillectomy evaluation of palatal mobility should be done by nasofiberoptic endoscope and/or videofluoroscopy. Also post-tonsillectomy evaluation of palatal mobility should be taken in consideration if adenoidectomy is needed to prevent possible postoperative open nasality.

  14. Velopharyngeal function assessment in patients with cleft palate: perceptual speech assessment versus nasopharyngoscopy.

    Science.gov (United States)

    Ma, Li; Shi, Bing; Li, Yang; Zheng, Qian

    2013-07-01

    There is no doubt that perceptual speech assessment and instrumental examination could provide different diagnostic information on patients with cleft palate (CP), but not all patients simultaneously need the 2 examinations. So the purposes of this study were to explore a simple and effective evaluation method to assess velopharyngeal function and to investigate speech traits that affect the diagnosis of velopharyngeal function in patients with CP. The investigators implemented a retrospective study, and 247 postoperative patients with CP were selected, including 155 boys and 92 girls, with a mean (SD) age of 13 years and 2 months (7 years and 7 months). All of these patients were assessed by perceptual speech evaluation and nasopharyngoscopy after surgery, and the result was divided into velopharyngeal closure (VPC), velopharyngeal insufficiency, and marginal VPC. The number of diagnostic consistency patients was 170 (VPC, 51 patients; velopharyngeal insufficiency, 115 patients; marginal VPC, 4 patients), and the consistent ratio was 68.83%. There was no significant difference between perceptual speech assessment and nasopharyngoscopy. Furthermore, the difference in distribution of hypernasality between the consistent group and the inconsistent group was significant. In addition, the correlation analysis indicated that surgical age, hypernasality, nasal emission, and compensatory articulation were correlated with the velopharyngeal function (P velopharyngeal function. Much more attention should be paid to the surgical age, the alteration of hypernasality, nasal emission, and compensatory articulation during CP therapy.

  15. Assessing patient care: summary of the breakout group on assessment of observable learner performance.

    Science.gov (United States)

    Takayesu, James Kimo; Kulstad, Christine; Wallenstein, Joshua; Gallahue, Fiona; Gordon, David; Leone, Katrina; Kessler, Chad

    2012-12-01

    There is an established expectation that physicians in training demonstrate competence in all aspects of clinical care prior to entering professional practice. Multiple methods have been used to assess competence in patient care, including direct observation, simulation-based assessments, objective structured clinical examinations (OSCEs), global faculty evaluations, 360-degree evaluations, portfolios, self-reflection, clinical performance metrics, and procedure logs. A thorough assessment of competence in patient care requires a mixture of methods, taking into account each method's costs, benefits, and current level of evidence. At the 2012 Academic Emergency Medicine (AEM) consensus conference on educational research, one breakout group reviewed and discussed the evidence supporting various methods of assessing patient care and defined a research agenda for the continued development of specific assessment methods based on current best practices. In this article, the authors review each method's supporting reliability and validity evidence and make specific recommendations for future educational research.

  16. Assessment of Personality Problems among Patients with Substance Use Disorders

    Directory of Open Access Journals (Sweden)

    Lien Ingebjørg Aspeland

    2016-09-01

    Full Text Available AIM – Several studies have shown that personality disorders (PDs are frequently occurring among patients with substance use disorders (SUDs. A development from research of co-occurrence estimates in this patient group investigates personality problems as dimensional constructs, which seek to capture the core of personality pathology. The aim of our study was to explore whether personality problems might be assessed among SUD patients in early stages of treatment. We also sought to investigate personality problem severity among Norwegian adult SUD patients.

  17. Quality assessment of patient leaflets on misoprostol-induced labour

    DEFF Research Database (Denmark)

    Clausen, Jette Aaroe; Juhl, Mette; Rydahl, Eva

    2016-01-01

    Objectives: The need for thorough patient information is increasing as maternity care becomes more medicalised. The aim was to assess the quality of written patient information on labour induction. In most Danish hospitals, misoprostol is the first-choice drug for induction in low-risk pregnancies......=13). Design: Patient leaflets were evaluated according to a validated scoring tool (International Patient Decision Aid Standards instrument, IPDAS), core elements in the Danish Health Act, and items regarding off-label use and non-registered medication. Two of the authors scored all leaflets...

  18. Qualitative release assessment to estimate the likelihood of henipavirus entering the United Kingdom.

    Directory of Open Access Journals (Sweden)

    Emma L Snary

    Full Text Available The genus Henipavirus includes Hendra virus (HeV and Nipah virus (NiV, for which fruit bats (particularly those of the genus Pteropus are considered to be the wildlife reservoir. The recognition of henipaviruses occurring across a wider geographic and host range suggests the possibility of the virus entering the United Kingdom (UK. To estimate the likelihood of henipaviruses entering the UK, a qualitative release assessment was undertaken. To facilitate the release assessment, the world was divided into four zones according to location of outbreaks of henipaviruses, isolation of henipaviruses, proximity to other countries where incidents of henipaviruses have occurred and the distribution of Pteropus spp. fruit bats. From this release assessment, the key findings are that the importation of fruit from Zone 1 and 2 and bat bushmeat from Zone 1 each have a Low annual probability of release of henipaviruses into the UK. Similarly, the importation of bat meat from Zone 2, horses and companion animals from Zone 1 and people travelling from Zone 1 and entering the UK was estimated to pose a Very Low probability of release. The annual probability of release for all other release routes was assessed to be Negligible. It is recommended that the release assessment be periodically re-assessed to reflect changes in knowledge and circumstances over time.

  19. Routine use of the confusion assessment method for the intensive care unit : a multicenter study

    NARCIS (Netherlands)

    van Eijk, Maarten M.; van den Boogaard, Mark; van Marum, Rob J.; Benner, Paul; Eikelenboom, Piet; Honing, Marina L.; van der Hoven, Ben; Horn, Janneke; Izaks, Gerbrand J.; Kalf, Annette; Karakus, Attila; Klijn, Ine A.; Kuiper, Michael A.; de Leeuw, Frank-Erik; de Man, Tjarda; van der Mast, Roos C.; Osse, Robert-Jan; Rooij, de Sophia; Spronk, Peter E.; van der Voort, Peter H.; van Gool, Willem A.; Slooter, Arjen J.

    2011-01-01

    Rationale: Delirium is often unrecognized in ICU patients and associated with poor outcome. Screening for ICU delirium is recommended by several medical organizations to improve early diagnosis and treatment. The Confusion Assessment Method for the ICU (CAM-ICU) has high sensitivity and specificity

  20. Routine use of the confusion assessment method for the intensive care unit: a multicenter study

    NARCIS (Netherlands)

    Eijk, M.M. van; Boogaard, M.H.W.A. van den; Marum, R.J. van; Benner, P.; Eikelenboom, P.; Honing, M.L.H.; Hoven, B. van der; Horn, J.; Izaks, G.J.; Kalf, A.; Karakus, A.; Klijn, I.A.; Kuiper, M.A.; Leeuw, F.E. de; Man, T. de; Mast, R.C. van der; Osse, R.J.; Rooij, S.E. De; Spronk, P.E.; Voort, P.H. van der; Gool, W.A. van; Slooter, A.J.

    2011-01-01

    RATIONALE: Delirium is often unrecognized in ICU patients and associated with poor outcome. Screening for ICU delirium is recommended by several medical organizations to improve early diagnosis and treatment. The Confusion Assessment Method for the ICU (CAM-ICU) has high sensitivity and specificity

  1. Routine use of the confusion assessment method for the intensive care unit : a multicenter study

    NARCIS (Netherlands)

    van Eijk, Maarten M; van den Boogaard, Mark; van Marum, Rob J; Benner, Paul; Eikelenboom, Piet; Honing, Marina L; van der Hoven, Ben; Horn, Janneke; Izaks, Gerbrand J; Kalf, Annette; Karakus, Attila; Klijn, Ine A; Kuiper, Michael A; de Leeuw, Frank-Erik; de Man, Tjarda; van der Mast, Roos C; Osse, Robert-Jan; de Rooij, Sophia E; Spronk, Peter E; van der Voort, Peter H; van Gool, Willem A; Slooter, Arjen J

    2011-01-01

    RATIONALE: Delirium is often unrecognized in ICU patients and associated with poor outcome. Screening for ICU delirium is recommended by several medical organizations to improve early diagnosis and treatment. The Confusion Assessment Method for the ICU (CAM-ICU) has high sensitivity and specificity

  2. Assessing Depression in Cardiac Patients: What Measures Should Be Considered?

    Directory of Open Access Journals (Sweden)

    M. Ceccarini

    2014-01-01

    Full Text Available It is highly recommended to promptly assess depression in heart disease patients as it represents a crucial risk factor which may result in premature deaths following acute cardiac events and a more severe psychopathology, even in cases of subsequent nonfatal cardiac events. Patients and professionals often underestimate or misjudge depressive symptomatology as cardiac symptoms; hence, quick, reliable, and early mood changes assessments are warranted. Failing to detect depressive signals may have detrimental effects on these patients’ wellbeing and full recovery. Choosing gold-standard depression investigations in cardiac patients that fit a hospitalised cardiac setting well is fundamental. This paper will examine eight well established tools following Italian and international guidelines on mood disorders diagnosis in cardiac patients: the Hospital Anxiety and Depression Scale (HADS, the Cognitive Behavioural Assessment Hospital Form (CBA-H, the Beck Depression Inventory (BDI, the two and nine-item Patient Health Questionnaire (PHQ-2, PHQ-9, the Depression Interview and Structured Hamilton (DISH, the Hamilton Rating Scale for Depression (HAM-D/HRSD, and the Composite International Diagnostic Interview (CIDI. Though their strengths and weaknesses may appear to be homogeneous, the BDI-II and the PHQ are more efficient towards an early depression assessment within cardiac hospitalised patients.

  3. Deciding intensive care unit-admission for critically ill cancer patients

    Directory of Open Access Journals (Sweden)

    Thiery Guillaume

    2007-01-01

    Full Text Available Over the last 15 years, the management of critically ill cancer patients requiring intensive care unit admission has substantially changed. High mortality rates (75-85% were reported 10-20 years ago in cancer patients requiring life sustaining treatments. Because of these high mortality rates, the high costs, and the moral burden for patients and their families, ICU admission of cancer patients became controversial, or even clearly discouraged by some. As a result, the reluctance of intensivists regarding cancer patients has led to frequent refusal admission in the ICU. However, prognosis of critically ill cancer patients has been improved over the past 10 years leading to an urgent need to reappraise this reluctance. In this review, the authors sought to highlight that critical care management, including mechanical ventilation and other life sustaining therapies, may benefit to cancer patients. In addition, criteria for ICU admission are discussed, with a particular emphasis to potential benefits of early ICU-admission.

  4. 10 CFR 35.604 - Surveys of patients and human research subjects treated with a remote afterloader unit.

    Science.gov (United States)

    2010-01-01

    ... 10 Energy 1 2010-01-01 2010-01-01 false Surveys of patients and human research subjects treated... Stereotactic Radiosurgery Units § 35.604 Surveys of patients and human research subjects treated with a remote... shall survey the patient or the human research subject and the remote afterloader unit with a...

  5. Needs Assessment for cancer patients and their families

    Directory of Open Access Journals (Sweden)

    Gustafson David H

    2004-02-01

    Full Text Available Abstract Background The assessment of needs for cancer care is a critical step in providing high quality care and achieving cancer patients' and families' satisfaction. Instruments can be used to assess needs and guide cancer care planning. This study discusses the importance of the needs assessment, relationships between needs, satisfaction and quality of life; and reviews the assessment instruments of needs experienced by cancer patients and their families. Methods A systematic search was conducted in MEDLINE and CANCERLIT data bases. Instruments were evaluated based on their conceptual and measurement models as well as their demonstrated reliability and validity. The authors also sought information pertaining to instruments' burden of administration and responsiveness. Measures compromised by a lack of published psychometric description were not included. Results This search identified 17 patient needs assessment instruments and seven family needs assessment instruments. The development and psychometric proprieties of most of these instruments were well documented. However, data on their responsiveness and burden of administration were scarce. Conclusions Each selected instrument meets some but not all of our criteria for validity, reliability, responsiveness and burden. It is questionable whether any instrument can be developed meeting all the requirements. However, there is still a need to continue researching and developing needs assessment instruments leading to effective intervention and improving quality of cancer care.

  6. The influence of care interventions on the continuity of sleep of intensive care unit patients1

    Science.gov (United States)

    Hamze, Fernanda Luiza; de Souza, Cristiane Chaves; Chianca, Tânia Couto Machado

    2015-01-01

    Objective: to identify care interventions, performed by the health team, and their influence on the continuity of sleep of patients hospitalized in the Intensive Care Unit. Method: descriptive study with a sample of 12 patients. A filming technique was used for the data collection. The awakenings from sleep were measured using the actigraphy method. The analysis of the data was descriptive, processed using the Statistical Package for the Social Sciences software. Results: 529 care interventions were identified, grouped into 28 different types, of which 12 (42.8%) caused awakening from sleep for the patients. A mean of 44.1 interventions/patient/day was observed, with 1.8 interventions/patient/hour. The administration of oral medicine and food were the interventions that caused higher frequencies of awakenings in the patients. Conclusion: it was identified that the health care interventions can harm the sleep of ICU patients. It is recommended that health professionals rethink the planning of interventions according to the individual demand of the patients, with the diversification of schedules and introduction of new practices to improve the quality of sleep of Intensive Care Unit patients. PMID:26487127

  7. Outcomes of Emergency Medical Patients Admitted to an Intermediate Care Unit With Detailed Admission Guidelines.

    Science.gov (United States)

    Simpson, Catherine E; Sahetya, Sarina K; Bradsher, Robert W; Scholten, Eric L; Bain, William; Siddique, Shazia M; Hager, David N

    2017-01-01

    An important, but not well characterized, population receiving intermediate care is that of medical patients admitted directly from the emergency department. To characterize emergency medical patients and their outcomes when admitted to an intermediate care unit with clearly defined admission guidelines. Demographic data, admitting diagnoses, illness severity, comorbid conditions, lengths of stay, and hospital mortality were characterized for all emergency medical patients admitted directly to an intermediate care unit from July through December 2012. A total of 317 unique patients were admitted (mean age, 54 [SD, 16] years). Most patients were admitted with respiratory (26.5%) or cardiac (17.0%) syndromes. The mean (SD) Acute Physiology and Chronic Health Evaluation score version II, Simplified Acute Physiology Score version II, and Charlson Comorbidity Index were 15.6 (6.5), 20.7 (11.8), and 2.7 (2.3), respectively. Severity of illness and length of stay were significantly different for patients who required intensive care within 24 hours of admission (n = 16) or later (n = 25), patients who continued with inter mediate care for more than 24 hours (n = 247), and patients who were downgraded or discharged in less than 24 hours (n = 29). Overall hospital mortality was 4.4% (14 deaths). Emergency medical patients with moderate severity of illness and comorbidity can be admitted to an intermediate level of care with relatively infrequent transfer to intensive care and relatively low mortality. ©2016 American Association of Critical-Care Nurses.

  8. Assessment of videoendoscopy-assisted abdominoplasty for diastasis recti patients

    Directory of Open Access Journals (Sweden)

    Cheng-Jen Chang

    2013-10-01

    Full Text Available Background : The objective of this retrospective analysis was to assess the treatment of endoscope abdominoplasty for diastasis recti deformity patients. Methods : From January 1999 to January 2011, 88 patients ranging from 35 to 46 years in age were treated with videoendoscopy-assisted minimally invasive surgery. All patients were Asian. Early ( 6 months complications were assessed throughout a follow-up period of up to 66 months. Results : Observations were conducted at the end of three weeks, six months, and 66 months. Early on, all patients experienced numbness with local paresthesia (100% closely after treatment, and reported the feelings to subside by six months post-treatment. Four patients (4.5% experienced ecchymosis, and three patients (3.4% were affected by seroma. One patient (1.1% had dyspnea immediately after surgery, which recovered after oxygen (O 2 administration. Only one patient (1.1% experienced minimal skin loss, which recovered after 3 months of surgery, and there were no further complications. Hypertrophic scars were apparent in three patients (3.4% who showed no unwanted signs or further complications after post-operative scar care. No hematoma had been reported. All complications subsided (> 6 months postoperatively. Conclusions : Videoendoscopy-assisted abdominoplasty can be used for diastasis recti deformity with minimal excess skin. Our study demonstrated effects against the formation of seroma and other complications.

  9. Nursing care of the brain injury patient on a locked neurobehavioral unit.

    Science.gov (United States)

    Becker, Christine

    2012-01-01

    Behavioral problems after a brain injury can be extremely challenging for those working with brain injured people. Nursing staff must be familiar with commonly used post brain injury medications and their effects, behavioral management plans, appropriate use of restrictive devices, and verbal or physical crisis intervention techniques when necessary. Rehabilitation nurses caring for brain injured patients on a locked neurobehavioral unit must maintain continual training and specific competence in this environment to ensure patient and staff safety.

  10. Patient safety culture in a Dutch pediatric surgical intensive care unit: an evaluation using the Safety Attitudes Questionnaire.

    Science.gov (United States)

    Poley, Marten J; van der Starre, Cynthia; van den Bos, Ada; van Dijk, Monique; Tibboel, Dick

    2011-11-01

    Nowadays, the belief is widespread that a safety culture is crucial to achieving patient safety, yet there has been virtually no analysis of the safety culture in pediatric hospital settings so far. Our aim was to measure the safety climate in our unit, compare it with benchmarking data, and identify potential deficiencies. Prospective longitudinal survey study at two points in time. Pediatric surgical intensive care unit at a Dutch university hospital. All unit personnel. To measure the safety climate, the Safety Attitudes Questionnaire was administered to physicians, nurses, nursing assistants, pharmacists, technicians, and ward clerks in both May 2006 and May 2007. This questionnaire assesses caregiver attitudes through use of the six following scales: teamwork climate, job satisfaction, perceptions of management, safety climate, working conditions, and stress recognition. Earlier research showed that the Safety Attitudes Questionnaire has good psychometric properties and produced benchmarking data that can be used to evaluate strengths and weaknesses in a given clinical unit against peers. The response rates for the Safety Attitudes Questionnaire were 85% (May 2006) and 74% (May 2007). There were mixed findings regarding the difference between physicians and nurses: on three scales (i.e., teamwork climate, safety climate, and stress recognition), physicians scored better than nurses at both points in time. On another two scales (i.e., perceptions of management and working conditions), nurses consistently had higher mean scale scores. Probably due to the small number of physicians, only some of these differences between physicians and nurses reached the level of statistical significance. Compared to benchmarking data, scores on perceptions of management were higher than expected (p culture in our unit was good when compared to benchmark data, there is still room for improvement. This requires us to continue working on interventions intended to improve the safety

  11. Knowledge, attitude and practices of diabetic patients in the United Arab Emirates

    National Research Council Canada - National Science Library

    Al-Maskari, Fatma; El-Sadig, Mohamed; Al-Kaabi, Juma M; Afandi, Bachar; Nagelkerke, Nicolas; Yeatts, Karin B

    2013-01-01

    ...) lack sufficient knowledge about their disease due to illiteracy. Thus, before considering any possible intervention it was imperative to assess present knowledge, attitudes, and practices of patients towards the management of diabetes...

  12. Paramedic assessment of pain in the cognitively impaired adult patient

    Directory of Open Access Journals (Sweden)

    Lord Bill

    2009-10-01

    Full Text Available Abstract Background Paramedics are often a first point of contact for people experiencing pain in the community. Wherever possible the patient's self report of pain should be sought to guide the assessment and management of this complaint. Communication difficulty or disability such as cognitive impairment associated with dementia may limit the patient's ability to report their pain experience, and this has the potential to affect the quality of care. The primary objective of this study was to systematically locate evidence relating to the use of pain assessment tools that have been validated for use with cognitively impaired adults and to identify those that have been recommended for use by paramedics. Methods A systematic search of health databases for evidence relating to the use of pain assessment tools that have been validated for use with cognitively impaired adults was undertaken using specific search criteria. An extended search included position statements and clinical practice guidelines developed by health agencies to identify evidence-based recommendations regarding pain assessment in older adults. Results Two systematic reviews met study inclusion criteria. Weaknesses in tools evaluated by these studies limited their application in assessing pain in the population of interest. Only one tool was designed to assess pain in acute care settings. No tools were located that are designed for paramedic use. Conclusion The reviews of pain assessment tools found that the majority were developed to assess chronic pain in aged care, hospital or hospice settings. An analysis of the characteristics of these pain assessment tools identified attributes that may limit their use in paramedic practice. One tool - the Abbey Pain Scale - may have application in paramedic assessment of pain, but clinical evaluation is required to validate this tool in the paramedic practice setting. Further research is recommended to evaluate the Abbey Pain Scale and to

  13. EFL Teachers' Views of English Language Assessment in Higher Education in the United Arab Emirates and Kuwait

    Science.gov (United States)

    Troudi, Salah; Coombe, Christine; Al-Hamliy, Mashael

    2009-01-01

    Issues of assessment design and implementation in Kuwait and the United Arab Emirates (UAE) have attracted some attention over recent years, but teachers' philosophies about assessment remain underexplored. This article reports the findings of a qualitative study into the assessment roles and philosophies of a group of teachers of English as a…

  14. Assessment of the economic impacts of porcine epidemic diarrhea virus in the United States.

    Science.gov (United States)

    Schulz, Lee L; Tonsor, Glynn T

    2015-11-01

    Porcine epidemic diarrhea virus (PEDV), which first emerged in the United States in 2013, spread throughout the U.S. hog population. Limited preemptive knowledge impeded the understanding of PEDV introduction, spread, and prospective economic impacts in the United States. To assess these impacts, this article reviews the timeline of PEDV in the United States and the corresponding impacts. PEDV is a supply-impacting disease and is not demand inhibiting, as pork demand remained strong since PEDV first appeared. Pig losses reached significant levels during September 2013 through August 2014, with the majority of pork production impacts occurring in 2014. PEDV had differing impacts for subsectors of the pork industry. A budget model demonstrates that producers could have had pig losses and decreases in productivity proportionally smaller than price increases, resulting in net returns above what was expected before the major outbreak of PEDV. Previous literature is reviewed to identify the potential main industry beneficiaries of the PEDV outbreaks in the United States. As a result of reduced volumes of available pig and hog supplies, reductions in annual returns likely occurred for packers, processors, distributors, and retailers. In addition, pork consumers who experienced reduced-supply-induced pork-price increases were likely harmed directly by higher prices paid for pork and indirectly as prices of competing meats were also likely strengthened by PEDV. This article also identifies future considerations motivated by the appearance of PEDV in the United States, such as discussions of industry-wide efficiency and competitive advantage, the future role of PEDV vaccines, enhancement in biosecurity measures, and consumer perceptions of food safety and insecurity.

  15. Hydrogeologic Assessment of the East Bear Creek Unit, San LuisNational Wildlife Refuge

    Energy Technology Data Exchange (ETDEWEB)

    Quinn, Nigel W.T.

    2007-07-15

    San Luis National Wildlife Refuge Complex to meetReclamation s obligations for Level 4 water supply under the CentralValley Project Improvement Act. Hydrogeological assessment of the EastBear Creek Unit of the San Luis National Wildlife Refuge was conductedusing a combination of field investigations and a survey of availableliterature from past US Geological Survey Reports and reports by localgeological consultants. Conservative safe yield estimates made using theavailable data show that the East Bear Creek Unit may have sufficientgroundwater resources in the shallow groundwater aquifer to meet aboutbetween 25 percent and 52 percent of its current Level II and between 17percent and 35 percent of its level IV water supply needs. The rate ofsurface and lateral recharge to the Unit and the design of the well fieldand the layout and capacity of pumped wells will decide both thepercentage of annual needs that the shallow aquifer can supply andwhether this yield is sustainable without affecting long-term aquiferquality. In order to further investigate the merits of pumping the nearsurface aquifer, which appears to have reasonable water quality for usewithin the East Bear Creek Unit -- monitoring of the potential sources ofaquifer recharge and the installation of a pilot shallow well would bewarranted. Simple monitoring stations could be installed both upstreamand downstream of both the San Joaquin River and Bear Creek and beinstrumented to measureriver stage, flow and electrical conductivity.Ideally this would be done in conjunction with a shallow pilot well,pumped to supply a portion of the Unit's needs for the wetland inundationperiod.

  16. Bleeding risk of terminally ill patients hospitalized in palliative care units: the RHESO study.

    Science.gov (United States)

    Tardy, B; Picard, S; Guirimand, F; Chapelle, C; Danel Delerue, M; Celarier, T; Ciais, J-F; Vassal, P; Salas, S; Filbet, M; Gomas, J-M; Guillot, A; Gaultier, J-B; Merah, A; Richard, A; Laporte, S; Bertoletti, L

    2017-03-01

    Essentials Bleeding incidence as hemorrhagic risk factors are unknown in palliative care inpatients. We conducted a multicenter observational study (22 Palliative Care Units, 1199 patients). At three months, the cumulative incidence of clinically relevant bleeding was 9.8%. Cancer, recent bleeding, thromboprophylaxis and antiplatelet therapy were independent risk factors.

  17. The low therapeutic efficacy of postoperative chest radiographs for surgical intensive care unit patients

    NARCIS (Netherlands)

    A. Kröner; E. van Iperen; J. Horn; J.M. Binnekade; P.E. Spronk; J. Stoker; M.J. Schultz

    2011-01-01

    Background. The clinical value of postoperative chest radiographs (CXRs) for surgical intensive care unit (ICU) patients is largely unknown. In the present study, we determined the diagnostic and therapeutic efficacy of postoperative CXRs for different surgical subgroups and related their efficacy t

  18. Motor unit properties of biceps brachii during dynamic contractions in chronic stroke patients

    NARCIS (Netherlands)

    Kallenberg, L.A.C.; Hermens, Hermanus J.

    The aim of this study was to investigate motor unit (MU) characteristics of the biceps brachii during sinusoidal contractions in chronic stroke patients using high-density surface electromyography. Ten sinusoidal elbow flexion and extension movements were performed both passively and actively by 18

  19. Computers in hospital management and improvements in patients care--new trends in the United States.

    Science.gov (United States)

    Pierskalla, W P; Woods, D

    1988-12-01

    This article discusses the current state of informations systems in hospital management. Decision Support Systems (DSS) for the management, administrative and patient care units of the hospital are described. These DSS's include market planning, nurse scheduling and blood screening systems. Trends for future uses of information systems in the hospital environment are addressed.

  20. Identifying and assessing anxiety in pre-operative patients.

    Science.gov (United States)

    Pritchard, Michael John

    Increasing demands for hospitals to be more efficient mean that patients attending for an operation are generally admitted on the day of surgery. As a result, healthcare professionals have little time to talk to the patient to ascertain his or her wellbeing, to check for any signs of anxiety and ask whether the patient requires further information about the forthcoming procedure. Healthcare professionals should be encouraged to use appropriate interventions to identify and assess anxious patients. There are several instruments available to measure the patient's level of pre-operative anxiety. This article reviews the Amsterdam Preoperative Anxiety and Information Scale, which is easy for patients to complete and may help to identify which individuals need extra support.