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Sample records for ward group critical

  1. Study of the outcome of suicide attempts: characteristics of hospitalization in a psychiatric ward group, critical care center group, and non-hospitalized group

    Directory of Open Access Journals (Sweden)

    Kemuyama Nobuo

    2010-01-01

    Full Text Available Abstract Background The allocation of outcome of suicide attempters is extremely important in emergency situations. Following categorization of suicidal attempters who visited the emergency room by outcome, we aimed to identify the characteristics and potential needs of each group. Methods The outcomes of 1348 individuals who attempted suicide and visited the critical care center or the psychiatry emergency department of the hospital were categorized into 3 groups, "hospitalization in the critical care center (HICCC", "hospitalization in the psychiatry ward (HIPW", or "non-hospitalization (NH", and the physical, mental, and social characteristics of these groups were compared. In addition, multiple logistic analysis was used to extract factors related to outcome. Results The male-to-female ratio was 1:2. The hospitalized groups, particularly the HICCC group, were found to have biopsychosocially serious findings with regard to disturbance of consciousness (JCS, general health performance (GAS, psychiatric symptoms (BPRS, and life events (LCU, while most subjects in the NH group were women who tended to repeat suicide-related behaviors induced by relatively light stress. The HIPW group had the highest number of cases, and their symptoms were psychologically serious but physically mild. On multiple logistic analysis, outcome was found to be closely correlated with physical severity, risk factor of suicide, assessment of emergent medical intervention, and overall care. Conclusion There are different potential needs for each group. The HICCC group needs psychiatrists on a full-time basis and also social workers and clinical psychotherapists to immediately initiate comprehensive care by a medical team composed of multiple professionals. The HIPW group needs psychological education to prevent repetition of suicide attempts, and high-quality physical treatment and management skill of the staff in the psychiatric ward. The NH group subjects need a

  2. Ward identities and Wilson renormalization group for QED

    CERN Document Server

    Bonini, M; Marchesini, G

    1994-01-01

    We analyze a formulation of QED based on the Wilson renormalization group. Although the ``effective Lagrangian'' used at any given scale does not have simple gauge symmetry, we show that the resulting renormalized Green's functions correctly satisfies Ward identities to all orders in perturbation theory. The loop expansion is obtained by solving iteratively the Polchinski's renormalization group equation. We also give a new simple proof of perturbative renormalizability. The subtractions in the Feynman graphs and the corresponding counterterms are generated in the process of fixing the physical conditions.

  3. Ward identities and Wilson renormalization group for QED

    Science.gov (United States)

    Bonini, M.; D'Attanasio, M.; Marchesini, G.

    1994-04-01

    We analyze a formulation of QED based on the Wilson renormalization group. Although the "effective lagrangian" used at any given scale does not have simple gauge symmetry, we show that the resulting renormalized Green's function correctly satisfies Ward identities to all orders in perturbation theory. The loop expansion is obtained by solving iteratively the Polchinski renormalization group equation. We also give a new simple proof of perturbative renormalizability. The subtractions in the Feynman graphs and the corresponing counter-terms are generated in the process of fixing the physical conditions.

  4. [Effects of Ward Interventions on Repeated Critical Incidents in Child and Adolescent Psychiatric Inpatient Care].

    Science.gov (United States)

    Ulke, Christine; Klein, Annette M; von Klitzing, Kai

    2014-01-01

    Effects of Ward Interventions on Repeated Critical Incidents in Child and Adolescent Psychiatric Inpatient Care. The aim of this study was to evaluate the effects of several ward interventions (transition to an open ward concept, individualized treatment plans, tiered crisis-management, staff training, quality control) on repeated critical incidents, non-restrictive and restrictive measures. The outcome variables were compared in two time periods, 2007 and 2011. The study included 74 critical incident reports of 51 child and adolescent inpatients that had at least one hospital stay and one critical incident in the selected time periods. Aggressive, self-harming, and absconding incidents were included. The quantitative results suggest that ward interventions can contribute to a reduction of repeated critical incidents and restrictive measures. The qualitative evaluation suggests a cultural change of crisis management.

  5. Medication communication between nurses and patients during nursing handovers on medical wards: a critical ethnographic study.

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    Liu, Wei; Manias, Elizabeth; Gerdtz, Marie

    2012-08-01

    Communication is central to safe medication management. Handover is a routine communication forum where nurses provide details about how patients' medications are managed. Previous studies have investigated handover processes as general communication forums without specific focus on medication information exchange. The effects of social, environmental and organisational contexts on handover communication and medication safety have not been explored. To examine dominant and submissive forms of communication and power relations surrounding medication communication among nurses, and between nurses and patients during handover. A critical ethnographic approach was utilised to unpack the social and power struggles embedded in handover practices. The study was conducted in two medical wards of a metropolitan teaching hospital in Melbourne, Australia from January to November 2010. All registered nurses employed in the medical wards during the study time were eligible for participation. Patients were eligible if they were able to communicate with nurses about how their medications were managed. In total, 76 nurses and 27 patients were recruited for the study after giving written consent for participation. Participant observations, field interviews, video-recordings and video reflexive focus groups were conducted. Fairclough's critical discourse analytic framework guided data analysis. Nurse coordinators' group handovers in private spaces prioritised organisational and biomedical discourses, with little emphasis on evaluating the effectiveness of medication treatment. The ward spatial structure provided an added complexity to how staff allocation occurred. Handovers involving patients in the public spaces at the bedside facilitated a partnership model in medication communication. Nurses exercised discretion during bedside handovers by discussing sensitive information away from the bedside. Handovers across different wards during patient transfers caused communication

  6. Talking therapy groups on acute psychiatric wards: patients' experience of two structured group formats

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    Radcliffe, Jonathan; Bird, Laura

    2016-01-01

    Aims and method We report the results of a clinical audit of patients' reactions to two types of talking therapy groups facilitated by assistant psychologists and psychology graduates on three acute wards. Patients' experiences of problem-solving and interpersonal group formats were explored via focus groups and structured interviews with 29 group participants. Results Both group formats generated high satisfaction ratings, with benefits related mostly to generic factors. Clinical implications Adequately trained and supported assistant psychologists and psychology graduates can provide supportive talking groups that patients find helpful. PMID:27512586

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

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    Krautter M

    2014-09-01

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

  8. Comparing the monitoring of patients transferred from a critical care unit to hospital wards at after-hours with day transfers: an exploratory, prospective cohort study.

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    Wood, Sally D; Coster, Samantha; Norman, Ian

    2014-12-01

    To investigate possible factors related to patient monitoring to explain the higher mortality rates associated with after-hours transfers compared with daytime transfers from critical care units to the wards. International research suggests that patients transferred from critical care units after-hours have a higher mortality rate than transfers during daytime, although the reasons remain unknown. A prospective exploratory study. Twenty-nine patients transferred from a UK critical care unit to a ward within the same hospital after-hours for 10 weeks beginning April 2009 were compared with 29 transfers during daytime hours matched on potentially confounding characteristics. UK Critical Care Unit transfer guidelines have remained unchanged since data collection. Outcomes were as follows: (i) frequency of nursing observations; (ii) time periods from transfer to first medical review; (iii) time period from transfer to first clinical observations; (iv) frequency of transfer to an inappropriate ward; (v) delayed transfers from Critical Care Unit to ward. Using Wilcoxon's Rank test (two tail) to compare paired data from the matched groups, observations were recorded significantly less frequently within the first 12 hours for after-hours transfers. Time from transfer to first clinical observations was significantly longer for after-hour transfer patients. The delay from when the patient was ready for ward care and actual transfer was also longer for the after-hours transfer group. Surveillance differences, including time to the first set of observations and frequency of observations in the first 12 hours, are potential factors that may explain the differential mortality associated with after-hours transfers. © 2014 John Wiley & Sons Ltd.

  9. OBSERVED HAND WASHING PRACTICES AMONG HEALTH WORKERS IN TWO CRITICAL PAEDIATRICS WARDS OF A SPECIALIST HOSPITAL

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    Balafama Abinye Alex-Hart

    2014-01-01

    Full Text Available Hand washing in between patient care by health workers is the single most important measure against occurrence and spread of nosocomial infections within health facilities. This study was done to observe health workers hand washing practices in two critical Paediatric wards of a specialist hospital. Trained observers observed and recorded health workers’ hand washing compliance while carrying out their routine patient care. Other information recorded included the time of observation and health workers’ occupation and rank. Data was fed in to excel spread sheet and analyzed using SPSS version 16.0. A total of 150 health workers were observed in this study. There were 116 (77.3% females and 34 (22.7% males giving a male: Female ratio of 1: 3.4. There were 86 (57.3% doctors and 64 (42.7% nurses. During the period of observation, soap with running water was found in only 39 (26.0% occasions. Common cotton towel was found in 78.7% of the period of observation as the only available hand drying facility. Doctors’ hand washing rates before and after patients contact were 17.4 and 64.0% respectively. Doctors’ hand washing rates before and after simple procedures ranged from 0 to 56.5 and 60.6 to 100% respectively. Nurses’ hand washing rates before and after simple procedures ranged from 1.3 to 28.6% and 19.7 to 88.4% respectively. Health workers (doctors and nurses hand washing rates on entering the wards was 4%. Hand washing rate before leaving the wards was 74.7%. Majority of the health workers dried their hands with non-disposable common cotton towels on 72.0% of the occasions. Hand washing rates was very low before patient contact and before simple procedures.

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

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    Ying Chen

    2016-04-01

    Full Text Available Abstract Background Regular and timely monitoring of blood glucose (BG levels in hospitalized patients with diabetes mellitus is crucial to optimizing inpatient glycaemic control. However, methods to quantify timeliness as a measurement of quality of care are lacking. We propose an analytical approach that utilizes BG measurements from electronic records to assess adherence to an inpatient BG monitoring protocol in hospital wards. Methods We applied our proposed analytical approach to electronic records obtained from 24 non-critical care wards in November and December 2013 from a tertiary care hospital in Singapore. We applied distributional analytics to evaluate daily adherence to BG monitoring timings. A one-sample Kolmogorov-Smirnov (1S-KS test was performed to test daily BG timings against non-adherence represented by the uniform distribution. This test was performed among wards with high power, determined through simulation. The 1S-KS test was coupled with visualization via the cumulative distribution function (cdf plot and a two-sample Kolmogorov-Smirnov (2S-KS test, enabling comparison of the BG timing distributions between two consecutive days. We also applied mixture modelling to identify the key features in daily BG timings. Results We found that 11 out of the 24 wards had high power. Among these wards, 1S-KS test with cdf plots indicated adherence to BG monitoring protocols. Integrating both 1S-KS and 2S-KS information within a moving window consisting of two consecutive days did not suggest frequent potential change from or towards non-adherence to protocol. From mixture modelling among wards with high power, we consistently identified four components with high concentration of BG measurements taken before mealtimes and around bedtime. This agnostic analysis provided additional evidence that the wards were adherent to BG monitoring protocols. Conclusions We demonstrated the utility of our proposed analytical approach as a monitoring

  11. Building Back Wards in a 'Post' Institutional Era: Hospital Confinement, Group Home Eviction, and Ontario's Treatment of People Labelled with Intellectual Disabilities

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    Natalie Spagnuolo

    2016-12-01

    Full Text Available Although Ontario has closed the regional centres that were intended for people labelled with intellectual disabilities and apologized to survivors, the institutionalization of disabled people persists in other forms in the province. This article demonstrates that the eligibility criteria established by privately-operated and publically-funded group homes contributes to the use of what will be termed 'back ward' placements in institutions such as hospitals and nursing homes. While group homes themselves have been – quite rightly – criticized as neo-institutional forms of residential support, they also play a role in shaping more overt forms of confinement by refusing to tailor their services to the needs of certain individuals. What follows is an analysis of residential support systems that builds upon case studies and reports to expose how impairment hierarchies, based on ranked support needs, determine who will end up in these 'back wards' and who will be offered a place in a group home.

  12. Intensive care survivors' experiences of ward-based care: Meleis' theory of nursing transitions and role development among critical care outreach services.

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    Ramsay, Pam; Huby, Guro; Thompson, Andrew; Walsh, Tim

    2014-03-01

    To explore the psychosocial needs of patients discharged from intensive care, the extent to which they are captured using existing theory on transitions in care and the potential role development of critical care outreach, follow-up and liaison services. Intensive care patients are at an increased risk of adverse events, deterioration or death following ward transfer. Nurse-led critical care outreach, follow-up or liaison services have been adopted internationally to prevent these potentially avoidable sequelae. The need to provide patients with psychosocial support during the transition to ward-based care has also been identified, but the evidence base for role development is currently limited. Twenty participants were invited to discuss their experiences of ward-based care as part of a broader study on recovery following prolonged critical illness. Psychosocial distress was a prominent feature of their accounts, prompting secondary data analysis using Meleis et al.'s mid-range theory on experiencing transitions. Participants described a sense of disconnection in relation to profound debilitation and dependency and were often distressed by a perceived lack of understanding, indifference or insensitivity among ward staff to their basic care needs. Negotiating the transition between dependence and independence was identified as a significant source of distress following ward transfer. Participants varied in the extent to which they were able to express their needs and negotiate recovery within professionally mediated boundaries. These data provide new insights into the putative origins of the psychosocial distress that patients experience following ward transfer. Meleis et al.'s work has resonance in terms of explicating intensive care patients' experiences of psychosocial distress throughout the transition to general ward-based care, such that the future role development of critical care outreach, follow-up and liaison services may be more theoretically informed

  13. Sensory signals and neuronal groups involved in guiding the sea-ward motor behavior in turtle hatchlings of Chelonia agassizi

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    Fuentes, A. L.; Camarena, V.; Ochoa, G.; Urrutia, J.; Gutierrez, G.

    2007-05-01

    Turtle hatchlings orient display sea-ward oriented movements as soon as they emerge from the nest. Although most studies have emphasized the role of the visual information in this process, less attention has been paid to other sensory modalities. Here, we evaluated the nature of sensory cues used by turtle hatchlings of Chelonia agassizi to orient their movements towards the ocean. We recorded the time they took to crawl from the nest to the beach front (120m long) in control conditions and in visually, olfactory and magnetically deprived circumstances. Visually-deprived hatchlings displayed a high degree of disorientation. Olfactory deprivation and magnetic field distortion impaired, but not abolished, sea-ward oriented movements. With regard to the neuronal mapping experiments, visual deprivation reduced dramatically c-fos expression in the whole brain. Hatchlings with their nares blocked revealed neurons with c-fos expression above control levels principally in the c and d areas, while those subjected to magnetic field distortion had a wide spread activation of neurons throughout the brain predominantly in the dorsal ventricular ridge The present results support that Chelonia agassizi hatchlings use predominantly visual cues to orient their movements towards the sea. Olfactory and magnetic cues may also be use but their influence on hatchlings oriented motor behavior is not as clear as it is for vision. This conclusion is supported by the fact that in the absence of olfactory and magnetic cues, the brain turns on the expression of c- fos in neuronal groups that, in the intact hatchling, are not normally involved in accomplishing the task.

  14. Graphs Whose Critical Groups Have Larger Rank

    Institute of Scientific and Technical Information of China (English)

    2011-01-01

    The critical group C(G) of a graph G is a refinement of the number of spanningtrees of the graph and is closely connected with the Laplaeian matrix. Let r(G) be the minimum number of generators (i.e., the rank) of the group C(G) and/β(G) be the number of independent cycles of G. In this paper, some forbidden induced subgraphs are given for r(G) = n - 3 and all graphs with r(G) = β(G) = n - 3 are characterized.

  15. Towards an inpatient diabetes curriculum: medical student-generated aims, objectives and methods for ward-based learning of non-critical, non-perioperative inpatient diabetes care.

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    Taylor, C G; Atherley, A; Murphy, M M

    2016-06-01

    To create a summative document containing aims, objectives and methods that can be used for the training of healthcare professionals in inpatient diabetes care. A four-stage approach was introduced for the ward-based teaching of inpatient diabetes care at the University of the West Indies, Cave Hill over the 2014-2015 academic year. Within this approach, 55 students (100%) submitted aims, objectives and methods to support two 2-h, ward-based sessions. This was guided by brief instructions and access to a copy of the Endocrine Society Clinical Practice Guideline on the management of non-critical, non-perioperative inpatient diabetes. Conceptual content analysis was used to convert submissions into a unifying document. Six themes emerged from students' submissions: diagnosis; assessment and investigation of diabetes and its complications; planning individualized care and pharmacological management; hypoglycaemia management, including severe hypoglycaemia; patient education; discharge planning; and multidisciplinary teamwork. Students were primarily interested in patient management and treatment using higher-level objectives and active learning methods. This study produced comprehensive, student-generated, and hence student-centred, aims, objectives and methods for inpatient diabetes care with objectives appropriately set for higher cognitive levels of learning. This material can be used to guide teaching or for further development into a curriculum. This is the first known publication of content that could be used in a ward-based inpatient diabetes curriculum. © 2015 Diabetes UK.

  16. Comparison of 2D fingerprint types and hierarchy level selection methods for structural grouping using Ward's clustering

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    Wild; Blankley

    2000-01-01

    Four different two-dimensional fingerprint types (MACCS, Unity, BCI, and Daylight) and nine methods of selecting optimal cluster levels from the output of a hierarchical clustering algorithm were evaluated for their ability to select clusters that represent chemical series present in some typical examples of chemical compound data sets. The methods were evaluated using a Ward's clustering algorithm on subsets of the publicly available National Cancer Institute HIV data set, as well as with compounds from our corporate data set. We make a number of observations and recommendations about the choice of fingerprint type and cluster level selection methods for use in this type of clustering

  17. Strategic defensiveness: public and private responses to group criticism.

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    Hornsey, Matthew J; Frederiks, Elisha; Smith, Joanne R; Ford, Lindsay

    2007-12-01

    This paper explores the strategic processes associated with responding to group criticism. In Experiment 1, Australians received criticism of their country from either an in-group or an out-group member. When participants believed their evaluations of the criticisms were private, they reported being more defensive when criticized by an out-group relative to an in-group member. However, this intergroup sensitivity effect disappeared on some measures when participants were led to believe their evaluations of the criticisms could be seen by an in-group audience. In Experiment 2, which focused on participants' identity as social science students, the attenuation of the intergroup sensitivity effect emerged only when the in-group audience was relatively high-status. Furthermore, in both experiments, increased reports of defensiveness in public only occurred in response to an in-group critic and not to an out-group critic. Theoretical and practical implications for intergroup and intragroup communication are discussed.

  18. A Note on the Critical Group of a Line Graph

    CERN Document Server

    Perkinson, David; Xu, Tianyuan

    2010-01-01

    This note answers a question posed by Levine in arkiv:math.CO/0906.2809. The main result is Theorem 1 which shows that under certain circumstances a critical group of a graph is the quotient of a critical group of its line graph.

  19. Noise pollution on an acute surgical ward.

    Science.gov (United States)

    McLaren, Emma; Maxwell-Armstrong, Charles

    2008-03-01

    This study was undertaken to measure and analyse noise levels over a 24-h period on five general surgical wards. Noise levels were measured on three wards with four bays of six beds each (wards A, B and C), one ward of side-rooms only (ward D) and a surgical high dependency unit (ward E) of eight beds. Noise levels were measured for 15 min at 4-hourly intervals over a period of 24 h midweek. The maximum sound pressure level, baseline sound pressure level and the equivalent continuous level (LEq) were recorded. Peak levels and LEq were compared with World Health Organization (WHO) guidelines for community noise. Control measurements were taken elsewhere in the hospital and at a variety of public places for comparison. The highest peak noise level recorded was 95.6 dB on ward E, a level comparable to a heavy truck. This exceeded all control peak readings except that recorded at the bus stop. Peak readings frequently exceeded 80 dB during the day on all wards. Each ward had at least one measurement which exceeded the peak sound level of 82.5 dB recorded in the supermarket. The highest peak measurements on wards A, B, C and E also exceeded peak readings at the hospital main entrance (83.4 dB) and coffee shop (83.4 dB). Ward E had the highest mean peak reading during the day and at night - 83.45 dB and 81.0 dB, respectively. Ward D, the ward of side-rooms, had the lowest day-time mean LEq (55.9 dB). Analysis of the LEq results showed that readings on ward E were significantly higher than readings on wards A, B and C as a group (P = 0.001). LEq readings on ward E were also significantly higher than readings on ward D (P < 0.001). Day and night levels differ significantly, but least so on the high dependency unit. The WHO guidelines state that noise levels on wards should not exceed 30 dB LEq (day and night) and that peak noise levels at night should not exceed 40 dB. Our results exceed these guidelines at all times. It is likely that these findings will translate to

  20. Critical realism art——On Russia Tour group Painting

    Institute of Scientific and Technical Information of China (English)

    杜月英

    2012-01-01

      The Tour group Painting inherited and developed some precious qualities of the early 19th century critical realism. The Tour group Painting artists were deeply influenced by the Russian realistic literature. They cared about reality, the history of the nation, focusing on the expression of personal feelings. They agreed that the art has the responsibility to educate people, to improve their consciousness .In their opinion, artists are also social activists. So they tirelessly fought towards critical realism and national art.

  1. Critical Reflections: How Groups Can Learn from Success and Failure

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    Ernst, Chris; Martin, Andre

    2006-01-01

    When people work together over time, certain key events stand out as having the potential to teach lasting lessons for the future. Leaders can use the Critical Reflections process to help their groups learn these lessons, whether the key event was a great success or a wretched failure. The goal is to affect future outcomes in similar situations:…

  2. Creating Moral Schools: The Enabling Potential of Critical Friends Groups

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    Law, Bruce

    2005-01-01

    Critical Friends Groups (CFGs) are vehicles for creating collective intentionality that reaches a shared end: increased opportunity for the disadvantaged to create equality of opportunity. Not that participating in CFGs is the only action educators can take to create moral schools; rather, moral schools reflect the beliefs, ends, and practices…

  3. Critical asymmetry in renormalization group theory for fluids.

    Science.gov (United States)

    Zhao, Wei; Wu, Liang; Wang, Long; Li, Liyan; Cai, Jun

    2013-06-21

    The renormalization-group (RG) approaches for fluids are employed to investigate critical asymmetry of vapour-liquid equilibrium (VLE) of fluids. Three different approaches based on RG theory for fluids are reviewed and compared. RG approaches are applied to various fluid systems: hard-core square-well fluids of variable ranges, hard-core Yukawa fluids, and square-well dimer fluids and modelling VLE of n-alkane molecules. Phase diagrams of simple model fluids and alkanes described by RG approaches are analyzed to assess the capability of describing the VLE critical asymmetry which is suggested in complete scaling theory. Results of thermodynamic properties obtained by RG theory for fluids agree with the simulation and experimental data. Coexistence diameters, which are smaller than the critical densities, are found in the RG descriptions of critical asymmetries of several fluids. Our calculation and analysis show that the approach coupling local free energy with White's RG iteration which aims to incorporate density fluctuations into free energy is not adequate for VLE critical asymmetry due to the inadequate order parameter and the local free energy functional used in the partition function.

  4. Accelerated HIV testing for PMTCT in maternity and labour wards is vital to capture mothers at a critical point in the programme at district level in Malawi.

    Science.gov (United States)

    Beltman, J J; Fitzgerald, M; Buhendwa, L; Moens, M; Massaquoi, M; Kazima, J; Alide, N; van Roosmalen, J

    2010-11-01

    Round the clock (24 hours×7 days) HIV testing is vital to maintain a high prevention of mother to child transmission (PMTCT) coverage for women delivering in district health facilities. PMTCT coverage increases when most of the pregnant women will have their HIV status tested. Therefore routine offering of HIV testing should be integrated and seen as a part of comprehensive antenatal care. For women who miss antenatal care and deliver in a health facility without having had their HIV status tested, the labour and maternity ward could still serve as other entry points.

  5. Improved renormalization group theory for critical asymmetry of fluids.

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    Wang, Long; Zhao, Wei; Wu, Liang; Li, Liyan; Cai, Jun

    2013-09-28

    We develop an improved renormalization group (RG) approach incorporating the critical vapor-liquid equilibrium asymmetry. In order to treat the critical asymmetry of vapor-liquid equilibrium, the integral measure is introduced in the Landau-Ginzbug partition function to achieve a crossover between the local order parameter in Ising model and the density of fluid systems. In the implementation of the improved RG approach, we relate the integral measure with the inhomogeneous density distribution of a fluid system and combine the developed method with SAFT-VR (statistical associating fluid theory of variable range) equation of state. The method is applied to various fluid systems including square-well fluid, square-well dimer fluid and real fluids such as methane (CH4), ethane (C2H6), trifluorotrichloroethane (C2F3Cl3), and sulfur hexafluoride (SF6). The descriptions of vapor-liquid equilibria provided by the developed method are in excellent agreement with simulation and experimental data. Furthermore, the improved method predicts accurate and qualitatively correct behavior of coexistence diameter near the critical point and produces the non-classical 3D Ising criticality.

  6. Renormalization group and critical behaviour in gravitational collapse

    CERN Document Server

    Hara, T; Adachi, S; Hara, Takashi; Koike, Tatsuhiko; Adachi, Satoshi

    1996-01-01

    We present a general framework for understanding and analyzing critical behaviour in gravitational collapse. We adopt the method of renormalization group, which has the following advantages. (1) It provides a natural explanation for various types of universality and scaling observed in numerical studies. In particular, universality in initial data space and universality for different models are understood in a unified way. (2) It enables us to perform a detailed analysis of time evolution beyond linear perturbation, by providing rigorous controls on nonlinear terms. Under physically reasonable assumptions we prove: (1) Uniqueness of the relevant mode around a fixed point implies universality in initial data space. (2) The critical exponent \\beta_{\\rm BH} and the unique positive eigenvalue \\kappa of the relevant mode is exactly related by \\beta_{\\rm BH} = \\beta /\\kappa, where \\beta is a scaling exponent. (3) The above (1) and (2) hold also for discretely self-similar case (replacing ``fixed point'' with ``limi...

  7. Accounting for care: Healthcare Resource Groups for paediatric critical care.

    Science.gov (United States)

    Murphy, Janet; Morris, Kevin

    2008-02-01

    Healthcare Resource Groups are a way of grouping patients in relation to the amount of healthcare resources they consume. They are the basis for implementation of Payment by Results by the Department of Health in England. An expert working group was set up to define a dataset for paediatric critical care that would in turn support the derivation of Healthcare Resource Groups. Three relevant classification systems were identified and tested with data from ten PICUs, including data about diagnoses, number of organ systems supported, interventions and nursing activity. Each PICU provided detailed costing for the financial year 2005/2006. Eighty-three per cent of PICU costs were found to be related to staff costs, with the largest cost being nursing costs. The Nursing Activity Score system was found to be a poor predictor of staff resource use, as was the adult HRG model based on the number of organ systems supported. It was decided to develop the HRGs based on a 'levels of care' approach; 32 data items were defined to support HRG allocation. From October 2007, data have been collected daily to identify the HRGs for each PICU patient and are being used by the Department of Health to estimate reference costs for PICU services. The data can also be used to support improved audit of PICU activity nationally as well as comparison of workload across different units and modelling of staff requirements within a unit.

  8. Some Critical Differences between Self-Help and Therapy Groups.

    Science.gov (United States)

    Riordan, Richard J.; Beggs, Marilyn S.

    1988-01-01

    Presents a scheme for addressing differences between self-help groups and therapy groups, characterizing a list of group work parameters according to emphasis placed on each in therapy groups in contrast with self-help groups. Distinguishes between support groups, started by professional helping organizations or individuals, and self-help groups,…

  9. Castle Ward, County Down

    OpenAIRE

    Fisher, Jonathan

    2008-01-01

    Fisher was a painter and engraver in Ireland, working after the Dutch and Italian landscape painting tradition. He is best known by engravings after his designs, of which a large number were produced during his career.[notes from Irish Paintings in the `National Gallery of Ireland?, 2001]The present painting depicts Castle Ward in the distance, an 18th century dwelling famed for its mix of Classical and Gothic architecture.

  10. Splitting Ward identity

    Energy Technology Data Exchange (ETDEWEB)

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

    2016-04-15

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

  11. Non-Critical Confining Strings and the Renormalization Group

    CERN Document Server

    Alvarez, Enrique

    1999-01-01

    String vacua for non critical strings satisfying the requirements of Zig-Zag invariance are constructed. The Liouville mode is shown to play the similarities with the D-brane near horizon approach to non supersymmetric gauge theories are discussed as well.

  12. Research on Application of Ward Management Group in the Improvement of Diabetes Nursing Management Quality%病房管理小组在糖尿病护理管理质量提升中的应用研究

    Institute of Scientific and Technical Information of China (English)

    李玉爱

    2016-01-01

    目的:病房管理小组在糖尿病护理管理质量提升中的应用及其发挥的作用。方法选择该院自动报名参与此次研究的54例专科护理人员开展培训并组成病房管理小组,为医院的糖尿病患者提供护理服务。于治疗前后分别观察并记录非糖尿病专业护理人员培训前后对糖尿病知识及护理技能掌握情况,比较观察组护理前后患者的治疗依从性。结果经过病房管理小组培训后,患者在饮制控制、坚持运动、健康课程的参与、用药控制和出院指导等就诊达标率,与治疗前的比较差异明显。结论非糖尿病专业护理人员培训前后对糖尿病知识及护理技能掌握情况,培训后比培训前有很大的提高。病房管理小组在糖尿病护理管理中的应用可以有效提高糖尿病护理管理质量、护理工作效率和患者的生活质量。%Objective To research the application and its application effect of ward management group in the improvement of diabetes nursing management quality. Methods 54 cases of specialty nursing personnel participating in this research ac-tively in our hospital were selected for training and composed the ward management group, and the patients with diabetes were provided with nursing service, the mastery degree of diabetes knowledge and nursing skill of non-diabetes professional nursing staff before and after training were respectively observed and recorded before and after treatment, and the treatment compliance of patients before and after nursing was compared and observed. Results After training of ward management group, the differences in the dieting control, regular exercise, participation in healthy course, medication control and dis-charged guidance and other diagnosis standard-reaching rate before and after treatment were obvious, in addition, the mas-tery degree of diabetes knowledge and nursing skill of non-diabetes professional nursing staff after training were

  13. Agreement between venous and arterial blood gas analysis of acid-base status in critical care and ward patients: a retrospective cohort study.

    Science.gov (United States)

    Martin, Claudio M; Priestap, Fran

    2017-08-23

    To determine whether the use of venous blood gases can be a suitable alternative to arterial sampling to evaluate acid-base status. The database of the clinical laboratory in a large academic hospital was searched for records of venous blood gas analysis and an arterial sample taken within ten minutes from the same patient. Bland-Altman analyses of pH, pCO2, and lactate were performed for samples obtained from patients separately from within and outside the intensive care unit (ICU). In 2,296 paired arterial-venous samples from 351 ICU patients, the bias was 0.044, -6.2 mmHg, and -0.07 mEq·L(-1) for pH, pCO2, and lactate, respectively. The range of agreement centred on this bias (upper minus lower level of agreement) was 0.134, 16.7 mmHg, and 1.35 mEq·L(-1) for pH, pCO2, and lactate, respectively. Intraclass correlation coefficients (ICCs) were 0.79, 0.76, and 0.99 for pH, pCO2, and lactate, respectively, indicating excellent agreement. Multiple samples obtained from the same patient had a median standard deviation of 0.02, 2.77 mmHg, and 0.18 mEq·L(-1) for pH, pCO2, and lactate, respectively. Similar agreement was observed in samples from patients outside the ICU, although the ICC was only 0.53 for pCO2. Venous gases are suitable for initial evaluation of acid-base status in critically ill patients. Based on clinical evaluation, an arterial sample may then be considered for confirmation, and thereafter, venous blood gases could be sufficient for monitoring response to treatment.

  14. Developing critical awareness : the consequences of action and reflection for perceptions of group injustices

    NARCIS (Netherlands)

    Turner-Zwinkels, Felicity M.; Postmes, Tom; van Zomeren, Martijn

    2016-01-01

    Individuals often cannot address (objective) group injustices until they develop a (subjective) critical awareness of them. In three studies, we tested two potential psychological pathways toward critical awareness: Reflection (deductive, knowledge driven) and action (inductive, action driven) minds

  15. Focus groups: From collecting data to critical pedagogical practice

    Directory of Open Access Journals (Sweden)

    Pavlović Jelena

    2007-01-01

    Full Text Available This paper presents the positivist and constructivist theory and practice of focus groups. We pointed out to the paradigmatic differences in notional attributes of focus groups, as well as to the historic circumstances of their appearance. We analyzed the practice of focus groups in positivist and constructivist paradigm, through the combination of two interpretative frameworks. The fist level of analysis is Foucault’s genealogy which enables to observe the research as a social technology of disciplining and producing the discourse of subjectivity. Goffman’s metaphor of social interaction as a "scene" where the rituals of its maintenance and disturbance constantly take place is the second level of analysis of practice of focus groups. These two levels of analysis are the tool for understanding the complex relation between the way in which social practice of research is constituted and the knowledge it produces.

  16. The Influence of Collaborative Group Work on Students' Development of Critical Thinking: The Teacher's Role in Facilitating Group Discussions

    Science.gov (United States)

    Fung, Dennis Chun-Lok; To, Helen; Leung, Kit

    2016-01-01

    The objective of this study was to determine whether the incorporation of group work in a teaching intervention can effectively foster students' critical thinking skills. Building upon Kuhn's critical thinking model, the research involved comparison of pretest and post-test results for 140 secondary four (10th grade) students in Hong Kong on two…

  17. Connecting Critical Reflection and Group Development in Online Adult Education Classrooms

    Science.gov (United States)

    Glowacki-Dudka, Michelle; Barnett, Nicole

    2007-01-01

    This qualitative multi-case study explored the space where critical reflection and group development met within the online environment for the adult learner. Using critical reflection with adult learners through their responses to Stephen Brookfield's (1995) Critical Incident Questionnaire (CIQ) in the online environment precipitated instructional…

  18. Renormalization Group for Critical Phenomena in Complex Networks

    Science.gov (United States)

    Boettcher, S.; Brunson, C. T.

    2011-01-01

    We discuss the behavior of statistical models on a novel class of complex “Hanoi” networks. Such modeling is often the cornerstone for the understanding of many dynamical processes in complex networks. Hanoi networks are special because they integrate small-world hierarchies common to many social and economical structures with the inevitable geometry of the real world these structures exist in. In addition, their design allows exact results to be obtained with the venerable renormalization group (RG). Our treatment will provide a detailed, pedagogical introduction to RG. In particular, we will study the Ising model with RG, for which the fixed points are determined and the RG flow is analyzed. We show that the small-world bonds result in non-universal behavior. It is shown that a diversity of different behaviors can be observed with seemingly small changes in the structure of hierarchical networks generally, and we provide a general theory to describe our findings. PMID:22194725

  19. SURVEY ON SOLIDARITY GROUPS OF BUYERS: CRITICAL ISSUES

    Directory of Open Access Journals (Sweden)

    L. Pennisi

    2011-08-01

    Full Text Available This work is intended to provide, through the analysis of the dynamics of purchase of solidarity groups of buyers, a contribution to the study of current trends that are affecting the alternative to the dominant agro-food industry. Through the use of a questionnaire the paper investigated the perception as consumers this particular class of buyers have of themselves and how their concepts of “conscious choice” and “responsibility” drive their shopping list and consequently influence the growth and development of the Short Supply Chain, as the work remarked the progressive and notable increment of commerce and families circling around this young but widespreading phenomenon. Particularly striking, in fact, emerge from the role that consumers are becoming part of this phenomenon and the most of them have matured during time the idea that biological and hand-made products are for themselves also Safe, while the Long Supply Chain should incarnate the role of an alienating and wholly food system. The analysis of the questionnaires revealed some problems concerning the methods of transport and storage.

  20. Nursing handover from ICU to cardiac ward: Standardised tools to reduce safety risks.

    Science.gov (United States)

    Graan, Sher Michael; Botti, Mari; Wood, Beverley; Redley, Bernice

    2016-08-01

    Standardising handover processes and content, and using context-specific checklists are proposed as solutions to mitigate risks for preventable errors and patient harm associated with clinical handovers. Adapt existing tools to standardise nursing handover from the intensive care unit (ICU) to the cardiac ward and assess patient safety risks before and after pilot implementation. A three-stage, pre-post interrupted time-series design was used. Data were collected using naturalistic observations and audio-recording of 40 handovers and focus groups with 11 nurses. In Stage 1, examination of existing practice using observation of 20 handovers and a focus group interview provided baseline data. In Stage 2, existing tools for high-risk handovers were adapted to create tools specific to ICU-to-ward handovers. The adapted tools were introduced to staff using principles from evidence-based frameworks for practice change. In Stage 3, observation of 20 handovers and a focus group with five nurses were used to verify the design of tools to standardise handover by ICU nurses transferring care of cardiac surgical patients to ward nurses. Stage 1 data revealed variable and unsafe ICU-to-ward handover practices: incomplete ward preparation; failure to check patient identity; handover located away from patients; and information gaps. Analyses informed adaptation of process, content and checklist tools to standardise handover in Stage 2. Compared with baseline data, Stage 3 observations revealed nurses used the tools consistently, ward readiness to receive patients (10% vs 95%), checking patient identity (0% vs 100%), delivery of handover at the bedside (25% vs 100%) and communication of complete information (40% vs 100%) improved. Clinician adoption of tools to standardise ICU-to-ward handover of cardiac surgical patients reduced handover variability and patient safety risks. The study outcomes provide context-specific tools to guide handover processes and delivery of verbal

  1. Ward identity in noncommutative QED

    OpenAIRE

    Mariz, T.; Pires, C. A. de S.; R F Ribeiro

    2002-01-01

    Although noncommutative QED presents a nonabelian structure, it does not present structure constants. In view of this we investigate how Ward identity is satisfied in pair annihilation process and $\\gamma \\gamma \\to \\gamma \\gamma$ scattering in noncommutative QED.

  2. What could critical mathematics education mean for different groups of students?

    DEFF Research Database (Denmark)

    Skovsmose, Ole

    2016-01-01

    In this article I consider what critical mathematics education could mean for different groups of students. Much discussion and research has addressed students at social risk. My point, however, is that critical mathematics education concerns other groups as well: for example, students in comfort......In this article I consider what critical mathematics education could mean for different groups of students. Much discussion and research has addressed students at social risk. My point, however, is that critical mathematics education concerns other groups as well: for example, students...... in comfortable positions, blind students, elderly students, "other" students, university students, as well as engineering students. By considering such different groups of students, I will show that "reading and writing the world with mathematics" opens towards a range of different interpretations, which brings...

  3. Critical properties of the classical Heisenberg and XY models : A mean field renormalization group study

    Directory of Open Access Journals (Sweden)

    A. Sadeghi

    2007-03-01

    Full Text Available  Using both mean field renormalization group (MFRG and Surface-Bulk MFRG (SBMFRG, we study the critical behavior of the classical Heisenberg and XY models on a simple cubic lattice. Critical temperatures as well as critical exponents, characteristic the universality classes of these two models were calculated, analytically for1, 2, 3 and 4 spin clusters. The results are in good agreement with higher accurate methods such as Monte Carlo and High- temperature series.

  4. Renormalization group theory of the critical properties of the interacting bose fluid

    NARCIS (Netherlands)

    Creswick, Richard J.; Wiegel, F.W.

    1982-01-01

    Starting from a functional integral representation of the partition function we apply the renormalization group to the interacting Bose fluid. A closed form for the renormalization equation is derived and the critical exponents are calculated in 4-ε dimensions.

  5. Critical mass and the dependency of research quality on group size

    CERN Document Server

    Kenna, Ralph

    2010-01-01

    Academic research groups are treated as complex systems and their cooperative behaviour is analysed from a mathematical and statistical viewpoint. Contrary to the naive expectation that the quality of a research group is simply given by the mean calibre of its individual scientists, we show that intra-group interactions play a dominant role. Our model manifests phenomena akin to phase transitions which are brought about by these interactions, and which facilitate the quantification of the notion of critical mass for research groups. We present these critical masses for many academic areas. A consequence of our analysis is that overall research performance of a given discipline is improved by supporting medium-sized groups over large ones, while small groups must strive to achieve critical mass.

  6. Light atmosphere in hospital wards

    DEFF Research Database (Denmark)

    Stidsen, Lone Mandrup

    Sociocultural aspects of light are important for the user experience of the atmosphere in a ward. According to the Danish Regulation for light in hospitals (DS703, 1983), a home-like feeling is required to support the patients, as they needa pleasant environment for their recovery. The term ‘Light...... Atmosphere' is the focal point developed through the study. Primarily, the model frames the study and serves as a design tool for creating the light atmosphere in hospital wards. First, brain storming is used to open up the field supported by theoretical aspects based on Gernot Böhmes' concept of atmosphere...

  7. Insider action research and the microsystem of a Danish surgical ward

    DEFF Research Database (Denmark)

    Paltved, Charlotte; Mørcke, Anne Mette; Musaeus, Peter

    2015-01-01

    This insider action research project aimed to improve interprofessional team performance at a surgical ward. The purpose of the project was (1) to critically appraise potential deficiencies in staffs’ identification, clinical judgment, and management of deteriorating ward patients, (2) to develop...

  8. Exploring creativity and critical thinking in traditional and innovative problem-based learning groups.

    Science.gov (United States)

    Chan, Zenobia C Y

    2013-08-01

    To explore students' attitude towards problem-based learning, creativity and critical thinking, and the relevance to nursing education and clinical practice. Critical thinking and creativity are crucial in nursing education. The teaching approach of problem-based learning can help to reduce the difficulties of nurturing problem-solving skills. However, there is little in the literature on how to improve the effectiveness of a problem-based learning lesson by designing appropriate and innovative activities such as composing songs, writing poems and using role plays. Exploratory qualitative study. A sample of 100 students participated in seven semi-structured focus groups, of which two were innovative groups and five were standard groups, adopting three activities in problem-based learning, namely composing songs, writing poems and performing role plays. The data were analysed using thematic analysis. There are three themes extracted from the conversations: 'students' perceptions of problem-based learning', 'students' perceptions of creative thinking' and 'students' perceptions of critical thinking'. Participants generally agreed that critical thinking is more important than creativity in problem-based learning and clinical practice. Participants in the innovative groups perceived a significantly closer relationship between critical thinking and nursing care, and between creativity and nursing care than the standard groups. Both standard and innovative groups agreed that problem-based learning could significantly increase their critical thinking and problem-solving skills. Further, by composing songs, writing poems and using role plays, the innovative groups had significantly increased their awareness of the relationship among critical thinking, creativity and nursing care. Nursing educators should include more types of creative activities than it often does in conventional problem-based learning classes. The results could help nurse educators design an appropriate

  9. Group Work and the Learning of Critical Thinking in the Hong Kong Secondary Liberal Studies Curriculum

    Science.gov (United States)

    Fung, Dennis; Howe, Christine

    2014-01-01

    This article reports the findings of a one-year longitudinal study that investigated the impact of group work on the development of students' critical thinking in Hong Kong secondary schools. It explores whether the participation of teachers in a group-based teaching intervention adapted from an earlier study conducted in the United Kingdom…

  10. Group Work and the Learning of Critical Thinking in the Hong Kong Secondary Liberal Studies Curriculum

    Science.gov (United States)

    Fung, Dennis; Howe, Christine

    2014-01-01

    This article reports the findings of a one-year longitudinal study that investigated the impact of group work on the development of students' critical thinking in Hong Kong secondary schools. It explores whether the participation of teachers in a group-based teaching intervention adapted from an earlier study conducted in the United Kingdom (UK)…

  11. Group process research and emergence of therapeutic factors in critical incident stress debriefing.

    Science.gov (United States)

    Pender, Debra A; Prichard, Karen K

    2008-01-01

    Critical incident stress debriefing is a highly utilized and often debated form of post-trauma exposure intervention. This article presents exploratory group process research that utilized a mixed method approach and group process research techniques. The article's findings, the emergence of therapeutic factors, support that CISD group work does yield indicators consistent with support/ psychoeducation groups with a crisis theme. Further the events that trigger the intervention yield specific therapeutic factors. CISD group work may be better understood through established group research patterns.

  12. Ideal ward round making in neurosurgical practice.

    Directory of Open Access Journals (Sweden)

    Pathak A

    2000-07-01

    Full Text Available The success of a perfect ward round lies in the role of the consultant leading the ′round making group′ (RMG as well as the hallmark of effective questioning and participation of each member. Twelve senior consultants with more than 10 years′ experience in neurosurgical practice at three different university hospitals were observed during round making by a participant observer. Observations were made on the group climate of the RMG, the leadership pattern and language expressed by the clinician conducting the round and the effectiveness in his performance as a leader during clinical discussions. The group climate showed evidence of good productivity and flexibility with 92% and 75% consultants, pleasantness of climate was above average with only 50% (6/12 and poor objectivity with 42% (5/12 consultants. Forty two percent of the consultants were not always very well comprehensible, while only 50% (6/12 spoke exactly fitting the occasion. Only 33% (4/12 of the consultants used humour effectively, while 42% (5/12 spoke unnecessarily in between discussion and were poor in introducing the problems of patient to the round making group. Ward round making in neurosurgical practice needs a holistic approach with motivation, planning, leadership skills and structured curriculum to fulfill its objectives.

  13. The critical value of focus group discussions in research with women living with HIV in Malawi.

    Science.gov (United States)

    Mkandawire-Valhmu, Lucy; Stevens, Patricia E

    2010-05-01

    This article is based on a critical ethnography about HIV and gender-based issues of power and violence conducted in Malawi in 2008. In all, 72 women living with HIV were recruited from four antiretroviral treatment clinics, three rural and one urban, to participate in 12 focus groups. Informed by a postcolonial feminist perspective, we analyze the process and products of these focus groups to interrogate their capacity to facilitate collective engagement with the social and structural realities confronting women in a resource-limited, highly AIDS-affected country. We present exemplars to show how women together created collective narratives to mobilize individuals to action. Findings indicate that focus groups can be used innovatively to benefit both the research and the participants, not only as a critical method of inquiry with marginalized groups but also as a forum in which validating dialogue, mutual support, and exchange of strategic information can generate transformative change to improve women's lives.

  14. The emotional intelligence of a group of critical-care nurses in South Africa

    Directory of Open Access Journals (Sweden)

    Amanda Towell

    2013-11-01

    Full Text Available Critical-care nurses often look after three or more critically-ill patients during a shift. The workload and emotional stress can lead to disharmony between the nurse’s body, mind and spirit. Nurses with a high emotional intelligence have less emotional exhaustion and psychosomatic symptoms; they enjoy better emotional health; gain more satisfaction from their actions (both at work and at home; and have improved relationships with colleagues at work. The question arises: what is the emotional intelligence of critical-care nurses? A quantitative survey was conducted. The target population was registered nurses working in critical-care units who attended the Critical Care Congress 2009 (N = 380. Data were collected with the use of the Trait Emotional Intelligence Short Form and analysed using the Statistical Package for the Social Sciences software. The sample (n= 220 was mainly a mature, female and professionally-experienced group of registered nurses. They held a variety of job descriptions within various critical-care units. Statistics indicated that the standard deviations were small and no aberrant aspects such as demographics skewed the findings. The conclusion was made that registered nurses who are older and that have more experience in critical care appear to have a higher range of emotional intelligence.

  15. Psychiatric wards: places of safety?

    Science.gov (United States)

    Jones, J; Nolan, P; Bowers, L; Simpson, A; Whittington, R; Hackney, D; Bhui, K

    2010-03-01

    In recent years, the purpose and quality of provision delivered in acute inpatient psychiatric settings have been increasingly questioned. Studies from a service user perspective have reported that while some psychiatric inpatients feel safe and cared for, others feel their time in hospital is neither safe nor therapeutic. This paper explores the experiences of service users on acute inpatient psychiatric wards in England, with a particular focus on their feelings of safety and security. Interviews were conducted with 60 psychiatric inpatients in England. The majority of service users felt safe in hospital and felt supported by staff and other service users. However, anything that threatened their sense of security such as aggression, bullying, theft, racism and the use of alcohol and drugs on the ward, made some respondents feel insecure and unsafe. Psychiatric wards are still perceived by many as volatile environments, where service users feel forced to devise personal security strategies in order to protect themselves and their property. It would appear that there remains much to do before research findings and policies are implemented in ways that facilitate all service users to derive the maximum benefit from their inpatient experience.

  16. Critical Classrooms: Using Artists' Lives to Teach Young Students Social Groups, Power, and Privilege

    Science.gov (United States)

    Silva, Janelle M.

    2012-01-01

    This article uses data from a 9-month ethnography in California to illustrate how elementary teacher's decision to reenact Jane Elliott's "A Class Divided" experiment, in conjunction with an artist-centered multicultural curriculum, shifted classroom conversations to a more critical dialogue of social groups, power, and privilege. Data illustrate…

  17. Variations on a Theme: As Needs Change, New Models of Critical Friends Groups Emerge

    Science.gov (United States)

    Fahey, Kevin; Ippolito, Jacy

    2015-01-01

    The Critical Friends Group, a highly articulated model of professional learning, posits that, in order for teachers to learn together in ways that change their practice, the content and nature of their conversations must change (National School Reform Faculty, 2012). The content needs to change from externally driven agendas that address (in a…

  18. Critical Classrooms: Using Artists' Lives to Teach Young Students Social Groups, Power, and Privilege

    Science.gov (United States)

    Silva, Janelle M.

    2012-01-01

    This article uses data from a 9-month ethnography in California to illustrate how elementary teacher's decision to reenact Jane Elliott's "A Class Divided" experiment, in conjunction with an artist-centered multicultural curriculum, shifted classroom conversations to a more critical dialogue of social groups, power, and privilege. Data…

  19. Group Communication and Critical Thinking Competence Development Using a Reality-Based Project

    Science.gov (United States)

    Paulson, Edward

    2011-01-01

    The presented merger and acquisition classroom exercise is based on a real yet incomplete transaction transpiring during the period of the class. The approach enables adult students to apply their previously acquired business experience to a strategic analysis project facilitating the development of group communication, critical thinking, and…

  20. Liberal Studies in Hong Kong: A New Perspective on Critical Thinking through Group Work

    Science.gov (United States)

    Fung, Dennis; Howe, Christine

    2012-01-01

    This article reports research that is contextualised within reforms of secondary education in Hong Kong and the reintroduction of Liberal Studies, which jointly emphasise the need for a learning environment that facilitates the practice of group work and the development of critical thinking. A study is described that explores the relevance of…

  1. Universal critical behavior of noisy coupled oscillators: a renormalization group study.

    Science.gov (United States)

    Risler, Thomas; Prost, Jacques; Jülicher, Frank

    2005-07-01

    We show that the synchronization transition of a large number of noisy coupled oscillators is an example for a dynamic critical point far from thermodynamic equilibrium. The universal behaviors of such critical oscillators, arranged on a lattice in a d -dimensional space and coupled by nearest-neighbors interactions, can be studied using field-theoretical methods. The field theory associated with the critical point of a homogeneous oscillatory instability (or Hopf bifurcation of coupled oscillators) is the complex Ginzburg-Landau equation with additive noise. We perform a perturbative renormalization group (RG) study in a (4-epsilon)-dimensional space. We develop an RG scheme that eliminates the phase and frequency of the oscillations using a scale-dependent oscillating reference frame. Within Callan-Symanzik's RG scheme to two-loop order in perturbation theory, we find that the RG fixed point is formally related to the one of the model A dynamics of the real Ginzburg-Landau theory with an O2 symmetry of the order parameter. Therefore, the dominant critical exponents for coupled oscillators are the same as for this equilibrium field theory. This formal connection with an equilibrium critical point imposes a relation between the correlation and response functions of coupled oscillators in the critical regime. Since the system operates far from thermodynamic equilibrium, a strong violation of the fluctuation-dissipation relation occurs and is characterized by a universal divergence of an effective temperature. The formal relation between critical oscillators and equilibrium critical points suggests that long-range phase order exists in critical oscillators above two dimensions.

  2. Augmentation of hospital critical care capacity after bioterrorist attacks or epidemics: recommendations of the Working Group on Emergency Mass Critical Care.

    Science.gov (United States)

    Rubinson, Lewis; Nuzzo, Jennifer B; Talmor, Daniel S; O'Toole, Tara; Kramer, Bradley R; Inglesby, Thomas V

    2005-10-01

    The Working Group on Emergency Mass Critical Care was convened by the Center for Biosecurity of the University of Pittsburgh Medical Center and the Society of Critical Care Medicine to provide recommendations to hospital and clinical leaders regarding the delivery of critical care services in the wake of a bioterrorist attack resulting in hundreds or thousands of critically ill patients. In these conditions, traditional hospital and clinical care standards in general, and critical care standards in particular, likely could no longer be maintained, and clinical guidelines for U.S. hospitals facing these situations have not been developed. The Working Group offers recommendations for this situation.

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

    Science.gov (United States)

    Townsend, Keith; Wilkinson, Adrian; Kellner, Ashlea

    2015-03-01

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

  4. Use and performance of non-invasive ventilation in Internal Medicine ward: a real-life study

    Directory of Open Access Journals (Sweden)

    Francesco Ventrella

    2015-01-01

    Full Text Available Controlled trials demonstrated efficacy and safety of non-invasive ventilation (NIV in treatment of acute respiratory failure, initially in Intensive Care Units, then in other care settings (semi-intensive care units, emergency departments, and also in the wards, more often pneumological ones. Few studies have been published about NIV in Italian wards of Internal Medicine with full self-management of NIV by internists in a normal ward setting. We performed a prospective real-life study about the use of NIV in Internal Medicine ward devoid of a critical area of semi-intensive therapy, with the aim of confirming, in this setting, the effectiveness of NIV. During a period of 13 months, 42 patients with hypercapnic respiratory failure of different etiology and acidosis (pH<7.25were treated by NIV. NIV was successful in 81% of patients. In-hospital mortality was 9.5%. Safety of NIV is demonstrated by the absence of serious complications: only 7 patients showed poor compliance and 2 patients had facial pressure ulcer due to the mask. There were not statistical differences in success rate of NIV according to severity of acidosis at admission (pH<7.25 vs pH>7.25, neither according to the acute physiology and chronic health evaluation II score and the national early warning score, but the modified early warning score only showed statistically significant difference with lower values in the success group: 2.82±1.57 vs 4.13±1.46 (P<0.05. NIV has proven to be effective and safe in Internal Medicine ward.

  5. Anatomy of the ward round.

    LENUS (Irish Health Repository)

    O'Hare, James A

    2008-07-01

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

  6. Food hygiene on the wards.

    Science.gov (United States)

    Steuer, Walter

    2007-09-13

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

  7. Anatomy of the ward round.

    Science.gov (United States)

    O'Hare, James A

    2008-07-01

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

  8. Light Atmosphere in Hospital Wards

    DEFF Research Database (Denmark)

    Stidsen, Lone Mandrup

    . The four key aspects are: ‘Light’, ‘Space’, ‘Users’ and ‘Time’. The ‘Light’ aspect describes, as shown in (Fig 0.6), the character of the light, light information and light effect i.e. function, aesthetics or symbolism. The ‘Space’ aspect looks into the dimension of the space, geographical orientation...... in Denmark are lastly an investigation on light zones at the hospital ward defined in order to optimize the illumination. The third cycle of iteration is an experimental study testing a lighting concept developed and grounded in the knowledge gained through the first and second cycle. The fourth cycle...

  9. Ward Identities for Hall Transport

    CERN Document Server

    Hoyos, Carlos; Oz, Yaron

    2014-01-01

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

  10. Critical experiments analyses by using 70 energy group library based on ENDF/B-VI

    Energy Technology Data Exchange (ETDEWEB)

    Tahara, Yoshihisa; Matsumoto, Hideki [Mitsubishi Heavy Industries Ltd., Yokohama (Japan). Nuclear Energy Systems Engineering Center; Huria, H.C.; Ouisloumen, M.

    1998-03-01

    The newly developed 70-group library has been validated by comparing kinf from a continuous energy Monte-Carlo code MCNP and two dimensional spectrum calculation code PHOENIX-CP. The code employs Discrete Angular Flux Method based on Collision Probability. The library has been also validated against a large number of critical experiments and numerical benchmarks for assemblies with MOX and Gd fuels. (author)

  11. Clinical course teaching in transport of critically ill patients: Small group methods

    Directory of Open Access Journals (Sweden)

    Mohammad Taghi Beigmohammadi

    2016-10-01

    Full Text Available Critically ill patient transfer is potentially risky and may be lead to morbidity and mortality. Physicians' skill is very important for safe transport. We want to evaluate the effect of clinical course teaching on the promotion of physicians' abilities in the transport of critically ill patients. In an interventional study, 320 interns, male and female, were taught about patient transfer in two groups include in one day clinical course as the small group system (n=160 and other group the lecture base learning (n=160. In the clinical course, each participant under observation of an anesthesiologist in the operation room and ICU was acquainted with mask ventilation, intubation and learned to work with a defibrillator, infusion pump, portable ventilator and pulse oximeter. In lecture group, the anesthesiologist explained the topics by video and dummy. At the end of education course, the interns’ abilities were evaluated based on checklist method and scored by the project colleague in all educational items. Three hundred twenty interns, 122 males, and 198 females; were enrolled, two groups. The clinical course training caused improvements in the interns’ knowledge and abilities in intubation and use of the defibrillator and portable ventilator vs.lecture group significantly (P<0.005. The males were better than females in laryngoscopy, but the progress of the females was significantly better than males (P=0.003. The rate of adverse events was reduced significantly after clinical course teaching (P=0.041 Clinical course teaching could promote interns' clinical competencies in the transport of critically ill patients.

  12. Critical groups vs. representative person: dose calculations due to predicted releases from USEXA

    Energy Technology Data Exchange (ETDEWEB)

    Ferreira, N.L.D., E-mail: nelson.luiz@ctmsp.mar.mil.br [Centro Tecnologico da Marinha (CTM/SP), Sao Paulo, SP (Brazil); Rochedo, E.R.R., E-mail: elainerochedo@gmail.com [Instituto de Radiprotecao e Dosimetria (lRD/CNEN-RJ), Rio de Janeiro, RJ (Brazil); Mazzilli, B.P., E-mail: mazzilli@ipen.br [Instituto de Pesquisas Energeticas e Nucleares (IPEN/CNEN-SP), Sao Paulo, SP (Brazil)

    2013-07-01

    The critical group cf Centro Experimental Aramar (CEA) site was previously defined based 00 the effluents releases to the environment resulting from the facilities already operational at CEA. In this work, effective doses are calculated to members of the critical group considering the predicted potential uranium releases from the Uranium Hexafluoride Production Plant (USEXA). Basically, this work studies the behavior of the resulting doses related to the type of habit data used in the analysis and two distinct situations are considered: (a) the utilization of average values obtained from official institutions (IBGE, IEA-SP, CNEN, IAEA) and from the literature; and (b) the utilization of the 95{sup tb} percentile of the values derived from distributions fit to the obtained habit data. The first option corresponds to the way that data was used for the definition of the critical group of CEA done in former assessments, while the second one corresponds to the use of data in deterministic assessments, as recommended by ICRP to estimate doses to the so--called 'representative person' . (author)

  13. Study on critical conditions for rock failure by means of group renormallzation

    Institute of Scientific and Technical Information of China (English)

    MENG Xiang-rui; GAO Zhao-ning; WANG Xiang-qian

    2009-01-01

    A study of the characteristics of the accumulative rock failure and its evolution by application of the group renormalization method were presented.In addition,the interaction and long-range correlated effects between the immediate neighboring units was studied.The concept of mechanical transference for model OFC,employed in the study of self-organized criticality,and the coefficient a were introduced into the calculation model for group renormalization.With the introduction,mechanisms for the drastic increase and de-crease of failure intensity of rocks were investigated under similar macro-conditions.

  14. Patients Light Preferences in Hospital Wards

    DEFF Research Database (Denmark)

    Stidsen, Lone; Bjerrum, H. S.; Kirkegaard, Poul Henning;

    2011-01-01

    it can have a positive influence on the recovery process. The present paper introduces the human perspective and the Danish cultural approach in illuminating homes and how it can contribute to innovative lighting design at hospitals. The importance of having a holistic approach to lighting design...... is introduced based on the theory by Gernot Böhmes i.e. “concept of atmosphere” dealing with the effect of experiencing atmosphere. The aim of this study for design of a lighting concept for wards is to get qualified information on patients light preferences for light atmosphere by studying the everyday use...... of light in homes. This explorative study displays the preferred light atmosphere in Danish homes in the age group of 60-85 years old people. With an anthropologically approach to the subject using semi structured interviews, the goal is to explore preferences for light atmosphere when the user...

  15. E-learning for Critical Thinking: Using Nominal Focus Group Method to Inform Software Content and Design.

    Science.gov (United States)

    Parker, Steve; Mayner, Lidia; Michael Gillham, David

    2015-12-01

    Undergraduate nursing students are often confused by multiple understandings of critical thinking. In response to this situation, the Critiique for critical thinking (CCT) project was implemented to provide consistent structured guidance about critical thinking. This paper introduces Critiique software, describes initial validation of the content of this critical thinking tool and explores wider applications of the Critiique software. Critiique is flexible, authorable software that guides students step-by-step through critical appraisal of research papers. The spelling of Critiique was deliberate, so as to acquire a unique web domain name and associated logo. The CCT project involved implementation of a modified nominal focus group process with academic staff working together to establish common understandings of critical thinking. Previous work established a consensus about critical thinking in nursing and provided a starting point for the focus groups. The study was conducted at an Australian university campus with the focus group guided by open ended questions. Focus group data established categories of content that academic staff identified as important for teaching critical thinking. This emerging focus group data was then used to inform modification of Critiique software so that students had access to consistent and structured guidance in relation to critical thinking and critical appraisal. The project succeeded in using focus group data from academics to inform software development while at the same time retaining the benefits of broader philosophical dimensions of critical thinking.

  16. E-learning for Critical Thinking: Using Nominal Focus Group Method to Inform Software Content and Design

    Directory of Open Access Journals (Sweden)

    Parker

    2015-12-01

    Full Text Available Background Undergraduate nursing students are often confused by multiple understandings of critical thinking. In response to this situation, the Critiique for critical thinking (CCT project was implemented to provide consistent structured guidance about critical thinking. Objectives This paper introduces Critiique software, describes initial validation of the content of this critical thinking tool and explores wider applications of the Critiique software. Materials and Methods Critiique is flexible, authorable software that guides students step-by-step through critical appraisal of research papers. The spelling of Critiique was deliberate, so as to acquire a unique web domain name and associated logo. The CCT project involved implementation of a modified nominal focus group process with academic staff working together to establish common understandings of critical thinking. Previous work established a consensus about critical thinking in nursing and provided a starting point for the focus groups. The study was conducted at an Australian university campus with the focus group guided by open ended questions. Results Focus group data established categories of content that academic staff identified as important for teaching critical thinking. This emerging focus group data was then used to inform modification of Critiique software so that students had access to consistent and structured guidance in relation to critical thinking and critical appraisal. Conclusions The project succeeded in using focus group data from academics to inform software development while at the same time retaining the benefits of broader philosophical dimensions of critical thinking.

  17. Identification of critical paralog groups with indispensable roles in the regulation of signaling flow.

    Science.gov (United States)

    Modos, Dezso; Brooks, Johanne; Fazekas, David; Ari, Eszter; Vellai, Tibor; Csermely, Peter; Korcsmaros, Tamas; Lenti, Katalin

    2016-12-06

    Extensive cross-talk between signaling pathways is required to integrate the myriad of extracellular signal combinations at the cellular level. Gene duplication events may lead to the emergence of novel functions, leaving groups of similar genes - termed paralogs - in the genome. To distinguish critical paralog groups (CPGs) from other paralogs in human signaling networks, we developed a signaling network-based method using cross-talk annotation and tissue-specific signaling flow analysis. 75 CPGs were found with higher degree, betweenness centrality, closeness, and 'bowtieness' when compared to other paralogs or other proteins in the signaling network. CPGs had higher diversity in all these measures, with more varied biological functions and more specific post-transcriptional regulation than non-critical paralog groups (non-CPG). Using TGF-beta, Notch and MAPK pathways as examples, SMAD2/3, NOTCH1/2/3 and MEK3/6-p38 CPGs were found to regulate the signaling flow of their respective pathways. Additionally, CPGs showed a higher mutation rate in both inherited diseases and cancer, and were enriched in drug targets. In conclusion, the results revealed two distinct types of paralog groups in the signaling network: CPGs and non-CPGs. Thus highlighting the importance of CPGs as compared to non-CPGs in drug discovery and disease pathogenesis.

  18. Health adaptation policy for climate vulnerable groups: a 'critical computational linguistics' analysis.

    Science.gov (United States)

    Seidel, Bastian M; Bell, Erica

    2014-11-28

    Many countries are developing or reviewing national adaptation policy for climate change but the extent to which these meet the health needs of vulnerable groups has not been assessed. This study examines the adequacy of such policies for nine known climate-vulnerable groups: people with mental health conditions, Aboriginal people, culturally and linguistically diverse groups, aged people, people with disabilities, rural communities, children, women, and socioeconomically disadvantaged people. The study analyses an exhaustive sample of national adaptation policy documents from Annex 1 ('developed') countries of the United Nations Framework Convention on Climate Change: 20 documents from 12 countries. A 'critical computational linguistics' method was used involving novel software-driven quantitative mapping and traditional critical discourse analysis. The study finds that references to vulnerable groups are relatively little present or non-existent, as well as poorly connected to language about practical strategies and socio-economic contexts, both also little present. The conclusions offer strategies for developing policy that is better informed by a 'social determinants of health' definition of climate vulnerability, consistent with best practice in the literature and global policy prescriptions.

  19. High-precision thermodynamic and critical properties from tensor renormalization-group flows.

    Science.gov (United States)

    Hinczewski, Michael; Berker, A Nihat

    2008-01-01

    The recently developed tensor renormalization-group (TRG) method provides a highly precise technique for deriving thermodynamic and critical properties of lattice Hamiltonians. The TRG is a local coarse-graining transformation, with the elements of the tensor at each lattice site playing the part of the interactions that undergo the renormalization-group flows. These tensor flows are directly related to the phase diagram structure of the infinite system, with each phase flowing to a distinct surface of fixed points. Fixed-point analysis and summation along the flows give the critical exponents, as well as thermodynamic functions along the entire temperature range. Thus, for the ferromagnetic triangular lattice Ising model, the free energy is calculated to better than 10(-5) along the entire temperature range. Unlike previous position-space renormalization-group methods, the truncation (of the tensor index range D) in this general method converges under straightforward and systematic improvements. Our best results are easily obtained with D=24, corresponding to 4624-dimensional renormalization-group flows.

  20. High-Precision Thermodynamic and Critical Properties from Tensor Renormalization-Group Flows

    Science.gov (United States)

    Hinczewski, Michael; Berker, A. Nihat

    2008-03-01

    The recently developed tensor renormalization-group (TRG) method [1] provides a highly precise technique for deriving thermodynamic and critical properties of lattice Hamiltonians. The TRG is a local coarse-graining transformation, with the elements of the tensor at each lattice site playing the part of the interactions that undergo the renormalization-group flows. These tensor flows are directly related [2] to the phase diagram structure of the infinite system, with each phase flowing to a distinct surface of fixed points. Fixed-point analysis and summation along the flows give the critical exponents, as well as thermodynamic functions along the entire temperature range. Thus, for the ferromagnetic triangular lattice Ising model, the free energy is calculated to better than 10-5 along the entire temperature range. Unlike previous position-space renormalization-group methods, the truncation (of the tensor index range D) in this general method converges under straightforward and systematic improvements. Our best results are easily obtained with D=24, corresponding to 4624-dimensional renormalization-group flows. [1] M. Levin and C.P. Nave, Phys. Rev. Lett. 99, 120601 (2007). [2] M. Hinczewski and A.N. Berker, arXiv:0709.2803v1 [cond-mat.stat-mech], Phys. Rev. E, in press.

  1. How does group antenatal care function within a caseload midwifery model? A critical ethnographic analysis.

    Science.gov (United States)

    Allen, J; Kildea, S; Stapleton, H

    2015-05-01

    caseload midwifery and CenteringPregnancy™ (a form of group antenatal care) are two models of maternity care that are separately associated with better clinical outcomes, maternal satisfaction scores and positive experiences compared to standard care. One study reported exclusively on younger women׳s experiences of caseload midwifery; none described younger women׳s experiences of group antenatal care. We retrieved no studies on the experiences of women who received a combination of caseload midwifery and group antenatal care. examine younger women׳s experiences of caseload midwifery in a setting that incorporates group antenatal care. a critical, focused ethnographic approach. the study was conducted in an Australian hospital and its associated community venue from 2011 to 2013. purposive sampling of younger (19-22 years) pregnant and postnatal women (n=10) and the caseload midwives (n=4) who provided group antenatal care within one midwifery group practice. separate focus group interviews with women and caseload midwives, observations of the setting and delivery of group antenatal care, and examination of selected documents. Thematic analyses of the women׳s accounts have been given primary significance. Coded segments of the midwives interview data, field notes and documents were used to compare and contrast within these themes. we report on women׳s first encounters with the group, and their interactions with peers and midwives. The group setting minimised the opportunity for the women and midwives to get to know each other. this study challenges the practice of combining group antenatal care with caseload midwifery and recommends further research. Copyright © 2015 Elsevier Ltd. All rights reserved.

  2. The Perception of Critical Success Factors for PPP Projects in Different Stakeholder Groups

    Directory of Open Access Journals (Sweden)

    Joanna Węgrzyn

    2016-06-01

    Full Text Available Objective:  The main goal of the research is to enhance understanding which factors are perceived as critical for the success of public-private partnerships (PPPs by different stakeholder groups on different stages of the project life cycle. Research Design & Methods:  The paper builds on a larger research study looking at the development of the best practice framework for PPPs. The research is based on both a literature review and empirical studies. To examinethe perception of critical success factors (CSFs a questionnaire was conducted within different stakeholder groups for PPPs in Poland. Findings:  The article concentrates on one of the two dimensions ofa PPP project success which is the idea of critical success factors. The research reveals that public and private parties do not share common perception of the PPPsuccess. In general, the private sector assigns lower values to the CSFs analysed from the whole life perspective of a PPP project. Implications & Recommendations: The research indicates that the interpretation of a PPP project success depends of the stakeholders' role  in the project. Future research might try to integrate a wider range of stakeholdersengaged in PPPs such as financial institutions or a final user of the services provided under a PPP project. Contribution & Value Added: The results of the study provides helpful information to identify areas that stakeholders should pay a specialattention to in order to achieve the success of a PPP project.

  3. Numerical renormalization group for impurity quantum phase transitions: structure of critical fixed points

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Hyun-Jung [Theoretische Physik III, Elektronische Korrelationen und Magnetismus, Institut fuer Physik, Universitaet Augsburg, D-86135 Augsburg (Germany); Bulla, Ralf [Theoretische Physik III, Elektronische Korrelationen und Magnetismus, Institut fuer Physik, Universitaet Augsburg, D-86135 Augsburg (Germany); Vojta, Matthias [Institut fuer Theorie der Kondensierten Materie, Universitaet Karlsruhe, D-76128 Karlsruhe (Germany)

    2005-11-02

    The numerical renormalization group method is used to investigate zero-temperature phase transitions in quantum impurity systems, in particular in the particle-hole symmetric soft-gap Anderson model. The model displays two stable phases whose fixed points can be built up of non-interacting single-particle states. In contrast, the quantum phase transitions turn out to be described by interacting fixed points, and their excitations cannot be described in terms of free particles. We show that the structure of the many-body spectrum of these critical fixed points can be understood using renormalized perturbation theory close to certain values of the bath exponents which play the role of critical dimensions. Contact is made with perturbative renormalization group calculations for the soft-gap Anderson and Kondo models. A complete description of the quantum critical many-particle spectra is achieved using suitable marginal operators; technically this can be understood as epsilon-expansion for full many-body spectra.

  4. Numerical renormalization group for impurity quantum phase transitions: structure of critical fixed points

    Science.gov (United States)

    Lee, Hyun-Jung; Bulla, Ralf; Vojta, Matthias

    2005-11-01

    The numerical renormalization group method is used to investigate zero-temperature phase transitions in quantum impurity systems, in particular in the particle-hole symmetric soft-gap Anderson model. The model displays two stable phases whose fixed points can be built up of non-interacting single-particle states. In contrast, the quantum phase transitions turn out to be described by interacting fixed points, and their excitations cannot be described in terms of free particles. We show that the structure of the many-body spectrum of these critical fixed points can be understood using renormalized perturbation theory close to certain values of the bath exponents which play the role of critical dimensions. Contact is made with perturbative renormalization group calculations for the soft-gap Anderson and Kondo models. A complete description of the quantum critical many-particle spectra is achieved using suitable marginal operators; technically this can be understood as epsilon-expansion for full many-body spectra.

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

    Science.gov (United States)

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

    2001-07-01

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

  6. Investigating the critical properties of beyond-QCD theories using Monte Carlo Renormalization Group matching

    CERN Document Server

    Hasenfratz, Anna

    2009-01-01

    Monte Carlo Renormalization Group (MCRG) methods were designed to study the non-perturbative phase structure and critical behavior of statistical systems and quantum field theories. I adopt the 2-lattice matching method used extensively in the 1980's and show how it can be used to predict the existence of non-perturbative fixed points and their related critical exponents in many flavor SU(3) gauge theories. This work serves to test the method and I study relatively well understood systems: the $N_f=0$, 4 and 16 flavor models. The pure gauge and $N_f=4$ systems are confining and chirally broken and the MCRG method can predict their bare step scaling functions. Results for the $N_f=16$ model indicate the existence of an infrared fixed point with nearly marginal gauge coupling. I present preliminary results for the scaling dimension of the mass at this new fixed point.

  7. Light atmosphere in hospital wards

    DEFF Research Database (Denmark)

    Stidsen, Lone Mandrup

    Sociocultural aspects of light are important for the user experience of the atmosphere in a ward. According to the Danish Regulation for light in hospitals (DS703, 1983), a home-like feeling is required to support the patients, as they needa pleasant environment for their recovery. The term ‘Light...... the requirements. What does it mean to create a 'home-like' and 'pleasant or appealing' light in this context? Does the composition of CRI and degree of Kelvin tell it all? Is it enough information to provide a proper illumination in which the patient can have a homely and pleasant experience? The 'Model of Light...... from the Danish interior design magazine BO BEDRE.The findings show that the placement of light atmosphere in Denmark are determined as three horizontal light zones: 'High Lighting Zone', 'Center Lighting Zone' and 'Low Lighting Zone' An experimental study evaluates the experience of the atmosphere...

  8. A Renormalization-Group Interpretation of the Connection between Criticality and Multifractals

    Science.gov (United States)

    Chang, Tom

    2014-05-01

    Turbulent fluctuations in space plasmas beget phenomena of dynamic complexity. It is known that dynamic renormalization group (DRG) may be employed to understand the concept of forced and/or self-organized criticality (FSOC), which seems to describe certain scaling features of space plasma turbulence. But, it may be argued that dynamic complexity is not just a phenomenon of criticality. It is therefore of interest to inquire if DRG may be employed to study complexity phenomena that are distinctly more complicated than dynamic criticality. Power law scaling generally comes about when the DRG trajectory is attracted to the vicinity of a fixed point in the phase space of the relevant dynamic plasma parameters. What happens if the trajectory lies within a domain influenced by more than one single fixed point or more generally if the transformation underlying the DRG is fully nonlinear? The global invariants of the group under such situations (if they exist) are generally not power laws. Nevertheless, as we shall argue, it may still be possible to talk about local invariants that are power laws with the nonlinearity of transformation prescribing a specific phenomenon as crossovers. It is with such concept in mind that we may provide a connection between the properties of dynamic criticality and multifractals from the point of view of DRG (T. Chang, Chapter VII, "An Introduction to Space Plasma Complexity", Cambridge University Press, 2014). An example in terms of the concepts of finite-size scaling (FSS) and rank-ordered multifractal analysis (ROMA) of a toy model shall be provided. Research partially supported by the US National Science Foundation and the European Community's Seventh Framework Programme (FP7/ 2007-2013) under Grant agreement no. 313038/STORM.

  9. Functional renormalization group analysis of the soft mode at the QCD critical point

    Science.gov (United States)

    Yokota, Takeru; Kunihiro, Teiji; Morita, Kenji

    2016-07-01

    We make an intensive investigation of the soft mode at the quantum chromodynamics (QCD) critical point on the basis of the functional renormalization group (FRG) method in the local potential approximation. We calculate the spectral functions ρ_{σ, π}(ω, p) in the scalar (σ) and pseudoscalar (π) channels beyond the random phase approximation in the quark-meson model. At finite baryon chemical potential μ with a finite quark mass, the baryon-number fluctuation is coupled to the scalar channel and the spectral function in the σ channel has a support not only in the time-like (ω > p) but also in the space-like (ω position of the latter becomes vanishingly small with the height being enhanced as the system approaches the QCD critical point, which is a manifestation of the fact that the phonon mode is the soft mode associated with the second-order transition at the QCD critical point, as has been suggested by some authors. Moreover, our extensive calculation of the spectral function in the (ω, p) plane enables us to see that the mesonic and phonon modes have the respective definite dispersion relations ω_{σ.ph}(p), and it turns out that ω_{σ}(p) crosses the light-cone line into the space-like region, and then eventually merges into the phonon mode as the system approaches the critical point more closely. This implies that the sigma-mesonic mode also becomes soft at the critical point. We also provide numerical stability conditions that are necessary for obtaining the accurate effective potential from the flow equation.

  10. A group randomized trial of critical incident stress debriefing provided to U.S. peacekeepers.

    Science.gov (United States)

    Adler, Amy B; Litz, Brett T; Castro, Carl Andrew; Suvak, Michael; Thomas, Jeffrey L; Burrell, Lolita; McGurk, Dennis; Wright, Kathleen M; Bliese, Paul D

    2008-06-01

    In a group randomized trial of critical incident stress debriefing (CISD) with platoons of 952 peacekeepers, CISD was compared with a stress management class (SMC) and survey-only (SO) condition. Multilevel growth curve modeling found that CISD did not differentially hasten recovery compared to the other two conditions. For those soldiers reporting the highest degree of exposure to mission stressors, CISD was minimally associated with lower reports of posttraumatic stress and aggression (vs. SMC), higher perceived organizational support (vs. SO), and more alcohol problems than SMC and SO. Soldiers reported that they liked CISD more than the SMC, and CISD did not cause undue distress.

  11. Measuring multidisciplinary team effectiveness in a ward-based healthcare setting: development of the team functioning assessment tool.

    Science.gov (United States)

    Sutton, Gigi; Liao, Jenny; Jimmieson, Nerina L; Restubog, Simon Lloyd D

    2011-01-01

    Nontechnical skills relating to team functioning are vital to the effective delivery of patient care and safety. In this study, we develop a reliable behavioral marker tool for assessing nontechnical skills that are critical to the success of ward-based multidisciplinary healthcare teams. The Team Functioning Assessment Tool (TFAT) was developed and refined using a literature review, focus groups, card-sorting exercise, field observations, and final questionnaire evaluation and refinement process. Results demonstrated that Clinical Planning, Executive Tasks, and Team Relations are important facets of effective multidisciplinary healthcare team functioning. The TFAT was also shown to yield acceptable inter-rater agreement.

  12. Who says we are bad people? The impact of criticism source and attributional content on responses to group-based criticism.

    Science.gov (United States)

    Rabinovich, Anna; Morton, Thomas A

    2010-04-01

    We investigated the interplay between the source of criticism and the attributional content of their message on behavioral responses to group-based criticism. Studies 1 and 2 revealed that outgroup critics were more effective when their criticism included internal attributions (to the ingroup's character) rather than external attributions (the ingroup's circumstances), whereas there was no effect of attributional content for ingroup critics (a significant Source x Content interaction). Study 3 explored the role of audiences in responses to outgroup criticism. The results indicated that the positive effects of internal versus external attributions were only evident when an outgroup audience was witness to participants' responses. Furthermore, these effects were mediated through concerns about the ingroup's image. Together, these patterns suggest that responses to criticism depend not just on the identity of the critic but also on what the critic says and who is watching. People may be surprisingly responsive to outgroup criticism-particularly when inaction might lead others to perceive them as "bad people."

  13. Biosphere Dose Conversion Factors for Reasonably Maximally Exposed Individual and Average Member of Critical Group

    Energy Technology Data Exchange (ETDEWEB)

    K. Montague

    2000-02-23

    The purpose of this calculation is to develop additional Biosphere Dose Conversion Factors (BDCFs) for a reasonably maximally exposed individual (RMEI) for the periods 10,000 years and 1,000,000 years after the repository closure. In addition, Biosphere Dose Conversion Factors for the average member of a critical group are calculated for those additional radionuclides postulated to reach the environment during the period after 10,000 years and up to 1,000,000 years. After the permanent closure of the repository, the engineered systems within the repository will eventually lose their abilities to contain radionuclide inventory, and the radionuclides will migrate through the geosphere and eventually enter the local water table moving toward inhabited areas. The primary release scenario is a groundwater well used for drinking water supply and irrigation, and this calculation takes these postulated releases and follows them through various pathways until they result in a dose to either a member of critical group or a reasonably maximally exposed individual. The pathways considered in this calculation include inhalation, ingestion, and direct exposure.

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

    Directory of Open Access Journals (Sweden)

    Nikendei, C.

    2016-04-01

    Full Text Available Introduction: Ward rounds are an essential activity for interprofessional teams in hospital settings and represent complex tasks requiring not only medical knowledge but also communication skills, clinical technical skills, patient management skills and team-work skills. The present study aimed to analyse final year students’, nurses’ as well as physiotherapists’ views on a simulation-based interprofessional ward round training.Methods: In two successive passes a total number of 29 final year students, nursing students and physiotherapy students (16 in the first run, 13 in the second volunteered to participate in two standardized patient ward round scenarios: (1 patient with myocardial infarction, and (2 patient with poorly controlled diabetes. Views on the interprofessional ward round training were assessed using focus groups.Results: Focus group based feedback contained two main categories (A ward round training benefits and (B difficulties. Positive aspects enfolded course preparation, setting of the training, the involvement of the participants during training and the positive learning atmosphere. Difficulties were seen in the flawed atmosphere and realization of ward rounds in the daily clinical setting with respect to inter-professional aspects, and course benefit for the different professional groups.Conclusion: The presented inter-professional ward round training represents a well received and valuable model of interprofessional learning. Further research should assess its effectiveness, processes of interprofessional interplay and transfer into clinical practice.

  15. Group critical incident stress debriefing with emergency services personnel: a randomized controlled trial.

    Science.gov (United States)

    Tuckey, Michelle R; Scott, Jill E

    2014-01-01

    Although single-session individual debriefing is contraindicated, the efficacy of group psychological debriefing remains unresolved. We conducted the first randomized controlled trial of critical incident stress debriefing (CISD) with emergency workers (67 volunteer fire-fighters) following shared exposure to an occupational potentially traumatic event (PTE). The goals of group CISD are to prevent post-traumatic stress and promote return to normal functioning following a PTE. To assess both goals we measured four outcomes, before and after the intervention: post-traumatic stress, psychological distress, quality of life, and alcohol use. Fire brigades were randomly assigned to one of three treatment conditions: (1) CISD, (2) Screening (i.e., no-treatment), or (3) stress management Education. Controlling for pre-intervention scores, CISD was associated with significantly less alcohol use post-intervention relative to Screening, and significantly greater post-intervention quality of life relative to Education. There were no significant effects on post-traumatic stress or psychological distress. Overall, CISD may benefit broader functioning following exposure to work-related PTEs. Future research should focus on individual, group, and organizational factors and processes that can promote recovery from operational stressors. Ultimately, an occupational health (rather than victim-based) approach will provide the best framework for understanding and combating potential threats to the health and well-being of workers at high risk for PTE exposure.

  16. Group-directed criticisms and recommendations for change: why newcomers arouse more resistance than old-timers.

    Science.gov (United States)

    Hornsey, Matthew J; Grice, Tim; Jetten, Jolanda; Paulsen, Neil; Callan, Victor

    2007-07-01

    Three experiments examine the extent to which newcomers are able to influence their groups relative to old-timers. Specifically, how group members respond to criticisms of their group was assessed as a function of the intragroup position of the speaker. When criticizing their workplace (Experiment 1; N = 116), their profession (Experiment 2; N = 106), or an Internet community (Experiment 3; N = 189), newcomers aroused more resistance than old-timers, an effect that was mediated by perceptions of how attached critics were to their group identity. Experiment 3 also showed that newcomers could reduce resistance to their criticisms by distancing themselves from a group of which they were previously members. Theoretical and practical implications of these findings are discussed.

  17. Functional renormalization group analysis of the soft mode at the QCD critical point

    CERN Document Server

    Yokota, Takeru; Morita, Kenji

    2016-01-01

    We make an intensive investigation of the soft mode at the QCD critical point on the basis of the the functional renormalization group (FRG) method in the local potential approximation. We calculate the the spectral functions $\\rho_{\\sigma, \\pi}(\\omega, p)$ in the scalar ($\\sigma$) and pseudoscalar ($\\pi$) channels beyond the random phase approximation in the quark-meson model. At finite baryon chemical potential $\\mu$ with a finite quark mass, the baryon-number fluctuation is coupled to the scalar channel and the spectral function in the $\\sigma$ channel has a support not only in the time-like ($\\omega > p$) and but also in the space-like ($\\omega < p$) regions, which correspond to the mesonic and the particle-hole phonon excitations, respectively. We find that the energy of the peak position of the latter becomes vanishingly small with the height being enhanced as the system approaches the QCD critical point, which is a manifestation of the fact that the phonon mode is the soft mode associated with the s...

  18. Critical Point Facility (CPE) Group in the Spacelab Payload Operations Control Center (SL POCC)

    Science.gov (United States)

    1992-01-01

    The primary payload for Space Shuttle Mission STS-42, launched January 22, 1992, was the International Microgravity Laboratory-1 (IML-1), a pressurized manned Spacelab module. The goal of IML-1 was to explore in depth the complex effects of weightlessness of living organisms and materials processing. Around-the-clock research was performed on the human nervous system's adaptation to low gravity and effects of microgravity on other life forms such as shrimp eggs, lentil seedlings, fruit fly eggs, and bacteria. Materials processing experiments were also conducted, including crystal growth from a variety of substances such as enzymes, mercury iodide, and a virus. The Huntsville Operations Support Center (HOSC) Spacelab Payload Operations Control Center (SL POCC) at the Marshall Space Flight Center (MSFC) was the air/ground communication channel used between the astronauts and ground control teams during the Spacelab missions. Featured is the Critical Point Facility (CPE) group in the SL POCC during STS-42, IML-1 mission.

  19. New real-space renormalization-group calculation for the critical properties of lattice spin systems

    Science.gov (United States)

    Hecht, Charles E.; Kikuchi, Ryoichi

    1982-05-01

    In evaluating the critical properties of lattice spin systems in the real-space renormalization-group theory we use the cluster variation method. A configuration in the transformed system is constrained and the probability of occurrence of this configuration is calculated both in the transformed system and in the original system. By equating the two probabilities and forming ratios of two such equalities (for two or more constrained configurations) the fixed point of the renormalization transformation is evaluated. The method can avoid the trouble due to different singularities in the original and transformed systems, and hence can obviate the possible development of spurious singularities in the transformation at low temperatures. The two-dimensional triangular Ising model is treated with numerical results comparable with those obtained by the cluster treatment of Niemeijer and van Leeuwen who used more and larger cluster types than those we introduce.

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

    Science.gov (United States)

    Liu, Wei; Manias, Elizabeth; Gerdtz, Marie

    2014-09-01

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

  1. Three point SUSY Ward identities without Ghosts

    CERN Document Server

    Walker, M L

    2004-01-01

    We utilise a non-local gauge transform which renders the entire action of SUSY QED invariant and respects the SUSY algebra modulo the gauge-fixing condition, to derive two- and three-point ghost-free SUSY Ward identities in SUSY QED. We use the cluster decomposition principle to find the Green's function Ward identities and then takes linear combinations of the latter to derive identities for the proper functions.

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

    Science.gov (United States)

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

    2012-02-01

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

  3. Conducting a critical interpretive synthesis of the literature on access to healthcare by vulnerable groups

    Directory of Open Access Journals (Sweden)

    Smith Lucy

    2006-07-01

    Full Text Available Abstract Background Conventional systematic review techniques have limitations when the aim of a review is to construct a critical analysis of a complex body of literature. This article offers a reflexive account of an attempt to conduct an interpretive review of the literature on access to healthcare by vulnerable groups in the UK Methods This project involved the development and use of the method of Critical Interpretive Synthesis (CIS. This approach is sensitised to the processes of conventional systematic review methodology and draws on recent advances in methods for interpretive synthesis. Results Many analyses of equity of access have rested on measures of utilisation of health services, but these are problematic both methodologically and conceptually. A more useful means of understanding access is offered by the synthetic construct of candidacy. Candidacy describes how people's eligibility for healthcare is determined between themselves and health services. It is a continually negotiated property of individuals, subject to multiple influences arising both from people and their social contexts and from macro-level influences on allocation of resources and configuration of services. Health services are continually constituting and seeking to define the appropriate objects of medical attention and intervention, while at the same time people are engaged in constituting and defining what they understand to be the appropriate objects of medical attention and intervention. Access represents a dynamic interplay between these simultaneous, iterative and mutually reinforcing processes. By attending to how vulnerabilities arise in relation to candidacy, the phenomenon of access can be better understood, and more appropriate recommendations made for policy, practice and future research. Discussion By innovating with existing methods for interpretive synthesis, it was possible to produce not only new methods for conducting what we have termed critical

  4. Radiochemical approach to the JCO criticality accident in Tokai-mura, 1999--an overview of the radiochemistry group.

    Science.gov (United States)

    Komura, K

    2001-09-01

    A few days after the JCO criticality accident in Tokai-mura, a collaborating scientific investigation group was organized to evaluate the environmental impact of the accident. The group consisted of two groups: an environmental research group (radiochemistry group) and a biological research group. This paper overviews the scientific activity of the former group based on 6 sampling campaigns conducted at the JCO campus, Tokai-mura and Naka-machi. Some of the topical results and our remaining tasks concerning the JCO accident are discussed.

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

    Science.gov (United States)

    Govranos, Melissa; Newton, Jennifer M

    2014-04-01

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

  6. Applying Critical Race Theory to Group Model Building Methods to Address Community Violence.

    Science.gov (United States)

    Frerichs, Leah; Lich, Kristen Hassmiller; Funchess, Melanie; Burrell, Marcus; Cerulli, Catherine; Bedell, Precious; White, Ann Marie

    2016-01-01

    Group model building (GMB) is an approach to building qualitative and quantitative models with stakeholders to learn about the interrelationships among multilevel factors causing complex public health problems over time. Scant literature exists on adapting this method to address public health issues that involve racial dynamics. This study's objectives are to (1) introduce GMB methods, (2) present a framework for adapting GMB to enhance cultural responsiveness, and (3) describe outcomes of adapting GMB to incorporate differences in racial socialization during a community project seeking to understand key determinants of community violence transmission. An academic-community partnership planned a 1-day session with diverse stakeholders to explore the issue of violence using GMB. We documented key questions inspired by critical race theory (CRT) and adaptations to established GMB "scripts" (i.e., published facilitation instructions). The theory's emphasis on experiential knowledge led to a narrative-based facilitation guide from which participants created causal loop diagrams. These early diagrams depict how violence is transmitted and how communities respond, based on participants' lived experiences and mental models of causation that grew to include factors associated with race. Participants found these methods useful for advancing difficult discussion. The resulting diagrams can be tested and expanded in future research, and will form the foundation for collaborative identification of solutions to build community resilience. GMB is a promising strategy that community partnerships should consider when addressing complex health issues; our experience adapting methods based on CRT is promising in its acceptability and early system insights.

  7. Group stability of bed particles near the critical threshold of motion

    Science.gov (United States)

    Simeonov, J.; Calantoni, J.

    2012-12-01

    The unsteady flow above a rough bed and its interaction with a group of mobile spherical particles is investigated with Direct Numerical Simulations. The velocity and pressure are resolved at sub-particle scales using a new Cartesian grid method based on a discontinuous extension of the pressure Poisson equation across particle boundaries. The hydrodynamics is fully resolved everywhere except in the gap between colliding particles when the latter becomes smaller than the grid step. The particle hydrodynamic forces are determined as a combination of the numerically resolved pressure/shear outside the gap and an analytical contribution for the unresolved gap dynamics. Theoretical Stokes flow models are used to estimate the unresolved lubrication pressure/shear force in the subgrid gap. For the mechanical contact, we use a soft-sphere approach where the normal and tangential forces are modeled using a linear elastic-plastic law and a history dependent friction law, respectively. The proposed collision model is validated against experimental data for normal and oblique immersed collisions of spherical particles. We find that the lubrication corrections for the unresolved gap flow are essential to correctly predict the observed decrease in the coefficient of restitution with decreasing collisional Stokes number including the value of the critical Stokes number where collisions cease to rebound. The low collisional Stokes number effects are important for dissipating the momentum of flow-induced vibrations of surface particles. The results from our numerical simulations for the initiation of motion are compared with existing laboratory data.

  8. The effect of acidified enteral feeds on gastric colonization in critically ill patients: results of a multicenter randomized trial. Canadian Critical Care Trials Group.

    Science.gov (United States)

    Heyland, D K; Cook, D J; Schoenfeld, P S; Frietag, A; Varon, J; Wood, G

    1999-11-01

    To evaluate the effect of acidified enteral feeds on gastric colonization in critically ill patients compared with a standard feeding formula. Randomized, double-blind, multicenter trial. Eight mixed intensive care units at tertiary care hospitals. We recruited mechanically ventilated critically ill patients expected to remain ventilated for >48 hrs. We excluded patients with gastrointestinal bleeding, acidemia, and renal failure requiring dialysis. We enrolled 120 patients; 38% were female, age (mean +/- SD) was 57.6+/-19.3 yrs, and Acute Physiology and Chronic Health Evaluation II score (mean +/- SD) was 21.6+/-7.6. Vital High Nitrogen (Abbott Laboratories, Ross Products Division, Columbus, OH) was used as the standard feeding formula for the control group (pH = 6.5). Hydrochloric acid was added to Vital High Nitrogen to achieve a pH of 3.5 in the experimental group. The main outcome measure was gastric colonization. Secondary outcomes included gastric pH, pneumonia, and mortality. The mean gastric pH in patients receiving acid feeds was lower (pH = 3.3) compared with controls (pH = 4.6; pacid feeds was colonized in the stomach with pathogenic bacteria, compared with 20 patients (43%) in the control group (pacid feeds group vs. 15% in the control group; p = .19). Overall, there were 15 deaths in the acid feeds group and seven in the control group (p = .10); four patients in the acid feeds group and three in the control group died during the study period (p not significant). Acidified enteral feeds preserve gastric acidity and substantially reduce gastric colonization in critically ill patients. Larger studies are needed to examine its effect on ventilator-associated pneumonia and mortality.

  9. Swimming Training Assessment: The Critical Velocity and the 400-m Test for Age-Group Swimmers.

    Science.gov (United States)

    Zacca, Rodrigo; Fernandes, Ricardo Jorge P; Pyne, David B; Castro, Flávio Antônio de S

    2016-05-01

    To verify the metabolic responses of oxygen consumption (V[Combining Dot Above]O2), heart rate (HR), blood lactate concentrations [La], and rate of perceived exertion (RPE) when swimming at an intensity corresponding to the critical velocity (CV) assessed by a 4-parameter model (CV4par), and to check the reliability when using only a single 400-m maximal front crawl bout (T400) for CV4par assessment in age-group swimmers. Ten age-group swimmers (14-16 years old) performed 50-, 100-, 200-, 400- (T400), 800-, and 1,500-m maximal front crawl bouts to calculate CV4par. V[Combining Dot Above]O2, HR, [La], and RPE were measured immediately after bouts. Swimmers then performed 3 × 10-minute front crawl (45 seconds rest) at CV4par. V[Combining Dot Above]O2, HR, [La], and RPE were measured after 10 minutes of rest (Rest), warm-up (Pre), each 10-minute repetition, and at the end of the test (Post). CV4par was 1.33 ± 0.08 m·s. V[Combining Dot Above]O2, HR, [La], and RPE were similar between first 10-minute and Post time points in the 3 × 10-minute protocol. CV4par was equivalent to 92 ± 2% of the mean swimming speed of T400 (v400) for these swimmers. CV4par calculated through a single T400 (92%v400) showed excellent agreement (r = 0.30; 95% CI: -0.04 to 0.05 m·s, p = 0.39), low coefficient of variation (2%), and root mean square error of 0.02 ± 0.01 m·s when plotted against CV4par assessed through a 4-parameter model. These results generated the equation CV4par = 0.92 × v400. A single T400 can be used reliably to estimate the CV4par typically derived with 6 efforts in age-group swimmers.

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

    DEFF Research Database (Denmark)

    Nørgaard, Kirsten; Ringsted, Charlotte; Dolmans, Diana

    2004-01-01

    BACKGROUND: Ward rounds are an essential responsibility for doctors in hospital settings. Tools for guiding and assessing trainees' performance of ward rounds are needed. A checklist was developed for that purpose for use with trainees in internal medicine. OBJECTIVE: To assess the content...... construct validity, an observer assessed 4 groups of doctors during performance of a complete ward round (n = 32). The nurse who accompanied the doctor on rounds made a global assessment of the performance. RESULTS: The response rate to the questionnaire was 80.7%. The respondents found that all 10 items...... on the checklist were relevant to ward round performance and that the item collection was comprehensive. Checklist mean-item scores differed between levels of expertise: junior house officers 1.4 (1.0-1.9); senior house officers 2.0 (1.5-2.9); specialist trainees 2.5 (1.8-2.8), and specialists 2.7 (2...

  11. Improving the quality and safety of care on the medical ward: A review and synthesis of the evidence base.

    Science.gov (United States)

    Pannick, Samuel; Beveridge, Iain; Wachter, Robert M; Sevdalis, Nick

    2014-12-01

    Despite its place at the heart of inpatient medicine, the evidence base underpinning the effective delivery of medical ward care is highly fragmented. Clinicians familiar with the selection of evidence-supported treatments for specific diseases may be less aware of the evolving literature surrounding the organisation of care on the medical ward. This review is the first synthesis of that disparate literature. An iterative search identified relevant publications, using terms pertaining to medical ward environments, and objective and subjective patient outcomes. Articles (including reviews) were selected on the basis of their focus on medical wards, and their relevance to the quality and safety of ward-based care. Responses to medical ward failings are grouped into five common themes: staffing levels and team composition; interdisciplinary communication and collaboration; standardisation of care; early recognition and treatment of the deteriorating patient; and local safety climate. Interventions in these categories are likely to improve the quality and safety of care in medical wards, although the evidence supporting them is constrained by methodological limitations and inadequate investment in multicentre trials. Nonetheless, with infrequent opportunities to redefine their services, institutions are increasingly adopting multifaceted strategies that encompass groups of these themes. As the literature on the quality of inpatient care moves beyond its initial focus on the intensive care unit and operating theatre, physicians should be mindful of opportunities to incorporate evidence-based practice at a ward level. Copyright © 2014 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

  12. Recommendations of the Working Groups from the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC) for the management of adult critically ill patients.

    Science.gov (United States)

    Hernández-Tejedor, A; Peñuelas, O; Sirgo Rodríguez, G; Llompart-Pou, J A; Palencia Herrejón, E; Estella, A; Fuset Cabanes, M P; Alcalá-Llorente, M A; Ramírez Galleymore, P; Obón Azuara, B; Lorente Balanza, J A; Vaquerizo Alonso, C; Ballesteros Sanz, M A; García García, M; Caballero López, J; Socias Mir, A; Serrano Lázaro, A; Pérez Villares, J M; Herrera-Gutiérrez, M E

    The standardization of the Intensive Care Medicine may improve the management of the adult critically ill patient. However, these strategies have not been widely applied in the Intensive Care Units (ICUs). The aim is to elaborate the recommendations for the standardization of the treatment of critical patients. A panel of experts from the thirteen working groups (WG) of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC) was selected and nominated by virtue of clinical expertise and/or scientific experience to carry out the recommendations. Available scientific literature in the management of adult critically ill patients from 2002 to 2016 was extracted. The clinical evidence was discussed and summarised by the experts in the course of a consensus finding of every WG and finally approved by the WGs after an extensive internal review process that was carried out between December 2015 and December 2016. A total of 65 recommendations were developed, of which 5 corresponded to each of the 13 WGs. These recommendations are based on the opinion of experts and scientific knowledge, and are intended as a guide for the intensivists in the management of critical patients. Copyright © 2017 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

  13. Modeling of the Critical Micelle Concentration (CMC) of Nonionic Surfactants with an Extended Group-Contribution Method

    DEFF Research Database (Denmark)

    Mattei, Michele; Kontogeorgis, Georgios; Gani, Rafiqul

    2013-01-01

    A group-contribution (GC) property prediction model for estimating the critical micelle concentration (CMC) of nonionic surfactants in water at 25 °C is presented. The model is based on the Marrero and Gani GC method. A systematic analysis of the model performance against experimental data......; and carbohydrate derivate ethers, esters, and thiols. The model developed consists of linear group contributions, and the critical micelle concentration is estimated using the molecular structure of the nonionic surfactant alone. Compared to other models used for the prediction of the critical micelle...... is carried out using data for a wide range of nonionic surfactants covering a wide range of molecular structures. As a result of this procedure, new third order groups based on the characteristic structures of nonionic surfactants are defined and are included in the Marrero and Gani GC model. In this way...

  14. Critical and strategic materials proceedings of the laboratory study group meeting

    Energy Technology Data Exchange (ETDEWEB)

    1983-06-01

    These Proceedings serve to identify the appropriate role for the DOE-BES-DMS Laboratory program concerning critical and strategic materials, identify and articulate high priority DOE-BES-DMS target areas so as to maximize programmatic responsiveness to national needs concerning critical and strategic materials, and identify research, expertise, and resources (including Collaborative Research Centers) that are relevant to critical and strategic materials that is either underway or in place under the DOE-BES-DMS Laboratory program. Laboratory statements of collaborative research are given.

  15. The emotional intelligence of a group of critical-care nurses in South Africa

    OpenAIRE

    Amanda Towell; Elzabe Nel; Ann Müller

    2013-01-01

    Critical-care nurses often look after three or more critically-ill patients during a shift. The workload and emotional stress can lead to disharmony between the nurse’s body, mind and spirit. Nurses with a high emotional intelligence have less emotional exhaustion and psychosomatic symptoms; they enjoy better emotional health; gain more satisfaction from their actions (both at work and at home); and have improved relationships with colleagues at work. The question arises: what is the emotiona...

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

    Science.gov (United States)

    Terkelsen, Toril Borch; Larsen, Inger Beate

    2013-10-01

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

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

    OpenAIRE

    Zhang, Ju; Ye, Wenqin; Fan, Fan

    2015-01-01

    Introduction: To provide high-quality nursing care, a reliable and feasible competency assessment tool is critical. Although several questionnaire-based competency assessment tools have been reported, a tool specific for obstetric nurses in rooming-in wards is lacking. Therefore, the purpose of this research is to develop a competency assessment tool for obstetric rooming-in ward nurses. Methods: A literature review was conducted to create an individual intensive interview with 14 nurse manag...

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

    Science.gov (United States)

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

    2014-01-01

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

  19. Genetics Home Reference: Romano-Ward syndrome

    Science.gov (United States)

    ... 2 MalaCards: scn5a-related romano ward syndrome Merck Manual Consumer Version: Long QT Syndrome My46 Trait Profile Orphanet: Familial long QT syndrome Patient Support and Advocacy Resources (3 links) National Organization for Rare Disorders Resource List from the University ...

  20. Limits of Freedom: The Ward Churchill Case

    Science.gov (United States)

    O'Nell, Robert M.

    2006-01-01

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

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

    Science.gov (United States)

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

    2014-01-01

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

  2. Existence of solution of sub-elliptic equations on the Heisenberg group with critical growth and double singularities

    Directory of Open Access Journals (Sweden)

    Jianqing Chen

    2013-01-01

    Full Text Available For a class of sub-elliptic equations on Heisenberg group \\(\\mathbb{H}^N\\ with Hardy type singularity and critical nonlinear growth, we prove the existence of least energy solutions by developing new techniques based on the Nehari constraint. This result extends previous works, e.g., by Han et al. [Hardy-Sobolev type inequalities on the H-type group, Manuscripta Math. 118 (2005, 235–252].

  3. Voluntary Organizations and Community Groups as New Partners in Diabetes Self-management and Education: A Critical Interpretative Synthesis

    NARCIS (Netherlands)

    Portillo, M.C.; Regaira, E.; Pumar-Mendez, M.J.; Mujika, A.; Vassilev, I.; Rogers, A.; Wensing, M.; Foss, C.; Knutsen, I.R.; Todorova, E.; Roukova, P.; Kennedy, A.; Serrano, M.; Lionis, C.; Angelaki, A.; Patelarou, E.; Koetsenruijter, J.

    2015-01-01

    PURPOSE: The purpose of this study is to critically review the literature on the role and work of voluntary organizations and community groups and volunteers in diabetes self-management programs. It seeks to explain how these organizations are located and could be integrated further within a broader

  4. Ethnic American Groups in Four Specialized Encyclopedic Works: A Comparative and Critical Analysis.

    Science.gov (United States)

    Wertsman, Vladimir F.

    1999-01-01

    Explores the treatment of ethnic groups in the United States in four encyclopedic works: (1) "Harvard Encyclopedia of American Ethnic Groups"; (2) "Gale Encyclopedia of Multicultural America"; (3) "Encyclopedia of New York City"; and (4) "American Immigrant Culture." (SLD)

  5. Building a Society of Solidarity through Critical Pedagogy: Group Teaching as a Social and Democratic Tool

    Science.gov (United States)

    Nikolakaki, Maria

    2012-01-01

    Against the menacing shadow of neoliberalism, which promotes individualism and competition, the author illustrates in this paper the need for group teaching. Group teaching as a method of instruction and learning fosters community bonds, solidarity, and is more effective teaching. Group teaching is a democratic tool necessary for society to…

  6. Does Ethnolinguistic Vitality Theory Account for the Actual Vitality of Ethnic Groups? A Critical Evaluation

    Science.gov (United States)

    Yagmur, Kutlay

    2011-01-01

    Ethnolinguistic vitality theory asserts that Status, Demographic, Institutional Support and Control factors make up the vitality of ethnolinguistic groups. An assessment of a group's strengths and weaknesses in each of these dimensions provides a rough classification of ethnolinguistic groups into those having low, medium, or high vitality. Low…

  7. Discussion Group Effectiveness Is Related to Critical Thinking through Interest and Engagement

    Science.gov (United States)

    Jones, Janelle M.

    2014-01-01

    Higher student enrolment at North American tertiary institutions over the last decade has led to a greater reliance on lecturing in large classes (i.e., 50 students or more). The efficiency of lecturing as a method of instruction can sometimes come at the cost of student interaction, engagement, critical thinking and satisfaction. Implementing…

  8. Discussion Group Effectiveness Is Related to Critical Thinking through Interest and Engagement

    Science.gov (United States)

    Jones, Janelle M.

    2014-01-01

    Higher student enrolment at North American tertiary institutions over the last decade has led to a greater reliance on lecturing in large classes (i.e., 50 students or more). The efficiency of lecturing as a method of instruction can sometimes come at the cost of student interaction, engagement, critical thinking and satisfaction. Implementing…

  9. Reflection in Action: Using Inquiry Groups to Explore Critical Digital Literacy with Pre-Service Teachers

    Science.gov (United States)

    Lohnes Watulak, Sarah

    2016-01-01

    The challenge of preparing teachers and their eventual students to be successful, full participants in today's digital society is one that faces all teacher preparation programs. However, in the United States our current system of technology instruction in pre-service education focuses primarily on functional technology skills, and critical and…

  10. Reflection in Action: Using Inquiry Groups to Explore Critical Digital Literacy with Pre-Service Teachers

    Science.gov (United States)

    Lohnes Watulak, Sarah

    2016-01-01

    The challenge of preparing teachers and their eventual students to be successful, full participants in today's digital society is one that faces all teacher preparation programs. However, in the United States our current system of technology instruction in pre-service education focuses primarily on functional technology skills, and critical and…

  11. Analysis of Critical Thinking Skills in an International, Cross-Institutional Group of Engineering Master's Students

    Science.gov (United States)

    Bramhall, Michael D.; Gray, Linda; Corker, Chris; Garnett, Kenisha; Hill, Richard

    2012-01-01

    UK educators often express concerns that students from some cultural backgrounds frequently seem unwilling or are unable to apply critical thinking skills within their academic programmes. This may be due not to a lack of ability or confidence but rather to the way they have been previously taught and assessed. Often, the design of UK courses…

  12. Critical Information Literacy beyond the University: Lessons from Service in a Women's Health Interest Group

    Science.gov (United States)

    Fountain, Kathleen Carlisle

    2013-01-01

    Library instruction methods most frequently focus on teaching students searching skills to navigate the maze of library databases to locate appropriate research materials. The current theory of critical information literacy instruction calls on librarians to spend more of their time in the classroom focused on understanding the social, political,…

  13. Nosocomial candidemia in patients admitted to medicine wards compared to other wards: a multicentre study.

    Science.gov (United States)

    Luzzati, Roberto; Merelli, Maria; Ansaldi, Filippo; Rosin, Chiara; Azzini, Annamaria; Cavinato, Silvia; Brugnaro, Pierluigi; Vedovelli, Claudio; Cattelan, Annamaria; Marina, Busetti; Gatti, Giuseppe; Concia, Ercole; Bassetti, Matteo

    2016-12-01

    Risk factors for nosocomial candidemia, severity of sepsis, treatment, and outcome were compared between patients admitted to medicine wards and those to surgical and intensive care units (ICUs). Data were retrospectively collected from patients belonging to six referral hospitals in Italy between January 2011 and December 2013. Risk factors for 30-day mortality were evaluated in the whole patient population. A total of 686 patients (mean age 70 ± 15 years) with candidemia were included. 367 (53.5 %) patients were in medicine wards, and 319 in surgery and ICUs. Host-related risk factors for candidemia were more common in medicine patients whereas healthcare-related factors in surgery/ICU patients. These patients showed severe sepsis and septic shock more commonly (71.7 %) than medicine patients (59.9 %) (p 0.003). The latter underwent central venous catheter (CVC) removal and adequate antifungal therapy less frequently than surgery/ICU patients. 149 (40.6 %) patients died with candidemia in medicine wards and 69 (21.6 %) in other wards (p candidemia was different between medicine patients and those in other wards. Despite the lower severity of candidemia in medicine patients, their mortality turned out to be higher than in surgery or ICU patients. Awareness of the best management of candidemia should be pursued, especially in medicine wards.

  14. [The role of the psychologist in hospitals and maternity wards in the state of Sergipe].

    Science.gov (United States)

    Santos, Lyvia de Jesus; Vieira, Maria Jésia

    2012-05-01

    This article seeks to reflect on the professional activity of the psychologist in the hospital context by examining the role of psychologists working in hospitals and maternity wards in the State of Sergipe. It seeks to identify the specific role of these professionals in hospitals and maternity wards, as well as their motivating forces and the difficulties encountered. This work is part of a broader project that sought to study not only the activity per se, but also training aspects of these professionals. The sample was analyzed using a qualitative and quantitative approach for thematic analysis. Results revealed that the characterization of the role of psychologists has a focus on psychotherapeutic work with patients before and after surgery, as well as the caregivers and family members of critically ill patients in the following units: ICU, ICC, oncology, dialysis and surgical wards, offering support, especially at the pre- and post-surgery phase.

  15. Monte Carlo tests of renormalization-group predictions for critical phenomena in Ising models

    Science.gov (United States)

    Binder, Kurt; Luijten, Erik

    2001-04-01

    A critical review is given of status and perspectives of Monte Carlo simulations that address bulk and interfacial phase transitions of ferromagnetic Ising models. First, some basic methodological aspects of these simulations are briefly summarized (single-spin flip vs. cluster algorithms, finite-size scaling concepts), and then the application of these techniques to the nearest-neighbor Ising model in d=3 and 5 dimensions is described, and a detailed comparison to theoretical predictions is made. In addition, the case of Ising models with a large but finite range of interaction and the crossover scaling from mean-field behavior to the Ising universality class are treated. If one considers instead a long-range interaction described by a power-law decay, new classes of critical behavior depending on the exponent of this power law become accessible, and a stringent test of the ε-expansion becomes possible. As a final type of crossover from mean-field type behavior to two-dimensional Ising behavior, the interface localization-delocalization transition of Ising films confined between “competing” walls is considered. This problem is still hampered by questions regarding the appropriate coarse-grained model for the fluctuating interface near a wall, which is the starting point for both this problem and the theory of critical wetting.

  16. A critical appraisal of existing concepts for the grouping of nanomaterials.

    Science.gov (United States)

    Arts, Josje H E; Hadi, Mackenzie; Keene, Athena M; Kreiling, Reinhard; Lyon, Delina; Maier, Monika; Michel, Karin; Petry, Thomas; Sauer, Ursula G; Warheit, David; Wiench, Karin; Landsiedel, Robert

    2014-11-01

    The grouping of substances serves to streamline testing for regulatory purposes. General grouping approaches for chemicals have been implemented in, e.g., the EU chemicals regulation. While specific regulatory frameworks for the grouping of nanomaterials are unavailable, this topic is addressed in different publications, and preliminary guidance is provided in the context of substance-related legislation or the occupational setting. The European Centre for Ecotoxicology and Toxicology of Chemicals Task Force on the Grouping of Nanomaterials reviewed available concepts for the grouping of nanomaterials for human health risk assessment. In their broad conceptual design, the evaluated approaches are consistent or complement each other. All go beyond the determination of mere structure-activity relationships and are founded on different aspects of the nanomaterial life cycle. These include the NM's material properties and biophysical interactions, specific types of use and exposure, uptake and kinetics, and possible early and apical biological effects. None of the evaluated grouping concepts fully take into account all of these aspects. Subsequent work of the Task Force will aim at combining the available concepts into a comprehensive 'multiple perspective' framework for the grouping of nanomaterials that will address all of the mentioned aspects of their life cycles.

  17. Implementing lean in a surgical ward

    DEFF Research Database (Denmark)

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

    Using the well-known principles from lean management in an orthopedic surgical ward at a major Danish hospital reorganized their work-flow and processes. The ward has ten operating rooms and performs the complete range of the orthopedic procedures ranging from patients that need simple standard...... for productivity improvement. Lean management has its origins in industrial production, but it is now being transferred to many other sectors, e.g., health care. Two important prerequisites exist for implementing lean management: Firstly, stable and standardized processes and secondly leveling of production...... be planned in advance and meet the prerequisites for lean management. Two of ten operating rooms have been allocated to this flow. Selected surgeons, nurses and porters have been allocated to the two operating rooms and they remain in the sterile environment for the duration of the workday. The effect...

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

    Science.gov (United States)

    Bonner, Gwen; McLaughlin, Sue

    2014-05-01

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

  19. Medical students learning experiences of the labour ward: a qualitative research study.

    Science.gov (United States)

    Cotter, Danielle; Turner, Michael J; McAuliffe, Fionnuala M; Higgins, Mary F

    2016-11-01

    To study the educational value to medical students of a labour ward rotation. Qualitative research study was performed in two tertiary level obstetric hospitals attached to a large medical school in Dublin. Medical students attending a six-week rotation in Obstetrics and Gynaecology in University College Dublin were invited to participate. As part of this rotation, students spend one week as part of the clinical team working on the labour ward. Focus groups were held in order to identify common themes and experiences of medical students during this labour ward week. Grounded theory with thematic analysis was used. The main outcome measures were the educational experience and value of a labour ward rotation to medical students. Five distinct themes developed from the focus groups of 19 students. A high value was placed on patient centred bedside teaching. Midwives were identified as excellent teachers and facilitators of learning. There was a clear sense of teamwork and belonging by the students. However, students reported frustration with unclear learning objectives. Students identified extra pre-learning with pre-specified learning aims before the labour ward week as being important. Bedside teaching was highly valued as it advanced student's knowledge of obstetrics theory and improved communication skills. In general, medical students reported a positive experience from working in the labour word but there is scope for improvement. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  20. The theory of critical phenomena an introduction to the renormalization group

    CERN Document Server

    Binney, J J; Fisher, A J; Newman, M E J

    1993-01-01

    The successful calculation of critical exponents for continuous phase transitions is one of the main achievements of theoretical physics over the last quarter-century. This was achieved through the use of scaling and field-theoretic techniques which have since become standard equipment in many areas of physics, especially quantum field theory. This book provides a thorough introduction to these techniques. Continuous phase transitions are introduced, then the necessary statistical mechanics is summarized, followed by standard models, some exact solutions and techniques for numerical simulation

  1. Ward identities for amplitudes with reggeized gluons

    Energy Technology Data Exchange (ETDEWEB)

    Bartles, J. [Hamburg Univ. (Germany). 2. Inst. fuer Theoretische Physik; Universidad Tecnica Federico Santa Maria, Valparaiso (Chile). Dept. de Fisica; Lipatov, L.N. [Hamburg Univ. (Germany). 2. Inst. fuer Theoretische Physik; St. Petersburg Nuclear Physics Institute (Russian Federation); Vacca, G.P. [INFN, Sezione di Bologna (Italy)

    2012-05-15

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

  2. Comparison Groups in Yoga Research: A Systematic Review and Critical Evaluation of the Literature

    Science.gov (United States)

    Groessl, Erik; Maiya, Meghan; Sarkin, Andrew; Eisen, Susan V.; Riley, Kristen; Elwy, A. Rani

    2014-01-01

    Objectives Comparison groups are essential for accurate testing and interpretation of yoga intervention trials. However, selecting proper comparison groups is difficult because yoga comprises a very heterogeneous set of practices and its mechanisms of effect have not been conclusively established. Methods We conducted a systematic review of the control and comparison groups used in published randomized controlled trials (RCTs) of yoga. Results We located 128 RCTs that met our inclusion criteria; of these, 65 included only a passive control and 63 included at least one active comparison group. Primary comparison groups were physical exercise (43%), relaxation/meditation (20%), and education (16%). Studies rarely provided a strong rationale for choice of comparison. Considering year of publication, the use of active controls in yoga research appears to be slowly increasing over time. Conclusions Given that yoga has been established as a potentially powerful intervention, future research should use active control groups. Further, care is needed to select comparison conditions that help to isolate the specific mechanisms of yoga’s effects. PMID:25440384

  3. Nursing safety management in onco-hematology pediatric wards

    Directory of Open Access Journals (Sweden)

    Marcelle Miranda da Silva

    2015-02-01

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

  4. Tagging Thinking Types in Asynchronous Discussion Groups: Effects on Critical Thinking

    Science.gov (United States)

    Schellens, T.; Van Keer, H.; De Wever, B.; Valcke, M.

    2009-01-01

    The present study focuses on the use of thinking types as a possible way to structure university students' discourse in asynchronous discussion groups and consequently promote their learning. More specifically, the aim of the study is to determine how requiring students to label their contributions by means of De Bono's (1991) thinking hats…

  5. A Framework for Conducting Critical Dialectical Pluralist Focus Group Discussions Using Mixed Research Techniques

    Science.gov (United States)

    Onwuegbuzie, Anthony J.; Frels, Rebecca K.

    2015-01-01

    Although focus group discussions (FGDs) represent a popular data collection tool for researchers, they contain an extremely serious flaw: FGD researchers have ultimate power over all decisions made at every stage of the research process--from the conceptualization of the research, to the planning of the research study, to the implementation of the…

  6. Creating Spaces for Critical Transformative Dialogues: Legitimising Discussion Groups as Professional Practice

    Science.gov (United States)

    Edwards-Groves, Christine J.

    2013-01-01

    Focussed dialogue (as lived and living practices) can have a powerful role in renewing professional practice, advancing its sustainability and development as administrative and political systems colonise the practices of teachers and teacher educators. However, participating in discussion groups for many teachers, including those in academia, is…

  7. High Mobility Group Protein HMGB2 Is a Critical Regulator of Plasmodium Oocyst Development*S⃞

    OpenAIRE

    Gissot, Mathieu; Ting, Li-Min; Daly, Thomas M.; Bergman, Lawrence W.; Sinnis, Photini; Kim, Kami

    2008-01-01

    The sexual cycle of Plasmodium is required for transmission of malaria from mosquitoes to mammals, but how parasites induce the expression of genes required for the sexual stages is not known. We disrupted the Plasmodium yoelii gene encoding high mobility group nuclear factor hmgb2, which encodes a DNA-binding protein potentially implicated in transcriptional regulation of malaria gene expression. We investigated its function in vivo in the vertebrate and invertebrate ...

  8. Identifying Critical Nutrient Intake in Groups at Risk of Poverty in Europe: The CHANCE Project Approach

    Directory of Open Access Journals (Sweden)

    Marina Nikolić

    2014-04-01

    Full Text Available The aim of the CHANCE project is to develop novel and affordable nutritious foods to optimize the diet and reduce the risk of diet-related diseases among groups at risk of poverty (ROP. This paper describes the methodology used in the two initial steps to accomplish the project’s objective as follows: 1. a literature review of existing data and 2. an identification of ROP groups with which to design and perform the CHANCE nutritional survey, which will supply new data that is useful for formulating the new CHANCE food. Based on the literature review, a low intake of fruit and vegetables, whole grain products, fish, energy, fiber, vitamins B1, B2, B3, B6, B12 and C, folate, calcium, magnesium, iron, potassium and zinc and a high intake of starchy foods, processed meat and sodium were apparent. However, the available data appeared fragmented because of the different methodologies used in the studies. A more global vision of the main nutritional problems that are present among low-income people in Europe is needed, and the first step to achieve this goal is the use of common criteria to define the risk of poverty. The scoring system described here represents novel criteria for defining at-risk-of-poverty groups not only in the CHANCE-participating countries but also all over Europe.

  9. Identifying Critical Nutrient Intake in Groups at Risk of Poverty in Europe: The CHANCE Project Approach

    Science.gov (United States)

    Nikolić, Marina; Glibetić, Maria; Gurinović, Mirjana; Milešević, Jelena; Khokhar, Santosh; Chillo, Stefania; Abaravicius, Jonas Algis; Bordoni, Alessandra; Capozzi, Francesco

    2014-01-01

    The aim of the CHANCE project is to develop novel and affordable nutritious foods to optimize the diet and reduce the risk of diet-related diseases among groups at risk of poverty (ROP). This paper describes the methodology used in the two initial steps to accomplish the project’s objective as follows: 1. a literature review of existing data and 2. an identification of ROP groups with which to design and perform the CHANCE nutritional survey, which will supply new data that is useful for formulating the new CHANCE food. Based on the literature review, a low intake of fruit and vegetables, whole grain products, fish, energy, fiber, vitamins B1, B2, B3, B6, B12 and C, folate, calcium, magnesium, iron, potassium and zinc and a high intake of starchy foods, processed meat and sodium were apparent. However, the available data appeared fragmented because of the different methodologies used in the studies. A more global vision of the main nutritional problems that are present among low-income people in Europe is needed, and the first step to achieve this goal is the use of common criteria to define the risk of poverty. The scoring system described here represents novel criteria for defining at-risk-of-poverty groups not only in the CHANCE-participating countries but also all over Europe. PMID:24699195

  10. The application of heterogeneous cluster grouping to reflective writing for medical humanities literature study to enhance students' empathy, critical thinking, and reflective writing

    National Research Council Canada - National Science Library

    Liao, Hung-Chang; Wang, Ya-Huei

    2016-01-01

    ... grouping in reflective writing for medical humanities literature acquisition could have positive effects on medical university students in terms of empathy, critical thinking, and reflective writing...

  11. APN arranges in groups with nurse the level management in the critically ill guardianship hospital ward application%APN排班与护士层级管理在重症监护病房中的应用

    Institute of Scientific and Technical Information of China (English)

    严艳玲; 李云玲; 梁冬梅; 罗进玲; 陈清

    2010-01-01

    目的 探讨APN排班与护士的层级管理在重症监护专科护理管理中的应用效果.方法 改变传统的排班模式,实施APN连续性分组排班,每小组均实行护理组长-责任护士-助理护士层级管理,新老搭配,使各项护理工作均能在监督指导下落实.结果 APN排班各班的护理人力安排均衡且交接次数比传统排班明显减少.实施APN排班与护士层级管理后,危重患者护理合格率由90.50%提高到98.50%,差异有显著性(P<0.05).结论 ICU开展APN连续排班和层级管理,有利于合理安排人力,分组排班,充分发挥团队协作精神及各层级护理人员的作用,有效降低年轻护士在岗时因专业能力不足所带来的安全隐患,确保护理安全,促进专科发展,全面提高护理质量.%Objective To explore the APN scheduling's and the hierarchical nurse management's effect on special nursing management of ICU.Methods Change the traditional Scheduling,and carry out the APN scheduling and the hierarchical nurse management by the experienced nurses and the less-experienced ones. All the nursing job is completed under supervising. Results After the practice of APN Scheduling, the nurse management is more rational. And the qualified rate of ICU nursing got a raise from 90.50% to 98.50%. Conclusions Carrying out the APN scheduling and the hierarchical nurse management in the ICU, can make the human capital arrangement more rational, and get a better team work. What's more, it can promote the development of the special nursing and the nursing quality.

  12. Calcium-independent phospholipase A₂, group VIA, is critical for RPE cell survival

    DEFF Research Database (Denmark)

    Kolko, Miriam; Vohra, Rupali; Westlund, Barbro S.;

    2014-01-01

    PURPOSE: To investigate the significance of calcium-independent phospholipase A₂, group VIA (iPLA2-VIA), in RPE cell survival following responses to sodium iodate (SI) in cell cultures. METHODS: The human retinal pigment epithelium (RPE) cell line (ARPE-19) cells and primary mouse-RPE cultures were...... of iPLA₂-VIA after SI exposure. Inhibitors of iPLA₂-VIA were used to explore a potential protective role in cells exposed to SI. Primary RPE cell cultures were grown from iPLA₂-VIA knockout mice and wild-type mice. The cultures were exposed to SI to investigate a possible increased protection against......-VIA-specific inhibitors in ARPE-19 cell cultures. RPE cultures from iPLA₂-VIA knockout mice were less vulnerable to SI-induced cell death compared to RPE cultures from wild-type mice. CONCLUSIONS: SI -induced RPE cell death involves iPLA₂-VIA upregulation and activation, and amelioration of SI...

  13. The Ward ansaetze and Painleve tau function

    Energy Technology Data Exchange (ETDEWEB)

    Mo, M Y [Department of Mathematics, University of Bristol, University Walk, Bristol, BS8 ITW (United Kingdom)

    2008-10-03

    We have classified a tau function for the hypergeometric solutions of the Painleve VI equation constructed by Shah and Woodhouse (2006 J. Phys. A: Math. Gen. 39, 12265-9) through twistor methods. We have shown that the tau function is the product of a Toeplitz determinant and a power of the time variable t. In a suitable trivialization of the twistor bundle, the symbol of this Toeplitz determinant is the minus of the off-diagonal entry in the patching matrix. The method can also be applied to other solutions obtained from the Ward ansaetze.

  14. Nurse rostering at a Danish ward

    DEFF Research Database (Denmark)

    Bæklund, Jonas

    2014-01-01

    , and its linear relaxation is solved by means of column generation. The pricing sub-problem is to generate feasible schedules for the nurses and -- as a couple of different constraints including several special Danish regulations have to be observed -- is solved by constraint programming. A number......This paper considers a nurse rostering problem from a ward at a Danish hospital.  The problem is highly constrained and comprises a large set of different constraints. A branch-and-price method for solving the problem exactly is proposed. The master problem is to assign schedules to the nurses...

  15. Effects of turbulent mixing on critical behaviour in the presence of compressibility: renormalization group analysis of two models

    Energy Technology Data Exchange (ETDEWEB)

    Antonov, N V; Kapustin, A S, E-mail: nikolai.antonov@pobox.spbu.r [Department of Theoretical Physics, St Petersburg State University, Uljanovskaja 1, St Petersburg, Petrodvorez 198504 (Russian Federation)

    2010-10-08

    Critical behaviour of two systems, subjected to the turbulent mixing, is studied by means of the field theoretic renormalization group. The first system, described by the equilibrium model A, corresponds to the relaxational dynamics of a non-conserved order parameter. The second one is the strongly non-equilibrium reaction-diffusion system known as Gribov process and equivalent to the Reggeon field theory. The turbulent mixing is modelled by the Kazantsev-Kraichnan 'rapid-change' ensemble: time-decorrelated Gaussian velocity field with the power-like spectrum {approx}k{sup -d-{xi}}. Effects of compressibility of the fluid are studied. It is shown that, depending on the relation between the exponent {xi} and the spatial dimension d, both the systems exhibit four different types of critical behaviour, associated with four possible fixed points of the renormalization group equations. Three fixed points correspond to known regimes: Gaussian fixed point, original model without mixing and passively advected scalar field. The most interesting fourth point corresponds to a new type of critical behaviour, in which both nonlinearity and turbulent mixing are relevant, and the critical exponents depend on d, {xi} and the degree of compressibility. The critical exponents and regions of stability for all the regimes are calculated in the leading order of the double expansion in two parameters {xi} and {epsilon} = 4 - d. For both models, compressibility enhances the role of the nonlinear terms in the dynamical equations: the region in the {epsilon}-{xi} plane, where the new nontrivial regime is stable, is getting much wider as the degree of compressibility increases. For the incompressible fluid, the most realistic values d = 3 and {xi} = 4/3 (Kolmogorov turbulence) lie in the region of stability of the passive scalar regime. If the compressibility becomes strong enough, the crossover in the critical behaviour occurs, and these values of d and {xi} fall into the region

  16. Manganese Homeostasis in Group A Streptococcus Is Critical for Resistance to Oxidative Stress and Virulence

    Science.gov (United States)

    Turner, Andrew G.; Ong, Cheryl-lynn Y.; Gillen, Christine M.; Davies, Mark R.; West, Nicholas P.; McEwan, Alastair G.

    2015-01-01

    ABSTRACT Streptococcus pyogenes (group A Streptococcus [GAS]) is an obligate human pathogen responsible for a spectrum of human disease states. Metallobiology of human pathogens is revealing the fundamental role of metals in both nutritional immunity leading to pathogen starvation and metal poisoning of pathogens by innate immune cells. Spy0980 (MntE) is a paralog of the GAS zinc efflux pump CzcD. Through use of an isogenic mntE deletion mutant in the GAS serotype M1T1 strain 5448, we have elucidated that MntE is a manganese-specific efflux pump required for GAS virulence. The 5448ΔmntE mutant had significantly lower survival following infection of human neutrophils than did the 5448 wild type and the complemented mutant (5448ΔmntE::mntE). Manganese homeostasis may provide protection against oxidative stress, explaining the observed ex vivo reduction in virulence. In the presence of manganese and hydrogen peroxide, 5448ΔmntE mutant exhibits significantly lower survival than wild-type 5448 and the complemented mutant. We hypothesize that MntE, by maintaining homeostatic control of cytoplasmic manganese, ensures that the peroxide response repressor PerR is optimally poised to respond to hydrogen peroxide stress. Creation of a 5448ΔmntE-ΔperR double mutant rescued the oxidative stress resistance of the double mutant to wild-type levels in the presence of manganese and hydrogen peroxide. This work elucidates the mechanism for manganese toxicity within GAS and the crucial role of manganese homeostasis in maintaining GAS virulence. PMID:25805729

  17. Validation of nuclear criticality safety software and 27 energy group ENDF/B-IV cross sections. Revision 1

    Energy Technology Data Exchange (ETDEWEB)

    Lee, B.L. Jr. [Battelle, Columbus, OH (United States); D`Aquila, D.M. [Lockheed Martin Utility Services, Inc., Oak Ridge, TN (United States)

    1996-01-01

    The original validation report, POEF-T-3636, was documented in August 1994. The document was based on calculations that were executed during June through August 1992. The statistical analyses in Appendix C and Appendix D were completed in October 1993. This revision is written to clarify the margin of safety being used at Portsmouth for nuclear criticality safety calculations. This validation gives Portsmouth NCS personnel a basis for performing computerized KENO V.a calculations using the Lockheed Martin Nuclear Criticality Safety Software. The first portion of the document outlines basic information in regard to validation of NCSS using ENDF/B-IV 27-group cross sections on the IBM3090 at ORNL. A basic discussion of the NCSS system is provided, some discussion on the validation database and validation in general. Then follows a detailed description of the statistical analysis which was applied. The results of this validation indicate that the NCSS software may be used with confidence for criticality calculations at the Portsmouth Gaseous Diffusion Plant. For calculations of Portsmouth systems using the specified codes and systems covered by this validation, a maximum k{sub eff} including 2{sigma} of 0.9605 or lower shall be considered as subcritical to ensure a calculational margin of safety of 0.02. The validation of NCSS on the IBM 3090 at ORNL was extended to include NCSS on the IBM 3090 at K-25.

  18. High Mobility Group Box-1 Protein and Outcomes in Critically Ill Surgical Patients Requiring Open Abdominal Management

    Directory of Open Access Journals (Sweden)

    Michelle S. Malig

    2017-01-01

    Full Text Available Background. Previous studies assessing various cytokines in the critically ill/injured have been uninformative in terms of translating to clinical care management. Animal abdominal sepsis work suggests that enhanced intraperitoneal (IP clearance of Damage-Associated Molecular Patterns (DAMPs improves outcome. Thus measuring the responses of DAMPs offers alternate potential insights and a representative DAMP, High Mobility Group Box-1 protein (HMGB-1, was considered. While IP biomediators are being recognized in critical illness/trauma, HMGB-1 behaviour has not been examined in open abdomen (OA management. Methods. A modified protocol for HMGB-1 detection was used to examine plasma/IP fluid samples from 44 critically ill/injured OA patients enrolled in a randomized controlled trial comparing two negative pressure peritoneal therapies (NPPT: Active NPPT (ANPPT and Barker’s Vacuum Pack NPPT (BVP. Samples were collected and analyzed at the time of laparotomy and at 24 and 48 hours after. Results. There were no statistically significant differences in survivor versus nonsurvivor HMGB-1 plasma or IP concentrations at baseline, 24 hours, or 48 hours. However, plasma HMGB-1 levels tended to increase continuously in the BVP cohort. Conclusions. HMGB-1 appeared to behave differently between NPPT cohorts. Further studies are needed to elucidate the relationship of HMGB-1 and outcomes in septic/injured patients.

  19. Effectiveness of Compassionate Mind Training on Depression, Anxiety, and Self-Criticism in a Group of Iranian Depressed Patients

    Directory of Open Access Journals (Sweden)

    Fatemeh Noorbala

    2013-09-01

    Full Text Available Objective:The purpose of this study was to examine the effectiveness of compassionate mind training (CMT on symptoms of depression and anxiety in Iranian depressed sufferers .Method:Nineteen depressed patients aged 20 to 40 (Beck Depression Inventory value≥20 were randomly assigned into two groups. The experimental group participated in 12 sessions of group therapy based on Paul Gilbert’s manual of CMT. The control group was given no intervention. The participants were assessed by Beck Depression Inventory-II (BDI-II, Anxiety Scale (AS, and Levels of Self-Criticism (LSCS questionnaires at the beginning and immediately after the intervention. To follow-up the therapeutic effect of CMT, the three questionnaires were answered again by participants two months after the end of the intervention. Data were analyzed by independent samples ttest. Results:The results revealed that CMT significantly decreases depression (P<0.05 and anxiety score (P<0.05 in the follow-up study, but not immediately after the intervention. Although CMT decreased selfcriticism, this effect was marginally insignificant.Conclusion:The findings indicated that CMT could alleviatedepression and anxiety in a group of Iranian depressed patients.

  20. The full Ward-Takahashi Identity for colored tensor models

    CERN Document Server

    Pérez-Sánchez, Carlos I

    2016-01-01

    We derive the full $\\mathrm{U}(\\infty)$-Ward-Takahashi Identities for random colored tensor models. The strategy is to expand the free energy in boundary graphs that determine the combinatorics of the sources. This contributes to the organization of the correlation functions of colored tensor models and is carried out for arbitrary interactions of any rank, $D$, with subsequent focus on the $\\varphi^4$-theories. The result is that the boundary sector of quartic melonic interactions suffices to generate all $D$-colored graphs. For the rank-$3$ $\\varphi^4$-theory we derive the exact integral-like equation for the 2-point function. Our results hold for some Group Field Theories as well. Altogether, our non-perturbative approach trades graph theory for analytical methods.

  1. Effects of Random Environment on a Self-Organized Critical System: Renormalization Group Analysis of a Continuous Model

    Directory of Open Access Journals (Sweden)

    Antonov N.V.

    2016-01-01

    Full Text Available We study effects of the random fluid motion on a system in a self-organized critical state. The latter is described by the continuous stochastic model proposed by Hwa and Kardar [Phys. Rev. Lett. 62: 1813 (1989]. The advecting velocity field is Gaussian, not correlated in time, with the pair correlation function of the form ∝ δ(t − t′/k⊥d-1+ξ , where k⊥ = |k⊥| and k⊥ is the component of the wave vector, perpendicular to a certain preferred direction – the d-dimensional generalization of the ensemble introduced by Avellaneda and Majda [Commun. Math. Phys. 131: 381 (1990]. Using the field theoretic renormalization group we show that, depending on the relation between the exponent ξ and the spatial dimension d, the system reveals different types of large-scale, long-time scaling behaviour, associated with the three possible fixed points of the renormalization group equations. They correspond to ordinary diffusion, to passively advected scalar field (the nonlinearity of the Hwa–Kardar model is irrelevant and to the “pure” Hwa–Kardar model (the advection is irrelevant. For the special case ξ = 2(4 − d/3 both the nonlinearity and the advection are important. The corresponding critical exponents are found exactly for all these cases.

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

    Science.gov (United States)

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

    2011-04-01

    It is obvious that pharmacists play a critical role as risk managers in the healthcare system, especially in medication treatment. Hitherto, there is not a single multicenter-survey report describing the effectiveness of clinical pharmacists in preventing medical errors from occurring in the wards in Japan. Thus, we conducted a 1-month survey to elucidate the relationship between the number of errors and working hours of pharmacists in the ward, and verified whether the assignment of clinical pharmacists to the ward would prevent medical errors between October 1-31, 2009. Questionnaire items for the pharmacists at 42 national university hospitals and a medical institute included the total and the respective numbers of medication-related errors, beds and working hours of pharmacist in 2 internal medicine and 2 surgical departments in each hospital. Regardless of severity, errors were consecutively reported to the Medical Security and Safety Management Section in each hospital. The analysis of errors revealed that longer working hours of pharmacists in the ward resulted in less medication-related errors; this was especially significant in the internal medicine ward (where a variety of drugs were used) compared with the surgical ward. However, the nurse assignment mode (nurse/inpatients ratio: 1 : 7-10) did not influence the error frequency. The results of this survey strongly indicate that assignment of clinical pharmacists to the ward is critically essential in promoting medication safety and efficacy.

  3. Pragmatic, cluster randomized trial of a policy to introduce low-low beds to hospital wards for the prevention of falls and fall injuries.

    Science.gov (United States)

    Haines, Terry P; Bell, Rebecca A R; Varghese, Paul N

    2010-03-01

    To evaluate the efficacy of a policy to introduce low-low beds for the prevention of falls and fall injuries on wards that had not previously accessed low-low beds. This was a pragmatic, matched, cluster randomized trial with wards paired according to rate of falls. Intervention and control wards were observed for a 6-month period after implementation of the low-low beds on the intervention wards. Data from a 6-month period before this were also collected and included in analyses to ensure comparability between intervention and control group wards. Public hospitals located in Queensland, Australia. Patients of 18 public hospital wards. Provision of one low-low bed for every 12 on a hospital ward, with written guidance for identifying patients at greatest risk of falls. Falls and fall injuries in the hospital measured using a computerized incident reporting system. There were 10,937 admissions to control and intervention wards combined during the pre-intervention period. There was no significant difference in the rate of falls per 1,000 occupied bed days between intervention and control group wards after the introduction of the low-low beds (generalized estimating equation coefficient=0.23, 95% confidence interval=-0.18-0.65, P=.28). The rate of bed falls, falls resulting in injury, and falls resulting in fracture also did not differ between groups. Some difficulties were encountered in intervention group wards in using the low-low beds as directed. A policy for the introduction of low-low beds did not appear to reduce falls or falls with injury, although larger studies would be required to determine their effect on fall-related fractures.

  4. Relative deprivation between neighbouring wards is predictive of coronary heart disease mortality after adjustment for absolute deprivation of wards.

    Science.gov (United States)

    Allender, Steven; Scarborough, Peter; Keegan, Thomas; Rayner, Mike

    2012-09-01

    The aims of this study were to assess whether deprivation inequality at small area level in England is associated with coronary heart disease (CHD) mortality rates and to assess whether this provides evidence of an association between area-level and individual-level risk. Mortality rates for all wards in England were calculated using all CHD deaths between 2001 and 2006. Ward-level deprivation was measured using the Carstairs Index. Deprivation inequality within local authorities (LAs) was measured by the IQR of deprivation for wards within the LA. Relative deprivation for wards was measured as the modulus of the difference between deprivation for the ward and average deprivation for all neighbouring wards. Deprivation inequality within LAs was positively associated with CHD mortality rates per 100000 (eg, all men β; 95% CI=2.7; 1.1 to 4.3) after adjustment for absolute deprivation (pRelative deprivation for wards was positively associated with CHD mortality rates per 100000 (eg, all men 1.4; 0.7 to 2.1) after adjustment for absolute deprivation (prelative deprivation was independently associated with CHD mortality rates in both affluent and deprived wards. Rich wards surrounded by poor areas have higher CHD mortality rates than rich wards surrounded by rich areas, and poor wards surrounded by rich areas have worse CHD mortality rates than poor wards surrounded by poor areas. Local deprivation inequality has a similar adverse impact on both rich and poor areas, supporting the hypothesis that income inequality of an area has an impact on individual-level health outcomes.

  5. Exploration of staff attitudes and experiences towards mixed- and single-sex wards in the National Secure Forensic Service for Young People.

    Science.gov (United States)

    Crutchley, Michael; O'Brien, Aileen

    2012-10-01

    Mixed-sex wards in adult forensic secure services have been abolished and replaced by single-sex services. The National Secure Forensic Service for Young People (NSFSYP) continues to use a mixture of single-sex male and mixed-sex wards. This study aimed to explore staff experiences and attitudes towards placing young people in mixed- or single-sex wards in the NSFSYP. Mixed methodology was adopted in the form of focus groups (qualitative) and questionnaires (semi-quantitative). Content analyses of the qualitative data revealed five themes: care of female patients, normalization, safety, commissioning and social representation of women. The questionnaire was developed from the qualitative findings and comprised 22 statements measuring attitudes towards mixed- and single-sex wards. One hundred and forty-five questionnaires were returned: a 44% total response rate. Overall, the responses to the questionnaire confirmed the focus group data. There were statistically significant differences in responses between staff working on mixed- and single-sex wards. Staff working on mixed-sex wards felt that mixing genders on wards is a crucial part of adolescent forensic inpatient treatment. For them, mixed wards provide a more developmentally appropriate environment for young people. The needs of female patients broaden the debate beyond segregating and mixing gender.

  6. Implementing lean in a surgical ward

    DEFF Research Database (Denmark)

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

    of the lean implementation has been a 33% increase in patient throughput. The second flow is unchanged and concerned with non-standard and emergency procedures, e.g.., major hip surgery on old people or surgery on traffic victims. The surgeries within this flow are non-routine, unpredictable and cannot....... Stable and standardized processes ensure quality and predictability (e.g. process time). Leveling of production is essential for production planning. Based on the results of the case study of the surgical ward this paper will discuss three issues or challenges that emerged from the implementation of lean...... procedures to patients in need of complex emergency procedures. The primary result of the lean project has been to split the flow of patients in two. The first flow is concerned with highly standardized and non-emergency procedures, e.g. minor knee surgery. These surgeries are routine, predictable and can...

  7. Positioning and change in a hospital ward

    DEFF Research Database (Denmark)

    Kjærbeck, Susanne

    2017-01-01

    Purpose This paper focuses on communication about hygiene in a hospital ward and with the relevant infection control organization. The purpose of this paper is to examine the function of the hygiene coordinator as a key change agent and the communicative challenges and role conflicts implied in her...... to positional dilemmas regarding professional hierarchies and collegial relations. In order to have the hygiene coordinator gain authority and achieve empowerment in her function, additional documentation and training are needed, and communication efforts between the department management and the hygiene...... coordinator need strengthening. Furthermore, the hygiene area should be connected to the hospital's overarching purpose of saving lives. Originality/value These findings point to the importance of taking communication on the departmental level into consideration in relation to change strategies...

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

    LENUS (Irish Health Repository)

    Dhillon, P

    2012-02-01

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

  9. Effect of early achievement of physiologic resuscitation goals in septic patients admitted from the ward on the kidneys.

    NARCIS (Netherlands)

    Kiers, H.D.; Griesdale, D.E.; Litchfield, A.; Reynolds, S.; Gibney, R.T.; Chittock, D.; Pickkers, P.; Sweet, D.D.

    2010-01-01

    PURPOSE: The aim of the study was to evaluate if early achievement of physiologic goals of resuscitation in critically ill septic patients admitted from the ward may prevent acute kidney injury (AKI). MATERIALS AND METHODS: Patients admitted to the intensive care unit (ICU) with a diagnosis of sepsi

  10. Ward leadership: balancing the clinical and managerial roles.

    Science.gov (United States)

    Firth, Kate

    2002-04-01

    This qualitative study investigated ward managers' experiences of combining a clinical leadership role with the managerial and administrative parts of their job. Ward managers saw their main task as one of developing their staff and improving the quality of their service, yet found balancing their different roles problematic.

  11. Critical rearing parameters of Tetrastichus planipennisi (Hymenoptera: Eulophidae) as affected by host plant substrate and host-parasitoid group structure.

    Science.gov (United States)

    Duan, Jian J; Oppel, Craig

    2012-06-01

    In laboratory assays, we evaluated the potential impact of host plant substrate types, host-parasitoid group sizes (densities), and parasitoid-to-host ratios on select fitness parameters of the larval endoparasitoid Tetrastichus planipennisi Yang (Hymenoptera: Eulophidae), newly introduced for biological control of emerald ash borer, Agrilus planipennis Fairmaire (Coleoptera: Buprestidae), in the United States. Results from our study showed that offspring production and critical fitness parameters (body size and sex ratio) of T. planipennisi from parasitized emerald ash borer larvae are significantly influenced by host plant substrate type, host-parasitoid group size, parasitoid-to-host ratio, or a combination in the primary exposure assay. The number of both female and male T. planipennisi progeny was significantly greater when emerald ash borer larvae were inserted into tropical ash [Fraxinus uhdei (Wenz.) Lingelsh.] logs rather than green ash (Fraxinus pensylvanica Marshall). When maintained at a constant 1:1 parasitoid-to-host ratio, assays with larger host-parasitoid group sizes (3:3-12:12) produced significantly greater numbers of both male and female offspring per parental wasp compared with those with the single host-parasitoid (1:1) group treatment. As the parasitoid-to-host ratio increased from 1:1 to 8:1 in the assay, the average brood size (number of offspring per parasitized emerald ash borer larva) increased significantly, whereas the average brood sex ratio (female to male) changed from being female-biased (6:1) to male-biased (1:2); body size of female offspring as measured by the length of ovipositor and left hind tibia also was reduced significantly. Based on these findings, we suggest that the current method of rearing T. planipennisi with artificially infested-emerald ash borer larvae use the tropical ash logs for emerald ash borer insertion, a larger (> or = 3:3) host-parasitoid group size and 1:1 parasitoid-to-host ratio in the primary

  12. Bacteria contamination of touch surfaces in Polish hospital wards

    Directory of Open Access Journals (Sweden)

    Anna Różańska

    2017-08-01

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

  13. Critical Evaluation of Thermochemical Properties of C1-C4 Species: Updated Group-Contributions to Estimate Thermochemical Properties

    Science.gov (United States)

    Burke, S. M.; Simmie, J. M.; Curran, H. J.

    2015-03-01

    A review of literature on enthalpies of formation and molar entropies for alkanes, alkenes, alcohols, hydroperoxides, and their associated radicals has been compiled and critically evaluated. By comparing literature values, the overall uncertainty in thermochemical properties of small hydrocarbons and oxygenated hydrocarbons can be highlighted. In general, there is good agreement between heat of formation values in the literature for stable species; however, there is greater uncertainty in the values for radical species and for molar entropy values. Updated values for a group-additivity method for the estimation of thermochemical properties based on the evaluated literature data are proposed. The new values can be used to estimate thermochemical data for larger, combustion-relevant species for which no calculations or measurements currently exist, with increased confidence.

  14. Develop high quality nursing service and normalize management of neonatal ward

    Directory of Open Access Journals (Sweden)

    Hua YANG

    2014-08-01

    Full Text Available Objective: To tamp basic neonatal care, provide high quality nursing service, improve the quality of neonatal care, guarantee the safety of nursing care, achieve satisfactory project. Methods:Adjust the staff of the neonatal ward , optimize schedule; strengthen the training and knowledge; strengthen the supervision and ensure the basic nursing; the nursing quality management group work out the rate of incidence of high quality nursing service, the incidence rate of hospital infection of the newborn as well as the satisfaction of their families. Results: The different data between the control group and observation group was statistically significant ( P < 0.05 . Conclusion: Develop the neonatal ward of high quality nursing service, ensure the basic nursing implement, significantly improve the quality of nursing, reduce nursing adverse events and neonatal hospital infection incidence to" zero defects and zero tolerance", and that ensures nursing safety, and achieve the goal of " quality care demonstration project" --- patient satisfaction, social satisfaction, and government satisfaction.

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

    Science.gov (United States)

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

    2013-10-01

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

  16. The David and Goliath principle: cultural, ideological, and attitudinal underpinnings of the normative protection of low-status groups from criticism.

    Science.gov (United States)

    Jeffries, Carla H; Hornsey, Matthew J; Sutton, Robbie M; Douglas, Karen M; Bain, Paul G

    2012-08-01

    Two studies documented the "David and Goliath" rule--the tendency for people to perceive criticism of "David" groups (groups with low power and status) as less normatively permissible than criticism of "Goliath" groups (groups with high power and status). The authors confirmed the existence of the David and Goliath rule across Western and Chinese cultures (Study 1). However, the rule was endorsed more strongly in Western than in Chinese cultures, an effect mediated by cultural differences in power distance. Study 2 identified the psychological underpinnings of this rule in an Australian sample. Lower social dominance orientation (SDO) was associated with greater endorsement of the rule, an effect mediated through the differential attribution of stereotypes. Specifically, those low in SDO were more likely to attribute traits of warmth and incompetence to David versus Goliath groups, a pattern of stereotypes that was related to the protection of David groups from criticism.

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

    Science.gov (United States)

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

    2017-01-01

    Purpose. Effectiveness of nonpharmacological multicomponent prevention delivered by trained volunteers (medical and psychology students), targeted at delirium risk factors in geriatric inpatients, was assessed at an internal medicine ward in Poland. Patients and Methods. Participants were recruited to intervention and control groups at the internal medicine ward (inclusion criteria: age ≥ 75, acute medical condition, basic orientation, and logical contact on admission; exclusion criteria: life expectancy internal medicine ward.

  18. Comparison of maternal anxiety scores in pediatric intensive care unit and general ward parents

    Directory of Open Access Journals (Sweden)

    Lie Affendi Kartikahadi

    2012-02-01

    Full Text Available Background Hospitalization of a child is known to be a dreadful and stressful situation for parents. One study reported that admitting a child to a general ward caused mild anxiety to mothers, while admitting a child to the pediatric intensive care unit (PICU caused moderate anxiety to mothers. Objective To compare Hamilton anxiety scores of mothers whose children were admitted to the PICU to those of mothers whose children were admitted to the general ward. Methods A cross-sectional study was done on mothers of children aged 1 month-12 years. Children were admitted to either the intensive care unit or the general ward from October 2010-January 2011. All subjects were assessed by Hamilton anxiety scores and questioned for risk factors and other causes of maternal anxiety. Consecutive sampling was used to allocate the subjects. Differences were considered statistically significant for P < 0.05. Results Of the 72 subjects, the median Hamilton anxiety score in mothers of children admitted to the PICU was 20.5 (interquartile range 14-29.75, higher than that of mothers of children admitted to the general ward (14, interquartile range 9-16.75. Mann-Whitney U test revealed a statistically significant difference in scores between the two groups (P = 0.001. Ancova multivariate analysis showed the admission location to be the only significant relationship to Hamilton anxiety score (P = 0.0001. Conclusion Hamilton anxiety scores were higher for mothers of children admitted to the PICU than that of mothers with children admitted to the general ward. [Paediatr Indones.2012;52:95-8].

  19. Kibel groups and their dynamic perspective

    DEFF Research Database (Denmark)

    Heinskou, Torben

    2010-01-01

    wards into therapeutic communities? Leonard Fagin The relevance of the entire team to practicing groupwork on the ward. Bob Harris Acute wards: Context, pressures and satisfactions. Frank Holloway Reflections on the psychodynamics of an acute ward: Bion’s work in practice. Richard Duggins Containing...... the uncontainable: A role for staff support groups. Ian Simpson Groupwork: The evidence base. Chris Evans et al The working alliance in groupwork on acute psychiatric wards. Oded Manor Part 2: Specific Therapeutic Applications Specific Therapeutic Applications. Inpatient group therapy based on the Yalom......, the issues raised have a wider interest for those working to achieve excellent acute inpatient psychiatric settings in other countries. CONTENTS Part 1: Background and Principles What actually happens on acute wards? An observational study. Jonathan Radcliffe and Roger Smith Is it possible to make acute...

  20. Ward identity implies recursion relations in Yang-Mills theory

    Science.gov (United States)

    Chen, Gang

    2012-07-01

    The Ward identity in gauge theory constrains the behavior of the amplitudes. We discuss the Ward identity for amplitudes with a pair of shifted lines with complex momenta. This will induce a recursion relation identical to Britto-Cachazo-Feng-Witten recursion relations at the finite poles of the complexified amplitudes. Furthermore, according to the Ward identity, it is also possible to transform the boundary term into a simple form, which can be obtained by a new recursion relation. For the amplitude with one off-shell line in pure Yang-Mills theory, we find this technique is effective for obtaining the amplitude even when there are boundary contributions.

  1. Spectral functions in functional renormalization group approach -- analysis of the collective soft modes at the QCD critical point --

    CERN Document Server

    Yokota, Takeru; Morita, Kenji

    2016-01-01

    We first review the method to calculate the spectral functions in the functional renormalization group (FRG) approach, which has been recently developed. We also provide the numerical stability conditions given by the present authors for a generic nonlinear evolution equation that are necessary for obtaining the accurate effective potential from the flow equation in the FRG. As an interesting example, we report the recent calculation of the spectral functions of the mesonic and particle-hole excitations using a chiral effective model of Quantum Chromodynamics (QCD); we extract the dispersion relations from them and try to reveal the nature of the soft modes at the QCD critical point (CP) where the phase transition is second order. Our result shows that a clear development and the softening of the phonon mode in the space-like region as the system approaches the CP; furthermore it turns out that the sigma mesonic mode once in the time-like region gets to merge with the phonon mode in the close vicinity of the ...

  2. Assessing Economic Modulation of Future Critical Materials Use: The Case of Automotive-Related Platinum Group Metals.

    Science.gov (United States)

    Zhang, Jingshu; Everson, Mark P; Wallington, Timothy J; Field, Frank R; Roth, Richard; Kirchain, Randolph E

    2016-07-19

    Platinum-group metals (PGMs) are technological and economic enablers of many industrial processes. This important role, coupled with their limited geographic availability, has led to PGMs being labeled as "critical materials". Studies of future PGM flows have focused on trends within material flows or macroeconomic indicators. We complement the previous work by introducing a novel technoeconomic model of substitution among PGMs within the automotive sector (the largest user of PGMs) reflecting the rational response of firms to changing prices. The results from the model support previous conclusions that PGM use is likely to grow, in some cases strongly, by 2030 (approximately 45% for Pd and 5% for Pt), driven by the increasing sales of automobiles. The model also indicates that PGM-demand growth will be significantly influenced by the future Pt-to-Pd price ratio, with swings of Pt and Pd demand of as much as 25% if the future price ratio shifts higher or lower even if it stays within the historic range. Fortunately, automotive catalysts are one of the more effectively recycled metals. As such, with proper policy support, recycling can serve to meet some of this growing demand.

  3. Infantile diarrhea in the Pediatric Ward of Dr. Pirngadi Hospital Medan.

    Science.gov (United States)

    Metrizal; Sinuhaji, A B; Sutanto, A H

    1991-01-01

    A retrospective study was done on infants with diarrhea who were hospitalized at the Pediatric ward of Dr. Pirngadi Hospital, Medan in a period of one year (January 1 to December 31, 1986). There were 3317 hospitalized patients and 1506 (45.40%) of them had diarrhea. Of these, 773 (51.32%) were in the age group of under 2 years. Thirty eight patients (4.91%) with infantile diarrhea died and prolonged diarrhea was found in 54 (6.98%) cases.

  4. Teaching strategies used by internal medicine residents on the wards.

    Science.gov (United States)

    Smith, Dustin T; Kohlwes, R Jeffrey

    2011-01-01

    Residents serve as teachers to interns and students in most internal medicine residency programs. The purpose of our study is to explore what internal medicine residents perceive as effective teaching strategies in the inpatient setting and to formulate a guideline for preparing residents to lead their ward teams. Housestaff identified as excellent teaching residents were recruited from a large internal medicine residency program. Focus groups were formed and interviews were conducted using open-ended questions. Transcripts of the interviews were reviewed, analyzed, and compared for accuracy by two investigators. The transcripts were then coded to categorize data into similar subjects from which recurrent themes in resident teaching were identified. Twenty-two residents participated in four focus group interviews held in 2008. We identified five principal themes for effective teaching by residents: (T)aking advantage of teaching opportunities, (E)mpowering learners, (A)ssuming the role of leader, (C)reating a learning environment, and (H)abituating the practice of teaching. Strategies for effective teaching by residents exist. The TEACH mnemonic is a resident-identified method of instruction. Use of this tool could enable residency programs to create instructional curricula to prepare their residents and interns to take on the roles of team leaders and teachers.

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

    Science.gov (United States)

    ... https://medlineplus.gov/news/fullstory_162758.html On Hospital Wards, Patient Crises May Have 'Domino Effect' When ... should serve as a wake-up call for hospital-based physicians," study author Dr. Matthew Churpek, an ...

  6. Developing skills in clinical leadership for ward sisters.

    Science.gov (United States)

    Fenton, Katherine; Phillips, Natasha

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

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

    Science.gov (United States)

    Fernandes, Darren; Eneje, Philip

    2017-01-01

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

  8. Noise Pollution in Intensive Care Units and Emergency Wards

    Directory of Open Access Journals (Sweden)

    Gholamreza Khademi

    2011-03-01

    Full Text Available Introduction: The improvement of technology has increased noise levels in hospital Wards to higher than international standard levels (35-45 dB. Higher noise levels than the maximum level result in patient’s instability and dissatisfaction. Moreover, it will have serious negative effects on the staff’s health and the quality of their services. The purpose of this survey is to analyze the level of noise in intensive care units and emergency wards of the Imam Reza Teaching Hospital, Mashhad. Procedure: This research was carried out in November 2009 during morning shifts between 7:30 to 12:00. Noise levels were measured 10 times at 30-minute intervals in the nursing stations of 10 wards of the emergency, the intensive care units, and the Nephrology and Kidney Transplant Departments of Imam Reza University Hospital, Mashhad. The noise level in the nursing stations was tested for both the maximum level (Lmax and the equalizing level (Leq. The research was based on the comparison of equalizing levels (Leq because maximum levels were unstable. Results: In our survey the average level (Leq in all wards was much higher than the standard level. The maximum level (Lmax in most wards was 85-86 dB and just in one measurement in the Internal ICU reached 94 dB. The average level of Leq in all wards was 60.2 dB. In emergency units, it was 62.2 dB, but it was not time related. The highest average level (Leq was measured at 11:30 AM and the peak was measured in the Nephrology nursing station. Conclusion:  The average levels of noise in intensive care units and also emergency wards were  more than the standard levels and as it is known these wards have vital roles in treatment procedures, so more attention is needed in this area.

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

    Science.gov (United States)

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

    2015-06-01

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

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

    Science.gov (United States)

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

    2012-01-01

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

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

    Science.gov (United States)

    Dean, Linda; Black, Sharon

    This paper reports on a study of experiences of young people aged 14 to 18 years who were nursed on acute adult hospital wards in NHS hospitals in England. In spite of British government guidelines, young people from 14 years of age continue to be admitted to adult wards in the UK. Although much has been written about the transition of the young person to adult services, there is little research about the experiences of young people who are nursed on adult wards. Hermeneutic phenomenology was used to explore the lived experiences of eight young people who had been nursed on adult wards between 2004 and 2010. Data were collected in 2010. In-depth interviews were recorded, transcribed and analysed using Colaizzi's framework ( Colaizzi, 1978 ). Themes explored included expectations of what the experience may be like, young people's first impressions of the ward environment, the feelings of the young person while in hospital, the attitudes of people towards them including, both staff and other patients, and future admissions and how they would cope with readmissions. Better provision needs to be made for young people including appropriately trained staff, adolescent-friendly environments and areas in adult wards that are dedicated to adolescents.

  12. Study of the effect of humanistic nursing care model wards in Children Caring Ward School on the nurses' caring ability

    Directory of Open Access Journals (Sweden)

    Jiao He

    2016-03-01

    Conclusions: The humanistic nursing care model wards in CCWS has a positive effect on the nurses' caring ability, not only to help build great relationships between nurses and patients but also to enhance the patients' satisfaction.

  13. Study of the effect of humanistic nursing care model wards in Children Caring Ward School on the nurses' caring ability

    Institute of Scientific and Technical Information of China (English)

    Jiao He; De-Ying Hu; Yi-Lan Liu; Li-Fen Wu; Lian Liu

    2016-01-01

    Objective: To understand the effect of humanistic nursing care model wards in Children Caring Ward School (CCWS) on the nurses' caring ability. Methods: Questionnaire 25 nurses of humanistic nursing care model wards in CCWS using the Nkongho Caring Ability Inventory (CAI) before and after implement the humanistic nursing care model, including reform the systems of nursing care, introduce humanistic care model, implement the humanistic care, to measure the nurses' caring ability. Results: The nurses' caring ability had significantly developed on total, cognition dimension, courage dimension and patience dimension after all measures considered (p Conclusions: The humanistic nursing care model wards in CCWS has a positive effect on the nurses' caring ability, not only to help build great relationships between nurses and patients but also to enhance the patients' satisfaction.

  14. Analysis of core–periphery organization in protein contact networks reveals groups of structurally and functionally critical residues

    Indian Academy of Sciences (India)

    Arnold Emerson Isaac; Sitabhra Sinha

    2015-10-01

    The representation of proteins as networks of interacting amino acids, referred to as protein contact networks (PCN), and their subsequent analyses using graph theoretic tools, can provide novel insights into the key functional roles of specific groups of residues. We have characterized the networks corresponding to the native states of 66 proteins (belonging to different families) in terms of their core–periphery organization. The resulting hierarchical classification of the amino acid constituents of a protein arranges the residues into successive layers – having higher core order– with increasing connection density, ranging from a sparsely linked periphery to a densely intra-connected core (distinct from the earlier concept of protein core defined in terms of the three-dimensional geometry of the native state, which has least solvent accessibility). Our results show that residues in the inner cores are more conserved than those at the periphery. Underlining the functional importance of the network core, we see that the receptor sites for known ligand molecules of most proteins occur in the innermost core. Furthermore, the association of residues with structural pockets and cavities in binding or active sites increases with the core order. From mutation sensitivity analysis, we show that the probability of deleterious or intolerant mutations also increases with the core order. We also show that stabilization centre residues are in the innermost cores, suggesting that the network core is critically important in maintaining the structural stability of the protein. A publicly available Web resource for performing core–periphery analysis of any protein whose native state is known has been made available by us at http://www.imsc.res.in/ ~ sitabhra/proteinKcore/index.html.

  15. Critical appraisal of the International Study Group of Pancreatic Surgery (ISGPS) consensus definition of postoperative hemorrhage after pancreatoduodenectomy.

    Science.gov (United States)

    Welsch, Thilo; Eisele, Hanna; Zschäbitz, Stefanie; Hinz, Ulf; Büchler, Markus W; Wente, Moritz N

    2011-08-01

    Postpancreatectomy hemorrhage (PPH) is one of the most serious complications after pancreatoduodenectomy (PD). This study analyzed and validated the International Study Group of Pancreatic Surgery (ISGPS) definition of PPH and aimed to identify risk factors for early (<24 h) and late PPH. Patients who underwent PD for pancreatic head tumors between 2001 and 2008 were included and complications were prospectively recorded. Factors associated with PPH were assessed by uni- and multivariate analysis. Complete datasets were available for 796 patients. Classic and pylorus-preserving PD was performed in 13.8% and 86.2% of the patients, respectively. According to the ISGPS definition, PPH occurred in 29.1% of the cases (232 of 796 patients): 4.8% grade A, 15.2% grade B, and 9.2% grade C. The definition is based largely on surrogate markers (e.g., transfusion requirement) that are affected by other critical illnesses and more than 97% of patients with mild PPH had no clinical signs of bleeding. The need for postoperative intensive care as well as the incidence of pancreatic fistula, relaparotomy, and mortality rates significantly increased from grades A to C. Thirty-seven patients (4.6%) required interventional (endoscopy or angiography) and/or relaparotomy for PPH. Relaparotomy for PPH was performed in 3.1% of all patients. Independent risk factors for early PPH were preoperative anemia (hemoglobin, <11 mg/dl) and multivisceral resection while advanced age, chronic renal insufficiency, increased blood loss, and long operation time were associated with late PPH. The ISGPS definition of PPH is feasible and applicable but produces a high rate of false positive mild PPH cases. The different grades still significantly correlate with relevant outcome variables, thus the definition discriminates postoperative courses, but a minor modification of the definition of mild PPH is suggested. The new results further demonstrate the need to optimize preoperative anemia and chronic renal

  16. Magnetic transition from the paramagnetic to long-period structure in RMn2O5 multiferroics: Renormalization group analysis of critical behavior

    Science.gov (United States)

    Men'shenin, V. V.

    2013-06-01

    A transition from the paramagnetic state to a long-period magnetic structure with an incommensurate wave vector along one crystallographic axis in RMn2O5 multiferroics is considered. An effective Hamiltonian for these oxides is constructed with allowance for spin fluctuations. Critical points are found, and their stability is analyzed using the renormalization group approach. It is shown that critical fluctuations in these compounds admit a second-order phase transition with respect to a multicomponent order parameter.

  17. Adverse incidents, patient flow and nursing workforce variables on acute psychiatric wards: the Tompkins Acute Ward Study

    OpenAIRE

    Bowers, L.; Allan, T.; Simpson, A.; Nijman, H; Warren, J.

    2007-01-01

    Background: Adverse incidents (violence, self-harm and absconding) can cause significant harm to patients and staff, are difficult to predict, and are driving an increase in security measures and defensive practice.\\ud \\ud Aims: To explore the relationship between adverse incidents on acute psychiatric wards, admissions and nursing workforce variables.\\ud \\ud Methods: A retrospective analysis of officially collected data covering a period of 30 months on 14 acute wards at three hospitals. Thi...

  18. Intussusception at the pediatric ward of Dr. Pirngadi Hospital, Medan.

    Science.gov (United States)

    Lubis, A H; Sinuhaji, A B; Sutanto, A H; Yosodiharjo, A

    1990-01-01

    A retrospective study had been conducted on hospitalized infants and children in the Pediatric ward of Dr. Pirngadi Hospital, Medan from January 1, 1987 through December 31, 1988. The purpose is to assess the incidence and clinical manifestations of intussusception. During the same period, there were 6484 infants and children hospitalized, 39 (0.6%) with intussusception, consisting of 23 (58.9%) males and (41.1%) females. Most of the cases (53.85%) were in age group of 4-6 months. Thirty four patients (87.12%) were wellnourished, and 5 patients (12.82%) undernourished. The major symptoms of intussusception were bloody diarrhoea (87.17%), vomiting (82.05%) and abdominal distention (66.41%). Successful reposition with barium enema occurred in 1 (20%) out of 5 patients. The major symptoms of intussusception were bloody diarrhoea (87.17%), vomiting. Surgical intervention was performed in 22 patients (56.41%). The result was as follows: discharged in good condition in 15 (68.18%) and deaths occurred in the remaining cases (7 cases = 31.82%). Of those 7 cases who died after operation, 2 cases were hospitalized in less than 2 days, 3 cases in less than 3 days and the remaining 2 cases in more than 3 days, after the symptoms developed.

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

    Directory of Open Access Journals (Sweden)

    Haug Jon B

    2011-12-01

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

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

    Science.gov (United States)

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

    2010-08-25

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

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

    Science.gov (United States)

    Thompson, George A.

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

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

    Science.gov (United States)

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

    2014-12-01

    Quality improvement (QI) Programmes, like the Productive Ward: Releasing-time-to-care initiative, aim to 'engage' and 'empower' ward teams to actively participate, innovate and lead quality improvement at the front line. However, little is known about the relationship and impact that QI work has on the 'engagement' of the clinical teams who participate and vice-versa. This paper explores and examines the impact of a large-scale QI programme, the Productive Ward, on the 'work engagement' of the nurses and ward teams involved. Using the Utrecht Work Engagement Scale (UWES), we surveyed, measured and analysed work engagement in a representative test group of hospital-based ward teams who had recently commenced the latest phase of the national 'Productive Ward' initiative in Ireland and compared them to a control group of similar size and matched (as far as is possible) on variables such as ward size, employment grade and clinical specialty area. 338 individual datasets were recorded, n=180 (53.6%) from the Productive Ward group, and n=158 (46.4%) from the control group; the overall response rate was 67%, and did not differ significantly between the Productive Ward and control groups. The work engagement mean score (±standard deviation) in the Productive group was 4.33(±0.88), and 4.07(±1.06) in the control group, representing a modest but statistically significant between-group difference (p=0.013, independent samples t-test). Similarly modest differences were observed in all three dimensions of the work engagement construct. Employment grade and the clinical specialty area were also significantly related to the work engagement score (pengagement (the vigour, absorption and dedication) of ward-based teams. The use and suitability of the UWES as an appropriate measure of 'engagement' in QI interventions was confirmed. The engagement of nurses and front-line clinical teams is a major component of creating, developing and sustaining a culture of improvement. Copyright

  3. Occurrence of hypoxia in the wards of a teaching hospital

    Directory of Open Access Journals (Sweden)

    Virendra Singh

    2012-01-01

    Full Text Available Objective : Appearance of hypoxia in a patient may be an indicator of a serious medical condition that can have grave consequences. Clinical evaluation fails to detect majority of the patients of hypoxia, and therefore, it may remain unnoticed in the wards. We planned to assess the magnitude of hypoxia in different wards of our tertiary care hospital. Materials and Methods: We studied all the patients admitted in various medical and surgical wards during 1 week of study. Oxygen saturation (SpO 2 was measured with the help of a pulse oximeter in all the patients who remained admitted for at least 24 h. Hypoxia was diagnosed in a patient when he had SpO 2 less than 90%. Results: During the study period, 1167 patients were admitted in various wards of the hospital. Hypoxia was detected in 121 patients (10.36%. Among them, 7 (0.59% patients were already having a diagnosis of respiratory failure, but were not on oxygen therapy while 5 (0.42% patients were having SpO 2 less than 90% despite of oxygen therapy. In 109 (9.34% patients, hypoxia was detected incidentally. Conclusion: Unnoticed hypoxia was detected in a significant number of the patients admitted in the wards of the hospital. Therefore, it is concluded that oxygen saturation measurements should be included with other vital parameters like pulse, temperature, and blood pressure, in the monitoring chart of all the admitted patients.

  4. Ward Valley status report: Science versus politics. Which will win?

    Energy Technology Data Exchange (ETDEWEB)

    Pasternak, A.D. [California Radioactive Materials Management Forum, Lafayette, CA (United States)

    1996-10-01

    The State of California has issued a license to US Ecology, Inc. to construct and operate a disposal facility for low-level radioactive waste (LLRW) at the remote, arid Ward Valley site in the Mojave Desert. The license and certification of the associated environmental documentation have been upheld by the California courts. The Ward Valley license is the first and, so far, only license to be issued for a new LLRW disposal facility pursuant to the Low-Level Radioactive Waste Policy Act enacted in 1980 and amended in 1985. However, the dates of construction and operation of the disposal facility are uncertain because the federal government has refused to sell land in Ward Valley to the State of California for the site of the Southwestern Compact`s regional disposal facility. The Clinton Administration`s repeated excuses for delaying the land transfer, and the circumstances of these delays, indicate that prospects for success of the Ward Valley project, and perhaps the Policy Act itself, depend on the outcome of a battle between science and politics. In view of these delays by the administration, Congressional action to Transfer the Ward Valley lands to California will serve both state and federal goals for safe disposal of LLRW.

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

    Science.gov (United States)

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

    2015-01-01

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

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

    Science.gov (United States)

    Sternal, Danuta; Wilczyński, Krzysztof; Szewieczek, Jan

    2017-01-01

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

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

    Science.gov (United States)

    Sternal, Danuta; Wilczyński, Krzysztof; Szewieczek, Jan

    2017-01-01

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

  8. Quality Improvement Project to Improve Timeliness Between Bronchodilator Treatments from Emergency Department to Medical Wards.

    Science.gov (United States)

    Cockerham, Jennifer R; Lowe, Gary R; Willis, Randy; Stecks, Ryan M; Berlinski, Ariel

    2016-12-01

    Quality improvement methodology was applied to study sporadic reports that patients with asthma were not given bronchodilator treatments or assessed within an appropriate time frame when they were admitted from the emergency department to the medical ward. The goal was to increase the number of patients who had an interval between emergency department assessment/bronchodilator treatment and medical ward assessment/treatment of flow chart diagram, a fishbone diagram, data collection, intervention implementation, and data monitoring and analysis were used in this study. Data were collected on a pre-test of change cohort of 227 subjects with asthma from January 2013 to March 2014. A test of change adding a Q2H respiratory therapist assessment and as needed bronchodilator treatment order while the subject was in the emergency department was implemented during May of 2014. These data were compared with a post-test of change cohort of 278 subjects with asthma from May 2014 to July 2015. Data collection for both cohorts included the time from the last assessment/bronchodilator treatment in the emergency department to emergency department discharge, the time from emergency department discharge to assessment/treatment in the medical ward, and the sum of these 2 time periods. Mean times (minutes) were noted, and comparisons were made using 2-tailed independent t tests with significance set at P process control charts. There was a 124% increase noted in the percentage of subjects who received bronchodilator treatment within 120 min, a 53% increase within 180 min, and a 19% increase within 240 min. The interval time between treatments decreased 21%. Through quality improvement methodology, the group was able to significantly decrease the time between the last assessment/bronchodilator treatment in the emergency department and the first assessment/treatment in the medical ward for subjects with asthma. Moreover, improvement was seen in all studied parameters despite similar

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

    Directory of Open Access Journals (Sweden)

    A. Kumar Chandra Gupta

    2017-09-01

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

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

    Science.gov (United States)

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

    2017-09-01

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

  11. Validation of the Monte Carlo criticality program KENO IV and the Hansen-Roach sixteen-energy-group-cross sections for high-assay uranium systems. [KENO IV criticality code

    Energy Technology Data Exchange (ETDEWEB)

    Handley, G. R.; Masters, L. C.; Stachowiak, R. V.

    1981-04-10

    Validation of the Monte Carlo criticality code, KENO IV, and the Hansen-Roach sixteen-energy-group cross sections was accomplished by calculating the effective neutron multiplication constant, k/sub eff/, of 29 experimentally critical assemblies which had uranium enrichments of 92.6% or higher in the uranium-235 isotope. The experiments were chosen so that a large variety of geometries and of neutron energy spectra were covered. Problems, calculating the k/sub eff/ of systems with high-uranium-concentration uranyl nitrate solution that were minimally reflected or unreflected, resulted in the separate examination of five cases.

  12. Examining the Use of Video Study Groups for Developing Literacy Pedagogical Content Knowledge of Critical Elements of Strategy Instruction with Elementary Teachers

    Science.gov (United States)

    Shanahan, Lynn E.; Tochelli, Andrea L.

    2014-01-01

    This collective case study explored what nine elementary teachers' video study group discussions revealed about their understanding of pedagogical content knowledge for an explicit reading strategy instruction framework, Critical Elements of Strategy Instruction (CESI). Qualitative methods were used to inductively and deductively analyze…

  13. Drug dispensing errors in a ward stock system

    DEFF Research Database (Denmark)

    Andersen, Stig Ejdrup

    2010-01-01

    The aim of this study was to determine the frequency of drug dispensing errors in a traditional ward stock system operated by nurses and to investigate the effect of potential contributing factors. This was a descriptive study conducted in a teaching hospital from January 2005 to June 2007. In five....... Multivariable analysis showed that surgical and psychiatric settings were more susceptible to involvement in dispensing errors and that polypharmacy was a risk factor. In this ward stock system, dispensing errors are relatively common, they depend on speciality and are associated with polypharmacy...... wards, samples of dispensed solid drugs were collected prospectively and compared with the prescriptions. Data were evaluated using multivariable logistic regression. Overall, 2173 samples were collected, 95.5% of which were correctly dispensed (95% CI 94.5-96.2). In total, 124 errors in 6715...

  14. Creating a simulated Mental Health Ward: lessons learned.

    Science.gov (United States)

    Rossetti, Jeanette; Musker, Kathleen; Smyth, Siobhan; Byrne, Evelyn; Maney, Catherine; Selig, Kristen; Jones-Bendel, Trish

    2014-10-01

    The future of psychiatric-mental health nursing depends on the preparation of nurses who will meet the mental health care needs of society. The current article discusses the development of the "Mental Health Ward," a simulated mental health experience that was offered for the first time to undergraduate baccalaureate nursing students at a Midwestern university in the United States. The Mental Health Ward is an innovative simulated hospital environment that includes the use of standardized patients and role play scenarios, resulting in a full mission simulation whereby students learn various psychiatric diagnoses and practice various pertinent skills, including nursing assessments, admission and discharge processes, medication administration, and therapeutic communication. Lessons learned by faculty and students in formulating the Mental Health Ward are presented.

  15. Identifying Patients With Sepsis on the Hospital Wards.

    Science.gov (United States)

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

    2017-04-01

    Sepsis contributes to up to half of all deaths in hospitalized patients, and early interventions, such as appropriate antibiotics, have been shown to improve outcomes. Most research has focused on early identification and treatment of patients with sepsis in the ED and the ICU; however, many patients acquire sepsis on the general wards. The goal of this review is to discuss recent advances in the detection of sepsis in patients on the hospital wards. We discuss data highlighting the benefits and limitations of the systemic inflammatory response syndrome (SIRS) criteria for screening patients with sepsis, such as its low specificity, as well as newly described scoring systems, including the proposed role of the quick sepsis-related organ failure assessment (qSOFA) score. Challenges specific to detecting sepsis on the wards are discussed, and future directions that use big data approaches and automated alert systems are highlighted. Copyright © 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

  16. Kibel groups and their dynamic perspective

    DEFF Research Database (Denmark)

    Heinskou, Torben

    2010-01-01

    -therapists. Jack Nathan and Wil Pennycook-Graves Applying the Kanas Method on an acute ward. Ronan McIvor and Wil Pennycook-Graves Kibel groups and their dynamic perspective. Torben Heinskou Psychodynamic discussion groups on acute wards. Jonathan Radcliffe and Debora Diamond Using groups to provide containment...... and structure on an adolescent acute ward. Dylan Griffiths Moving groupwork into the day hospital setting. Isaura Manso Neto ABOUT THE EDITORS Jonathan Radcliffe, Katja Hajek, and Jerome Carson are Consultant Clinical Psychologists with the South London and Maudsley NHS Foundation Trust All have run groups...

  17. The application of heterogeneous cluster grouping to reflective writing for medical humanities literature study to enhance students' empathy, critical thinking, and reflective writing.

    Science.gov (United States)

    Liao, Hung-Chang; Wang, Ya-Huei

    2016-09-02

    To facilitate interdisciplinary collaboration and to make connections between patients' diseases and their social/cultural contexts, the study examined whether the use of heterogeneous cluster grouping in reflective writing for medical humanities literature acquisition could have positive effects on medical university students in terms of empathy, critical thinking, and reflective writing. A 15-week quasi-experimental design was conducted to investigate the learning outcomes. After conducting cluster algorithms, heterogeneous learning clusters (experimental group; n = 43) and non-heterogeneous learning clusters (control group; n = 43) were derived for a medical humanities literature study. Before and after the intervention, an Empathy Scale in Patient Care (ES-PC), a critical thinking disposition assessment (CTDA-R), and a reflective writing test were administered to both groups. The findings showed that on the empathy scale, significant differences in the "behavioral empathy," "affective empathy," and overall sections existed between the post-test mean scores of the experimental group and those of the control group, but such differences did not exist in "intelligent empathy." Regarding critical thinking, there were significant differences in "systematicity and analyticity," "skepticism and well-informed," "maturity and skepticism," and overall sections. As for reflective writing, significant differences existed in "ideas," "voice and point of view," "critical thinking and representation," "depth of reflection on personal growth," and overall sections, but not in "focus and context structure" and "language and conventions." This study outlined an alternative for using heterogeneous cluster grouping in reflective writing about medical humanities literature to facilitate interdisciplinary cooperation to provide more humanizing medical care.

  18. Effects of discontinuing cover gowns on a postpartal ward upon cord colonization of the newborn.

    Science.gov (United States)

    Renaud, M T

    1983-01-01

    To determine if the incidence of bacterial cord colonization in neonates increased when cover gowns were discontinued on a postpartal ward, a study was conducted. All infants who were admitted to and discharged from the well infant nursery at an Army medical center in Denver, Colorado, were cultured at the umbilicus at the time of admission and at discharge. The control group (N = 74) continued to gown as usual; the experimental group (N = 50) did not wear gowns. Visitors in both groups received the same instructions regarding handwashing. For all organisms, the control group demonstrated 80% colonization of infants who were negative on admission, and the experimental group demonstrated a colonization rate of 62%. When the chi square is applied, these data are statistically significant for P = 0.02 and P = 0.05. The experimental group had less colonization than the control group.

  19. Dynamic isolation technologies in negative pressure isolation wards

    CERN Document Server

    Xu, Zhonglin

    2017-01-01

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

  20. Ward-type Data Flow Diagram Simulating System

    OpenAIRE

    Arisawa, Makoto; Iwatani, Yasuaki; Kato, Juniji

    1989-01-01

    In the present paper we discuss about a Ward-type Data Flow Diagram Simulating System that we implemented. The system works on NEC PC9801/VX personal computer with a mouse. It consists of two parts, DFD editor and DFD Interpreter. The DFD Editor is to draw Ward-type DFD's along with Mini Spec. in the form of Finite State Automaton and Guarded Command. The DFD Interpreter is to simulate the parallel process interactions and to output the results. We have a simple assumption that time sequence ...

  1. Holographic Ward identities: Examples from 2+1 gravity

    CERN Document Server

    Bañados, M; Banados, Maximo; Caro, Rodrigo

    2004-01-01

    In the AdS/CFT correspondence the boundary Ward identities are encoded in the bulk constraints. We study the three-dimensional version of this result using the Chern-Simons formulation of gravity. Due the metric boundary conditions the conformal identities cannot be derived in a straightforward way from the chiral ones. We pay special attention to this case and find the necessary modifications to the chiral currents in order to find the two Virasoro operators. The supersymmetric Ward identities are studied as well.

  2. Modelling of coughed droplets in a hospital ward

    DEFF Research Database (Denmark)

    Sadrizadeh, Sasan; Nielsen, Peter Vilhelm

    2016-01-01

    Coughing and its importance for spreading respiratory infectious diseases has been confirmed in many previous studies. The dispersion process of respiratory droplets released by the coughing of a patient in a hospital ward was studied using computational fluid dynamics simulation. Two relatively...... realistic three-dimensional thermal mannequins with a parallel bed arrangement simulated the patients. The maximum dispersion distances in time under ward ventilation conditions were studied. A velocity profile simulated a time-dependent cough with total duration of 0.4 s. The results indicated...

  3. [Job stress and burnout among nurses and care workers in psychiatric wards].

    Science.gov (United States)

    Fukuzaki, Toshiki; Tanihara, Hiroyuki

    2014-01-01

    To demonstrate the actual state of job stress and burnout among nurses and care workers working in psychiatric wards by comparing them with those who serve in internal medicine wards. A survey was conducted of female ward nurses and care workers working at two psychiatric hospitals and two general hospitals in the Chugoku area using the brief job stress questionnaire and the Maslach burnout inventory-Japanese version. A total of 232 female nurses and care workers were analyzed, 125 from psychiatric wards and 107 from internal medicine wards. Job stressors of stress due to workplace environment, job control, skill utilization, job aptitude and worthwhileness of working life were significantly greater in psychiatric wards than in internal medicine wards. Stress of quantitative and qualitative workloads, however, was significantly lower in psychiatric wards than in internal medicine wards. For job stress reaction, vigor was significantly lower in psychiatric wards than in internal medicine wards. For burnout, psychiatric wards scored significantly higher in depersonalization and reduced personal accomplishment compared with internal medicine wards. Reviewing these results and their association with stress control policy in psychiatric wards, we suggest that three factors are important: maintaining working environment, enhancing conferences, and providing learning opportunities.

  4. Group Dynamics as a Critical Component of Successful Space Exploration: Conceptual Theory and Insights from the Biosphere 2 Closure Experiment

    Science.gov (United States)

    Nelson, Mark; Allen, John P.

    As space exploration and eventually habitation achieves longer durations, successfully managing group dynamics of small, physically isolated groups will become vital. The paper summarizes important underlying research and conceptual theory and how these manifested in a well-documented example: the closure experiments of Biosphere 2. Key research breakthroughs in discerning the operation of small human groups comes from the pioneering work of W.R. Bion. He discovered two competing modalities of behavior. The first is the “task-oriented” or work group governed by shared acceptance of goals, reality-thinking in relation to time, resources and rational, and intelligent management of challenges presented. The opposing, usually unconscious, modality is what Bion called the “basic-assumption” group and alternates between three “group animal” groups: dependency/kill the leader; fight/flight and pairing. If not dealt with, these dynamics work to undermine and defeat the conscious task group’s goal achievement. The paper discusses crew training and selection, various approaches to structuring the work and hierarchy of the group, the importance of contact with a larger population through electronic communication and dealing with the “us-them” syndrome frequently observed between crew and Mission Control. The experience of the first two year closure of Biosphere 2 is drawn on in new ways to illustrate vicissitudes and management of group dynamics especially as both the inside team of biospherians and key members of Mission Control had training in working with group dynamics. Insights from that experience may help mission planning so that future groups in space cope successfully with inherent group dynamics challenges that arise.

  5. Nurse health-related quality of life: associations with patient and ward characteristics in Japanese general acute care wards.

    Science.gov (United States)

    Oyama, Yumiko; Yonekura, Yuki; Fukahori, Hiroki

    2015-09-01

    To investigate the factors affecting nurse health-related quality of life (HRQOL) by considering the patient characteristics and ward characteristics. Nurse health-related quality of life is an important health outcome, and should be promoted for quality nursing care. This cross-sectional study was conducted on nurses who work in general acute care wards in three university hospitals in metropolitan Japan. Multilevel analysis was conducted to investigate possible factors related to nurse health-related quality of life. Nurses who worked at a ward had a significantly lower physical health score (β = -0.13, P characteristics. Further large-scale studies are needed in order to investigate the effect of hospital characteristics on nurse health-related quality of life. Increasing the number of nurses' aides and delegating assistance with ADL to them could support nurse health-related quality of life in the acute care setting. © 2014 John Wiley & Sons Ltd.

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

    Science.gov (United States)

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

    2017-08-01

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

  7. Typhoid fever in children presenting to paediatric medical wards of ...

    African Journals Online (AJOL)

    Typhoid fever in children presenting to paediatric medical wards of Ahmadu ... and management outcomes of children admitted with typhoid fever during a ... All the children had pre-admission antibiotics, while 93.3% had abdominal pain, ... had laparotomy but there was no mortality, and all were discharged after recovery.

  8. An observational study of hand hygiene compliance in paediatric wards.

    Science.gov (United States)

    Randle, Jacqueline; Firth, Joseph; Vaughan, Natalie

    2013-09-01

    To measure healthcare workers', children's and visitors' hand hygiene compliance in a paediatric oncology ward and a paediatric respiratory ward in an English hospital. Children are especially vulnerable to healthcare-associated infections, yet few studies have reported on hand hygiene compliance in paediatric clinical areas. This was an observational study. We measured hand hygiene compliance over an eight-hour period in two hospital wards using the 'five moments of hand hygiene' observation tool. We monitored a total of 407 hand hygiene opportunities. Overall opportunities for compliance were 74% for healthcare workers (n = 315) and children and visitors 23% (n = 92). Compliance was 84% for allied health professionals, 81% for doctors, 75% for nurses and 73% for ancillary and other staff. Hand hygiene compliance varied depending on which of the five moments of hygiene healthcare workers were undertaking (p hygiene compliance, and for visitors to the oncology ward, hand hygiene compliance was higher (p hygiene compliance; however, visitors' compliance was low. Among healthcare workers, levels of compliance were higher compared with previous reported estimates. Visitors had the lowest level of compliance yet owing to the nature of the clinical environments, nearly a quarter of care is delivered by them rather than healthcare workers, and so, this offers opportunities for specific future interventions aimed at families and carers. © 2012 Blackwell Publishing Ltd.

  9. Accounting for Inpatient Wards When Developing Master Surgical Schedules

    NARCIS (Netherlands)

    Vanberkel, Peter T.; Boucherie, Richard J.; Hans, Erwin W.; Hurink, Johann L.; Lent, van Wineke A.M.; Harten, van Wim H.

    2011-01-01

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

  10. Accounting for Inpatient Wards when developing Master Surgical Schedules

    NARCIS (Netherlands)

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

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

  11. Transverse Ward-Takahashi Relation to One Loop

    Institute of Scientific and Technical Information of China (English)

    HEHan-Xin

    2005-01-01

    We calculate the transverse Ward-Takahashi relation for the vector vertex in momentum space at one-loop order in four-dimensional Abelian gauge theory. We demonstrate explicitly that the result is exactly the same as that derived by using one-loop vector vertex calculations.

  12. Benefits of automated surface decontamination of a radioiodine ward.

    Science.gov (United States)

    Westcott, Eliza; Broadhurst, Alicia; Crossley, Steven; Lee, Lloyd; Phan, Xuyen; Scharli, Rainer; Xu, Yan

    2012-02-01

    A floor-washing robot has been acquired to assist physicists with decontamination of radioiodine therapy ward rooms after discharge of the patient at Sir Charles Gairdner Hospital. The effectiveness of the robot in decontaminating the ward has been evaluated. A controlled experiment was performed by deliberately contaminating a polyvinyl chloride flooring offcut with 131I followed by automated decontamination with the robot. The extent of fixed and removable contamination was assessed before and after decontamination by two methods: (1) direct Geiger-Mueller counting and (2) beta-counting wipe tests. Surface contamination was also assessed in situ on the ward by Geiger-Mueller counting and wipe testing. Contamination maps confirmed that contamination was removed rather than spread around by the robot. Wipe testing revealed that the robot was successful in clearing approximately 60-80% of removable contamination. The robotic floor-washing device was considered suitable to provide effective automated decontamination of the radioiodine ward. In addition, the robot affords other benefits: the time spent by the physicists decontaminating the room is greatly reduced offering financial and occupational safety and health benefits. The robot has also found utility in other decontamination applications in the healthcare environment.

  13. Ward Identities, B-> \\rho Form Factors and |V_ub|

    CERN Document Server

    Gilani, A H S; Riazuddin, M; Gilani, Amjad Hussain Shah

    2003-01-01

    The exclusive FCNC beauty semileptonic decay B-> \\rho is studied using Ward identities in a general vector meson dominance framework, predicting vector meson couplings involved. The long distance contributions are discussed which results to obtain form factors and |V_ub|. A detailed comparison is given with other approaches.

  14. Accounting for Inpatient Wards when developing Master Surgical Schedules

    NARCIS (Netherlands)

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

    2011-01-01

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

  15. A structured multicomponent group programme for carers of people with acquired brain injury: Effects on perceived criticism, strain, and psychological distress.

    Science.gov (United States)

    Fortune, Dónal G; Rogan, Carol R; Richards, Helen L

    2016-02-01

    The purpose of this study was to examine whether a brief structured multicomponent group programme for carers of people with acquired brain injury (ABI) was effective in reducing carer distress, strain, and critical comments between carer and person with an ABI compared to a waiting list control condition. Waiting list controlled study. Pre- and post-test design with outcomes measured at induction, at the end of the intervention, and at the 3-month follow-up. One hundred and thirteen carers took part in the study: 75 carers in the intervention group and 38 in the waiting list control group (2:1 ratio). All participants completed assessments of caregiver strain (Caregiver Strain Index), perceived criticism towards and from the person with an ABI (Perceived Criticism Scale), and psychological distress (Hospital Anxiety and Depression Scale). The person with an ABI was also assessed on the Functional Independence Measure/Functional Assessment Measure. Using an intention to treat analysis, there were significant effects of group (intervention vs. waiting list control) at the 3-month follow-up on carers' perceptions of stress and strain resulting from caring, and perceptions of criticism received by the carer from the person with an ABI. A subsequent per-protocol analysis showed an additional reduction at 3 months in levels of criticism expressed towards the person with an ABI by the carer. There was no significant effect of the intervention on psychological distress. The structured multicomponent carers programme showed beneficial effects in terms of reducing carer strain and in the reduction of elements of perceived criticism at the 3-month follow-up; however, it did not significantly affect psychological distress in carers, suggesting the need for additional support for this group of carers. What is already known on this subject? A number of studies have suggested that carers of people with acquired brain injury (ABI) experience greater levels of carer burden and

  16. User Evaluation of Neonatology Ward Design.

    Science.gov (United States)

    Trujillo, Juan Luis Higuera; Aviñó, Antoni Montañana I; Millán, Carmen Llinares

    2017-01-01

    The object of this article is to identify the set of affective and emotional factors behind users' assessments of a space in a neonatology unit and to propose design guidelines based on these. The importance of the neonatology service and the variety of users place great demands on the space at all levels. Despite the repercussions, the emotional aspects of the environment have received less attention. To avoid incurring limitations in the user mental scheme, this study uses two complementary methodologies: focus group and semantic differential. The (qualitative) focus group methodology provides exploratory information and concepts. The (quantitative) semantic differential methodology then uses these concepts to extract the conceptual structures that users employ in their assessment of the space. Of the total 175 subjects, 31 took part in focus groups and 144 in semantic differential. Five independent concepts were identified: privacy, functionality and professional nature, spaciousness, lighting, and cleanliness. In relation to the importance of the overall positive assessment of the space, the perception of privacy and sensations of dominance and pleasure are fundamental. Six relevant design aspects were also identified: provide spacious surroundings, facilitate sufficient separation between the different posts or cots, use different colors from those usually found in health-care centers, as some aversion was found to white and especially green, design areas with childhood themes, use warm artificial light, and choose user-friendly equipment. Results provide design recommendations of interest and show the possibilities offered by combining both systems to analyze user response.

  17. The relationship between leadership, teamworking, structure, burnout and attitude to patients on acute psychiatric wards

    NARCIS (Netherlands)

    Bowers, L.; Nijman, H.L.I.; Simpson, A.; Jones, J.

    2011-01-01

    Background: Conflict (aggression, substance use, absconding, etc.) and containment (coerced medication, manual restraint, etc.) threaten the safety of patients and staff on psychiatric wards. Previous work has suggested that staff variables may be significant in explaining differences between wards

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

    NARCIS (Netherlands)

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

    2009-01-01

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

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

    CSIR Research Space (South Africa)

    Ribbens, H

    2008-07-01

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

  20. Speech Criticism, Group Presentations, and Centrality: A Marriage Made in Heaven for the Basic Public Speaking Course.

    Science.gov (United States)

    Ayres, Joe; Sonandre, Debbie Ayres

    This paper presents an exercise which serves as an addition to public speaking courses. Showing students how to uncover the speech patterns that shape their lives allows them to appreciate the importance of speech communication in their lives. In the exercise, groups analyze speeches and report their findings to the class. The exercise improves…

  1. Census of Ligurian Internal Medicine Wards of non-teaching hospitals

    Directory of Open Access Journals (Sweden)

    Micaela La Regina

    2014-12-01

    Full Text Available What is the future of internal medicine in Italy? Which competencies? Which potentialities? To this aim Ligurian FADOI Regional Society performed a census among 18 Internal Medicine Wards (IMWs in non-teaching Ligurian Hospital. We administered, by email, a questionnaire to the heads of IMWs. Data about staffing, equipment, skills, competencies and productivity during 2011 were collected from 1st to 31st November 2012. A total of 15/18 (83.3% chiefs answered to the questionnaire. The number of beds was largely variable among the wards. In 2011, mean diagnosis-related group (DRG-weight was 1.09 (range 0.91-1.6 and that revenues/costs ratio much higher than 1.5. Staff was quite adequate to standards defined by current law, only 33% has got a doctor:patients ratio superior to 1:6.4. However, annual hospitalizations exceed the availability of beds in medicine and the complexity of the patients would require a lower doctor:patients ratio, at least for a group of patients. In fact, 4 wards have a progressive care organization with a defined area for more seriously ill patients. Mean length of stay was 10 days. Expertise was wide, covering almost all medical sub-specialties. Acquired skills such as abdominal, heart and vascular ultrasounds, invasive procedures and their comprehensive knowledge make internists complete and cost-effective specialists. IMWs, as a concentrate of medical knowledge and skills, are the natural destination of current patients with co-morbidities. Staffing and number of beds should be revised according to this new demand. Their revenues/costs ratio resulted favorable and their global approach to patients and not to disease can be useful for resource rationalization. Wider and further studies are needed to improve the awareness of stakeholders about Internal Medicine.

  2. Improving critical care discharge summaries: a collaborative quality improvement project using PDSA.

    Science.gov (United States)

    Goulding, Lucy; Parke, Hannah; Maharaj, Ritesh; Loveridge, Robert; McLoone, Anne; Hadfield, Sophie; Helme, Eloise; Hopkins, Philip; Sandall, Jane

    2015-01-01

    Around 110,000 people spend time in critical care units in England and Wales each year. The transition of care from the intensive care unit to the general ward exposes patients to potential harms from changes in healthcare providers and environment. Nurses working on general wards report anxiety and uncertainty when receiving patients from critical care. An innovative form of enhanced capability critical care outreach called 'iMobile' is being provided at King's College Hospital (KCH). Part of the remit of iMobile is to review patients who have been transferred from critical care to general wards. The iMobile team wished to improve the quality of critical care discharge summaries. A collaborative evidence-based quality improvement project was therefore undertaken by the iMobile team at KCH in conjunction with researchers from King's Improvement Science (KIS). Plan, Do, Study, Act (PDSA) methodology was used. Three PDSA cycles were undertaken. Methods adopted comprised: a scoping literature review to identify relevant guidelines and research evidence to inform all aspects of the quality improvement project; a process mapping exercise; informal focus groups / interviews with staff; patient story-telling work with people who had experienced critical care and subsequent discharge to a general ward; and regular audits of the quality of both medical and nursing critical care discharge summaries. The following behaviour change interventions were adopted, taking into account evidence of effectiveness from published systematic reviews and considering the local context: regular audit and feedback of the quality of discharge summaries, feedback of patient experience, and championing and education delivered by local opinion leaders. The audit results were mixed across the trajectory of the project, demonstrating the difficulty of sustaining positive change. This was particularly important as critical care bed occupancy and through-put fluctuates which then impacts on work

  3. Effects of neuromuscular electrostimulation in patients with heart failure admitted to ward

    Directory of Open Access Journals (Sweden)

    de Araújo Carlos José Soares

    2012-11-01

    Full Text Available Abstract Background Neuromuscular electrostimulation has become a promising issue in cardiovascular rehabilitation. However there are few articles published in the literature regarding neuromuscular electrostimulation in patients with heart failure during hospital stay. Methods This is a randomized controlled pilot trial that aimed to investigate the effect of neuromuscular electrostimulation in the walked distance by the six-minute walking test in 30 patients admitted to ward for heart failure treatment in a tertiary cardiology hospital. Patients in the intervention group performed a conventional rehabilitation and neuromuscular electrostimulation. Patients underwent 60 minutes of electrostimulation (wave frequency was 20 Hz, pulse duration of 20 us two times a day for consecutive days until hospital discharge. Results The walked distance in the six-minute walking test improved 75% in the electrostimulation group (from 379.7 ± 43.5 to 372.9 ± 46.9 meters to controls and from 372.9 ± 62.4 to 500 ± 68 meters to electrostimulation, p Conclusion The neuromuscular electrostimulation group showed greater improvement in the walked distance in the six-minute walking test in patients admitted to ward for compensation of heart failure.

  4. Risk factors for requiring intensive care among children admitted to ward with bronchiolitis.

    Science.gov (United States)

    Hasegawa, Kohei; Pate, Brian M; Mansbach, Jonathan M; Macias, Charles G; Fisher, Erin S; Piedra, Pedro A; Espinola, Janice A; Sullivan, Ashley F; Camargo, Carlos A

    2015-01-01

    To examine risk factors for transfer of bronchiolitis patients from the ward to the intensive care unit (ICU) and/or initiation of critical care interventions. We performed a 16-center, prospective cohort study of hospitalized children age bronchiolitis. During the winters of 2007 to 2010, researchers collected clinical data and nasopharyngeal aspirates from study participants. The primary outcome was late intensive care use, defined as a transfer to the ICU and/or use of mechanical ventilation (regardless of location) after the child's first inpatient day. Among 2104 children hospitalized with bronchiolitis, 1762 (84%) were identified as initial ward patients, comprising the analysis cohort. The median age was 4 months (interquartile range, 2-9 months), and 1048 (59%) were boys. The most frequently detected pathogens were respiratory syncytial virus (72%) and rhinovirus (25%). After the first inpatient day, 47 (3%; 95% confidence interval, 2-4) were subsequently transferred to the ICU or required mechanical ventilation. In the multivariable logistic regression model predicting subsequent transfer to the ICU or mechanical ventilation use, the significant predictors were birth weight bronchiolitis, low birth weight and tachypnea were significantly associated with subsequent transfer to the ICU and/or use of mechanical ventilation. Copyright © 2015 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

  5. Impact of the physical environment of psychiatric wards on the use of seclusion

    NARCIS (Netherlands)

    Schaaf, P.S. van der; Dusseldorp, E.; Keuning, F.M.; Janssen, W.A.; Noorthoorn, E.O.

    2013-01-01

    BACKGROUND: The physical environment is presumed to have an effect on aggression and also on the use of seclusion on psychiatric wards. Multicentre studies that include a broad variety of design features found on psychiatric wards and that control for patient, staff and general ward characteristics

  6. Perturbative Correction to Transverse Ward-Takahashi Relation for the Vector Vertex

    Institute of Scientific and Technical Information of China (English)

    HE Han-Xin; YU Hong-Wei

    2003-01-01

    We re-derive exactly the transverse Ward-Takahashi relation for the vector vertex in momentum space.The result shows that this transverse Ward-Takahashi relation in momentum space involves a perturbative correction term. We demonstrate explicitly that this transverse Ward-Takahashi relation is satisfied indeed at one-loop order.

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

    DEFF Research Database (Denmark)

    Skov, Mikael B.; Høegh, Rune Thaarup

    2006-01-01

    Ward is to support nurses in conducting morning procedures in a hospital ward. MobileWard is context-aware as it is able to discover and react autonomously according to changes in the environment and since it integrates the ability to provide information and services to the user where the relevancy depends...

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

    NARCIS (Netherlands)

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

    2011-01-01

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

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

    Science.gov (United States)

    2010-12-27

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

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

    Science.gov (United States)

    2013-03-06

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

  11. Dissociative disorders in the psychiatric emergency ward.

    Science.gov (United States)

    Sar, Vedat; Koyuncu, Ahmet; Ozturk, Erdinc; Yargic, L Ilhan; Kundakci, Turgut; Yazici, Ahmet; Kuskonmaz, Ekrem; Aksüt, Didem

    2007-01-01

    The aim of this study was to determine the prevalence of dissociative disorders among emergency psychiatric admissions. Forty-three of the 97 consecutive outpatients admitted to the psychiatric emergency unit of a university hospital were screened using the Dissociative Experiences Scale (DES). Seventeen (39.5% of the 43 evaluated) patients with a DES score above 25.0 were then interviewed with the Dissociative Disorders Interview Schedule and the Structured Clinical Interview for Dissociative Disorders. Fifteen emergency unit patients (34.9% of the 43 evaluated participants) were diagnosed as having a dissociative disorder. Six (14.0%) patients had dissociative identity disorder, 6 (14.0%) had dissociative disorder not otherwise specified, and 3 (7.0%) had dissociative amnesia. The average DES score of dissociative patients was 43.7. A majority of them had comorbid major depression, somatization disorder, and borderline personality disorder. Most of the patients with dissociative disorder reported auditory hallucinations, symptoms associated with psychogenic amnesia, flashback experiences, and childhood abuse and/or neglect. Dissociative disorders constitute one of the diagnostic groups with high relevance in emergency psychiatry.

  12. Critical issues with the in vivo comet assay: A report of the comet assay working group in the 6th International Workshop on Genotoxicity Testing (IWGT).

    Science.gov (United States)

    Speit, Günter; Kojima, Hajime; Burlinson, Brian; Collins, Andrew R; Kasper, Peter; Plappert-Helbig, Ulla; Uno, Yoshifumi; Vasquez, Marie; Beevers, Carol; De Boeck, Marlies; Escobar, Patricia A; Kitamoto, Sachiko; Pant, Kamala; Pfuhler, Stefan; Tanaka, Jin; Levy, Dan D

    2015-05-01

    As a part of the 6th IWGT, an expert working group on the comet assay evaluated critical topics related to the use of the in vivo comet assay in regulatory genotoxicity testing. The areas covered were: identification of the domain of applicability and regulatory acceptance, identification of critical parameters of the protocol and attempts to standardize the assay, experience with combination and integration with other in vivo studies, demonstration of laboratory proficiency, sensitivity and power of the protocol used, use of different tissues, freezing of samples, and choice of appropriate measures of cytotoxicity. The standard protocol detects various types of DNA lesions but it does not detect all types of DNA damage. Modifications of the standard protocol may be used to detect additional types of specific DNA damage (e.g., cross-links, bulky adducts, oxidized bases). In addition, the working group identified critical parameters that should be carefully controlled and described in detail in every published study protocol. In vivo comet assay results are more reliable if they were obtained in laboratories that have demonstrated proficiency. This includes demonstration of adequate response to vehicle controls and an adequate response to a positive control for each tissue being examined. There was a general agreement that freezing of samples is an option but more data are needed in order to establish generally accepted protocols. With regard to tissue toxicity, the working group concluded that cytotoxicity could be a confounder of comet results. It is recommended to look at multiple parameters such as histopathological observations, organ-specific clinical chemistry as well as indicators of tissue inflammation to decide whether compound-specific toxicity might influence the result. The expert working group concluded that the alkaline in vivo comet assay is a mature test for the evaluation of genotoxicity and can be recommended to regulatory agencies for use.

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

    Directory of Open Access Journals (Sweden)

    Sirio Fiorino

    2013-04-01

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

  14. Liouville theory Ward identities for generating functional and modular geometry

    CERN Document Server

    Takhtajan, L A

    1994-01-01

    We continue the study of quantum Liouville theory through Polyakov's functional integral \\cite{Pol1,Pol2}, started in \\cite{T1}. We derive the perturbation expansion for Schwinger's generating functional for connected multi-point correlation functions involving stress-energy tensor, give the "dynamical" proof of the Virasoro symmetry of the theory and compute the value of the central charge, confirming previous calculation in \\cite{T1}. We show that conformal Ward identities for these correlation functions contain such basic facts from Kähler geometry of moduli spaces of Riemann surfaces, as relation between accessory parameters for the Fuchsian uniformization, Liouville action and Eichler integrals, Kähler potential for the Weil-Petersson metric, and local index theorem. These results affirm the fundamental role, that universal Ward identities for the generating functional play in Friedan-Shenker modular geometry \\cite{FS}.

  15. Modelling of coughed droplets in a hospital ward

    DEFF Research Database (Denmark)

    Sadrizadeh, Sasan; Nielsen, Peter Vilhelm

    2016-01-01

    Coughing and its importance for spreading respiratory infectious diseases has been confirmed in many previous studies. The dispersion process of respiratory droplets released by the coughing of a patient in a hospital ward was studied using computational fluid dynamics simulation. Two relatively...... realistic three-dimensional thermal mannequins with a parallel bed arrangement simulated the patients. The maximum dispersion distances in time under ward ventilation conditions were studied. A velocity profile simulated a time-dependent cough with total duration of 0.4 s. The results indicated...... that the transport characteristic of droplets due to coughing is highly influenced by their size. Although the effects of gravity or inertia on small droplets ( 40 μm are significantly affected by gravity and soon fall...

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

    DEFF Research Database (Denmark)

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

    2011-01-01

    of lighting design in private and public settings are often not similar. The purpose of this article is therefore present a approach dividing the hospital ward in 3 user zones for patients, staff and visitors. The main user of the zone should be in control of the light scenario and thereby a refining......Studying Standard and recommendations for lighting in hospital environment its often suggest a uniform light distribution to facilitate the needs of the staff. At the same time the standards recommend a lighting design supporting the patients feeling a homely and pleasant atmosphere, and point out...... that the light should not be disrupting the patients wellbeing. These two approaches are not necessarily consistent because the right quality and quantity of light in wards is highly depending on the functionality of the space and the wished and expected lighting atmosphere of the space, and a comparison...

  17. Lighting quality in hospital wards - State of the art

    DEFF Research Database (Denmark)

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

    and a multitude of users with many different needs and requirements. It is a public domain with many references to the design of homes in the private sphere. The aim of the report is to display the existing research in the area of lighting design in hospital wards, and to present new lighting design strategies......When constructing and designing hospitals for the future, patients, staff and guests are in focus. Designing a healing hospital environment is a very important factor when planning new hospitals. How can aspects such as design, architecture, arts, lights, sounds and materials support and improve......, the furnishing, the acoustics and light are essential in evaluating of the experience of an environment. The light is crucial for the physical and psychological experience of wellbeing and the feeling of safety. The ward is a complex and interesting architectural space to design. It has a wide range of functions...

  18. Prevalence of delirium among patients at a cancer ward

    DEFF Research Database (Denmark)

    Grandahl, Mia Gall; Nielsen, Svend Erik; Kørner, Ejnar Alex;

    2016-01-01

    Background Delirium is a frequent psychiatric complication to cancer, but rarely recognized by oncologists. Aims 1. To estimate the prevalence of delirium among inpatients admitted at an oncological cancer ward 2. To investigate whether simple clinical factors predict delirium 3. To examine...... the value of cognitive testing in the assessment of delirium. Methods On five different days, we interviewed and assessed patients admitted to a Danish cancer ward. The World Health Organization International Classification of Diseases Version 10, WHO ICD-10 Diagnostic System and the Confusion Assessment...... Method (CAM) were used for diagnostic categorization. Clinical information was gathered from medical records and all patients were tested with Mini Cognitive Test, The Clock Drawing Test, and the Digit Span Test. Results 81 cancer patients were assessed and 33% were diagnosed with delirium. All delirious...

  19. Body image and its relation to obesity for Pacific minority ethnic groups in New Zealand: a critical analysis.

    Science.gov (United States)

    Teevale, Tasileta

    2011-03-01

    The stimulus behind most of the early investigations into Pacific or Polynesian peoples' body image, particularly those that looked to compare with Western or Westernised groups, is the assumption that Pacific peoples valued and therefore desired very large bodies, and in relation to obesity-risk, this is a problematic cultural feature to have. This may be driven by popular anecdotes which are captured in the title of one such study "Do Polynesians still believe that big is beautiful?" To the author's knowledge, no research in Pacific peoples' body image has been conducted in the New Zealand (NZ) context by Pacific researchers. This study makes a contribution to the literature gap and more importantly through an emic viewpoint. A critique of the current literature is provided below which calls into question the initial catalyst behind earlier investigations which have led to the perpetuation of particular types of body image research for Pacific groups. Using mixed-methods, the specific objective of this study was to describe the behaviours, beliefs and values of Pacific adolescents and their parents, that are related to body image. A self-completion questionnaire was administered to 2495 Pacific students who participated in the New Zealand arm of the Obesity Prevention In Communities (OPIC) project. Sixty-eight people (33 adolescents and 35 parents) from 30 Pacific households were interviewed in the qualitative phase of the study. This study found Pacific adolescents and their parents did not desire obesity-sized bodies but desired a range of average-sized bodies that met their Pacific-defined view of health. It is not clear whether body image research makes any meaningful contribution to obesity prevention for Pacific people, given the cultural-bounded nature of the concept "body image" which sits communication and understanding between obesity interventionists and all healthcare workers generally and Pacific communities. For obesity interventions to be

  20. Risk factors for early-onset group B streptococcal sepsis: estimation of odds ratios by critical literature review.

    Science.gov (United States)

    Benitz, W E; Gould, J B; Druzin, M L

    1999-06-01

    To identify and to establish the prevalence of ORs factors associated with increased risk for early-onset group B streptococcal (EOGBS) infection in neonates. streptococcal (EOGBS) infection in neonates. Literature review and reanalysis of published data. Risk factors for EOGBS infection include group B streptococcal (GBS)-positive vaginal culture at delivery (OR: 204), GBS-positive rectovaginal culture at 28 (OR: 9.64) or 36 weeks gestation (OR: 26. 7), vaginal Strep B OIA test positive at delivery (OR: 15.4), birth weight 18 hours (OR: 7.28), intrapartum fever >37.5 degrees C (OR: 4.05), intrapartum fever, PROM, or prematurity (OR: 9.74), intrapartum fever or PROM at term (OR: 11.5), chorioamnionitis (OR: 6.43). Chorioamnionitis is reported in most (88%) cases in which neonatal infection occurred despite intrapartum maternal antibiotic therapy. ORs could not be estimated for maternal GBS bacteriuria during pregnancy, with preterm premature rupture of membranes, or with a sibling or twin with invasive GBS disease, but these findings seem to be associated with a very high risk. Multiple gestation is not an independent risk factor for GBS infection. h Mothers with GBS bacteriuria during pregnancy, with another child with GBS disease, or with chorioamnionitis should receive empirical intrapartum antibiotic treatment. Their infants should have complete diagnostic evaluations and receive empirical treatment until infection is excluded by observation and negative cultures because of their particularly high risk for EOGBS infection. Either screening with cultures at 28 weeks gestation or identification of clinical risk factors, ie, PROM, intrapartum fever, or prematurity, may identify parturients whose infants include 65% of those with EOGBS infection. Intrapartum screening using the Strep B OIA rapid test identifies more at-risk infants (75%) than any other method. These risk identifiers may permit judicious selection of patients for prophylactic interventions.

  1. The background scale Ward identity in quantum gravity

    CERN Document Server

    Percacci, Roberto

    2016-01-01

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

  2. Ward-Takahashi Identity on the Light-Front

    CERN Document Server

    Naus, H W L; Frederico, T

    1998-01-01

    The Ward-Takahashi identity, reflecting local gauge invariance, is perturbatively verified for a boson model in light front field theory. A careful integration over the light front energy, corresponding to exactly taking into account pair terms, which are the contributions of the zero longitudinal momentum mode, is crucial to obtain this result. Furthermore, the one-loop boson form factors are calculated for arbitrary off-shell momenta.

  3. The background scale Ward identity in quantum gravity

    Energy Technology Data Exchange (ETDEWEB)

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

    2017-01-15

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

  4. The Johns Hopkins Hospital Ward-Nutrition Communication Application

    OpenAIRE

    Ardolino, Margaret K.; Kahane, Stephen N.; Nichols, Karen; Richmond, Debra W.

    1987-01-01

    Communicating patient-specific diet information at any large medical institution is a complex process. The Johns Hopkins Hospital has chosen to automate the manual method of communicating this information. The development of the “Ward-Nutrition Communication Application” will allow users on an inpatient Nursing unit to order patient diets and other nutritional needs utilizing a multi-windowed, menu-based and mouse driven environment. This, and other applications, will run on high performance,...

  5. Utility of Ward-Based Retinal Photography in Stroke Patients.

    Science.gov (United States)

    Frost, Shaun; Brown, Michael; Stirling, Verity; Vignarajan, Janardhan; Prentice, David; Kanagasingam, Yogesan

    2017-03-01

    Improvements in acute care of stroke patients have decreased mortality, but survivors are still at increased risk of future vascular events and mitigation of this risk requires thorough assessment of the underlying factors leading to the stroke. The brain and eye share a common embryological origin and numerous similarities exist between the small vessels of the retina and brain. Recent population-based studies have demonstrated a close link between retinal vascular changes and stroke, suggesting that retinal photography could have utility in assessing underlying stroke risk factors and prognosis after stroke. Modern imaging equipment can facilitate precise measurement and monitoring of vascular features. However, use of this equipment is a challenge in the stroke ward setting as patients are frequently unable to maintain the required seated position, and pupil dilatation is often not feasible as it could potentially obscure important neurological signs of stroke progression. This small study investigated the utility of a novel handheld, nonmydriatic retinal camera in the stroke ward and explored associations between retinal vascular features and stroke risk factors. This camera circumvented the practical limitations of conducting retinal photography in the stroke ward setting. A positive correlation was found between carotid disease and both mean width of arterioles (r = .40, P = .00571) and venules (r = .30, P = .0381). The results provide further evidence that retinal vascular features are clinically informative about underlying stroke risk factors and demonstrate the utility of handheld retinal photography in the stroke ward. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  6. Crossing boundaries, re-defining care: the role of the critical care outreach team.

    Science.gov (United States)

    Coombs, Maureen; Dillon, Ann

    2002-05-01

    There is clear indication that both government and professional policy in the United Kingdom supports a radical change in the role of healthcare practitioners, with a move towards a patient-focused service delivered by clinical teams working effectively together. Recent health service imperatives driving the agenda for flexible clinical teams have occurred simultaneously with an increased public and political awareness of deficits in availability of critical care services. Against this policy backdrop, working across professional and organizational boundaries is fundamental to supporting quality service improvements. In the acute care sector, the development of critical care outreach teams is an innovation that seeks to challenge the traditional support available for sick ward patients. Activity data and observations from the first 6-month evaluation of two critical care outreach teams identify the need for clinical support and education offered by critical care practitioners to ward-based teams. The experiences from such flexible clinical teams provides a foundation from which to explore key issues for intradisciplinary and interdisciplinary working across clinical areas and organizational boundaries. Adopting innovative approaches to care delivery, such as critical care outreach teams, can enable clinical teams and NHS trusts to work together to improve the quality of care for acutely ill patients, support clinical practitioners working with this client group, and develop proactive service planning.

  7. Future: new strategies for hospitalists to overcome challenges in teaching on today's wards.

    Science.gov (United States)

    Martin, Shannon K; Farnan, Jeanne M; Arora, Vineet M

    2013-07-01

    Changes in the clinical learning environment under resident duty hours restrictions have introduced a number of challenges on today's wards. Additionally, the current group of medical trainees is largely represented by the Millennial Generation, a generation characterized by an affinity for technology, interaction, and group-based learning. Special attention must be paid to take into account the learning needs of a generation that has only ever known life with duty hours. A mnemonic for strategies to augment teaching rounds for hospitalists was created using an approach that considers time limitations due to duty hours as well as the preferences of Millennial learners. These strategies to enhance learning during teaching rounds are Flipping the Wards, Using Documentation to Teach, Technology-Enabled Teaching, Using Guerilla Teaching Tactics, Rainy Day Teaching, and Embedding Teaching Moments into Rounds (FUTURE). Hospitalists serving as teaching attendings should consider these possible strategies as ways to enhance teaching in the post-duty hours era. These techniques appeal to the preferences of today's learners in an environment often limited by time constraints. Hospitalists are well positioned to champion innovative approaches to teaching in a dynamic and evolving clinical learning environment. © 2013 Society of Hospital Medicine.

  8. Impact of team-versus ward-aligned clinical pharmacy on unintentional medication discrepancies at admission.

    Science.gov (United States)

    Byrne, Sharon M; Grimes, Tamasine C; Jago-Byrne, Marie-Claire; Galvin, Mairéad

    2017-02-01

    Background Medication reconciliation at admission to hospital reduces the prevalence of medication errors. Strategies are needed to ensure timely and efficient delivery of this service. Objective To investigate the effect of aligning clinical pharmacy services with consultant teams, by pharmacists attending post-admission ward rounds, in comparison to a ward-based service, on prevalence of unintentional unresolved discrepancies 48 h into admission. Setting A 243-bed public university teaching hospital in Ireland. Method A prospective, uncontrolled before-after observational study. A gold standard preadmission medication list was completed for each patient and compared with the patient's admission medication prescription and discrepancies were noted. Unresolved discrepancies were examined at 48 h after admission to determine if they were intentional or unintentional. Main outcome measured Number of patients with one or more unintentional, unresolved discrepancy 48 h into admission. Results Data were collected for 140 patients, of whom 73.5% were over 65 years of age. There were no differences between before (ward-aligned) and after (team-aligned) groups regarding age, number of medications or comorbidities. There was a statistically significant reduction in the prevalence of unintentional, unresolved discrepancy(s) per patient (67.3 vs. 27.3%, p medication (13.7 vs. 4.1%, p medications and comorbidities (adjusted odds ratio 4.9, 95% confidence interval 2.3-10.6). Conclusion A consultant team-based clinical pharmacy service contributed positively to medication reconciliation at admission, reducing the prevalence of unintentional, unresolved discrepancy(s) present 48 h after admission.

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

    Science.gov (United States)

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

    2014-01-01

    Learning on the ward as a practice-oriented preparation for the future workplace plays a crucial role in the medical education of future physicians. However, students' ward internship is partially problematic due to condensed workflows on the ward and the high workload of supervising physicians. For the first time in a German-speaking setting, students' expectations and concerns about their internship on the ward are examined in a qualitative analysis regarding their internal medicine rotation within clinical medical education. Of a total of 168 medical students in their 6th semester at the Medical Faculty of Heidelberg, 28 students (m=8, f=20, Ø 23.6 years) took part in focus group interviews 3 to 5 days prior to their internship on the internal medicine ward within their clinical internal medicine rotation. Students were divided into four different focus groups. The protocols were transcribed and a content analysis was conducted based on grounded theory. We gathered a total of 489 relevant individual statements. The students hope for a successful integration within the ward team, reliable and supportive supervisors and supervision in small groups. They expect to face the most common diseases, to train the most important medical skills, to assume full responsibility for their own patients and to acquire their own medical identity. The students fear an insufficient time frame to achieve their aims. They are also concerned they will have too little contact with patients and inadequate supervision. For the development and standardization of effective student internships, the greatest relevance should be attributed to guidance and supervision by professionally trained and well-prepared medical teachers, entailing a significant increase in staff and costs. A structural framework is required in order to transfer the responsibility for the treatment of patients to the students at an early stage in medical education and in a longitudinal manner. The data suggest that the

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

    Science.gov (United States)

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

    2014-01-01

    Background: Learning on the ward as a practice-oriented preparation for the future workplace plays a crucial role in the medical education of future physicians. However, students’ ward internship is partially problematic due to condensed workflows on the ward and the high workload of supervising physicians. For the first time in a German-speaking setting, students’ expectations and concerns about their internship on the ward are examined in a qualitative analysis regarding their internal medicine rotation within clinical medical education. Methods: Of a total of 168 medical students in their 6th semester at the Medical Faculty of Heidelberg, 28 students (m=8, f=20, Ø 23.6 years) took part in focus group interviews 3 to 5 days prior to their internship on the internal medicine ward within their clinical internal medicine rotation. Students were divided into four different focus groups. The protocols were transcribed and a content analysis was conducted based on grounded theory. Results: We gathered a total of 489 relevant individual statements. The students hope for a successful integration within the ward team, reliable and supportive supervisors and supervision in small groups. They expect to face the most common diseases, to train the most important medical skills, to assume full responsibility for their own patients and to acquire their own medical identity. The students fear an insufficient time frame to achieve their aims. They are also concerned they will have too little contact with patients and inadequate supervision. Conclusion: For the development and standardization of effective student internships, the greatest relevance should be attributed to guidance and supervision by professionally trained and well-prepared medical teachers, entailing a significant increase in staff and costs. A structural framework is required in order to transfer the responsibility for the treatment of patients to the students at an early stage in medical education and in a

  11. Medical academia clinical experiences of Ward Round Teaching curriculum

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    Fariba Haghani

    2014-01-01

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

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

    Science.gov (United States)

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

    2014-01-01

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

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

    Science.gov (United States)

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

    2014-06-01

    A prospective observational study was conducted to evaluate the impact of delirium on geriatric inpatients in internal medical wards and to identify predisposing factors for the development of delirium. The study included all patients aged 65 years and older, who were consecutively admitted to the internal medicine wards of two public hospitals in Florence, Italy. On admission, 29 baseline risk factors were examined, cognitive impairment was evaluated by Short Portable Mental Status Questionnaire, and prevalent delirium cases were diagnosed by Confusion Assessment Method (CAM). Enrolled patients were evaluated daily with CAM to detect incident delirium cases. Among the 560 included patients, 19 (3 %) had delirium on admission (prevalent) and 44 (8 %) developed delirium during hospitalization (incident). Prevalent delirium cases were excluded from the statistical analysis. Incident delirium was associated with increased length of hospital stay (p delirium during hospitalization. Results show that delirium impact is relevant to older patients hospitalized in internal medicine wards. The present study confirms cognitive impairment as a risk factor for incident delirium. The cognitive evaluation proved to be an important instrument to improve identification of patients at high risk for delirium. In this context, our study may contribute to improve application of preventive strategies.

  14. A qualitative assessment of implementing a cross-cultural survey on cancer wards in Denmark--a description of barriers

    DEFF Research Database (Denmark)

    Kristiansen, Maria; Hassani, Amani; Krasnik, Allan

    2010-01-01

    Research into migration and health is often confronted with methodological challenges related to the identification of migrants in various settings. Furthermore, it is often difficult to reach an acceptable level of participation among migrant groups in quantitative research. The aim of this stud...... is to conduct a qualitative assessment of the barriers encountered during the implementation of a cross-cultural survey on cancer wards in Copenhagen, Denmark....

  15. Functional feeding groups of aquatic insect families in Latin America: a critical analysis and review of existing literature.

    Science.gov (United States)

    Ramírez, Alonso; Gutiérrez-Fonseca, Pablo E

    2014-04-01

    Aquatic macroinvertebrates are involved in numerous processes within aquatic ecosystems. They often have important effects on ecosystem processes such as primary production (via grazing), detritus breakdown, and nutrient mineralization and downstream spiraling. The functional feeding groups (FFG) classification was developed as a tool to facilitate the incorporation of macroinvertebrates in studies of aquatic ecosystems. This classification has the advantage of combining morphological characteristics (e.g., mouth part specialization) and behavioral mechanisms (e.g., way of feeding) used by macroinvertebrates when consuming resources. Although recent efforts have greatly advanced our ability to identify aquatic macroinvertebrates, there is limited information on FFG assignment. Furthermore, there has been some variation in the use of the FFG classification, in part due to an emphasis on using gut content analysis to assign FFG, which is more appropriate for assigning trophic guilds. Thus, the main goals of this study are to (1) provide an overview of the value of using the FFG classification, (2) make an initial attempt to summarize available information on FFG for aquatic insects in Latin America, and (3) provide general guidelines on how to assign organisms to their FFGs. FFGs are intended to reflect the potential effects of organisms in their ecosystems and the way they consume resources. Groups include scrapers that consume resources that grow attached to the substrate by removing them with their mouth parts; shredders that cut or chew pieces of living or dead plant material, including all plant parts like leaves and wood; collectors-gatherers that use modified mouth parts to sieve or collect small particles (< 1 mm) accumulated on the stream bottom; filterers that have special adaptations to remove particles directly from the water column; and predators that consume other organisms using different strategies to capture them. In addition, we provide details on

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

    Science.gov (United States)

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

    2016-01-01

    Infection is a potentially serious complication of epidural analgesia and with an increase in its use in wards there is a necessity to demonstrate its safety. We aimed to compare the incidence of colonization of epidural catheters retained for short duration (for 48 h) postoperative analgesia in postanesthesia care unit and wards. It was a prospective observational study done in a tertiary care teaching public hospital over a period of 2 years and included 400 patients with 200 each belonged to two groups PACU and ward. We also studied epidural tip culture pattern, skin swab culture at the entry point of the catheter, their relation to each other and whether colonization is equivalent to infection. Data were analyzed using statistical software GraphPad. Overall positive tip culture was 6% (24), of them 7% (14) were from PACU and 5% (10) were from ward (P = 0.5285). Positive skin swab culture was 38% (150), of them 20% (80) were from PACU and 18% (70) were from ward (P = 0.3526). The relation between positive tip culture and positive skin swab culture in same patients is extremely significant showing a strong linear relationship (95% confidence interval = 0.1053–0.2289). The most common microorganism isolated was Staphylococcus epidermidis. No patient had signs of local or epidural infection. There is no difference in the incidence of epidural catheter tip culture and skin swab culture of patients from the general ward and PACU. Epidural analgesia can be administered safely for 48 h in general wards without added risk of infection. The presence of positive tip culture is not a predictor of epidural space infection, and colonization is not equivalent to infection; hence, routine culture is not needed. Bacterial migration from the skin along the epidural track is the most common mode of bacterial colonization; hence, strict asepsis is necessary. PMID:27076712

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

    Directory of Open Access Journals (Sweden)

    Minal Harde

    2016-01-01

    Full Text Available Infection is a potentially serious complication of epidural analgesia and with an increase in its use in wards there is a necessity to demonstrate its safety. We aimed to compare the incidence of colonization of epidural catheters retained for short duration (for 48 h postoperative analgesia in postanesthesia care unit and wards. It was a prospective observational study done in a tertiary care teaching public hospital over a period of 2 years and included 400 patients with 200 each belonged to two groups PACU and ward. We also studied epidural tip culture pattern, skin swab culture at the entry point of the catheter, their relation to each other and whether colonization is equivalent to infection. Data were analyzed using statistical software GraphPad. Overall positive tip culture was 6% (24, of them 7% (14 were from PACU and 5% (10 were from ward (P = 0.5285. Positive skin swab culture was 38% (150, of them 20% (80 were from PACU and 18% (70 were from ward (P = 0.3526. The relation between positive tip culture and positive skin swab culture in same patients is extremely significant showing a strong linear relationship (95% confidence interval = 0.1053–0.2289. The most common microorganism isolated was Staphylococcus epidermidis. No patient had signs of local or epidural infection. There is no difference in the incidence of epidural catheter tip culture and skin swab culture of patients from the general ward and PACU. Epidural analgesia can be administered safely for 48 h in general wards without added risk of infection. The presence of positive tip culture is not a predictor of epidural space infection, and colonization is not equivalent to infection; hence, routine culture is not needed. Bacterial migration from the skin along the epidural track is the most common mode of bacterial colonization; hence, strict asepsis is necessary.

  18. Can patients with moderate to severe acute respiratory failure from COPD be treated safely with noninvasive mechanical ventilation on the ward?

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    Yalcinsoy M

    2016-05-01

    Full Text Available Murat Yalcinsoy,1 Cuneyt Salturk,2 Selahattin Oztas,2 Sinem Gungor,2 Ipek Ozmen,2 Feyyaz Kabadayi,2 Aysem Askim Oztim,2 Emine Aksoy,2 Nalan Adıguzel,2 Ozlem Oruc,2 Zuhal Karakurt2 1Department of Pulmonary Medicine, Inonu University Medical Faculty, Turgut Ozal Medical Center, Malatya, 2Department of Pulmonary Medicine, Sureyyapaşa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey Purpose: Noninvasive mechanical ventilation (NIMV usage outside of intensive care unit is not recommended in patients with COPD for severe acute respiratory failure (ARF. We assessed the factors associated with failure of NIMV in patients with ARF and severe acidosis admitted to the emergency department and followed on respiratory ward.Patients and methods: This is a retrospective observational cohort study conducted in a tertiary teaching hospital specialized in chest diseases and thoracic surgery between June 1, 2013 and May 31, 2014. COPD patients who were admitted to our emergency department due to ARF were included. Patients were grouped according to the severity of acidosis into two groups: group 1 (pH=7.20–7.25 and group 2 (pH=7.26–7.30.Results: Group 1 included 59 patients (mean age: 70±10 years, 30.5% female and group 2 included 171 patients (mean age: 67±11 years, 28.7% female. On multivariable analysis, partial arterial oxygen pressure to the inspired fractionated oxygen (PaO2/FiO2 ratio <200, delta pH value <0.30, and pH value <7.31 on control arterial blood gas after NIMV in the emergency room and peak C-reactive protein were found to be the risk factors for NIMV failure in COPD patients with ARF in the ward.Conclusion: NIMV is effective not only in mild respiratory failure but also with severe forms of COPD patients presenting with severe exacerbation. The determination of the failure criteria of NIMV and the expertise of the team is critical for treatment success. Keywords: noninvasive mechanical ventilation

  19. LIVING THE SUFFERING AND CHALLENGES IN THE WORK: SELF-CRITICAL OPINIONS OF A NURSE-EDUCATORS GROUP

    Directory of Open Access Journals (Sweden)

    Marta Lenise do Prado

    2004-04-01

    Full Text Available This is a cutting of my máster, thisI had as objective to know the nurses-educators self-criticalexpressions concerning the working process on professional teaching for technical nursing. was based on theconstructive, social-interactive conception by Vygotsky, which assembled expressions from a nursing teachinggroup who works in a Brazilian South region state. There were carried out thematic and systematic meetings withthe subjects of this study where their reports about their respective pedagogical experiences were explored. It wasused the method proposed by Trentini and Paim as an analysis procedure. The results point out that these nurseseducatorsexpress their pleasure of working with technical nursing teaching. They also show that the different kindof problems they face during the working process can lead them to all sort of devaluation. Apart from this, theresults point out some aspects that are indicatives of internal organization of a social institution as interactiveamong the subjects of this education level. It also shows that this kind of organization seems to keep changing thepedagogical competence of this group.

  20. Adverse incidents, patient flow and nursing workforce variables on acute psychiatric wards: the Tompkins Acute Ward Study.

    Science.gov (United States)

    Bowers, Len; Allan, Teresa; Simpson, Alan; Nijman, Henk; Warren, Jonathan

    2007-01-01

    Adverse incidents (violence, self-harm and absconding) can cause significant harm to patients and staff, are difficult to predict, and are driving an increase in security measures and defensive practice. To explore the relationship between adverse incidents on acute psychiatric wards, admissions and nursing workforce variables. A retrospective analysis of officially collected data covering a period of 30 months on 14 acute wards at three hospitals. This data included 69 serious untoward incidents. Adverse incidents were more likely during and after weeks of high numbers of male admissions, during weeks when other incidents also occurred, and during weeks of high regular staff absence through leave and vacancy. It may be possible to predict adverse incidents. Careful staff management and deployment may reduce the risks.

  1. Development and validation of scales to measure organisational features of acute hospital wards.

    Science.gov (United States)

    Adams, A; Bond, S; Arber, S

    1995-12-01

    In order to make comparisons between wards and explain variations in outcomes of nursing care, there is a growing need in nursing research for reliable and valid measures of the organisational features of acute hospital wards. This research developed The Ward Organisational Features Scales (WOFS); each set of six scales comprising 14 subscales which measure discrete dimensions of acute hospital wards. A study of a nationally representative sample of 825 nurses working in 119 acute wards in 17 hospitals, drawn from seven Regional Health Authorities in England provides evidence for the structure, reliability and validity of this comprehensive set of measures related to: the physical environment of the ward, professional nursing practice, ward leadership, professional working relationships, nurses' influence and job satisfaction. Implications for further research are discussed.

  2. Employee critical psychological states as determinants of employee brand equity in banking: a multi-group analysis

    Directory of Open Access Journals (Sweden)

    Mohsin Altaf

    2017-09-01

    Full Text Available The objective of the study is to investigate the moderating role of affective sentiments of brand psychological ownership of an employee in the relationship among the cognitive sentiments of employee brand understanding and employee brand equity of conventional and Islamic banks. Survey method was adopted to collect data from respondents from conventional and Islamic banks. Data were collected from 279 employees from the banking sector using two-stage probability sampling. Disproportionate stratified random sampling and simple random sampling were employed to collect responses. To analyze the data, multi-group analysis was applied using PLS-SEM technique through SmartPLS 3.0. Results demonstrated that congruence between brand image and individuals has a moderating effect on the relationship between brand confidence and employee brand equity in conventional banking. Responsibility to maintain brand image has a moderating effect on the relationship between brand knowledge and employee brand equity in conventional banking. In case of Islamic banking, only congruence between brand image and individuals exhibited a moderating role on the relationship between brand knowledge and employee brand equity. The importance of brand understanding of employees and psychological ownership of a brand has been widely discussed in branding literature. However, only a few studies investigated the relationship between dimensions of employee brand understanding and the employee brand psychological ownership with employee brand equity. The cognitive and affective sentiments of both exogenous latent constructs, their relationships, and the interaction effect of cognitive and affective sentiments were seldom discussed in branding literature. This study covers the in-depth view and investigation of brand understanding of employ¬ees and the affective and cognitive sentiments of brand psychological ownership with em¬ployee behavior toward a brand. This study also

  3. Nonperturbative functional renormalization-group approach to transport in the vicinity of a (2 +1 ) -dimensional O(N )-symmetric quantum critical point

    Science.gov (United States)

    Rose, F.; Dupuis, N.

    2017-01-01

    Using a nonperturbative functional renormalization-group approach to the two-dimensional quantum O (N ) model, we compute the low-frequency limit ω →0 of the zero-temperature conductivity in the vicinity of the quantum critical point. Our results are obtained from a derivative expansion to second order of a scale-dependent effective action in the presence of an external (i.e., nondynamical) non-Abelian gauge field. While in the disordered phase the conductivity tensor σ (ω ) is diagonal, in the ordered phase it is defined, when N ≥3 , by two independent elements, σA(ω ) and σB(ω ) , respectively associated to SO (N ) rotations which do and do not change the direction of the order parameter. For N =2 , the conductivity in the ordered phase reduces to a single component σA(ω ) . We show that limω→0σ (ω ,δ ) σA(ω ,-δ ) /σq2 is a universal number, which we compute as a function of N (δ measures the distance to the quantum critical point, q is the charge, and σq=q2/h the quantum of conductance). On the other hand we argue that the ratio σB(ω →0 ) /σq is universal in the whole ordered phase, independent of N and, when N →∞ , equal to the universal conductivity σ*/σq at the quantum critical point.

  4. Student attitudes towards the goals of an inter-professional training ward.

    Science.gov (United States)

    Wijma, M B

    1999-01-01

    For some years, a 14-day practice period in an inter-professional, integrated training ward has been a compulsory element for students in six programmes at the Faculty of Health Sciences (FHS) in Linkoping, Sweden.The main purposes of the training are to enable students to collaborate in teams and to understand the competences and skills of the other students, to recognize the needs of the patients and to practise and develop their own professional role. A process evaluation of the first year of this training ward focused on students' attitudes towards the goals of the integrated learning activity.Results show that students from all programmes, generally speaking, entered the training with high expectations and that these expectations changed very little, i.e.their expectations were satisfied.The ability to 'understand other competences and skills' had an impact as a result of the training and was the only goal showing a measurable change in a positive direction. As regards programmes, the student nurses were the most positive group. It seems that students representing caring professions, who will cooperate closely in the future, have the highest expectations of teamwork and development of their own professional role and that these expectations are satisfied. Students from medicine and the paramedical programmes were less positive regarding the goal of developing their own professional role. A possible goal conflict between teamwork and practising one's own professional role is discussed.

  5. Utilization Pattern of Antibiotics in Different Wards of Sari Imam Khomeini Teaching Hospital

    Directory of Open Access Journals (Sweden)

    M.A. Ebrahimzadeh, Ph.D.

    2007-01-01

    Full Text Available AbstractBackground and Purpose: Due to an increase in cases of irrational drug prescription and it's health and economic consequences, evaluation of the rational use of drugs seemed necessary. Among drug groups antibiotics are greatly significant.Materials and Methods: Utilization pattern of antibiotics in different wards of Sari Imam Khomeini teaching hospital in the first half of 2000 and 2005 were reviewed. ATC/DDD (Anatomic, Therapeutic, Chemical/ Defined Daily Dose methodology was used.Results: Data showed, use of antibiotics jumped from 95.4 DBDs (DDD per patient’s bed-days to 124 DBDs. Distribution of different class of anti-microbial, showed the highest increase in use of vancomycin and clindamycin. Use of cotrimoxazole and aminoglycosides remained fairly unchanged, howerrs consumption of Penicillin G dropped. In year 2005, ICU ward followed by gynecology, were among the University Hospital departments with the highest consumption of antibiotics. Cefazolin was the most prescribed antibiotics during this study.Conclusion: It appers that there is a need for more national drug policities and drug education program for health care professionals. Evaluation of drug distribution in hospitals seems to be necessary.Key words:

  6. Gastroenteritis at the pediatric ward of Tembakau Deli Hospital, Medan, in 1988.

    Science.gov (United States)

    Nasution, F R; Panggabean, G; Loebis, M S; Siregar, Z

    1991-01-01

    In a period of 1 year (1 January-31 December 1988) a retrospective study on patients admitted to the Pediatric ward of Tembakau Deli Hospital, Medan, was done. This hospital is a referral hospital for patients from hospitals of Dept. of Plantation in North Sumatera and Aceh. During year 1988, there were 1339 infants and children hospitalized at the Pediatric ward Tembakau Deli, Medan. Of these patients, 183 had gastroenteritis; it was most frequently found in the age group of 0-13 months (46.4%). The patients consisted of 53.55% males and 46.45% females. Most of the patients i.e. 140 (76.51%), had good nutrition. Malnutrition were found in 31 patients where 16.94% among them were moderate malnutrition, and 12 patients (6.55%) had malnutrition. The total mortality rate of gastroenteritis in this study was 2.18% which was usually associated with severe complications while pure gastroenteritis showed no (0%) mortality.

  7. Surveying Substance Abuse Frequency in Hospitalized Patients in Psychiatric Ward of Farshchian Hospital in Hamadan

    Directory of Open Access Journals (Sweden)

    A. Ghaleiha

    2010-04-01

    Full Text Available Introduction & Objective: Substance abuse is believed to be one of the greatest social, economical ,and cultural problems all over the world and it is commonly observed among all social classes especially among mental disorder patients. Substance abuse can influence on the receptive-mental states such as mood and on the external visible activities such as behaviors. The aim of this study is to survey the frequency of Substance abuse in hospitalized mental-psychic patients in psychiatric ward of Farshchian hospital in Hamadan. Materials & Methods: In this descriptive and retrospective study, available sampling method was used along with examining filed records in which the records of 400 hospitalized patients (293 men and 107 women from September 2000 to 2001 were checked and required data such as demographic information, infliction duration, substance abuse duration, psychiatric diagnosis were extracted and registered. The data were analyzed with descriptive statistical methods.Results: About half of the hospitalized patients in the psychiatric ward had simultaneous substance abuse. Men had substance abuse more than women and the youths aged 20-39 more than the other groups. The study showed that widowing had positive relationship and higher education negative relationship with substance abuse.Conclusion: Mood disorders with 90.53%, schizophrenia with 8.29%, and other diagnostics with 1.18% were observed in persons with substance abuse and these diagnostics in non substance abuse persons were 79.22% ,11.26% and 9.52% respectively.

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

    Science.gov (United States)

    Chapman, Alan; Law, Shirley

    2009-04-01

    Nursing a person with dementia in a ward setting can be stressful and a challenge for staff and patients alike. Healthcare assistants are identified as requiring a specific training program. They form part of the front-line workforce and yet have the least access to training but often most contact with patients. The program in this study focused on person-centered care and used six self-study workbooks. Experienced registered nurses are trained to be facilitators of 12 group discussions in the ward setting. The training program viewed the facilitator as playing a key role in empowering the healthcare assistant but also in promoting reflective practice. The outcomes to date have been positive and showed a development in confidence and competence of the healthcare assistants involved.

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

    Directory of Open Access Journals (Sweden)

    Alicia Oiberman

    2016-02-01

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

  10. GIS-based identification of areas that have resource potential for critical minerals in six Selected Groups of Deposit Types in Alaska

    Science.gov (United States)

    Karl, Susan M.; Jones, III, James V.; Hayes, Timothy S.

    2016-11-16

    Alaska has considerable potential for undiscovered mineral resources. This report evaluates potential for undiscovered critical minerals in Alaska. Critical minerals are those for which the United States imports more than half of its total supply and which are largely derived from nations that cannot be considered reliable trading partners. In this report, estimated resource potential and certainty for the state of Alaska are analyzed and mapped for the following six selected mineral deposit groups that may contain one or more critical minerals: (1) rare earth elements-thorium-yttrium-niobium(-uranium-zirconium) [REE-Th-Y-Nb(-U-Zr)] deposits associated with peralkaline to carbonatitic igneous intrusive rocks; (2) placer and paleoplacer gold (Au) deposits that in some places might also produce platinum group elements (PGE), chromium (Cr), tin (Sn), tungsten (W), silver (Ag), or titanium (Ti); (3) platinum group elements(-cobalt-chromium-nickel-titanium-vanadium) [PGE(-Co-Cr-Ni-Ti-V)] deposits associated with mafic to ultramafic intrusive rocks; (4) carbonate-hosted copper(-cobalt-silver-germanium-gallium) [Cu(-Co-Ag-Ge-Ga)] deposits; (5) sandstone-hosted uranium(-vanadium-copper) [U(-V-Cu)] deposits; and (6) tin-tungsten-molybdenum(-tantalum-indium-fluorspar) [Sn-W-Mo(-Ta-In-fluorspar)] deposits associated with specialized granites.This study used a data-driven, geographic information system (GIS)-implemented method to identify areas that have mineral resource potential in Alaska. This method systematically and simultaneously analyzes geoscience data from multiple geospatially referenced datasets and uses individual subwatersheds (12-digit hydrologic units) as the spatial unit of classification. The final map output uses a red, yellow, green, and gray color scheme to portray estimated relative potential (High, Medium, Low, Unknown) for each of the six groups of mineral deposit types, and it indicates the relative certainty (High, Medium, Low) of that estimate for

  11. The educational value of ward rounds for junior trainees

    Directory of Open Access Journals (Sweden)

    Faidon-Marios Laskaratos

    2015-04-01

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

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

    Directory of Open Access Journals (Sweden)

    L.M. Cremer

    1980-09-01

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

  13. The Good Pain Management (GPM) Ward Program in China and its impact on Chinese cancer patients:the SYSUCC experience

    Institute of Scientific and Technical Information of China (English)

    Yun-Peng Yang; Yu-Xiang Ma; Yan Huang; Yuan-Yuan Zhao; Fei Xu; Ying Tian; Ben-Yan Zou; Rui-Zhen Gao; Li Zhang

    2014-01-01

    To improve cancer pain management, the Medical Oncology Department of Sun Yat-sen University Cancer Center (SYSUCC) launched the Good Pain Management (GPM) Ward Program, which has been recognized by the Chinese Ministry of Health and promoted throughout the nation. This retrospective case-control study was designed to evaluate the effectiveness of the program. Patients diagnosed with malignant solid tumors with bone metastasis were eligible. Patients who were admitted 6 months before the initiation of the GPM program were used as the control group, and patients admitted 6 months after the initiation of the program were used as the GPM group. The pain-reporting rate and pain management index (PMI) were calculated. The pain levels before and after pain management were compared. A total of 475 patients (244 in the control group and 231 in the GPM group) were analyzed. The pain-reporting rate of the GPM group was significantly higher than that of the control group (62.8% vs. 37.7%,P< 0.001). The PMI of the GPM group was significantly higher than that of the control group (0.083 vs. -0.261,P< 0.001). Therefore, the GPM Ward Program improved the pain management of cancer patients and provided experience for improving cancer pain management in the future.

  14. Mass-flow error in the numerical renormalization-group method and the critical behavior of the sub-Ohmic spin-boson model

    Science.gov (United States)

    Vojta, Matthias; Bulla, Ralf; Güttge, Fabian; Anders, Frithjof

    2010-02-01

    We discuss a particular source of error in the numerical renormalization group (NRG) method for quantum impurity problems, which is related to a renormalization of impurity parameters due to the bath propagator. At any step of the NRG calculation, this renormalization is only partially taken into account, leading to systematic variation in the impurity parameters along the flow. This effect can cause qualitatively incorrect results when studying quantum-critical phenomena, as it leads to an implicit variation in the phase transition’s control parameter as function of the temperature and thus to an unphysical temperature dependence of the order-parameter mass. We demonstrate the mass-flow effect for bosonic impurity models with a power-law bath spectrum, J(ω)∝ωs , namely, the dissipative harmonic oscillator and the spin-boson model. We propose an extension of the NRG to correct the mass-flow error. Using this, we find unambiguous signatures of a Gaussian critical fixed point in the spin-boson model for s<1/2 , consistent with mean-field behavior as expected from quantum-to-classical mapping.

  15. The Ottoman Hammam Al-Ward In Saida, Lebanon

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    Howayda al-Harithy

    2016-12-01

    Full Text Available Hammam Al-Ward is an Ottoman monument in Saida. Siada (or Sidon is a coastal city in Lebanon and a hidden treasure with numerous Mamluk and Ottoman monuments. These monuments are of various types, from mosques to hammams to palaces and khans. They remain unstudied and at times undocumented. This is an architectural monograph of Hammam Al-Ward placed within the urban history of the city and the social practices of its inhabitants. Through documentation and comparative analysis, the paper argues that the hammam was built during the early eighteenth century but carries within it an old tradition of building that dates back to the Mamluk period and an old socio-spatial practice that dates back to Roman times. The article investigates and presents the urban condition that unfolds through the hammam patronage, style and location, the architectural interpretation of the hammam type of the Mediterranean Arab World and the socio-spatial practices of bathing and leisure that continue till modern times.

  16. Evaluation of the effect of music on anxiety level of patients hospitalized in cardiac wards before angiography

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    Zahra Pourmovahed

    2016-02-01

    Full Text Available Background: Patients experience high levels of anxiety before angiography, which is mostly associated with irreparable effects on health status of such individuals. Use of alternative medicine to reduce stress and anxiety is of paramount importance. Therefore, this study aimed to evaluate the effect of music on anxiety level of patients hospitalized in cardiac wards before angiography. Methods: This clinical trial was conducted on 70 patients admitted to cardiac wards before angiography in three selected hospitals of Shiraz, Iran in 2015. Samples were selected through randomized and available sampling and divided into two groups of control (n=35 and intervention (n=35. In this study, the intervention group received one hour of music before angiography for 20 minutes, whereas the usual care of ward was provided for the control group. Data was collected using the state-trait anxiety inventory (STAI by Spielberger one hour before angiography (immediately before the intervention and 20 minutes after angiography (immediately after the intervention through interviews with all the participants. Data analysis was performed in SPSS version 22 using descriptive statistics, Chi-square, as well as paired and independent-tests. Results: In this study, mean anxiety scores of patients in the intervention and control groups before the intervention were 48.45±6.63 and 48.25±6.63, respectively. After the intervention, these scores were changed to 44.28±5.21 and 49.02±7.74 in the intervention (P=0.004 and control (P=0.90 groups, respectively. Therefore, a significant difference was observed between the groups after the intervention (P=0.008. Conclusion: According to the results of this study, music before angiography could lead to a significant decrease in anxiety level of patients. Therefore, this approach could be used as an effective method to alleviate anxiety in patients.

  17. Evaluation of the effect of music on anxiety level of patients hospitalized in cardiac wards before angiography

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    Pourmovahed Zahra

    2016-08-01

    Full Text Available Background and Objective: Patients experience high levels of anxiety before angiography, which is mostly associated with irreparable effects on health status of such individuals. Use of alternative medicine to reduce stress and anxiety is of paramount importance. Therefore, this study aimed to evaluate the effect of music on anxiety level of patients hospitalized in cardiac wards before angiography. Materials and Method: This clinical trial was conducted on 70 patients admitted to cardiac wards before angiography in three selected hospitals of Shiraz, Iran in 2015. Samples were randomized convenience sampling and divided into two groups of control (n=35 and intervention (n=35. In this study, the intervention group received one hour of music before angiography for 20 minutes, whereas the usual care of ward was provided for the control group. Data was collected using the state-trait anxiety inventory (STAI by Spielberger one hour before angiography (immediately before the intervention and 20 minutes after angiography (immediately after the intervention through interviews with all the participants. Data analysis was performed in SPSS version 22 using descriptive statistics, Chi-square, as well as paired and independent-tests. Results: In this study, mean anxiety scores of patients in the intervention and control groups before the intervention were 48.45±6.63 and 48.25±6.63, respectively. After the intervention, these scores were changed to 44.28±5.21 and 49.02±7.74 in the intervention (P=0.004 and control (P=0.90 groups, respectively. Therefore, a significant difference was observed between the groups after the intervention (P=0.008. Conclusion: According to the results of this study, music before angiography could lead to a significant decrease in anxiety level of patients. Therefore, this approach could be used as an effective method to alleviate anxiety in patients.

  18. Fostering interprofessional communication through case discussions and simulated ward rounds in nursing and medical education: A pilot project

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    Wershofen, Birgit

    2016-04-01

    Full Text Available Background: Poor communication between physicians and nursing staff could result in inadequate interprofessional collaboration with negative effects on patient health. In order to ensure optimal health care for patients, it is important to strengthen interprofessional communication and collaboration between physicians and nurses during their education. Aim: The aim of this project is to foster communication for medical and nursing students through interprofessional case discussions and simulated ward rounds as a form of training.Method: In 2013-15 a total of 39 nursing students and 22 medical students participated in eight seminars, each covering case discussions and simulated ward rounds. The seminar was evaluated based on student assessment of the educational objectives.Results: Students who voluntarily signed up for the seminar profited from the interprofessional interaction and gathered positive experiences working in a team.Conclusion: Through practicing case discussions and ward rounds as a group, interprofessional communication could be fostered between medical and nursing students. Students took advantage of the opportunity to ask those from other profession questions and realized that interprofessional interaction can lead to improved health care.

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

    Science.gov (United States)

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

    2011-03-01

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

  20. Bacterial contamination of the hands of doctors: A study in the medicine and dermatology wards

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    Rudrajit Paul

    2011-01-01

    Full Text Available Background: Doctors′ hands are a common source of bacterial contamination. Often, these organisms are found to be virulent species with multidrug-resistance patterns. These are the sources of nosocomial infections in many patients. Aims: The present study was undertaken to find out the prevalence of bacterial contamination in the hands of doctors in the Medicine and Dermatology wards of a tertiary care hospital. Methods: The hands of 44 doctors were swabbed and cultured at entry to ward and at exit. Then, tap water and alcohol swab wash techniques were used and further swabs were done at each step. Thus, each doctor was sampled four-times for the study. The antibiotic-sensitivity pattern of the organisms was determined by the disc-diffusion method. Results: There was a significant contamination of the doctors′ hands at entry (59.1% and at exit (90.9%. Overall, Staphylococcus was the predominant organism (59% at entry and 85% at exit; coagulase-negative ones were more prevalent at entry (32% and coagulase-positive ones were more prevalent at exit (54%. There was no difference in the hand contamination rates of junior and senior doctors. Also, the contamination rates were similar in the Medicine and Dermatology wards. Among the Gram negative organisms, Escherichia coli (4.5%, Pseudomonas (4.5%, Enterococci (13.6% and Klebsiella (9% were the main ones isolated. Gram negative organisms were significantly more prevalent at exit (P = 0.009 compared with their numbers at entry. Hand washing techniques reduced the contamination rates significantly, 76% with tap water wash and further 16.5% with alcohol swab. The removal rate for both groups of organisms was similar. Also, coagulase-positive and -negative Staphylococci showed equal rates of removal with hand washing (P = 0.9793. The organisms were found to be resistant to most of the commonly used antibiotics; the beta-lactam group was especially largely resistant both for Gram positive and Gram

  1. Ventilation of wards and nosocomial outbreak of severe acute respiratory syndrome among healthcare workers

    Institute of Scientific and Technical Information of China (English)

    江山平; 黄莉文; 陈锡龙; 王景峰; 伍卫; 尹松梅; 陈为宪; 詹俊; 严励; 马丽萍; 李建国; 黄子通

    2003-01-01

    Objective To identify valid measures for preventing outbreaks of severe acute respiratory syndrome (SARS) among protected healthcare workers in isolation units.Methods Architectural factors, admitted SARS cases and infection of healthcare workers in different isolation wards between January 30 and March 30, 2003 were analyzed.Results Four types of isolation wards were analyzed, including the ward where the thirty-first bed was located on the twelfth floor, the laminar flow ward in the Intensive Care Unit where the tenth bed was located on the fifteenth floor, the ward where the twenty-seventh bed was located on the thirteenth floor of the Lingnan Building, and thirty wards on the fourteenth to eighteenth floors of the Zhongshan Building. The ratios (m2/m3) of the area of the ventilation windows to the volume of the rooms were 0, 0, 1∶ 95 and 1∶ 40, respectively. Numbers of SARS cases in the wards mentioned above were 1, 1, 1 and 96, respectively. Total times of hospitalization were 43, 168, 110 and 1272 hours, respectively. The infection rates of the healthcare workers in the areas mentioned above were 73.2%, 32.1%, 27.5% and 1.7%, respectively. The difference in the infection rates was of statistical significance.Conclusions Isolating SARS cases in wards with good ventilation could reduce the viral load of the ward and might be the key to preventing outbreaks of SARS among healthcare workers along with strict personal protection measures in isolation units.

  2. A virtual psychiatric ward for orientating patients admitted for the first time.

    Science.gov (United States)

    Lau, Wai-Chi; Choi, Kup-Sze; Chung, Wai-Yee

    2010-12-01

    Misconceptions about psychiatric wards frequently cause newly admitted mental patients to stay away from these wards despite their need for treatment. Although ward orientation is typically conducted by nurses in an attempt to help patients to adapt to the new environment, it is considered time-consuming, and the method of orientation and the explanations given may vary among different nurses. This situation calls for a more effective and standardized approach to orientating mental patients on their first admission. To this end, a computer-based interactive virtual environment was developed based on a real psychiatric ward by using virtual reality (VR) technologies. It enables the patient to navigate around to gain understanding about the ward through a virtual guided tour. The effectiveness of this VR orientation approach was investigated by a randomized controlled trial with consecutive sampling. Fifty-four Chinese participants were randomly assigned to undergo ward orientation by either using the VR-based approach or reading text-based electronic information sheets about the ward with a computer. Subjective and objective measures were obtained respectively using the Chinese version of the State-Trait Anxiety Inventory questionnaire and the heart-rate variability measurement before and after the intervention. In addition, a test on the level of understanding about the ward was administered at the end of the session. The results showed that the VR orientation approach is helpful in reducing patients' anxiety while also improving their level of understanding about the ward.

  3. Perceptions of nursing students trained in a new model teaching ward in Malawi

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    Thokozani Bvumbwe

    2015-11-01

    Full Text Available This study aimed to investigate the perceptions of nursing students trained in a new model teaching ward in Malawi. A total of 90students from five nursing colleges were randomly assigned to one model ward and two ordinary wards in a single teaching hospital. The students were administered a revised version of the Student Evaluation of Clinical Education Environment questionnaire. Significant differences among the three wards were found in all items in the communication/feedback subscale, with the exception of the item “nursing staff provided constructive feedback” (P=0.162. Within the learning opportunities subscale all items showed significant differences among the three wards, whereas 50% of the items in the learning support/assistance subscale had significantly different responses among the three wards. Within the department atmosphere subscale, no significant differences were found in the items assessing whether an adequate number and variety of patients were present in the ward (P=0.978. The strategies that are being implemented to improve the educational environment showed positive results. Students scored the model teaching ward highly. Students who underwent precepting in the model teaching wards reported having more learning opportunities and a positive learning environment.

  4. Warding off the evil eye: when the fear of being envied increases prosocial behavior.

    Science.gov (United States)

    van de Ven, Niels; Zeelenberg, Marcel; Pieters, Rik

    2010-11-01

    The fear of being envied makes people act prosocially, in an attempt to ward off the potentially destructive effects of envy. In three experiments, people who were in a superior position and could be envied were more likely than control participants to give time-consuming advice to a potentially envious person or to help a potentially envious person pick up erasers she had accidentally scattered. However, helping behavior increased only if envy was likely to be malicious rather than benign. People who were better off did not increase their helping behavior toward people in general, but increased their helping only toward the potentially envious. This finding is consistent with the idea that the better off act more prosocially as an appeasement strategy. The fear of being envied serves useful group functions, because it triggers prosocial behavior that is likely to dampen the potentially destructive effects of envy and simultaneously helps to improve the situation of people who are worse off.

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

    Science.gov (United States)

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

    2016-01-01

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

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

    Science.gov (United States)

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

    2017-01-01

    Purpose. Effectiveness of nonpharmacological multicomponent prevention delivered by trained volunteers (medical and psychology students), targeted at delirium risk factors in geriatric inpatients, was assessed at an internal medicine ward in Poland. Patients and Methods. Participants were recruited to intervention and control groups at the internal medicine ward (inclusion criteria: age ≥ 75, acute medical condition, basic orientation, and logical contact on admission; exclusion criteria: life expectancy delirium episodes, and antipsychotic prescriptions were assessed retrospectively from medical documentation. Results. 130 patients (38.4% males) participated in the study, with 65 in the intervention group. Antipsychotic medications were initiated less frequently in the intervention group compared to the control group. There was a trend towards a shorter hospitalization time and a not statistically significant decrease in deaths in the intervention group. Conclusion. Nonpharmacological multicomponent intervention targeted at delirium risk factors effectively reduced length of hospitalization and need for initiating antipsychotic treatment in elderly patients at the internal medicine ward. PMID:28164113

  7. The effect of additional training on motor outcomes at discharge from recovery phase rehabilitation wards: a survey from multi-center stroke data bank in Japan.

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    Nariaki Shiraishi

    Full Text Available The purpose of the present study was to examine the potential benefits of additional training in patients admitted to recovery phase rehabilitation ward using the data bank of post-stroke patient registry.Subjects were 2507 inpatients admitted to recovery phase rehabilitation wards between November 2004 and November 2010. Participants were retrospectively divided into four groups based upon chart review; patients who received no additional rehabilitation, patients who were added with self-initiated off hours training, patients who were added with off hours training by ward staff, patients who received both self-initiated training and training by ward staff. Parameters for assessing outcomes included length of stay, motor/cognitive subscales of functional independent measures (FIM and motor benefit of FIM calculated by subtracting the score at admission from that at discharge.Participants were stratified into three groups depending on the motor FIM at admission (≦28, 29∼56, 57≦ for comparison. Regarding outcome variables, significant inter-group differences were observed in all items examined within the subgroup who scored 28 or less and between 29 and 56. Meanwhile no such trends were observed in the group who scored 57 or more compared with those who scored less. In a decision tree created based upon Exhaustive Chi-squared Automatic Interaction Detection method, variables chosen were the motor FIM at admission (the first node additional training (the second node, the cognitive FIM at admission(the third node.Overall the results suggest that additional training can compensate for the shortage of regular rehabilitation implemented in recovery phase rehabilitation ward, thus may contribute to improved outcomes assessed by motor FIM at discharge.

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

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    Morphet J

    2014-06-01

    Full Text Available Julia Morphet,1 Kerry Hood,2 Robyn Cant,2 Julie Baulch,3 Alana Gilbee,3 Kate Sandry4 1School of Nursing and Midwifery, Monash University, Frankston, Victoria, Australia; 2School of Nursing and Midwifery, Monash University, Clayton, Victoria, Australia; 3Southern Clinical School, Monash University, Monash Health, Clayton, Victoria, Australia; 4Dandenong Emergency Department, Monash Health, David St, Dandenong, Victoria, Australia Abstract: The establishment of interprofessional teamwork training in the preprofessional health care curriculum is a major challenge for teaching faculties. Interprofessional clinical placements offer an opportunity for teamwork education, as students in various professions can work and learn together. In this sequential, mixed-method study, focus group and survey techniques were used to evaluate students' educational experiences after 2-week ward-based interprofessional clinical placements. Forty-five senior nursing, medicine, and other health care students cared for patients in hospital wards under professional supervision, with nursing-medicine student "teams" leading care. Thirty-six students attended nine exit focus groups. Five central themes that emerged about training were student autonomy and workload, understanding of other professional roles, communication and shared knowledge, interprofessional teamwork/collaboration, and the "inner circle", or being part of the unit team. The learning environment was described as positive. In a postplacement satisfaction survey (n=38, students likewise rated the educational experience highly. In practicing teamwork and collaboration, students were able to rehearse their future professional role. We suggest that interprofessional clinical placements be regarded as an essential learning experience for senior preprofessional students. More work is needed to fully understand the effect of this interactive program on students' clinical learning and preparation for practice

  9. Systems for grading the quality of evidence and the strength of recommendations I: Critical appraisal of existing approaches The GRADE Working Group

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    Schünemann Holger

    2004-12-01

    Full Text Available Abstract Background A number of approaches have been used to grade levels of evidence and the strength of recommendations. The use of many different approaches detracts from one of the main reasons for having explicit approaches: to concisely characterise and communicate this information so that it can easily be understood and thereby help people make well-informed decisions. Our objective was to critically appraise six prominent systems for grading levels of evidence and the strength of recommendations as a basis for agreeing on characteristics of a common, sensible approach to grading levels of evidence and the strength of recommendations. Methods Six prominent systems for grading levels of evidence and strength of recommendations were selected and someone familiar with each system prepared a description of each of these. Twelve assessors independently evaluated each system based on twelve criteria to assess the sensibility of the different approaches. Systems used by 51 organisations were compared with these six approaches. Results There was poor agreement about the sensibility of the six systems. Only one of the systems was suitable for all four types of questions we considered (effectiveness, harm, diagnosis and prognosis. None of the systems was considered usable for all of the target groups we considered (professionals, patients and policy makers. The raters found low reproducibility of judgements made using all six systems. Systems used by 51 organisations that sponsor clinical practice guidelines included a number of minor variations of the six systems that we critically appraised. Conclusions All of the currently used approaches to grading levels of evidence and the strength of recommendations have important shortcomings.

  10. Trends in critical care beds and use among population groups and Medicare and Medicaid beneficiaries in the United States: 2000–2010

    Science.gov (United States)

    Halpern, Neil A.; Goldman, Debra A.; Tan, Kay See; Pastores, Stephen M.

    2017-01-01

    Objectives To analyze patterns of critical care medicine (CCM) beds, use, and costs in acute care hospitals in the United States (US), and relate CCM beds and use to population shifts, age groups, and Medicare and Medicaid beneficiaries from 2000 to 2010. Design Retrospective study of data from the federal Healthcare Cost Report Information System, American Hospital Association and US Census Bureau. Setting Acute care US hospitals with intensive care beds. Measurements and Main Results From 2000 to 2010, US hospitals with CCM beds decreased by 17% (3,586 to 2,977), while the US population increased by 9.6% (282.2M to 309.3M). Although hospital beds decreased by 2.2% (655,785 to 641,395), CCM beds increased by 17.8% (88,235 to 103,900), a 20.4% increase in the CCM/hospital bed ratio (13.5% to 16.2%). There was a greater percentage increase in premature/neonatal (29%, 14,391 to 18,567) than in adult (15.9%, 71,978 to 83,417) or pediatric (2.7%, 1,866 to 1,916) CCM beds. Hospital occupancy rates increased by 10% (59% to 65%), while CCM occupancy rates were stable (range 65%–68%). CCM beds per 100,000 total population increased by 7.4% (31.3 to 33.6). The proportional use of CCM services by Medicare beneficiaries decreased by 17% (37.9% to 31.4%) whereas that by Medicaid rose by 18% (14.5% to 17.2%). Between 2000 and 2010, annual CCM costs nearly doubled (92.9%, $56 to $108 billion). In the same period, the proportion of CCM cost to the Gross Domestic Product (GDP) increased by 32.1% (0.54% to 0.72%, $10,285 to $14,964 trillion). Conclusions Critical care medicine use and costs in the US continue to rise. The increasing use of CCM by the premature/neonatal and Medicaid populations should be considered by healthcare policy makers, state agencies, and hospitals as they wrestle with critical care bed growth and the associated costs. PMID:27136721

  11. A critical assessment of monitoring practices, patient deterioration, and alarm fatigue on inpatient wards: a review.

    Science.gov (United States)

    Curry, J Paul; Jungquist, Carla R

    2014-01-01

    Approximately forty million surgeries take place annually in the United States, many of them requiring overnight or lengthier post operative stays in the over five thousand hospitals that comprise our acute healthcare system. Leading up to this Century, it was common for most hospitalized patients and their families to believe that being surrounded by well-trained nurses and physicians assured their safety. That bubble burst with the Institute of Medicine's 1999 report: To Err Is Human, followed closely by its 2001 report: Crossing the Quality Chasm. This review article discusses unexpected, potentially lethal respiratory complications known for being difficult to detect early, especially in postoperative patients recovering on hospital general care floors (GCF). We have designed our physiologic explanations and simplified cognitive framework to give our front line clinical nurses a thorough, easy-to-recall understanding of just how these events evolve, and how to detect them early when most amenable to treatment. Our review will also discuss currently available practices in general care floor monitoring that can both improve patient safety and significantly reduce monitor associated alarm fatigue.

  12. A critical assessment of monitoring practices, patient deterioration, and alarm fatigue on inpatient wards: a review

    National Research Council Canada - National Science Library

    Curry, J Paul; Jungquist, Carla R

    2014-01-01

    ... acute healthcare system. Leading up to this Century, it was common for most hospitalized patients and their families to believe that being surrounded by well-trained nurses and physicians assured their safety...

  13. Clinical ethics ward rounds: building on the core curriculum.

    Science.gov (United States)

    Parker, Lisa; Watts, Lisa; Scicluna, Helen

    2012-08-01

    The clinical years of medical student education are an ideal time for students to practise and refine ethical thinking and behaviour. We piloted a new clinical ethics teaching activity this year with undergraduate medical students within the Rural Clinical School at the University of New South Wales. We used a modified teaching ward round model, with students bringing deidentified cases of ethical interest for round-table discussion. We found that students were more engaged in the subject of clinical ethics after attending the teaching sessions and particularly appreciated having structured time to listen to and learn from their peers. Despite this, we found no change in student involvement in managing or planning action in situations that they find ethically challenging. A key challenge for educators in clinical ethics is to address the barriers that prevent students taking action.

  14. Nosocomial klebsiellas. II. Transfer in a hospital ward.

    Science.gov (United States)

    Haverkorn, M J; Michel, M F

    1979-04-01

    During a 6-month period an epidemiological survey of the carriage of Klebsiella was conducted in a hospital ward where no outbreak of nosocomial infection occurred. In this endemic situation the regular sampling of several sites of patients, members of the nursing staff, and the environment, and the biotyping of Klebsiella made it possible to analyse the patterns of transmission between sites. There was abundant evidence for striking transmission of Klebsiella between the throat, hands, and faeces of patients. Transmission between patients seemed to be mainly through hands. The role of nurses' hands in transmission was not evident from this survey, probably due to the relatively long interval (a week) between samplings. Through the hands of patients, wash stands and the surrounding floor were contaminated with Klebsiella. The biotyping of Klebsiella facilitated the epidemiological analysis of the results.

  15. Christmas cards workshop in a Restricted Access Ward

    Directory of Open Access Journals (Sweden)

    Teresa García

    2003-12-01

    Full Text Available The Christmas cards workshop is an intervention study made in the Restricted Access Ward (RAW of Hospital Gregorio Marañón (Madrid, in December 2001, from the 5th to the 22nd. The object of this study was to assess the effectiveness of this workshop to improve the quality of the RAW patients´ hospital day, through their participation. They made 47 cards, the mean per patient was 1,52. Participation: 91,2% of the patients that fulfilled the inclusion criteria. Drawings and texts alluded to the convict´s perspective of Christmas time, from their own experience. The Christmas cards were exhibited in the hospital and they also were sent to different penitentiary institutions in Madrid, to make the RAW known. The course “Education for health for interdisciplinary projects in penitentiary institutions” was the frame of this workshop.

  16. $B_7$, $B_8$ and chiral Ward identities

    CERN Document Server

    Lee, W; Lee, Weonjong; Fleming, George T.

    2005-01-01

    We present recent progress in understanding weak matrix elements on the lattice. We use HYP staggered fermions in quenched QCD to study numerically various properties of the $K^+\\to\\pi^+$ amplitudes of the electroweak penguin operators $Q_7$ and $Q_8$. We check chiral Ward identities to probe the validity of using improved staggered fermions in the calculation of weak matrix elements. We address the issue of mixing with unphysical lower dimension operators, which causes a divergent term in the case of the $\\Delta I = 1/2$ amplitudes. We propose a particular subtraction method as the best choice. We also measure the gold-plated ratio $R$ originally suggested by Becirevic and Villadoro.

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

    DEFF Research Database (Denmark)

    Houben, Steven; Schmidt, Mathias; Frost, Mads

    2015-01-01

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

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

    Science.gov (United States)

    Wilson, Gwyneth

    2009-07-01

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

  19. 4WARD: A European Perspective towards the Future Internet

    Science.gov (United States)

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

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

  20. Prevention of measles spread on a paediatric ward.

    Science.gov (United States)

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

    2015-03-01

    Since measles is a highly contagious respiratory infection with significant airborne transmission risk in hospitals, effective prevention measures are crucial. After a mother accompanying her child on a paediatric ward lacking a negative pressure room was diagnosed with measles, exposed persons without evidence of immunity (documentary evidence of receiving two doses of measles-mumps-rubella vaccine) were treated with vaccination or intravenous immunoglobulin (IVIG). The interruption of transmission with these treatments was evaluated. There were 44 children and 101 adults exposed to the index patient. Twenty-five children and 88 adults were considered immune, providing evidence of immunity. Nineteen children and 13 adults were either given vaccination or IVIG for post-exposure prophylaxis (PEP). There were no additional cases of measles after 3 weeks follow-up. We conclude that measles is highly preventable by adequate PEP with vaccination or IVIG in a healthcare setting that lacks the benefit of a negative pressure room.

  1. Design Proposal for Pleasurable Light Atmosphere in Hospital Wards

    DEFF Research Database (Denmark)

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

    2010-01-01

    When constructing and designing Danish hospitals for the future, patients, staff and guests are in focus. It is found important to have a starting point in healing architecture and create an environment with knowledge of users sensory and functionally needs and looks at how hospital wards can...... support patients’ experience or maybe even have a positive influence on the recovery process. Thus at a general level, it is a crucial task to investigate how aspects such as the design of the environment, arts, lights, sounds can support and improve the patients’ recovery rate and the satisfaction...... of staff and guests in the future hospital. This paper introduce the concept of atmosphere based on the theory of Gernot Böhmes and it is dealing with the effect of light in experiencing atmosphere, looking at the importance having a holistic approach to lighting design. The paper displays important design...

  2. Patient safety culture lives in departments and wards: Multilevel partitioning of variance in patient safety culture

    Directory of Open Access Journals (Sweden)

    Hofoss Dag

    2010-03-01

    Full Text Available Abstract Background Aim of study was to document 1 that patient safety culture scores vary considerably by hospital department and ward, and 2 that much of the variation is across the lowest level organizational units: the wards. Setting of study: 500-bed Norwegian university hospital, September-December 2006. Methods Data collected from 1400 staff by (the Norwegian version of the generic version of the Safety Attitudes Questionnaire (SAQ Short Form 2006. Multilevel analysis by MLwiN version 1.10. Results Considerable parts of the score variations were at the ward and department levels. More organization level variation was seen at the ward level than at the department level. Conclusions Patient safety culture improvement efforts should not be limited to all-hospital interventions or interventions aimed at entire departments, but include involvement at the ward level, selectively aimed at low-scoring wards. Patient safety culture should be studied as closely to the patient as possible. There may be such a thing as "hospital safety culture" and the variance across hospital departments indicates the existence of department safety cultures. However, neglecting the study of patient safety culture at the ward level will mask important local variations. Safety culture research and improvement should not stop at the lowest formal level of the hospital (wards, out-patient clinics, ERs, but proceed to collect and analyze data on the micro-units within them.

  3. Incidence, staff awareness and mortality of patients at risk on general wards

    DEFF Research Database (Denmark)

    Fuhrmann, L.; Lippert, A.; Perner, A.;

    2008-01-01

    The aim of this study was to estimate the incidence, staff awareness and subsequent mortality of patients with abnormal vital signs on general wards in a Danish university hospital.......The aim of this study was to estimate the incidence, staff awareness and subsequent mortality of patients with abnormal vital signs on general wards in a Danish university hospital....

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

    NARCIS (Netherlands)

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

    2011-01-01

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

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

    Science.gov (United States)

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

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

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

    Science.gov (United States)

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

    2013-01-01

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

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

    Science.gov (United States)

    Gebhardt, R P; Schmidt-Michel, P O

    2002-04-01

    A satellite ward is a psychiatric ward at a general hospital settled within the catchment area that is administered by a psychiatric hospital. The objective of the satellite model is to approach community treatment on the one hand and somatic medicine on the other hand, consequently diminishing the threshold for hospital treatment. This study investigated whether the diagnostic, psychopathologic and social reasons for admissions changed from this catchment area due to the lower threshold of a satellite ward. The results were controlled with another catchment area's admissions to the 30 km distant psychiatric hospital. The opening of the satellite ward was followed by an 81 % increase of admissions. In particular, admissions of patients with neuroses and personality disorders were more frequent. There was no change of the severity code of psychopathology at admission. From the catchment area of the satellite ward less patients were admitted involuntarily whereas more admissions happened due to social reasons and after patients' own decision.

  8. Nonperturbative functional renormalization-group approach to transport in the vicinity of a $(2+1)$-dimensional O($N$)-symmetric quantum critical point

    CERN Document Server

    Rose, Félix

    2016-01-01

    Using a nonperturbative functional renormalization-group approach to the two-dimensional quantum O($N$) model, we compute the low-frequency limit $\\omega\\to 0$ of the zero-temperature conductivity in the vicinity of the quantum critical point. Our results are obtained from a derivative expansion to second order of a scale-dependent effective action in the presence of an external (i.e., non-dynamical) non-Abelian gauge field. While in the disordered phase the conductivity tensor $\\sigma(\\omega)$ is diagonal, in the ordered phase it is defined, when $N\\geq 3$, by two independent elements, $\\sigma_{\\rm A}(\\omega)$ and $\\sigma_{\\rm B}(\\omega)$, respectively associated to SO($N$) rotations which do and do not change the direction of the order parameter. For $N=2$, the conductivity in the ordered phase reduces to a single component $\\sigma_{\\rm A}(\\omega)$. We show that $\\lim_{\\omega\\to 0}\\sigma(\\omega,\\delta)\\sigma_{\\rm A}(\\omega,-\\delta)/\\sigma_q^2$ is a universal number which we compute as a function of $N$ ($\\d...

  9. Comparative effectiveness of peripheral vascular intervention versus surgical bypass for critical limb ischemia in the Vascular Study Group of Greater New York.

    Science.gov (United States)

    Meltzer, Andrew J; Sedrakyan, Art; Isaacs, Abby; Connolly, Peter H; Schneider, Darren B

    2016-11-01

    In this study, the effectiveness of peripheral vascular intervention (PVI) was compared with surgical bypass grafting (BPG) for critical limb ischemia (CLI) in the Vascular Study Group of Greater New York (VSGGNY). Patients undergoing BPG or PVI for CLI at VSGGNY centers (2011-2013) were included. The Society for Vascular Surgery objective performance goals for CLI were used to directly compare the safety and effectiveness of PVI and BPG. Propensity score matching was used for risk-adjusted comparisons of PVI with BPG. A total of 414 patients (268 PVI, 146 BPG) were treated for tissue loss (69%) or rest pain (31%). Patients undergoing PVI were more likely to have tissue loss (74.6% vs 57.5%; P PVI was associated with improved freedom from major adverse limb events and postoperative death at 1 year (95.6% vs 88.5%; P PVI. However, risk-adjusted comparison underscores the safety and effectiveness of PVI in the treatment of CLI. Copyright © 2016 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

  10. Studies on environmental impacts of the JCO criticality accident conducted by grant-in aid for scientific research from the ministry of education, science, sports and culture, Japan. Overview of environmental research group

    Energy Technology Data Exchange (ETDEWEB)

    Komura, K. [Kanazawa Univ., Faculty of Science, Low Level Radioactivity Laboratory, Tatsunokuchi, Ishikawa (Japan)

    2001-11-01

    Environmental impacts of the JCO criticality accident in Tokai-mura were investigated by a Monbusho collaborating scientific group composed of more than 50 members. This paper describes the scientific activity of the group based on 6 times of sampling campaigns in the JCO campus, specially emphasis on topical results and our remaining tasks on the accident. (author)

  11. Effects of staff education and standardizing dosing and collection times on vancomycin trough appropriateness in ward patients

    Directory of Open Access Journals (Sweden)

    Hammond DA

    2017-06-01

    Full Text Available Background: Many institutions have guidelines for initiation and monitoring, but not timing, of vancomycin. Objective: Our objective was to evaluate vancomycin trough collection appropriateness before and after an initiative to change the dosing and trough collection times in ward patients. Methods: A retrospective cohort study of ward patients from May 2014-16 who received scheduled intravenous vancomycin was performed. Nurse managers and pharmacists provided staff education. Differences between pre- and post-intervention groups were compared using student's t-test for continuous data and chi-square test for categorical data. Results: Baseline characteristics were similar between the pre-intervention (n=124 and post-intervention (n=122 groups except for weight-based maintenance dose (15.3 mg/kg vs. 16.5 mg/kg, p=0.03 and percentage of troughs collected with morning labs (14% vs. 87%, p<0.001. Patients in the pre- and post-intervention groups received a similar frequency of loading doses (14.5% vs. 16%, p=0.68. There was no significant difference in percentage of vancomycin troughs collected appropriately at 30 (40% vs. 42%, p=0.72, 60 (57% vs. 63%, p=0.35, or 75 (60% vs. 68%, p=0.22 minutes from the scheduled time of the next dose. Conclusion: Staff education and standardizing collection of vancomycin troughs with morning blood collections did not affect the percentage of appropriately collected vancomycin troughs.

  12. [GEIPC-SEIMC (Study Group for Infections in the Critically Ill Patient of the Spanish Society for Infectious Diseases and Clinical Microbiology) and GTEI-SEMICYUC ( Working Group on Infectious Diseases of the Spanish Society of Intensive Medicine, Critical Care, and Coronary Units) recommendations for antibiotic treatment of gram-positive cocci infections in the critical patient].

    Science.gov (United States)

    Astigarraga, P M Olaechea; Montero, J Garnacho; Cerrato, S Grau; Colomo, O Rodríguez; Martínez, M Palomar; Crespo, R Zaragoza; García-Paredes, P Muñoz; Cerdá, E Cerdá; Lerma, F Alvarez

    2007-01-01

    In recent years, an increment of infections caused by gram-positive cocci has been documented in nosocomial and hospital-acquired-infections. In diverse countries, a rapid development of resistance to common antibiotics against gram-positive cocci has been observed. This situation is exceptional in Spain but our country might be affected in the near future. New antimicrobials active against these multi-drug resistant pathogens are nowadays available. It is essential to improve our current knowledge about pharmacokinetic properties of traditional and new antimicrobials to maximize its effectiveness and to minimize toxicity. These issues are even more important in critically ill patients because inadequate empirical therapy is associated with therapeutic failure and a poor outcome. Experts representing two scientific societies (Grupo de estudio de Infecciones en el Paciente Crítico de la SEIMC and Grupo de trabajo de Enfermedades Infecciosas de la SEMICYUC) have elaborated a consensus document based on the current scientific evidence to summarize recommendations for the treatment of serious infections caused by gram-positive cocci in critically ill patients.

  13. Factors Influencing Participation of Rural Women in Zimbabwes 2013 Constitution Referendum A Case Study Of Ward 22 Gutu District

    Directory of Open Access Journals (Sweden)

    Barbra Ncube

    2015-08-01

    Full Text Available Abstract Participation is the cornerstone of citizen engagement. In constitution making and other public policy formulation processes public participation typically involves preparing the public to participate through civic education and public information campaigns as well as consulting the public on issues such as how the process should take place and the contents of the constitution itself. This study sought to examine the factors that influence womens participation in constitution making processes specifically relating to voting in the constitution referendum in the case of rural women residing in ward 22 of Gutu district of Zimbabwe. Gutu District is the third largest district in Masvingo province. Ward 22 is located in the communal region of Gutu central. The people of ward 22 largely depend on subsistence farming and market gardening for their livelihoods. The objectives of the study were to ascertain to what extent media campaign and publicity efforts by womens civic groups and public interaction through public meetings and hearings were able to influence the participation of Zimbabwean women in the 2013 referendum in ward 22 Gutu district. Over and above these objectives the study sought to document the experiences and views of rural Zimbabwean women on the constitution making process. This study adopted a descriptive case study research design. Samples of 108 women from Ward 22 Gutu District were conveniently selected to participate in this study. Data was collected using a structured interview guide and questionnaires which were administered to the respondents. A focused group discussion was also carried out to verify the information gathered through these instruments. Findings and conclusions were derived by means of detailed comparative and inductive analysis of data. Descriptive statistics were employed in the presentation of the findings. Amongst the major findings are that rural women in ward 22 in Gutu district were in actual

  14. Gastroenteritis in the pediatric ward of Dr. Pirngadi Hospital Medan in 1983.

    Science.gov (United States)

    Pasaribu, S; Lubis, M; Arsyad, F; Barus, N; Sutanto, A H

    1987-01-01

    In 1983, 2869 infants and children were hospitalized in the pediatric ward of the Dr. Pirngadi Hospital Mecan. Of these, 1317 (46.2%) were gastroenteritis cases; 635 of these patients (48.2%) were those ages 0-1 year. The highest prevalence is found among this group. The months of July and August accounted for the majority of gastroenteritis cases, 15.6% in the 1st and 14.2% in the 2nd. This condition held true for all age groups. Mild, moderate, and severe dehydration were encountered in 4.3%, 35.7%, and 60.6% of the cases. The over 3 year olds had the highest number of severe dehydration cases; 76.5% of all patients in the same age group. Most of these cases occurred in July; 71.2% in that month. A significant inverse correlation between age and diarrhea duration was evident--the younger the age, the longer the duration of diarrhea (p0.01). Administration of oral electrolyte solution did not significantly alter the duration of diarrhea. The overall mortality rate was 13%. The highest age specific fatality rate was found among those ages 0-1 (20.3%). Mortality for those children older than 3 was 1.8%.

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

    Directory of Open Access Journals (Sweden)

    Hui Xie

    2012-01-01

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

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

    Science.gov (United States)

    Xie, Hui; Kang, Jian

    2012-01-01

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

  17. Overcrowding in Psychiatric Wards is Associated With Increased Risk of Adverse Incidents.

    Science.gov (United States)

    Teitelbaum, Alexander; Lahad, Amnon; Calfon, Nitza; Gun-Usishkin, Monica; Lubin, Gad; Tsur, Anat

    2016-03-01

    To study the association between bed occupancy in psychiatric wards and rate of adverse incidents (AIs) including aggressive behavior and falls. This is a retrospective study analyzing bed occupancy and AIs' data in 4 closed wards in a state psychiatric hospital in Israel over a 20-month period. Ward-level daily records were extracted from the hospital's electronic admission-discharge and AI registries, creating a log of 609 days for each of the 4 wards. Relationships between gross and net bed occupancy and AIs rate were calculated, in general and for each ward and type of incidents. Average gross occupancy was 106±14.8% and net occupancy was 96.4±15.6%. Gross occupancy >100% was recorded in 51% of days. Net occupancy was higher on days with at least 1 incident than on no-incident days (98.6±14.8% vs. 95.7±15.7%, Poccupancy quadrant (up to 85% occupancy), compared with 26.7% of days in the highest occupancy quadrant (106% and above). Moreover, aggressive behavior-type incidents were significantly lower in the lowest occupancy quadrant days compared with the highest occupancy quadrant (8.3% vs. 14.1%, Pbed occupancy on AIs rate was found. Overoccupancy is prevalent in psychiatric wards and is associated with an increased rate of aggressive AIs and falls. Policy makers should be convinced about the necessity to reduce overcrowding in psychiatric wards and to improve safety of inpatient facilities.

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

    Science.gov (United States)

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

    2010-11-01

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

  19. Quantification of the diversity among common bean accessions using Ward-MLM strategy Quantificação da diversidade entre acessos de feijoeiro-comum com uso da estratégia Ward-MLM

    Directory of Open Access Journals (Sweden)

    Pablo Diego Silva Cabral

    2010-10-01

    Full Text Available The present work aimed at evaluating the divergence among common bean accessions by their agronomic, morphological and molecular traits, based on the Ward-MLM procedure. A collection of 57 accessions from the gene bank of Universidade Federal do Espírito Santo was used in this study, from which: 31 were landraces belonging to the community Fortaleza, in the municipality of Muqui, ES, Brazil; 20 accessions were provided by Embrapa Trigo; and 6 were commercial cultivars. Five agronomic traits (plant cycle, number of seeds per pod, number of pods per plant, weight of 100 seeds, and grain yield, five morphological traits (growth habit, plant size, seed shape, seed color, and commercial group and 16 microsatellite primers were evaluated. High genetic variability was detected considering morphological, agronomic and molecular traits in the 57 common bean accessions studied. The Ward-MLM procedure showed that the ideal number of groups was five, according to the pseudo F and pseudo t² criteria. The accessions from Andean origin had heavier seeds than others and formed a cluster. The Ward-MLM statistical procedure is a useful technique to detect genetic divergence and to cluster genotypes by simultaneously using morphological, agronomic and molecular data.O objetivo deste trabalho foi avaliar a divergência de acessos de feijoeiro-comum por suas características agronômicas, morfológicas e moleculares, com base no procedimento Ward-MLM. Uma coleção de 57 acessos do banco de germoplasma da Universidade Federal do Espírito Santo foi utilizada neste estudo, dos quais: 31 acessos locais, pertencentes à comunidade Fortaleza, no Município de Muqui, ES; 20 acessos fornecidos pela Embrapa Trigo; e 6 cultivares comerciais. Foram avaliados cinco caracteres agronômicos (ciclo da planta, número de sementes por vagem, número de vagens por planta, peso de 100 grãos e produtividade de grãos, cinco caracteres morfológicos (hábito de crescimento, porte

  20. Effectiveness of a Web-Based Simulation in Improving Nurses' Workplace Practice With Deteriorating Ward Patients: A Pre- and Postintervention Study.

    Science.gov (United States)

    Liaw, Sok Ying; Wong, Lai Fun; Lim, Eunice Ya Ping; Ang, Sophia Bee Leng; Mujumdar, Sandhya; Ho, Jasmine Tze Yin; Mordiffi, Siti Zubaidah; Ang, Emily Neo Kim

    2016-02-19

    Nurses play an important role in detecting patients with clinical deterioration. However, the problem of nurses failing to trigger deteriorating ward patients still persists despite the implementation of a patient safety initiative, the Rapid Response System. A Web-based simulation was developed to enhance nurses' role in recognizing and responding to deteriorating patients. While studies have evaluated the effectiveness of the Web-based simulation on nurses' clinical performance in a simulated environment, no study has examined its impact on nurses' actual practice in the clinical setting. The objective of this study was to evaluate the impact of Web-based simulation on nurses' recognition of and response to deteriorating patients in clinical settings. The outcomes were measured across all levels of Kirkpatrick's 4-level evaluation model with clinical outcome on triggering rates of deteriorating patients as the primary outcome measure. A before-and-after study was conducted on two general wards at an acute care tertiary hospital over a 14-month period. All nurses from the two study wards who undertook the Web-based simulation as part of their continuing nursing education were invited to complete questionnaires at various time points to measure their motivational reaction, knowledge, and perceived transfer of learning. Clinical records on cases triggered by ward nurses from the two study wards were evaluated for frequency and types of triggers over a period of 6 months pre- and 6 months postintervention. The number of deteriorating patients triggered by ward nurses in a medical general ward increased significantly (Pnurses reported positively on the transfer of learning (mean 3.89, SD 0.49) from the Web-based simulation to clinical practice. A significant increase (Pnurses also perceived positively their motivation (mean 3.78, SD 0.56) to engage in the Web-based simulation. This study provides evidence on the effectiveness of Web-based simulation in improving

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

    Directory of Open Access Journals (Sweden)

    Acharya V

    2015-10-01

    , as well as using greater sample sizes from different hospital departments and the inclusion of a control group, is needed. Keywords: medical education, learner-focused ward rounds, trainee-centered ward round, workplace-based learning

  2. The effects of group reminiscence therapy on depression, self esteem, and life satisfaction of elderly nursing home residents.

    Science.gov (United States)

    Chao, Shu-Yuan; Liu, Hsing-Yuan; Wu, Chiu-Yen; Jin, Suh-Fen; Chu, Tsung-Lan; Huang, Tzu-Shin; Clark, Mary Jo

    2006-03-01

    The need to provide quality mental health care for elders in nursing home settings has been a critical issue, as the aging population grows rapidly and institutional care becomes a necessity for some elders. The purpose of this quasi-experimental study was to describe the effect of participation in reminiscence group therapy on older nursing home residents' depression, self-esteem, and life satisfaction. Purposive sampling was used to recruit participants who met the study criteria. Residents of one ward were assigned to the reminiscence therapy group intervention, while residents of the other ward served as controls. Nine weekly one-hour sessions were designed to elicit reminiscence as group therapy for 12 elders in the experimental group. Another 12 elders were recruited for a control group matched to experimental subjects on relevant criteria. Depression, self-esteem, and life satisfaction were measured one week before and after the therapy. The Statistical Package for the Social Sciences (SPSS, Version 10.0) was used to analyze data. Results indicated that group reminiscence therapy significantly improved self-esteem, although effects on depression and life satisfaction were not significant. Reminiscence groups could enhance elders' social interaction with one another in nursing home settings and become support groups for participants. The model we created here can serve as a reference for future application in institutional care.

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

    LENUS (Irish Health Repository)

    Gill, Finola

    2012-02-01

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

  4. BED UTILIZATION IN CARDIO VASCULAR AND THORACIC SURGERY WARD

    Directory of Open Access Journals (Sweden)

    Ishtyak

    2015-11-01

    Full Text Available BACKGROUND: Of all the subsystems of a hospital, inpatient care occupies prime place in terms of resource consumed, use of specialized technical man power, technology and skill. In spite of the huge investment of money, material and the manpower at times even the basic needs of patients are not met. AIMS: The study was conducted, to observe the average length of stay (ALS of patients in cardio vascular and thoracic Surgery (CVTS ward, and to find out the bed occupancy rate. METHODS: The admission and discharge record of all the patients was recorded from the report books, hospital files of all the patients were checked to know complete biodata. Medical record section was consulted and admission discharge register/files were recorded to know the symptomatology, clinical findings, diagnosis and the management thereof. Mortality and morbidity was recorded from admission files. RESULTS: A total of 732 patients were admitted on a bed complement of 11712 days having 8639 bed days. 84.28% of the patients underwent surgical procedures. Daily average beds occupied were 23.60 beds per day, average length of stay was 11.23 days, and 73.76% was the bed occupancy rate. CONCLUSION: Patients having major operations had more length of stay compared to patients who were admitted after pre anesthetic checkup and full planning from outdoor departments. Preadmission evaluation, pre anesthetic checkup and preventing post-operative morbidity decrease length of stay

  5. An Analysis On Ward Identity For Multi-Field Inflation

    CERN Document Server

    Parthasarathy, Varadarajan

    2013-01-01

    Given a correlation function (or n-point function), can the corresponding nature of space-time be determined ? To answer this question it is required to derive the Ward Identity (WI), analyse the symmetries and arrive at the law of conservation. Modus operandi involves Lie differentiating two-point function considering the symmetry to be non-anomalous. The WI so obtained is shown to form a Lie algebra which determines the nature of space-time. Solving the identity results in a law of conservation, which physically explains the reason for WI to form an algebra and contains in it an equation of motion for four-point function. As a special case, a relation between mass and potential involving the spatial derivatives of four- and five- point function is obtained. Finally, the conservation equation is exploited to get the probability amplitude for the two-point function which shows how correlation functions provide an opportunity to probe the fundamental laws of physics.

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

    Science.gov (United States)

    Yeo, Jing Ming

    2016-01-01

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

  7. Strange and charm quark spins from the anomalous Ward identity

    Science.gov (United States)

    Gong, Ming; Yang, Yi-Bo; Liang, Jian; Alexandru, Andrei; Draper, Terrence; Liu, Keh-Fei; χQCD Collaboration

    2017-06-01

    We present a calculation of the strange and charm quark contributions to the nucleon spin from the anomalous Ward identity (AWI). This is performed with overlap valence quarks on 2 +1 -flavor domain-wall fermion gauge configurations on a 2 43×64 lattice with lattice spacing a-1=1.73 GeV and the light sea mass at mπ=330 MeV . To satisfy the AWI, the overlap fermion for the pseudoscalar density and the overlap Dirac operator for the topological density, which do not have multiplicative renormalization, are used to normalize the form factor of the local axial-vector current at finite q2. For the charm quark, we find that the negative pseudoscalar term almost cancels the positive topological term. For the strange quark, the pseudoscalar term is less negative than that of the charm. By imposing the AWI, the strange gA(q2) at q2=0 is obtained by a global fit of the pseudoscalar and the topological form factors, together with gA(q2) and the induced pseudoscalar form factor hA(q2) at finite q2. The chiral extrapolation to the physical pion mass gives Δ s +Δ s ¯=-0.0403 (44 )(78 ).

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

    DEFF Research Database (Denmark)

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

    2007-01-01

    OBJECTIVE: To assess the effects and cost effects of introducing clinical pharmacists on hospital wards. METHODS: Comparative prospective study on four orthopaedic surgical wards in two hospitals. The primary effect variables were 10 target areas widely considered to be indicators of good...... sub-optimal prescriptions were changed, 43% resulted in cost reductions. The reductions achieved could cover 47% of the costs of clinical pharmacy service. CONCLUSION: Clinical pharmacy services offered to four orthopaedic surgical wards resulted in reduction of sub-optimal prescriptions. Every time...

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

    Science.gov (United States)

    Kennedy, Maggie

    2016-01-01

    Ward clerks are essential members of the healthcare team, providing administrative and organizational support to acute care units and clinics. This role influences such matters as nurses' direct patient-care time, timeliness of patient discharges, and patient safety. To support ward clerks in the varying responsibilities and complex scope of this role, a formal orientation and ongoing education program is imperative. Whereas corporate orientation informs new employees of overall organizational processes, a ward clerk-specific workplace education program prepares individuals for the demands of the position, ultimately supporting the healthcare team and patient safety.

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

    DEFF Research Database (Denmark)

    Qian, Hua; Li, Yuguo; Sun, Hequan

    2010-01-01

    Use of a HEPA (high efficiency particulate air) filter in a room is believed to assist in reducing the risk of transmission of infectious diseases through removing the particles or large droplets to which pathogens may be attached. Use of a portable HEPA filter(s) in hospital wards is hypothesized...... of beds in an isolation ward is insufficient. An experiment was conducted in a full scale experimental ward with a dimension of 6.7 m × 6 m × 2.7 m and 6 beds to test these hypotheses for a portable HEPA filter. The removal efficiency for different size particles was measured at different locations...

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

    Directory of Open Access Journals (Sweden)

    Stanislaw Gorski

    2017-01-01

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

  12. 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.

  13. A Monte Carlo method for critical systems in infinite volume: the planar Ising model

    CERN Document Server

    Herdeiro, Victor

    2016-01-01

    In this paper we propose a Monte Carlo method for generating finite-domain marginals of critical distributions of statistical models in infinite volume. The algorithm corrects the problem of the long-range effects of boundaries associated to generating critical distributions on finite lattices. It uses the advantage of scale invariance combined with ideas of the renormalization group in order to construct a type of "holographic" boundary condition that encodes the presence of an infinite volume beyond it. We check the quality of the distribution obtained in the case of the planar Ising model by comparing various observables with their infinite-plane prediction. We accurately reproduce planar two-, three- and four-point functions of spin and energy operators. We also define a lattice stress-energy tensor, and numerically obtain the associated conformal Ward identities and the Ising central charge.

  14. Monte Carlo method for critical systems in infinite volume: The planar Ising model.

    Science.gov (United States)

    Herdeiro, Victor; Doyon, Benjamin

    2016-10-01

    In this paper we propose a Monte Carlo method for generating finite-domain marginals of critical distributions of statistical models in infinite volume. The algorithm corrects the problem of the long-range effects of boundaries associated to generating critical distributions on finite lattices. It uses the advantage of scale invariance combined with ideas of the renormalization group in order to construct a type of "holographic" boundary condition that encodes the presence of an infinite volume beyond it. We check the quality of the distribution obtained in the case of the planar Ising model by comparing various observables with their infinite-plane prediction. We accurately reproduce planar two-, three-, and four-point of spin and energy operators. We also define a lattice stress-energy tensor, and numerically obtain the associated conformal Ward identities and the Ising central charge.

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

    Science.gov (United States)

    Lewin, Simon; Reeves, Scott

    2011-05-01

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

  16. Nurse Managers' Perceptions Related to Their Leadership Styles, Knowledge, and Skills in These Areas—A Viewpoint: Case of Health Centre Wards in Finland

    OpenAIRE

    Soili Vesterinen; Marjo Suhonen; Arja Isola; Leena Paasivaara; Helena Laukkala

    2013-01-01

    The purpose of this study was to explore nurse managers' perceptions related to their leadership styles, knowledge, and their skills in these areas in health centre wards in Finland. The data were collected from nurse managers (n = 252) in health centre hospitals in Finland using a structured questionnaire (response rate 63%). Six leadership styles—visionary, coaching, affiliate, democratic, commanding, and isolating—were reflected on. Almost all respondents in every age group considered four...

  17. Do educational meetings and group detailing change adherence to drug formularies in hospitals? A cluster randomized controlled trial

    DEFF Research Database (Denmark)

    Plet, Hanne T.; Kjeldsen, Lene J.; Christensen, René Depont;

    2014-01-01

    The aim of this study was to examine whether educational meetings and group detailing could increase the use of drugs from the ward lists or the drug formulary in hospitals.......The aim of this study was to examine whether educational meetings and group detailing could increase the use of drugs from the ward lists or the drug formulary in hospitals....

  18. "SEND IN THE CLOWNS!", OR THE IMAGINATION AT WORK: THE NARRATIVES OF THREE PEDIATRIC WARD CLOWNS

    National Research Council Canada - National Science Library

    Francesca Gobbo

    2014-01-01

      The article presents an interpretation of three narratives collected from three young professionals who volunteer as clowns for the young patients of a pediatric ward in a northern Italian hospital...

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

    Science.gov (United States)

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

    2010-04-01

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

  20. Structured risk assessment and violence in acute psychiatric wards: randomised controlled trial

    National Research Council Canada - National Science Library

    Abderhalden, Christoph; Needham, Ian; Dassen, Theo; Halfens, Ruud; Haug, Hans-Joachim; Fischer, Joachim E

    2008-01-01

    .... To assess whether such risk assessments decrease the incidence of violence and coercion. A cluster randomised controlled trial was conducted with 14 acute psychiatric admission wards as the units of randomisation, including a preference arm...

  1. Attitudes of parents and staff towards medical students on the paediatric wards.

    Science.gov (United States)

    Duignan, A; Kennedy, C; Canas-Martinez, A; Gildea, D; Jamaludin, M A; Moore, M; Meehan, J; Nadeem, M

    2014-01-01

    This study investigates attitudes of parents and staff to medical students on paediatric wards in a Dublin teaching hospital. We invited 100 parents of patients and 30 staff involved in the care of children on the paediatric wards to participate. The majority of parents agreed or strongly agreed that they would be happy for a student to interview them (n = 87; (87%)), interview their child (80%) or examine their child (74%). Of 30 staff, 12 (40%) staff agreed that the presence of medical students on the ward increased their job satisfaction, 13 (43%) agreed or strongly agreed that medical student presence encouraged them to keep up to date with recent medical developments and 6 (20%) felt that it increased the quality of patient care. Attitudes of both parents and staff to medical students on paediatric wards are positive with both emphasising the need for professional behaviour.

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

    Science.gov (United States)

    Lee, Woo Kyeong; Kim, Yong Kyu

    2013-09-01

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

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

    National Research Council Canada - National Science Library

    Zulfikar A Adamu; Andrew Price

    2015-01-01

      Adequate ventilation is necessary for thermal comfort and reducing risks from infectious bio-aerosols in hospital wards, but achieving this with mechanical ventilation has carbon and energy implications...

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

    Directory of Open Access Journals (Sweden)

    Lazić-Mitrović Tanja

    2015-01-01

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

  5. Classifying nursing organization in wards in Norwegian hospitals: self-identification versus observation

    Directory of Open Access Journals (Sweden)

    Helgeland Jon

    2010-02-01

    Full Text Available Abstract Background The organization of nursing services could be important to the quality of patient care and staff satisfaction. However, there is no universally accepted nomenclature for this organization. The objective of the current study was to classify general hospital wards based on data describing organizational practice reported by the ward nurse managers, and then to compare this classification with the name used in the wards to identify the organizational model (self-identification. Methods In a cross-sectional postal survey, 93 ward nurse managers in Norwegian hospitals responded to questions about nursing organization in their wards, and what they called their organizational models. K-means cluster analysis was used to classify the wards according to the pattern of activities attributed to the different nursing roles and discriminant analysis was used to interpret the solutions. Cross-tabulation was used to validate the solutions and to compare the classification obtained from the cluster analysis with that obtained by self-identification. The bootstrapping technique was used to assess the generalizability of the cluster solution. Results The cluster analyses produced two alternative solutions using two and three clusters, respectively. The three-cluster solution was considered to be the best representation of the organizational models: 32 team leader-dominated wards, 23 primary nurse-dominated wards and 38 wards with a hybrid or mixed organization. There was moderate correspondence between the three-cluster solution and the models obtained by self-identification. Cross-tabulation supported the empirical classification as being representative for variations in nursing service organization. Ninety-four per cent of the bootstrap replications showed the same pattern as the cluster solution in the study sample. Conclusions A meaningful classification of wards was achieved through an empirical cluster solution; this was, however, only

  6. Patient safety culture lives in departments and wards: Multilevel partitioning of variance in patient safety culture

    OpenAIRE

    Hofoss Dag; Deilkås Ellen

    2010-01-01

    Abstract Background Aim of study was to document 1) that patient safety culture scores vary considerably by hospital department and ward, and 2) that much of the variation is across the lowest level organizational units: the wards. Setting of study: 500-bed Norwegian university hospital, September-December 2006. Methods Data collected from 1400 staff by (the Norwegian version of) the generic version of the Safety Attitudes Questionnaire (SAQ Short Form 2006). Multilevel analysis by MLwiN vers...

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

    OpenAIRE

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

    2012-01-01

    Background: HIV screening in a labour ward is the last opportunity to initiate an antiretroviral prophylaxis among pregnant women living with HIV to prevent mother-to-child HIV transmission. Little is known about the feasibility and acceptability of HIV screening during labour in West Africa. Findings: A cross-sectional survey was conducted in the labour ward at the Tokoin Teaching Hospital in Lomé (Togo) between May and August 2010. Pregnant women admitted for labour were randomly sel...

  8. Training program conference of "Good Pain Management Ward" was launched in Wuhan

    Institute of Scientific and Technical Information of China (English)

    Yi Cheng

    2012-01-01

    @@ On March 6th, the training program conference of "Good Pain Management Ward" (GPM ward) was launched in the conference hall of Westin Hotel, Wuhan.The conference was hosted by Clinics Medical Secretary, Ministry of Health, and undertaken by CSCO and Mundipharma (China) Pharmaceutical Co., Ltd.Three hundreds experts, doctors and nurses, from departments of oncology, pain, anesthesiology and pharmacy, in 6 provinces (including Hubei, Hunan, Jiangxi, Shanxi, Shanxi, Henan), attended the conference.

  9. Observations on Henneguya salminicola Ward, a myxosporidian parasitic in Pacific salmon

    Science.gov (United States)

    Fish, F.F.

    1939-01-01

    Henneguya salminicola was described in 1919 by Dr. H. B. Ward from cysts found in the body musculature of a silver salmon (Oncorhynchus kisutch Walbaum) taken from the Stickeen River in southeastern Alaska. Ward described the cysts as “pyriform, fairly uniform in size, and hard to the touch. . . . The cysts measured 3 to 6 mm in diameter and were found everywhere through the muscle mass.”

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

    Directory of Open Access Journals (Sweden)

    Zahra Kamali Sarwestani

    2017-07-01

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

  11. Medication prescribing errors and associated factors at the pediatric wards of Dessie Referral Hospital, Northeast Ethiopia

    OpenAIRE

    Zeleke, Abebe; Chanie, Tesfahun; Woldie, Mirkuzie

    2014-01-01

    Background Medication error is common and preventable cause of medical errors and occurs as a result of either human error or a system flaw. The consequences of such errors are more harmful and frequent among pediatric patients. Objective To assess medication prescribing errors and associated factors in the pediatric wards of Dessie Referral Hospital, Northeast Ethiopia. Methods A cross-sectional study was carried out in the pediatric wards of Dessie Referral Hospital from February 17 to Marc...

  12. Outbreak of staphylococcal bullous impetigo in a maternity ward linked to an asymptomatic healthcare worker.

    Science.gov (United States)

    Occelli, P; Blanie, M; Sanchez, R; Vigier, D; Dauwalder, O; Darwiche, A; Provenzano, B; Dumartin, C; Parneix, P; Venier, A G

    2007-11-01

    An outbreak of staphylococcal bullous impetigo occurred over a period of five months in a maternity ward involving seven infected and two colonised neonates. The skin lesions were due to epidermolytic toxin A-producing Staphylococcus aureus. Infection control measures were implemented and a retrospective case-control study performed. Contact with an auxiliary nurse was the only risk factor for cases of bullous impetigo (Pimpetigo and the auxiliary nurse was reassigned to an adult ward.

  13. Psychiatric wards in general hospitals - the opinions of psychiatrists employed there

    Directory of Open Access Journals (Sweden)

    Janusz Chojnowski

    2016-04-01

    The psychiatrists employed in the psychiatric wards in general hospitals in Poland evaluate this organisational model positively. However, the destabilisation of economic foundations of these wards reported in the world literature was also reflected in the results of a survey conducted in Poland. There is a need to develop standards for the organisation and financing departments of psychiatry in general hospitals providing them stable status in the healthcare system in Poland.

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

    Directory of Open Access Journals (Sweden)

    Heshmatollah Nourmoradi

    2012-01-01

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

  15. The 'Releasing Time to Care--the Productive Ward' programme: participants' perspectives.

    Science.gov (United States)

    Davis, Jacqueline; Adams, John

    2012-04-01

    The aim of this study was to explore the perceptions of nursing staff concerning the implementation of the 'Releasing Time to Care - the Productive Ward' programme in a specialist cardiothoracic hospital. The 'Releasing Time to Care - the Productive Ward' programme uses the 'lean' philosophy originally developed in the Japanese motor industry to improve the efficiency of hospital wards. Its aim is to increase the proportion of time that nurses are able to spend in direct patient care. This study used a descriptive qualitative method with a sample size of four nurses and two health-care support workers. Thematic analysis of the interview transcripts was undertaken using the procedure developed by Burnard. Thematic content analysis identified five major themes: starting to implement the programme, anxiety and defensiveness, the importance of leadership and communication, challenges, and learning and personal development. Overall, the programme had a positive impact on both the wards studied. Challenges that were identified included the need to sustain momentum once the initial enthusiasm had waned. This study highlighted the importance of key transformational leadership skills at ward manager level, such as the ability to inspire nurses to approach old problems in new ways, in the implementation of the 'Releasing Time to Care - the Productive Ward' programme. © 2011 Blackwell Publishing Ltd.

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

    Science.gov (United States)

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

    2015-04-01

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

  17. Outside the operating room: How a robotics program changed resource utilization on the inpatient Ward.

    Science.gov (United States)

    Leung, Annie; Abitbol, Jeremie; Ramana-Kumar, Agnihotram V; Fadlallah, Bassam; Kessous, Roy; Cohen, Sabine; Lau, Susie; Salvador, Shannon; Gotlieb, Walter H

    2017-04-01

    To analyze the changes in the composition of the gynecologic oncology inpatient ward following the implementation of a robotic surgery program and its impact on inpatient resource utilization and costs. Retrospective review of the medical charts of patients admitted onto the gynecologic oncology ward the year prior to and five years after the implementation of robotics. The following variables were collected: patient characteristics, hospitalization details (reason for admission and length of hospital stay), and resource utilization (number of hospitalization days, consultations, and imaging). Following the introduction of robotic surgery, there were more admissions for elective surgery yet these accounted for only 21% of the inpatient ward in terms of number of hospital days, compared to 36% prior to the robotic program. This coincided with a sharp increase in the overall number of patients operated on by a minimally invasive approach (15% to 76%, probotics era. The robotics program contributed to a ward with higher proportion of patients with complex comorbidities (Charlson≥5: RR 1.06), Stage IV disease (RR 1.30), and recurrent disease (RR 1.99). Introduction of robotic surgery allowed for more patients to be treated surgically while simultaneously decreasing inpatient resource use. With more patients with non-surgical oncological issues and greater medical complexity, the gynecologic oncology ward functions more like a medical rather than surgical ward after the introduction of robotics, which has implications for hospital-wide resource planning. Copyright © 2017 Elsevier Inc. All rights reserved.

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

    Science.gov (United States)

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

    2015-09-01

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

  19. Is clinical competence perceived differently for student daily performance on the wards versus clerkship grading?

    Science.gov (United States)

    Wimmers, Paul F; Kanter, Steven L; Splinter, Ted A W; Schmidt, Henk G

    2008-12-01

    Clinical rotations play an important role in the medical curriculum and are considered crucial for student learning. However, competencies that should be learned can differ from those that are assessed. In order to explore which competencies are considered important for daily performance of student on the wards and to what extent clinical teachers consider the same competencies important for clerkship grading, a survey that consisted of 21 different student characteristics was administered to clinical teachers. Two independent factor analyses using structural equation modeling were conducted to abstract underlying latent relationships among the different student characteristics and to define a clinical competence profile for daily performance of students on the wards and clerkship grading. Differences between the degree of importance for student daily ward performance and clerkship grading are considered and discussed. The results of the survey indicate that the degree of importance of competencies are rated different for daily performance of students on the wards and clerkship grades. Competencies related to the diagnostic process are more important for clerkship grading, whereas interpersonal skills, professional qualities, and motivation are more important for daily ward performance. It is concluded that the components of clinical competence considered important for adequate performance are not necessarily in alignment with what is required for grading. Future research should focus on an explanation why clinical educators think differently about the importance of competencies for student examination in contrast to what is required for adequate daily performance on the wards.

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

    Science.gov (United States)

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

    2011-03-01

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

  1. Assesment of psychosocial work conditions of nurses at selected hospital wards

    Directory of Open Access Journals (Sweden)

    Iwona Rotter

    2014-04-01

    Full Text Available Background: Good organisation of work, clear division of responsibilities, support from superiors are factors that positively influence the satisfaction of the profession. The purpose of the work was the assessment of psychosocial working conditions of nurses. Material and Methods: The research included 388 nurses working at surgical wards, medical treatment wards, and psychiatric wards. The research method was a diagnostic survey carried out by means of a questionnaire called Psychosocial Work Conditions. The obtained results were statistically analysed. Results: Nearly a half of the nurses considers the requirements at work as moderate, and 36.66% as high. Nurses from medical treatment wards indicate the highest level of requirements. Nurses working at psychiatric wards and in a shift system significantly more often feel the requirements relating to overload and resulting from a conflict of roles. Nurses working in the profession for more than 10 years considerably more often describe the level of behavioural control as high in comparison to those working for a shorter time. Regardless of the character of a ward, nurses most often (44.33% assess the support from co-workers as average, and 1/5 considered this as low. Conclusions: The results indicate the correctness of introducing psychosocial training for professionally active nurses. Med Pr 2014;65(2:173–179

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

    Directory of Open Access Journals (Sweden)

    Deboye O Kolawole

    Full Text Available In contrast to developed countries, only limited data on the prevalence, resistance and clonal structure of Staphylococcus aureus are available for African countries. Since S. aureus carriage is a risk factor for postoperative wound infection, patients who had been hospitalized in surgical wards in a Nigerian University Teaching Hospital were screened for S. aureus carriage. All S. aureus isolates were genotyped (spa, agr and assigned to multilocus sequence types (MLST. Species affiliation, methicillin-resistance, and the possession of pyrogenic toxin superantigens (PTSAg, exfoliative toxins (ETs and Panton-Valentine Leukocidin (PVL were analyzed. Of 192 patients screened, the S. aureus carrier rate was 31.8 % (n = 61. Of these isolates, 7 (11.5% were methicillin-resistant (MRSA. The isolates comprised 24 spa types. The most frequent spa types were t064, t084, t311, and t1931, while the most prevalent MLST clonal complexes were CC5 and CC15. The most frequent PTSAg genes detected were seg/sei (41.0% followed by seb (29.5%, sea (19.7%, seh (14.7% and sec (11.5. The difference between the possession of classical and newly described PTSAg genes was not significant (63.9% versus 59.0% respectively; P = 0.602. PVL encoding genes were found in 39.3% isolates. All MRSA isolates were PVL negative, SCCmec types I and VI in MLST CC 5 and CC 30, respectively. Typing of the accessory gene regulator (agr showed the following distribution: agr group 1 (n = 20, group II (n = 17, group III (n = 14 and group IV (n = 10. Compared to European data, enterotoxin gene seb and PVL-encoding genes were more prevalent in Nigerian methicillin-susceptible S. aureus isolates, which may therefore act as potential reservoir for PVL and PTSAg genes.

  3. The bourgeoisie framed: Mafalda and its group criticize elements of the bourgeois society (the naturalization of the differences, the inhumanuzation and the competition in the History class

    Directory of Open Access Journals (Sweden)

    Carlos Eduardo Rebuá Oliveira

    2012-08-01

    Full Text Available The purpose of this work, from a marxist point of view, is to think about the possibility in criticizing the bourgeosie society in History classes, to set up colectively, at last, anti-hegemonic reality readings. Based upon Gramsci concept of hegemony and on anti-hegemony notion, we have analyzed the comics not with the intention of making this language more and more present in the classes but with the attempt of understanding them as a tool that may contribute a lot for a real criticism and for the explicitness of the historic moment in which they were created, for a teaching, at the same time, more playful and critic. In methodological terms, we have selected three Mafalda’s strips (named “The naturalization of the differences”, “The inhumanization” and “The competition”, shown on Toda Mafalda (2002 aiming to replace the insights herein sketched. This work is a part of the master’s degree lecture, read  at the Postgraduation Program in Education of UERJ (ProPed in March 2011, under the title of Mafalda in The History class: a criticism of the bourgeoise society charactheristic elements and the collective making-up of hegemonic meanings.

  4. The Effect of Stress Management on Occupational Stress and Satisfaction among Midwives in Obstetrics and Gynecology Hospital Wards in Iran

    Science.gov (United States)

    Jahromi, Mahdi Karimyar; Minaei, Shahnaz; Abdollahifard, Sareh; Maddahfar, Majid

    2016-01-01

    Introduction: Occupational stress is one of the major problems of health care staff, substantially affecting their professional and personal performance. This research has been conducted with the aim of determining the effect of stress management on occupational stress and satisfaction among the Midwives in Obstetrics and Gynecology Hospital wards at Motahari Hospital in Jahrom, Iran 2013-2014. Methods: This is a Quasi-experimental study of the pre- and post-clinical trials type. The study population included midwives employed in the Obstetrics and Gynecology Hospital wards selected trough census. The samples were categorized into two groups randomly. The intervention group participated in the short-term training workshop of stress management. The studied samples were measured in terms of occupational stress and satisfaction before, right after, and one month after the workshop. Occupational stress measurement was measured by Toft-Anderson occupational stress questionnaire (1981). Similarly, the occupational satisfaction was measured by JDI checklist developed by Stephen Robins (1994). In order to analyze the information, SPSS 16 together with descriptive statistics tests (frequency, percentile, mean, and standard deviation), independent sample t-tests, iterative measurement and Spearman correlation coefficient were used. Results: A total of 70 people (two 35-person groups) of midwives participated in this study. The findings revealed that there was a significant difference between the mean of scores of occupational stress between the two groups before and after the workshop (p=0.001). There was, however, no significant difference between the scores of satisfactions across the two groups. Discussion: Training of skills of coping with stress including stress management can be effective in diminishing level of occupational stress. Mitigation of stress without catering for professional, occupational, organizational, and environmental factors would not lead to

  5. Community-Based Wetland Restoration Workshop in the Lower Ninth Ward, New Orleans

    Science.gov (United States)

    Wang, H. F.; Craig, L.; Ross, J. A.; Zepeda, L.; Carpenter, Q.

    2010-12-01

    Since 2007 a workshop class of University of Wisconsin-Madison students has participated in a community-based project in New Orleans to investigate the feasibility of restoring the Bayou Bienvenue Wetland Triangle (BBWT), which is adjacent to the Lower 9th Ward in New Orleans. This 440-acre region is currently open water but was a cypress forest until the 1970s. Restoration would provide protection from storm surges, restored ecological services, and recreational use. The workshop introduced students to the multidisciplinary skills needed to work effectively with the complex and interconnected issues within a project involving many stakeholders. The stakeholders included the Center for Sustainable Engagement and Development (CSED), Lower 9th Ward residents, non-profits (e.g., Sierra Club, Environmental Defense, Lake Pontchartrain Basin Foundation, National Wildlife Federation), government agencies (e.g., New Orleans Sewerage and Water Board, Army Corps of Engineers), neighborhood groups (e.g., Holy Cross Neighborhood Association, The Village), and universities (Tulane, U. of New Orleans, LSU, U. Colorado-Denver, Southeastern Louisiana). The course ran initially as a Water Resources Management practicum in the first two summers and then as a broader multidisciplinary project with student expertise in hydrology, social science, law, planning, policy analysis, community development, GIS, public health, environmental education and ecological restoration. The project divided into three main components: wetland science, social science, and land tenure and planning. Principal activities in wetland science were to monitor water levels and water quality, inventory flora and fauna, and plant grasses on small “floating islands.” The principal social science activity was to conduct a neighborhood survey about knowledge of the wetland and interest in its restoration. The land tenure and planning activity was to investigate ownership and transfer of property within the

  6. The impact of facility relocation on patients' perceptions of ward atmosphere and quality of received forensic psychiatric care.

    Science.gov (United States)

    Alexiou, Eirini; Degl' Innocenti, Alessio; Kullgren, Anette; Wijk, Helle

    2016-08-01

    In recent years, large groups of forensic psychiatric patients have been relocated into new medium- and maximum-security forensic psychiatric facilities in Sweden, where a psychosocial care approach is embedded. From this perspective and on the assumption that physical structures affect the therapeutic environment, a prospective longitudinal study was designed to investigate the impact of the facility relocation of three forensic psychiatric hospitals on patients' perceptions of ward atmosphere and quality of received forensic psychiatric care. Participants were patients over 18 years of age sentenced to compulsory forensic psychiatric treatment. Data were obtained by validated questionnaires. Overall, 58 patients (78%) answered the questionnaires at baseline with a total of 25 patients (34%) completing follow-up 1 at six months and 11 patients (15%) completing follow-up 2, one year after relocation. Approximately two-thirds of the participants at all time-points were men and their age range varied from 18 to 69. The results of this study showed that poor physical environment features can have a severe impact on care quality and can reduce the possibilities for person-centered care. Furthermore, the study provides evidence that the patients' perceptions of person-centered care in forensic psychiatric clinics are highly susceptible to factors in the physical and psychosocial environment. Future work will explore the staff's perception of ward atmosphere and the possibilities to adapt a person-centered approach in forensic psychiatric care after facility relocation.

  7. Effects of antidiabetes drugs on functional independence measure on a subacute rehabilitation ward for stroke patients.

    Science.gov (United States)

    Kose, E; Toyoshima, M; Tachi, T; Teramachi, H; Kawakubo, T; Hayashi, H

    2015-07-01

    It has been reported that the improvement of activities of daily living (ADL) by rehabilitation affects glycemic control. However, there are no reports about antidiabetes drugs as factors affecting the outcomes of rehabilitation. Therefore, we investigated the effects of antidiabetes drugs on functional independence measure (FIM) [total (T), motor (M), and cognition (C) items] in stroke patients with diabetes who were discharged from the subacute rehabilitation ward. We chose the frequently used antidiabetes drugs [sulfonylurea (SU), dipeptidyl peptidase-IV inhibitors (DPP-IVIs), and α-glycosidase inhibitors (α-GIs)] as the basis for categorizing the patients. We compared the patients' background features and laboratory data among the three groups. As a result, when SU was used in stroke patients with diabetes, it is difficult to obtain significant FIM-M gain, FIM-C gain, FIM-M efficiency, and FIM-C efficiency compared with of-GIs. As a reason for this, we hypothesize the possibility of the involvement of insulin resistance. Therefore, we consider that insulin resistance should be determined early and that it is important to reduce insulin resistance comprehensively by involving experts.

  8. Inpatients' attitudes towards the rationale use of drugs at a cardiology ward

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    Ugur Ugrak

    2015-04-01

    Full Text Available AIM: This descriptive survey purposed to evaluate inpatients' attitudes towards the rationale use of drugs at a cardiology ward in GATA. METHODS: Rational Drug Use Questionnaire designed by T.C. Health Ministry was performed. The patients hospitalized during the research period were tried to be reached and 121 inpatients completed the questionnaire. SPSS 15.0 program was used for data evaluation. Descriptive statistics were indicated with mean, standard deviation, frequency. Pearsons Chi-Square Test was used for comparison of groups. Statistical significance at p<0.05 was adopted. RESULTS: Mean age of patient surveyed was 29.3+/-16.4 year and 68.6% of the patients were male. It was seen that 49.6% of the patients reserved residual drugs of a treatment at home to reuse, 87.6% of the patients applied to a physician when drug side effect was seen. 42.1% of female and 36.2% of married participants were seen to use painkiller without prescription. Additionally, significant relationship was observed between attitude of using painkiller without prescription and gender, marital status. CONCLUSION: Our research participants' attitudes towards rational drug use found more positive than previous researches performed in Turkey. It is assessed this difference resulted from participant's high education level and participants' obligation to use drugs for long time because most of them had chronic or congenital heart disease. [TAF Prev Med Bull 2015; 14(2.000: 137-144

  9. The Changing Pattern of Hospital Admission to Medical Wards; Burden of non-communicable diseases at a hospital in a developing country

    Directory of Open Access Journals (Sweden)

    Sufian K. Noor

    2015-11-01

    Full Text Available Objectives: This study aimed to determine the pattern of hospital admissions and patient outcomes in medical wards at Atbara Teaching Hospital in River Nile State, Sudan. Methods: This retrospective cross-sectional study was conducted from August 2013 to July 2014 and included all patients admitted to medical wards at the Atbara Teaching Hospital during the study period. Morbidity and mortality data was obtained from medical records. Diseases were categorised using the World Health Organization’s International Classification of Diseases (ICD coding system. Results: A total of 2,614 patient records were analysed. The age group with the highest admissions was the 56‒65-year-old age group (19.4% and the majority of patients were admitted for one week or less (86.4%. Non-communicable diseases constituted 71.8% of all cases. According to ICD classifications, patients were admitted most frequently due to infectious or parasitic diseases (19.7%, followed by diseases of the circulatory (16.4%, digestive (16.4% and genito-urinary (13.8% systems. The most common diseases were cardiovascular disease (16.4%, malaria (11.3%, gastritis/peptic ulcer disease (9.8%, urinary tract infections (7.2% and diabetes mellitus (6.9%. The mortality rate was 4.7%. Conclusion: The burden of non-communicable diseases was found to exceed that of communicable diseases among patients admitted to medical wards at the Atbara Teaching Hospital.

  10. CriticalEd

    DEFF Research Database (Denmark)

    Kjellberg, Caspar Mølholt; Meredith, David

    2014-01-01

    The best text method is commonly applied among music scholars engaged in producing critical editions. In this method, a comment list is compiled, consisting of variant readings and editorial emendations. This list is maintained by inserting the comments into a document as the changes are made....... Since the comments are not input sequentially, with regard to position, but in arbitrary order, this list must be sorted by copy/pasting the rows into place—an error-prone and time-consuming process. Scholars who produce critical editions typically use off-the-shelf music notation software...... such as Sibelius or Finale. It was hypothesized that it would be possible to develop a Sibelius plug-in, written in Manuscript 6, that would improve the critical editing work flow, but it was found that the capabilities of this scripting language were insufficient. Instead, a 3-part system was designed and built...

  11. Candidemia in Patients with Body Temperature Below 37°C and Admitted to Internal Medicine Wards: Assessment of Risk Factors.

    Science.gov (United States)

    Tascini, Carlo; Falcone, Marco; Bassetti, Matteo; De Rosa, Francesco G; Sozio, Emanuela; Russo, Alessandro; Sbrana, Francesco; Ripoli, Andrea; Merelli, Maria; Scarparo, Claudio; Carmassi, Franco; Venditti, Mario; Menichetti, Francesco

    2016-12-01

    An increasing number of candidemia episodes has been reported in patients cared for in internal medicine wards. These usually older and frail patients may not be suspected as having candidemia because they lack fever at the onset of the episode. To identify the risk factors associated with the lack of fever at the onset of candidemia (ie, the collection of the first positive blood culture for Candida spp.) in patients cared for in internal medicine wards, we compared 2 group of patients with or without fever. We retrospectively review data charts from 3 tertiary care, university hospitals in Italy, comparing patients with or without fever at onset of candidemia. Consecutive candidemic episodes in afebrile patients and matched febrile controls were identified during the 3-year study period. Patient baseline characteristics and several infection-related variables were examined. Random forest analysis was used, given the number of predictors to be considered and the potential complexity of their relations with the onset of fever. We identified 147 candidemic episodes without fever at onset and 147 febrile candidemia episodes. Factors associated with the lack of fever at onset of candidemia were diabetes, Clostridium difficile infection, and a shorter delta time from internal medicine wards admission to the onset of candidemia. The only variable associated with fever was the use of intravascular devices. Quite unexpectedly, antifungal therapy was administered more frequently to patients without fever, and no differences on 30-day mortality rate were documented in the 2 study groups. Clinicians should be aware that an increasing number of patients with invasive candidiasis cared for in internal medicine wards may lack fever at onset, especially those with diabetes and C. difficile infection. Candidemia should be suspected in patients with afebrile systemic inflammatory response syndrome or in worsening clinical condition: blood cultures should be taken, and a timely

  12. Comparison of PCR/Electron Spray Ionization-Time-of-Flight-Mass Spectrometry versus Traditional Clinical Microbiology for Active Surveillance of Organisms Contaminating High-Use Surfaces in a Burn Intensive Care Unit, an Orthopedic Ward and Healthcare Workers

    Science.gov (United States)

    2012-10-10

    Enterobacter spp., Streptococcus spp. (68% viridans group), Pseudomonas aeruginosa, and Acinetobacter baumannii -calcoaceticus complex; the proportions of these...Staphylococcus aureus and Acinetobacter baumannii on computer interface surfaces of hospital wards and association with clinical isolates. BMC Infect Dis 2009, 9...Cursino MR, Sinto S: Environmental contamination by multidrug resistant Acinetobacter baumannii in an intensive care unit. Infect Control Hosp Epidemiol

  13. Critical care nurses' experiences of nursing mothers in an ICU after complicated childbirth.

    Science.gov (United States)

    Engström, Asa; Lindberg, Inger

    2013-09-01

    Providing nursing care for a critically ill obstetric patient or a patient who has just become a mother after a complicated birth can be a challenging experience for critical care nurses (CCNs). These patients have special needs because of the significant alterations in their physiology and anatomy together with the need to consider such specifics as breastfeeding and mother-child bonding. The aim with this study was to describe CCNs' experience of nursing the new mother and her family after a complicated childbirth. The design of the study was qualitative. Data collection was carried out through focus group discussions with 13 CCNs in three focus groups during spring 2012. The data were subjected to qualitative content analysis. The analysis resulted in the formulation of four categories: the mother and her vital functions are prioritized; not being responsible for the child and the father; an environment unsuited to the new family and collaboration with staff in neonatal and maternity delivery wards. When nursing a mother after a complicated birth the CCNs give her and her vital signs high priority. The fathers of the children or partners of the mothers are expected to take on the responsibility of caring for the newborn child and of being the link with the neonatal ward. It is suggested that education about the needs of new families for nursing care would improve the situation and have clinical implications. Whether the intensive care unit is always the best place in which to provide care for mothers and new families is debatable. © 2013 British Association of Critical Care Nurses.

  14. Critical Mass

    CERN Multimedia

    AUTHOR|(CDS)2070299

    2017-01-01

    Critical Mass is a cycling event typically held on the last Friday of every month; its purpose is not usually formalized beyond the direct action of meeting at a set location and time and traveling as a group through city or town streets on bikes. The event originated in 1992 in San Francisco; by the end of 2003, the event was being held in over 300 cities around the world. At CERN it is held once a year in conjunction with the national Swiss campaing "Bike to work".

  15. Clinical nursing leaders' perceptions of nutrition quality indicators in Swedish stroke wards: a national survey.

    Science.gov (United States)

    Persenius, Mona; Hall-Lord, Marie-Louise; Wilde-Larsson, Bodil; Carlsson, Eva

    2015-09-01

    To describe nursing leaders' perceptions of nutrition quality in Swedish stroke wards. A high risk of undernutrition places great demand on nutritional care in stroke wards. Evidence-based guidelines exist, but healthcare professionals have reported low interest in nutritional care. The Donabedian framework of structure, process and outcome is recommended to monitor and improve nutrition quality. Using a descriptive cross-sectional design, a web-based questionnaire regarding nutritional care quality was delivered to eligible participants. Most clinical nursing leaders reported structure indicators, e.g. access to dieticians. Among process indicators, regular assessment of patients' swallowing was most frequently reported in comprehensive stroke wards compared with other stroke wards. Use of outcomes to monitor nutrition quality was not routine. Wards using standard care plans showed significantly better results. Using the structure, process and outcome framework to examine nutrition quality, quality-improvement needs became visible. To provide high-quality nutrition, all three structure, process and outcome components must be addressed. The use of care pathways, standard care plans, the Senior Alert registry, as well as systematic use of outcome measures could improve nutrition quality. To assist clinical nursing leaders in managing all aspects of quality, structure, process and outcome can be a valuable framework. © 2013 John Wiley & Sons Ltd.

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

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    Saadi Amini

    2015-08-01

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

  17. Interprofessional communication between surgery trainees and nurses in the inpatient wards: Why time and space matter.

    Science.gov (United States)

    Fernando, Oshan; Coburn, Natalie G; Nathens, Avery B; Hallet, Julie; Ahmed, Najma; Conn, Lesley Gotlib

    2016-09-01

    Optimal interprofessional communication (IPC) is broadly viewed as a prerequisite to providing quality patient care. In this study, we explored the enablers and barriers to IPC between surgical trainees and ward nurses with a view towards improving IPC and the quality of surgical patient care. We conducted an ethnography in two academic centres in Canada totalling 126 hours of observations and 32 semi-structured interviews with trainees and nurses. Our findings revealed constraints on IPC between trainees and nurses derived from contested meanings of space and time. Trainees experienced the contested spatial boundaries of the surgical ward when they perceived nurses to project a sense of territoriality. Nurses expressed difficulty getting trainees to respond and attend to pages from the ward, and to have a poor understanding of the nurses' role. Contestations over time spent in training and patient care were found in trainee-nurse interactions, wherein trainees perceived seasoned nurses to devalue their clinical knowledge on the ward. Nurses viewed the limited time that trainees spent in clinical rotation in the ward as adversely affecting communication. This study underscores that challenges to enhancing IPC at academic health centres are rooted in team and professional cultures. Efforts to improve IPC should therefore: identify and target the social and cultural dimensions of healthcare team member relations; recognise how power is deployed and experienced in ways that negatively impact IPC; and enhance an understanding and appreciation in the temporal and spatial dimensions of IPC.

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

    Directory of Open Access Journals (Sweden)

    Rao GRR

    2007-01-01

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

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

    Science.gov (United States)

    Shafipour, Vida; Mohammad, Eesa; Ahmadi, Fazlollah

    2014-08-15

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

  20. Close encounters in a pediatric ward: measuring face-to-face proximity and mixing patterns with wearable sensors.

    Directory of Open Access Journals (Sweden)

    Lorenzo Isella

    Full Text Available BACKGROUND: Nosocomial infections place a substantial burden on health care systems and represent one of the major issues in current public health, requiring notable efforts for its prevention. Understanding the dynamics of infection transmission in a hospital setting is essential for tailoring interventions and predicting the spread among individuals. Mathematical models need to be informed with accurate data on contacts among individuals. METHODS AND FINDINGS: We used wearable active Radio-Frequency Identification Devices (RFID to detect face-to-face contacts among individuals with a spatial resolution of about 1.5 meters, and a time resolution of 20 seconds. The study was conducted in a general pediatrics hospital ward, during a one-week period, and included 119 participants, with 51 health care workers, 37 patients, and 31 caregivers. Nearly 16,000 contacts were recorded during the study period, with a median of approximately 20 contacts per participants per day. Overall, 25% of the contacts involved a ward assistant, 23% a nurse, 22% a patient, 22% a caregiver, and 8% a physician. The majority of contacts were of brief duration, but long and frequent contacts especially between patients and caregivers were also found. In the setting under study, caregivers do not represent a significant potential for infection spread to a large number of individuals, as their interactions mainly involve the corresponding patient. Nurses would deserve priority in prevention strategies due to their central role in the potential propagation paths of infections. CONCLUSIONS: Our study shows the feasibility of accurate and reproducible measures of the pattern of contacts in a hospital setting. The obtained results are particularly useful for the study of the spread of respiratory infections, for monitoring critical patterns, and for setting up tailored prevention strategies. Proximity-sensing technology should be considered as a valuable tool for measuring such

  1. A work-based learning approach for clinical support workers on mental health inpatient wards.

    Science.gov (United States)

    Kemp, Philip; Gilding, Moorene; Seewooruttun, Khooseal; Walsh, Hannah

    2016-09-14

    Background With a rise in the number of unqualified staff providing health and social care, and reports raising concerns about the quality of care provided, there is a need to address the learning needs of clinical support workers. This article describes a qualitative evaluation of a service improvement project that involved a work-based learning approach for clinical support workers on mental health inpatient wards. Aim To investigate and identify insights in relation to the content and process of learning using a work-based learning approach for clinical support workers. Method This was a qualitative evaluation of a service improvement project involving 25 clinical support workers at the seven mental health inpatient units in South London and Maudsley NHS Foundation Trust. Three clinical skills tutors were appointed to develop, implement and evaluate the work-based learning approach. Four sources of data were used to evaluate this approach, including reflective journals, qualitative responses to questionnaires, three focus groups involving the clinical support workers and a group interview involving the clinical skills tutors. Data were analysed using thematic analysis. Findings The work-based learning approach was highly valued by the clinical support workers and enhanced learning in practice. Face-to-face learning in practice helped the clinical support workers to develop practice skills and reflective learning skills. Insights relating to the role of clinical support workers were also identified, including the benefits of face-to-face supervision in practice, particularly in relation to the interpersonal aspects of care. Conclusion A work-based learning approach has the potential to enhance care delivery by meeting the learning needs of clinical support workers and enabling them to apply learning to practice. Care providers should consider how the work-based learning approach can be used on a systematic, organisation-wide basis in the context of budgetary

  2. Clinical features of severe malnutrition at the pediatric ward of Dr. Pirngadi Hospital Medan.

    Science.gov (United States)

    Barus, S T; Rani, R; Lubis, N U; Hamid, E D; Tarigan, S

    1990-01-01

    A retrospective study on severe malnutrition concerning children hospitalized at the Pediatric ward of Dr. Pirngadi Hospital, Medan from January 1 to December 31, 1988 was conducted. Patients less than five years old were included in this study. The purpose of this study was to know the incidence of severe malnutrition, its symptoms and signs, the immunization status, feeding pattern and socio-economic factors. Out of the 3370 hospitalized patients, 2453 (72.78%) were children under five years old. Of these, 312 (12%) suffered from severe malnutrition. It consisted of marasmus 131 (41.9%), marasmic kwashiorkor 94 (30.1%) and kwashiorkor 87 (27.8%). The highest incidence was found in the age group of 0-2 years (58%). Clinical manifestation of marasmus were old man face (131 or 100%), muscular hypotrophy (118 or 71.9%) and decreased subcutaneous fat (116 or 71.1%) in marasmic kwashiorkor children 46 or 50% had their hair easily picked out, 45 or 46.3% showed hyperpigmentation and 48 or 52% had pretibial edema in the kwashiorkor group 29 or 63% had moon face, 52 or 60.4% showed crazy pavement dermatosis, 77 or 51.3% had hepatomegaly and 87 or 48% pretebial edema. Moon face was seen in 29 (63%), crazy Pavement Dermatosis in 52 (60.4%), hepatomegaly in 77 (51.3%), and pretebial edema in 87 (48%) of kwashiorkor cases. The accompanying diseases were mostly diarrhea (95%) and bronchopneumonia (22%). Immunization status showed that BCG comprised 50.6%, while DPT III and OPV III in 13.7% and 10.5% respectively and measles only 0.64%. More than half (59.6%) of them were breast-fed up to 6 months.(ABSTRACT TRUNCATED AT 250 WORDS)

  3. A Hierarchical Grouping of Great Educators

    Science.gov (United States)

    Barker, Donald G.

    1977-01-01

    Great educators of history were categorized on the basis of their: aims of education, fundamental ideas, and educational theories. They were classed by Ward's method of hierarchical analysis into six groupings: Socrates, Ausonius, Jerome, Abelard; Quintilian, Origen, Melanchthon, Ascham, Loyola; Alciun, Comenius; Vittorino, Basedow, Pestalozzi,…

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

    Science.gov (United States)

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

    2016-01-01

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

  5. Determination of platinum-group metals and lead in vegetable environmental bio-monitors by voltammetric and spectroscopic techniques: critical comparison.

    Science.gov (United States)

    Locatelli, Clinio; Melucci, Dora; Torsi, Giancarlo

    2005-08-01

    This paper reports voltammetric sequential determination of Pt(II), Pd(II), and Rh(III), by square-wave adsorption stripping voltammetry (SWAdSV), and Pb(II), by square-wave anodic stripping voltammetry (SWASV), in vegetable environmental matrices. Analytical procedures were verified by the analysis of the standard reference materials: Olive Leaves BCR-CRM 062 and Tomato Leaves NIST-SRM 1573a. Precision and accuracy, expressed as relative standard deviation and relative error, respectively, were always less than 6% and the limits of detection (LOD) for each element were below 0.096 mug g(-1). Once set up on the standard reference materials, the analytical procedure was transferred and applied to laurel leaves sampled in proximity to a superhighway and in the Po river mouth area. A critical comparison with spectroscopic measurements is discussed.

  6. Quantitative analysis of oleic acid and three types of polyethers according to the number of hydroxy end groups in Polysorbate 80 by hydrophilic interaction chromatography at critical conditions.

    Science.gov (United States)

    Zhang, Rui; Wang, Yu; Ji, Yu; Shi, Bei-jia; Zhang, Zai-ping; Zhang, Hai-yan; Yang, Ming; Wang, Yong-mei

    2013-01-11

    A quantitative characterization of Polysorbate 80 is crucial for its many applications. In this paper we report a quick RP-HPLC method for the quantitative determination of Polysorbate 80. The hydrolysis of Polysorbate 80 to release oleic acid and three types of polyethers was first carried out. A chromatographic method based on liquid chromatography at critical conditions (LCCC) was then developed for an endgroup-based separation of low-molecular-mass polyether. With this method the polyether, irrespective of its molecular-mass, is separated according to endgroups (functionality) due to interactions of the polar endgroups with the hydrophilic stationary phase. The different types of polyethers and oleic acid were identified using on-line electrospray ionization mass spectrometry and quantified by evaporative light scattering detection.

  7. Acceptance of the 2009 Henry Baldwin Ward Medal: The accidental parasitologist

    Science.gov (United States)

    Lafferty, Kevin D.

    2009-01-01

    Members of the Society, President Conn, colleagues, friends, and particularly students, the Ward Medal recipient, from Clarke Read onward, traditionally recounts how their career was shaped. A decade ago, in a crumbling Kona hotel, the ASP's own tattooed lady, Janine Caira, opened her Ward Medal address with: “To all future Ward Medalists, many of whom I trust are sitting in the audience out there today, I say: savor the moment! You have no idea how much easier it is to be sitting out there where you are than standing up here where I am” (Caira 1998). I certainly didn't imagine that Janine was delivering her advice to me and it is presumptuous to imagine my story is a template for shaping a career. As the title of my talk indicates, it was an accident.

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

    DEFF Research Database (Denmark)

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

    2009-01-01

    , computers on wheels (COWs) and tablet PCs-was made. Two types of COWs were available on the wards: generic COWs (laptops mounted on trolleys) and ergonomic COWs (an integrated computer and cart device). Heuristic evaluation of the user interfaces was also carried out. RESULTS: The majority (93......BACKGROUND: Selecting the right mix of stationary and mobile computing devices is a significant challenge for system planners and implementers. There is very limited research evidence upon which to base such decisions. OBJECTIVE: We aimed to investigate the relationships between clinician role......, clinical task, and selection of a computer hardware device in hospital wards. METHODS: Twenty-seven nurses and eight doctors were observed for a total of 80 hours as they used a range of computing devices to access a computerized provider order entry system on two wards at a major Sydney teaching hospital...

  9. [Intercommunication and information flow. An explorative study about ward rounds and patients' documentation].

    Science.gov (United States)

    Maier, Uwe; Fotuhi, Parwis; Seele, Anja; Nikolic, Djordje

    2008-07-01

    In modern patient interprofessional communication is an impor tant factor of good outcome. The aim of this study was to analyse the intercommunication during ward rounds and information passed by patients' documentation on an internal and geriatric medicine ward. Beside frequent interruptions the ward rounds showed a restricted flow of information that is based and targeted on the chief physician Nursing staff felt excluded from the informational flow. Regarding patients' documentation staff complained about lack of information and illegible notes. Availability of written information was found to be problematic. A team-orientated approach could help to improve interprofessional communication in the future. Besides the importance of carefully performed documentation as a reliable form of communication, communicative contribution of the nursing staff has to be upvalued.

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

    Science.gov (United States)

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

    2016-01-01

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

  11. Experiences of therapeutic relationships on hospital wards, dissociation, and making connections.

    Science.gov (United States)

    Parry, Sarah; Lloyd, Mike; Simpson, Jane

    2017-01-01

    An interpretive phenomenological analysis sought to explore how people reporting moderate to high levels of dissociation experienced relationships with multidisciplinary hospital ward staff. Three superordinate themes were developed. First, the theme "multiple me and multiple them" explores the instability experienced by the participants as they managed their dissociative experiences alongside many inconsistencies. Second, "recognizing, meeting, or neglecting interpersonal and care needs" reflects on participants' needs within therapeutic relationships. Third, "between the needs of the internal system: navigating between 'better on my own' and 'someone to talk to'" discusses the confusion and understanding around dissociation and the importance of working with parts, not around them. Findings suggested that the current culture of some hospital wards directly influenced participants' distress, which could lead to further dissociation as a means of coping with perceived threats. Reflections on relational complexities and developing ward-based treatment are discussed.

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

    DEFF Research Database (Denmark)

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

    2004-01-01

    Airflow and Contaminant Distribution in Hospital Wards with a Displacement Ventilalation System. The 2nd International Conference on Build Environment and Public Health, BEPH 2004, Shenzhen , China . ABSTRACT Displacement ventilation has not been considered to be an applicable system for hospital...... to accurately predict three-dimensional distribution of air velocity, temperature, and contaminant concentration in the ward. Indoor airflow in a displacement ventilation system involves a combination of different flow streams such as the gravity currents and thermal plumes. It is important to choose...... assisted us to understand the contaminant dispersion. It was shown that the interaction of exhaled flow and the body thermal plume generated by manikin would affect exhaled virus-laden aerosols distribution in the ward with displacement ventilation system....

  13. Cross Infection in a Hospital Ward and Deposition of Particles Exhaled from a Source Manikin

    DEFF Research Database (Denmark)

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

    2009-01-01

    The cross infection in a hospital ward is studied. Deposition of particles exhaled from a source manikin is investigated in a full-scale hospital ward ventilated by downward directed ventilation. Deposition on vertical surfaces close to the source shows distribution of particles directed upwards...... in the room. Deposition at the four beds shows that particles smaller than 10 μm disperse evenly in the ward, indicating that particles smaller than this size are airborne. The influence of top and bottom extraction openings on dispersion of particles is investigated. Results show that vertical distribution...... in the room is not affected by the position of the return openings. Deposition of particles at the four beds gives some indication of a less wide spread of particles with the use of ceiling-mounted return openings, and thereby a better protection of patients compared with bottom return openings....

  14. Dispersion of Exhalation Pollutants in a Two-bed Hospital Ward with a Downward Ventilation System

    DEFF Research Database (Denmark)

    Qian, Hua; Nielsen, Peter V.; Hyldgård, Carl-Erik

    2006-01-01

    heavier clean air from a ceiling diffuser to push down contaminants, which would then be removed via outlets at floor level. A "laminar" (strictly speaking, unidirectional) flow is expected to be produced to avoid flow mixing and thus reduce cross-infection risk. Experiments were carried out in a full......-scale experimental hospital ward with a downward ventilation system to investigate the possibility of applying downward ventilation in a general hospital ward. Two life-sized breathing thermal manikins were used to simulate a source patient and a receiving patient. Computation fluid dynamics was also used...... to investigate the airflow pattern and pollutant dispersion in the test ward. Based on both experimental and numerical results, the laminar airflow pattern was shown to be impossible to achieve due to turbulent flow mixing and flow entrainment into the supply air stream. The thermal plumes produced above people...

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

    Energy Technology Data Exchange (ETDEWEB)

    Nepomuceno, Leonardo

    1993-07-01

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

  16. The effect of a virtual ward program on emergency services utilization and quality of life in frail elderly patients after discharge: a pilot study

    Directory of Open Access Journals (Sweden)

    Leung DYP

    2015-02-01

    Full Text Available Doris Y P Leung,1 Diana Tze-Fan Lee,1 Iris F K Lee,1 Lai-Wah Lam,1 Susanna W Y Lee,2 May W M Chan,3 Yin-Ming Lam,4 Siu-Hung Leung,5 Pui-Chi Chiu,6 Nelly K F Ho,7 Ming-Fai Ip,8 May My Hui8 1The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, Hong Kong; 2Hospital Authority Head Office, 3Kowloon West Cluster, 4New Territories West Cluster, 5Kowloon East Cluster, 6United Christian Hospital, 7Kowloon Hospital, 8Tuen Mun Hospital, Hong Kong Hospital Authority, Kowloon, Hong Kong Introduction: Attendance at emergency departments and unplanned hospital readmissions are common for frail older patients after discharge from hospitals. A virtual ward service was piloted to deliver “hospital-at-home” services by community nurses and geriatricians to frail older patients immediately after their discharge from hospital to reduce emergency services utilization.Objectives: This study examined the impacts of the virtual ward service on changes in the patients’ emergency attendance and medical readmissions, and their quality of life (QOL.Methods: A matched-control quasi-experimental study was conducted at four hospitals, with three providing the virtual ward service (intervention and one providing the usual community nursing care (control. Subjects in the intervention group were those who are at high risk of readmission and who are supported by home carers recruited from the three hospitals providing the virtual ward service. Matched control patients were those recruited from the hospital providing usual care. Outcome measures include emergency attendance and medical readmission in the past 90 days as identified from medical records, and patient-reported QOL as measured by the modified Quality-of-Life Concerns in the End of Life Questionnaire (Chinese version. Wilcoxon signed-rank tests compared the changes in the outcome variables between groups.Results: A total of 39 patients in each of the two groups were recruited. The virtual

  17. A STUDY ON PROGNOSTIC VALUE OF SERUM CORTISOL IN DETERMINING THE OUTCOME IN THE CRITICALLY ILL PATIENTS

    Directory of Open Access Journals (Sweden)

    Chandrashekar

    2015-07-01

    Full Text Available INTRODUCTION: Critically ill patients are at risk for the development of adrenal insufficiency of critical illness (AICI. This may present as hypotension, unresponsiveness to catecholamine infusions, and/or ventilator dependence. The study aims at the prognostic value of serum cortisol in determining the outcome in the critically ill patients. METHODOLOGY : The study was conducted at the General Medicine and Intensive Care units of SMS Medical college Hospital, Jaipur. It was a Hospital based Case control study done over one year period. Patients were enrolled in to two groups after matching factors like age, sex etc. Those fulfilling definition of critical illness and APACHE II score>20 were enrolled as cases ( G roup A and those with non - critical illness were included in control group ( G roup B. Venous blood samples for serum cortisol were drawn under aseptic conditions at morning 8AM. Serum cortisol level was determined by Chemo Luminescent Immuno Assay. Cortisol levels were then compared between group A and group B patients. Later correlation between serum cortisol and outcome in these groups was analyzed. RESULTS: 80 patients admitted in Medical ICU and wards, who satisfied the inclusion criteria were enrolled in the study and were grouped in to group A (40 Critically – ill and Group B (40 non Critically – ill and were followed till discharge or death. Group A, mean cortisol level was 33.68 μg / dl , and in group B mean cortisol level was 15.94 μg / dl and the difference was statistically significant p=0.001. There was a positive correlation between APACHE II score and cortisol level and was statistically significant. CONCLUSION: C ortisol level is increased in critically ill and can be used as a prognostic marker of mortality in critically ill. Correlation between APACHE II score and cortisol in our study proposes cortisol level as an alternative to complicated APACHE II score in predicting outcome in critically ill patients

  18. Critical rearing parameters of Tetrastichus planipennisi (Hymenoptera: Eulophidae) as affected by host-plant substrate and host-parasitoid group structure

    Science.gov (United States)

    Laboratory studies were conducted to evaluate the potential impact of host-plant substrate types, host-parasitoid group size and host to parasitoid ratios on select fitness parameters of the larval parasitoid Tetrastichus planipennisi Yang, newly introduced for biological control of the invasive eme...

  19. Are senior nurses on Clinical Commissioning Groups in England inadvertently supporting the devaluation of their profession?: A critical integrative review of the literature.

    Science.gov (United States)

    Allan, Helen Therese; Dixon, Roz; Lee, Gay; O'Driscoll, Michael; Savage, Jan; Tapson, Christine

    2016-06-01

    In this study, we discuss the role of senior nurses who sit on clinical commissioning groups that now plan and procure most health services in England. These nurses are expected to bring a nursing view to all aspects of clinical commissioning group business. The role is a senior level appointment and requires experience of strategic commissioning. However, little is known about how nurses function in these roles. Following Barrientos' methodology, published policy and literature were analysed to investigate these roles and National Health Service England's claim that nursing can influence and advance a nursing perspective in clinical commissioning groups. Drawing on work by Berg, Barry and Chandler on 'new public management', we discuss how nurses on clinical commissioning groups work at the alignment of the interests of biomedicine and managerialism. We propose that the way this nursing role is being implemented might paradoxically offer further evidence of the devaluing of nursing rather than the emergence of a strong professional nursing voice at the level of strategic commissioning.

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

    Science.gov (United States)

    Berg, Robert A.; Sutton, Robert M.; Holubkov, Richard; Nicholson, Carol E.; Dean, J. Michael; Harrison, Rick; Heidemann, Sabrina; Meert, Kathleen; Newth, Christopher; Moler, Frank; Pollack, Murray; Dalton, Heidi; Doctor, Allan; Wessel, David; Berger, John; Shanley, Thomas; Carcillo, Joseph; Nadkarni, Vinay M.

    2013-01-01

    Objective The aim of this study was to evaluate the relative frequency of pediatric in-hospital CPR events occurring in intensive care units (ICUs) compared to general wards. We hypothesized that the proportion of pediatric CPR provided in ICUs versus general wards has increased over the past decade and this shift is associated with improved resuscitation outcomes. Design Prospective, observational study. Setting Total of 315 hospitals in the American Heart Association’s Get With The Guidelines-Resuscitation (GTWG-R) database. Patients Total of 5,870 pediatric cardiopulmonary resuscitation (CPR) events between January 1, 2000 and September 14, 2010. CPR events were defined as external chest compressions >1minute. Measurements and Results The primary outcome was proportion of total ICU versus general ward CPR events over time evaluated by chi square test for trend. Secondary outcome included return of spontaneous circulation (ROSC) following the CPR event. Among 5870 pediatric CPR events, 5477 (93.3%) occurred in ICUs compared to 393 (6.7%) on inpatient wards. Over time, significantly more of these CPR events occurred in the ICU compared to the wards (test for trend: p<0.01), with a prominent shift noted between 2003 and 2004 (2000-2003: 87 - 91% vs. 2004-2010: 94 - 96%). In a multivariable model controlling for within center variability and other potential confounders, ROSC increased in 2004-2010 compared with 2000-2003 (RR 1.08, 95% confidence interval: 1.03-1.13). Conclusions In-hospital pediatric CPR is much more commonly provided in ICUs vs. Wards and the proportion has increased significantly over the past decade with concomitant increases in return of spontaneous circulation. PMID:23921270

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

    Science.gov (United States)

    Zaman, Shahaduz

    2004-11-01

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

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

    Directory of Open Access Journals (Sweden)

    Celebi Nora

    2012-06-01

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

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

    Directory of Open Access Journals (Sweden)

    Nina Hynninen

    2016-11-01

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

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

    Science.gov (United States)

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

    1997-04-01

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

  5. Lung ultrasound and chest x-ray for detecting pneumonia in an acute geriatric ward

    OpenAIRE

    2016-01-01

    Abstract Background: Our aim was to compare the accuracy of lung ultrasound (LUS) and standard chest x-ray (CXR) for diagnosing pneumonia in older patients with acute respiratory symptoms (dyspnea, cough, hemoptysis, and atypical chest pain) admitted to an acute-care geriatric ward. Methods: We enrolled 169 (80 M, 89 F) multimorbid patients aged 83.0 ± 9.2 years from January 1 to October 31, 2015. Each participant underwent CXR and bedside LUS within 6 hours from ward admission. LUS was perfo...

  6. Experience based co-design reduces formal complaints on an acute mental health ward.

    Science.gov (United States)

    Springham, Neil; Robert, Glenn

    2015-01-01

    An acute mental health triage ward at Oxleas NHS Foundation Trust was attracting high levels of formal service user and family complaints. The Trust used experience based co-design to examine the issues and redesign procedures. This resulted in an immediate eradication of formal complaints for a period of 23 months. This paper describes two outcomes: firstly, the successful adaptations made to the experience based co-design methodology from its origins in physical care, in order to ensure it was safe and effective in an acute mental health setting; and, secondly, the changes made to the ward as a result of this quality improvement intervention.

  7. Comparison Patients and Staffs Satisfaction in General Versus Special Wards of Hospitals of Jahrom.

    Science.gov (United States)

    Taheri, Leila; Kargar Jahromi, Marzieh; Hojat, Mohsen

    2015-04-02

    Patient satisfaction is the most important indicator of high-quality health care and is used for the assessment and planning of health care. Also, Job satisfaction is an important factor on prediction and perception of organizational manner. The aim of this study is to identify and compare patient and staff satisfaction in general versus special wards. In order to identify the various indicators of satisfaction and dissatisfaction, a descriptive study (cross sectional) was done to assess patients' satisfaction with in-patient care at Jahrom University of Medical Science hospitals. The sample size was 600 patients that selected by sequential random sampling technique and are close to their discharge from the hospital. Patients were asked to indicate the scale point which best reflected their level of satisfaction with the treatment or service. Also we assess the staff satisfaction (sample size was 408 staffs) in general ward using a researcher made questionnaire. It should be noted that the participants were anonymous and there was no obligation to participation. We tried to set a secure and comfortable environment for filling out the questionnaire. Among 600 patients, 239 (n=38.67%) were men and 368 (61.33%) were female. Number of nurses was 408, of which 135 (33.08%) were men and 273 (66.92%) female. There was a significant correlation between working experience and professional factors of personnel. The mean total patient satisfaction in general and special wards is (2.75±.35, 3.03±.53) respectively. Differences of patient satisfaction in domains such respect, care and confidence in general wards versus special ward were statistically significant, but there was no difference in expect time of patients in these wards. Differences Between the mean patient and staff satisfaction in the general wards versus special wards were statistically significant using independent t-tests (p=.018, p=.029). Spearman test showed a statistically significant correlation between

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

    Science.gov (United States)

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

    2016-10-01

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

  9. Transition of care: A set of pharmaceutical interventions improves hospital discharge prescriptions from an internal medicine ward.

    Science.gov (United States)

    Neeman, Marine; Dobrinas, Maria; Maurer, Sophie; Tagan, Damien; Sautebin, Annelore; Blanc, Anne-Laure; Widmer, Nicolas

    2017-03-01

    Continuity of care between hospitals and community pharmacies needs to be improved to ensure medication safety. This study aimed to evaluate whether a set of pharmaceutical interventions to prepare hospital discharge facilitates the transition of care. This study took place in the internal medicine ward and in surrounding community pharmacies. The intervention group's patients underwent a set of pharmaceutical interventions during their hospital stay: medication reconciliation at admission, medication review, and discharge planning. The two groups were compared with regards to: number of community pharmacist interventions, time spent on discharge prescriptions, and number of treatment changes. Comparison between the groups showed a much lower (77% lower) number of community pharmacist interventions per discharge prescription in the intervention (n=54 patients) compared to the control group (n=64 patients): 6.9 versus 1.6 interventions, respectively (phospital physician. The number of medication changes at different steps was also significantly lower in the intervention group: 40% fewer (phospital admission and discharge, 66% fewer (phospital discharge and community pharmacy care, and 25% fewer (p=0.002) between community pharmacy care and care by a general practitioner. An intervention group underwent significantly fewer medication changes in subsequent steps in the transition of care after a set of interventions performed during their hospital stay. Community pharmacists had to perform fewer interventions on discharge prescriptions. Altogether, this improves continuity of care. Copyright © 2016 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

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

    African Journals Online (AJOL)

    This article focuses on how emotional intelligence could be utilised to enhance ... aspects such as self-awareness, motivation, self-management, social awareness, ... Data were collected through focus group interviews, questionnaires and a ...

  11. Less is more: a project to reduce the number of PIMs (potentially inappropriate medications) on an elderly care ward

    Science.gov (United States)

    Aung, Tin Htun; Judith Beck, Adèle; Siese, Thomas; Berrisford, Richard

    2016-01-01

    Potentially inappropriate prescribing in healthcare of the elderly (HCE) is associated with avoidable adverse drug events (ADEs).1,2 A recent set of prescribing criteria has been designed and validated, called “Screening Tool of Older Persons' Prescriptions” (STOPP), to rationalise prescribing in hospitalised patients on HCE wards.1,3 The aim of this quality improvement project was to identify how many potentially inappropriate medications (PIMs) were prescribed on these wards, and remove them. This was executed by implementing a ward round checklist, which incorporated STOPP criteria, for the twice weekly, consultant led ward rounds. This quality improvement project was carried out over four months. In a pilot study, we identified eight inappropriate medical prescriptions among 148 medications (5.4% ) prescribed on one ward. After applying a checklist for a structured ward round, we reviewed the medications prescribed on that ward, and found 10 PIMs out of 192 (5.2% ). Utilising the increasingly recognised “plan, do, study, act” (PDSA) cycle,4 we implemented departmental teaching and meetings with other members of the multidisciplinary team, which raised awareness of PIMs among junior doctors, as well as involving our pharmacists in drug chart screening. During this process we continued with a further six cycles on a bi-weekly basis, and saw a gradual decrease in PIM to 1.5%. In conclusion, a structured ward round, facilitated by a checklist that included review of drug charts based on STOPP criteria, demonstrated a considerable reduction of PIMs. It would be interesting to apply this quality improvement project to non-HCE wards, including general surgical wards or adult psychiatry wards, as a means of not only reducing the effects of ADEs, but also the expenditure associated with unnecessary drug prescriptions, and the costs associated with additional care arising from associated ADEs. PMID:27096089

  12. Outcome risk factors during respiratory infections in a paediatric ward in Antananarivo, Madagascar 2010-2012.

    Directory of Open Access Journals (Sweden)

    Soatiana Rajatonirina

    Full Text Available BACKGROUND: Acute respiratory infections are a leading cause of infectious disease-related morbidity, hospitalisation and mortality among children worldwide, and particularly in developing countries. In these low-income countries, most patients with acute respiratory infection (ARI, whether it is mild or severe, are still treated empirically. The aim of the study was to evaluate the risk factors associated with the evolution and outcome of respiratory illnesses in patients aged under 5 years old. MATERIALS AND METHODS: We conducted a prospective study in a paediatric ward in Antananarivo from November 2010 to July 2012 including patients under 5 years old suffering from respiratory infections. We collected demographic, socio-economic, clinical and epidemiological data, and samples for laboratory analysis. Deaths, rapid progression to respiratory distress during hospitalisation, and hospitalisation for more than 10 days were considered as severe outcomes. We used multivariate analysis to study the effects of co-infections. RESULTS: From November 2010 to July 2012, a total of 290 patients were enrolled. Co-infection was found in 192 patients (70%. Co-infections were more frequent in children under 36 months, with a significant difference for the 19-24 month-old group (OR: 8.0. Sixty-nine percent (230/290 of the patients recovered fully and without any severe outcome during hospitalisation; the outcome was scored as severe for 60 children and nine patients (3% died. Risk factors significantly associated with worsening evolution during hospitalisation (severe outcome were admission at age under 6 months (OR = 5.3, comorbidity (OR = 4.6 and low household income (OR = 4.1. CONCLUSION: Co-mordidity, low-income and age under 6 months increase the risk of severe outcome for children infected by numerous respiratory pathogens. These results highlight the need for implementation of targeted public health policy to reduce the contribution of

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

    Science.gov (United States)

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

    2016-12-30

    Evidence suggests that health outcomes for hospitalised children in the UK are worse than other countries in Europe, with an estimated 1500 preventable deaths in hospital each year. It is presumed that some of these deaths are due to unanticipated deterioration, which could have been prevented by earlier intervention, for example, sepsis. The Situation Awareness For Everyone (SAFE) intervention aims to redirect the 'clinical gaze' to encompass a range of prospective indicators of risk or deterioration, including clinical indicators and staff concerns, so that professionals can review relevant information for any given situation. Implementing the routine use of huddles is central to increasing situation awareness in SAFE. In this article, we describe the realistic evaluation framework within which we are evaluating the SAFE programme. Multiple methods and data sources are used to help provide a comprehensive understanding of what mechanisms for change are triggered by an intervention and how they have an impact on the existing social processes sustaining the behaviour or circumstances that are being targeted for change. Ethics approval was obtained from London-Dulwich Research Ethics Committee (14/LO/0875). It is anticipated that the findings will enable us to understand what the important elements of SAFE and the huddle are, the processes by which they might be effective and-given the short timeframes of the project-initial effects of the intervention on outcomes. The present research will add to the extant literature by providing the first evidence of implementation of SAFE and huddles in paediatric wards in the UK. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  14. ICU护理小组对危重患者护理质量的影响%Effect of ICU nursing group on nursing quality in critically ill patients

    Institute of Scientific and Technical Information of China (English)

    欧阳凤珍

    2013-01-01

    目的 探讨ICU护理小组对危重患者护理质量的影响.方法 将本院ICU自2010年9月至2012年12月收治的700例患者按照护理方法的不同分为观察组和对照组,对照组采用常规护理,观察组采用ICU护理小组进行护理,比较两组患者的护理质量.结果 观察组的平均监护时间、护理不良事件的发生率、住院时间显著少于对照组,护理到位率高于对照组(P<0.05).观察组家属在宣教、环境、态度等护理项目方面的满意度均显著高于对照组(P<0.05).结论 ICU护理小组能够显著提高危重患者的护理质量,促进患者康复.%Objective To explore the effect of ICU nursing group on nursing quality in critically ill patients.Methods Seven hundred ICU patients treated in our hospital from 2010 September to 2012 December were divided into the observation group and the control group,the control group was given the conventional nursing,the observation group was given ICU group nursing care,nursing quality were compared between the two groups.Results The average nursing care time,incidence of adverse events and hospitalization days of the observation group were significantly were less than those of the control group,The satisfaction of education environment,attitude,operation and treatment in the observation group were significantly higher than those in the control group (P < 0.05).Conclusions ICU nursing group can significantly improve the quality of care for critically ill patients,promote the rehabilitation of patients.

  15. Making Sense of Critical Pedagogy in L2 Education through a Collaborative Study Group (Dándole sentido a la pedagogía crítica en la educación en L2 a través de un grupo de estudio colaborativo)

    Science.gov (United States)

    Echeverri Sucerquia, Paula Andrea; Pérez Restrepo, Sebastián

    2014-01-01

    In this article we discuss our experiences in the process of understanding critical pedagogy within an English teachers' study group which was created for the purpose of learning how to teach language from a critical perspective. We particularly focus on the challenges of meaning making around critical pedagogy, as we realized that we were not all…

  16. A staff questionnaire study of MRSA infection on ENT and general surgical wards.

    Science.gov (United States)

    Phillips, P S; Golagani, A K; Malik, A; Payne, F B

    2010-09-01

    Methicillin-resistant Staphyloccocus aureus (MRSA) infection has received much attention in both the medical and non-medical press. However, it is not widely encountered on ENT wards, given the profile of short-stay, relatively well patients, although its impact seems to be increasing. We wished to explore the knowledge and attitudes towards MRSA on general surgical and ENT wards, and see if there were any significant differences between specialties, or between doctors and nurses. A 13-item questionnaire with a Likert scale response with six knowledge questions and seven attitude questions was prepared. It was completed anonymously by all nursing and medical staffs on the ENT and general surgical wards of a large District General Hospital. ENT doctors displayed the lowest knowledge and attitude scores; however, this only attained significance in terms of the knowledge of the difference between infection and colonization. Overall, nurses displayed significantly more positive attitudes towards MRSA patients than doctors, but knowledge scores were not significantly different between professions. The study suggests a lack of knowledge about and preponderance of negative attitudes towards MRSA amongst ENT doctors. The difference between colonization and infection is not well understood. Reasons for this may include the relative rarity of MRSA cases on ENT wards.

  17. Potentially pathogenic free-living amoebae isolated from hospital wards with immunodeficient patients in Tehran, Iran.

    Science.gov (United States)

    Lasjerdi, Zohreh; Niyyati, Maryam; Haghighi, Ali; Shahabi, Saed; Biderouni, Farid Tahvildar; Taghipour, Niloofar; Eftekhar, Mohamad; Nazemalhosseini Mojarad, Ehsan

    2011-09-01

    This study investigated the occurrence of free-living amoebae (FLA) in immunodeficiency wards of hospitals in Tehran, Iran. A total of 70 dust and biofilm samples from wards serving transplant, pediatric (malignancies), HIV, leukemia and oncology patients of five university hospitals were collected and examined for the presence of FLA using culturing and molecular approaches. Based on the morphology of the amoebae in plate cultures, primer sets were applied for molecular identification of Acanthamoeba, vahlkampfiid amoebae and Hartmannella. Out of 70 samples, 37 (52.9%) were positive for FLA. Acanthamoeba belonged to the T4 genotype was the most prevalent isolate. Presence of the T4 genotype on medical instruments, including an oxygen mask in an isolation room of an immunodeficiency pediatric ward, should be of concern for health authorities. Acanthamoeba T5 genotypes, Hartmannella vermiformis, and Vahlkampfia avara were also present. These results highlight a clear need for greater attention to improved disinfection, especially where susceptible patients, such as those who are immune-suppressed, are served. To our knowledge, this is the first report of these FLA in immunodeficiency wards in Iran, and also the first to identify Acanthamoeba T5, Hartmannella, and Vahlkampfia in moist habitats, such as biofilms, in this country.

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

    Science.gov (United States)

    Schmidt, Peter

    2009-01-01

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

  19. Prevention and management of aggression training and violent incidents on U.K. Acute psychiatric wards.

    Science.gov (United States)

    Bowers, Len; Nijman, Henk; Allan, Teresa; Simpson, Alan; Warren, Jonathan; Turner, Lynny

    2006-07-01

    Reports of violence and injuries to staff and patients in acute psychiatric inpatient settings have led to the development and implementation of training courses in the Prevention and Management of Violence and Aggression (PMVA). The purpose of this study was to explore the relationship between PMVA training of acute psychiatric ward nursing staff and officially reported violent incident rates. A retrospective analysis was conducted of training records (312 course attendances) and violent incident rates (684 incidents) over two-and-a-half years on 14 acute admission psychiatric wards (5,384 admissions) at three inner-city hospitals in the United Kingdom as part of the Tompkins Acute Ward Study. A positive association was found between training and rates of violent incidents. There was weak evidence that increased rates of aggressive incidents prompted course attendance, no evidence that course attendance reduced violence, and some evidence that attendance of briefer update courses triggered small short-term rises in rates of physical aggression. Course attendance was associated with a rise in physical and verbal aggression while staff were away from the ward. The failure to find a drop in incident rates after training, coupled with the small increases in incidents detected, raises concerns about the training course's efficacy as a preventive strategy. Alternatively, the results are consistent with a threshold effect, indicating that once adequate numbers of staff have been trained, further training keeps incidents at a low rate.

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

    LENUS (Irish Health Repository)

    Tan, T

    2012-02-01

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

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

    Directory of Open Access Journals (Sweden)

    Parivash Davoodian

    2012-01-01

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

  2. Is Clinical Competence Perceived Differently for Student Daily Performance on the Wards versus Clerkship Grading?

    Science.gov (United States)

    Wimmers, Paul F.; Kanter, Steven L.; Splinter, Ted A. W.; Schmidt, Henk G.

    2008-01-01

    Clinical rotations play an important role in the medical curriculum and are considered crucial for student learning. However, competencies that should be learned can differ from those that are assessed. In order to explore which competencies are considered important for daily performance of student on the wards and to what extent clinical teachers…

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

    DEFF Research Database (Denmark)

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

    2015-01-01

    AIMS AND OBJECTIVES: To elicit knowledge of patient experiences of postoperative intermediate care in an intensive care unit and standard postoperative care in a surgical ward after emergency abdominal surgery. BACKGROUND: Emergency abdominal surgery is common, but little is known about how patie...

  4. Constructing and Evaluating a Validity Argument for the Final-Year Ward Simulation Exercise

    Science.gov (United States)

    Till, Hettie; Ker, Jean; Myford, Carol; Stirling, Kevin; Mires, Gary

    2015-01-01

    The authors report final-year ward simulation data from the University of Dundee Medical School. Faculty who designed this assessment intend for the final score to represent an individual senior medical student's level of clinical performance. The results are included in each student's portfolio as one source of evidence of the student's…

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

    NARCIS (Netherlands)

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

    2010-01-01

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

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

    Science.gov (United States)

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

    2016-01-01

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

  7. Predicting Spatial Distribution of Infection Risk of Airborne Transmission Diseases in a Hospital Ward

    DEFF Research Database (Denmark)

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

    2007-01-01

    This study attempt to integrate the Wells-Riley equation and computational fluid dynamics for analyzing the risk of airborne transmission diseases in a building. The new method can predict the spatial distribution of the infection risk of the airborne transmission diseases in a large hospital ward...

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

    Science.gov (United States)

    Byrd, Jodi A.

    2007-01-01

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

  9. Proposed Reference Model for Guiding Teachers to Perform Ward Round Teaching

    Directory of Open Access Journals (Sweden)

    Luís Alberto Corona Martínez

    2014-06-01

    Full Text Available Ward round teaching is an essential professional medical activity as an organizational form of teaching in undergraduate medical education. Its great importance for shaping a professional "personality" is well recognized by the faculty; as well as its extremely complex implementation and development of the necessary skills. The problem to be solved in this paper is related to the need to help younger clinical teachers in undergraduate medical education to develop the skills to conduct ward round teaching; which would be achieved through appropriate guidance on how to perform this activity. Based on this, the teaching staff in the Department of Clinical Sciences of the Dr. Raúl Dorticós Torrado Faculty of Medical Sciences in Cienfuegos has designed a model or representation of ward round teaching to be used as a guide. The main results include the development of a model with two variants, according to the care provided to a recently admitted patient or an already known patient; and the definition of conditions, both in practical and educational areas, which should be considered for the proper implementation of the activity. The model is not a complete representation of the ward round teaching, thus the proposal is open to review and improvement; and its use is based on its adaptation to the particularities of the different disciplines and learning scenarios.

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

    DEFF Research Database (Denmark)

    Kjerholt, Mette; Wagner, Lis; Lindhardt, Tove;

    2016-01-01

    roles, responsibility. Conclusion: Before using PAR it is crucial to investigate if the organization and the participants at all levels are suited and agree to participate actively. The findings indicate, that to carry out PAR in a busy medical ward, it is necessary to evaluate whether the necessary...

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

    DEFF Research Database (Denmark)

    Nordentoft, Helle Merete

    2008-01-01

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

  12. Overcrowding in hospital wards as a predictor of antidepressant treatment among hospital staff.

    Science.gov (United States)

    Virtanen, Marianna; Pentti, Jaana; Vahtera, Jussi; Ferrie, Jane E; Stansfeld, Stephen A; Helenius, Hans; Elovainio, Marko; Honkonen, Teija; Terho, Kirsi; Oksanen, Tuula; Kivimäki, Mika

    2008-11-01

    This report assessed whether hospital ward overcrowding predicts antidepressant use among hospital staff. The extent of hospital ward overcrowding was determined using administrative records of monthly bed occupancy rates between 2000 and 2004 in 203 somatic illness wards in 16 Finnish hospitals providing specialized health care. Information on job contracts for personnel was obtained from the employers' registers. Comprehensive daily data on purchased antidepressant prescriptions (World Health Organization's Anatomical Therapeutic Chemical classification code N06A) for nurses (N=6,699) and physicians (N=641) was derived from national registers. Cox proportional hazards models were used to examine the association between bed occupancy rate and subsequent antidepressant treatment. Monthly bed occupancy rates were used as a time-dependent exposure that could change in value over the course of observation. Hazard ratios were adjusted for sex, age, occupation, type and length of employment contract, hospital district, specialty, and calendar year. Exposure over 6 months to an average bed occupancy rate over 10% in excess of the recommended limit was associated with new antidepressant treatment. This association followed a dose-response pattern, with increasing bed occupancy associated with an increasing likelihood of antidepressant use. There was no evidence of reverse causality; antidepressant treatment among employees did not predict subsequent excess bed occupancy. The increased risk of antidepressant use observed in this study suggests that overcrowding in hospital wards may have an adverse effect on the mental health of staff.

  13. Heterogeneous models for an early discrimination between sepsis and non-infective SIRS in medical ward patients: a pilot study.

    Science.gov (United States)

    Mearelli, Filippo; Fiotti, Nicola; Altamura, Nicola; Zanetti, Michela; Fernandes, Giovanni; Burekovic, Ismet; Occhipinti, Alessandro; Orso, Daniele; Giansante, Carlo; Casarsa, Chiara; Biolo, Gianni

    2014-10-01

    The objective of the study was to determine the accuracy of phospholipase A2 group II (PLA2-II), interferon-gamma-inducible protein 10 (IP-10), angiopoietin-2 (Ang-2), and procalcitonin (PCT) plasma levels in early ruling in/out of sepsis among systemic inflammatory response syndrome (SIRS) patients. Biomarker levels were determined in 80 SIRS patients during the first 4 h of admission to the medical ward. The final diagnosis of sepsis or non-infective SIRS was issued according to good clinical practice. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for sepsis diagnosis were assessed. The optimal biomarker combinations with clinical variables were investigated by logistic regression and decision tree (CART). PLA2-II, IP-10 and PCT, but not Ang-2, were significantly higher in septic (n = 60) than in non-infective SIRS (n = 20) patients (P ≤ 0.001, 0.027, and 0.002, respectively). PLA2-II PPV and NPV were 88 and 86%, respectively. The corresponding figures were 100 and 31% for IP-10, and 93 and 35% for PCT. Binary logistic regression model had 100% PPV and NPV, while manual and software-generated CART reached an overall accuracy of 95 and 98%, respectively, both with 100% NPV. PLA2-II and IP-10 associated with clinical variables in regression or decision tree heterogeneous models may be valuable biomarkers for sepsis diagnosis in SIRS patients admitted to medical ward (MW). Further studies are needed to introduce them into clinical practice.

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

    Science.gov (United States)

    Srulovici, Einav; Drach-Zahavy, Anat

    2017-08-16

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

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

    Science.gov (United States)

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

    2015-04-23

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

  16. Toll-like receptor 4 and high-mobility group box 1 are critical mediators of tissue injury and survival in a mouse model for heatstroke.

    Directory of Open Access Journals (Sweden)

    Mohammed Dehbi

    Full Text Available The molecular mechanisms that initiate the inflammatory response in heatstroke and their relation with tissue injury and lethality are not fully elucidated. We examined whether endogenous ligands released by damaged/stressed cells such as high-mobility group box 1 (HMGB1 signaling through Toll-like receptor 4 (TLR4 may play a pathogenic role in heatstroke. Mutant TLR4-defective (C3H/HeJ and wild type (C3H/HeOuJ mice were subjected to heat stress in an environmental chamber pre-warmed at 43.5 °C until their core temperature reached 42.7°C, which was taken as the onset of heatstroke. The animals were then allowed to recover passively at ambient temperature. A sham-heated group served as a control. Mutant mice displayed more histological liver damage and higher mortality compared with wild type mice (73% vs. 27%, respectively, P<0.001. Compared to wild type mice, mutant mice exhibited earlier plasma release of markers of systemic inflammation such as HMGB1 (206 ± 105 vs. 63 ± 21 ng/ml; P = 0.0018 and 209 ± 100 vs. 46 ± 32 ng/ml; P<0.0001, IL-6 (144 ± 40 vs. 46 ± 20 pg/ml; P<0.001 and 184 ± 21 vs. 84 ± 54 pg/ml; P = 0.04, and IL-1β (27 ± 4 vs. 1.7 ± 2.3 pg/ml; P<0.0001 at 1 hour. Both strains of mice displayed early release of HMGB1 into the circulation upstream of IL-1β and IL-6 responses which remained elevated up to 24 h. Specific inhibition of HMGB1 activity with DNA-binding A Box (600 µg/mouse protected the mutant mice against the lethal effect of heat stress (60% A Box vs. 18% GST protein, P = 0.04. These findings suggest a protective role for the TLR4 in the host response to severe heat stress. They also suggest that HMGB1 is an early mediator of inflammation, tissue injury and lethality in heatstroke in the presence of defective TLR4 signaling.

  17. A quantitative comparison of ward-based clinical pharmacy activities in 7 acute UK hospitals.

    Science.gov (United States)

    Onatade, Raliat; Miller, Gavin; Sanghera, Inderjit

    2016-12-01

    Background Several clinical pharmacy activities are common to UK hospitals. It is not clear whether these are provided at similar levels, and whether they take similar amounts of time to carry out. Objective To quantify and compare clinical pharmacist ward activities between different UK hospitals. Setting Seven acute hospitals in the Greater London area (UK). Methods A list of common ward activities was developed. On five consecutive days, pharmacists visiting hospital wards documented total time spent and how many of each activity they undertook. Results were analysed by hospital. The range and number of activities per 100 occupied bed days, and per 24 beds were compared. Main outcome measure Time spent on wards and numbers of each activity undertaken. Results Pharmacists logged a total of 2291 h carrying out 40,000 activities. 4250 changes to prescriptions were made or recommended. 5901 individual medication orders were annotated for clarity or safety. For every 24 beds visited, mean time spent was 230 min-seeing 6.2 new patients, carrying out 3.9 calculations and 1.3 patient consultations, checking and authorising 1.8 discharge prescriptions, and providing staff with information twice. Other activities varied significantly, not all could be explained by differences in hospital specialties or Information Technology systems. Conclusion This is the first detailed comparison of clinical pharmacy ward activities between different hospitals. There are some typical levels of activities carried out. Wide variations in other activities could not always be explained. Despite a large number of contacts, pharmacists reported very few consultation sessions with patients.

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

    Science.gov (United States)

    Puvaneswaralingam, Shobitha; Ross, Daniella

    2016-01-01

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

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

    Science.gov (United States)

    Puvaneswaralingam, Shobitha; Ross, Daniella

    2016-01-01

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

  20. Umbilical cord clamping at birth--practice in Norwegian maternity wards.

    Science.gov (United States)

    Lundberg, Camilla; Øian, Pål; Klingenberg, Claus

    2013-11-26

    The timing and practice used for umbilical cord clamping of neonates are controversial internationally as well as in Norway. We therefore wished to investigate routines and practices for umbilical cord clamping of neonates in Norway. A web-based questionnaire was sent to heads of departments of all maternity wards in Norway (n = 52). They were asked about their practice with regard to umbilical cord clamping of neonates and whether written routines had been prepared for this purpose. We defined early umbilical cord clamping as immediate or within 30 seconds and late clamping as ≥ 1 minute or not until pulsation in the umbilical cord had ceased. Fifty (96%) of the maternity institutions returned a completed questionnaire. Twelve institutions (24%) reported to clamp the umbilical cord of full-term neonates early, and 38 (76%) reported to practise late clamping. Nineteen maternity wards (38%) followed written routines for umbilical cord clamping of full-term neonates, and among these, early umbilical cord clamping was practised in nine (47%). In the 31 maternity wards that had no written routines, early umbilical cord clamping was practised in three (10%). Twenty-seven of the maternity wards reported that the child is placed on the maternal abdomen before clamping of the umbilical cord, 14 reported that the child commonly is held below the introitus before umbilical cord clamping, and the rest did not report any consistent practice. There is wide variation in the practice for umbilical cord clamping in Norwegian maternity wards, many of which have no written guidelines. We argue that national guidelines for umbilical cord clamping of neonates should be established.

  1. Detection of prescription errors by a unit-based clinical pharmacist in a nephrology ward.

    Science.gov (United States)

    Vessal, Ghazal

    2010-02-01

    To determine the impact of a clinical pharmacist on detection and prevention of prescription errors at the nephrology ward of a referral hospital. Nephrology ward of a major referral hospital in Southern Iran. During a 4-month period, a clinical pharmacist was assigned to review medication order sheets and drug orders three times a week at the nephrology ward. Besides chart review, the clinical pharmacist participated in medical rounds once a week. The occurrence of prescribing errors, and related harm was determined on hospitalized patients in this ward during the 4 month period. When an error was detected, intervention was made after agreement of the attending physician. Number and types of prescribing errors, level of harm, and number of interventions were determined. Seventy six patient charts were reviewed during the 4-month period. A total of 818 medications were ordered in these patients. Eighty six prescribing errors were detected in 46 hospital admissions. The mean age of the patients was 47.7 +/- 17.2. Fifty five percent were male while 45% were female. Different types of prescribing errors and their frequencies were as follows: wrong frequency (37.2%), wrong drug selection (19.8%), overdose (12.8%), failure to discontinue (10.5%), failure to order (7 %), under- dose (3.5%), wrong time (3.5%), monitoring (3.5%), wrong route (1.2%), and drug interaction (1.2 %). The attending physician agreed to 96.5% of the prescription errors detected, and interventions were made. Although 89.5% of the detected errors caused no harm, 4(4.7%) of the errors increased the need for monitoring, 2 (2.3%) increased length of stay, and 2 (2.3%) led to permanent patient harm. presence of a clinical pharmacist at the nephrology ward helps in early detection of prescription errors, and therefore potential prevention of negative consequences due to drug administration.

  2. Unplanned Transfers from Hospital Wards to the Neurological Intensive Care Unit.

    Science.gov (United States)

    Gold, C A; Mayer, S A; Lennihan, L; Claassen, J; Willey, J Z

    2015-10-01

    The aim of this study is to evaluate the characteristics of unplanned transfers of adult patients from hospital wards to a neurological intensive care unit (NICU). We retrospectively reviewed consecutive unplanned transfers from hospital wards to the NICU at our institution over a 3-year period. In-hospital mortality rates were compared between patients readmitted to the NICU ("bounce-back transfers") and patients admitted to hospital wards from sources other than the NICU who were then transferred to the NICU ("incident transfers"). We also measured clinical characteristics of transfers, including source of admission and indication for transfer. A total of 446 unplanned transfers from hospital wards to the NICU occurred, of which 39% were bounce-back transfers. The in-hospital mortality rate associated with all unplanned transfers to the NICU was 17% and did not differ significantly between bounce-back transfers and incident transfers. Transfers to the NICU within 24 h of admission to a floor service accounted for 32% of all transfers and were significantly more common for incident transfers than bounce-back transfers (39 vs. 21%, p = .0002). Of patients admitted via the emergency department who had subsequent incident transfers to the NICU, 50% were transferred within 24 h of admission. Unplanned transfers to an NICU were common and were associated with a high in-hospital mortality rate. Quality improvement projects should target the triage process and transitions of care to the hospital wards in order to decrease unplanned transfers of high-risk patients to the NICU.

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

    Science.gov (United States)

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

    2016-07-11

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

  4. A multi-center prospective cohort study of patient transfers from the intensive care unit to the hospital ward.

    Science.gov (United States)

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

    2017-08-29

    To provide a 360-degree description of ICU-to-ward transfers. Prospective cohort study of 451 adults transferred from a medical-surgical ICU to a hospital ward in 10 Canadian hospitals July 2014-January 2016. Transfer processes documented in the medical record. Patient (or delegate) and provider (ICU/ward physician/nurse) perspectives solicited by survey 24-72 h after transfer. Medical records (100%) and survey responses (ICU physicians-80%, ICU nurses-80%, ward physicians-46%, ward nurses-64%, patients-74%) were available for most transfers. The median time from initiation to completion of transfer was 25 h (IQR 6-52). ICU physicians and nurses reported communicating with counterparts via telephone (78 and 75%) when transfer was requested (82 and 24%) or accepted (31 and 59%) and providing more elements of clinical information than ward physicians (mean 4.7 vs. 3.9, p transfer when they received more information (OR 1.32, 95% CI 1.18-1.48), had their questions addressed (OR 3.96, 95% CI 1.33-11.84), met the ward physician prior to transfer (OR 4.61, 95% CI 2.90-7.33), and were assessed by a nurse within 1 h of ward arrival (OR 4.70, 95% CI 2.29-9.66). Recommendations for improvement included having a documented care plan travel with the patient (all stakeholders), standardized face-to-face handover (physicians), avoiding transfers at shift change (nurses) and informing patients about pending transfers in advance (patients). ICU-to-ward transfers are characterized by failures of patient flow and communication; experienced differently by patients, ICU/ward physicians and nurses, with distinct suggestions for improvement.

  5. Disparities in health, poverty, incarceration, and social justice among racial groups in the United States: a critical review of evidence of close links with neoliberalism.

    Science.gov (United States)

    Nkansah-Amankra, Stephen; Agbanu, Samuel Kwami; Miller, Reuben Jonathan

    2013-01-01

    Problems of poverty, poor health, and incarceration are unevenly distributed among racial and ethnic minorities in the United States. We argue that this is due, in part, to the ascendance of United States-style neoliberalism, a prevailing political and economic doctrine that shapes social policy, including public health and anti-poverty intervention strategies. Public health research most often associates inequalities in health outcomes, poverty, and incarceration with individual and cultural risk factors. Contextual links to structural inequality and the neoliberal doctrine animating state-sanctioned interventions are given less attention. The interrelationships among these are not clear in the extant literature. Less is known about public health and incarceration. Thus, the authors describe the linkages between neoliberalism, public health, and criminal justice outcomes. We suggest that neoliberalism exacerbates racial disparities in health, poverty, and incarceration in the United States. We conclude by calling for a new direction in public health research that advances a pro-poor public health agenda to improve the general well-being of disadvantaged groups.

  6. A stepped wedge, cluster controlled trial of an intervention to improve safety and quality on medical wards: the HEADS-UP study protocol.

    Science.gov (United States)

    Pannick, Samuel; Beveridge, Iain; Ashrafian, Hutan; Long, Susannah J; Athanasiou, Thanos; Sevdalis, Nick

    2015-06-22

    The majority of preventable deaths in healthcare are due to errors on general wards. Staff perceptions of safety correlate with patient survival, but effectively translating ward teams' concerns into tangibly improved care remains problematic. The Hospital Event Analysis Describing Significant Unanticipated Problems (HEADS-UP) trial evaluates a structured, multidisciplinary team briefing, capturing safety threats and adverse events, with rapid feedback to clinicians and service managers. This is the first study to rigorously assess a simpler intervention for general medical units, alongside an implementation model applicable to routine clinical practice. 7 wards from 2 hospitals will progressively incorporate the intervention into daily practice over 14 months. Wards will adopt HEADS-UP in a pragmatic sequence, guided by local clinical enthusiasm. Initial implementation will be facilitated by a research lead, but rapidly delegated to clinical teams. The primary outcome is excess length of stay (a surplus stay of 24 h or more, compared to peer institutions' Healthcare Resource Groups-predicted length of stay). Secondary outcomes are 30-day readmission or excess length of stay; in-hospital death or death/readmission within 30 days; healthcare-acquired infections; processes of escalation of care; use of traditional incident-reporting systems; and patient safety and teamwork climates. HEADS-UP will be analysed as a stepped wedge cluster controlled trial. With 7840 patients, using best and worst case predictions, the study would achieve between 75% and 100% power to detect a 2-14% absolute risk reduction in excess length of stay (two-sided pmodels or generalised estimating equations, and a time-to-event regression model. A qualitative analysis will evaluate facilitators and barriers to HEADS-UP implementation and impact. Participating institutions' Research and Governance departments approved the study. Results will be published in peer-reviewed journals and at

  7. Evaluation of Mental Workload among ICU Ward's Nurses.

    Science.gov (United States)

    Mohammadi, Mohsen; Mazloumi, Adel; Kazemi, Zeinab; Zeraati, Hojat

    2015-01-01

    High level of workload has been identified among stressors of nurses in intensive care units (ICUs). The present study investigated nursing workload and identified its influencing perfor-mance obstacles in ICUs. This cross-sectional study was conducted, in 2013, on 81 nurses working in ICUs in Imam Khomeini Hospital in Tehran, Iran. NASA-TLX was applied for assessment of workload. Moreover, ICUs Performance Obstacles Questionnaire was used to identify performance obstacles associated with ICU nursing. Physical demand (mean=84.17) was perceived as the most important dimensions of workload by nurses. The most critical performance obstacles affecting workload included: difficulty in finding a place to sit down, hectic workplace, disorganized workplace, poor-conditioned equipment, waiting for using a piece of equipment, spending much time seeking for supplies in the central stock, poor quality of medical materials, delay in getting medications, unpredicted problems, disorganized central stock, outpatient surgery, spending much time dealing with family needs, late, inadequate, and useless help from nurse assistants, and ineffective morning rounds (P-value<0.05). Various performance obstacles are correlated with nurses' workload, affirms the significance of nursing work system characteristics. Interventions are recommended based on the results of this study in the work settings of nurses in ICUs.

  8. Thinking Critically about Critical Thinking

    Science.gov (United States)

    Mulnix, Jennifer Wilson

    2012-01-01

    As a philosophy professor, one of my central goals is to teach students to think critically. However, one difficulty with determining whether critical thinking can be taught, or even measured, is that there is widespread disagreement over what critical thinking actually is. Here, I reflect on several conceptions of critical thinking, subjecting…

  9. Drug Utilization on Neonatal Wards: A Systematic Review of Observational Studies

    Science.gov (United States)

    Rosli, Rosliana; Dali, Ahmad Fauzi; Abd Aziz, Noorizan; Abdullah, Amir Heberd; Ming, Long Chiau; Manan, Mohamed Mansor

    2017-01-01

    Despite limited evidence on safety and efficacy of drug use in neonates, drugs are extensively used in this age group. However, the availability of information on drug consumption in neonates, especially inpatient neonates, is limited. This paper systematically reviews published studies on drug utilization in hospitalized neonates. A systematic literature review was carried out to identify observational studies published from inception of databases used till August 2016. Four search engines, namely Medline, CINAHL, Embase, and PubMed, were used. Publications written in English that described drug utilization in neonatal wards were selected. Assessment of the data was based on the category of the study design, the objective of study and the method used in reporting drug consumption. A total of 20 drug utilization studies were identified, 12 of which focused on all drug classes, while the other eight evaluated antimicrobials. Studies were reported in Europe (n = 7), the United States (n = 6), India (n = 5), Brazil (n = 1), and Iran (n = 1). Substantial variance with regard to study types (study design and methods), data source, and sample size were found among the selected studies. Of the studies included, 45% were cross-sectional or retrospective, 40% were prospective studies, and the remaining 15% were point prevalence surveys. More than 70% of the studies were descriptive studies, describing drug consumption patterns. Fifteen per cent of the descriptive studies evaluated changes in drug utilization patterns in neonates. Volume of units was the most prevalent method used for reporting all drug categories. The ATC/DDD system for reporting drug use was only seen in studies evaluating antimicrobials. The most commonly reported drugs across all studies are anti-infectives for systemic use, followed by drugs for the cardiovascular system, the nervous system and the respiratory system. Ampicillin and gentamicin were the most prescribed antimicrobials in hospitalized

  10. Contingency nursing care management for ICU wards in case of power failure%我院ICU病房停电应急护理管理的实践

    Institute of Scientific and Technical Information of China (English)

    陈巧玲; 柳芳登; 王建红; 杜肖红; 林秀霞

    2012-01-01

    介绍了我院应对重症加强护理病房(ICU)停电应急护理管理的实践.我院的SICU病房制定了《SICU标准化停电应急预案》,预案中将停电事件突发时当班护理人员,根据其当前的岗位及资质分为A、B、C3种角色,分别赋予负责患者安全、负责协调指挥、负责医疗辅助的应急职责,并建立相应职能的应急行为流程.通过培训和考核,使医护人员熟练掌握应急预案的流程,明确自己的职责.经过4次实践,应急预案的实施降低了风险事件的发生率,提高了满意度.预案管理使ICU护理人员在停电事件中能快速有效地应对危机事件,规避ICU护理风险.%The paper described the practice of contingency nursing management for ICU wards in case of power breakdown in the hospital The SICU wards have developed their power failure contingency plan in which the nurses on duty are divided into Group A,B and C according to their positions and qualifications.Respectively,they take charge of patient safety,coordination and command,and medical aid.We also established the procedure of emergency response for these duties.Training and examination familiarize the medical personnel with the procedure and their duties.Four practices proved that the implementation of the plan reduces risks exposure and improves the satisfaction.With the contingency plan,the nurses in ICU can now take care of critical incidents and avoid nursing risks in ICU efficiently.

  11. Critical Care Team

    Science.gov (United States)

    ... Patients and Families > About Critical Care > Team Tweet Team Page Content ​The critical care team is a group of specially trained caregivers who ... help very ill patients get better. The care team often teach the patient and family strategies that ...

  12. Critical Care

    Science.gov (United States)

    Critical care helps people with life-threatening injuries and illnesses. It might treat problems such as complications ... a team of specially-trained health care providers. Critical care usually takes place in an intensive care ...

  13. Developing an holistic assessment protocol on a hospice inpatient ward: staff engagement and my role as a practice development facilitator

    Directory of Open Access Journals (Sweden)

    John Lansdell

    2016-05-01

    Full Text Available Background: In 2014 I received the Richard Tompkins Nurse Development Scholarship, granted through the Foundation of Nursing Studies and including attendance at a five-day International Practice Development Collaborative practice development school, followed by a year’s mentorship. The scholarship aims to foster the delivery of person-centred care, which I hoped to achieve by enhancing holistic nursing assessment on a hospice inpatient ward. Aims: This article is a critical reflection on my learning through the scholarship, specifically related to staff engagement and my role as a practice development facilitator. Conclusions: While the project has not yet reached its conclusion, the learning has been invaluable. I have deepened my understanding of the need for collaboration, inclusion and participation to foster engagement and cultural change. More fundamentally, understanding how different aspects of my role enable change has proved both challenging and constructive, resulting in greater self-awareness and confidence. I remain committed to refining holistic nursing assessment to allow a greater degree of person-centred care in the hospice. Implications for practice: Practice development combines a variety of approaches to realise a shared vision; collaboration, inclusion and participation are central to fostering engagement Balancing different elements of a role (for instance, leader-manager-facilitator has the potential to be confusing and contradictory; awareness of how these elements interrelate promotes effectiveness when introducing change Individuals in a practice development role must ensure they have good sources of support

  14. Archetypal Criticism.

    Science.gov (United States)

    Chesebro, James W.; And Others

    1990-01-01

    Argues that archetypal criticism is a useful way of examining universal, historical, and cross-cultural symbols in classrooms. Identifies essential features of an archetype; outlines operational and critical procedures; illustrates archetypal criticism as applied to the cross as a symbol; and provides a synoptic placement for archetypal criticism…

  15. Audit of co-management and critical care outreach for high risk postoperative patients (The POST audit).

    Science.gov (United States)

    Story, D A; Shelton, A; Jones, D; Heland, M; Belomo, R

    2013-11-01

    Co-management and critical care outreach for high risk surgical patients have been proposed to decrease postoperative complications and mortality. We proposed that a clinical project with postoperative comanagement and critical care outreach, the Post Operative Surveillance Team: (POST), would be associated with decreased hospital length of stay. We conducted a retrospective before (control group) and after (POST group) audit of this hospital program. POST was staffed for four months in 2010 by two intensive care nurses and two senior registrars who conducted daily ward rounds for the first five postoperative days on high risk patients undergoing inpatient general or urological surgery. The primary endpoint was length of hospital stay and secondary endpoints were Medical Emergency Team (MET) calls, cardiac arrests and in-hospital mortality. There were 194 patients in the POST group and 1,185 in the control group. The length of stay in the POST group, median nine days (Inter-quartile range [IQR]: 5 to 17 days), was longer than the control group, median seven days (IQR: 4 to 13 days): difference two days longer (95.0% confidence interval [95.0% CI]: 1 to 3 days longer, P audit found that the POST service was not associated with reduced length of stay. Models of co-management, different to POST, or with different performance metrics, could be tested.

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

    DEFF Research Database (Denmark)

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

    2008-01-01

    to assess, from the relatives' perspective, collaboration between relatives of frail elderly patients and nurses in acute hospital wards, as well as prerequisites for, and outcome of, collaboration. DESIGN: Instrument development and psychometric testing. SETTING: Acute medical and geriatric wards......BACKGROUND: Collaboration between relatives and nurses in acute care settings is sparsely investigated, and that mostly from nurses' point of view. Feasible and valid instruments are needed for assessing collaboration, its prerequisites and outcome. OBJECTIVES: To develop and test an instrument....... PARTICIPANTS: One hundred fifty-six relatives. Women constituted 74.8%, offspring 63.9% and spouses 20%, respectively. METHODS: A model for collaboration was developed and underpinned the development and construction of the instrument. Face and content validity was examined by relatives and an expert panel...

  17. The effect of pharmacy restriction of clindamycin on Clostridium difficile infection rates in an orthopedics ward.

    Science.gov (United States)

    Cruz-Rodríguez, Nora Cecilia; Hernández-García, Raúl; Salinas-Caballero, Ana Gabriela; Pérez-Rodríguez, Edelmiro; Garza-González, Elvira; Camacho-Ortiz, Adrián

    2014-06-01

    A high consumption of clindamycin was noted in an orthopedics ward with high rates of Clostridium difficile infection (CDI). We restricted clindamycin for the entire ward. A reduction of 88% in CDI (1.07 to 0.12 × 1,000 patients-days, P = .056) and 84% for all-cause diarrhea (2.40 to 0.38 × 1,000 patients-days, P = .021) was achieved. Clindamycin was reduced 92.61% without an increase in other antibiotics. We identified high consumption of clindamycin as a risk factor for CDI. Copyright © 2014 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

  18. The Romano-Ward syndrome: a case presenting as near drowning with a clinical review.

    Science.gov (United States)

    Harris, E M; Knapp, J F; Sharma, V

    1992-10-01

    Patients with the Romano-Ward syndrome, a form of congenital long Q-T syndrome (LQTS), present with syncopal episodes and are at risk for sudden death. Patients with LQTS may be misdiagnosed if the physician is unaware of this entity. The risk of sudden death makes recognition important so that appropriate therapy can be initiated. A case is discussed in which the patient presented following a near-drowning episode. Family history revealed a familial "seizure disorder." After analysis of the patient's and father's ECGs, the diagnosis of Romano-Ward syndrome was made. A review of the literature was done, concentrating on presentation, pathophysiology, electrocardiographic findings, etiology, diagnosis, prognosis, and treatment of congenital LQTS. This paper is presented to emphasize the importance of physician awareness of LQTS because of the risk of sudden death. Proper diagnosis can lead to treatment that is effective in reducing mortality by more than 90%.

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

    DEFF Research Database (Denmark)

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

    2010-01-01

    A two-bed hospital ward with one standing healthcare person and a ceiling-mounted lowimpulse semicircular inlet diffuser is simulated in a full-scale room. Tracer gas is used for simulating gaseous contaminants, and the concentration is measured at different air change rates and different postures...... of the patients. A textile partition between the beds, which is typical in a hospital ward, is used for protection of the patients in some of the experiments. Three different layouts of return openings are tested. One layout with one opening at the ceiling, another with four openings at the wall opposite...... to the inlet diffuser, and one with a high location of these four openings. The downward recirculating flow is on average parallel with the partition, and in most cases the partition does not decrease cross-infection. A high location of the four return openings decreases the risk of cross-infection....

  20. Noise at night in hospital general wards: a mapping of the literature.

    Science.gov (United States)

    Fillary, Julie; Chaplin, Hema; Jones, Gill; Thompson, Angela; Holme, Anita; Wilson, Patricia

    English NHS inpatient surveys consistently identify that noise at night in hospitals and its impact on patients' sleep is a persisting problem that needs addressing. To identify how noise at night in hospital affects patients on general wards and the range of interventions aimed at reducing the problem, a systematic mapping of the literature was undertaken. All primary studies and relevant literature published January 2003-July 2013 were included. Key issues identified in the literature included noise levels and causes, impact on patient experience, and lack of staff awareness. Interventions to reduce noise were targeted at staff education, behaviour modification, care organisation and environmental solutions. The scoping suggested that when compared with specialist units, there is little evidence on effective interventions reducing disturbance from night-time noise on general wards. The available evidence suggests a whole systems approach should be adopted to aid quality sleep and promote recovery.

  1. Validity of the Ward seven-subtest WAIS-III short form in a neuropsychological population.

    Science.gov (United States)

    Pilgrim, B M; Meyers, J E; Bayless, J; Whetstone, M M

    1999-01-01

    An investigation of the Ward 7-subtest short form of the Wechsler Adult Intelligence Scale-III (WAIS-III) in a neuropsychological clinic sample finds that the short form retains equivalent psychometric properties to those previously reported for the same short form of the Wechsler Adult Intelligence Scale-Revised (WAIS-R). The correlations found for the 7-subtest form of the WAIS-III were .95 for Performance IQ, .97 for Verbal IQ, and .98 for Full Scale IQ. The 7-subtest short form of the WAIS-III was also found to perform similarly to its WAIS-R counterpart on other markers of test accuracy. These results support the continued use of the Ward 7-subtest short form of the WAIS-III in a neuropsychological population.

  2. Applying Mobile and Pervasive Computer Technology to Enhance Coordination of Work in a Surgical Ward

    DEFF Research Database (Denmark)

    Hansen, Thomas Riisgaard; Bardram, Jakob

    2007-01-01

    , and unnecessary stress. To accommodate this situation and to increase the quality of work in operating wards, we have designed a set of pervasive computer systems which supports what we call context-mediated communication and awareness. These systems use large interactive displays, video streaming from key...... locations, tracking systems, and mobile devices to support social awareness and different types of communication modalities relevant to the current context. In this paper we report qualitative data from a one-year deployment of the system in a local hospital. Overall, this study shows that 75......Collaboration, coordination, and communication are crucial in maintaining an efficient and smooth flow of work in an operating ward. This coordination, however, often comes at a high price in terms of unsuccessfully trying to get hold of people, disturbing telephone calls, looking for people...

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

    DEFF Research Database (Denmark)

    Hansen, Thomas Riisgaard; Bardram, Jakob Eyvind

    2007-01-01

    , and unnecessary stress. To accommodate this situation and to increase the quality of work in operating wards, we have designed a set of pervasive computer systems which supports what we call context-mediated communication and awareness. These systems use large interactive displays, video streaming from key...... locations, tracking systems, and mobile devices to support social awareness and different types of communication modalities relevant to the current context. In this paper we report qualitative data from a one-year deployment of the system in a local hospital. Overall, this study shows that 75......Collaboration, coordination, and communication are crucial in maintaining an efficient and smooth flow of work in an operating ward. This coordination, however, often comes at a high price in terms of unsuccessfully trying to get hold of people, disturbing telephone calls, looking for people...

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

    DEFF Research Database (Denmark)

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

    2009-01-01

    and doctors were observed performing workarounds, such as transcribing medication orders from the computer to paper. CONCLUSIONS: The choice of device was related to clinical role, nature of the clinical task, degree of mobility required, including where task completion occurs, and device design. Nurses' work......, and clinical tasks performed by doctors during ward rounds, require highly mobile computer devices. Nurses and doctors on ward rounds showed a strong preference for generic COWs over all other devices. Tablet PCs were selected by doctors for only a small proportion of clinical tasks. Even when using mobile......BACKGROUND: Selecting the right mix of stationary and mobile computing devices is a significant challenge for system planners and implementers. There is very limited research evidence upon which to base such decisions. OBJECTIVE: We aimed to investigate the relationships between clinician role...

  5. Parenteral Admixture Compatibility in Neurosurgery Ward in Prof. Dr. Margono Soekarjo Regional Public Hospital

    Directory of Open Access Journals (Sweden)

    Laksmi Maharani

    2014-03-01

    Full Text Available Parenteral admixtures (intravenous admixtures have been done commonly in hospitals. However, it has a possibility of failures, like incompatibilities and changes in drug stabilities. The aim of this study was to determine the rate of drug incompatibilities in mixing parenteral preparations in neurosurgery ward in Prof. Dr. Margono Soekarjo Regional Public Hospital which undergo physical incompatibility observed in organoleptic. This study was a prospective descriptive research for one month period. Data were collected and analyzed descriptively. The results showed that from 667 parenteral admixtures in neurosurgery ward in Prof Dr Margono Soekarjo Hospital in February 2010, there were 0.45% potential incompatibility and 2.55% actual incompatibility happened. Actual incompatibility shown as crystal 0.17%, sediment 0.17%, and 2.04% was non-permanent haze in phenytoin and sodium chloride or ringer lactate admixtures.

  6. Optimization of hospital ward resources with patient relocation using Markov chain modeling

    DEFF Research Database (Denmark)

    Andersen, Anders Reenberg; Nielsen, Bo Friis; Reinhardt, Line Blander

    2017-01-01

    Overcrowding of hospital wards is a well-known and often revisited problem in the literature, yet it appears in many different variations. In this study, we present a mathematical model to solve the problem of ensuring sufficient beds to hospital wards by re-distributing beds that are already...... that patient occupancy is reflected by our Markov chain model, and that a local optimum can be derived within a reasonable runtime.Using a Danish hospital as our case study, the Markov chain model is statistically found to reflect occupancy of hospital beds by patients as a function of how hospital beds...... are distributed. Furthermore, our heuristic is found to efficiently derive the optimal solution. Applying our model to the hospital case, we found that relocation of daily arrivals can be reduced by 11.7% by re-distributing beds that are already available to the hospital....

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

    DEFF Research Database (Denmark)

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

    2013-01-01

    % of total). During the prescribing reviews, a total of 860 prescription errors were detected, approximately one per medication review. Almost all of the detected prescription errors were later accepted and/or corrected by the physicians. "Dosage and time interval errors" were the most frequently detected...... and prescribing reviews. A secondary aim was to evaluate whether the interventions made by pharmacy technicians could reduce the time spent by the nurses on administration of medications to the patients. METHODS: This observational study was conducted over a 7 week period in the geriatric ward at Odense...... University Hospital, Denmark. Two pharmacy technicians conducted medication reconciliation and prescribing reviews at the time of patients' admission to the ward. The reviews were conducted according to standard operating procedures developed by a clinical pharmacist and approved by the Head of the Geriatric...

  8. How Critical Is Critical Thinking?

    Science.gov (United States)

    Shaw, Ryan D.

    2014-01-01

    Recent educational discourse is full of references to the value of critical thinking as a 21st-century skill. In music education, critical thinking has been discussed in relation to problem solving and music listening, and some researchers suggest that training in critical thinking can improve students' responses to music. But what exactly is…

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

    Directory of Open Access Journals (Sweden)

    Mekonnen AB

    2013-03-01

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

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

    Science.gov (United States)

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

    2017-08-22

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

  11. [The paradoxes of humanized childbirth care in a public maternity ward in Brazil].

    Science.gov (United States)

    Tornquist, Carmen Susana

    2003-01-01

    The maternity ward of the University Hospital in Florianópolis, Santa Catarina, Brazil, attempts to follow World Health Organization guidelines for humanized childbirth care, including the encouragement of non-surgical delivery, breastfeeding, rooming-in, extended family visitation, and reduction of excessive technological intervention in the delivery process. The study focuses specifically on the choice of delivery procedure and on family presence during labor/childbirth, as well as women's experience with labor and breastfeeding.

  12. Transverse Ward-Takahashi Relation for the Vector Vertex in Quantum Field Theory

    Institute of Scientific and Technical Information of China (English)

    HE Han-Xin

    2001-01-01

    The transverse Ward-Takahashi (W-T) relation for the vector vertex in quantum field theory is derived by calculating the curl of the time-ordered product of the three-point function including the vector current operator. This provides the constraint on the transverse part of the vertex. By combining the transverse and normal (longitudinal)W-T identities, we obtain the expression for the full vector vertex function.``

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

    Directory of Open Access Journals (Sweden)

    Fitsum Sebsibe Teni

    2014-11-01

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

  14. Nature and frequency of medication errors in a geriatric ward: an Indonesian experience

    OpenAIRE

    2014-01-01

    Desak Ketut Ernawati,1,2 Ya Ping Lee,2 Jeffery David Hughes21Faculty of Medicine, Udayana University, Denpasar, Bali, Indonesia; 2School of Pharmacy and Curtin Health Innovation and Research Institute, Curtin University, Perth, WA, AustraliaPurpose: To determine the nature and frequency of medication errors during medication delivery processes in a public teaching hospital geriatric ward in Bali, Indonesia.Methods: A 20-week prospective study on medication errors occurring during the medicati...

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

    OpenAIRE

    Hamada, Ken-ji

    1995-01-01

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

  16. Development of a nurse robot serving in infectious disease isolation wards

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    A prototype of nurse robot system serving in infectious disease wards is developed by analyzing the systems requirement. Firstly, the type synthesis and dimension synthesis for optimizing the workspace are presented. Secondly, the tele-control system based on velocity control mode is introduced, and tele-control program is written. Finally, the imitation of position workspace and experiment of transforming objects from buffer area to isolation area are carried out.

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

    Science.gov (United States)

    2014-01-01

    Background Continuous positive airway pressure (CPAP) is commonly used to relieve respiratory distress in infants with bronchiolitis, but has mostly been studied in an intensive care setting. Our prime aim was to evaluate the feasibility of CPAP for infants with bronchiolitis in a general paediatric ward, and secondary to assess capillary PCO2 (cPCO2) levels before and during treatment. Methods From May 1st 2008 to April 30th 2012, infants with bronchiolitis at Stavanger University Hospital were treated with CPAP in a general paediatric ward, but could be referred to an intensive care unit (ICU) when needed, according to in-house guidelines. Levels of cPCO2 were prospectively registered before the start of CPAP and at approximately 4, 12, 24 and 48 hours of treatment as long as CPAP was given. We had a continuous updating program for the nurses and physicians caring for the infants with CPAP. The study was population based. Results 672 infants (3.4%) were hospitalized with bronchiolitis. CPAP was initiated in 53 infants (0.3%; 7.9% of infants with bronchiolitis), and was well tolerated in all but three infants. 46 infants were included in the study, the majority of these (n = 33) were treated in the general ward only. These infants had lower cPCO2 before treatment (8.0; 7.7, 8.6)(median; quartiles) than those treated at the ICU (n = 13) (9.3;8.5, 9.9) (p bronchiolitis may be feasible in a general paediatric ward, providing sufficient staffing and training, and the possibility of referral to an ICU when needed. PMID:24886569

  18. Improving Intensive Care Unit and Ward Utilization by Adapting Master Surgery Schedules.

    Science.gov (United States)

    Fügener, Andreas; Edenharter, Guenther Michael; Kiefer, Paskal; Mayr, Ulrike; Schiele, Julian; Steiner, Fabian; Kolisch, Rainer; Blobner, Manfred

    2016-03-15

    With increasing organizational and financial pressure on hospitals, each individual surgical treatment has to be reviewed and planned thoroughly. Apart from the expensive operating room facilities, proper staffing and planning of downstream units, like the wards or the intensive care units (ICUs), should be considered as well. In this article, we outline the relationship between a master surgery schedule (MSS), i.e., the assignment of surgical blocks to medical specialties, and the bed demand in the downstream units using an analytical model. By using historical data retrieved from the clinical information system and a patient flow model, we applied a recently developed algorithm for predicting bed demand based on the MSSs for patients of 3 surgical subspecialties of a hospital. Simulations with 3 different MSSs were performed. The impact on the required amount of beds in the downstream units was analyzed. We show the potential improvements of the current MSS considering 2 main goals: leveling workload among days and reduction of weekend utilization. We discuss 2 different MSSs, one decreasing the weekend ICU utilization by 20% and the other one reducing maximum ward bed demand by 7%. A test with 12 months of real-life data validates the results. The application of the algorithm provides detailed insights for the hospital into the impact of MSS designs on the bed demand in downstream units. It allowed creating MSSs that avoid peaks in bed demand and high weekend occupancy levels in the ICU and the ward.

  19. The permeable institution: an ethnographic study of three acute psychiatric wards in London.

    Science.gov (United States)

    Quirk, Alan; Lelliott, Paul; Seale, Clive

    2006-10-01

    In Asylums, Goffman [1961. Asylums. London: Penguin] identified some permeable features of the old mental hospitals but presented them as exceptions to the rule and focused on their impermeable aspects. We argue that this emphasis is no longer valid and offer an alternative ideal type that better represents the reality of everyday life in contemporary 'bricks and mortar' psychiatric institutions. We call this the "permeable institution". The research involved participant observation of between 3 and 4 months and interviews with patients, patient advocates and staff on 3 psychiatric wards. Evidence for permeability includes that ward membership is temporary and changes rapidly (patients tend to have very short stays and staff turnover is high); patients maintain contact with the outside world during their stay; and institutional identities are blurred to the point where visitors or new patients can easily mistake staff and patients for one another. Permeability has both positive consequences (e.g., reduced risk of institutionalism), and negative consequences (e.g., unwanted people coming into hospital to cause trouble, and illicit drug use among patients). Staff employ various methods to regulate their ward's permeability, within certain parameters. The metaphor of the total/closed institution remains valuable, but it fails to capture the highly permeable nature of the psychiatric institutions we studied. Analysts may therefore find the permeable institution a more helpful reference point or ideal type against which to examine and compare empirical cases. Perhaps most helpful is to conceptualise a continuum of institutional permeability with total and permeable institutions at each extreme.

  20. Caring for Acutely Ill Patients in General Wards: A Qualitative Study.

    Science.gov (United States)

    Jeddian, Ali Reza; Lindenmeyer, Antje; Marshall, Tom; Rashidian, Arash; Sayadi, Leila; Jafari, Nazila

    2016-09-01

    The number of acutely ill patients has risen in general wards due to the aging population, more advanced and complicated therapeutic methods, economic changes in the health system, therapeutic choices and shortage of intensive care unit beds. This may lead to adverse events and outcomes with catastrophic results. The purpose of this study was to describe the conditions of acutely ill patients, from the perspective of caregivers. The study was conducted in Tehran University of Medical Sciences and its two affiliated general teaching hospitals. Ten nurses and physicians participated in interviews, which were analyzed using qualitative content analysis methods. Four main categories of difficulties in caring for acutely ill patients in general wards were described: problems in identifying acutely ill patients, problems in clinical management of acutely ill patients, inappropriate use of Intensive Care Unit (ICU) beds, and poor structure for mortality control. The staff do not appropriately diagnose the signs of deterioration. There are problems with the appropriate management of acutely ill patients, even if they are considered to be acutely ill and in need of special attention in general wards. Many shortcomings exist caring for acutely ill patients, ranging from identification to clinical management; there are also structural and contextual problems. An immediate plan is necessary to circumvent the challenges and to improve the care for acutely ill patients. These challenges highlight the need for changes in current levels of care for acutely ill patients, as well as the need for appropriate support systems.