WorldWideScience

Sample records for wards multi-method study

  1. Interactions between lean management and the psychosocial work environment in a hospital setting - a multi-method study.

    Science.gov (United States)

    Ulhassan, Waqar; von Thiele Schwarz, Ulrica; Thor, Johan; Westerlund, Hugo

    2014-10-22

    As health care struggles to meet increasing demands with limited resources, Lean has become a popular management approach. It has mainly been studied in relation to health care performance. The empirical evidence as to how Lean affects the psychosocial work environment has been contradictory. This study aims to study the interaction between Lean and the psychosocial work environment using a comprehensive model that takes Lean implementation information, as well as Lean theory and the particular context into consideration. The psychosocial work environment was measured twice with the Copenhagen Psychosocial Questionnaire (COPSOQ) employee survey during Lean implementations on May-June 2010 (T1) (n = 129) and November-December 2011 (T2) (n = 131) at three units (an Emergency Department (ED), Ward-I and Ward-II). Information based on qualitative data analysis of the Lean implementations and context from a previous paper was used to predict expected change patterns in the psychosocial work environment from T1 to T2 and subsequently compared with COPSOQ-data through linear regression analysis. Between T1 and T2, qualitative information showed a well-organized and steady Lean implementation on Ward-I with active employee participation, a partial Lean implementation on Ward-II with employees not seeing a clear need for such an intervention, and deterioration in already implemented Lean activities at ED, due to the declining interest of top management. Quantitative data analysis showed a significant relation between the expected and actual results regarding changes in the psychosocial work environment. Ward-I showed major improvements especially related to job control and social support, ED showed a major decline with some exceptions while Ward-II also showed improvements similar to Ward-I. The results suggest that Lean may have a positive impact on the psychosocial work environment given that it is properly implemented. Also, the psychosocial work environment may even

  2. Problematising Short-Term Participant Observation and Multi-Method Ethnographic Studies

    Science.gov (United States)

    Brockmann, Michaela

    2011-01-01

    This article reports on a study of apprentices in England and Germany designed to explore young people's learner identities over time and in relation to particular learning environments. The research adopts a multi-method ethnographic approach, combining biographical interviews with multi-site participant observation. The article problematises the…

  3. How do cynical employees serve their customers? A multi-method study

    NARCIS (Netherlands)

    E. Demerouti (Eva); Xanthopoulou, D. (Despoina); A.B. Bakker (Arnold)

    2017-01-01

    textabstractIn this multi-method study, we investigate how social job demands (i.e., social interruptions) and resources (i.e., colleague support) in the service context influence employee (negative) (re)actions to customers through cynicism towards the job. In addition, we investigate why customers

  4. 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.

  5. 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.

  6. #JeSuisCharlie: Towards a Multi-Method Study of Hybrid Media Events

    Directory of Open Access Journals (Sweden)

    Johanna Sumiala

    2016-10-01

    Full Text Available This article suggests a new methodological model for the study of hybrid media events with global appeal. This model, developed in the project on the 2015 Charlie Hebdo attacks in Paris, was created specifically for researching digital media—and in particular, Twitter. The article is structured as follows. Firstly, the methodological scope is discussed against the theoretical context, e.g. the theory of media events. In the theoretical discussion, special emphasis is given to i disruptive, upsetting, or disintegrative media events and hybrid media events and ii the conditions of today’s heterogeneous and globalised media communication landscape. Secondly, the article introduces a multi-method approach developed for the analysis of hybrid media events. In this model, computational social science—namely, automated content analysis (ACA and social network analytics (SNA—are combined with a qualitative approach—specifically, digital ethnography. The article outlines three key phases for research in which the interplay between quantitative and qualitative approaches is played out. In the first phase, preliminary digital ethnography is applied to provide the outline of the event. In the second phase, quantitative social network analytics are applied to construct the digital field for research. In this phase, it is necessary to map a what is circulating on the websites and b where this circulation takes place. The third and final phase applies a qualitative approach and digital ethnography to provide a more nuanced, in-depth interpretation of what (substance/content is circulating and how this material connects with the ‘where’ in the digital landscape, hence constituting links and connections in the hybrid media landscape. In conclusion, the article reflects on how this multi-method approach contributes to understanding the workings of today’s hybrid media events: how they create and maintain symbolic battles over certain imagined

  7. Mania risk and creativity: a multi-method study of the role of motivation.

    Science.gov (United States)

    Ruiter, Margina; Johnson, Sheri L

    2015-01-01

    Substantial literature has linked bipolar disorder and risk for bipolar disorder with creative accomplishment, but few multimodal studies of creativity are available, and little is known about mechanisms. We use a multi-method approach to test the association of bipolar risk with several creativity measures, including creative accomplishments, creative personality traits, and a laboratory index of insight. We also examined whether multiple facets of motivation accounted for the links of bipolar risk with creativity. Among 297 undergraduates, mania risk, as measured with the Hypomanic Personality Scale was related to lifetime creativity and creative personality, but not to performance on the insight task. Motivational traits appeared to mediate the links of mania risk with both lifetime creative accomplishments and self-rated creativity. The study relied on a cross-sectional design and a convenience sample. Future studies would benefit from exploring motivation as a positive aspect of manic vulnerability that may foster greater creativity. Copyright © 2014 Elsevier B.V. All rights reserved.

  8. Job stress among community health workers: a multi-method study from Pakistan

    Directory of Open Access Journals (Sweden)

    Iqbal Zafar

    2008-10-01

    Full Text Available Abstract Background In low income countries, the task of providing primary health care is often the responsibility of community health workers. In Pakistan, community workers called Lady Health Workers (LHW deliver basic health care at the doorstep in the rural areas and urban slums. Evaluations show that it is a successful programme but point out inconsistencies in the quality of service provided. In order achieve this, it would be important to obtain the workers' viewpoint on their job-description, the problems they face and the levels of stress they encounter. Methods We conducted a multi-method study to investigate the aforementioned issues. All LHWs from one typical rural sub-district in Rawalpindi were surveyed. Focus group discussions with a sub-set of these workers were also conducted. Results About a quarter of the LHWs were found to have significant occupational stress. Factors associated with stress included having low socio-economic status and having to travel long distances for work. Inconsistent medical supplies, inadequate stipends, lack of career structure and not being equipped to communicate effectively with families were the main factors for job dissatisfaction among these workers. Recommendations Improvement in remuneration, better administration of supplies and a structured career path should be ensured for better performance of community health workers. In addition, communication skills learning should be an essential part of their training programme.

  9. Ethnic differences in help-seeking behaviour following child sexual abuse: a multi-method study.

    Science.gov (United States)

    Okur, Pinar; van der Knaap, Leontien M; Bogaerts, Stefan

    2016-01-01

    In Western societies, groups from a minority ethnic background are under-represented in formal mental health care. However, it is unknown if the minority ethnic victims of child sexual abuse differ from majority ethnic victims regarding their help-seeking behaviours. This study used a multi-method design to investigate the prevalence of (in) formal help-seeking after child sexual abuse and the influence of attitudes towards gender roles and sexuality on help-seeking among the Dutch minority ethnic and majority ethnic victims. We also examined differences in reasons not to seek help. Quantitative survey data on help-seeking patterns among 1496 child sexual abuse victims were collected. Four qualitative focus groups were conducted with professionals working in the field of child sexual abuse and minority ethnic groups to explore help-seeking behaviour. No significant differences between ethnicity emerged in help-seeking rates. However, respondents with more liberal gender attitudes were more likely to disclose than conservative respondents. Additionally, an interaction effect was observed between ethnicity and gender attitudes, indicating that, contrary to the main effect, young people of Moroccan and Turkish heritage with more liberal gender attitudes were less likely to disclose abuse. Reasons for not seeking help differed among groups. Focus group members emphasised mistrust towards counsellors and perceptions that inhibit minority ethnic youth from seeking help.

  10. Healthcare workers' attitudes towards working during pandemic influenza: A multi method study

    Directory of Open Access Journals (Sweden)

    Petts Judith

    2008-06-01

    Full Text Available Abstract Background Healthcare workers (HCWs will be key players in any response to pandemic influenza, and will be in the front line of exposure to infection. Responding effectively to a pandemic relies on the majority of medical, nursing, laboratory and hotel services staff continuing to work normally. Planning assumes that during a pandemic normal healthcare service levels will be provided, although it anticipates that as caseloads increase only essential care will be provided. The ability of the NHS to provide expected service levels is entirely dependent upon HCWs continuing to work as normal. Methods/design This study is designed as a two-phase multi-method study, incorporating focus groups and a questionnaire survey. In phase one, qualitative methods will be used to collect the views of a purposive sample of HCWs, to determine the range of factors associated with their responses to the prospect of working through pandemic influenza. In phase two, the findings from the focus groups, combined with the available literature, will be used to inform the design of a survey to determine the generalisability of these factors, enabling the estimation of the likely proportion of HCWs affected by each factor, and how likely it is that they would be willing and/or able to continue to work during an influenza pandemic. Discussion There are potentially greater than normal health risks for some healthcare workers working during a pandemic, and these workers may be concerned about infecting family members/friends. HCWs will be as liable as other workers to care for sick family members and friends. It is vital to have information about how motivated HCWs will be to continue to work during such a crisis, and what factors might influence their decision to work/not to work. Through the identification and subsequent management of these factors it may be possible to implement strategies that will alleviate the concerns and fears of HCWs and remove potential

  11. 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.

  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. 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...

  15. 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.

  16. 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.

  17. 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.

  18. 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.

  19. [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.

  20. Successes and challenges in a field-based, multi-method study of home telehealth.

    Science.gov (United States)

    Hebert, M A; Jansen, J J; Brant, R; Hailey, D; van der Pol, M

    2004-01-01

    We are conducting a three-year study of telehealth in 11 home care offices that serve rural clients in Alberta. Three hundred and twenty palliative home care clients are being recruited to participate in a randomized controlled trial (RCT) to answer three questions about the use of video-phones and their effect on symptom management, quality of life and cost, as well as readiness to use the technology. Both successes and challenges have been identified in three main areas: technology, people/organizational issues and study design. Maintaining study integrity has been the key factor in decision making, as adjustments from the original proposal are made. It is already clear that field-based RCTs are feasible, but require commitment and flexibility on the part of researchers and community partners to work through the study implementation.

  1. Deployment and Dehumanization: A Multi-Method Study of Combat Soldiers’ Loss of Empathy

    DEFF Research Database (Denmark)

    Brænder, Morten

    2015-01-01

    Studies in soldier motivation and socialization have shown that servicemen's level of compassion decreases following deployment to war. This may to some extent be explained by the transgressive nature of the combat soldier's service : the soldier puts himself in harm's way, and must if necessary ...

  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. Deployment and Dehumanization: A Multi-Method Study of Combat Soldiers’ Loss of Empathy

    DEFF Research Database (Denmark)

    Brænder, Morten

    2015-01-01

    Studies in soldier motivation and socialization have shown that servicemen's level of compassion decreases following deployment to war. This may to some extent be explained by the transgressive nature of the combat soldier's service : the soldier puts himself in harm's way, and must if necessary...... kill the enemy. Hence, a certain 'emotional distance' may be required for him to cope with deployment life. To kill the enemy, it might be necessary for the soldier to deprive the enemy of his human capacities, to dehumanize him. However, by combining quantitative and qualitative methods, this study...... suggests that the enemy is not the only one who is dehumanized. The data analyzed were collected immediately before and after deployment of Danish combat soldiers to Helmand, Afghanistan. Quantitative findings show that the soldiers' empathetic motivation to serve civilians, compatriots and other soldiers...

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

    Science.gov (United States)

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

    2016-10-01

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

  5. A multi-method exploratory study of stress, coping, and substance use among high school youth in private schools.

    Science.gov (United States)

    Leonard, Noelle R; Gwadz, Marya V; Ritchie, Amanda; Linick, Jessica L; Cleland, Charles M; Elliott, Luther; Grethel, Michele

    2015-01-01

    There is growing awareness that students' experiences of stress may impede academic success, compromise mental health, and promote substance use. We examined these factors in an under-studied population, private/independent high school students, using a multi-method (qualitative and quantitative), iterative data collection and analytic process. We first conducted qualitative interviews with faculty and staff at a number of highly competitive private schools, followed by an anonymous quantitative survey with 128 11th grade students from two of these settings. We then conducted a qualitative exploration of the quantitative results with a subset of students. Next, a set of Expert Panel members participated in qualitative interviews to reflect on and interpret study findings. Overall, we found students experienced high levels of chronic stress, particularly in relation to academic performance and the college admissions process. While students described a range of effective, adaptive coping strategies, they also commonly internalized these serious pressures and turned to alcohol and drugs to cope with chronic stress, although not typically at problematic levels. We discuss study implications for both schools and families derived from the Expert Panel.

  6. 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.

  7. 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

  8. 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)

  9. Multi-method characterisation of an active landslide: Case study in the Pays d'Auge plateau (Normandy, France)

    Science.gov (United States)

    Fressard, M.; Maquaire, O.; Thiery, Y.; Davidson, R.; Lissak, C.

    2016-10-01

    Shallow landslides are among the most frequent natural hazards in the Pays d'Auge plateau (Normandy, France) but no study has yet focused on the functioning of these phenomena at a detailed scale. This study aims to identify the structure and mechanical properties of a representative case study in the region. The main objective is to understand landslide dynamics and behaviour in order to assess triggering conditions and quantify triggering thresholds. The results will help complement the regional landslide hazard mapping based on landslide statistical susceptibility mapping and quantification of triggering thresholds. The landslide morphology and internal structure were identified using a multi-method approach. A morphodynamic map was produced in the field using cartographic GPS to depict the surface morphology and map the estimated landslide activity. These field measurements were completed by an analysis of all available aerial-photo images from the French National Geographic Institute (IGN) to identify the occurrence dates and possible landslide reactivations. The landslide structure was defined using multiple electrical tomography profiles, boreholes, augerings and penetration tests. Despite the overall low electrical resistivity of the landslide materials (i.e. ± < 80 Ω·m), the electrical profiles showed good agreement with the interpreted structure based on direct observations (augerings and penetration tests). The landslide slip surface, internal morphology and palaeotopography were identified. A finite slope model was used to calculate the landslide safety factor based on the internal structure and geotechnical data. The evolution of this safety factor according to the rainfall and the groundwater levels shows that the landslides are more likely to occur after long episodes of high cumulative precipitations with an important role being played by the preliminary conditions and the rise of the surficial groundwater table level.

  10. Mealtimes in a neurological ward: a phenomenological-hermeneutic study

    DEFF Research Database (Denmark)

    Beck, Malene; Martinsen, Bente; Poulsen, Ingrid

    2016-01-01

    AIMS AND OBJECTIVES: To examine the environment surrounding hospital meals for patients with neurological diseases. BACKGROUND: A determined effort has been made to optimise the nutrition of hospitalised patients. However, the organisation of mealtimes and their relational and aesthetic aspects...... challenged by the design of the physical space and institutional structures. CONCLUSION: This study contributes to our understanding of the environment surrounding hospital meals for patients with neurological diseases. Based on this study, it can be concluded that meals were at a high risk of being served...... as a mindless task without the recognition that mealtimes are sensed with the whole body of the patient and not only by the mouth. RELEVANCE TO CLINICAL PRACTICE: The importance of the mealtime environment must be acknowledged because it serves as a communicative aspect for neurological patients by letting them...

  11. Ethical and despotic leadership, relationships with leader's social responsibility, top management team effectiveness and subordinates' optimism: A multi-method study

    NARCIS (Netherlands)

    de Hoogh, A.H.B.; den Hartog, D.N.

    2008-01-01

    In this multi-method study, we examined the relationships of leader's social responsibility with different aspects of ethical leadership (morality and fairness, role clarification, and power sharing) as well as with despotic leadership. We also investigated how these leadership behaviors relate to

  12. Ethical and despotic leadership, relationships with leader's social responsibility, top management team effectiveness and subordinates' optimism: A multi-method study

    NARCIS (Netherlands)

    de Hoogh, A.H.B.; den Hartog, D.N.

    2008-01-01

    In this multi-method study, we examined the relationships of leader's social responsibility with different aspects of ethical leadership (morality and fairness, role clarification, and power sharing) as well as with despotic leadership. We also investigated how these leadership behaviors relate to e

  13. 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.

  14. 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.

  15. 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.

  16. 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

  17. 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.

  18. Epidemiology, microbiology, clinical characteristics, and outcomes of candidemia in internal medicine wards-a retrospective study.

    Science.gov (United States)

    Eliakim-Raz, Noa; Babaoff, Roi; Yahav, Dafna; Yanai, Shirly; Shaked, Hila; Bishara, Jihad

    2016-11-01

    The clinical characteristics of internal medicine ward (IMW) patients with candidemia are unclear. The aim of this study was to define the clinical characteristics of candidemic IMW patients and to study the incidence, species distribution, and outcomes of these patients compared to surgical and intensive care unit (ICU) candidemic patients. A retrospective cohort of candidemic patients in IMWs, general surgery wards, and an ICU at Beilinson Hospital during the period 2007-2014 was analyzed. A total of 118 patients with candidemia were identified in six IMWs, two general surgery wards, and one ICU in the hospital. Candida albicans was the leading causative agent (41.1%). Higher proportions of Candida parapsilosis and Candida tropicalis isolates were observed in the IMW patients. IMW patients were significantly older, with poorer functional capacity, and had more frequently been exposed to antibiotic therapy within 90 days, in particular β-lactam-β-lactamase inhibitor combinations and cephalosporins. At onset of candidemia, a significantly lower number of IMW patients were mechanically ventilated (p48h. IMW candidemic patients account for a substantial proportion of candidemia cases and have unique characteristics and high mortality rates. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

  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. Clinical components and associated behavioural aspects of a complex healthcare intervention: Multi-methods study of selective decontamination of the digestive tract in critical care

    OpenAIRE

    Dombrowski, S.U.; Prior, M. E.; Duncan, E. M.; Cuthbertson, B H; Bellingan, G; Campbell, M. K.; Rose, L; Binning, A. R.; Gordon, A C; Wilson, P.; Shulman, R; Francis, J.

    2013-01-01

    Background This study sought to identify and describe the clinical and behavioural components (e.g. the what, how, when, where and by whom) of ‘selective decontamination of the digestive tract’ (SDD) as routinely implemented in the care of critically ill patients. Methods Multi-methods study, consisting of semi-structured observations of SDD delivery, interviews with clinicians and documentary analysis, conducted in two ICUs in the UK that routinely deliver SDD. Data were analysed w...

  1. A study on bed utilization in the gynaecological ward of a district hospital in West Bengal.

    Science.gov (United States)

    Dutta, S; Biswas, R; Lahiri, A

    2005-01-01

    A study was conducted in a non-paying gynaecological ward of the district hospital, South 24 Parganas, West Bengal to assess different bed efficiency indicators. Total 331 patients were admitted in 23 study beds (12 OPD beds and 11 emergency beds) during an observation period of six months. Overall average number of admissions were 14.4 and average length of stay 14.7days. Bed turnover rate was 13.8 and was higher for emergency beds (22.1) compared to OPD beds (9). Bed occupancy rate was 61.3% with significant difference between OPD beds (57.5%) and emergency beds (65.4%).

  2. Opportunities, ethical challenges, and lessons learned from working with peer research assistants in a multi-method HIV community-based research study in Ontario, Canada.

    Science.gov (United States)

    Logie, Carmen; James, Llana; Tharao, Wangari; Loutfy, Mona R

    2012-10-01

    We discuss ethical challenges and opportunities experienced by peer research assistants (PRAs) in a multi-method HIV community-based research study in Ontario, Canada. We review lessons learned and best practices based on our experience conducting a qualitative investigation of research priorities with diverse women living with HIV (WLWH) and implementation of a cross-sectional survey with African, Caribbean, and Black WLWH. While some opportunities were similar across research phases for PRAs (e.g., skill building), distinct challenges emerged in qualitative and quantitative phases. For example, our training did not adequately prepare PRAs with focus group facilitation skills; at times, survey implementation became counseling sessions. Researchers should assess how best to support PRAs as part of multi-method research processes.

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

    Science.gov (United States)

    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

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

    Directory of Open Access Journals (Sweden)

    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

  5. Incidence of nutritional support complications in patient hospitalized in wards. multicentric study

    Directory of Open Access Journals (Sweden)

    Gloria María Agudelo Ochoa

    2012-06-01

    Full Text Available Introduction: Nutritional support generates complications that must be detected and treated on time. Objective: To estimate the incidence of some complications of nutritional support in patients admitted to general hospital wards who received nutritional support in six high-complexity institutions. Methods: Prospective, descriptive and multicentric study in patients with nutritional support; the variables studied were medical diagnosis, nutritional condition, nutritional support duration, approach, kind of formula, and eight complications. Results: A total of 277 patients were evaluated; 83% received enteral nutrition and 17% received parenteral nutrition. Some 69.3% presented risk of malnourishment or severe malnourishment at admittance. About 35.4% of those receiving enteral nutrition and 39.6% of the ones who received parenteral nutrition had complications; no significant difference per support was found (p = 0.363. For the enteral nutrition, the most significant complication was the removal of the catheter (14%, followed by diarrhea (8.3%; an association between the duration of the enteral support with diarrhea, constipation and removal of the catheter was found (p < 0.05. For parenteral nutrition, hyperglycemia was the complication of highest inci­dence (22.9%, followed by hypophosphatemia (12.5%; all complications were associated with the duration of the support (p < 0.05. Nutritional support was suspended in 24.2% of the patients. Conclusions: Complications with nutritional support in hospital-ward patients were frequent, with the removal of the catheter and hyperglycemia showing the highest incidence. Duration of the support was the variable that revealed an asso­ciation with complications. Strict application of protocols could decrease the risk for complications and boost nutritional support benefits.

  6. Oxygen therapy multicentric study--a nationwide audit to oxygen therapy procedures in internal medicine wards.

    Science.gov (United States)

    Neves, J T; Lobão, M J

    2012-01-01

    Oxygen therapy is a common and important treatment in Internal Medicine wards, however, several studies report that it isn't provided accordingly with the best of care. The goal of this work is to evaluate oxygen therapy procedures in Portuguese Internal Medicine wards, comparing them to the standards established by the British Thoracic Society (BTS) in its consensus statement "BTS guideline for emergency oxygen use in adult patients". Between September 3rd and 23rd 2010, each one of the 24 enrolled hospitals audited the oxygen therapy procedures for one randomly chosen day. All Internal Medicine inpatients under oxygen therapy or with oxygen prescription were included. Data was collected regarding oxygen prescription, administration and monitoring. Of the 1549 inpatients, 773 met inclusion criteria. There was an oxygen prescription in 93,4%. Most prescriptions were by a fixed dose (82,4%), but only 11,6% of those stated all the required parameters. Absence of oxygen therapy duration and monitoring were the most frequent errors. Oxygen was administered to only 77,0% of the patients with fixed dose prescriptions. FiO(2) or flow rate and the delivery device were the same as prescribed in 70,9 and 89,2% of the patients, respectively. Out of the 127 patients with oxygen therapy prescriptions by target SatO(2) range, 82,7% were on the prescribed SatO(2) objective range. Several errors were found in oxygen therapy procedures, particularly regarding fixed dose prescriptions, jeopardizing the patients. Although recommended by BTS, oxygen therapy prescriptions by target SatO(2) range are still a minority.

  7. Community engagement to enhance trust between Gypsy/Travellers, and maternity, early years' and child dental health services: protocol for a multi-method exploratory study.

    Science.gov (United States)

    McFadden, Alison; Atkin, Karl; Bell, Kerry; Innes, Nicola; Jackson, Cath; Jones, Helen; MacGillivray, Steve; Siebelt, Lindsay

    2016-11-14

    Gypsy/Travellers have poor health and experience discrimination alongside structural and cultural barriers when accessing health services and consequently may mistrust those services. Our study aims to investigate which approaches to community engagement are most likely to be effective at enhancing trust between Gypsy/Travellers and mainstream health services. This multi-method 30-month study, commenced in June 2015, and comprises four stages. 1. Three related reviews: a) systematic review of Gypsy/Travellers' access to health services; b) systematic review of reviews of how trust has been conceptualised within healthcare; c) realist synthesis of community engagement approaches to enhance trust and increase Gypsy/Travellers' participation in health services. The reviews will consider any economic literature; 2. Online consultation with health and social care practitioners, and civil society organisations on existing engagement activities, including perceptions of barriers and good practice; 3. Four in-depth case studies of different Gypsy/Traveller communities, focusing on maternity, early years and child dental health services. The case studies include the views of 32-48 mothers of pre-school children, 32-40 healthcare providers and 8-12 informants from third sector organisations. 4. Two stakeholder workshops exploring whether policy options are realistic, sustainable and replicable. Case study data will be analysed thematically informed by the evaluative framework derived from the realist synthesis in stage one. The main outputs will be: a) an evaluative framework of Gypsy/Travellers' engagement with health services; b) recommendations for policy and practice; c) evidence on which to base future implementation strategies including estimation of costs. Our novel multi-method study seeks to provide recommendations for policy and practice that have potential to improve uptake and delivery of health services, and to reduce lifetime health inequalities for Gypsy

  8. Patients' approaches to students' learning at a clinical education ward--an ethnographic study.

    Science.gov (United States)

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

    2014-07-02

    It is well known that patients' involvement in health care students' learning is essential and gives students opportunities to experience clinical reasoning and practice clinical skills when interacting with patients. Students encounter patients in different contexts throughout their education. However, looking across the research providing evidence about learning related to patient-student encounters reveals a lack of knowledge about the actual learning process that occurs in encounters between patients and students. The aim of this study was to explore patient-student encounters in relation to students' learning in a patient-centered health-care setting. An ethnographic approach was used to study the encounters between patients and students. The setting was a clinical education ward for nursing students at a university hospital with eight beds. The study included 10 observations with 11 students and 10 patients. The observer followed one or two students taking care of one patient. During the fieldwork observational and reflective notes were taken. After each observation follow-up interviews were conducted with each patient and student separately. Data were analyzed using an ethnographic approach. The most striking results showed that patients took different approaches in the encounters with students. When the students managed to create a good atmosphere and a mutual relationship, the patients were active participants in the students' learning. If the students did not manage to create a good atmosphere, the relationship became one-way and the patients were passive participants, letting the students practice on their bodies but without engaging in a dialogue with the students. Patient-student encounters, at a clinical education ward with a patient-centred pedagogical framework, can develop into either a learning relationship or an attending relationship. A learning relationship is based on a mutual relationship between patients and students resulting in patients

  9. Patients’ approaches to students’ learning at a clinical education ward-an ethnographic study

    Science.gov (United States)

    2014-01-01

    Background It is well known that patients’ involvement in health care students’ learning is essential and gives students opportunities to experience clinical reasoning and practice clinical skills when interacting with patients. Students encounter patients in different contexts throughout their education. However, looking across the research providing evidence about learning related to patient-student encounters reveals a lack of knowledge about the actual learning process that occurs in encounters between patients and students. The aim of this study was to explore patient-student encounters in relation to students’ learning in a patient-centered health-care setting. Methods An ethnographic approach was used to study the encounters between patients and students. The setting was a clinical education ward for nursing students at a university hospital with eight beds. The study included 10 observations with 11 students and 10 patients. The observer followed one or two students taking care of one patient. During the fieldwork observational and reflective notes were taken. After each observation follow-up interviews were conducted with each patient and student separately. Data were analyzed using an ethnographic approach. Results The most striking results showed that patients took different approaches in the encounters with students. When the students managed to create a good atmosphere and a mutual relationship, the patients were active participants in the students’ learning. If the students did not manage to create a good atmosphere, the relationship became one-way and the patients were passive participants, letting the students practice on their bodies but without engaging in a dialogue with the students. Conclusions Patient-student encounters, at a clinical education ward with a patient-centred pedagogical framework, can develop into either a learning relationship or an attending relationship. A learning relationship is based on a mutual relationship between

  10. Structured smoking cessation training for health professionals on cardiology wards: a prospective study.

    Science.gov (United States)

    Raupach, Tobias; Falk, Jan; Vangeli, Eleni; Schiekirka, Sarah; Rustler, Christa; Grassi, Maria Caterina; Pipe, Andrew; West, Robert

    2014-07-01

    Smoking is a major cardiovascular risk factor, and smoking cessation is imperative for patients hospitalized with a cardiovascular event. This study aimed to evaluate a systems-based approach to helping hospitalized smokers quit and to identify implementation barriers. Prospective intervention study followed by qualitative analysis of staff interviews. The prospective intervention study assessed the effects of implementing standard operating procedures (SOPs) for the provision of counselling and pharmacotherapy to smokers admitted to cardiology wards on counselling frequency. In addition, a qualitative analysis of staff interviews was undertaken to examine determinants of physician and nurse behaviour; this sought to understand barriers in terms of motivation, capability, and/or opportunity. A total of 150 smoking patients were included in the study (75 before and 75 after SOP implementation). Before the implementation of SOPs, the proportion of patients reporting to have received cessation counselling from physicians and nurses was 6.7% and 1.3%, respectively. Following SOP implementation, these proportions increased to 38.7% (p motivation, e.g. role incongruence, appeared to be a major barrier. Introduction of a set of standard operating procedures for smoking cessation advice was effective with physicians but not nurses. Analysis of barriers to implementation highlighted lack of motivation rather than capability or opportunity as a major factor that would need to be addressed. © The European Society of Cardiology 2012.

  11. Epidemiology and outcome of candidemia in internal medicine wards: A regional study in Italy.

    Science.gov (United States)

    Tedeschi, Sara; Tumietto, Fabio; Giannella, Maddalena; Bartoletti, Michele; Cristini, Francesco; Cioni, Giorgio; Ambretti, Simone; Carretto, Edoardo; Sambri, Vittorio; Sarti, Mario; Viale, Pierluigi

    2016-10-01

    More than one-third of candidemia episodes occur in Internal Medicine Wards (IMWs) but only few studies have focused on this setting and specific data about epidemiology, clinical characteristics and risk factors for mortality are scant. To describe epidemiology and to assess risk factors for in-hospital mortality among patients with candidemia in IMWs. Multicenter retrospective cohort study on patients with candidemia cared for in IMWs of an Italian region (Emilia Romagna) from January 2012 to December 2013. Non survivors were compared with survivors; variables with p≤0.1 at univariate analysis were entered into a multivariate Cox regression model. 232 patients were included. Overall candidemia incidence was 2.2 cases/1000 admissions. Candida albicans accounted for 59% of cases. Antifungal treatment was started 72h from blood cultures in 47%, 27% and 12% of patients, respectively; 13.8% of patients received no antifungal treatment. In-hospital mortality was 40%. At multivariate analysis, chronic-obstructive-pulmonary-disease (HR 2.72, 95%CI 1.66-4.45, pcandidemia in IMWs, with a worrisome rate of inappropriateness in patient management. Specific interventions aimed to increase awareness of IMWs about candidemia are needed. Copyright © 2016 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

  12. 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.

  13. The effect of an active on-ward participation of hospital pharmacists in Internal Medicine teams on preventable Adverse Drug Events in elderly inpatients: protocol of the WINGS study (Ward-oriented pharmacy in newly admitted geriatric seniors

    Directory of Open Access Journals (Sweden)

    Dijkgraaf Marcel G

    2011-05-01

    Full Text Available Abstract Background The potential of clinical interventions, aiming at reduction of preventable Adverse Drug Events (preventable ADEs during hospital stay, have been studied extensively. Clinical Pharmacy is a well-established and effective service, usually consisting of full-time on-ward participation of clinical pharmacists in medical teams. Within the current Hospital Pharmacy organisation in the Netherlands, such on-ward service is less feasible and therefore not yet established. However, given the substantial incidence of preventable ADEs in Dutch hospitals found in recent studies, appears warranted. Therefore, "Ward-Oriented Pharmacy", an on-ward service tailored to the Dutch hospital setting, will be developed. This service will consist of multifaceted interventions implemented in the Internal Medicine wards by hospital pharmacists. The effect of this service on preventable ADEs in elderly inpatients will be measured. Elderly patients are at high risk for ADEs due to multi-morbidity, concomitant disabilities and polypharmacy. Most studies on the incidence and preventability of ADEs in elderly patients have been conducted in the outpatient setting or on admission to a hospital, and fewer in the inpatient setting. Moreover, recognition of ADEs by the treating physicians is challenging in elderly patients because their disease presentation is often atypical and complex. Detailed information about the performance of the treating physicians in ADE recognition is scarce. Methods/Design The design is a multi-centre, interrupted time series study. Patients of 65 years or older, consecutively admitted to Internal Medicine wards will be included. After a pre-measurement, a Ward-Oriented Pharmacy service will be introduced and the effect of this service will be assessed during a post-measurement. The primary outcome measures are the ADE prevalence on admission and ADE incidence during hospital stay. These outcomes will be assessed using structured

  14. Women's Voices on Recovery: A Multi-Method Study of the Complexity of Recovery from Child Sexual Abuse

    Science.gov (United States)

    Banyard, Victoria L.; Williams, Linda M.

    2007-01-01

    Objective: The current study was exploratory and used multiple methods to examine patterns of stability and change in resilient functioning across 7 years of early adulthood. Second, qualitative data were used to examine in greater detail survivors' own narratives about correlates of healing. Method: This study was longitudinal and used both…

  15. Network Horizon and the Dynamics of Network Positions: A Multi-Method Multi-Level Longitudinal Study of Interfirm Networks

    NARCIS (Netherlands)

    D.W. van Liere (Diederik)

    2007-01-01

    textabstractDiederik van Liere was born in Kortenhoef, the Netherlands, on February 18, 1978. He attended Herman Jordan Lyceum in Zeist, from which he received his Atheneum diploma in 1996. After high school, Diederik went on to study Business Administration at the Erasmus University Rotterdam, the

  16. Network Horizon and the Dynamics of Network Positions: A Multi-Method Multi-Level Longitudinal Study of Interfirm Networks

    NARCIS (Netherlands)

    D.W. van Liere (Diederik)

    2007-01-01

    textabstractDiederik van Liere was born in Kortenhoef, the Netherlands, on February 18, 1978. He attended Herman Jordan Lyceum in Zeist, from which he received his Atheneum diploma in 1996. After high school, Diederik went on to study Business Administration at the Erasmus University Rotterdam, the

  17. Composing and Performing in the Key Stage 3 Classroom: A Study using Multi-Trait, Multi-Method Analysis

    Science.gov (United States)

    Fowler, Andrew

    2014-01-01

    "Music is both a creative and a performing art" (Hallam, 2006, p. 70). Many musicians and music educators maintain that composing and performing, although related, are essentially different aspects of musical activity. In the professional musical sphere, composition and performance are almost invariably separated; academic studies have…

  18. Network Horizon and the Dynamics of Network Positions: A Multi-Method Multi-Level Longitudinal Study of Interfirm Networks

    OpenAIRE

    Liere, Diederik

    2007-01-01

    textabstractDiederik van Liere was born in Kortenhoef, the Netherlands, on February 18, 1978. He attended Herman Jordan Lyceum in Zeist, from which he received his Atheneum diploma in 1996. After high school, Diederik went on to study Business Administration at the Erasmus University Rotterdam, the Netherlands. In 1997, he founded his own Internet design company and was an exchange student at Brandeis University, Boston, United States, in 2000. In November 2002, Diederik received his Master’s...

  19. Managing visitor impacts in parks: A multi-method study of the effectiveness of alternative management practices

    Science.gov (United States)

    Park, L.O.; Marion, J.L.; Manning, R.E.; Lawson, S.R.; Jacobi, C.

    2008-01-01

    How can recreation use be managed to control associated environmental impacts? What management practices are most effective and why? This study explored these and related questions through a series of experimental ?treatments? and associated ?controls? at the summit of Cadillac Mountain in Acadia National Park, a heavily used and environmentally fragile area. The treatments included five management practices designed to keep visitors on maintained trails, and these practices ranged from ?indirect? (information/education) to ?direct? (a fence bordering the trail). Research methods included unobtrusive observation of visitors to determine the percentage of visitors who walked off-trail and a follow-up visitor survey to explore why management practices did or didn?t work. All of the management practices reduced the percentage of visitors who walked off-trail. More aggressive applications of indirect practices were more effective than less aggressive applications, and the direct management practice of fencing was the most effective of all. None of the indirect management practices reduced walking off-trail to a degree that is likely to control damage to soil and vegetation at the study site. Study findings suggest that an integrated suite of direct and indirect management practices be implemented on Cadillac Mountain (and other, similar sites) that includes a) a regulation requiring visitors to stay on the maintained trail, b) enforcement of this regulation as needed, c) unobtrusive fencing along the margins of the trail, d) redesign of the trail to extend it, widen it in key places, and provide short spur trails to key ?photo points?, and e) an aggressive information/education program to inform visitors of the regulation to stay on the trail and the reasons for it. These recommendations are a manifestation of what may be an emerging principle of park and outdoor recreation management: intensive use requires intensive management.

  20. The effect of an active on-ward participation of hospital pharmacists in Internal Medicine teams on preventable Adverse Drug Events in elderly inpatients: protocol of the WINGS study (Ward-oriented pharmacy in newly admitted geriatric seniors)

    NARCIS (Netherlands)

    Klopotowska, J.E.; Wierenga, P.C.; de Rooij, S.E.; Stuijt, C.C.; Arisz, L.; Kuks, P.F.; Dijkgraaf, M.G.; Lie-A-Huen, L.; Smorenburg, S.M.

    2011-01-01

    The potential of clinical interventions, aiming at reduction of preventable Adverse Drug Events (preventable ADEs) during hospital stay, have been studied extensively. Clinical Pharmacy is a well-established and effective service, usually consisting of full-time on-ward participation of clinical

  1. 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

  2. Evaluation of the Septifast MGrade Test on Standard Care Wards--A Cohort Study.

    Directory of Open Access Journals (Sweden)

    Franz Ratzinger

    Full Text Available The immediate need for appropriate antimicrobial therapy in septic patients requires the detection of the causative pathogen in a timely and reliable manner. In this study, the real-time PCR Septifast MGrade test was evaluated in adult patients meeting the systemic inflammatory response syndrome (SIRS criteria that were treated at standard care wards.Patients with clinical suspected infection, drawn blood cultures (BC, the Septifast M(Grade test (SF and sepsis biomarkers were prospectively screened for fulfillment of SIRS criteria and evaluated using the criteria of the European Centre of Disease Control (ECDC for infection point prevalence studies.In total, 220 patients with SIRS were prospectively enrolled, including 56 patients with detection of bacteria in the blood (incidence: 25.5%. BC analysis resulted in 75.0% sensitivity (95% confidence interval, CI: 61.6%- 85.6% with 97.6% specificity (CI: 93.9%- 99.3% for detecting bacteria in the blood. In comparison to BC, SF presented with 80.4% sensitivity (CI: 67.6%- 89.8% and with 97.6% specificity (CI: 93.9%- 99.3%. BC and SF analysis yielded comparable ROC-AUCs (0.86, 0.89, which did not differ significantly (p = 0.558. A trend of a shorter time-to-positivity of BC analysis was not seen in bacteremic patients with a positive SF test than those with a negative test result. Sepsis biomarkers, including PCT, IL-6 or CRP, did not help to explain discordant test results for BC and SF.Since negative results do not exclude bacteremia, the Septifast M(Grade test is not suited to replacing BC, but it is a valuable tool with which to complement BC for faster detection of pathogens.

  3. A preliminary study of Patient Dignity Inventory validation among patients hospitalized in an acute psychiatric ward

    Directory of Open Access Journals (Sweden)

    Di Lorenzo R

    2017-01-01

    excellent internal consistency (Cronbach’s alpha coefficient =0.93. The factorial analysis showed the following three factors with eigenvalue >1 (Kaiser’s criterion, which explained >80% of total variance with good internal consistency: 1 “Loss of self-identity and social role”, 2 “Anxiety and uncertainty for future” and 3 “Loss of personal autonomy”. The PDI and the three-factor scores were statistically significantly positively correlated with the Hamilton Scales for Depression and Anxiety but not with other scale scores. Conclusion: Our preliminary research suggests that PDI can be a reliable tool to assess patients’ dignity perception in a psychiatric setting, until now little investigated, helping professionals to improve quality of care and patients to accept treatments. Keywords: dignity experience, Patient Dignity Inventory, patients hospitalized in a psychiatric ward, factor analysis, validation study, dignity distress measurement

  4. Evidence-informed health policy 1 – Synthesis of findings from a multi-method study of organizations that support the use of research evidence

    Directory of Open Access Journals (Sweden)

    Moynihan Ray

    2008-12-01

    Full Text Available Abstract Background Organizations have been established in many countries and internationally to support the use of research evidence by producing clinical practice guidelines, undertaking health technology assessments, and/or directly supporting the use of research evidence in developing health policy on an international, national, and state or provincial level. Learning from these organizations can reduce the need to 'reinvent the wheel' and inform decisions about how best to organize support for such organizations, particularly in low- and middle-income countries (LMICs. Methods We undertook a multi-method study in three phases – a survey, interviews, and case descriptions that drew on site visits – and in each of the second and third phases we focused on a purposive sample of those involved in the previous phase. We used the seven main recommendations that emerged from the advice offered in the interviews to organize much of the synthesis of findings across phases and methods. We used a constant comparative method to identify themes from across phases and methods. Results Seven recommendations emerged for those involved in establishing or leading organizations that support the use of research evidence in developing health policy: 1 collaborate with other organizations; 2 establish strong links with policymakers and involve stakeholders in the work; 3 be independent and manage conflicts of interest among those involved in the work; 4 build capacity among those working in the organization; 5 use good methods and be transparent in the work; 6 start small, have a clear audience and scope, and address important questions; and 7 be attentive to implementation considerations, even if implementation is not a remit. Four recommendations emerged for the World Health Organization (WHO and other international organizations and networks: 1 support collaborations among organizations; 2 support local adaptation efforts; 3 mobilize support; and 4 create

  5. A multi-method study to determine the effectiveness of, and student attitudes to, online instructional videos for teaching clinical nursing skills.

    Science.gov (United States)

    Kelly, Mary; Lyng, Colette; McGrath, Mary; Cannon, Gerald

    2009-04-01

    E-learning is regularly promoted in higher education settings as a way of fostering more flexible approaches to learning. It has been argued however that the 'potential benefits of new information and communication technology instruments in education' have not been subjected to critical scrutiny (Debande, O., 2004. ICTs and the development of e-learning in Europe: the role of the public and private sectors. European Journal of Education 39 (2), 191-208, p. 192). This paper outlines a multi-method evaluation of an e-learning innovation designed to teach clinical skills to student nurses. Responding to the challenges of teaching clinical skills to large class sizes, we developed a set of instructional videos for one undergraduate skills-based module, which are now integral to the module and available online to students on a continuous basis. Evaluation suggests that students' performance outcomes are unchanged. The students view the flexible and self-management aspects of this method of learning positively, with some attitudinal differences between male and female, and mature and non-mature students. However, it is best used to complement rather than replace lecturer demonstration, lending support to a 'blended' model (Collis, B., van der Wende, M., 2002. Models of Technology and Change in Higher Education: An International Comparative Survey on The Current and Future Use of ICT in Higher Education, University of Twente, Center for Higher Education Policy Studies, The Netherlands).

  6. Small-scale, homelike facilities versus regular psychogeriatric nursing home wards: a cross-sectional study into residents' characteristics

    Directory of Open Access Journals (Sweden)

    Kempen Gertrudis IJM

    2010-01-01

    Full Text Available Abstract Background Nursing home care for people with dementia is increasingly organized in small-scale and homelike care settings, in which normal daily life is emphasized. Despite this increase, relatively little is known about residents' characteristics and whether these differ from residents in traditional nursing homes. This study explored and compared characteristics of residents with dementia living in small-scale, homelike facilities and regular psychogeriatric wards in nursing homes, focusing on functional status and cognition. Methods A cross-sectional study was conducted, including 769 residents with dementia requiring an intensive level of nursing home care: 586 from regular psychogeriatric wards and 183 residents from small-scale living facilities. Functional status and cognition were assessed using two subscales from the Resident Assessment Instrument Minimum Data Set (RAI-MDS: the Activities of Daily Living-Hierarchy scale (ADL-H and the Cognitive Performance Scale (CPS. In addition, care dependency was measured using Dutch Care Severity Packages (DCSP. Finally, gender, age, living condition prior to admission and length of stay were recorded. Descriptive analyses, including independent samples t- tests and chi-square tests, were used. To analyze data in more detail, multivariate logistic regression analyses were performed. Results Residents living in small-scale, homelike facilities had a significantly higher functional status and cognitive performance compared with residents in regular psychogeriatric wards. In addition, they had a shorter length of stay, were less frequently admitted from home and were more often female than residents in regular wards. No differences were found in age and care dependency. While controlling for demographic variables, the association between dementia care setting and functional status and cognition remained. Conclusions Although residents require a similar intensive level of nursing home care

  7. An observational study in psychiatric acute patients admitted to General Hospital Psychiatric Wards in Italy

    Directory of Open Access Journals (Sweden)

    Margari Francesco

    2007-01-01

    Full Text Available Abstract Objectives this Italian observational study was aimed at collecting data of psychiatric patients with acute episodes entering General Hospital Psychiatric Wards (GHPWs. Information was focused on diagnosis (DSM-IV, reasons of hospitalisation, prescribed treatment, outcome of aggressive episodes, evolution of the acute episode. Methods assessments were performed at admission and discharge. Used psychometric scales were the Brief Psychiatric Rating Scale (BPRS, the Modified Overt Aggression Scale (MOAS and the Nurses' Observation Scale for Inpatient Evaluation (NOSIE-30. Results 864 adult patients were enrolled in 15 GHPWs: 728 (320 M; mean age 43.6 yrs completed both admission and discharge visits. A severe psychotic episode with (19.1% or without (47.7% aggressive behaviour was the main reason of admission. Schizophrenia (42.8% at admission and 40.1% at discharge and depression (12.9% at admission and 14.7% at discharge were the predominant diagnoses. The mean hospital stay was 12 days. The mean (± SD total score of MOAS at admission, day 7 and discharge was, respectively, 2.53 ± 5.1, 0.38 ± 2.2, and 0.21 ± 1.5. Forty-four (6.0% patients had episodes of aggressiveness at admission and 8 (1.7% at day 7. A progressive improvement in each domain/item vs. admission was observed for MOAS and BPRS, while NOSIE-30 did not change from day 4 onwards. The number of patients with al least one psychotic drug taken at admission, in the first 7 days of hospitalisation, and prescribed at discharge, was, respectively: 472 (64.8%, 686 (94.2% and 676 (92.9%. The respective most frequently psychotic drugs were: BDZs (60.6%, 85.7%, 69.5%, typical anti-psychotics (48.3%, 57.0%, 49.6%, atypical anti-psychotics (35.6%, 41.8%, 39.8% and antidepressants (40.9%, 48.8%, 43.2%. Rates of patients with one, two or > 2 psychotic drugs taken at admission and day 7, and prescribed at discharge, were, respectively: 24.8%, 8.2% and 13.5% in mono-therapy; 22.0%, 20

  8. Teens, Food Choice, and Health: How Can a Multi-Method Research Methodology Enhance the Study of Teen Food Choice and Health Messaging?

    OpenAIRE

    Wiseman, Kelleen

    2011-01-01

    This research report compares alternative approaches to analyzing the complex factors that influence teenagers' food choice. Specifically, a multi-method approach-which involves the integration of the qualitative and quantitative research methodoligies, data and analysis-is compared to a single methodological approach, which involves use of either a quantitative or qualitative methodology.

  9. ICU ward design and nosocomial infection rates: a cross-sectional study in Germany.

    Science.gov (United States)

    Stiller, A; Schröder, C; Gropmann, A; Schwab, F; Behnke, M; Geffers, C; Sunder, W; Holzhausen, J; Gastmeier, P

    2017-01-01

    There is increasing interest in the effects of hospital and ward design on multi-faceted infection control. Definitive evidence is rare and the state of knowledge about current ward design is lacking. To collect data on the current status of ward design for intensive care units (ICUs) and to analyse associations between particular design factors and nosocomial infection rates. In 2015, operational infrastructure data were collected via an online questionnaire from ICUs participating voluntarily in the German nosocomial infection surveillance system (KISS). A multi-variate analysis was subsequently undertaken with nosocomial infection rates from the KISS database from 2014 to 2015. In total, 534 ICUs submitted data about their operational infrastructure. Of these, 27.1% of beds were hosted in single-bed rooms with a median size of 18m(2) (interquartile range 15-21m(2)), and 73.5% of all ICU beds had a hand rub dispenser nearby. The authors were able to match 266 ICUs in the multi-variate analysis. ICUs with openable windows in patient rooms were associated with lower device-associated lower respiratory tract infections [odds ratio (OR) 0.73, 95% confidence interval (CI) 0.58-0.90]. ICUs with >40% two-bed rooms were associated with lower primary bloodstream infection rates (OR 0.66, 95% CI 0.51-0.86). Only minor associations were found between design factors and ICU infection rates. Most were surrogates for other risk factors. Copyright © 2016 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

  10. A multi-method assessment of bone maintenance and loss in an Imperial Roman population: Implications for future studies of age-related bone loss in the past.

    Science.gov (United States)

    Beauchesne, Patrick; Agarwal, Sabrina C

    2017-09-01

    One of the hallmarks of contemporary osteoporosis and bone loss is dramatically higher prevalence of loss and fragility in females post-menopause. In contrast, bioarchaeological studies of bone loss have found a greater diversity of age- and sex-related patterns of bone loss in past populations. We argue that the differing findings may relate to the fact that most studies use only a single methodology to quantify bone loss and do not account for the heterogeneity and complexity of bone maintenance across the skeleton and over the life course. We test the hypothesis that bone mass and maintenance in trabecular bone sites versus cortical bone sites will show differing patterns of age-related bone loss, with cortical bone sites showing sex difference in bone loss that are similar to contemporary Western populations, and trabecular bone loss at earlier ages. We investigated this hypothesis in the Imperial Roman population of Velia using three methods: radiogrammetry of the second metacarpal (N = 71), bone histology of ribs (N = 70), and computerized tomography of trabecular bone architecture (N = 47). All three methods were used to explore sex and age differences in patterns of bone loss. The suite of methods utilized reveal differences in the timing of bone loss with age, but all methods found no statistically significant differences in age-related bone loss. We argue that a multi-method approach reduces the influence of confounding factors by building a reconstruction of bone turnover over the life cycle that a limited single-method project cannot provide. The implications of using multiple methods beyond studies of bone loss are also discussed. © 2017 Wiley Periodicals, Inc.

  11. 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

  12. A multi-method approach for groundwater resource assessment in coastal carbonate (karst) aquifers: the case study of Sierra Almijara (southern Spain)

    Science.gov (United States)

    Andreo, B.; Barberá, J. A.; Mudarra, M.; Marín, A. I.; García-Orellana, J.; Rodellas, V.; Pérez, I.

    2017-08-01

    Understanding the transference of water resources within hydrogeological systems, particularly in coastal aquifers, in which groundwater discharge may occur through multiple pathways (through springs, into rivers and streams, towards the sea, etc.), is crucial for sustainable groundwater use. This research aims to demonstrate the usefulness of the application of conventional recharge assessment methods coupled to isotopic techniques for accurately quantifying the hydrogeological balance and submarine groundwater discharge (SGD) from coastal carbonate aquifers. Sierra Almijara (Southern Spain), a carbonate aquifer formed of Triassic marbles, is considered as representative of Mediterranean coastal karst formations. The use of a multi-method approach has permitted the computation of a wide range of groundwater infiltration rates (17-60%) by means of direct application of hydrometeorological methods (Thornthwaite and Kessler) and spatially distributed information (modified APLIS method). A spatially weighted recharge rate of 42% results from the most coherent information on physiographic and hydrogeological characteristics of the studied system. Natural aquifer discharge and groundwater abstraction have been volumetrically quantified, based on flow and water-level data, while the relevance of SGD was estimated from the spatial analysis of salinity, 222Rn and the short-lived radium isotope 224Ra in coastal seawater. The total mean aquifer discharge (44.9-45.9 hm3 year-1) is in agreement with the average recharged groundwater (44.7 hm3 year-1), given that the system is volumetrically equilibrated during the study period. Besides the groundwater resources assessment, the methodological aspects of this research may be interesting for groundwater management and protection strategies in coastal areas, particularly karst environments.

  13. Priorities and strategies for improving disabled women's access to maternity services when they are affected by domestic abuse: a multi-method study using concept maps.

    Science.gov (United States)

    Bradbury-Jones, Caroline; Breckenridge, Jenna P; Devaney, John; Duncan, Fiona; Kroll, Thilo; Lazenbatt, Anne; Taylor, Julie

    2015-12-28

    Domestic abuse is a significant public health issue. It occurs more frequently among disabled women than those without a disability and evidence suggests that a great deal of domestic abuse begins or worsens during pregnancy. All women and their infants are entitled to equal access to high quality maternity care. However, research has shown that disabled women who experience domestic abuse face numerous barriers to accessing care. The aim of the study was to identify the priority areas for improving access to maternity services for this group of women; develop strategies for improved access and utilisation; and explore the feasibility of implementing the identified strategies. This multi-method study was the third and final part of a larger study conducted in the UK between 2012 and 2014. The study used a modified concept mapping approach and was theoretically underpinned by Andersen's model of healthcare use. Seven focus group interviews were conducted with a range of maternity care professionals (n = 45), incorporating quantitative and qualitative components. Participants ranked perceived barriers to women's access and utilisation of maternity services in order of priority using a 5-point Likert scale. Quantitative data exploration used descriptive and non-parametric analyses. In the qualitative component of each focus group, participants discussed the barriers and identified potential improvement strategies (and feasibility of implementing these). Qualitative data were analysed inductively using a framework analysis approach. The three most highly ranked barriers to women's access and utilisation of maternity services identified in the quantitative component were: 1) staff being unaware and not asking about domestic abuse and disability; 2) the impact of domestic abuse on women; 3) women's fear of disclosure. The top two priority strategies were: providing information about domestic abuse to all women and promoting non-judgemental staff attitude. These were

  14. Tracing the evolution of chiropractic students' confidence in clinical and patient communication skills during a clinical internship: a multi-methods study.

    Science.gov (United States)

    Hecimovich, Mark; Volet, Simone

    2012-06-19

    Anecdotal evidence points to variations in individual students' evolving confidence in clinical and patient communication skills during a clinical internship. A better understanding of the specific aspects of internships that contribute to increasing or decreasing confidence is needed to best support students during the clinical component of their study. A multi-method approach, combining two large-scale surveys with 269 students and three in-depth individual interviews with a sub-sample of 29 students, was used to investigate the evolution of change in student confidence during a 10-month long internship. Change in levels of confidence in patient communication and clinical skills was measured and relationship to demographic factors were explored. The interviews elicited students' accounts and reflections on what affected the evolution of their confidence during the internship. At the start of their internship, students were more confident in their patient communication skills than their clinical skills but prior experience was significantly related to confidence in both. Initial confidence in patient communication skills was also related to age and prior qualification but not gender whilst confidence in clinical skills was related to gender but not age or prior qualification. These influences were maintained over time. Overall, students' levels of confidence in patient communication and clinical skills confidence increased significantly over the duration of the internship with evidence that change over time in these two aspects were inter-related. To explore how specific aspects of the internship contributed to changing levels of confidence, two extreme sub-groups of interviewees were identified, those with the least increase and those with the highest increase in professional confidence over time. A number of key factors affecting the development of confidence were identified, including among others, interactions with clinicians and patients, personal agency and

  15. Tracing the evolution of chiropractic students’ confidence in clinical and patient communication skills during a clinical internship: a multi-methods study

    Science.gov (United States)

    2012-01-01

    Background Anecdotal evidence points to variations in individual students’ evolving confidence in clinical and patient communication skills during a clinical internship. A better understanding of the specific aspects of internships that contribute to increasing or decreasing confidence is needed to best support students during the clinical component of their study. Methods A multi-method approach, combining two large-scale surveys with 269 students and three in-depth individual interviews with a sub-sample of 29 students, was used to investigate the evolution of change in student confidence during a 10-month long internship. Change in levels of confidence in patient communication and clinical skills was measured and relationship to demographic factors were explored. The interviews elicited students’ accounts and reflections on what affected the evolution of their confidence during the internship. Results At the start of their internship, students were more confident in their patient communication skills than their clinical skills but prior experience was significantly related to confidence in both. Initial confidence in patient communication skills was also related to age and prior qualification but not gender whilst confidence in clinical skills was related to gender but not age or prior qualification. These influences were maintained over time. Overall, students’ levels of confidence in patient communication and clinical skills confidence increased significantly over the duration of the internship with evidence that change over time in these two aspects were inter-related. To explore how specific aspects of the internship contributed to changing levels of confidence, two extreme sub-groups of interviewees were identified, those with the least increase and those with the highest increase in professional confidence over time. A number of key factors affecting the development of confidence were identified, including among others, interactions with clinicians

  16. 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

  17. Prospective pilot study on the incidence of infections caused by peripheral venous catheters at a general surgical ward

    Directory of Open Access Journals (Sweden)

    Heinrich, Ines

    2013-04-01

    Full Text Available [english] Device-associated infections comprise a significant proportion of all nosocomial infections. In this prospective, observational pilot study the incidence of infections in 89 peripheral venous catheters (PVCs was documented on a general surgical ward employing an infection data sheet developed by the Institute of Hygiene and Environmental Medicine, Greifswald in adherence to CDC standards for infections. 16 of 20 infections were documented during a four-week time period when medical students in the first four months of their practical year performed their compulsory rotation on the general surgical ward. Insufficient knowledge of adequate hygienic measures as well as non-compliance to aseptical procedural measures prior to and following insertion of a peripheral venous catheter are the assumed instigators of these infections. In order to ensure a uniform hygienic standard in the performance of applied procedures, it is essential that medical students during this practical year receive not only theoretical, but also hands-on schooling prior to initiation of their subsequent official residency.

  18. 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

  19. 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.

  20. Anti-anxiety Activity Studies on Homoeopathic Formulations of Turnera aphrodisiaca Ward

    Directory of Open Access Journals (Sweden)

    Suresh Kumar

    2005-01-01

    Full Text Available Turnera aphrodisiaca Ward (Turneraceae has been traditionally used for the treatment of anxiety neurosis, and as an aphrodisiac. Mother tinctures (85% ethanol extracts of T. aphrodisiaca have also been used for the treatment of central nervous system disorders. In the present investigation, T. aphrodisiaca mother tinctures formulated by three reputed manufacturers of homoeopathic medicines (NLK, DWSG and SBL were evaluated for their anxiolytic activity. Dried mother tinctures of T. aphrodisiaca were subjected to anxiolytic activity evaluation at various doses, i.e. 50, 75, 100, 125 or 150 mg/kg p.o. in mice using elevated plus maze apparatus. Dried mother tinctures exhibited significant anxiolytic activity at 50 mg/kg (NLK, 75 mg/kg (DWSG and 125 mg/kg (SBL, respectively, with reference to control as well as standard (diazepam, 2 mg/kg p.o.. Mother tinctures of T. aphrodisiaca available in the market, have significant anxiolytic activity. Amongst the three mother tinctures of T. aphrodisiaca analyzed, the dry residue of NLK possesses the highest amount of anxiolytic constituent(s. To ensure uniformity and consistency of biological effects in herbal formulations, these should be standardized on the basis of bioactive markers. The authors are actively involved in isolating the bioactive constituent(s from T. aphrodisiaca so that the plant can be standardized on the basis of biologically active constituent(s.

  1. Cost-effectiveness of ward-based pharmacy care in surgical patients: protocol of the SUREPILL (Surgery & Pharmacy In Liaison study

    Directory of Open Access Journals (Sweden)

    Kuks Paul F

    2011-03-01

    Full Text Available Abstract Background Preventable adverse drug events (pADEs are widely known to be a health care issue for hospitalized patients. Surgical patients are especially at risk, but prevention of pADEs in this population is not demonstrated before. Ward-based pharmacy interventions seem effective in reducing pADEs in medical patients. The cost-effectiveness of these preventive efforts still needs to be assessed in a comparative study of high methodological standard and also in the surgical population. For these aims the SUREPILL (Surgery & Pharmacy in Liaison study is initiated. Methods/Design A multi-centre controlled trial, with randomisation at ward-level and preceding baseline assessments is designed. Patients admitted to the surgical study wards for elective surgery with an expected length of stay of more than 48 hours will be included. Patients admitted to the intervention ward, will receive ward-based pharmacy care from the clinical pharmacy team, i.e. pharmacy practitioners and hospital pharmacists. This ward-based pharmacy intervention includes medication reconciliation in consultation with the patient at admission, daily medication review with face-to-face contact with the ward doctor, and patient counselling at discharge. Patients admitted in the control ward, will receive standard pharmaceutical care. The primary clinical outcome measure is the number of pADEs per 100 elective admissions. These pADEs will be measured by systematic patient record evaluation using a trigger tool. Patient records positive for a trigger will be evaluated on causality, severity and preventability by an independent expert panel. In addition, an economic evaluation will be performed from a societal perspective with the costs per preventable ADE as the primary economic outcome. Other outcomes of this study are: severity of pADEs, number of patients with pADEs per total number of admissions, direct (non-medical costs and indirect non-medical costs, extra costs per

  2. Results of prospective multicenter study on heart failure on Campania Internal Medicine wards: the FASHION study

    Directory of Open Access Journals (Sweden)

    Fernando Gallucci

    2017-06-01

    Full Text Available Heart failure (HF is characterized by a high prevalence and hospitalization rate with considerable health and social impact; the knowledge of its epidemiological features remains the mainstay to assess adequacy of the health care needs. The aim of this study was to evaluate the prevalence of HF in Internal Medicine Units of the Campania region (Italy and patients’ characteristics. We recruited all patients with HF admitted between April 1 and June 30, 2014, in 23 Units of Internal Medicine: 975 patients (19.5% of 5000 admissions, 518 women and 457 men, mean age 76.9±9.9 (range 34-100 with 741 (76% older than 70 years. The mean age was higher in women than men; 35.8% of patients had atrial fibrillation, with higher prevalence in women than in men. Coronary artery disease represented the leading etiology while prevalence of non-ischemic heart failure was higher in women. New York Heart Association class was indicated in 926 patients. Left ventricular ejection fraction (LVEF was measured in 503 patients; 18.4% of patients had a severely reduced LVEF<35%, mostly men (P=0.0001 and 67.4% presented a LVEF>40%. At least one hospital admission in the previous 12 months was registered in 39.6% of patients. One, two and more than two relevant comorbidities were present in 8.6%, 24.7% and 64.8% of patients, respectively. Arterial hypertension and coronary artery disease were more frequent in female. In conclusion, advanced age and clinical complexity were the main characteristics of HF patients hospitalized in the Internal Medicine Units in Campania. Gender differences also emerged from the analysis of demographic parameters and etiopathogenetic features. Some diagnostic and therapeutic aspects not in line with that recommended by the most recent HF international guidelines were registered.

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

    DEFF Research Database (Denmark)

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

    2013-01-01

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

  4. A preliminary study of Patient Dignity Inventory validation among patients hospitalized in an acute psychiatric ward

    Science.gov (United States)

    Di Lorenzo, Rosaria; Cabri, Giulio; Carretti, Eleonora; Galli, Giacomo; Giambalvo, Nina; Rioli, Giulia; Saraceni, Serena; Spiga, Giulia; Del Giovane, Cinzia; Ferri, Paola

    2017-01-01

    Purpose To investigate the perception of dignity among patients hospitalized in a psychiatric setting using the Patient Dignity Inventory (PDI), which had been first validated in oncologic field among terminally ill patients. Patients and methods After having modified two items, we administered the Italian version of PDI to all patients hospitalized in a public psychiatric ward (Service of Psychiatric Diagnosis and Treatment of a northern Italian town), who provided their consent and completed it at discharge, from October 21, 2015 to May 31, 2016. We excluded minors and patients with moderate/severe dementia, with poor knowledge of Italian language, who completed PDI in previous hospitalizations and/or were hospitalized for Depression and Anxiety, Global Assessment of Functioning and Health of the Nation Outcome Scales) to analyze the PDI concurrent validity. Results With a response rate of 93%, we obtained a mean PDI score of 48.27 (±19.59 SD) with excellent internal consistency (Cronbach’s alpha coefficient =0.93). The factorial analysis showed the following three factors with eigenvalue >1 (Kaiser’s criterion), which explained >80% of total variance with good internal consistency: 1) “Loss of self-identity and social role”, 2) “Anxiety and uncertainty for future” and 3) “Loss of personal autonomy”. The PDI and the three-factor scores were statistically significantly positively correlated with the Hamilton Scales for Depression and Anxiety but not with other scale scores. Conclusion Our preliminary research suggests that PDI can be a reliable tool to assess patients’ dignity perception in a psychiatric setting, until now little investigated, helping professionals to improve quality of care and patients to accept treatments. PMID:28182110

  5. 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/.

  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. 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...

  8. 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.

  9. Effects of sharing information on drug administration errors in pediatric wards: a pre–post intervention study

    Directory of Open Access Journals (Sweden)

    Chua SS

    2017-03-01

    Full Text Available Siew-Siang Chua,1 Sim-Mei Choo,1 Che Zuraini Sulaiman,2 Asma Omar,3 Meow-Keong Thong3 1Department of Pharmacy, Faculty of Medicine, University of Malaya, 2Pharmacy Department, University Malaya Medical Centre, 3Department of Paediatrics, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia Background and purpose: Drug administration errors are more likely to reach the patient than other medication errors. The main aim of this study was to determine whether the sharing of information on drug administration errors among health care providers would reduce such problems. Patients and methods: This study involved direct, undisguised observations of drug administrations in two pediatric wards of a major teaching hospital in Kuala Lumpur, Malaysia. This study consisted of two phases: Phase 1 (pre-intervention and Phase 2 (post-intervention. Data were collected by two observers over a 40-day period in both Phase 1 and Phase 2 of the study. Both observers were pharmacy graduates: Observer 1 just completed her undergraduate pharmacy degree, whereas Observer 2 was doing her one-year internship as a provisionally registered pharmacist in the hospital under study. A drug administration error was defined as a discrepancy between the drug regimen received by the patient and that intended by the prescriber and also drug administration procedures that did not follow standard hospital policies and procedures. Results from Phase 1 of the study were analyzed, presented and discussed with the ward staff before commencement of data collection in Phase 2. Results: A total of 1,284 and 1,401 doses of drugs were administered in Phase 1 and Phase 2, respectively. The rate of drug administration errors reduced significantly from Phase 1 to Phase 2 (44.3% versus 28.6%, respectively; P<0.001. Logistic regression analysis showed that the adjusted odds of drug administration errors in Phase 1 of the study were almost three times that in Phase 2 (P<0.001. The most

  10. AGGRESSION IN PSYCHIATRY - A QUALITATIVE STUDY FOCUSING ON THE CHARACTERIZATION AND PERCEPTION OF PATIENT AGGRESSION BY NURSES WORKING ON PSYCHIATRIC-WARDS

    NARCIS (Netherlands)

    FINNEMA, EJ; DASSEN, T; HALFENS, R

    The present study focuses on the characterization and perception of patient aggression by nurses working in a psychiatric hospital in The Netherlands. Data have been collected by interviewing nurses working on open and closed wards. The results have been compared and related to the existing

  11. On-ward participation of a hospital pharmacist in a Dutch intensive care unit reduces prescribing errors and related patient harm: an intervention study

    NARCIS (Netherlands)

    Klopotowska, J.E.; Kuiper, R.; van Kan, H.J.; de Pont, A.C.; Dijkgraaf, M.G.; Lie-A-Huen, L.; Vroom, M.B.; Smorenburg, S.M.

    2010-01-01

    Introduction: Patients admitted to an intensive care unit (ICU) are at high risk for prescribing errors and related adverse drug events (ADEs). An effective intervention to decrease this risk, based on studies conducted mainly in North America, is on-ward participation of a clinical pharmacist in an

  12. 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

  13. Characteristics of patients frequently subjected to pharmacological and mechanical restraint--a register study in three Norwegian acute psychiatric wards.

    Science.gov (United States)

    Knutzen, Maria; Bjørkly, Stål; Eidhammer, Gunnar; Lorentzen, Steinar; Mjøsund, Nina Helen; Opjordsmoen, Stein; Sandvik, Leiv; Friis, Svein

    2014-01-30

    This retrospective study from three catchment-area-based acute psychiatric wards showed that of all the pharmacologically and mechanically restrained patients (n=373) 34 (9.1%) had been frequently restrained (6 or more times). These patients accounted for 39.2% of all restraint episodes during the two-year study period. Adjusted binary logistic regression analyses showed that the odds for being frequently restrained were 91% lower among patients above 50 years compared to those aged 18-29 years; a threefold increase (OR=3.1) for those admitted 3 times or more compared to patients with only one stay; and, finally, a threefold increase (OR=3.1) if the length of stay was 16 days or more compared to those admitted for 0-4 days. Among frequently restrained patients, males (n=15) had significantly longer stays than women (n=19), and 8 of the females had a diagnosis of personality disorder, compared to none among males. Our study showed that being frequently restrained was associated with long inpatient stay, many admissions and young age. Teasing out patient characteristics associated with the risk of being frequently restraint may contribute to reduce use of restraint by developing alternative interventions for these patients.

  14. Interventions following a high violence risk assessment score: a naturalistic study on a Finnish psychiatric admission ward.

    Science.gov (United States)

    Kaunomäki, Jenni; Jokela, Markus; Kontio, Raija; Laiho, Tero; Sailas, Eila; Lindberg, Nina

    2017-01-11

    Patient aggression and violence against staff members and other patients are common concerns in psychiatric units. Many structured clinical risk assessment tools have recently been developed. Despite their superiority to unaided clinical judgments, staff has shown ambivalent views towards them. A constant worry of staff is that the results of risk assessments would not be used. The aims of the present study were to investigate what were the interventions applied by the staff of a psychiatric admission ward after a high risk patient had been identified, how frequently these interventions were used and how effective they were. The data were collected in a naturalistic setting during a 6-month period in a Finnish psychiatric admission ward with a total of 331 patients with a mean age of 42.9 years (SD 17.39) suffering mostly from mood, schizophrenia-related and substance use disorders. The total number of treatment days was 2399. The staff assessed the patients daily with the Dynamic Appraisal of Situational Aggression (DASA), which is a structured violence risk assessment considering the upcoming 24 h. The interventions in order to reduce the risk of violence following a high DASA total score (≥4) were collected from the patients' medical files. Inductive content analysis was used. There were a total of 64 patients with 217 observations of high DASA total score. In 91.2% of cases, at least one intervention aiming to reduce the violence risk was used. Pro re nata (PRN)-medication, seclusion and focused discussions with a nurse were the most frequently used interventions. Non-coercive and non-pharmacological interventions like daily activities associated significantly with the decrease of perceived risk of violence. In most cases, a high score in violence risk assessment led to interventions aiming to reduce the risk. Unfortunately, the most frequently used methods were psychopharmacological or coercive. It is hoped that the findings will encourage the staff to use

  15. Assessment of risk factors for candidemia in non-neutropenic patients hospitalized in Internal Medicine wards: A multicenter study.

    Science.gov (United States)

    Falcone, M; Tiseo, G; Tascini, C; Russo, A; Sozio, E; Raponi, G; Rosin, C; Pignatelli, P; Carfagna, P; Farcomeni, A; Luzzati, R; Violi, F; Menichetti, F; Venditti, M

    2017-06-01

    An increasing prevalence of candidemia has been reported in Internal Medicine wards (IMWs). The aim of our study was to identify risk factors for candidemia among non-neutropenic patients hospitalized in IMWs. A multicenter case-control study was performed in three hospitals in Italy. Patients developing candidemia (cases) were compared to patients without candidemia (controls) matched by age, time of admission and duration of hospitalization. A logistic regression analysis identified risk factors for candidemia, and a new risk score was developed. Validation was performed on an external cohort of patients. Overall, 951 patients (317 cases of candidemia and 634 controls) were included in the derivation cohort, while 270 patients (90 patients with candidemia and 180 controls) constituted the validation cohort. Severe sepsis or septic shock, recent Clostridium difficile infection, diabetes mellitus, total parenteral nutrition, chronic obstructive pulmonary disease, concomitant intravenous glycopeptide therapy, presence of peripherally inserted central catheter, previous antibiotic therapy and immunosuppressive therapy were factors independently associated with candidemia. The new risk score showed good area under the curve (AUC) values in both derivation (AUC 0.973 95% CI 0.809-0.997, pcandidemia. A new risk score with a good performance could facilitate the identification of candidates to early antifungal therapy. Copyright © 2017 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

  16. An IBCLC in the Maternity Ward of a Mother and Child Hospital: A Pre- and Post-Intervention Study

    Directory of Open Access Journals (Sweden)

    Antonella Chiurco

    2015-08-01

    Full Text Available Published evidence on the impact of the integration of International Board Certified Lactation Consultants (IBCLCs for breastfeeding promotion is growing, but still relatively limited. Our study aims at evaluating the effects of adding an IBCLC for breastfeeding support in a mother and child hospital environment. We conducted a prospective study in the maternity ward of our maternal and child health Institute, recruiting 402 mothers of healthy term newborns soon after birth. The 18-month intervention of the IBCLC (Phase II was preceded (Phase I by data collection on breastfeeding rates and factors related to breastfeeding, both at hospital discharge and two weeks later. Data collection was replicated just before the end of the intervention (Phase III. In Phase III, a significantly higher percentage of mothers: (a received help to breastfeed, and also received correct information on breastfeeding and community support, (b started breastfeeding within two hours from delivery, (c reported a good experience with the hospital staff. Moreover, the frequency of sore and/or cracked nipples was significantly lower in Phase III. However, no difference was found in exclusive breastfeeding rates at hospital discharge or at two weeks after birth.

  17. Potential drug-drug interactions in pediatric wards of Gondar University Hospital, Ethiopia:A cross sectional study

    Institute of Scientific and Technical Information of China (English)

    Henok Getachew; Mohammed Assen; Feser Dula; Akshaya Srikanth Bhagavathula

    2016-01-01

    Objective: To determine the prevalence, level of severity of potential drug–drug in-teractions (PDDIs) and the associated factors for PDDIs in hospitalized pediatric patients of Gondar University Hospital. Methods: A retrospective cross-sectional study was conducted for a period of 3 months from March to May 2014 in pediatric wards of Gondar University Hospital. Systematic random sampling technique was used to select charts from all pediatric patients' charts with every 7th interval to get sample size of 384. Univariate and multivariate analysis were performed to compute crude odds ratio and adjusted odds ratio respectively. Sta-tistical significance was set at P value Results: A total of 176 (45.8%) patients had at least one PDDI. A total of 393 PDDIs, which were comprised of 283 types of interacting combinations, were identified. Of the total of 393 PDDIs, most were of moderate severity [201 (51%)] followed by minor [152 (39%)] and major severity [40 (10%)]. The most common interacting pairs of major severity were gentamicin + furosemide (6), cotrimoxazole + methotrexate (4) and phenytoin + artemether (4). The occurrence of PDDIs was significantly associated with age and polypharmacy. Conclusions: The study showed that most of the interactions had moderate severity followed by minor severity. Age and polypharmacy were found to show statistically significant association with the occurrence of PDDIs. Due to sensitive nature of pediatrics population, close monitoring is recommended for the detection and management of PDDIs to prevent its negative consequences.

  18. 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.

    Science.gov (United States)

    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.

  19. Destruction of urban greenary of Indian cities: A study of the two wards of Kolkata through GIS and remote sensing

    Directory of Open Access Journals (Sweden)

    Mondal Kanti Biraj

    2013-01-01

    Full Text Available At present the rampant construction and poor compensatory plantation are taking a heavy toll on Kolkata’s environment. Now, Kolkata’s green cover stands at a dismal 5%, which is below the requirement of 15% for the Indian Metros. Last year Kolkata and its adjoining area have lost more than 5,000 trees to development projects, unauthorized chapping and natural causes. This has pushed up the carbon count by an alarming 5,500,000 kg. per year. The environmentalists feel that, the impact of this loss would be felt in the coming years. Thus, the rapid destruction of the urban greenery from the Indian city’s environs affects the urban ecology and causes environmental degradation. Therefore, an attempt has been made here to analyze the urban greenery or vegetation profile of Kolkata at micro level. Vegetation covers of ward 19 and 20 of Kolkata Municipal Corporation Area along with the search of its low existence (KMCA has been worked for the study. To speed up mapping and decision making, remotely sensed satellite data have been advocated and GIS technology has been used to represent the research work more advanced.

  20. Bringing Benefits and Warding off Blights in Due Commandment (Analytic Study Compared with the Jordanian Law)

    Science.gov (United States)

    Al Etoum, Niebal Mohd Ibrahim; Mowafi, Hanan Sami Mohammad; Al Zubaidi, Faraj Hamad Salem

    2016-01-01

    The study aims to highlight the benefits and blights of the due commandment (intestate law) under Jordanian law for the year (2010) in the article (279). The study came in two sections, the first one dealt with the concept of due commandment, its legitimacy, verdict and terms; in the second section, I've dealt with the persons entitled to due…

  1. Drug utilization study in postoperative patients in obstetrics and gynaecology ward of tertiary care hospital

    Directory of Open Access Journals (Sweden)

    Rajeshwari Neela

    2016-04-01

    Conclusions: The present study provides valuable insight about the overall pattern of drug used in postoperative patients. The study is useful in decreasing the irrational prescription, which helps to decrease the morbidity and health care burden in the society. [Int J Basic Clin Pharmacol 2016; 5(2.000: 329-334

  2. Flow situations during everyday practice in a medical hospital ward. Results from a study based on experience sampling method

    Directory of Open Access Journals (Sweden)

    Ejlertsson Göran

    2011-02-01

    Full Text Available Abstract Background Nursing is a constant balance between strain and stimulation and work and health research with a positive reference point has been recommended. A health-promoting circumstance for subjective experience is flow, which is a psychological state, when individuals concurrently experience happiness, motivation and cognitive efficiency. Flow situations can be identified through individuals' estimates of perceived challenge and skills. There is, to the best of our knowledge, no published study of flow among health care staff. The aim of this study was to identify flow-situations and study work-related activities and individual factors associated with flow situations, during everyday practice at a medical emergency ward in Sweden, in order to increase the knowledge on salutogenic health-promoting factors. Methods The respondents consisted of 17 assistant nurses and 14 registered nurses, who randomly and repeatedly answered a small questionnaire, through an experience sampling method, during everyday nursing practice. The study resulted in 497 observations. Flow situations were defined as an exact match between a high challenge and skill estimation and logistic regression models were used to study different variables association to flow situations. Results The health care staff spent most of its working time in individual nursing care and administrative and communicative duties. The assistant nurses were more often occupied in individual nursing care, while the registered nurses were more involved in medical care and administrative and communicative duties. The study resulted in 11.5% observations of flow situations but the relative number of flow situations varied between none to 55% among the participants. Flow situations were positively related to medical care activities and individual cognitive resources. Taking a break was also positively associated with flow situations among the assistant nurses. Conclusions The result showed

  3. The Patient Participation Culture Tool for healthcare workers (PaCT-HCW) on general hospital wards: A development and psychometric validation study.

    Science.gov (United States)

    Malfait, S; Eeckloo, K; Van Daele, J; Van Hecke, A

    2016-09-01

    Patient participation is an important subject for modern healthcare. In order to improve patient participation on a ward, the ward's culture regarding patient participation should first be measured. In this study a measurement tool for patient participation culture from the healthcare worker's perspective, the Patient Participation Culture Tool for healthcare workers (PaCT-HCW), was developed and psychometrically evaluated. The aim of this study was to develop and validate a tool that measures the healthcare worker-related factors of patient participation and information sharing and dialogue in patient participation from the healthcare worker's perspective in order to represent the patient participation culture on general and university hospital wards. A four-phased validation study was conducted: (1) defining the construct of the PaCT-HCW, (2) development of the PaCT-HCW, (3) content validation, and (4) psychometric evaluation. The Belgian Federal Government invited all Flemish general and university hospitals by e-mail to distribute the PaCT-HCW in their organization. Fifteen general hospitals took part in the study. Units for surgery, general medicine, medical rehabilitation, geriatric and maternal care were included. Intensive care-units, emergency room-units, psychiatric units and units with no admitted patients (e.g. radiology) were excluded. The respondents had to be caregivers, with hands-on patient contact, who worked on the same ward for more than six months. Nursing students and other healthcare workers with short-time internship on the ward were excluded. The tool was completed by 1329 respondents on 163 wards. The PaCT-HCW was psychometrically evaluated by use of an exploratory factor analysis and calculation of the internal consistency. A model containing eight components was developed through a literature review, individual interviews, and focus interviews. The developed model showed high sampling adequacy and the Bartlett's test of sphericity was

  4. Substance abuse in patients admitted voluntarily and involuntarily to acute psychiatric wards: a national cross-sectional study

    Directory of Open Access Journals (Sweden)

    Anne Opsal

    2011-12-01

    Full Text Available Background: Substance abuse and mental disorder comorbidity is high among patients admitted to acute psychiatric wards. The aim of the study was to identify this co-occurrence as a reason for involuntary admission and if specific substance use-related diagnoses were associated with such admissions.Methods: The study was a part of a multicentre, cross-sectional national study carried out during 2005-2006 within a research network of acute mental health services. Seventy-five percent of Norwegian hospitals providing acute in-patient treatment participated. Substance use was measured using the Clinician Rating Scale and the ICD-10 diagnoses F10-19. Diagnostic assessments were performed by the clinicians during hospital stay.Results: Overall, 33.2% (n=1,187 of the total patient population (3,506 were abusing alcohol or drugs prior to admission according to the Clinician Rating Scale. No difference in the overall prevalence of substance abuserelated diagnoses between the two groups was found. Overall, 310 (26% of the admissions, 216 voluntarily and 94 involuntarily admitted patients received a double diagnosis. Frequent comorbid combinations among voluntarily admitted patients were; a combination of alcohol and either mood disorder (40% or multiple mental disorders (29%. Among involuntarily admitted patients, a combination of poly drug use and schizophrenia was most frequent (47%. Substance abusing patients diagnosed with mental and behavioral disorders due to the use of psychoactive stimulant substances had a significantly higher risk of involuntary hospitalization (OR 2.3.Conclusion: Nearly one third of substance abusing patients are involuntarily admitted to mental hospitals, in particular stimulant drug use was associated with involuntarily admissions.

  5. Treatment of schizophrenia with antipsychotics in Norwegian emergency wards, a cross-sectional national study

    Directory of Open Access Journals (Sweden)

    Wentzel-Larsen Tore

    2009-05-01

    Full Text Available Abstract Background Surveys on prescription patterns for antipsychotics in the Scandinavian public health system are scarce despite the prevalent use of these drugs. The clinical differences between antipsychotic drugs are mainly in the areas of safety and tolerability, and international guidelines for the treatment of schizophrenia offer rational strategies to minimize the burden of side effects related to antipsychotic treatment. The implementation of treatment guidelines in clinical practice have proven difficult to achieve, as reflected by major variations in the prescription patterns of antipsychotics between different comparable regions and countries. The objective of this study was to evaluate the practice of treatment of schizophrenic patients with antipsychotics at discharge from acute inpatient settings at a national level. Methods Data from 486 discharges of patients from emergency inpatient treatment of schizophrenia were collected during a three-month period in 2005; the data were collected in a large national study that covered 75% of Norwegian hospitals receiving inpatients for acute treatment. Antipsychotic treatment, demographic variables, scores from the Global Assessment of Functioning and Health of the Nation Outcome Scales and information about comorbid conditions and prior treatment were analyzed to seek predictors for nonadherence to guidelines. Results In 7.6% of the discharges no antipsychotic treatment was given; of the remaining discharges, 35.6% were prescribed antipsychotic polypharmacy and 41.9% were prescribed at least one first-generation antipsychotic (FGA. The mean chlorpromazine equivalent dose was 450 (SD 347, range 25–2800. In the multivariate regression analyses, younger age, previous inpatient treatment in the previous 12 months before index hospitalization, and a comorbid diagnosis of personality disorder or mental retardation predicted antipsychotic polypharmacy, while previous inpatient treatment in

  6. Treatment of schizophrenia with antipsychotics in Norwegian emergency wards, a cross-sectional national study

    Science.gov (United States)

    Kroken, Rune A; Johnsen, Erik; Ruud, Torleif; Wentzel-Larsen, Tore; Jørgensen, Hugo A

    2009-01-01

    Background Surveys on prescription patterns for antipsychotics in the Scandinavian public health system are scarce despite the prevalent use of these drugs. The clinical differences between antipsychotic drugs are mainly in the areas of safety and tolerability, and international guidelines for the treatment of schizophrenia offer rational strategies to minimize the burden of side effects related to antipsychotic treatment. The implementation of treatment guidelines in clinical practice have proven difficult to achieve, as reflected by major variations in the prescription patterns of antipsychotics between different comparable regions and countries. The objective of this study was to evaluate the practice of treatment of schizophrenic patients with antipsychotics at discharge from acute inpatient settings at a national level. Methods Data from 486 discharges of patients from emergency inpatient treatment of schizophrenia were collected during a three-month period in 2005; the data were collected in a large national study that covered 75% of Norwegian hospitals receiving inpatients for acute treatment. Antipsychotic treatment, demographic variables, scores from the Global Assessment of Functioning and Health of the Nation Outcome Scales and information about comorbid conditions and prior treatment were analyzed to seek predictors for nonadherence to guidelines. Results In 7.6% of the discharges no antipsychotic treatment was given; of the remaining discharges, 35.6% were prescribed antipsychotic polypharmacy and 41.9% were prescribed at least one first-generation antipsychotic (FGA). The mean chlorpromazine equivalent dose was 450 (SD 347, range 25–2800). In the multivariate regression analyses, younger age, previous inpatient treatment in the previous 12 months before index hospitalization, and a comorbid diagnosis of personality disorder or mental retardation predicted antipsychotic polypharmacy, while previous inpatient treatment in the previous 12 months also

  7. A PROSPECTIVE STUDY ON TOXIC MULTINODULAR GOITRE IN SURGICAL WARDS OF ANDHRA MEDICAL COLLEGE, VISAKHAPATNAM

    Directory of Open Access Journals (Sweden)

    Suganakar Kodi

    2016-06-01

    Full Text Available BACKGROUND Multinodular goitre (MNG is the most common thyroid disease in the world with more than 300 million people estimated to be affected. MNG is the result of aberrant growth of thyroid follicular cells following chronic TSH stimulation, which, via hyperplasia, leads to the nodular degeneration of thyroid tissue. METHODS 500 patients presenting with MNG without obvious evidence of malignancy were studied, out of them 58 cases were toxic MNG. All patients presented with palpable neck swelling, were evaluated in terms of history, clinical examination and subjected for relevant investigations, taken up for surgery with prior thyroid profile, USG neck, FNAC and histopathology of resected specimen done postoperatively. RESULTS Toxic MNG constituted 11% of MNG. Toxic MNG is more common in females (female to male ratio is 5:1 and majority are in the age group of 41-50 years (48%. In majority (90% of patients, duration of the swelling prior to the presentation was 2- 5 years. CONCLUSION Total thyroidectomy is the surgery of choice for toxic MNG. Surgical therapy has major advantage of rapid control of thyrotoxicosis, minimise the cardiac effects of coexisting severe cardiotoxicity

  8. Everyday practices at the medical ward: a 16-month ethnographic field study

    Directory of Open Access Journals (Sweden)

    Wolf Axel

    2012-07-01

    Full Text Available Abstract Background Modern hospital care should ostensibly be multi-professional and person-centred, yet it still seems to be driven primarily by a hegemonic, positivistic, biomedical agenda. This study aimed to describe the everyday practices of professionals and patients in a coronary care unit, and analyse how the routines, structures and physical design of the care environment influenced their actions and relationships. Methods Ethnographic fieldwork was conducted over a 16-month period (between 2009 and 2011 by two researchers working in parallel in a Swedish coronary care unit. Observations, informal talks and formal interviews took place with registered nurses, assistant nurses, physicians and patients in the coronary care unit. The formal interviews were conducted with six registered nurses (five female, one male including the chief nurse manager, three assistant nurses (all female, two cardiologists and three patients (one female, two male. Results We identified the structures that either promoted or counteracted the various actions and relationships of patients and healthcare professionals. The care environment, with its minimalistic design, strong focus on routines and modest capacity for dialogue, restricted the choices available to both patients and healthcare professionals. This resulted in feelings of guilt, predominantly on the part of the registered nurses. Conclusions The care environment restricted the choices available to both patients and healthcare professionals. This may result in increased moral stress among those in multi-professional teams who work in the grey area between biomedical and person-centred care.

  9. Advanced cancer patients' self-assessed physical and emotional problems on admission and discharge from hospital general ward - a questionnaire study

    DEFF Research Database (Denmark)

    Sølver, Lisbeth; Østergaard, Birte; Rydahl Hansen, Susan;

    2012-01-01

    SOELVER L., OESTERGAARD B., RYDAHL-HANSEN S. & WAGNER L. (2012) European Journal of Cancer Care21, 667-676 Advanced cancer patients' self-assessed physical and emotional problems on admission and discharge from hospital general wards - a questionnaire study Most cancer patients receiving life......-prolonging or palliative treatment are offered non-specialist palliative services. There is a lack of knowledge about their problem profile. The aim of this article is to describe the incidence of patient-reported physical and emotional problems on admission and discharge from general hospital wards and health staff......-reported problems and reported intervention for physical function, pain, constipation and loss of appetite. Palliative cancer patients' self-reported problem profile on admission and discharge from hospital has not previously been described and the results indicate a need to focus on improvements to palliative...

  10. '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.

  11. 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.

  12. 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

  13. Multi-method investigation of cushion peatlands (

    Science.gov (United States)

    Forbriger, M.; Schittek, K.; Höfle, B.; Siart, C.; Eitel, B.

    2012-04-01

    This study presents a multi-method and multi-proxy approach for palaeonvironmental investigations in the western andean cordillera of southern Peru (Lucanas province, 14° S) using cushion peatlands as terrestrial geoarchives. The region stretching between the Altiplano and the Peruvian desert in the lowland shares a long term settlement history, in which local cultures adapted to climate change in many different ways. Being one of the most outstanding human remains, the abri below Cerro Llamoca, 4.450 m a.s.l. in the uppermost ranges of the Llamoca peatland catchment area further reveals an occupation history of almost 10.000 years, as revealed by latest archaeological investigations. In remote and highly elevated regions such as the central Andes, cushion peatlands basically represent the only high resolution terrestrial archives suitable for geoarchaeological and palaeoenvironmental studies. Characterized by high accumulation rates, they ideally document environmental changes, particularly at small time intervals. Within the multidisciplinary project 'Andean Transect - Climate Sensitivity of pre-Columbian Man-Environment-Systems' several sediment cores with depths up to 11.5 m b.s. were recovered from the Llamoca peatland. Based on almost 100 AMS 14C-datings they provide a chronology of 8000 years and, thus, offer profound insights into climatic and environmental changes in the study area. While nearly homogeneous peat layers record stable environmental conditions, the heterogeneous granulometric composition of intercalated sediment layers documents several periods of intense geomorphodynamic activity. Due to high resolution geochemical analyses of peat layers (1 cm interval; humification degree, CNS measurements, XRF-scanning), the existence of slight and short-term trends of landscape development during these phases can be identified. Additional pollen, charred particles and plant macrofossil analyses confirm these findings and help reconstructing local

  14. 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.

  15. Study of user experience of an objective test (QbTest) to aid ADHD assessment and medication management: a multi-methods approach.

    Science.gov (United States)

    Hall, Charlotte L; Valentine, Althea Z; Walker, Gemma M; Ball, Harriet M; Cogger, Heather; Daley, David; Groom, Madeleine J; Sayal, Kapil; Hollis, Chris

    2017-02-10

    The diagnosis and monitoring of Attention deficit hyperactivity disorder (ADHD) typically relies on subjective reports and observations. Objective continuous performance tests (CPTs) have been incorporated into some services to support clinical decision making. However, the feasibility and acceptability of adding such a test into routine practice is unknown. The study aimed to investigate the feasibility and acceptability of adding an objective computerised test to the routine assessment and monitoring of attention deficit hyperactivity disorder (ADHD). Semi-structured interviews were conducted with clinicians (n = 10) and families (parents/young people, n = 20) who participated in a randomised controlled trial. Additionally, the same clinicians (n = 10) and families (n = 76) completed a survey assessing their experience of the QbTest. The study took place in child and adolescent mental health and community paediatric clinics across the UK. Interview transcripts were thematically analysed. Interviewed clinicians and families valued the QbTest for providing an objective, valid assessment of symptoms. The QbTest was noted to facilitate communication between clinicians, families and schools. However, whereas clinicians were more unanimous on the usefulness of the QbTest, survey findings showed that, although the majority of families found the test useful, less than half felt the QbTest helped them understand the clinician's decision making around diagnosis and medication. The QbTest was seen as a potentially valuable tool to use early in the assessment process to streamline the care pathway. Although clinicians were conscious of the additional costs, these could be offset by reductions in time to diagnosis and the delivery of the test by a Healthcare Assistant. The findings indicate the QbTest is an acceptable and feasible tool to implement in routine clinical settings. Clinicians should be mindful to discuss the QbTest results with families to enable

  16. 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.

  17. 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...

  18. 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

  19. All in a day's work: an observational study to quantify how and with whom doctors on hospital wards spend their time.

    Science.gov (United States)

    Westbrook, Johanna I; Ampt, Amanda; Kearney, Leanne; Rob, Marilyn I

    2008-05-05

    To quantify time doctors in hospital wards spend on specific work tasks, and with health professionals and patients. Observational time and motion study. 400-bed teaching hospital in Sydney. 19 doctors (seven registrars, five residents, seven interns) in four wards were observed between 08:30 and 19:00 for a total of 151 hours between July and December 2006. Proportions of time in categories of work; proportions of tasks performed with health professionals and patients; proportions of tasks using specific information tools; rates of multitasking and interruptions. The greatest proportions of doctors' time were in professional communication (33%; 95% CI, 29%-38%); social activities, such as non-work communication and meal breaks (17%; 95% CI, 13%-21%), and indirect care, such as planning care (17%; 95% CI, 15%-19%). Multitasking involved 20% of time, and on average, doctors were interrupted every 21 minutes. Most tasks were completed with another doctor (56%; 95% CI, 55%-57%), while 24% (95% CI, 23%-25%) were undertaken alone and 15% (95% CI, 15%-16%) with a patient. Interns spent more time completing documentation and administrative tasks, and less time in direct care than residents and registrars. The time interns spent documenting (22%) was almost double the time they were engaged in direct patient care. Two-thirds of doctors' time was consumed by three work categories: professional communication, social activities and indirect care. Doctors on wards are interrupted at considerably lower rates than those in emergency and intensive care units. The results confirm interns' previously reported dissatisfaction with their level of administrative work and documentation.

  20. 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.)

  1. Nurses' experience of collaboration with relatives of frail elderly patients in acute hospital wards: a qualitative study

    DEFF Research Database (Denmark)

    Lindhardt, Tommi Bo; Hallberg, I.R.; Poulsen, Ingrid

    2008-01-01

    . OBJECTIVE: To illuminate nurses' experience of collaboration with relatives of frail elderly patients in acute hospital wards, and of the barriers and promoters for collaboration. DESIGN AND SETTING: The design was descriptive. Three acute units in a large Danish university hospital participated....... PARTICIPANTS: Six registered nurses and two auxiliary nurses in charge of discharge planning for the patients were included. METHOD: Open interviews using an interview guide. Manifest and latent content analysis was applied. RESULT: The main theme Encountering relatives-to be caught between ideals and practice...... reflected the nurses' two sets of conflicting attitudes towards collaboration with relatives, one in accordance with professional nursing values, the other reflecting the values of every day practice. The dual attitudes were reflected in two themes The coincidental encounter-the collaboration and Relatives...

  2. Nurses' experience of collaboration with relatives of frail elderly patients in acute hospital wards: A qualitative study

    DEFF Research Database (Denmark)

    Tove, Lindhardt; Hallberg, Ingalill Rahm; Poulsen, Ingrid

    2008-01-01

    . OBJECTIVE: To illuminate nurses' experience of collaboration with relatives of frail elderly patients in acute hospital wards, and of the barriers and promoters for collaboration. DESIGN AND SETTING: The design was descriptive. Three acute units in a large Danish university hospital participated....... PARTICIPANTS: Six registered nurses and two auxiliary nurses in charge of discharge planning for the patients were included. METHOD: Open interviews using an interview guide. Manifest and latent content analysis was applied. RESULT: The main theme Encountering relatives-to be caught between ideals and practice...... reflected the nurses' two sets of conflicting attitudes towards collaboration with relatives, one in accordance with professional nursing values, the other reflecting the values of every day practice. The dual attitudes were reflected in two themes The coincidental encounter-the collaboration and Relatives...

  3. 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.

  4. Ⅰ期临床试验病房规范化管理的探讨%Study of Standardized Management of Phase Ⅰ Clinical Trial Ward

    Institute of Scientific and Technical Information of China (English)

    李楠; 黄海涛; 王蓝天; 黄娟; 雍小兰

    2012-01-01

    目的:规范药物Ⅰ期临床试验病房的各项管理标准.方法:分析、总结Ⅰ期临床试验研究人员、受试者、试验药物、病房监护等方面的管理经验和体会.其中受试者管理包括受试者的招募、知情同意、筛选、入住、饮食、用药、观察及采血、出组,试验药物的管理包括试验药物的验收、存放、领用、使用和回收处理.结果:通过分析、总结Ⅰ期临床试验病房的各个管理环节中可能存在的问题,提出规范化、系统化的管理要求.Ⅰ期临床试验研究人员应经过系统化的GCP培训,严格按照试验方案执行;受试者应在全面知情同意后参加试验,并遵守病房各项规章制度;试验药物应按照要求妥善保管,在各个环节监控和记录试验药物的流向;病房监护应做到抢救设备定期维护,抢救药品定期更换,专人负责保管.结论:通过规范化流程和系统管理,能够有效地降低Ⅰ期临床试验存在的风险.%Objective: To standardize the management of phase I clinical trial ward. Methods: The experiences of management of phase I clinical trial ward were analyzed and summarized from the researchers, subjects, experimental drugs and guardianship of ward. The management of subjects included recruitment, informed consent, screening, check-in, diet, medications, observation and blood collection and removal. The management of experimental drugs included acceptance, deposit, receiving, use and reclamation. Results: Standardized and systematic management requirements were proposed by means of the analysis and summary of the problems of management of phase I clinical trial ward. Researchers should be trained with GCP systematically, and should implement the trial strictly according to study protocol. Subjects should take part in the trial after understanding the informed consent comprehensively, and comply with the rules of the trial. Experimental drugs should be kept as required

  5. On-ward participation of a hospital pharmacist in a Dutch intensive care unit reduces prescribing errors and related patient harm: an intervention study.

    Science.gov (United States)

    Klopotowska, Joanna E; Kuiper, Rob; van Kan, Hendrikus J; de Pont, Anne-Cornelie; Dijkgraaf, Marcel G; Lie-A-Huen, Loraine; Vroom, Margreeth B; Smorenburg, Susanne M

    2010-01-01

    Patients admitted to an intensive care unit (ICU) are at high risk for prescribing errors and related adverse drug events (ADEs). An effective intervention to decrease this risk, based on studies conducted mainly in North America, is on-ward participation of a clinical pharmacist in an ICU team. As the Dutch Healthcare System is organized differently and the on-ward role of hospital pharmacists in Dutch ICU teams is not well established, we conducted an intervention study to investigate whether participation of a hospital pharmacist can also be an effective approach in reducing prescribing errors and related patient harm (preventable ADEs) in this specific setting. A prospective study compared a baseline period with an intervention period. During the intervention period, an ICU hospital pharmacist reviewed medication orders for patients admitted to the ICU, noted issues related to prescribing, formulated recommendations and discussed those during patient review meetings with the attending ICU physicians. Prescribing issues were scored as prescribing errors when consensus was reached between the ICU hospital pharmacist and ICU physicians. During the 8.5-month study period, medication orders for 1,173 patients were reviewed. The ICU hospital pharmacist made a total of 659 recommendations. During the intervention period, the rate of consensus between the ICU hospital pharmacist and ICU physicians was 74%. The incidence of prescribing errors during the intervention period was significantly lower than during the baseline period: 62.5 per 1,000 monitored patient-days versus 190.5 per 1,000 monitored patient-days, respectively (P Medication Error Reporting and Prevention severity categories E and F) were reduced from 4.0 per 1,000 monitored patient-days during the baseline period to 1.0 per 1,000 monitored patient-days during the intervention period (P = 0.25). Per monitored patient-day, the intervention itself cost €3, but might have saved €26 to €40 by preventing

  6. 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.

  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. Characteristics associated with falls among the elderly within aged care wards in a tertiary hospital: a retrospective case-control study

    Institute of Scientific and Technical Information of China (English)

    CHEN Xue-li; LIU Yun-hu; Daniel KY Chan; SHEN Qing; Huong Van Nguyen

    2010-01-01

    Background Falls are the most frequently reported adverse events in inpatient settings. We conducted a retrospective case-control study of inpatient falls within aged care wards in a tertiary hospital to investigate the associated characteristics of elderly patients suffering from falls and fall-related characteristics.Methods Consecutive retrospective cross-sectional design spanned July 2006 to December 2008. Patient group: Information on all aged care inpatients who suffered from 1 or more falls was extracted from Incident information Management System (IIMS). Further details about the particular admission(s) were obtained from patients' medical records, e.g., patients' characteristics and circumstances surrounding the falls. Randomly selected aged care patients who did not suffer from a fall and who were discharged from the hospital in the same period served control group. Characteristics among patients with single fall and recurrent falls, as well as non-fallers were compared. Results Of the 438 falls evaluated, 71.9% occurred in patients' room and 18.9% in patients' bathroom/toilet. The common activities were moving/transferring and taking shower/toileting, respectively, 70.3%, 12.1% while occurring falls; and time of falls had a high peak during 9:00-11:00 a.m. Many were unassisted while falling. The common contributing factors for fall were intrinsic factors. Patients with recurrent falls were more likely to have lower Mini-Mental State Examination (MMSE) score. Logistic regression analysis showed length of stay longer than five weeks, dementia and stroke were independent risk factors for recurrent falls; and living in hostel/nursing home preadmission, needing assistance with mobility, cognitive impairment, stroke, incontinence and arthritis/osteoporosis were independent risk factors for fall.Conclusions In an aged care ward, falls are independently associated with recurrent factors. Cognitive impairment/dementia was a strong risk factor for falls, and main

  9. Facilitating and inhibiting factors in change processes based on the lean tool ‘value stream mapping’: an exploratory case study at hospital wards

    DEFF Research Database (Denmark)

    Winkel, Jørgen; Edwards, Kasper; Birgisdóttir, Birna Dröfn

    2015-01-01

    and ergonomics. The aim of the present exploratory study is to report observations that seem to play significant roles as inhibitors and facilitators for proper intervention processes when using VSM. Seven hospital wards have been investigated in Denmark, Iceland and Sweden. Information was obtained by screening...... key hospital documents and interviewing participants in and around the VSM processes. Nine tape-recorded interviews were performed. The results tentatively point to the facilitating effect on the VSM process by emphasising involvement and decision-making among the participants, first line manager...... support and engagement, allocation of sufficient resources, work environment issues as part of the VSM methodology and VSM routines that are well-established and broadly accepted....

  10. Relationship between healthcare worker surface contacts, care type and hand hygiene: an observational study in a single-bed hospital ward.

    Science.gov (United States)

    King, M-F; Noakes, C J; Sleigh, P A; Bale, S; Waters, L

    2016-09-01

    This study quantifies the relationship between hand hygiene and the frequency with which healthcare workers (HCWs) touch surfaces in patient rooms. Surface contacts and hand hygiene were recorded in a single-bed UK hospital ward for six care types. Surface contacts often formed non-random patterns, but hygiene before or after patient contact depends significantly on care type (P=0.001). The likelihood of hygiene correlated with the number of surface contacts (95% confidence interval 1.1-5.8, P=0.002), but not with time spent in the room. This highlights that a potential subconscious need for hand hygiene may have developed in HCWs, which may support and help focus future hygiene education programmes. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

  11. Compliance of energy-dense, small volume oral nutritional supplements in the daily clinical practice on a geriatric ward--an observational study.

    Science.gov (United States)

    Lombard, K; van Steijn, J; Schuur, T; Kuhn, M; Rouws, C; Huinink, E-L; van der Hooft, C; van Asselt, D

    2014-07-01

    Compliance is important in optimizing the clinical effectiveness of oral nutritional supplements (ONS). Small volume, energy-dense ONS (ED-ONS; ≥ 2 kcal/ml) have been shown to improve compliance in clinical trial settings. However, data from clinical practice is still lacking. The aim of the present study was to evaluate the effect of ED-ONS on the compliance in an observational set-up to obtain data from daily clinical practice on a geriatric ward. Geriatric inpatients, undernourished or at risk of undernutrition received two servings of either ED-ONS (125 ml, 2.4 kcal/ml: Nutridrink Compact Energy, Nutricia) or a standard ONS (S-ONS; 200 ml, 1.5 kcal/ml: Nutridrink) as part of their daily routine care. Patients were allocated to a group according to availability of beds and placement on the ward. Compliance (kcal/day and % of prescribed volume) was assessed by weighing returned bottles. Data were analyzed via Mixed Model for Repeated Measures. Forty-seven patients received ED-ONS, and 61 patients received S-ONS. Compliance was significantly higher with ED-ONS in geriatric inpatients compared to S-ONS ( 378 ± 14.0 kcal/day vs. 337 ± 13.6 kcal/day (mean ± SEM), p = 0.039, 63.0 ± 2.34% vs. 56.2 ± 2.26%, p = 0.039). Moreover, a trend (p=0.078) was observed towards an increasing difference in compliance over time. This study shows that compliance to ED-ONS is significantly better than to S-ONS in daily clinical practice. Although small, the difference in compliance seems to increase over time, suggesting clinical relevance with longer treatment.

  12. 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

  13. Accurate paleointensities - the multi-method approach

    Science.gov (United States)

    de Groot, Lennart

    2016-04-01

    The accuracy of models describing rapid changes in the geomagnetic field over the past millennia critically depends on the availability of reliable paleointensity estimates. Over the past decade methods to derive paleointensities from lavas (the only recorder of the geomagnetic field that is available all over the globe and through geologic times) have seen significant improvements and various alternative techniques were proposed. The 'classical' Thellier-style approach was optimized and selection criteria were defined in the 'Standard Paleointensity Definitions' (Paterson et al, 2014). The Multispecimen approach was validated and the importance of additional tests and criteria to assess Multispecimen results must be emphasized. Recently, a non-heating, relative paleointensity technique was proposed -the pseudo-Thellier protocol- which shows great potential in both accuracy and efficiency, but currently lacks a solid theoretical underpinning. Here I present work using all three of the aforementioned paleointensity methods on suites of young lavas taken from the volcanic islands of Hawaii, La Palma, Gran Canaria, Tenerife, and Terceira. Many of the sampled cooling units are <100 years old, the actual field strength at the time of cooling is therefore reasonably well known. Rather intuitively, flows that produce coherent results from two or more different paleointensity methods yield the most accurate estimates of the paleofield. Furthermore, the results for some flows pass the selection criteria for one method, but fail in other techniques. Scrutinizing and combing all acceptable results yielded reliable paleointensity estimates for 60-70% of all sampled cooling units - an exceptionally high success rate. This 'multi-method paleointensity approach' therefore has high potential to provide the much-needed paleointensities to improve geomagnetic field models for the Holocene.

  14. 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.

  15. 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

  16. The relationship between therapeutic alliance and service user satisfaction in mental health inpatient wards and crisis house alternatives: a cross-sectional study.

    Directory of Open Access Journals (Sweden)

    Angela Sweeney

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

  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

    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.

  18. 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 ...

  19. Estimation of hand hygiene opportunities on an adult medical ward using 24-hour camera surveillance: validation of the HOW2 Benchmark Study.

    Science.gov (United States)

    Diller, Thomas; Kelly, J William; Blackhurst, Dawn; Steed, Connie; Boeker, Sue; McElveen, Danielle C

    2014-06-01

    We previously published a formula to estimate the number of hand hygiene opportunities (HHOs) per patient-day using the World Health Organization's "Five Moments for Hand Hygiene" methodology (HOW2 Benchmark Study). HHOs can be used as a denominator for calculating hand hygiene compliance rates when product utilization data are available. This study validates the previously derived HHO estimate using 24-hour video surveillance of health care worker hand hygiene activity. The validation study utilized 24-hour video surveillance recordings of 26 patients' hospital stays to measure the actual number of HHOs per patient-day on a medicine ward in a large teaching hospital. Statistical methods were used to compare these results to those obtained by episodic observation of patient activity in the original derivation study. Total hours of data collection were 81.3 and 1,510.8, resulting in 1,740 and 4,522 HHOs in the derivation and validation studies, respectively. Comparisons of the mean and median HHOs per 24-hour period did not differ significantly. HHOs were 71.6 (95% confidence interval: 64.9-78.3) and 73.9 (95% confidence interval: 69.1-84.1), respectively. This study validates the HOW2 Benchmark Study and confirms that expected numbers of HHOs can be estimated from the unit's patient census and patient-to-nurse ratio. These data can be used as denominators in calculations of hand hygiene compliance rates from electronic monitoring using the "Five Moments for Hand Hygiene" methodology. Copyright © 2014 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

  20. Profile of inpatient falls in patients with dementia: A prospective comparative study between 100% single rooms and traditional multibedded wards

    Directory of Open Access Journals (Sweden)

    Sophie Knight

    2016-09-01

    Conclusion: Patients with dementia were at an increased risk of recurrent IF in single rooms compared with MB-Ws. Recurrent IF could be correlated with longer LoS but it is difficult to establish the cause and effect due to the low power of the study. There was no significant difference in terms of injury or mortality between the two settings.

  1. Potential drug–drug interactions in pediatric wards of Gondar University Hospital, Ethiopia: A cross sectional study

    Directory of Open Access Journals (Sweden)

    Henok Getachew

    2016-06-01

    Conclusions: The study showed that most of the interactions had moderate severity followed by minor severity. Age and polypharmacy were found to show statistically significant association with the occurrence of PDDIs. Due to sensitive nature of pediatrics population, close monitoring is recommended for the detection and management of PDDIs to prevent its negative consequences.

  2. STUDY OF PRESCRIBING PATTERNS OF ANTIMICROBIAL AGENTS IN THE PAEDIATRIC WARDS AT TERTIARY TEACHING CARE HOSPITAL, GUJARAT

    Directory of Open Access Journals (Sweden)

    Vipul Prajapati* and J.D. Bhatt

    2012-07-01

    Full Text Available Background: Prescription of drugs, which needs to be continuously assessed and refined according to disease progression. It not only reflects the physician’s knowledge about drugs but also his/her skill in diagnose and attitude towards selecting the most appropriate cost-effective treatment. Antimicrobials are among the most commonly prescribed drugs in hospital. As per literature, they account for over 50% of total value of drugs sold in our country. Such studies have been sparse from Gujarat and hence, this study was undertaken.Methods: Retrospective study was carried out by collecting 350 prescriptions containing antimicrobial agents in paediatric department at Sir Sayajirao General (SSG Hospital, Vadodara to assess the prescribing patterns of antimicrobial agents. All information about the drugs details recorded in pre-tested Proforma that was finalized by our Pharmacology department. Results: Total 350 prescriptions containing 690 antimicrobial drugs were prescribed in patients during study. Of them aminoglycosides (233; 33.77% was frequently prescribed followed by β-lactam group (191; 27.68 and cephalosporins (176; 25.5%. Average numbers of antimicrobials per prescription was 1.97.Out of 690 antimicrobial prescribed, 576(83.48% were prescribed by generic name, while 114(16.52% were prescribed by trade name. Total numbers of antimicrobial prescribed by parenteral route were 599 (86.81%, while only 91(13.18% antimicrobial agents were prescribed by oral route. Out of 350 prescriptions two or more than two antimicrobial agents were prescribed in 249(71.14% prescriptions, while 101(28.85% prescriptions constitute one antimicrobial agent. Conclusion: Results indicates need for improving the prescribing pattern of drugs and minimizing the use of antimicrobial agents. It is suggested that further detail analysis to judge the rationality of the therapy is necessary.

  3. Etiological study of fever of unknown origin in patients admitted to medicine ward of a teaching hospital of Eastern India

    Directory of Open Access Journals (Sweden)

    Dipanjan Bandyopadhyay

    2011-01-01

    Full Text Available Background: In a developing country, infectious disease remains the most important cause of fever, but the noncommunicable diseases, like malignancy, are fast becoming important differential diagnoses. An important clinical problem is the cases labeled as fever of unknown origin (FUO, which often evade diagnosis. Objective: The present study was undertaken to find the cause of FUO in a tertiary care hospital of eastern India. Materials and Methods: This is a prospective study of inpatients, with regard to both clinical signs and investigations. Results: The main diagnosis in the end was tuberculosis, closely followed by hematological malignancy. A substantial number of cases remained undiagnosed despite all investigations. The provisional diagnosis matched with the final in around two thirds of the cases. While for younger patients leukemia was a significant diagnosis, for older ones, extra-pulmonary tuberculosis was a main concern. Interpretation: In India, infectious disease still remains the most important cause of fever. Thus the initial investigations should always include tests for that purpose in a case of FUO. Conclusion: Geographic variations and local infection profiles should always be considered when investigating a case of FUO. However, some of the cases always elude diagnosis, although the patients may respond to empirical therapy.

  4. The pattern of plasma sodium abnormalities in an acute elderly care ward: a cross-sectional study.

    LENUS (Irish Health Repository)

    O'Connor, K A

    2012-02-03

    INTRODUCTION: The combination of ageing, illness, and medications can lead to hyponatraemia or hypernatraemia. AIMS: To describe the distribution of plasma sodium levels in older patients admitted to hospital. METHODS: We carried out a hospital based cross-sectional study examining 1,511 serum sodium concentrations ([Na+]) among 336 elderly patients and attempted to elucidate the cause(s) of the abnormal serum [Na+]. RESULTS: The study population had a mean age of 81.4. Ninety-two (27.4%) patients had hyponatraemia and seven patients (2.1%) had hypernatraemia during their hospitalisation. The distribution of [Na+] results was towards the lower end of the normal range. The mortality rate of patients with hyponatraemia was 14.1% and that of patients with normal serum [Na+] was 8.9%. Six patients with hypernatraemia died in hospital. Lower respiratory tract infection and medication accounted for the majority of cases. CONCLUSIONS: Deranged [Na+] is common among elderly patients admitted to hospital.

  5. Incorporation of fasting therapy in an integrative medicine ward: evaluation of outcome, safety, and effects on lifestyle adherence in a large prospective cohort study.

    Science.gov (United States)

    Michalsen, Andreas; Hoffmann, Barbara; Moebus, Susanne; Bäcker, Markus; Langhorst, Jost; Dobos, Gustav J

    2005-08-01

    The aim of this study was to implement fasting therapy in an inpatient integrative medicine ward and to evaluate safety, acceptance, and effects on health-related outcomes and lifestyle adherence. This was a prospective observational study with consecutive inpatients over 3 [corrected] years. Inclusion and exclusion criteria for fasting therapy were checked by treating physicians and recommendations given. After receiving full information patients decided whether they would participate in fasting. Outcomes were assessed on admission, at discharge, and 3 and 6 months after discharge. The study took place in an integrative medicine department of an academic teaching hospital. Subjects were newly admitted inpatients with chronic internal diseases and chronic pain syndromes, with lengths of hospital stay of >3 days. All patients received intensive integrative treatments including Mind/Body Medicine, acupuncture, nutritional/lifestyle education, and hydrotherapy. Fasting patients participated in a 7-day juice fast (intake fasting, severity of main complaint, quality of life (QOL, MOS 36-Item Short-Form Health Survey), safety, lifestyle adherence to recommendations given (relaxation, diet, exercise). Of 2121 patients with complete discharge questionnaires, 952 patients participated in fasting, 873 had a normocaloric vegetarian diet, and 296 patients had other diets and were excluded. Response rates were 71% and 56% at 3- and 6-month follow-up. The main disease-related complaint at discharge was significantly greater improved in fasters versus nonfasters (p Fasting was well tolerated and no serious fasting-related adverse effects were reported. In all, 743 (78%) of fasting patients reported improvement of their health through fasting. Descriptors of lifestyle adherence showed higher levels of related activities in the 3 and 6 months of follow-up. Fasting can safely and successfully be implemented in an inpatient integrative medicine concept and is perceived as a health

  6. Variables Associated with Adherence to Stress Ulcer Prophylaxis in Patients Admitted to the General Hospital Wards: A Prospective Study

    Directory of Open Access Journals (Sweden)

    Shadi Farsaei

    2017-04-01

    Full Text Available Purpose: Nanostructured lipid carriers (NLCs composed of solid lipid and oil are a new generation of lipid nanoparticles which have exhibited some merits over traditional used lipid nanoparticles in fortifying food and beverages and nutraceuticals delivery systems such as liposomes and solid lipid nanoparticles. Methods: In this study, Precirol and Compritol as solid lipids, Miglyol and Octyloctanoat as liquid lipids, Tween80, Tween20 and Poloxamer407 as surfactants were used to prepare vitamin D3-loaded NLC dispersion using hot homogenization method. The particle size and size distribution for all formulations were evaluated by immediately after production and during a storage period of 60 days. Results: The Precirol-based NLC showed superiority over Compritol-based NLC in the point of physical stability. Results clearly suggested that an optimum concentration of 3% of Poloxamer407 or 2% of Tween20 was sufficient to cover the surface of nanoparticles effectively and prevent agglomeration during the homogenization process. Octyloctanoat was introduced for the first time as a good substituent for Miglyol in the preparation of NLC formulations. The vitamin D3 Intestinal absorption enhanced by the incorporating in NLCs. Conclusion: It was concluded that NLC showed a promising approach for fortifying beverages by lipophilic nutraceuticals such as vitamin D.

  7. 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.

  8. Time of drug elimination in chronic drug abusers. Case study of 52 patients in a "low-step" detoxification ward.

    Science.gov (United States)

    Reiter, A; Hake, J; Meissner, C; Rohwer, J; Friedrich, H J; Oehmichen, M

    2001-06-15

    The elimination time of illicit drugs and their metabolites is of both clinical and forensic interest. In order to determine the elimination time for various drugs and their metabolites we recruited 52 volunteers in a protected, low-step detoxification program. Blood samples were taken from each volunteer for the first 7 days, daily, urine sample for the first 3 weeks, daily. Urine was analyzed using a fluorescence-polarization immunoassay (FPIA) and gas chromatography/mass spectrometry (GC/MS), serum using GC/MS. The elimination times of the drugs and/or their metabolites in urine and serum as well as the tolerance intervals/confidence intervals were determined. Due to the sometimes extremely high initial concentrations and low cut-off values, a few of the volunteers had markedly longer elimination times than those described in the literature. The cut-off values were as follows: barbiturates II (200ng/ml), cannabinoids (20ng/ml), cocaine metabolites (300ng/ml), opiates (200ng/ml). GC/MS detected the following maximum elimination times: total morphine in urine up to 270.3h, total morphine and free morphine in serum up to 121.3h, monoacetylmorphine in urine up to 34.5h, 11-nor-9-carboxy-delta-9-tetrahydrocannabinol (THC-COOH) in urine up to 433.5h, THC-COOH in serum up to 74.3h, total codeine in urine up to 123h, free codeine in urine up to 97.5h, total codeine in serum up to 29h, free codeine in serum up to 6.3h, total dihydrocodeine (DHC) in urine up to 314.8h, free DHC in urine up to 273.3h, total and free DHC in serum up to 50.1h. Cocaine and its metabolites were largely undetectable in the present study.

  9. Prescribing patterns of antibiotics and sensitivity patterns of common microorganisms in the Internal Medicine ward of a teaching hospital in Western Nepal: a prospective study

    Directory of Open Access Journals (Sweden)

    Easow Joshy

    2003-07-01

    Full Text Available Abstract Background Information about antibiotic use and resistance patterns of common microorganisms are lacking in hospitals in Western Nepal. Excessive and inappropriate use of antibiotics contributes to the development of bacterial resistance. The parameter: Defined daily dose/100 bed-days, provides an estimate of consumption of drugs among hospital in-patients. This study was carried out to collect relevant demographic information, antibiotic prescribing patterns and the common organisms isolated including their antibiotic sensitivity patterns. Methods The study was carried out over a 3-month period (01.04.2002 to 30.06.2002 at the Manipal Teaching Hospital, Western Nepal. The median number of days of hospitalization and mean ± SD cost of antibiotics prescribed during hospital stay were calculated. The use of antibiotics was classified for prophylaxis, bacteriologically proven infection or non-bacteriologically proven infection. Sensitivity patterns of the common organisms were determined. Defined daily dose/100 bed-days of the ten most commonly prescribed antibiotics were calculated. Results 203 patients were prescribed antibiotics; 112 were male. Median duration of hospitalization was 5 days. 347 antibiotics were prescribed. The most common were ampicillin, amoxicillin, metronidazole, ciprofloxacin and benzylpenicillin. Mean ± SD cost of antibiotics was 16.5 ± 13.4 US$. Culture and sensitivity testing was carried out in 141 patients. The common organisms isolated were H. influenzae, E. coli, K. pneumoniae and S. aureus. Conclusions Antibiotic resistance is becoming a problem in the Internal Medicine ward. Formulation of a policy for hospital antibiotic use and an educational programme especially for junior doctors is required.

  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. 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

  12. [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.

  13. 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.

  14. Aggression in Psychiatric Wards

    DEFF Research Database (Denmark)

    Hvidhjelm, Jacob; Sestoft, Dorte; Skovgaard, Lene Theil

    2016-01-01

    Health care workers are often exposed to violence and aggression in psychiatric settings. Short-term risk assessments, such as the Brøset Violence Checklist (BVC), are strong predictors of such aggression and may enable staff to take preventive measures against aggression. This study evaluated...

  15. A Multi-Method Investigation of Mathematics Motivation for Elementary Age Students

    Science.gov (United States)

    Linder, Sandra M.; Smart, Julie B.; Cribbs, Jennifer

    2015-01-01

    This paper presents the results of a multi-method study examining elementary students with high self-reported levels of mathematics motivation. Second- through fifth-grade students at a Title One school in the southeastern United States completed the Elementary Mathematics Motivation Instrument (EMMI), which examines levels of mathematics…

  16. The Role of Attention in Somatosensory Processing: A Multi-Trait, Multi-Method Analysis

    Science.gov (United States)

    Wodka, Ericka L.; Puts, Nicolaas A. J.; Mahone, E. Mark; Edden, Richard A. E.; Tommerdahl, Mark; Mostofsky, Stewart H.

    2016-01-01

    Sensory processing abnormalities in autism have largely been described by parent report. This study used a multi-method (parent-report and measurement), multi-trait (tactile sensitivity and attention) design to evaluate somatosensory processing in ASD. Results showed multiple significant within-method (e.g., parent report of different…

  17. A Multi-Method Investigation of Mathematics Motivation for Elementary Age Students

    Science.gov (United States)

    Linder, Sandra M.; Smart, Julie B.; Cribbs, Jennifer

    2015-01-01

    This paper presents the results of a multi-method study examining elementary students with high self-reported levels of mathematics motivation. Second- through fifth-grade students at a Title One school in the southeastern United States completed the Elementary Mathematics Motivation Instrument (EMMI), which examines levels of mathematics…

  18. A Study to Identify Functions Which Inhibit or Facilitate the Health Care Delivery Process on Ward 51 at Walter Reed Army Medical Center, Washington, D.C.

    Science.gov (United States)

    1980-08-01

    system for distribution of supplies and linen on mobile supply carts has become a manual system because of design flaws in the monorail which was desigred...point have malfunctioned, creating the need for manual transport systems. 5. The move into the new facility coincided with fu]l implementation of the...of logistics technicians 3. Helpfulness of ward desk personnel - 29 - Administrativo Personnel 1. Information presented on nursing organization 2

  19. A multi-method proposal to study the Public Space in the Scale of Neighborhood from a Transactional Approach Una propuesta Multimétodo para un Abordaje Transaccional del Espacio Público en la Escala de Barrio

    Directory of Open Access Journals (Sweden)

    Hector Rodrigo Berroeta Torres

    2012-03-01

    Full Text Available The transactional perspective is very attractive to analyze and act on public space on the scale of the neighborhood, however, language and methodological differences between the various disciplines involved make it quite complex. In this article we present a multi-method qualitative strategy of analysis that integrates graphical work spatialisation results, as an attempt to bring together the graphic and textual languages that dominate single-discipline approaches of public space.
    Various techniques were triangulated and underwent the same analytical process (Grounded Theory, which supported by the processing software Atlas / ti and made it possible to link aspects Arcgis graphics (maps and images with comments from researchers and biographical accounts of the participants, associating in this manner, specific physical spaces with the development and construction of spatial meanings and uses.La perspectiva transaccional resulta muy atractiva para analizar y actuar sobre el espacio público en la escala de barrio, sin embargo, las diferencias metodológicas y de lenguaje entre las distintas disciplinas implicadas lo hacen bastante complejo. En este artículo queremos presentar una estrategia cualitativa de análisis multimetodo, que integra un trabajo de espacialización gráfica de resultados, como una tentativa de acercar los lenguajes gráficos y textuales que dominan los abordajes unidisciplinares del espacio público.
    Se triangularon diversas técnicas y se sometieron a un mismo proceso analítico (Grounded Theory, lo que apoyado por los programas de procesamiento Atlas/ti y Arcgis hicieron posible ligar aspectos gráficos (mapas e imágenes con observaciones de los investigadores y narraciones biográficas de los participantes, asociando de esta manera, espacios físicos concretos con la evolución y construcción de significados y usos espaciales.

  20. 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.

  1. 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

  2. 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.

  3. 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.

  4. Medically unexplained illness and the diagnosis of hysterical conversion reaction (HCR in women’s medicine wards of Bangladeshi hospitals: a record review and qualitative study

    Directory of Open Access Journals (Sweden)

    Kendall Emily A

    2012-10-01

    Full Text Available Abstract Background Frequent reporting of cases of hysterical conversion reaction (HCR among hospitalized female medical patients in Bangladesh’s public hospital system led us to explore the prevalence of “HCR” diagnoses within hospitals and the manner in which physicians identify, manage, and perceive patients whom they diagnose with HCR. Methods We reviewed admission records from women’s general medicine wards in two public hospitals to determine how often and at what point during hospitalization patients received diagnoses of HCR. We also interviewed 13 physicians about their practices and perceptions related to HCR. Results Of 2520 women admitted to the selected wards in 2008, 6% received diagnoses of HCR. HCR patients had wide-ranging symptoms including respiratory distress, headaches, chest pain, convulsions, and abdominal complaints. Most doctors diagnosed HCR in patients who had any medically-unexplained physical symptom. According to physician reports, women admitted to medical wards for HCR received brief diagnostic evaluations and initial treatment with short-acting tranquilizers or placebo agents. Some were referred to outpatient psychiatric treatment. Physicians reported that repeated admissions for HCR were common. Physicians noted various social factors associated with HCR, and they described failures of the current system to meet psychosocial needs of HCR patients. Conclusions In these hospital settings, physicians assign HCR diagnoses frequently and based on vague criteria. We recommend providing education to increase general physicians’ awareness, skill, and comfort level when encountering somatization and other common psychiatric issues. Given limited diagnostic capacity for all patients, we raise concern that when HCR is used as a "wastebasket" diagnosis for unexplained symptoms, patients with treatable medical conditions may go unrecognized. We also advocate introducing non-physician hospital personnel to address

  5. 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.

  6. 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...

  7. Unexplained Falls Are Frequent in Patients with Fall-Related Injury Admitted to Orthopaedic Wards: The UFO Study (Unexplained Falls in Older Patients

    Directory of Open Access Journals (Sweden)

    Mussi Chiara

    2013-01-01

    Full Text Available To evaluate the incidence of unexplained falls in elderly patients affected by fall-related fractures admitted to orthopaedic wards, we recruited 246 consecutive patients older than 65 (mean age 82±7 years, range 65–101. Falls were defined “accidental” (fall explained by a definite accidental cause, “medical” (fall caused directly by a specific medical disease, “dementia-related” (fall in patients affected by moderate-severe dementia, and “unexplained” (nonaccidental falls, not related to a clear medical or drug-induced cause or with no apparent cause. According to the anamnestic features of the event, older patients had a lower tendency to remember the fall. Patients with accidental fall remember more often the event. Unexplained falls were frequent in both groups of age. Accidental falls were more frequent in younger patients, while dementia-related falls were more common in the older ones. Patients with unexplained falls showed a higher number of depressive symptoms. In a multivariate analysis a higher GDS and syncopal spells were independent predictors of unexplained falls. In conclusion, more than one third of all falls in patients hospitalized in orthopaedic wards were unexplained, particularly in patients with depressive symptoms and syncopal spells. The identification of fall causes must be evaluated in older patients with a fall-related injury.

  8. Unexplained Falls Are Frequent in Patients with Fall-Related Injury Admitted to Orthopaedic Wards: The UFO Study (Unexplained Falls in Older Patients).

    Science.gov (United States)

    Chiara, Mussi; Gianluigi, Galizia; Pasquale, Abete; Alessandro, Morrione; Alice, Maraviglia; Gabriele, Noro; Paolo, Cavagnaro; Loredana, Ghirelli; Giovanni, Tava; Franco, Rengo; Giulio, Masotti; Gianfranco, Salvioli; Niccolò, Marchionni; Andrea, Ungar

    2013-01-01

    To evaluate the incidence of unexplained falls in elderly patients affected by fall-related fractures admitted to orthopaedic wards, we recruited 246 consecutive patients older than 65 (mean age 82 ± 7 years, range 65-101). Falls were defined "accidental" (fall explained by a definite accidental cause), "medical" (fall caused directly by a specific medical disease), "dementia-related" (fall in patients affected by moderate-severe dementia), and "unexplained" (nonaccidental falls, not related to a clear medical or drug-induced cause or with no apparent cause). According to the anamnestic features of the event, older patients had a lower tendency to remember the fall. Patients with accidental fall remember more often the event. Unexplained falls were frequent in both groups of age. Accidental falls were more frequent in younger patients, while dementia-related falls were more common in the older ones. Patients with unexplained falls showed a higher number of depressive symptoms. In a multivariate analysis a higher GDS and syncopal spells were independent predictors of unexplained falls. In conclusion, more than one third of all falls in patients hospitalized in orthopaedic wards were unexplained, particularly in patients with depressive symptoms and syncopal spells. The identification of fall causes must be evaluated in older patients with a fall-related injury.

  9. 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...

  10. 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.

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

    Directory of Open Access Journals (Sweden)

    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.

  12. 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.

  13. 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.

  14. 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....

  15. 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,…

  16. 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

  17. 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...

  18. 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.

  19. 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.

  20. 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

  1. 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...

  2. 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.

  3. Analytic Study of Conflict between the Theory of Evolution and the Creation System from Keith Ward’s Perspective

    Directory of Open Access Journals (Sweden)

    Forogh Rahimpoor

    2010-03-01

    Full Text Available About the seventeenth century till nineteenth century, the world was witnessed the emersion of modern science, that challenged the principles of theism and prepare context of conflict between science and religion. In nineteenth century one of these scientific theories that inquietude the problem of belief in God, was Darwin’s theory of evolution.   In this research we are trying to mention on philosophic issue of the theory of evolution and among this consecequent, we worked conflict between the theory of evolution and belief in God according to Argument from design and then from the perspective of contemporary of philopher “Keith Ward”, we investigate the cause and the salvation this conflict.   In this subject Keith Ward as religious man who accepted theory of evolution tried to rectified perceive of religious people about the theory of evolution, specially the principle of Natural Selection and on the other hand, he wanted to show the mistake of biologist who imposed value of principle of evolution and with rectified of these mater, he try to solved the conflict between the theory of evolution and belief in God, more than any other theory, can prove the creation system based on theory of evolution.

  4. [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.

  5. The Significance of Experiences of Nature for People with Parkinson’s Disease, with Special Focus on Freezing of Gait—The Necessity for a Biophilic Environment. A Multi-Method Single Subject Study

    Directory of Open Access Journals (Sweden)

    Johan Ottosson

    2015-06-01

    Full Text Available Freezing of Gait (FOG is a common condition in people with Parkinson’s disease (PD. FOG entails suddenly experiencing difficulties moving or feeling that one’s feet are as glued to the ground. It is triggered, e.g., when passing through doorways. Earlier studies suggest that being in natural environments affects FOG in a positive way. Five subjects were recruited to serve as five single subject cases. We used interviews, observations, questionnaires and collected gait pattern data with aid of an accelerometer. A special designed outdoor setting was used, where we investigated whether passing through hedge openings with or without built elements triggered FOG. We found that no one experienced a FOG reaction when they passed through hedge openings without built elements. However, FOG was triggered when a doorframe was inserted into a hedge opening, and/or when peripheral vision was blocked. We interpret the results such that the doorframe triggered a phobic reflex, causing a freezing reaction. Passing through hedge openings does not trigger FOG, which we interpret as a biophilic reaction. Our results, if repeated in future studies, may have significance to everyday lives of PD patients, who could get a simpler life by consciously prioritizing stays in natural surroundings.

  6. The Significance of Experiences of Nature for People with Parkinson’s Disease, with Special Focus on Freezing of Gait—The Necessity for a Biophilic Environment. A Multi-Method Single Subject Study

    Science.gov (United States)

    Ottosson, Johan; Lavesson, Lillian; Pinzke, Stefan; Grahn, Patrik

    2015-01-01

    Freezing of Gait (FOG) is a common condition in people with Parkinson’s disease (PD). FOG entails suddenly experiencing difficulties moving or feeling that one’s feet are as glued to the ground. It is triggered, e.g., when passing through doorways. Earlier studies suggest that being in natural environments affects FOG in a positive way. Five subjects were recruited to serve as five single subject cases. We used interviews, observations, questionnaires and collected gait pattern data with aid of an accelerometer. A special designed outdoor setting was used, where we investigated whether passing through hedge openings with or without built elements triggered FOG. We found that no one experienced a FOG reaction when they passed through hedge openings without built elements. However, FOG was triggered when a doorframe was inserted into a hedge opening, and/or when peripheral vision was blocked. We interpret the results such that the doorframe triggered a phobic reflex, causing a freezing reaction. Passing through hedge openings does not trigger FOG, which we interpret as a biophilic reaction. Our results, if repeated in future studies, may have significance to everyday lives of PD patients, who could get a simpler life by consciously prioritizing stays in natural surroundings. PMID:26132480

  7. Equilibrium and structure of the Al(III)-ethylenediamine-N,N'-bis(3-hydroxy-2-propionate) (EDBHP) complex. A multi-method study by potentiometry, NMR, ESI MS and X-ray diffraction.

    Science.gov (United States)

    Jószai, Róbert; Kerekes, Imola; Satoshi, Igarashi; Sawada, Kiyoshi; Zékány, László; Tóth, Imre

    2006-07-14

    The equilibrium and structure of the complex formed by Al(III) and ethylenediamine-N,N'-bis(3-hydroxy-2-propionate) (EDBHP2-) have been studied using pH-potentiometry, 1H and 27Al NMR, ESI MS and single crystal X-ray diffraction methods. The EDBHP ligand is a strong Al-binder in aqueous solution for pH between 4 and 8 and for c(Al) = c(EDBHP)> or = 0.1 mmol dm(-3). The dominating complex identified by ESI MS and potentiometry is a neutral dimer, Al2L2(OH)2, with logbeta(22-2) = 14.16 +/- 0.03. In the solid Al2(EDBHP)2(OH)2.2H2O the Al(III) ions are connected through a double hydroxo bridge. Both four-dentate organic ligands are coordinated terminally through two carboxylate groups and two N-donors forming three five-membered chelate rings. The hydroxyl groups of the ligand EDBHP remain protonated and are not coordinated to the aluminium ions. The structure and composition of the dimer are very likely the same in solution and the solid state.

  8. 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.

  9. 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.

  10. 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.

  11. 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...

  12. 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.

  13. 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.

  14. 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...

  15. 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.

  16. [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.

  17. Study comparing the stroke unit outcome and conventional ward treatment: a randomized study in Joinville, Brazil Estudo comparativo dos desfechos entre uma unidade de AVC e uma enfermaria geral: estudo randomizado em Joinville, Brasil

    Directory of Open Access Journals (Sweden)

    Norberto L. Cabral

    2003-06-01

    Full Text Available BACKGROUND AND PURPOSE: To assess the impact of a stroke unit (SU on acute phase treatment when compared to a conventional general ward treatment (GW. METHOD: Seventy-four patients with acute stroke were randomized between a SU and conventional general ward (GW. We compared both groups regarding the length of hospital stay, lethality and functional and clinical status within 6 months, using the Scandinavian scale and Barthel index. RESULTS: Thirty-five and thirty-nine patients were allocated at SU and GW, respectively. Lethality on the 10th day at SU and GW achieved 8.5% and 12.8% respectively (p= 0.41, whereas 30-days mortality rates achieved 14.2% and 28.2% (p= 0.24, 17.4% and 28.7% on the 3rd month (p= 0.39, and 25.7% and 30.7% on the 6th month (p= 0.41. Thirty-day survival curve achieved 1.8 log rank (p= 0.17, with a trend for lower lethality in the SU. In order to save one death in 6 months in SU, NNT (the number need to treat was 20; to get one more home independent patient NNT was 15. No significant difference was found between the length of hospital stay and morbidity. CONCLUSION: No significant benefit was found in SU patients compared to GW group. However,an evident benefit in absolute numbers was observed in lethality, survival curve and NNT in thirty days period after stroke. Further collaborative studies or incresead number of patients are required to define the role of SU.OBJETIVO: Avaliar se o tratamento da fase aguda em uma unidade de acidente vascular cerebral (U-AVC reduz a morbi-mortalidade quando comparado a uma enfermaria geral. MÉTODO: Pacientes com AVC agudo foram randomizados entre a U-AVC e uma enfermaria geral (EG. Comparou-se tempo de internação, letalidade e dependência funcional e clínica no período de 6 meses. RESULTADOS: Obtivemos 35 pacientes na U-AVC e 39 pacientes na EG. A letalidade encontrada na U-VAC e na EG foram respectivamente 8,5% e 12,8% no décimo dia (p=,41, 14,2% e 28,2% no trigésimo dia (p=,24

  18. A formative multi-method approach to evaluating training.

    Science.gov (United States)

    Hayes, Holly; Scott, Victoria; Abraczinskas, Michelle; Scaccia, Jonathan; Stout, Soma; Wandersman, Abraham

    2016-10-01

    This article describes how we used a formative multi-method evaluation approach to gather real-time information about the processes of a complex, multi-day training with 24 community coalitions in the United States. The evaluation team used seven distinct, evaluation strategies to obtain evaluation data from the first Community Health Improvement Leadership Academy (CHILA) within a three-prong framework (inquiry, observation, and reflection). These methods included: comprehensive survey, rapid feedback form, learning wall, observational form, team debrief, social network analysis and critical moments reflection. The seven distinct methods allowed for both real time quality improvement during the CHILA and long term planning for the next CHILA. The methods also gave a comprehensive picture of the CHILA, which when synthesized allowed the evaluation team to assess the effectiveness of a training designed to tap into natural community strengths and accelerate health improvement. We hope that these formative evaluation methods can continue to be refined and used by others to evaluate training.

  19. Medical academia clinical experiences of Ward Round Teaching curriculum

    Directory of Open Access Journals (Sweden)

    Fariba Haghani

    2014-01-01

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

  20. 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.

  1. 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}.

  2. 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...

  3. 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.

  4. 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.

  5. 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...

  6. 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.

  7. Lernen durch aktive Partizipation in der klinischen Patientenversorgung - Machbarkeitsstudie einer internistischen PJ-Ausbildungsstation [Learning by active participation in clinical care - a feasibility study of a clinical education ward in internal medicine

    Directory of Open Access Journals (Sweden)

    Tauschel, Diethard

    2009-08-01

    Full Text Available [english] Background and aims: The final year of the undergraduate medical curriculum in Germany consists of three 16-week rotations including one hospital-based rotation in internal medicine. The final-year program is supposed to be oriented toward real-world practice and competency-based learning. A Clinical Education Ward (CEW was developed to promote contextual and self-directed learning among medical students during their final-year rotation in internal medicine. The goal of multisource evaluation is to analyze the implications of this model in terms of patient care, ward organization, and the learning progress of medical students. Prerequisites for a “learning organization” should be established. Methods: At the CEW, final-year medical students were acting as “doctors under supervision” and taking care of patients in a ward for internal medicine. Students were instructed and closely supervised by clinical tutors. All patients admitted to the CEW were surveyed using a questionnaire to assess the implications of student involvement in clinical care. Clinical staff members (physicians, nurses, therapists were asked about changes in terms of ward organization and interprofessional teamwork. Students assessed themselves at the beginning and at the end of the rotation in terms of clinical competencies, which were developed in cooperation with the students in preparation for the CEW.The project is part of the Integrated Studies of Anthroposophic Medicine program at the University of Witten/Herdecke (Germany, which aims to foster self-directed learning. Results: Fifty-six patients on the CEW were asked to complete a survey; 34 (60.7% responded. The majority (71% saw positive implications of student involvement in clinical care. Staff members (n = 28, return: 23 or 82% were in favor of the continued implementation of the CEW as a permanent institution. Medical students of the first two rotations (n = 9 self-assessed progress in all

  8. [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.

  9. 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

  10. "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)…

  11. 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 ...

  12. 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…

  13. "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)…

  14. 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.

  15. 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...

  16. 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.

  17. 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.

  18. 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.

  19. [An analysis of cost and profit of a nursing unit using performance-based costing: case of a general surgical ward in a general hospital].

    Science.gov (United States)

    Lim, Ji Young

    2008-02-01

    The aim of this study was to analyze net income of a surgical nursing ward in a general hospital. Data collection and analysis was conducted using a performance-based costing and activity-based costing method. Direct nursing activities in the surgical ward were 68, indirect nursing activities were 10. The total cost volume of the surgical ward was calculated at won 119,913,334.5. The cost volume of the allocated medical department was won 91,588,200.3, and the ward consumed cost was won 28,325,134.2. The revenue of the surgical nursing ward was won 33,269,925.0. The expense of a surgical nursing ward was 28,325,134.2. Therefore, the net income of a surgical nursing ward was won 4,944,790.8. We suggest that to develop a more refined nursing cost calculation model, a standard nursing cost calculation system needs to be developed.

  20. 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

  1. 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

  2. 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.

  3. 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.

  4. 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.

  5. 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...

  6. 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.

  7. Clinical characteristics of very old patients hospitalized in internal medicine wards for heart failure: a sub-analysis of the FADOI-CONFINE Study Group

    Directory of Open Access Journals (Sweden)

    Paolo Biagi

    2014-03-01

    Full Text Available The incidence and prevalence of chronic heart failure are increasing worldwide, as is the number of very old patients (>85 years affected by this disease. The aim of this sub-analysis of the multicenter, observational CONFINE study was to detect clinical and therapeutic peculiarities in patients with chronic heart failure aged >85 years. We recruited patients admitted with a diagnosis of chronic heart failure and present in the hospital in five index days, in 91 Units of Internal Medicine. The patients’ clinical characteristics, functional and cognitive status, and the management of the heart failure were analyzed. A total of 1444 subjects were evaluated, of whom 329 (23.1% were over 85 years old. Signs and symptoms of chronic heart failure were more common in very old patients, as were severe renal insufficiency, anemia, disability and cognitive impairment. The present survey found important age-related differences (concomitant diseases, cognitive status among patients with chronic heart failure, as well as different therapeutic strategies and clinical outcome for patients over 85 years old. Since these patients are usually excluded from clinical trials and their management remains empirical, specific studies focused on the treatment of very old patients with chronic heart failure are needed.

  8. The Role of Attention in Somatosensory Processing: A Multi-trait, Multi-method Analysis

    Science.gov (United States)

    Puts, Nicolaas A. J.; Mahone, E. Mark; Edden, Richard A. E.; Tommerdahl, Mark; Mostofsky, Stewart H.

    2016-01-01

    Sensory processing abnormalities in autism have largely been described by parent report. This study used a multi-method (parent-report and measurement), multi-trait (tactile sensitivity and attention) design to evaluate somatosensory processing in ASD. Results showed multiple significant within-method (e.g., parent report of different traits)/cross-trait (e.g., attention and tactile sensitivity) correlations, suggesting that parent-reported tactile sensory dysfunction and performance-based tactile sensitivity describe different behavioral phenomena. Additionally, both parent-reported tactile functioning and performance-based tactile sensitivity measures were significantly associated with measures of attention. Findings suggest that sensory (tactile) processing abnormalities in ASD are multifaceted, and may partially reflect a more global deficit in behavioral regulation (including attention). Challenges of relying solely on parent-report to describe sensory difficulties faced by children/families with ASD are also highlighted. PMID:27448580

  9. Limitaciones de esfuerzos terapéuticos: Resultados de un registro prospectivo en una sala de clínica médica Limitation of life-sustaining treatment: A prospective study developed in a clinical ward

    Directory of Open Access Journals (Sweden)

    Abel Novillo

    2008-12-01

    Full Text Available El objetivo de este trabajo fue describir el proceso de limitación de los esfuerzos terapéuticos (LET en los pacientes internados en una sala general. Para ello se realizó un estudio prospectivo descriptivo, desarrollado en la sala de internación general de un hospital universitario. Fueron evaluados pacientes que tuviesen alguna LET, asistidos por el servicio de clínica médica en un período de 60 días consecutivos. Durante el mismo se hospitalizaron 402 pacientes, 62 (15% tuvieron algún tipo de LET. Este último grupo estaba compuesto por un 66% de mujeres, la mediana de edad fue de 86 años (78-90 y de la duración de hospitalización de 12 días (8-18. La mala calidad de vida fue la causa más frecuente de LET (69%. Se brindó información acerca de las limitaciones a 43 familias (69% y 8 pacientes (13%. En la decisión participaron el médico de cabecera (50%, médicos de planta (50%, residentes (40%, la familia (42% y los propios pacientes (11%. En 7 casos hubo constancia en la historia clínica (11%. Diecisiete pacientes (27% con LET fallecieron durante la internación, mientras que 44 (71% fueron dados de alta. En conclusión, la limitación de esfuerzos terapéuticos en nuestros pacientes constituyó un hecho frecuente. No se logró identificar un proceso uniforme o sistematizado para la toma de la decisión de LET. Resulta innegable la necesidad de normativas que guíen al equipo de salud en la toma de decisiones, tranquilicen a familiares y acompañen a los pacientes en sus reales necesidades.The purpose of this study is to describe the limiting life-sustaining treatment process of patients admitted to a general ward. A prospective descriptive study was designed. The setting was the general ward of universitary hospital. Study participants were patients assisted by the internal medicine department during a 60- consecutive days period who had limitations of life sustaining treatments. During the study period, 402 patients were

  10. Multi-method attribution analysis of extreme precipitation in Boulder, Colorado

    Science.gov (United States)

    Eden, Jonathan M.; Wolter, Klaus; Otto, Friederike E. L.; van Oldenborgh, Geert Jan

    2016-12-01

    Understanding and attributing the characteristics of extreme events that lead to societal impacts is a key challenge in climate science. Detailed analysis of individual case studies is particularly important in assessing how anthropogenic climate change is changing the likelihood of extreme events and their associated risk at relevant spatial scales. Here, we conduct a comprehensive multi-method attribution analysis of the heavy precipitation that led to widespread flooding in Boulder, Colorado in September 2013. We provide clarification on the source regions of moisture associated with this event in order to highlight the difficulty of separating dynamic and thermodynamic contributions. Using extreme value analysis of, first of all, historical observations, we then assess the influence of anthropogenic climate change on the overall likelihood of one- and five-day precipitation events across the Boulder area. The same analysis is extended to the output of two general circulation model ensembles. By combining the results of different methods we deduce an increase in the likelihood of extreme one-day precipitation but of a smaller magnitude than what would be expected in a warming world according to the Clausius-Clapeyron relation. For five-day extremes, we are unable to detect a change in likelihood. Our results demonstrate the benefits of a multi-method approach to making robust statements about the anthropogenic influence on changes in the overall likelihood of such an event irrespective of its cause. We note that, in this example, drawing conclusions solely on the basis of thermodynamics would have overestimated the increase in risk.

  11. 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.

  12. 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...

  13. Explicating students’ personal professional theories in vocational education through multi-method triangulation

    NARCIS (Netherlands)

    Schaap, Harmen; De Bruijn, Elly; Van der Schaaf, Marieke; Baartman, Liesbeth; Kirschner, Paul A.

    2011-01-01

    Schaap, H., De Bruijn, E., Van der Schaaf, M. F., Baartman, L. K. J., & Kirschner, P. A. (2011). Explicating students’ personal professional theories in vocational education through multi-method triangulation. Scandinavian Journal of Educational Research, 55, 567-586.

  14. Explicating students’ personal professional theories in vocational education through multi-method triangulation

    NARCIS (Netherlands)

    Schaap, Harmen; De Bruijn, Elly; Van der Schaaf, Marieke; Baartman, Liesbeth; Kirschner, Paul A.

    2011-01-01

    Schaap, H., De Bruijn, E., Van der Schaaf, M. F., Baartman, L. K. J., & Kirschner, P. A. (2011). Explicating students’ personal professional theories in vocational education through multi-method triangulation. Scandinavian Journal of Educational Research, 55, 567-586.

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

    Directory of Open Access Journals (Sweden)

    Saadi Amini

    2015-08-01

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

  16. [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.

  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. 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.

  19. Multidisciplinary case management for patients at high risk of hospitalization: comparison of virtual ward models in the United kingdom, United States, and Canada.

    Science.gov (United States)

    Lewis, Geraint; Wright, Lorraine; Vaithianathan, Rhema

    2012-10-01

    Virtual wards are a model for delivering multidisciplinary case management to people who are at high predicted risk of unplanned acute care hospitalization. First introduced in Croydon, England, in 2006, this concept has since been adopted and adapted by health care organizations in other parts of the United Kingdom and internationally. In this article, the authors review the model of virtual wards as originally described-with its twin pillars of (1) using a predictive model to identify people who are at high risk of future emergency hospitalization, and (2) offering these individuals a period of intensive, multidisciplinary preventive care at home using the systems, staffing, and daily routines of a hospital ward. The authors then describe how virtual wards have been modified and implemented in 6 sites in the United Kingdom, United States, and Canada where they are subject to formal evaluation. Like hospital wards, virtual wards vary in terms of patient selection, ward configuration, staff composition, and ward processes. Policy makers and researchers should be aware of these differences when considering the evaluation results of studies investigating the cost-effectiveness of virtual wards.

  20. [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.

  1. 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....

  2. 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.

  3. 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...

  4. Evaluating First Experiences with an Educational Computer Game: A multi-Method Approach

    Directory of Open Access Journals (Sweden)

    Marianna Obrist

    2011-10-01

    Full Text Available This paper presents our evaluation approach for a specific case study, namely the evaluation of an early prototype of an educational game with children aged between 12 and 14 years. The main goal of this initial evaluation study was to explore children’s first impressions and experiences of the game on the one hand and to assess the students’ ideas and wishes for the further development of the game on the other hand. The main challenge for the evaluation activities was the selection of the appropriate methodological approach, taking into account children as a special user group. We opted for a combination of different, mainly qualitative and explorative methods that were reported beneficial for work with children in the human-computer interaction (HCI field. By presenting our multi-method approach, in particular the different steps and procedure within our study, other researchers can get inspirations for follow up activities when evaluating games with children as well as benefit from our experiences in exploring more collaborative methods and methodological combinations.

  5. 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

  6. 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.

  7. A multi-method approach to evaluate health information systems.

    Science.gov (United States)

    Yu, Ping

    2010-01-01

    Systematic evaluation of the introduction and impact of health information systems (HIS) is a challenging task. As the implementation is a dynamic process, with diverse issues emerge at various stages of system introduction, it is challenge to weigh the contribution of various factors and differentiate the critical ones. A conceptual framework will be helpful in guiding the evaluation effort; otherwise data collection may not be comprehensive and accurate. This may again lead to inadequate interpretation of the phenomena under study. Based on comprehensive literature research and own practice of evaluating health information systems, the author proposes a multimethod approach that incorporates both quantitative and qualitative measurement and centered around DeLone and McLean Information System Success Model. This approach aims to quantify the performance of HIS and its impact, and provide comprehensive and accurate explanations about the casual relationships of the different factors. This approach will provide decision makers with accurate and actionable information for improving the performance of the introduced HIS.

  8. Multi-method automated diagnostics of rotating machines

    Science.gov (United States)

    Kostyukov, A. V.; Boychenko, S. N.; Shchelkanov, A. V.; Burda, E. A.

    2017-08-01

    The automated machinery diagnostics and monitoring systems utilized within the petrochemical plants are an integral part of the measures taken to ensure safety and, as a consequence, the efficiency of these industrial facilities. Such systems are often limited in their functionality due to the specifics of the diagnostic techniques adopted. As the diagnostic techniques applied in each system are limited, and machinery defects can have different physical nature, it becomes necessary to combine several diagnostics and monitoring systems to control various machinery components. Such an approach is inconvenient, since it requires additional measures to bring the diagnostic results in a single view of the technical condition of production assets. In this case, we mean by a production facility a bonded complex of a process unit, a drive, a power source and lines. A failure of any of these components will cause an outage of the production asset, which is unacceptable. The purpose of the study is to test a combined use of vibration diagnostics and partial discharge techniques within the diagnostic systems of enterprises for automated control of the technical condition of rotating machinery during maintenance and at production facilities. The described solutions allow you to control the condition of mechanical and electrical components of rotating machines. It is shown that the functionality of the diagnostics systems can be expanded with minimal changes in technological chains of repair and operation of rotating machinery. Automation of such systems reduces the influence of the human factor on the quality of repair and diagnostics of the machinery.

  9. 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

  10. Multi-Method Provenance Analysis of Namibian Desert Sand

    Science.gov (United States)

    Vermeesch, P.; Garzanti, E.

    2014-12-01

    Mineralogical, geochemical and geochronological provenance proxies each have their own strengths and weaknesses: a. Bulk geochemistry, framework petrography and heavy mineral compositions can differentiate between source areas characterised by different lithologies, but are sensitive to hydraulic sorting and chemical alteration. b. Detrital zircon U-Pb geochronology is insensitive to winnowing effects, but is 'blind' to lithologies devoid of zircon and cannot differentiate between first cycle and recycled sediments. c. Cosmogenic neon isotopes can be used to identify different generations of surface exposure while simultaneously tracking different magmatic sources. The challenge is then to combine these different proxies into a self consistent story, and do so in as objective a manner as possible. We here present a case study of Namibia's Namib Sand Sea and Skeleton Coast ergs, in which all the aforementioned methods have been combined using a three-way multidimensional scaling (aka INDividual Differences SCALing or INDSCAL) analysis: 1. Each of the datasets was represented by a 'dissimilarity matrix' of pairwise distances between samples. 2. The set of these matrices was fed into the INDSCAL algorithm, which produces two pieces of graphical output: the 'group configuration', which is a scatter plot or 'map' in which similar samples plot close together and dissimilar samples plot far apart, and the 'proxy weights', in which not the samples but the proxies are plotted according to the weight they attached to the 'group configuration' axes. The INDSCAL map of the Namibia dataset indicates that (a) long-shore drift of Orange River sediments dominates the coastal sediment compositions all along the Namibian coast until Angola, and (b) that light and heavy minerals tell complementary parts of the provenance story.

  11. 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.

  12. Reconstructing paleo- and initial landscapes using a multi-method approach in hummocky NE Germany

    Science.gov (United States)

    van der Meij, Marijn; Temme, Arnaud; Sommer, Michael

    2016-04-01

    The unknown state of the landscape at the onset of soil and landscape formation is one of the main sources of uncertainty in landscape evolution modelling. Reconstruction of these initial conditions is not straightforward due to the problems of polygenesis and equifinality: different initial landscapes can change through different sets of processes to an identical end state. Many attempts have been done to reconstruct this initial landscape. These include remote sensing, reverse modelling and the usage of soil properties. However, each of these methods is only applicable on a certain spatial scale and comes with its own uncertainties. Here we present a new framework and preliminary results of reconstructing paleo-landscapes in an eroding setting, where we combine reverse modelling, remote sensing, geochronology, historical data and present soil data. With the combination of these different approaches, different spatial scales can be covered and the uncertainty in the reconstructed landscape can be reduced. The study area is located in north-east Germany, where the landscape consists of a collection of small local depressions, acting as closed catchments. This postglacial hummocky landscape is suitable to test our new multi-method approach because of several reasons: i) the closed catchments enable a full mass balance of erosion and deposition, due to the collection of colluvium in these depressions, ii) significant topography changes only started recently with medieval deforestation and recent intensification of agriculture and iii) due to extensive previous research a large dataset is readily available.

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

    Directory of Open Access Journals (Sweden)

    Wann-Hansson Christine

    2011-06-01

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

  14. 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.

  15. $B_7$, $B_8$ 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.

  16. 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…

  17. 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

  18. 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...

  19. 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

  20. 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.

  1. 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.

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

    Science.gov (United States)

    Sadsad, Rosemarie; Sintchenko, Vitali; McDonnell, Geoff D; Gilbert, Gwendolyn L

    2013-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Rosemarie Sadsad

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

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

    Science.gov (United States)

    Lu, Po-Liang; Siu, L K; Chen, Tun-Chieh; Ma, Ling; Chiang, Wen-Gin; Chen, Yen-Hsu; Lin, Sheng-Fung; Chen, Tyen-Po

    2009-10-01

    Computer keyboards and mice are potential reservoirs of nosocomial pathogens, but routine disinfection for non-water-proof computer devices is a problem. With better hand hygiene compliance of health-care workers (HCWs), the impact of these potential sources of contamination on clinical infection needs to be clarified. This study was conducted in a 1600-bed medical center of southern Taiwan with 47 wards and 282 computers. With education and monitoring program of hand hygiene for HCWs, the average compliance rate was 74% before our surveillance. We investigated the association of methicillin-resistant Staphylococcus aureus (MRSA), Pseudomonas aeruginosa and Acinetobacter baumannii, three leading hospital-acquired pathogens, from ward computer keyboards, mice and from clinical isolates in non-outbreak period by pulsed field gel electrophoresis and antibiogram. Our results revealed a 17.4% (49/282) contamination rate of these computer devices by S. aureus, Acinetobacter spp. or Pseudomonas spp. The contamination rates of MRSA and A. baumannii in the ward computers were 1.1% and 4.3%, respectively. No P. aeruginosa was isolated. All isolates from computers and clinical specimens at the same ward showed different pulsotypes. However, A. baumannii isolates on two ward computers had the same pulsotype. With good hand hygiene compliance, we found relatively low contamination rates of MRSA, P. aeruginosa and A. baumannii on ward computer interface, and without further contribution to nosocomial infection. Our results suggested no necessity of routine culture surveillance in non-outbreak situation.

  5. 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.

  6. 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.

  7. 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.

  8. 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.

  9. 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.

  10. 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.

  11. 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].

  12. 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.

  13. 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

  14. 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.

  15. 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.

  16. Synthesized Multi-Method to Detect and Classify Epileptic Waves in EEG

    Institute of Scientific and Technical Information of China (English)

    万柏坤; 毕卡诗; 綦宏志; 赵丽

    2004-01-01

    In order to sufficiently exploit the advantages of different signal processing methods, such as wavelet transformation (WT), artificial neural networks (ANN) and expert rules (ER),a synthesized multi-method was introduced to detect and classify the epileptic waves in the EEG data. Using this method, at first, the epileptic waves were detected from pre-processed EEG data at different scales by WT, then the characteristic parameters of the chosen candidates of epileptic waves were extracted and sent into the well-trained ANN to identify and classify the true epileptic waves,and at last, the detected epileptic waves were certificated by ER. The statistic results of detection and classification show that, the synthesized multi-method has a good capacity to extract signal features and to shield the signals from the random noise. This method is especially fit for the analysis of the biomedical signals in biomedical engineering which are usually non-placid and nonlinear.

  17. [Perceiving gender or profession: the practical experience of male nursing students in the obstetrics and gynecology ward].

    Science.gov (United States)

    Lee, Ya-Fen; Yang, Yu-O; Tu, Chia-Ling

    2013-06-01

    The impact of general gender stereotypes on nursing is severe and influential, especially with regard to male nursing students working in obstetrics and gynecology wards. This study examined the experience of male nursing students in obstetrics and gynecology wards. We used a phenomenological qualitative research approach and a sample of 10 male nursing students currently studying at a nursing college in central Taiwan. All participants had obstetrics and gynecology ward experience. Individual interviews were transcribed into the procedural record. Colaizzi content analysis analyzed and categorized research data. Based on participants practical experiences in the obstetrics and gynecology ward, the main stages of participants professional development through their internship experience included: (1) Unbalanced self-role recognition; (2) being defined by the gender framework (gender stereotypes); (3) the difference between male doctor and male nurse; (4) learning appropriate communication techniques; (5) mutual and empathetic understanding of the female psychology during childbirth; (6) gaining sources for positive feedback; (7) releasing the shackles of gender and gaining full insight into and comprehension of nursing functions; and (8) given the opportunity to learn. Through ongoing examination and learning, participant internships in the obstetrics and gynecology wards were significant and essential learning experiences that validated their necessity. Nursing schools and internship institutions alike must realize the importance of gender-equality education to the nursing profession. Medical institutions are encouraged to offer equal learning opportunities to male and female nursing students and provide targeted assistance to males to help them master clinical nursing care practices in the obstetrics and gynecology department.

  18. 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.

  19. The construct validity of the Spanish version of the ABQ using a multi-trait/multi-method approach

    Directory of Open Access Journals (Sweden)

    Thomas D. Raedeke

    2013-10-01

    Full Text Available This study was designed to evaluate construct validity evidence associated with the Spanish version of the Athlete Burnout Questionnaire (ABQ using a multi-trait/multi-method (MTMM approach. The ABQ was administered to a sample of 302 Spanish athletes, along with two other questionnaires including the Maslach Burnout Inventory-General Survey (MBI-GS and the Depression, Anxiety, Stress Scale (DASS-21, which respectively measure burnout in organizational settings and indicators of ill being including depression, anxiety and stress. A structural equation modeling approach to a MTMM analysis was used. Results revealed by comparative analysis of four models that the Spanish version of ABQ has convergent and internal discriminant validity evident by high correlations between matching burnout subscales across two measures and lower correlations between non-matching dimensions. In addition, the burnout measures exhibited external discriminant validity as the correlations between burnout dimensions were higher than those seen between conceptually related, but unique, constructs.

  20. 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

  1. ICU护士与病人亲属对病人家庭需要重要性认识的调查分析%Comparative Study on the Family Needs for Nurses and Patients' Relatives in ICU Wards

    Institute of Scientific and Technical Information of China (English)

    王文茹; 李小妹; 高睿

    2001-01-01

    In order to investigate the family needs for the ICU nurses and patients' relatives in ICU wards, Molter family need scale for emergent and severe patients was applied to comparatively analyze 50 relatives of ICU patients and 50 ICU nurses. The results showed that the relatives of the ICU patients and ICU nurses all considered that the needs closely related with the life and benefit of the patients was the most important, but there was a significant difference in the scores between the relatives of the ICU patients and ICU nurses (P<0.05). It was suggested that ICU nurses should pay attention to the needs of the ICU patients, immediately provide information and fully understand the need of the relatives of the patients to help the patients' family act on the emergent status of the patients and maintain the physical and mental health of the patients and their relatives.%为了解病人在ICU接受监护时,其亲属及ICU护士对病人家庭需要重要性的认识,应用Molter“急危重病人家庭需要量表”对50名ICU病人亲属及50名ICU护士进行调查。结果ICU病人亲属及ICU护士均认为与病人生命及利益密切相关的需要最重要,但其得分比较,差异有显著性意义(P<0.05)。提示ICU护士必须充分认识ICU病人需要的重要性,及时提供各种信息,并充分认识其亲属的需要,以帮助病人家庭应对其危机状态,维护病人及亲属的身心健康。

  2. 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.

  3. 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....

  4. 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.

  5. 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.

  6. The Changing Pattern of Hospital Admission to Medical Wards: Burden of non-communicable diseases at a hospital in a developing country

    OpenAIRE

    Noor, Sufian K.; Elmadhoun, Wadie M.; Bushara, Sarra O.; Ahmed, Mohamed H

    2015-01-01

    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 Healt...

  7. 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.

  8. 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

  9. 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.

  10. 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

  11. 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.

  12. [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.

  13. 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...

  14. 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...

  15. 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 ...

  16. [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.

  17. 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

  18. 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. 

  19. Role of clinical pharmacists' interventions in detection and prevention of medication errors in a medical ward.

    Science.gov (United States)

    Khalili, Hossein; Farsaei, Shadi; Rezaee, Haleh; Dashti-Khavidaki, Simin

    2011-04-01

    Frequency and type of medication errors and role of clinical pharmacists in detection and prevention of these errors were evaluated in this study. During this interventional study, clinical pharmacists monitored 861 patients' medical records and detected, reported, and prevented medication errors in the infectious disease ward of a major referral teaching hospital in Tehran, Iran. Error was defined as any preventable events that lead to inappropriate medication use related to the health care professionals or patients regardless of outcomes. Classification of the errors was done based on Pharmaceutical Care Network Europe Foundation drug-related problem coding. During the study period, 112 medication errors (0.13 errors per patient) were detected by clinical pharmacists. Physicians, nurses, and patients were responsible for 55 (49.1%), 54 (48.2%), and 3 (2.7%) of medication errors, respectively. Drug dosing, choice, use and interactions were the most causes of error in medication processes, respectively. All of these errors were detected, reported, and prevented by infectious diseases ward clinical pharmacists. Medication errors occur frequently in medical wards. Clinical pharmacists' interventions can effectively prevent these errors. The types of errors indicate the need for continuous education and implementation of clinical pharmacist's interventions.

  20. 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.

  1. 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.

  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. 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.

  5. 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.

  6. 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...

  7. Risk Assessment Tool for Pressure Ulcer Development in Indian Surgical Wards.

    Science.gov (United States)

    Kumari, Sushma; Sharma, Deborshi; Rana, Anshika; Pathak, Reetesh; Lal, Romesh; Kumar, Ajay; Biswal, U C

    2015-06-01

    The aims of this paper were to compare the predictive validity of three pressure ulcer (PU) risk scales-the Norton scale, the Braden scale, and the Waterlow scale-and to choose the most appropriate calculator for predicting PU risk in surgical wards of India. This is an observational prospective cohort study in a tertiary educational hospital in New Delhi among 100 surgical ward patients from April to July 2011. The main outcomes measured included sensitivity, specificity, positive predictive value (PVP) and negative predictive value (PVN), and the area under the curve of the receiver operating characteristic (ROC) curve of the three PU risk assessment scales. Based on the cutoff points found most appropriate in this study, the sensitivity, specificity, PVP, and PVN were as follows: the Norton scale (cutoff, 16) had the values of 95.6, 93.5, 44.8, and 98.6, respectively; the Braden scale (cutoff, 17) had values of 100, 89.6, 42.5, and 100, respectively; and the Waterlow scale (cutoff, 11) had 91.3, 84.4, 38.8, and 97, respectively. According to the ROC curve, the Norton scale is the most appropriate tool. Factors such as physical condition, activity, mobility, body mass index (BMI), nutrition, friction, and shear are extremely significant in determining risk of PU development (p nutrition, friction, and shear are the most significant factors in Indian surgical ward settings with necessity for future comparison with established scales.

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

    Science.gov (United States)

    Hallin, Karin; Kiessling, Anna

    2016-01-01

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

  9. Understanding the modifiable health systems barriers to hypertension management in Malaysia: a multi-method health systems appraisal approach

    National Research Council Canada - National Science Library

    Risso-Gill, Isabelle; Balabanova, Dina; Majid, Fadhlina; Ng, Kien Keat; Yusoff, Khalid; Mustapha, Feisul; Kuhlbrandt, Charlotte; Nieuwlaat, Robby; Schwalm, J-D; McCready, Tara; Teo, Koon K; Yusuf, Salim; McKee, Martin

    2015-01-01

    .... We describe a multi-method health system appraisal to inform the design of an intervention that will be used in a cluster randomized controlled trial to improve hypertension control in Malaysia...

  10. 住院癌症患者疼痛管理结局现状及影响因素分析%Descriptive study of outcomes of cancer pain management in patients from good pain management ward

    Institute of Scientific and Technical Information of China (English)

    赵贝贝; 娄小平; 康晶晶; 杜文婷; 郑晓; 申红霞

    2016-01-01

    目的:探讨无痛病房住院癌症患者疼痛管理结局现状及影响因素。方法:应用美国疼痛协会患者结局问卷修订版,采用分层随机整群的抽样方法进行抽样后,对郑州市5家无痛病房458例癌症患者进行调查。结果:住院癌症患者平均疼痛程度得分为(3.16±1.39)分,疼痛对患者的影响程度得分为(3.68±1.94)分,患者疼痛管理满意度得分为(4.54±0.66)分,患者的疼痛信念得分为(2.45±0.88)分。回归分析结果显示,影响疼痛程度的因素有疼痛缓解程度、性别、等待止痛药时间、肿瘤分期、止痛药物类型、评估记录、疼痛治疗指数(P<0.05);影响疼痛对患者的影响程度的因素有换用其他止痛药物、疼痛缓解程度、等待止痛药时间、止痛药物类型、评估记录、用药方法(P<0.05);影响疼痛管理满意度的因素有疼痛缓解程度、护士态度、换用其他止痛药物、医院级别和疼痛治疗指数( P<0.05);影响疼痛信念的因素有护士关注度、医生态度、等待止痛药时间、疼痛缓解程度和医院级别(P<0.05)。结论:无痛病房癌症患者仍有中到低度的疼痛,疼痛信念较差。医护人员应对患者加强疼痛教育。%Aim:To describe the outcomes of cancer pain management in good pain management ward and explore re -lated factors .Methods:The American Pain Society Patient Outcomes Questionnaire Modified was used to survey 458 canc-er inpatients recruited from good pain management wards of five hospitals in Zhengzhou City .Results: The mean of the pain intensity was (3.16 ±1.39), the mean of pain interfere was (3.68 ±1.94), the mean of patients′satisfaction was (4.54 ±0.66), and the mean of pain beliefs was (2.45 ±0.88).The predictors of the pain intensity included pain relief , gender, waiting time for analgesic, cancer stage, analgesic type,assessment and

  11. 老年患者医院获得性血流感染的临床回顾性研究%Hospital-acquired bloodstream infections in geriatric wards: a retrospective clinical study

    Institute of Scientific and Technical Information of China (English)

    柏淑禹; 张伟

    2016-01-01

    目的 探讨老年病房医院感染血流感染病例的临床特点、病原学特征及其他相关因素,为临床诊疗提供科学依据.方法 对我院老年病房2010年6月至2015年10月医院获得性血流感染患者的相关因素及临床特征进行回顾性分析.结果 老年血流感染患者64例,基础疾病以恶性肿瘤(39.1%)及2型糖尿病(32.8%)为主;原发血流感染53例,占82.8%;继发性血流感染11例,占17.2%;原发感染病灶以呼吸道、泌尿道和肝胆系统为主.13例患者死亡,病死率高达20.3%.多因素条件Logistic逐步回归分析显示,中心静脉置管或输液港≥7 d(OR=49.51)、使用质子泵抑制剂药物≥3d(OR=13.63)是老年患者血流感染发生的独立危险因素;64例患者中,共检出66株病原菌.G+菌以凝固酶阴性葡萄球菌属最常见(18.2%);G-菌以埃希菌属(18.2%)和克雷伯菌属(15.2%)多见,二者产超广谱β-内酰胺酶株为54.5%.结论 血流感染严重影响老年患者的预后.减少侵袭性操作、积极防治肿瘤、改善内环境、保护重要脏器功能,是降低老年病房血流感染发生率的主要措施.%Objective To investigate the clinical and pathogenic features and other related factors of hospital-acquired bloodstream infections (HABSI) in geriatric wards,in order to provide the scientific basis for clinical diagnosis and therapy.Methods Clinical characteristics and other related factors of HABSI in patients admitted to the Department of Geriatrics of our hospital from June 2010 to October 2015 were retrospectively analyzed.Results Of the 64 elderly patients with HABSI,malignant tumor (39.1%) and type 2 diabetes mellitus (32.8%) were among the main disorders for their admission to the hospital.There were 53 cases of primary bloodstream infections and 11 cases of secondary bloodstream infections,accounting for 82.8% and 17.2%,respectively.Primary infections involved mostly the respiratory,urinary and

  12. 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.

  13. 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,

  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.

    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

  15. 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.

  16. 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.

  17. 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

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

    Directory of Open Access Journals (Sweden)

    Paulo E Marchiori

    2011-01-01

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

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

    Science.gov (United States)

    Marchiori, Paulo E; Lino, Angelina M M; Machado, Luis R; Pedalini, Livia M; Boulos, Marcos; Scaff, Milberto

    2011-01-01

    OBJECTIVES: This study was undertaken to characterize the neuroinfection profile in a tertiary neurological ward. INTRODUCTION: Neuroinfection is a worldwide concern and bacterial meningitis, tetanus and cerebral malaria have been reported as the commonest causes in developing countries. METHODS: From 1999 to 2007, all patients admitted to the Neurology Ward of Hospital das Clínicas, S�o Paulo University School of Medicine because of neuroinfection had their medical records reviewed. Age, gender, immunological status, neurological syndrome at presentation, infectious agent and clinical outcome were recorded. RESULTS: Three hundred and seventy four cases of neuroinfectious diseases accounted for 4.2% of ward admissions and the identification of infectious agent was successful in 81% of cases. Mean age was 40.5±13.4 years, 63.8% were male, 19.7% were immunocompromised patients and meningoencephalitis was the most common clinical presentation despite infectious agent. Viruses and bacteria were equally responsible for 29.4% of neuroinfectious diseases; parasitic, fungal and prion infections accounted for 28%, 9.6% and 3.5% respectively. Human immunodeficiency virus (HIV), herpes simplex virus 1 (HSV1), Mycobacterium tuberculosis, Treponema pallidum, Taenia solium, Schistosoma mansoni, Cryptococcus neoformans and Histoplasma capsulatum were the more common infectious pathogens in the patients. Infection mortality rate was 14.2%, of which 62.3% occurred in immunocompetent patients. CONCLUSION: Our institution appeared to share some results with developed and developing countries. Comparison with literature may be considered as quality control to health assistance. PMID:21808869

  20. Analysis of Outcomes of the NRS 2002 in Patients Hospitalized in Nephrology Wards

    Directory of Open Access Journals (Sweden)

    Paulina Borek

    2017-03-01

    Full Text Available Introduction: Malnutrition is a common problem among hospitalized patients. In chronic kidney disease, it affects up to 50% of the population. Undernourishment has an adverse effect on prognosis and prolongs convalescence. The aim of the study was to test the effectiveness of NRS (Nutrition Risk Screening -2002 in the assessment of risk of malnutrition for patients hospitalized in nephrology wards. The aim was to develop clinical characteristics of malnourished patients and to assess the relationship between nutritional status and patient outcome. Methods: The analysis included 292 patients, consecutively admitted to nephrology wards. NRS-2002 was assessed in comparison to subjective global assessment. Associations with patient characteristics and outcome were evaluated. Results: Out of all the respondents, 119 patients (40% suffered from malnutrition. The NRS-2002 showed a very strong relationship with Subjective Global Assessment (SGA (p < 0.0001. Malnourished patients were older, were characterized by a significantly lower body mass index (BMI, and had a much longer hospitalization duration. In multiple regression analysis, the presence of malnutrition proved to be an independent predictor of the duration of hospital stay. CONCLUSIONS: Malnutrition is highly prevalent among patients hospitalized in nephrology wards, and it affects the length of hospitalization. Identification of malnourished patients and patients at serious risk of malnutrition progression allows the implementation of appropriate nutritional intervention.

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

    Directory of Open Access Journals (Sweden)

    Ma Ling

    2009-10-01

    Full Text Available Abstract Background Computer keyboards and mice are potential reservoirs of nosocomial pathogens, but routine disinfection for non-water-proof computer devices is a problem. With better hand hygiene compliance of health-care workers (HCWs, the impact of these potential sources of contamination on clinical infection needs to be clarified. Methods This study was conducted in a 1600-bed medical center of southern Taiwan with 47 wards and 282 computers. With education and monitoring program of hand hygiene for HCWs, the average compliance rate was 74% before our surveillance. We investigated the association of methicillin-resistant Staphylococcus aureus (MRSA, Pseudomonas aeruginosa and Acinetobacter baumannii, three leading hospital-acquired pathogens, from ward computer keyboards, mice and from clinical isolates in non-outbreak period by pulsed field gel electrophoresis and antibiogram. Results Our results revealed a 17.4% (49/282 contamination rate of these computer devices by S. aureus, Acinetobacter spp. or Pseudomonas spp. The contamination rates of MRSA and A. baumannii in the ward computers were 1.1% and 4.3%, respectively. No P. aeruginosa was isolated. All isolates from computers and clinical specimens at the same ward showed different pulsotypes. However, A. baumannii isolates on two ward computers had the same pulsotype. Conclusion With good hand hygiene compliance, we found relatively low contamination rates of MRSA, P. aeruginosa and A. baumannii on ward computer interface, and without further contribution to nosocomial infection. Our results suggested no necessity of routine culture surveillance in non-outbreak situation.

  2. 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.

  3. 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

  4. 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

  5. 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...

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

    DEFF Research Database (Denmark)

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

    2009-01-01

    at Herlev Hospital, Denmark. In the pre-intervention period (June-July 2006) and post-intervention period (November-December 2007), all patients on the wards had vital signs measured in the evening by study personnel, who also asked nursing staff questions about patients with abnormal vital signs...

  7. 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

  8. 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.

  9. 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

  10. 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.

  11. 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...

  12. 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

  13. 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...

  14. 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...

  15. Quality Control of Air Disinfection Cleanliness in Burn Ward%烧伤病房空气消毒洁净度的质量控制

    Institute of Scientific and Technical Information of China (English)

    周树仁; 彭幼林; 王建莉; 程永佳

    2011-01-01

    目的:研究烧伤病房空气净化消毒洁净度的质量控制.方法:选择层流、静电和紫外线消毒烧伤病房各一间,分别在开机前、消毒后进行采样做空气培养和微粒检测.结果:层流烧伤病房细菌数明显少于静电和紫外线消毒烧伤病房.结论:烧伤病房层流净化消毒是一种理想的空气净化消毒方式,是实现烧伤病房现代化管理目标的重要设施之一.%Objective To study the quality control of air purification disinfection cleanliness in burn ward. Methods Three bum wards are selected including laminar flow, electrostatic and ultraviolet disinfection respectively. Sampling, air cultivation and particle detection were performed before starting and after disinfection. Results The number of bacteria in laminar flow bum wards is obviously less than wards with electrostatic and ultraviolet disinfection. Conclusion Laminar purification disinfection of bum ward is an ideal air disinfection way, which is is one of the important facilities to realize the modernization management target in bum ward.

  16. Identification and characteristics of imipenem-resistant Acinetobacter baumannii in surgical wards in a Chinese university hospital.

    Science.gov (United States)

    Wang, Dalin; Ma, Linlin; Wu, Zhenyu; Li, Mingcheng; Li, Xiaohan; Zhang, Wei; Chen, Kun

    2015-03-01

    The aim of this study was to investigate the prevalence and characteristics of imipenem-resistant Acinetobacter baumanni isolated from surgical wards in a university hospital, China. A total of 143 non-duplicate A. baumannii were isolated from 517 inpatients in surgery intensive care units (ICUs), burn wards, and general surgery wards. Of these, 102 isolates of A. baumannii (71.3%) were resistant to imipenem. Among imipenem-resistant isolates, all isolates were resistant to almost all antimicrobial agents except polymyxin E, all isolates were positive for blaOXA-23 and blaOXA-51 in addition to ISAba1, 52 (51%) were positive for blaOXA-58, 8 (7.8%) contained blaVIM-2, which co-harbored with blaOXA-58. Molecular typing revealed the presence of three clones among imipenem-resistant isolates. This study confirmed that A. baumannii strains harboring OXA or VIM type β-lactamases are widely distributed throughout the surgery wards. The data demonstrate that there was a high prevalence of imipenem-resistant A. baumannii infection in the region.

  17. Infecção de corrente sanguínea relacionada a cateter venoso central (ICSRC em enfermarias: estudo prospectivo comparativo entre veia subclávia e veia jugular interna Catheter-associated bloodstream infections (CA-BSI in wards: a prospective comparative study between subclavian and jugular access

    Directory of Open Access Journals (Sweden)

    Gustavo Lopes Gomes Siqueira

    2011-09-01

    Full Text Available CONTEXTO: Hemocultura positiva associada a cateter venoso central tem sido estudada em unidades de terapia intensiva (UTI, mas ainda é controverso se o acesso jugular tem maior incidência de complicações infecciosas que o acesso na veia subclávia. OBJETIVO: Comparar índice de infecção entre os acessos na jugular interna e os na veia subclávia em pacientes internados nas enfermarias de cirurgia. MÉTODOS: Estudo prospectivo, descritivo e comparativo com 114 cateteres em 96 pacientes admitidos nas enfermarias de cirurgia de um Hospital Quaternário, tendo como variáveis o local de inserção, número de lumens, tempo de uso, comparando-os com o índice de complicações infecciosas. RESULTADOS: O índice de infecção foi de 9,64% (11 cateteres, sem significância estatística quando comparados o número de lumens (mono versus duplo e infecção (p=0,274; também sem significância estatística a comparação entre o tempo de uso (>14 dias e infecção (p=0,156. Comparando os acessos jugular e subclávia, encontramos significância estatística tendo infecção em 17,2% na subclávia e 1,8% na jugular, com p=0,005. Índice de Hemocultura positivo associado a cateter venoso central foi maior no acesso subclávia quando comparado com jugular interna, com OR 11,2, IC95% (1,4-90,9; p=0,023. CONCLUSÕES: O acesso venoso central na jugular interna tem menor risco de infecção se comparado com subclávia em enfermarias.BACKGROUND: Positive hemoculture associated with central venous catheters has been studied in intensive care units (ICU, but is still controversial if the internal jugular vein access has a higher incidence of infection than subclavian or femoral vein access. OBJECTIVE: To compare catheter-related bloodstream infection (CABSI rates between internal jugular and subclavian vein access in patients admitted to surgical wards. METHODS: This is a prospective, descriptive and comparative study of 114 central venous catheters placed in

  18. 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...

  19. 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...

  20. 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.

  1. 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.

  2. 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.)

  3. 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,...

  4. Automated auditory brainstem response: Its efficacy as a screening tool for neonatal hearing screening in the postnatal ward

    Directory of Open Access Journals (Sweden)

    Chavakula Rajkumar

    2016-01-01

    Full Text Available Introduction: This observational study was carried out to determine the sensitivity and specificity of MB11 BERAphone® , when used for neonatal hearing screening in a postnatal ward setting in comparison against the gold standard, auditory brainstem response (ABR. Materials and Methods: Thirty-seven consecutive newborns (74 ears who either unilaterally or bilaterally failed hearing screening with MB11 BERAphone in the postnatal ward were recruited and a second screening with BERAphone was performed after 1 week along with confirmatory testing using ABR. Results: MB11 BERAphone showed sensitivity of 92.9%, specificity of 50%, positive predictive value of 30.23%, and negative predictive value of 96.77% for the diagnosis of hearing loss. The prevalence of confirmed hearing impairment was 18.9%. The rate of unilateral impairment was 10.8%, and the rate of bilateral impairment was 13.5%. The average ambient noise levels in the postnatal ward setting was 62.1 dB. Conclusion: Although the sensitivity of MB11 BERAphone is good, the specificity is significantly lower when the test is performed in the postnatal ward setting with high ambient noise. Neonates who fail the two-step screening should undergo auditory response for confirming the diagnosis of hearing loss.

  5. Evaluation of reasons for staying and waiting for more than 24 hours in the emergency ward of Imam Hossein hospital

    Directory of Open Access Journals (Sweden)

    Hossein Alimohammadi

    2015-06-01

    Full Text Available Objective: Standardization of hospital emergency units is a major goal in developed countries to decrease the duration of patients stay in these units. The present study was undertaken to evaluate the prevalence of long-term staying in an emergency ward. Methods: In the present 2-month cross-sectional study, patients referring to the emergency ward of Imam Hossein hospital were assessed. The patients’ demographic data, including age, the presenting symptoms and signs, reasons for delays, and the final outcome in relation to the location of hospitalization and discharge information were recorded. Data were reported as frequencies and percentages. The results were reported as means and standard deviations using SPSS version 20. Results: Of 10087 patients admitted into the emergency ward during a 2-month period, 75 patients (0.7% needed to stay and wait for more than 24 hours. The mean ± standard deviation of the patients’ ages was 62.5 ± 20.2 years, with 60% of the patients being over 60 years of age. The most common reason for overcrowding in the emergency ward was a lack of empty beds, with the need for ICU beds as the most important reason for bed deficiency in 59% of the cases. Nervous system problems were the most common reasons for referring to the emergency unit (41% in patients under study. Finally, 81% of the patients were hospitalized, 10% died, 7% were discharged based on personal request and 1.3% were transferred to another hospital. Conclusion: The prevalence of patients staying and waiting in the emergency ward for more than 24 hours was 0.7%. Lack of empty ICU beds was the most important reason for such delays; however, paraclinical problems had no role in these delays which were associated with the death of 10% of patients

  6. 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.

  7. 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.

  8. Monitoring the live to dead transition of bacteria during thermal stress by a multi-method approach.

    Science.gov (United States)

    Kramer, B; Thielmann, J

    2016-04-01

    Rapid microbiological methods to assess cell physiological properties of microorganisms are gaining interest in the elucidation of the effect of antimicrobial agents or physical inactivation. Fluorescent probes combined with flow cytometry or microplate assays provide information about cellular targets of chemical or physical stressors and help to clarify the underlying mode of action. In this work we exemplarily monitored the bacterial response of Listeria innocua, Staphylococcus aureus, Salmonella enterica and Escherichia coli to a mild thermal treatment by applying various methods to illustrate bacterial vital functions like the redox activity, membrane potential, esterase activity, efflux activity, glucose uptake, membrane integrity and plate counts. It was observed that some cellular properties are affected earlier than others. Respiration, glucose-uptake and pump activity were the most sensitive parameters, followed by the loss of membrane potential and membrane integrity. Unspecific esterase was found to be relatively resistant to mild heat exposure. This study shows that such a multi-method approach is a suitable tool to monitor the impact of inactivation treatments on bacteria, providing information about the mode of action, the heterogeneity of populations, species-specific differences to stressors and valuable insight in vital functions beyond pure culturability.

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

    Directory of Open Access Journals (Sweden)

    Vincent P Pitche

    2012-07-01

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

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

    Science.gov (United States)

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

    2012-01-01

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

  11. Detection and management of medication errors in internal wards of a teaching hospital by clinical pharmacists.

    Science.gov (United States)

    Abbasinazari, Mohammad; Hajhossein Talasaz, Azita; Eshraghi, Azadeh; Sahraei, Zahra

    2013-08-07

    Any suboptimum treatment in the management of patients can lead to medication errors (MEs) that may increase morbidity and mortality in hospitalized individuals. By establishing well-designed patient care activities within the managed care setting, clinical pharmacists can cooperate with other health care professionals to provide quality care and maximize safety. The aim of this study was to evaluate the frequency and prevention of MEs by clinical pharmacists. This was a cross-sectional interventional study conducted in internal wards of a teaching hospital during a two-month period. During this period, patient records, and physician orders were reviewed by clinical pharmacists. Any prescription error identified was documented. Incorrect drug selection, dose, dosage form, frequency, or route of administration all were considered as medication errors. Then, the clinical pharmacist discuss about findings with the clinical fellows to change faulty orders. The frequency and types of MEs in different wards that were detected and prevented by clinical pharmacists was documented. During the study period, in 132 patients, 262 errors were detected (1.98 per each). Wrong frequency 71 (27%), forget to order 37 (14.1%), wrong selection 33 (12.5%), drug interactions 26 (9.9%), forget to discontinue 25 (9.5%) and inappropriate dose adjustment in renal impairment 25 (9.5%) were the most types of errors. Cardiovascular medications were the class with the highest detected errors (31.6%) followed by gastrointestinal agents (15.6%). Medication errors are common problems in medical wards that their frequency can be restricted by the intervention of clinical pharmacists.

  12. Detection and management of medication errors in internal wards of a teaching hospital by clinical pharmacists.

    Directory of Open Access Journals (Sweden)

    Mohammad Abbasinazari

    2013-07-01

    Full Text Available Any suboptimum treatment in the management of patients can lead to medication errors (MEs that may increase morbidity and mortality in hospitalized individuals. By establishing well-designed patient care activities within the managed care setting, clinical pharmacists can cooperate with other health care professionals to provide quality care and maximize safety. The aim of this study was to evaluate the frequency and prevention of MEs by clinical pharmacists. This was a cross-sectional interventional study conducted in internal wards of a teaching hospital during a two-month period. During this period, patient records, and physician orders were reviewed by clinical pharmacists. Any prescription error identified was documented. Incorrect drug selection, dose, dosage form, frequency, or route of administration all were considered as medication errors. Then, the clinical pharmacist discuss about findings with the clinical fellows to change faulty orders. The frequency and types of MEs in different wards that were detected and prevented by clinical pharmacists was documented. During the study period, in 132 patients, 262 errors were detected (1.98 per each. Wrong frequency 71 (27%, forget to order 37 (14.1%, wrong selection 33 (12.5%, drug interactions 26 (9.9%, forget to discontinue 25 (9.5% and inappropriate dose adjustment in renal impairment 25 (9.5% were the most types of errors. Cardiovascular medications were the class with the highest detected errors (31.6% followed by gastrointestinal agents (15.6%. Medication errors are common problems in medical wards that their frequency can be restricted by the intervention of clinical pharmacists.

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

    Energy Technology Data Exchange (ETDEWEB)

    Agnihotri, M.P.

    2007-04-27

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

  14. The impact of web-based and face-to-face simulation on patient deterioration and patient safety: protocol for a multi-site multi-method design.

    Science.gov (United States)

    Cooper, Simon J; Kinsman, Leigh; Chung, Catherine; Cant, Robyn; Boyle, Jayne; Bull, Loretta; Cameron, Amanda; Connell, Cliff; Kim, Jeong-Ah; McInnes, Denise; McKay, Angela; Nankervis, Katrina; Penz, Erika; Rotter, Thomas

    2016-09-07

    There are international concerns in relation to the management of patient deterioration which has led to a body of evidence known as the 'failure to rescue' literature. Nursing staff are known to miss cues of deterioration and often fail to call for assistance. Medical Emergency Teams (Rapid Response Teams) do improve the management of acutely deteriorating patients, but first responders need the requisite skills to impact on patient safety. In this study we aim to address these issues in a mixed methods interventional trial with the objective of measuring and comparing the cost and clinical impact of face-to-face and web-based simulation programs on the management of patient deterioration and related patient outcomes. The education programs, known as 'FIRST(2)ACT', have been found to have an impact on education and will be tested in four hospitals in the State of Victoria, Australia. Nursing staff will be trained in primary (the first 8 min) responses to emergencies in two medical wards using a face-to-face approach and in two medical wards using a web-based version FIRST(2)ACTWeb. The impact of these interventions will be determined through quantitative and qualitative approaches, cost analyses and patient notes review (time series analyses) to measure quality of care and patient outcomes. In this 18 month study it is hypothesised that both simulation programs will improve the detection and management of deteriorating patients but that the web-based program will have lower total costs. The study will also add to our overall understanding of the utility of simulation approaches in the preparation of nurses working in hospital wards. (ACTRN12616000468426, retrospectively registered 8.4.2016).

  15. Fronto-parietal regulation of media violence exposure in adolescents: a multi-method study.

    Science.gov (United States)

    Strenziok, Maren; Krueger, Frank; Deshpande, Gopikrishna; Lenroot, Rhoshel K; van der Meer, Elke; Grafman, Jordan

    2011-10-01

    Adolescents spend a significant part of their leisure time watching TV programs and movies that portray violence. It is unknown, however, how the extent of violent media use and the severity of aggression displayed affect adolescents' brain function. We investigated skin conductance responses, brain activation and functional brain connectivity to media violence in healthy adolescents. In an event-related functional magnetic resonance imaging experiment, subjects repeatedly viewed normed videos that displayed different degrees of aggressive behavior. We found a downward linear adaptation in skin conductance responses with increasing aggression and desensitization towards more aggressive videos. Our results further revealed adaptation in a fronto-parietal network including the left lateral orbitofrontal cortex (lOFC), right precuneus and bilateral inferior parietal lobules, again showing downward linear adaptations and desensitization towards more aggressive videos. Granger causality mapping analyses revealed attenuation in the left lOFC, indicating that activation during viewing aggressive media is driven by input from parietal regions that decreased over time, for more aggressive videos. We conclude that aggressive media activates an emotion-attention network that has the capability to blunt emotional responses through reduced attention with repeated viewing of aggressive media contents, which may restrict the linking of the consequences of aggression with an emotional response, and therefore potentially promotes aggressive attitudes and behavior.

  16. Fronto-parietal regulation of media violence exposure in adolescents: a multi-method study

    OpenAIRE

    Strenziok, Maren; Krueger, Frank; Deshpande, Gopikrishna; Lenroot, Rhoshel K.; Van der Meer, Elke; Grafman, Jordan

    2010-01-01

    Adolescents spend a significant part of their leisure time watching TV programs and movies that portray violence. It is unknown, however, how the extent of violent media use and the severity of aggression displayed affect adolescents’ brain function. We investigated skin conductance responses, brain activation and functional brain connectivity to media violence in healthy adolescents. In an event-related functional magnetic resonance imaging experiment, subjects repeatedly viewed normed video...

  17. Knowledge, Skills, and Abilities for Entry-Level Business Analytics Positions: A Multi-Method Study

    Science.gov (United States)

    Cegielski, Casey G.; Jones-Farmer, L. Allison

    2016-01-01

    It is impossible to deny the significant impact from the emergence of big data and business analytics on the fields of Information Technology, Quantitative Methods, and the Decision Sciences. Both industry and academia seek to hire talent in these areas with the hope of developing organizational competencies. This article describes a multi-method…

  18. A multi-method approach for the study of lanthanum speciation in coastal and estuarine sediments

    Digital Repository Service at National Institute of Oceanography (India)

    Chakraborty, P.; Babu, P.V.R.; Sarma, V.V.

    stream_size 45797 stream_content_type text/plain stream_name J_Geochem_Explor_110_225a.pdf.txt stream_source_info J_Geochem_Explor_110_225a.pdf.txt Content-Encoding UTF-8 Content-Type text/plain; charset=UTF-8 Author...) in different fields (agricultural field, water treatment technology, nuclear industry, glass industry and medicine manufacturing industry) (Guo, 1987; Zhang et al. 1988; Eisenbud and Paschoa, 1989; Tribe et al. 1990; Buckingham et al. 1995) is expected...

  19. Knowledge, Skills, and Abilities for Entry-Level Business Analytics Positions: A Multi-Method Study

    Science.gov (United States)

    Cegielski, Casey G.; Jones-Farmer, L. Allison

    2016-01-01

    It is impossible to deny the significant impact from the emergence of big data and business analytics on the fields of Information Technology, Quantitative Methods, and the Decision Sciences. Both industry and academia seek to hire talent in these areas with the hope of developing organizational competencies. This article describes a multi-method…

  20. A Design Approach for Collaboration Processes: A Multi-Method Design Science Study in Collaboration Engineering

    NARCIS (Netherlands)

    Kolfschoten, G.L.; De Vreede, G.J.

    2009-01-01

    Collaboration Engineering is an approach for the design and deployment of repeatable collaboration processes that can be executed by practitioners without the support of collaboration professionals such as facilitators. A critical challenge in Collaboration Engineering concerns how the design activi

  1. How Should Intelligent Tutoring Systems Sequence Multiple Graphical Representations of Fractions? A Multi-Methods Study

    Science.gov (United States)

    Rau, M. A.; Aleven, V.; Rummel, N.; Pardos, Z.

    2014-01-01

    Providing learners with multiple representations of learning content has been shown to enhance learning outcomes. When multiple representations are presented across consecutive problems, we have to decide in what sequence to present them. Prior research has demonstrated that interleaving "tasks types" (as opposed to blocking them) can…

  2. Frequency and severity of aggressive incidents in acute psychiatric wards in Switzerland

    Directory of Open Access Journals (Sweden)

    Fischer Joachim E

    2007-12-01

    Full Text Available Abstract Background Aggression and violence and negative consequences thereof are a major concern in acute psychiatric inpatient care globally. Variations in study designs, settings, populations, and data collection methods render comparisons of the incidence of aggressive behaviour in high risk settings difficult. Objective To describe the frequency and severity of aggressive incidents in acute psychiatric wards in the German speaking part of Switzerland. Methods We conducted a prospective multicentre study on 24 acute admission wards in 12 psychiatric hospitals in the German speaking part of Switzerland. Aggressive incidents were recorded by the revised Staff Observation Aggression Scale (SOAS-R and we checked the data collection for underreporting. Our sample comprised 2344 treatment episodes of 2017 patients and a total of 41'560 treatment days. Results A total of 760 aggressive incidents were registered. We found incidence rates per 100 treatment days between 0.60 (95% CI 0.10–1.78 for physical attacks and 1.83 (1.70–1.97 for all aggressive incidents (including purely verbal aggression. The mean severity was 8.80 ± 4.88 points on the 22-point SOAS-R-severity measure; 46% of the purely verbally aggression was classified as severe (≥ 9 pts.. 53% of the aggressive incidents were followed by a coercive measure, mostly seclusion or seclusion accompanied by medication. In 13% of the patients, one ore more incidents were registered, and 6.9% of the patients were involved in one ore more physical attack. Involuntary admission (OR 2.2; 1.6–2.9, longer length of stay (OR 2.7; 2.0–3.8, and a diagnosis of schizophrenia (ICH-10 F2 (OR 2.1; 1.5–2.9 was associated with a higher risk for aggressive incidents, but no such association was found for age and gender. 38% of the incidents were registered within the first 7 days after admission. Conclusion Aggressive incidents in acute admission wards are a frequent and serious problem. Due to the

  3. [Mother/child affective bond at the unit of the pediatric ward].

    Science.gov (United States)

    Faquinello, Paula; Collet, Neusa

    2003-12-01

    This study presents the importance of the mother-son relationship in the child physical and emotional development. It aims at contributing to the construction of knowledge in nursing, by rescuing the importance of the mothers' stay in the units of the pediatric ward. It is a bibliographical research using as sources: books, scientific articles, journals, magazines, encyclopedias and the Internet. By reading and analyzing the texts it is possible to identify how the consolidation of the mother and son affective bond is processed and to point out the positive aspects of the mother's stay with the hospitalized son.

  4. Tracheostomy patients on the ward: multiple benefits from a multidisciplinary team?

    Science.gov (United States)

    Yu, Mihae

    2010-01-01

    Patients requiring tracheostomies tend to have a longer length of stay due to their underlying disease. After a thorough literature search, Garrubba and colleagues found only three studies assessing the impact of multidisciplinary teams (MDTs) on tracheostomy patients on the ward. One consistent observation was the decreased time to decannulation after institution of MDT care when compared with historical controls. Although a large prospective randomized trial is desirable before MDT is recommended, many institutions may have already formed a team approach to provide coordinated care resulting in improved outcome and length of stay.

  5. 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

    an appropriate turbulent model to simulate and reproduce the process of contaminant dispersion. The low Reynolds-number (LRN) k-e (Launder and Sharma, 1978) turbulence model with a damping function (Chikamoto et al., 1992) was considered and evaluated by experiment. We carried out an experimental study to test...... wards probably due to its inability to remove large particles and risk of particle deposition on horizontal surfaces in the occupied regions. However, the existing downward ventilation system commonly used in isolation rooms does not deliver the required performance. There is a need to develop effective...

  6. Mode analysis and Ward identities for perturbative quantum gravity in de Sitter space

    Science.gov (United States)

    Tsamis, N. C.; Woodard, R. P.

    1992-10-01

    We study linearized gravitons on the D-dimensional open submanifold spanned by de Sitter conformal coordinates. The physical modes are found in the same way as for flat space by imposing exact gauge conditions on the invariant field equations and then exploiting the residual gauge freedom of solutions. The resulting polatization tensors have vanishing zero components and are transverse and traceless, just as in flat space. We also show that vacua exist such that the ghost and graviton propagators obey the Ward identity relating them.

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

    Directory of Open Access Journals (Sweden)

    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.

  8. Evaluating performance of the operational managers of obstetrics and gynecology service providing wards.

    Science.gov (United States)

    Parvaresh, Zahra; Kazemi, Ashraf; Ehsanpour, Soheila; Sajadi, Haniye Sadat

    2016-01-01

    The goal of hospitals, as the most important health care providing centers, is to improve the health level of the society. Achieving this goal is directly related with performance of the managers. This study was conducted to evaluate the performance of operational managers of obstetrics and gynecology service providing wards from the point of view of the staff at educational hospitals of Isfahan University of Medical Sciences in 2015. In this descriptive study, target population comprised all supervisors and the staff working at obstetrics and gynecology and maternity wards. Data were collected through a researcher-made questionnaire after evaluation of its reliability and validity using questions on managerial performance (planning, organizing, leadership, and control dimensions) and demographic characteristics of the managers and staff. Data were analyzed using independent t-test, one sample t-test, Spearman and Pearson coefficient tests, and one-way analysis of variance. The total mean score of staff's point of view toward performance of managers' performance was significantly higher than the average level (P < 0.001, t = 13.2). In addition, mean scores of managerial performance in planning (P < 0.001, t = 14.93), organizing (P < 0.001, t = 11.64), leadership (P < 0.001, t = 11.16), and control (P < 0.001, t = 13.75) dimensions were significantly higher than the moderate level. With respect to the fact that maintaining and improving the health of mothers and neonates depends on the management and managers' performance in obstetrics and gynecology service providing wards, more than moderate managers' performance need to be improved. It is recommended that higher-level managers pay special attention to the empowerment of managerial skills among operational managers.

  9. Personnel exposure to violence in hospital emergency wards: a routine activity approach.

    Science.gov (United States)

    Landau, Simha F; Bendalak, Yehudit

    2008-01-01

    This study analyzes violence against personnel in the emergency wards of all 25 general hospitals in Israel using a self-report questionnaire (N=2,356). Informed by the routine activity theory, the hypotheses related to the major concepts of this approach: exposure, target suitability, guarding and proximity to offenders. A General Exposure to Violence Index (GEVI) was constructed, based on the participants' reports about type and frequency of their victimization to violence during the preceding year. The multiple regression analysis for explaining the GEVI was composed of 15 independent variables relating to participants' professional and personal characteristics as well as to structural features of hospitals. As predicted, higher exposure to violence was related to security or nursing staff and positions of authority; high weekly workload; working in a profession other than that of training; inability of coping with verbal violence; having no access to an emergency button, and working in settings restricting the number of accompanying persons to one only. Unexpectedly, previous training in coping with violence was related to higher victimization. Younger age, male gender and being of European/American origin (mainly from the former Soviet Union) was also related to higher risk of victimization. The results support the utility of the routine activities approach in explaining differences in emergency ward personnel victimization. The findings also indicate, however, the need to add domain-specific contextual analyses to this approach to reach a fuller understanding of the behaviors under discussion. Implications of the finding to coping with violence against emergency ward personnel are discussed, and suggestions are put forward for further study in this field.

  10. 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

  11. Etiologies of Prolonged Unconjugated Hyperbilirubinemia in Neonates Admitted to Neonatal Wards

    Directory of Open Access Journals (Sweden)

    Mohammad Kazem Sabzehei

    2015-12-01

    Full Text Available Background: Jaundice is a common condition among neonates. Prolonged unconjugated hyperbilirubinemia occurs when jaundice persists beyond two weeks in term neonates and three weeks in preterm neonates. This study aimed to determine the etiologies of prolonged unconjugated hyperbilirubinemia in infants admitted to the neonatal ward of Besat Hospital in Hamadan, Iran. Methods: This study was conducted on all infants diagnosed with prolonged unconjugated hyperbilirubinemia during 2007-2012 in the neonatal ward of Besat Hospital in Hamadan, Iran. Demographic characteristics of infants, physical examination and laboratory findings were collected and analyzed to determine the etiologies of neonatal hyperbilirubinemia. Results: In total, 100 infants diagnosed with neonatal hyperbilirubinemia were enrolled in this study, including 49 male and 51 female neonates with mean age of 20±1 days and mean bilirubin level of 17.5±4.0 mg/dL. Main causes of hyperbilirubinemia were urinary tract infection, ABO incompatibility, hypothyroidism and glucose-6-phosphate dehydrogenase deficiency in 14%, 5%, 6% and 5% of neonates, respectively. Moreover, unknown etiologies, such as breastfeeding, were detected in 70% of the studied infants. Conclusion: According to the results of this study, determining the main causes of prolonged unconjugated hyperbilirubinemia in neonates is of paramount importance. In the majority of cases, neonatal hyperbilirubinemia is associated with physiological factors, such as breastfeeding.

  12. Using Isovist Application to Explore Visibility Area of Hospital Inpatient Ward

    Science.gov (United States)

    Sengke, M. M. C.; Atmodiwirjo, P.

    2017-03-01

    This paper reports an on-going project that explores the use of digital application to study human field of view. The focus of discussion is to study the patients’ visual experience, in relation to the arrangement of interior elements in patients’ ward. The physical qualities of the environment can influence the healing process of the patient. Typical layout of interior elements often fails to provide visual stimulus that could support the healing process of the. This study explores the experience of seeing by simulating the hospital ward setting into 3D model using isovist analysis. Isovist is used to represent the experience of seeing by the patient from particular point of view and also to represent the object and surfaces that are being seen. Isovist has a function to show us the boundary of the visible areas, which can reveal which elements can and cannot seen by the patient. Isovist provides a way to understand the experience of seeing and being seen by visualizing the visibility area through three dimensional modelling. This study suggests the possibility to study human field of view to support the design of architecture for health.

  13. Respiratory rates measured by a standardised clinical approach, ward staff, and a wireless device.

    Science.gov (United States)

    Granholm, A; Pedersen, N E; Lippert, A; Petersen, L F; Rasmussen, L S

    2016-11-01

    Respiratory rate is among the first vital signs to change in deteriorating patients. The aim was to investigate the agreement between respiratory rate measurements by three different methods. This prospective observational study included acutely admitted adult patients in a medical ward. Respiratory rate was measured by three methods: a standardised approach over 60 s while patients lay still and refrained from talking, by ward staff and by a wireless electronic patch (SensiumVitals). The Bland-Altman method was used to compare measurements and three breaths per minute (BPM) was considered a clinically relevant difference. We included 50 patients. The mean difference between the standardised approach and the electronic measurement was 0.3 (95% CI: -1.4 to 2.0) BPM; 95% limits of agreement were -11.5 (95% CI: -14.5 to -8.6) and 12.1 (95% CI: 9.2 to 15.1) BPM. Removal of three outliers with huge differences lead to a mean difference of -0.1 (95% CI: -0.7 to 0.5) BPM and 95% limits of agreement of -4.2 (95% CI: -5.3 to -3.2) BPM and 4.0 (95% CI: 2.9 to 5.0) BPM. The mean difference between staff and electronic measurements was 1.7 (95% CI: -0.5 to 3.9) BPM; 95% limits of agreement were -13.3 (95% CI: -17.2 to -9.5) BPM and 16.8 (95% CI: 13.0 to 20.6) BPM. A concerning lack of agreement was found between a wireless monitoring system and a standardised clinical approach. Ward staff's measurements also seemed to be inaccurate. © 2016 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

  14. Creation of a questionnaire to measure stress among nurses engaged in palliative care on general wards.

    Science.gov (United States)

    Terakado, Ako; Watanabe, Takako

    2012-10-01

    This study was conducted to create a questionnaire that measures stress among nurses engaged in palliative care on general wards. Nurses with at least 3 years of experience involved in palliative care on a general ward in six facilities in Japan were the subjects from September 7 to October 4, 2004. A draft questionnaire on stress factors and conditions of stress in nurses engaged in end-of-life care was created, and question items and content meaning were revised to produce 32 question items, with a four-point Likert scale for the responses. Two pretests were conducted. Internal validity was investigated and resulted in 31 question items. Factor analysis using the principal factor method (Varimax rotation) was performed, and Cronbach's coefficient alpha was used to evaluate internal consistency and check reliability. The survey response rate was 94%, with a valid response rate of 98%. Analysis was conducted using responses from 269 participants, of whom 98.9% were female, with a mean age of 35.4 years. The mean length of experience as a nurse was 13.6 years, and the mean length of experience in cancer nursing was 8 years. Results of factor analysis produced eigenvalues of 5.260-1.558 and a cumulative proportion of 58.032%. After two items were deleted, six stress-related factors were identified; their alpha coefficients were 0.753 to 0.912, ensuring high reliability. The questionnaire developed had high internal validity and high reliability, and it can thus serve as a first stage in elucidating stress among nurses engaged in palliative care on general wards.

  15. 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.

  16. 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.

  17. Enhancing Learning Management Systems Utility for Blind Students: A Task-Oriented, User-Centered, Multi-Method Evaluation Technique

    Science.gov (United States)

    Babu, Rakesh; Singh, Rahul

    2013-01-01

    This paper presents a novel task-oriented, user-centered, multi-method evaluation (TUME) technique and shows how it is useful in providing a more complete, practical and solution-oriented assessment of the accessibility and usability of Learning Management Systems (LMS) for blind and visually impaired (BVI) students. Novel components of TUME…

  18. 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”. 

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

    Science.gov (United States)

    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

  20. 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.

  1. 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.

  2. 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.

  3. 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.

  4. 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.

  5. A study of the experiences of domestic child labour among primary school children whose parents are in the formal or informal sector : the case of Itigi Ward in Manyoni district - Singida region in Tanzania

    OpenAIRE

    Mbogoma, Charles George Joseph

    2007-01-01

    The study aimed at developing an understanding of the attitudes and experiences of child labour among the primary school children whose parents were in the formal or informal sectors. It was hypothesized that the rights of the children were being abrogated and abused through domestic and field labour and that children whose parents were in the formal or informal sectors had different attitude and experiences toward the labour they performed. Also, it was thought that Child labo...

  6. A case-control study of VDRL-positive antenatal clinic attenders at the Port Moresby General Hospital Antenatal Clinic and Labour Ward to determine outcomes, sociodemographic features and associated risk factors.

    Science.gov (United States)

    Mola, Glen D L; Golpak, Alex; Amoa, A B

    2008-01-01

    Between June 2001 and December 2002, 152 antenatal patients at Port Moresby General Hospital who were Venereal Disease Research Laboratory (VDRL) serology positive and 150 unselected antenatal patients who tested negative were studied to determine the gestational age at which the tests were performed, the time it took for results to become available, the proportion of patients who received treatment, the sociodemographic characteristics associated with VDRL positivity and the effect of VDRL positivity on maternal and perinatal outcomes. The prevalence rate of VDRL positive among antenatal clinic attenders in Port Moresby at that time was 4.4%. Of the 152 VDRL-positive patients in this study 97% were also Treponema pallidum haemagglutination (TPHA) positive. Significantly more of the positive patients were of highlands origin, lived in settlements, had previous marriages, had lower parities, delivered preterm babies, had stillbirths, had growth-restricted babies and had babies with lower Apgar scores at both 1 and 5 minutes. The mean birthweight was significantly lower among the positive patients. Significantly more of the positive patients were married to spouses with occupations which were regarded as 'risky' for sexually transmitted infections. There was no difference between the two groups with respect to patient's education, marital status, husband's education, gestational age at delivery and the number of days the baby spent in the Special Care Unit. The study concluded that the current antenatal screening does not provide adequate coverage for our patients. If the current availability of clinic-based strip tests provided by a non-government organization can be continued by the Ministry of Health we should be able to overcome this problem.

  7. The Effect of Stress Management on Occupational Stress and Satisfaction among Midwives in Obstetrics and Gynecology Hospital Wards in Iran

    OpenAIRE

    Jahromi, Mahdi Karimyar; Minaei, Shahnaz; Abdollahifard, Sareh; Maddahfar, Majid

    2015-01-01

    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 po...

  8. Role of Clinical Pharmacists in Early Detection, Reporting and Prevention of Medication Errors in a Medical Ward

    Directory of Open Access Journals (Sweden)

    Solmaz Hassani

    2017-03-01

    Full Text Available Background: Drug utilization evaluation (DUE is an effective process in order to identifying variability in drug use and subsequent application of effective interventions for improving  patient outcomes. In this study, appropriate uses of drugs were evaluated by pharmacy service.Methods: A prospective, interventional study was designed for determining frequency and type of clinical pharmacists’ interventions and medication errors occurred in the infectious disease ward of Loghman hospital, affiliated to Shahid Beheshti University of Medical Sciences, Tehran, Iran during 8 months. Results: During the 8 months of the study period, 498 errors were detected among 419 patients that admitted to infectious disease ward of Loghman hospital. Most common errors were related to DVT prophylaxis, SUP and vancomycin monitoring. Discussion: Our result showed that clinical pharmacy interventions can have an important role in reducing adverse drug events and their activities can be effective for reducing of medication error.

  9. 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.

  10. Evaluation of the biological efficacy of hydrogen peroxide vapour decontamination in wards of an Australian hospital.

    Science.gov (United States)

    Chan, H-T; White, P; Sheorey, H; Cocks, J; Waters, M-J

    2011-10-01

    This study assessed the efficacy of a 'dry' hydrogen peroxide vapour decontamination in an Australian hospital via a two-armed study. The in vivo arm examined the baseline bacterial counts in high-touch zones within wards and evaluated the efficacy of cleaning with a neutral detergent followed by either hydrogen peroxide vapour decontamination, or a manual terminal clean with bleach or Det-Sol 500. The in vitro arm examined the efficacy of hydrogen peroxide vapour decontamination on a variety of different surfaces commonly found in the wards of an Australian hospital, deliberately seeded with a known concentration of vancomycin-resistant enterococci (VRE). All bacterial counts were evaluated by a protocol of contact plate method. In the in vivo arm, 33.3% of the high-touch areas assessed had aerobic bacterial count below the detection limit (i.e. no bacteria recoverable) post hydrogen peroxide decontamination, and in all circumstances the highest microbial density was ≤3 cfu/cm(2), while in the in vitro arm there was at least a reduction in bacterial load by a factor of 10 at all surfaces investigated. These results showed that dry hydrogen peroxide vapour room decontamination is highly effective on a range of surfaces, although the cleanliness data obtained by these methods cannot be easily compared among the different surfaces as recovery of organisms is affected by the nature of the surface.

  11. Assessment of Midwives’ Communication Skills at the Maternity Wards of Teaching Hospitals in Mashhad in 2014

    Directory of Open Access Journals (Sweden)

    Talate Khadivzadeh

    2015-06-01

    Full Text Available Background & aim:The quality of communication between midwives and parturient women is a determinant of maternal satisfaction with midwifery care. Therefore, this study was conducted to determine the communication skills of midwives at maternity wards of Mashhad teaching hospitals in 2014.   Methods:In this descriptive study, 49 midwives, working at Mashhad teaching hospitals, were randomly selected. All midwives worked rotating shifts at the wards. The midwives’ communication skills were assessed by the researcher, using the self-structured  observation checklist of communicative performance.   Results: The mean age of midwives was 39.11±9.66 years and their mean work experience was 15.9±8.77 years. In total, 68.3% of the participants experienced childbirth themselves. 66.7% of midwives were moderately  keen on midwifery as a profession. The mean score of the checklist obtained by midwives was 67.9±10.7. There was no relationship between midwives’ communication skills and work experience, childbirth experience, age or interest in midwifery. Conclusion:Considering the inadequacy of midwives’ communication skills, which could be the major cause of maternal dissatisfaction with delivery care, it is recommended that in-service training courses be held by applying new teaching methods. Moreover, the educational needs of midwives, including communication skills, should be considered in these training programs .

  12. 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.

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

    Directory of Open Access Journals (Sweden)

    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.

  14. 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

  15. A multi-method and multi-scale approach for estimating city-wide anthropogenic heat fluxes

    Science.gov (United States)

    Chow, Winston T. L.; Salamanca, Francisco; Georgescu, Matei; Mahalov, Alex; Milne, Jeffrey M.; Ruddell, Benjamin L.

    2014-12-01

    A multi-method approach estimating summer waste heat emissions from anthropogenic activities (QF) was applied for a major subtropical city (Phoenix, AZ). These included detailed, quality-controlled inventories of city-wide population density and traffic counts to estimate waste heat emissions from population and vehicular sources respectively, and also included waste heat simulations derived from urban electrical consumption generated by a coupled building energy - regional climate model (WRF-BEM + BEP). These component QF data were subsequently summed and mapped through Geographic Information Systems techniques to enable analysis over local (i.e. census-tract) and regional (i.e. metropolitan area) scales. Through this approach, local mean daily QF estimates compared reasonably versus (1.) observed daily surface energy balance residuals from an eddy covariance tower sited within a residential area and (2.) estimates from inventory methods employed in a prior study, with improved sensitivity to temperature and precipitation variations. Regional analysis indicates substantial variations in both mean and maximum daily QF, which varied with urban land use type. Average regional daily QF was ∼13 W m-2 for the summer period. Temporal analyses also indicated notable differences using this approach with previous estimates of QF in Phoenix over different land uses, with much larger peak fluxes averaging ∼50 W m-2 occurring in commercial or industrial areas during late summer afternoons. The spatio-temporal analysis of QF also suggests that it may influence the form and intensity of the Phoenix urban heat island, specifically through additional early evening heat input, and by modifying the urban boundary layer structure through increased turbulence.

  16. 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.

  17. 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.

  18. [Creation and validation of an instrument to identify nursing activities in pediatric wards: information for determining workload].

    Science.gov (United States)

    Santos, Nanci Cristiano; Fugulin, Fernanda Maria Togeiro

    2013-10-01

    The aim of this study was to develop and validate an instrument for identifying nursing activities performed in a pediatric ward and to provide a basis for defining the workload of these units. The instrument was developed by selecting the activities relevant to pediatric nursing from the Nursing Intervention Classification and then submitting them to a panel of judges for validation. The panel considered the selected activities relevant and representative of pediatric nursing practice. Now that representative activities for the nursing workload have been identified, we envision new studies to verify their usefulness in practice. Determining the amount of time each activity takes to perform will help to develop a system for measuring the workloads of nursing teams in pediatric wards.

  19. Creation and validation of an instrument to identify nursing activities in pediatric wards: information for determining workload

    Directory of Open Access Journals (Sweden)

    Nanci Cristiano Santos

    2013-10-01

    Full Text Available The aim of this study was to develop and validate an instrument for identifying nursing activities performed in a pediatric ward and to provide a basis for defining the workload of these units. The instrument was developed by selecting the activities relevant to pediatric nursing from the Nursing Intervention Classification and then submitting them to a panel of judges for validation. The panel considered the selected activities relevant and representative of pediatric nursing practice. Now that representative activities for the nursing workload have been identified, we envision new studies to verify their usefulness in practice. Determining the amount of time each activity takes to perform will help to develop a system for measuring the workloads of nursing teams in pediatric wards.

  20. 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.

  1. Challenges of the ward round teaching based on the experiences of medical clinical teachers

    Directory of Open Access Journals (Sweden)

    Kamran Soltani Arabshahi

    2015-01-01

    Full Text Available Background: Holding educational sessions in a clinical environment is a major concern for faculty members because of its special difficulties and restrictions. This study attempts to recognize the challenges of the ward round teaching through investigating the experiences of clinical teachers in 2011. Materials and Methods: This qualitative research is carried out through purposive sampling with maximum variation from among the clinical teachers of major departments in Isfahan University of Medical Sciences (9 persons. The sampling continued until data saturation. Data were collected through semi-structured interview and analyzed through Collaizzi method. Data reliability and validity was confirmed through the four aspects of Lincoln and Guba method (credibility, conformability, transferability, and dependability. Results: Three major themes and their related sub-themes (minor themes were found out including the factors related to the triad of clinical teaching (patient, learner, and clinical teacher (concern about patient′s welfare, poor preparation, lack of motivation, ethical problems, factors related to the educational environment (stressful environment, humiliating environment and poor communication and the factors related to the educational system of the clinical environment (poor organizing and arrangement of resources, poor system′s monitoring, bad planning and inadequate resource. Conclusion: Ward round teaching has many concerns for teachers, and this should be recognized and resolved by authorities and teachers. If these problems are not resolved, it would affect the quality of clinical teaching.

  2. Challenges of the ward round teaching based on the experiences of medical clinical teachers.

    Science.gov (United States)

    Arabshahi, Kamran Soltani; Haghani, Fariba; Bigdeli, Shoaleh; Omid, Athar; Adibi, Peyman

    2015-03-01

    Holding educational sessions in a clinical environment is a major concern for faculty members because of its special difficulties and restrictions. This study attempts to recognize the challenges of the ward round teaching through investigating the experiences of clinical teachers in 2011. This qualitative research is carried out through purposive sampling with maximum variation from among the clinical teachers of major departments in Isfahan University of Medical Sciences (9 persons). The sampling continued until data saturation. Data were collected through semi-structured interview and analyzed through Collaizzi method. Data reliability and validity was confirmed through the four aspects of Lincoln and Guba method (credibility, conformability, transferability, and dependability). Three major themes and their related sub-themes (minor themes) were found out including the factors related to the triad of clinical teaching (patient, learner, and clinical teacher) (concern about patient's welfare, poor preparation, lack of motivation, ethical problems), factors related to the educational environment (stressful environment, humiliating environment and poor communication) and the factors related to the educational system of the clinical environment (poor organizing and arrangement of resources, poor system's monitoring, bad planning and inadequate resource). Ward round teaching has many concerns for teachers, and this should be recognized and resolved by authorities and teachers. If these problems are not resolved, it would affect the quality of clinical teaching.

  3. 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:

  4. Large-eddy simulation of airflow and heat transfer in a general ward of hospital

    Science.gov (United States)

    Hasan, Md. Farhad; Himika, Taasnim Ahmed; Molla, Md. Mamun

    2016-07-01

    In this paper, a very popular alternative computational technique, the Lattice Boltzmann Method (LBM) has been used for Large-Eddy Simulation (LES) of airflow and heat transfer in general ward of hospital. Different Reynolds numbers have been used to study the airflow pattern. In LES, Smagorinsky turbulence model has been considered and a discussion has been conducted in brief. A code validation has been performed comparing the present results with benchmark results for lid-driven cavity problem and the results are found to agree very well. LBM is demonstrated through simulation in forced convection inside hospital ward with six beds with a partition in the middle, which acted like a wall. Changes in average rate of heat transfer in terms of average Nusselt numbers have also been recorded in tabular format and necessary comparison has been showed. It was found that partition narrowed the path for airflow and once the air overcame this barrier, it got free space and turbulence appeared. For higher turbulence, the average rate of heat transfer increased and patients near the turbulence zone released maximum heat and felt more comfortable.

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

    OpenAIRE

    Ma Ling; Chen Tun-Chieh; Siu LK; Lu Po-Liang; Chiang Wen-Gin; Chen Yen-Hsu; Lin Sheng-Fung; Chen Tyen-Po

    2009-01-01

    Abstract Background Computer keyboards and mice are potential reservoirs of nosocomial pathogens, but routine disinfection for non-water-proof computer devices is a problem. With better hand hygiene compliance of health-care workers (HCWs), the impact of these potential sources of contamination on clinical infection needs to be clarified. Methods This study was conducted in a 1600-bed medical center of southern Taiwan with 47 wards and 282 computers. With education and monitoring program of h...

  6. Care of severe head injury patients in the Sarawak General Hospital: intensive care unit versus general ward.

    Science.gov (United States)

    Sim, S K; Lim, S L; Lee, H K; Liew, D; Wong, A

    2011-06-01

    Intensive care for severe head injury patients is very important in the prevention and treatment of secondary brain injury. However, in a resources constraint environment and limited availability of Intensive Care Unit (ICU) beds in the hospitals, not all severe head injury patients will receive ICU care. This prospective study is aimed to evaluate the outcome of severe head injured patients who received ICU and general ward care in Sarawak General Hospital (SGH) over a 6-month period. A total of thirty five severe head injury patients were admitted. Twenty three patients (65.7%) were ventilated in general ward whereas twelve patients (34.3%) were ventilated in ICU. Overall one month mortality in this study was 25.7%. Patients who received ICU care had a lower one month mortality than those who received general ward care (16.7% vs 30.4%), although it was not statistically different. Multivariate analysis revealed only GCS on admission (OR 0.731; 95% CI 0.460 to 0.877; P=0.042) as the independent predictive factor for one month mortality in this study.

  7. 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.

  8. 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.

  9. 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'....

  10. 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

  11. 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.

  12. 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.

  13. 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...

  14. 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.

  15. Prevalence of potential drug-drug interactions among internal medicine ward in University of Gondar Teaching Hospital, Ethiopia

    Institute of Scientific and Technical Information of China (English)

    Akshaya Srikanth Bhagavathula; Alemayehu Berhanie; Habtamu Tigistu; Yishak Abraham; Yosheph Getachew; Tahir Mehmood Khan; Chandrashekhar Unakal

    2014-01-01

    Objective: To determine the prevalence, clinical significance and the associated risk factors of potential drug-drug interactions (DDIs) at internal medicine ward of University of Gondar (UOG) hospital.Method:medicine ward of UOG hospital from April 29, 2013 to June 2, 2013. Data was collected from medical records and by interviewing the patients face to face. Descriptive analysis was conducted for back ground characteristics and logistic regression was used to determine the associated risk factors.Result:A prospective cross-sectional study was conducted on patients treated in internal interacting combinations with 4.13 potential DDIs per patient. Among 413 potential DDIs most were of moderate interactions 61.2% (n=253) followed by 26% (n=107) of minor interactions and 12.8% (n=53) of major interactions. There was significant association of occurrence of potential DDIs only with taking three or more medications.Conclusion:We have recorded a high rate of prevalence of potential DDI in the internal In our study, we have identified a total number of 413 potential DDIs and 184 types of medicine ward of UOG hospital and a high number of clinically significant DDIs which the most prevalent DDI were of moderate severity. Careful selection of drugs and active pharmaceutical care is encouraged in order to avoid negative consequences of these interactions.

  16. The team builder: the role of nurses facilitating interprofessional student teams at a Swedish clinical training ward.

    Science.gov (United States)

    Elisabeth, Carlson; Ewa, Pilhammar; Christine, Wann-Hansson

    2011-09-01

    Interprofessional education (IPE) is an educational strategy attracting increased interest as a method to train future health care professionals. One example of IPE is the clinical training ward, where students from different health care professions practice together. At these wards the students work in teams with the support of facilitators. The professional composition of the team of facilitators usually corresponds to that of the students. However, previous studies have revealed that nurse facilitators are often in the majority, responsible for student nurses' profession specific facilitation as well as interprofessional team orientated facilitation. The objective of this study was to describe how nurses act when facilitating interprofessional student teams at a clinical training ward. The research design was ethnography and data were collected through participant observations and interviews. The analysis revealed the four strategies used when facilitating teams of interprofessional students to enhance collaborative work and professional understanding. The nurse facilitator as a team builder is a new and exciting role for nurses taking on the responsibility of facilitating interprofessional student teams. Future research needs to explore how facilitating nurses balance profession specific and team oriented facilitating within the environment of an interprofessional learning context.

  17. 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...

  18. 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…

  19. Does antimicrobial use density at the ward level influence monthly central line-associated bloodstream infection rates?

    Directory of Open Access Journals (Sweden)

    Yoshida J

    2014-12-01

    Full Text Available Junichi Yoshida, Yukiko Harada, Tetsuya Kikuchi, Ikuyo Asano, Takako Ueno, Nobuo Matsubara Infection Control Committee, Shimonoseki City Hospital, Shimonoseki, Japan Abstract: The aim of this study was to elucidate risk factors, including ward antimicrobial use density (AUD, for central line-associated bloodstream infection (CLABSI as defined by the Centers for Disease Control and Prevention in a 430-bed community hospital using central venous lines with closed-hub systems. We calculated AUD as (total dose/(defined daily dose × patient days ×1,000 for a total of 20 drugs, nine wards, and 24 months. Into each line day data, we inputed AUD and device utilization ratios, number of central line days, and CLABSI. The ratio of susceptible strains in isolates were subjected to correlation analysis with AUD. Of a total of 9,997 line days over 24 months, CLABSI was present in 33 cases (3.3 ‰, 14 (42.4% of which were on surgical wards out of nine wards. Of a total of 43 strains isolated, eight (18.6% were methicillin-resistant Staphylococcus aureus (MRSA; none of the MRSA-positive patients had received cefotiam before the onset of infection. Receiver-operating characteristic analysis showed that central line day 7 had the highest accuracy. Logistic regression analysis showed the central line day showed an odds ratio of 5.511 with a 95% confidence interval of 1.936–15.690 as did AUD of cefotiam showing an odds ratio of 0.220 with 95% confidence interval of 0.00527–0.922 (P=0.038. Susceptible strains ratio and AUD showed a negative correlation (R2=0.1897. Thus, CLABSI could be prevented by making the number of central line days as short as possible. The preventative role of AUD remains to be investigated. Keywords: bloodstream infection, central line, antimicrobial use density

  20. Antibiotic resistance and OXA-type carbapenemases-encoding genes in airborne Acinetobacter baumannii isolated from burn wards.

    Science.gov (United States)

    Gao, Jing; Zhao, Xiaonan; Bao, Ying; Ma, Ruihua; Zhou, Yufa; Li, Xinxian; Chai, Tongjie; Cai, Yumei

    2014-03-01

    The study was conducted to investigate drug resistance, OXA-type carbapenemases-encoding genes and genetic diversity in airborne Acinetobacter baumannii (A. baumannii) in burn wards. Airborne A. baumannii were collected in burn wards and their corridors using Andersen 6-stage air sampler from January to June 2011. The isolates susceptibility to 13 commonly used antibiotics was examined according to the CLSI guidelines; OXA-type carbapenemases-encoding genes and molecular diversity of isolates were analyzed, respectively. A total of 16 non-repetitive A. baumannii were isolated, with 10 strains having a resistance rate of greater than 50% against the 13 antibiotics. The resistance rate against ceftriaxone, cyclophosvnamide, ciprofloxacin, and imipenem was 93.75% (15/16), but no isolate observed to be resistant to cefoperazone/sulbactam. Resistance gene analyses showed that all 16 isolates carried OXA-51, and 15 isolates carried OXA-23 except No.15; but OXA-24 and OXA-58 resistance genes not detected. The isolates were classified into 13 genotypes (A-M) according to repetitive extragenic palindromic sequence PCR (REP-PCR) results and only six isolates had a homology ≥90%. In conclusion, airborne A. baumannii in the burn wards had multidrug resistance and complex molecular diversity, and OXA-23 and OXA-51 were dominant mechanisms for resisting carbapenems.

  1. Understanding the modifiable health systems barriers to hypertension management in Malaysia: a multi-method health systems appraisal approach.

    Science.gov (United States)

    Risso-Gill, Isabelle; Balabanova, Dina; Majid, Fadhlina; Ng, Kien Keat; Yusoff, Khalid; Mustapha, Feisul; Kuhlbrandt, Charlotte; Nieuwlaat, Robby; Schwalm, J-D; McCready, Tara; Teo, Koon K; Yusuf, Salim; McKee, Martin

    2015-07-03

    The growing burden of non-communicable diseases in middle-income countries demands models of care that are appropriate to local contexts and acceptable to patients in order to be effective. We describe a multi-method health system appraisal to inform the design of an intervention that will be used in a cluster randomized controlled trial to improve hypertension control in Malaysia. A health systems appraisal was undertaken in the capital, Kuala Lumpur, and poorer-resourced rural sites in Peninsular Malaysia and Sabah. Building on two systematic reviews of barriers to hypertension control, a conceptual framework was developed that guided analysis of survey data, documentary review and semi-structured interviews with key informants, health professionals and patients. The analysis followed the patients as they move through the health system, exploring the main modifiable system-level barriers to effective hypertension management, and seeking to explain obstacles to improved access and health outcomes. The study highlighted the need for the proposed intervention to take account of how Malaysian patients seek treatment in both the public and private sectors, and from western and various traditional practitioners, with many patients choosing to seek care across different services. Patients typically choose private care if they can afford to, while others attend heavily subsidised public clinics. Public hypertension clinics are often overwhelmed by numbers of patients attending, so health workers have little time to engage effectively with patients. Treatment adherence is poor, with a widespread belief, stemming from concepts of traditional medicine, that hypertension is a transient disturbance rather than a permanent asymptomatic condition. Drug supplies can be erratic in rural areas. Hypertension awareness and education material are limited, and what exist are poorly developed and ineffective. Despite having a relatively well funded health system offering good access to

  2. A prospective, multi-method, multi-disciplinary, multi-level, collaborative, social-organisational design for researching health sector accreditation [LP0560737

    Directory of Open Access Journals (Sweden)

    Braithwaite Jeffrey

    2006-09-01

    Full Text Available Abstract Background Accreditation has become ubiquitous across the international health care landscape. Award of full accreditation status in health care is viewed, as it is in other sectors, as a valid indicator of high quality organisational performance. However, few studies have empirically demonstrated this assertion. The value of accreditation, therefore, remains uncertain, and this persists as a central legitimacy problem for accreditation providers, policymakers and researchers. The question arises as to how best to research the validity, impact and value of accreditation processes in health care. Most health care organisations participate in some sort of accreditation process and thus it is not possible to study its merits using a randomised controlled strategy. Further, tools and processes for accreditation and organisational performance are multifaceted. Methods/design To understand the relationship between them a multi-method research approach is required which incorporates both quantitative and qualitative data. The generic nature of accreditation standard development and inspection within different sectors enhances the extent to which the findings of in-depth study of accreditation process in one industry can be generalised to other industries. This paper presents a research design which comprises a prospective, multi-method, multi-level, multi-disciplinary approach to assess the validity, impact and value of accreditation. Discussion The accreditation program which assesses over 1,000 health services in Australia is used as an exemplar for testing this design. The paper proposes this design as a framework suitable for application to future international research into accreditation. Our aim is to stimulate debate on the role of accreditation and how to research it.

  3. [Hygiene and motivation factors of nursing work in a cardiology ward].

    Science.gov (United States)

    Somense, Carolina Bueno; Duran, Erika Christiane Marocco

    2014-09-01

    The present study aimed to identify hygienic and motivational factors in the nursing work according to the Two-Factor Theory, as well as their relation with professional satisfaction/dissatisfaction. This exploratory-descriptive study involved nine nurses from the cardiology ward of a hospital in the interior of the State of São Paulo, between August and September 2013. A self-applied questionnaire was used, including open and closed questions. The data were categorized as hygienic and motivational. Results show the nurses' satisfaction with autonomy, work itself and teamwork, duties, content and responsibilities of the job. Dissatisfaction is related to career growth possibilities; work, political and administrative conditions at the institution, supervision and lack of institutional support. Satisfaction and dissatisfaction factors include relationships, acknowledgements and remuneration. Nurses' satisfaction is determined by multiple and often controversial factors.

  4. Hygiene and motivation factors of nursing work in a cardiology ward

    Directory of Open Access Journals (Sweden)

    Carolina Bueno Somense

    Full Text Available The present study aimed to identify hygienic and motivational factors in the nursing work according to the Two-Factor Theory, as well as their relation with professional satisfaction/dissatisfaction. This exploratory-descriptive study involved nine nurses from the cardiology ward of a hospital in the interior of the State of São Paulo, between August and September 2013. A self-applied questionnaire was used, including open and closed questions. The data were categorized as hygienic and motivational. Results show the nurses' satisfaction with autonomy, work itself and teamwork, duties, content and responsibilities of the job. Dissatisfaction is related to career growth possibilities; work, political and administrative conditions at the institution, supervision and lack of institutional support. Satisfaction and dissatisfaction factors include relationships, acknowledgements and remuneration. Nurses' satisfaction is determined by multiple and often controversial factors.

  5. Application of a multi-method approach in characterization of natural aquatic colloids from different sources along Huangpu River in Shanghai, China

    Energy Technology Data Exchange (ETDEWEB)

    Yan, Caixia [School of Geography and Environment, Key Laboratory of Poyang Lake Wetland and Watershed Research, Ministry of Education, Jiangxi Normal University, 99 Ziyang Road, Nanchang 330022 (China); Center for Environmental Nanoscience and Risk, Arnold School of Public Health, University of South Carolina, 921 Assembly Street, Columbia 29208 (United States); State Key Laboratory of Estuarine and Coastal Research, East China Normal University, 3663 North Zhongshan Road, Shanghai 200062 (China); Nie, Minghua [School of Geography and Environment, Key Laboratory of Poyang Lake Wetland and Watershed Research, Ministry of Education, Jiangxi Normal University, 99 Ziyang Road, Nanchang 330022 (China); Lead, Jamie R. [Center for Environmental Nanoscience and Risk, Arnold School of Public Health, University of South Carolina, 921 Assembly Street, Columbia 29208 (United States); Yang, Yi [State Key Laboratory of Estuarine and Coastal Research, East China Normal University, 3663 North Zhongshan Road, Shanghai 200062 (China); Key Laboratory of Geographic Information Science of the Ministry of Education, Department of Geosciences, East China Normal University, 3663 North Zhongshan Road, Shanghai, 200062 (China); Zhou, Junliang [State Key Laboratory of Estuarine and Coastal Research, East China Normal University, 3663 North Zhongshan Road, Shanghai 200062 (China); Merrifield, Ruth [Center for Environmental Nanoscience and Risk, Arnold School of Public Health, University of South Carolina, 921 Assembly Street, Columbia 29208 (United States); Baalousha, Mohammed, E-mail: MBAALOUS@mailbox.sc.edu [Center for Environmental Nanoscience and Risk, Arnold School of Public Health, University of South Carolina, 921 Assembly Street, Columbia 29208 (United States)

    2016-06-01

    Natural colloid properties and the impact of human activities on these properties are important considerations for studies seeking to understand the fate and transport of pollutants. In this study, the relationship between size and fluorescence properties of natural colloids from 4 different sources were quantified using a multi-method analytical approach including UV–visible and fluorescence spectroscopy, flow field flow fractionation (FlFFF) coupled online to fluorescence spectrometer, and atomic force microscopy (AFM). Results indicate that colloids from pristine natural river water have higher aromaticity and humification, higher fluorescent intensity, and smaller size compared to those from the rivers impacted by livestock. The majority of colloids are smaller than 10 nm in size as measured by AFM and FlFFF. Colloid size measured by FlFFF coupled to fluorescence spectroscopy increases in the order peak C (Ex/Em at 300–340/400–460 nm) < peak D (Ex/Em at 210–230/340–360 nm) < peak T (Ex/Em at 270–280/330–370 nm) < peak A (Ex/Em at 210–250/400–460 nm), revealing that optical properties such as fluorescence are correlated with size. This trend is confirmed by the principal component analysis, which demonstrates that the first principal component (PC1) reflecting colloid optical properties decrease with the increase in PC3 which is correlated to the colloid size. - Highlights: • Natural aquatic colloids from different sources were isolated using cross flow ultrafiltration. • Multi-method approach is applied for colloidal characterization. • Colloids in pristine natural river water showed higher aromaticity, humification, fluorescent intensity, and smaller sizes. • Optical properties of colloids are size-dependent.

  6. Working time structure of pediatric nurses in hospital wards representing different referential levels

    Directory of Open Access Journals (Sweden)

    Ewa Smoleń

    2017-02-01

    Full Text Available Background: Working time is a non-renewable and important element in the management of an organization. The implementation of changes in the structure of working time may be facilitated by the insight into activities undertaken by employees during work. Such an approach plays an important role since the effective use of time improves the quality of care, prevents timewasting and optimizes the use of the full potential of employees, including nurses. The objective of the study was to determine the structure of working time of pediatric nurses in hospital wards of 2 referential levels. Material and Methods: The study was conducted in 2 wards (2nd and 3rd levels of reference in the Regional Specialist Children’s Hospital in Olsztyn. The research method involved the measurement of working time, as well as continuous and snap-shot observation techniques. Standardized research instruments were used in the study; 8 continuous observations and 2333 snap-shot observations were carried out. Results: In the structure of working time of pediatric nurses indirect nursing-related activities predominated (52.2%. Direct nursing made 28.7% of the working time. The nurses devoted the smallest amount of time to coordination and organization – 8%. The percentage of time associated with non-duty activities and breaks at work was 11.1%. In direct nursing activities associated with diagnosing (9% and treatment (11.7% prevailed. In indirect nursing activities pertaining to documentation of activities related to direct nursing made 24.6%. Conclusions: Pediatric nurses devote insufficient amount of time to direct nursing. Activities associated with documentation of activities related to direct nursing, preparation for direct nursing, as well as treatment and diagnosing predominate in the working time structure of nurses. Med Pr 2017;68(1:95–103

  7. A Survey of the quantity and type of biological aerosols in selected wards of a teaching hospital in Ghazvin

    Science.gov (United States)

    Eslami, Akbar; Karimi, Fatemeh; Karimi, Zainab; Rajabi, Zahra

    2016-01-01

    Introduction Bioaerosols are agents that can cause infection, allergy or induce other toxic effects in the human body. If the person exposed to such particles is not capable of their destruction or elimination from the body, the established chemical and physiological disorders can result in disease or death. The aim of this study was to assess the concentrations of bioaerosols in several wards of a teaching hospital. Methods Given that gas air-conditioners (split and window types) were used for ventilation in the eye operating room, internal intensive care unit, and the respiratory isolation room, these wards were selected for passive sampling. Sterile plates containing culture medium were exposed for two hours to the wards’ indoor ambient air. After this time, they were transferred to a lab to undergo incubation, colony count, and identification of the microorganisms. The data were analyzed using SPSS software, version 18, and the significance level of less than 0.05 was used. Results Based on our findings, the highest colony-forming bacterial unit was observed 22 cfu/plate/h in the eye operating room and, the highest colony-forming fungal unit was observed 4 cfu/plate/h in the internal intensive care unit. Based on the results of the differential tests, the most prevalent bacteria identified were Staphylococcus epidermidis (75%) in the air of eye operating room and Staphylococcus saprophyticus (52%) in the internal intensive care unit and isolation room. The most prevalent identified fungi in the air of selected wards were related to Alternaria alternata (43%), Aspergillus flavus (24%), Penicillium (36%) and Curvularia (21%) types. Based on Spearman’s correlation test, no significant relationship was observed between the factor of temperature and the number of fungal and bacterial colonies (r = 0.201, p = 0.42; r = −0.197, p = 0.41). Moreover, a meaningful relationship was observed only between the number of individuals and the bacterial colonies present in

  8. Feasibility of Progressive Strength Training Implemented in the Acute Ward after Hip Fracture Surgery

    DEFF Research Database (Denmark)

    Kronborg, Lise; Bandholm, Thomas; Palm, Henrik;

    2014-01-01

    IMPORTANCE: Patients with a hip fracture lose more than 50% knee-extension strength in the fractured limb within one week of surgery. Hence, immediate progressive strength training following hip fracture surgery may be rational, but the feasibility unknown. OBJECTIVE: To examine the feasibility...... of in-hospital progressive strength training implemented in the acute ward following hip fracture surgery, based on pre-specified criteria for feasibility. DESIGN, SETTING AND PATIENTS: A prospective cohort study conducted in an acute orthopedic hip fracture unit at a university hospital. A consecutive...... sample of 36 patients, 18 with a cervical and 18 with a trochanteric hip fracture (27 women and 9 men, mean (SD) age of 79.4 (8.3) years) were included between June and December 2012. INTERVENTION: A daily (on weekdays) program of progressive knee-extension strength training for the fractured limb, using...

  9. 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.

  10. Ward Identity and Homes' Law in a Holographic Superconductor with Momentum Relaxation

    CERN Document Server

    Kim, Keun-Young; Park, Miok

    2016-01-01

    We study three properties of a holographic superconductor related to conductivities, where momentum relaxation plays an important role. First, we find that there are constraints between electric, thermoelectric and thermal conductivities. The constraints are analytically derived by the Ward identities regarding diffeomorphism from field theory perspective. We confirm them by numerically computing all two-point functions from holographic perspective. Second, we investigate Homes' law and Uemura's law for various high-temperature and conventional superconductors. They are empirical and (material independent) universal relations between the superfluid density at zero temperature, the transition temperature, and the electric DC conductivity right above the transition temperature. In our model, it turns out that the Homes' law does not hold but the Uemura's law holds at small momentum relaxation related to coherent metal regime. Third, we explicitly show that the DC electric conductivity is finite for a neutral sc...

  11. 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.

  12. Ventilatory pattern and associated episodic hypoxaemia in the late postoperative period in the general surgical ward

    DEFF Research Database (Denmark)

    Rosenberg, J; Rasmussen, G I; Wøjdemann, K R;

    1999-01-01

    Episodic oxygen desaturation is frequent in the late postoperative period and seems most pronounced on the second and third postoperative nights. However, the ventilatory pattern has not been described systematically during this period. We studied the ventilatory pattern and associated arterial...... oxygenation using the Edentrace II equipment (impedance pneumography and pulse oximetry) on the second and third postoperative nights in 28 patients undergoing major abdominal surgery. Ventilatory disturbances were common and included periods of hypopnoea, and obstructive, central and mixed apnoeas. Overall...... disturbances. Overall, 23% (0-100) of the hypopnoeas and 7% (0-100) of the apnoeas were associated with episodic hypoxaemia. In conclusion, ventilatory disturbances were common in the late postoperative period in the general surgical ward and often associated with episodes of oxygen desaturation....

  13. HOSPITAL’S WALL COLOUR IMPACT ON STROKE PATIENTS’ WARD USERS IN SURABAYA

    Directory of Open Access Journals (Sweden)

    Tanuwidjaja GUNAWAN

    2015-12-01

    Full Text Available The Cardiovascular diseases have become the top killer since 1970 worldwide. In 2005, it was recorded the present of 5.7 million stroke survivors. On the other hand, healing stroke and its related complications required much more considerable time. So the patients’ wards quality especially related to wall colour become very important for the patients' recovery. The study was conducted with exploratory methods combining visual methods of research and Luscher colour test. Series of interviews were conducted to gather the users’ perception. So, it was found on that blue wall colour calmed the medical personals, patients, and their family. The most soothing Blue colour variant according to respondents was the Artic Blue (hue 9.8 B, value 7.4 and chroma 5.6.

  14. Self-Dual Supersymmetry and Supergravity in Atiyah-Ward Space-Time

    CERN Document Server

    Ketov, S V; Gates, S J; Ketov, Sergei V.; Nishino, Hitoshi

    1993-01-01

    We study supersymmetry and self-duality in a four-dimensional space-time with the signature (2,2), that we call the Atiyah-Ward space-time. Dirac matrices and spinors, in particular Majorana-Weyl spinors, are investigated in detail. We formulate $ N\\ge 1 $ supersymmetric self-dual Yang-Mills theories and self-dual supergravities. An N=1 ``self-dual'' tensor multiplet is constructed and a possible ten-dimensional theory that gives rise to the four-dimensional self-dual supersymmetric theories is found. Instanton solutions are given as the zero modes in the N=2 self-dual Yang-Mills theory. The N=2 superstrings are conjectured to have no possible counter-terms at quantum level to all orders. These self-dual supersymmetric theories are to generate exactly soluble supersymmetric systems in lower dimensions.

  15. Assessing the safety and quality of ward-based renal transplant biopsies

    Directory of Open Access Journals (Sweden)

    Kenneth Wu

    2010-10-01

    Full Text Available Kenneth Wu1, Bindhu Musunuru1, Chera Arunachalam1, Aung Sett1, Paul Musker21Renal Unit, St James’ University Hospital, Leeds, West Yorkshire, UK; 2Renal Unit, St Luke’s Hospital, Bradford, West Yorkshire, UKAbstract: The aim of this pilot study was to compare renal transplant biopsies carried out by ward-based nephrology trainees and departmental based radiologists, primarily reviewing major complications and glomerular yield. There was only one patient who developed a single episode of major complication out of the 145 procedures recorded. We concluded there is no significant difference in complication rate and glomerular yield for renal allograft biopsies between nephrology trainees and radiologists, regardless of location.Keywords: renal transplant, kidney biopsy complications, renal hemorrhage, glomerular yield

  16. 儿科重症监护室和普通病房小儿下呼吸道感染病原学分析%Study on Pathogen of Lower Respiratory Tract Infection in Children in Pediatric Intensive Care Unit and Common Ward

    Institute of Scientific and Technical Information of China (English)

    倪少娟; 陶春凤; 周华辉; 黄丽英; 李明艺

    2012-01-01

    Objective To investigate the pathogen of low respiratory tract infection in children in pediatric intensive care unit (PICU) and common ward.Methods From May to July,2011,a total of 397 cases (240 boys and 157 girls) with low respiratory tract infection were included into this study.They were divided into two groups,PICU group (n =77) and common ward group (n=320).There had no significant differences in age and gender between two groups (P>0.05).The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Maternity and Child Care Hospital of Guangxi Zhuang Autonomous Region.Informed consent was obtained from all participates' parents.The samples were collected from two groups for the test of indirect immunofluorescence assay (FIA).The following items were detected,IgM antibody of 5 viruses (7 types),including respiratory syncytial virus (RSV),adenovirus(ADV),influenza virus type A (IV-A),influenza virus type B (IV-B),parainfluenza virus type (PIV-1,2,3) and 4 atypical pathogens,including Mycoplasma pneumonia (MP),Legionella pneumophila 1 (LP 1),Chlamydia pneumonia (CPn),Q fever rickettsia (QFR).Results Among PICU group (n=77),positive rate of pathogen was 55.84% (43/77),of which,atypical pathogens detected rate was 68.83% (53/77),and virus detected rate was 19.48% (15/77),mixed infection were detected in 22 of 43 positive infectors (51.16%).Among common ward group (n=320),positive rate of pathogen was 35.94% (115/320),of which,atypical pathogens detected rate was 42.5% (136/320),and virus detected rate was 16.56% (53/320),mixed infection were detected in 58 of 115 positive infectors (50.43%).MP was the most common pathogen with higher positive rate of two groups (41.56% vs.24.69%).Conclusions Atypical pathogens was the mostly pathogen of lower respiratory tract infection in pediatric clinics,especially PICU children.Further more,dual mixed infections (MP + LP 1) is the most prevalent.%目的 探讨儿科重

  17. Effectiveness of a Multimodal Intervention Program for Restraint Prevention in an Acute Spanish Psychiatric Ward.

    Science.gov (United States)

    Guzman-Parra, Jose; Aguilera Serrano, Carlos; García-Sánchez, Juan A; Pino-Benítez, Isabel; Alba-Vallejo, Mercedes; Moreno-Küstner, Berta; Mayoral-Cleries, Fermin

    2016-05-01

    International recommendations have called to implement strategies to reduce the use of coercion in psychiatric settings. However, in Spain there is a lack of research about intervention programs to reduce mechanical restraint in acute psychiatric units. The aim of this study was to evaluate the effectiveness of a multimodal intervention program based on the principles of six core strategies to reduce the frequency of use of mechanical restraint in an acute psychiatric ward. The design was a retrospective analysis of the frequency and duration of episodes of mechanical restraint prior to the intervention program (2012) and during the intervention program (2013) in one acute psychiatric ward. The intervention was governed by four strategies: (1) leadership and organizational changes, (2) registration and monitoring of risk patients, (3) staff training, and (4) involving patients in the treatment program. There was a significant difference between the mean number of monthly episodes of mechanical restraint per 1,000 patient days, pre-intervention (18.54 ± 8.78) compared with postintervention (8.53 ± 7.00; p = .005). We found the probability that mechanical restraint would occur in a hospital admission decreased after performing the intervention (odds ratio = .587; confidence interval = 0.411-0.838; p = .003) after adjusting for confounding variables. The total percentage of restrained patients fell from 15.07% to 9.74%. The main implication of the study is to support the effectiveness of specific intervention programs based on different measures to reduce mechanical restraint and without contemplating all the strategies that are considered effective. © The Author(s) 2016.

  18. Frequency, types, and direct related costs of medication errors in an academic nephrology ward in Iran.

    Science.gov (United States)

    Gharekhani, Afshin; Kanani, Negin; Khalili, Hossein; Dashti-Khavidaki, Simin

    2014-09-01

    Medication errors are ongoing problems among hospitalized patients especially those with multiple co-morbidities and polypharmacy such as patients with renal diseases. This study evaluated the frequency, types and direct related cost of medication errors in nephrology ward and the role played by clinical pharmacists. During this study, clinical pharmacists detected, managed, and recorded the medication errors. Prescribing errors including inappropriate drug, dose, or treatment durations were gathered. To assess transcription errors, the equivalence of nursery charts and physician's orders were evaluated. Administration errors were assessed by observing drugs' preparation, storage, and administration by nurses. The changes in medications costs after implementing clinical pharmacists' interventions were compared with the calculated medications costs if the medication errors were continued up to patients' discharge time. More than 85% of patients experienced medication error. The rate of medication errors was 3.5 errors per patient and 0.18 errors per ordered medication. More than 95% of medication errors occurred at prescription nodes. Most common prescribing errors were omission (26.9%) or unauthorized drugs (18.3%) and low drug dosage or frequency (17.3%). Most of the medication errors happened on cardiovascular drugs (24%) followed by vitamins and electrolytes (22.1%) and antimicrobials (18.5%). The number of medication errors was correlated with the number of ordered medications and length of hospital stay. Clinical pharmacists' interventions decreased patients' direct medication costs by 4.3%. About 22% of medication errors led to patients' harm. In conclusion, clinical pharmacists' contributions in nephrology wards were of value to prevent medication errors and to reduce medications cost.

  19. Nature and frequency of medication errors in a geriatric ward: an Indonesian experience

    Directory of Open Access Journals (Sweden)

    Ernawati DK

    2014-06-01

    Full Text Available Desak Ketut Ernawati,1,2 Ya Ping Lee,2 Jeffery David Hughes21Faculty of Medicine, Udayana University, Denpasar, Bali, Indonesia; 2School of Pharmacy and Curtin Health Innovation and Research Institute, Curtin University, Perth, WA, AustraliaPurpose: To determine the nature and frequency of medication errors during medication delivery processes in a public teaching hospital geriatric ward in Bali, Indonesia.Methods: A 20-week prospective study on medication errors occurring during the medication delivery process was conducted in a geriatric ward in a public teaching hospital in Bali, Indonesia. Participants selected were inpatients aged more than 60 years. Patients were excluded if they had a malignancy, were undergoing surgery, or receiving chemotherapy treatment. The occurrence of medication errors in prescribing, transcribing, dispensing, and administration were detected by the investigator providing in-hospital clinical pharmacy services.Results: Seven hundred and seventy drug orders and 7,662 drug doses were reviewed as part of the study. There were 1,563 medication errors detected among the 7,662 drug doses reviewed, representing an error rate of 20.4%. Administration errors were the most frequent medication errors identified (59%, followed by transcription errors (15%, dispensing errors (14%, and prescribing errors (7%. Errors in documentation were the most common form of administration errors. Of these errors, 2.4% were classified as potentially serious and 10.3% as potentially significant.Conclusion: Medication errors occurred in every stage of the medication delivery process, with administration errors being the most frequent. The majority of errors identified in the administration stage were related to documentation. Provision of in-hospital clinical pharmacy services could potentially play a significant role in detecting and preventing medication errors.Keywords: geriatric, medication errors, inpatients, medication delivery process

  20. 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.

  1. 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.

  2. 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.

  3. 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.

  4. 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.

  5. 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 ).

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

    Directory of Open Access Journals (Sweden)

    Morphet J

    2014-06-01

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

  7. 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.

  8. 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...

  9. Children's disengagement from cancer care and treatment on the ward: an undesirable social tactic in the long term

    DEFF Research Database (Denmark)

    Løvschal-Nielsen, Pia; Meinert, Lotte; Clausen, Niels

    2016-01-01

    This anthropological study explores children’s non-social reactions during the active treatment period, the on-treatment, in a paediatric oncology ward in a Danish university hospital. It is argued that, although some children’s non-social reactions is a tactical disengagement to manage the on...... and open-ended interviewing. Fifty children of both sexes between 4 and 15 years, their families and hospital staff participated in the study. These data formed the basis for the study. The findings show that children’s response to care challenges, including exhaustion from care management, exposure from...... and damaging tactic for survivors of cancer in childhood....

  10. 伦理查房的研究进展综述%Review on the Research Prowess on Ethical Ward- Round

    Institute of Scientific and Technical Information of China (English)

    刘雪莲; 嵇承栋

    2011-01-01

    In the process of medical service, the ethical ward - rounds which begin at 2002 reflect the important content of medical ethics. This paper summarize the concept, methods, content, effect, and the problem in the process of the ethical ward - rounds. Besides, feasible suggestions are also provided, such as the personnel constitution of ethical ward - rounds, promotion of ethics education, objective demonstration of ethical ward - rounds, concern for patients'psychological health, and ethical principle for out -patient clinic, in order to provide theoretical basis of further study.%在医疗服务的进程中,体现医学伦理重要内容的就是伦理查房.通过对伦理查房的概念、查房方式、查房内容、由此在实践中产生的成效,提出伦理查房目前还存在的问题及其思考,如伦理查房的人员构成、继续加强伦理教育、伦理查房客观论证、关注患者心理健康、门诊的伦理原则等,从而为进一步对伦理查房的研究提供理论基础.

  11. "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...

  12. 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.

  13. 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...

  14. 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...

  15. 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...

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

    Directory of Open Access Journals (Sweden)

    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

    Directory of Open Access Journals (Sweden)

    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. 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...

  19. 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.

  20. 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.”

  1. 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.

  2. 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

    Full Text Available Vikas Acharya,1Amir Reyahi,2 Samuel M Amis,3 Sami Mansour2 1Department of Neurosurgery, University Hospitals Coventry and Warwickshire, Coventry, 2Luton and Dunstable University Hospital, Luton, 3Warwick Medical School, University of Warwick, Coventry, UK Abstract: Ward rounds are widely considered an underutilized resource with regard to medical education, and therefore, a project was undertaken to assess if the initiation of “trainee-centered ward rounds” would help improve the confidence, knowledge acquisition, and workplace satisfaction of junior doctors in the clinical environment. Data were collated from junior doctors, registrar grade doctors, and consultants working in the delivery suite at Luton and Dunstable University Hospital in Luton over a 4-week period in March–April 2013. A review of the relevant literature was also undertaken. This pilot study found that despite the reservations around time constraints held by both junior and senior clinicians alike, feedback following the intervention was largely positive. The junior doctors enjoyed having a defined role and responsibility during the ward round and felt they benefited from their senior colleagues’ feedback. Both seniors and junior colleagues agreed that discussing learning objectives prior to commencing the round was beneficial and made the round more learner-orientated; this enabled maximal learner-focused outcomes to be addressed and met. The juniors were generally encouraged to participate more during the round and the consultants endeavored to narrate their decision-making, both were measures that led to greater satisfaction of both parties. This was in keeping with the concept of “Legitimate peripheral participation” as described by Lave and Wenger. Overall, trainee-centered ward rounds did appear to be effective in overcoming some of the traditional barriers to teaching in the ward environment, although further work to formalize and quantify these findings

  3. 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.

  4. [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.

  5. 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.

  6. 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.

  7. 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

  8. Evaluation of clinical pharmacist's interventions in an infectious diseases ward and impact on patient's direct medication cost.

    Science.gov (United States)

    Khalili, Hossein; Karimzadeh, Iman; Mirzabeigi, Parastoo; Dashti-Khavidaki, Simin

    2013-04-01

    A clinical pharmacist is a key member of the antimicrobial multidisciplinary team involved in patients' pharmacotherapy monitoring. The aim of this study was to determine the frequency and type of medication errors, the type of clinical pharmacy interventions, acceptance of pharmacist interventions by health-care provider team, nursing staff satisfaction with clinical pharmacy services, and the probable impact of clinical pharmacy interventions on decreasing direct medication costs at an infectious diseases ward in Iran. All clinical pharmacist interventions such as preventing medication errors were recorded in a previously designed pharmacotherapy monitoring forms. Direct medication cost of patients admitted during the study period was compared with that of subjects hospitalized at the same ward during the year before the intervention period to determine the impact of clinical pharmacy interventions on direct medication costs. The 3 most frequent medication error types were incorrect dose (35.5%), omission error (24.3%), and incorrect medication (14.3%). The mean number of clinical pharmacist intervention per patient was 3.2. Forty percent of clinical pharmacists' interventions are moderate to major clinical significant. Thirty nine percent of clinical pharmacist's interventions had moderate to major financial benefits in present study. The direct medication cost per patient was decreased about 3.8% following clinical pharmacist's interventions. Our data demonstrated that incorrect dose was the most frequent medication error in the infectious diseases ward. Major portion of clinical pharmacist interventions were accepted by physicians and nursing staff. Clinical pharmacist interventions non-significantly decreased the direct medication cost of patients. Copyright © 2012 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

  9. 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

  10. 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.

    Directory of Open Access Journals (Sweden)

    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.

  11. Poverty and Its Association with Child Labor in Njombe District in Tanzania: The Case of Igima Ward

    OpenAIRE

    Akarro, Rocky R.J.; Nathan Anthon Mtweve

    2011-01-01

    The main aim of the study is to present the state of child labour and factors behind this citing one of the most prevalent areas for child labour in Tanzania known as Njombe. Njombe district which is predominantly a rural area is one of the most prevalent areas of child labour in Tanzania. A survey of 300 household heads that were randomly selected from accessible four villages in Igima ward in Njombe district confirmed this phenomenon. Chi-square statistic analysis on the relationship betwee...

  12. Doctors and nurses on wards with greater access to clinical dietitians have better focus on clinical nutrition

    DEFF Research Database (Denmark)

    Thoresen, L.; Rothenberg, E.; Beck, Anne Marie

    2008-01-01

    , as well as to 678 clinical dietitians working in Scandinavian hospitals. The response rate of clinical dietitians, nurses and doctors were 53%, 46% and 29%, respectively. Nurses and doctors who saw clinical dietitians often found it less difficult to identify undernourished patients and found that insight...... into the importance of adequate nutrition was better than those who saw clinical dietitians seldom. Clinical nutrition had a higher priority in units with frequent visits by clinical dietitians. The present study shows that doctors and nurses on wards with greater access to clinical dietitians had better focus...

  13. Closing an open psychiatric ward: organizational change and its effect on staff uncertainty, self-efficacy, and professional functioning.

    Science.gov (United States)

    Melnikov, Semyon; Shor, Razya; Kigli-Shemesh, Ronit; Gun Usishkin, Monica; Kagan, Ilya

    2013-04-01

    Converting an open psychiatric ward to a closed one can be threatening and stressful for the medical and nursing staff involved. This study describes the effects of this change, in particular the before-after correlation among self-efficacy, professional functioning, and uncertainty. Forty-four staff participated, completing pre-/poststructured questionnaires. Uncertainty was higher before the conversion than after the conversion. Professional functioning declined after the conversion. Self-efficacy was positively correlated with pre- and postconversion functioning, but negatively correlated with postconversion uncertainty. It is important to prepare staff for this significant organizational change. Suggestions for prechange interventions are offered. © 2012 Wiley Periodicals, Inc.

  14. 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.

  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. User participation in a Municipal Acute Ward in Norway: dilemmas in the interface between policy ideals and work conditions.

    Science.gov (United States)

    Johannessen, Anne-Kari; Tveiten, Sidsel; Werner, Anne

    2017-08-23

    User participation has become an increasingly important principle in health care over the last few decades. Healthcare professionals are expected to involve patients in treatment decisions. Clear guidance as to what this should entail for professionals in clinical work is not accounted for in legislation. In this study, we explore how healthcare professionals in a Municipal Acute Ward perceived, experienced and performed user participation. The ward represents a new short-time service model for emergency assistance in Norway. We focused on the challenges the professionals faced in clinical work and how they dealt with these. Data were drawn from qualitative interviews with 11 healthcare professionals and from 10 observations in relation to previsits and physician's rounds in the ward. Transcripts of interviews and observations were analysed using a method for systematic text condensation. In the analysis, we applied Lipsky's perspective on dilemmas of street-level bureaucrats. The results show that that the professionals perceived user participation as an important and natural part of their work. They experienced difficulties related to collaboration with patients, caregivers, and professionals in other services, and with framework conditions that caused conflicting expectations, responsibility, and priorities. The professionals seemed to take a pragmatic approach to user participation, managing it within narrow perspectives. Our study indicates that the participants dealt with the dilemmas at the cost of user participation. The results demonstrate that there is a gap between the outlined health policy and the professionals' opportunities to fulfil this policy in clinical work regarding user participation. The policy decision-makers should recognise the balancing work required of healthcare professionals to deal with difficulties in clinical work. The knowledge that professionals possess as performers of services and the need for valuing in policy processes should

  17. The convergent and discriminant validity of burnout measures in sport: a multi-trait/multi-method analysis.

    Science.gov (United States)

    Cresswell, Scott L; Eklund, Robert C

    2006-02-01

    Athlete burnout research has been hampered by the lack of an adequate measurement tool. The Athlete Burnout Questionnaire (ABQ) and the Maslach Burnout Inventory General Survey (MBI-GS) are two recently developed self-report instruments designed to assess burnout. The convergent and discriminant validity of the ABQ and MBI-GS were assessed through multi-trait/multi-method analysis with a sporting population. Overall, the ABQ and the MBI-GS displayed acceptable convergent validity with matching subscales highly correlated, and satisfactory internal discriminant validity with lower correlations between non-matching subscales. Both scales also indicated an adequate discrimination between the concepts of burnout and depression. These findings add support to previous findings in non-sporting populations that depression and burnout are separate constructs. Based on the psychometric results, construct validity analysis and practical considerations, the results support the use of the ABQ to assess athlete burnout.

  18. Electrophysiological assessment of nociception in patients with Parkinson's disease : A multi-methods approach

    NARCIS (Netherlands)

    Priebe, Janosch A.; Kunz, Miriam; Morcinek, Christian; Rieckmann, Peter; Lautenbacher, Stefan

    2016-01-01

    Objective: Nociceptive abnormalities indicating increased pain sensitivity have been reported in patients with Parkinson's disease (PD). The disturbances are mostly responsive to dopaminergic (DA) treatment; yet, there are conflicting results. The objective of the present study was to investigate pa

  19. BED OCCUPANCY RATE AND LENGTH OF STAY OF PATIENTS IN MEDICAL AND ALLIED WARDS OF A TERTIARY CARE HOSPITAL.

    Science.gov (United States)

    Usman, Gulzar; Memon, Khalida Naz; Shaikh, Shazia

    2015-01-01

    A good hospital management includes an effective allocative planning for beds in a hospital. Bed-occupancy rates and length of stay are the measures that reflect the functional ability of a hospital. A cross sectional study of two months' duration was carried out in eight medical and allied wards of Liaquat University Hospital (LUH) Jamshoro with objective to estimate the bed occupancy rate and the average length of stay of patients. Data was collected by filling a predesigned check list and bed occupancy rate and average length of stay were computed. Associations were analysed by using SPSS version 16. The p-value 50.05 Was taken as level of significance. One hundred & seven admissions were recorded against 235 available beds. Average bed occupancy rate was 51.33%. The 51.4% of the patients in medical wards except paediatrics ward were of the age >50 years; the mean age was 45 years and standard deviation +/-6.4 years. Mean age in paediatrics was 3.89 years and standard deviation of +/-0.8 years. 55.1% patients had infectious diseases. The 32.7% patients stayed in hospital for up to 3 days showing significant association between nature of diseases and duration of stay (p=0.03). There was male preponderance, i.e., 54.2% males against 45.8% females. Showing significant association between gender and length of stay (p=0.01). Bed occupancy rate and average stay in hospital were found within recommended range; more improvement may be brought by doing further research on this issue.

  20. How Programming Can Make a Difference for Gifted Students--A Multi-Methods Model.

    Science.gov (United States)

    Hall, Eleanor G.

    A multimethod model of educating gifted and talented students was based on graduate students' study of 14 eminent self actualized individuals. Common environmental elements of these individuals were found in parent background, birth order, relationship with family, education, task commitment, personality traits, and interests. The model was…

  1. Epidemiologic features of early onset sepsis in neonatal ward of Shabih Khani hospital in Kashan

    Directory of Open Access Journals (Sweden)

    Ziba Mosayebi

    2015-02-01

    Full Text Available Background and objective: Neonatal sepsis is defined as presence of clinical signs accompanied by positive blood culture in newborns less than one month of age. Sepsis is a common cause of hospital admission in neonates, and it is known as one of the main causes of mortality among them, not only in developed countries but in developing ones. Delay in diagnosis and appropriate antibiotic therapy would result in death. The aim of this study is to find the main pathogens of sepsis and evaluate sensitivity changes of organisms to antibiotics in comparison with the past. Method: In this descriptive study, 104 (files of neonates, admitted to the neonatal ward of Shabih Khani Hospital, with positive blood culture over a 24-month period ( 2005-2007 were assessed. Data were extracted for analysis. Results: Over this 24-month study on 104 neonates with sepsis, the most common organisms included flavobacterium 43.3% , pseudomonas 33.3%, coagulase negative staphylococcus 17.3%, coagulase positive staphylococcus 5.9% followed by enterobacter , E.coli, beta-haemolytic streptococcus, klebsiella, diphtheriod and lysteria. Conclusion: In this study Flavobacterium is found to be the most common organism for early sepsis. Although infection with flavobacterium is rare, its rate of mortality is high and it is resistant to majority of common antibiotics. Therefore, early diagnosis and appropriate antibiotic prescription helps reduce its complications.

  2. Agglomeration behaviour of titanium dioxide nanoparticles in river waters: A multi-method approach combining light scattering and field-flow fractionation techniques.

    Science.gov (United States)

    Chekli, L; Roy, M; Tijing, L D; Donner, E; Lombi, E; Shon, H K

    2015-08-15

    Titanium dioxide nanoparticles (TiO2 NPs) are currently one of the most prolifically used nanomaterials, resulting in an increasing likelihood of release to the environment. This is of concern as the potential toxicity of TiO2 NPs has been investigated in several recent studies. Research into their fate and behaviour once entering the environment is urgently needed to support risk assessment and policy development. In this study, we used a multi-method approach combining light scattering and field-flow fractionation techniques to assess both the aggregation behaviour and aggregate structure of TiO2 NPs in different river waters. Results showed that both the aggregate size and surface-adsorbed dissolved organic matter (DOM) were strongly related to the initial DOM concentration of the tested waters (i.e. R(2) > 0.90) suggesting that aggregation of TiO2 NPs is controlled by the presence and concentration of DOM. The conformation of the formed aggregates was also found to be strongly related to the surface-adsorbed DOM (i.e. R(2) > 0.95) with increasing surface-adsorbed DOM leading to more compact structures. Finally, the concentration of TiO2 NPs remaining in the supernatant after sedimentation of the larger aggregates was found to decrease proportionally with both increasing IS and decreasing DOM concentration, resulting in more than 95% sedimentation in the highest IS sample.

  3. 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.

  4. Evaluation for Water Conservation in Agriculture: Using a Multi-Method Econometric Approach

    Science.gov (United States)

    Ramirez, A.; Eaton, D. J.

    2012-12-01

    Since the 1960's, farmers have implemented new irrigation technology to increase crop production and planting acreage. At that time, technology responded to the increasing demand for food due to world population growth. Currently, the problem of decreased water supply threatens to limit agricultural production. Uncertain precipitation patterns, from prolonged droughts to irregular rains, will continue to hamper planting operations, and farmers are further limited by an increased competition for water from rapidly growing urban areas. Irrigation technology promises to reduce water usage while maintaining or increasing farm yields. The challenge for water managers and policy makers is to quantify and redistribute these efficiency gains as a source of 'new water.' Using conservation in farming as a source of 'new water' requires accurately quantifying the efficiency gains of irrigation technology under farmers' actual operations and practices. From a water resource management and policy perspective, the efficiency gains from conservation in farming can be redistributed to municipal, industrial and recreational uses. This paper presents a methodology that water resource managers can use to statistically verify the water savings attributable to conservation technology. The specific conservation technology examined in this study is precision leveling, and the study includes a mixed-methods approach using four different econometric models: Ordinary Least Squares, Fixed Effects, Propensity Score Matching, and Hierarchical Linear Models. These methods are used for ex-post program evaluation where random assignment is not possible, and they could be employed to evaluate agricultural conservation programs, where participation is often self-selected. The principal method taken in this approach is Hierarchical Linear Models (HLM), a useful model for agriculture because it incorporates the hierarchical nature of the data (fields, tenants, and landowners) as well as crop rotation

  5. The prevalence of depression among elderly warded in a tertiary care centre in Wilayah Persekutuan.

    Science.gov (United States)

    Sherina, M S; Rampal, L; Hanim, M Arfah; Thong, P L

    2006-03-01

    Depression is characterized by symptoms like disturbance in behavior, cognition and mood. This is commonly known to affect people aged 60 years and above especially those who are also afflicted with illnesses. The objectives of this study were to determine the prevalence of depression and its associated factors among the elderly in a tertiary care centre in Wilayah Persekutuan. A cross sectional study design was done. Stratified cluster sampling method was used to select the respondents. All elderly patients were selected from the orthopaedic, surgical, gynaecology and medical wards in a government hospital in Wilayah Persekutuan. A 30-item Geriatric Depression Scale questionnaire was used as a screening instrument. Out of the 246 elderly subjects, 198 were interviewed giving a response rate of 80.5%. The results showed that 54% of the elderly respondents were found to have depressive symptoms. Age (p=0.022), sex (p=0.008), ethnicity (p=0.022) and functional disabilities in bathing (p=0.001), grooming (p=0.007), dressing (p= 0.007), using the toilet (p=0.002), transferring from bed to chair and back (p=0.000), mobility (p=0.000) and climbing stairs (p=0.000) were all found to be significantly associated with depression among the elderly respondents. The outcome of this study will have an important impact on the implementation of the health policy for the elderly patients admitted to hospitals.

  6. Chemical restraint in routine clinical practice: a report from a general hospital psychiatric ward in Greece

    Directory of Open Access Journals (Sweden)

    Papamichael Georgios

    2011-02-01

    Full Text Available Abstract Background There is a dearth of studies regarding chemical restraint in routine clinical psychiatric practice. There may be wide variations between different settings and countries. Methods A retrospective study on chemical restraint was performed in the 11-bed psychiatric ward of the General Hospital of Arta, in northwestern Greece. All admissions over a 2-year-period (from March 2008 to March 2010 were examined. Results Chemical restraint was applied in 33 cases (10.5% of total admissions. From a total of 82 injections, 22 involved a benzodiazepine and/or levomepromazine, whereas 60 injections involved an antipsychotic agent, almost exclusively haloperidol (96.7% of cases, usually in combination with a benzodiazepine (61.7% of cases. In 36.4% of cases the patient was further subjected to restraint or seclusion. Conclusions In our unit, clinicians prefer the combined antipsychotic/benzodiazepine regimen for the management of patients' acute agitation and violent behaviour. Conventional antipsychotics are administrated almost exclusively and in a significant proportion of cases further coercive measures are applied. Studies on the practice of chemical restraint should be regularly performed in clinical settings.

  7. A multi-method evaluation of a training course on dual diagnosis.

    LENUS (Irish Health Repository)

    Rani, S

    2012-08-01

    A training course on dual diagnosis was developed within the Irish forensic mental health service, to bridge the gap in the lack of training on dual diagnosis in Ireland. The course was designed for service providers within mental health and addiction services. Twenty participants involving nursing, social work, police and social welfare disciplines attended the first training course. A mixed methodology research design was adapted to describe participants\\' evaluation of the training course. Data were collected using multiple methods: pre- and post-test, daily evaluation and focus group interviews. Quantitative data were analysed using the spss Version 16.0 and qualitative data were analysed thematically. Findings from the pre- and post-test suggest an increase in participants\\' knowledge of dual diagnosis and an increase in confidence in conducting groups. Daily evaluation indicates that the course content largely met participants\\' needs. Finally, three themes emerged from the focus group interview: increased confidence, the training course\\/teaching methods and personal\\/organizational challenges. This study implies that service providers within mental health and addiction services benefit from inter-professional, needs and skills based courses incorporating a variety of teaching methods. The way forward for future dual diagnosis training course developments would be working in partnership with service users and carers.

  8. Multi-method analysis of MRI images in early diagnostics of Alzheimer's disease.

    Directory of Open Access Journals (Sweden)

    Robin Wolz

    Full Text Available The role of structural brain magnetic resonance imaging (MRI is becoming more and more emphasized in the early diagnostics of Alzheimer's disease (AD. This study aimed to assess the improvement in classification accuracy that can be achieved by combining features from different structural MRI analysis techniques. Automatically estimated MR features used are hippocampal volume, tensor-based morphometry, cortical thickness and a novel technique based on manifold learning. Baseline MRIs acquired from all 834 subjects (231 healthy controls (HC, 238 stable mild cognitive impairment (S-MCI, 167 MCI to AD progressors (P-MCI, 198 AD from the Alzheimer's Disease Neuroimaging Initiative (ADNI database were used for evaluation. We compared the classification accuracy achieved with linear discriminant analysis (LDA and support vector machines (SVM. The best results achieved with individual features are 90% sensitivity and 84% specificity (HC/AD classification, 64%/66% (S-MCI/P-MCI and 82%/76% (HC/P-MCI with the LDA classifier. The combination of all features improved these results to 93% sensitivity and 85% specificity (HC/AD, 67%/69% (S-MCI/P-MCI and 86%/82% (HC/P-MCI. Compared with previously published results in the ADNI database using individual MR-based features, the presented results show that a comprehensive analysis of MRI images combining multiple features improves classification accuracy and predictive power in detecting early AD. The most stable and reliable classification was achieved when combining all available features.

  9. Predicting pilot error: testing a new methodology and a multi-methods and analysts approach.

    Science.gov (United States)

    Stanton, Neville A; Salmon, Paul; Harris, Don; Marshall, Andrew; Demagalski, Jason; Young, Mark S; Waldmann, Thomas; Dekker, Sidney

    2009-05-01

    The Human Error Template (HET) is a recently developed methodology for predicting design-induced pilot error. This article describes a validation study undertaken to compare the performance of HET against three contemporary Human Error Identification (HEI) approaches when used to predict pilot errors for an approach and landing task and also to compare analyst error predictions to an approach to enhancing error prediction sensitivity: the multiple analysts and methods approach, whereby multiple analyst predictions using a range of HEI techniques are pooled. The findings indicate that, of the four methodologies used in isolation, analysts using the HET methodology offered the most accurate error predictions, and also that the multiple analysts and methods approach was more successful overall in terms of error prediction sensitivity than the three other methods but not the HET approach. The results suggest that when predicting design-induced error, it is appropriate to use a toolkit of different HEI approaches and multiple analysts in order to heighten error prediction sensitivity.

  10. A multi-method evaluation of a training course on dual diagnosis.

    Science.gov (United States)

    Rani, S; Byrne, H

    2012-08-01

    A training course on dual diagnosis was developed within the Irish forensic mental health service, to bridge the gap in the lack of training on dual diagnosis in Ireland. The course was designed for service providers within mental health and addiction services. Twenty participants involving nursing, social work, police and social welfare disciplines attended the first training course. A mixed methodology research design was adapted to describe participants' evaluation of the training course. Data were collected using multiple methods: pre- and post-test, daily evaluation and focus group interviews. Quantitative data were analysed using the spss Version 16.0 and qualitative data were analysed thematically. Findings from the pre- and post-test suggest an increase in participants' knowledge of dual diagnosis and an increase in confidence in conducting groups. Daily evaluation indicates that the course content largely met participants' needs. Finally, three themes emerged from the focus group interview: increased confidence, the training course/teaching methods and personal/organizational challenges. This study implies that service providers within mental health and addiction services benefit from inter-professional, needs and skills based courses incorporating a variety of teaching methods. The way forward for future dual diagnosis training course developments would be working in partnership with service users and carers.

  11. 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.

  12. 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.

  13. A Multi-Methods Approach to HRA and Human Performance Modeling: A Field Assessment

    Energy Technology Data Exchange (ETDEWEB)

    Jacques Hugo; David I Gertman

    2012-06-01

    The Advanced Test Reactor (ATR) is a research reactor at t