Journal articles on the topic 'Clinical Nursing: Tertiary (Rehabilitative)'
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Stamm, Brian J., Christina M. Lineback, Lesli E. Skolarus, Lewis B. Morgenstern, and Gaurang V. Shah. "Artery of Percheron Infarct: 12 Cases and Their Complex Clinical Courses." Neurohospitalist 8, no. 3 (December 28, 2017): 141–45. http://dx.doi.org/10.1177/1941874417748543.
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Strokes involving the artery of Percheron (AOP), an anatomic variant of thalamic vascular supply, are rare. Little is known about the inpatient hospital course for these patients. We retrospectively identified consecutive patients with AOP in their medical charts from a university-based tertiary care hospital from January 1, 2000, to August 15, 2017. A chart review identified demographics, transfer status, in-hospital versus community onset of stroke, emergency medical services (EMS) use, presenting signs/symptoms, time to radiologic diagnosis (from time of presentation to tertiary care hospital or from time of initial symptom onset in an already hospitalized patient), tissue plasminogen activator (tPA) use, intensive care unit (ICU) stays, intubation, length of stay (LOS), and discharge location. After radiologic inclusion/exclusion criteria were applied, 12 patients were included in the study. There were 7 men and 5 women, and the mean age (SD) was 68 (15). Seven were transfers, and 4 had an in-hospital stroke. Of the 8 community-onset strokes, 7 utilized EMS. Mental status changes occurred in 11 of 12 and ocular disturbances in all patients. Time to radiologic diagnosis averaged 1.9 (median = 1.1) days. One patient received tPA. Eight received care in the ICU. Four were intubated. Average LOS was 8.3 days. Four were discharged home, 3 entered inpatient rehabilitation facilities, and 5 entered skilled nursing facilities. In-hospital stroke status further complicates the already challenging diagnosis of AOP infarct, and clinicians must maintain a high suspicion for this rare stroke in order to quickly diagnose and intervene.
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Noë, Sofie, Ann Goeleven, Hilde Brouwers, Tom Meurrens, Alexander De Cock, Daphne Kos, and Kris Vanhaecht. "Training for Caregivers and Compliance with Dysphagia Recommendations in a Tertiary Multiple Sclerosis Rehabilitation Center." International Journal of MS Care 23, no. 5 (March 19, 2021): 223–28. http://dx.doi.org/10.7224/1537-2073.2020-019.
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Abstract Background: Dysphagia is common in persons with multiple sclerosis (MS). Speech and language therapists give dysphagia recommendations to persons with MS and caregivers. Nonadherence to these recommendations can increase the risk of aspiration. We investigated current compliance with dysphagia recommendations among caregivers and kitchen staff and assessed improvement in compliance by increasing knowledge through tailored training. Methods: An observational cohort study was conducted over 4 weeks during which the compliance of the caregivers and kitchen staff in a rehabilitation center was monitored. A questionnaire was used to assess reasons for noncompliance. A 2-hour training session was provided for all caregivers and kitchen staff to improve their knowledge and skills. The compliance rate was observed again 1 and 6 months after the training. Compliance was defined by whether recommendations were followed. Results: Results showed a significant improvement after training for overall compliance by caregivers (from 58% to >81%, P < .001). This improvement was still observed 6 months later (80%). After training, significant differences were found in compliance with the following recommendations (P ≤ .001): consistency of soup, consistency of liquids, food preparation, alertness, speed, amount, posture, and supervision. Recommendation for utensils did not improve (P = .44). Compliance with diet modifications made by the kitchen staff improved significantly (from 74% to >86%, P = .002), and even more during follow-up (to >95%, P = .009). Conclusions: Dysphagia training tailored to the needs of caregivers to improve knowledge significantly improves compliance with dysphagia recommendations and the quality of care.
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Small, Luke T., Madison Lampkin, Emre Vural, and Mauricio A. Moreno. "American Society of Anesthesiologists Class as Predictor for Perioperative Morbidity in Head and Neck Free Flaps." Otolaryngology–Head and Neck Surgery 161, no. 1 (March 26, 2019): 91–97. http://dx.doi.org/10.1177/0194599819832812.
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ObjectiveTo evaluate outcomes of free flaps in low- versus high-risk American Society of Anesthesiologists (ASA) classes utilizing a standardized perioperative clinical pathway.Study DesignCase series with chart review.SettingSingle tertiary care academic institution.Subjects and MethodsData were collected from 301 patients who underwent 305 free flap reconstructions for head and neck defects from January 2012 to March 2016 by a single surgeon (M.M.). A standardized perioperative clinical pathway was utilized for all patients, aimed at abbreviating hospital stay and minimizing intensive care unit stay. Data included ASA classification, comorbidities, length of hospitalization, intensive care unit stay, 30-day mortality/readmission, discharge disposition, flap survival, and postoperative complications. Low-risk ASA classes were defined as 1 and 2 (n = 53) and high risk as 3 and 4 (n = 248).ResultsTotal medical complication rates ( P = .012) were mildly increased in the high-risk group, as a result of increased minor—not major—medical complication rates ( P = .007). Discharge to a nursing or rehabilitation facility was found to be more common in the high-risk group ( P = .024). All other outcomes were not statistically different between the cohorts.ConclusionThe ASA classification system is a validated tool in determining perioperative risk. We found that minor medical complications and discharge to a rehabilitation/nursing facility were increased in the high-risk ASA classes; otherwise, there were no statistical differences between the groups. These findings suggest that the ASA classification may be helpful for preoperative discharge planning and counseling but should not be used for patient selection or to assess candidacy for the procedure.
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Safaee, Michael M., Ramin A. Morshed, Jordan Spatz, Sujatha Sankaran, Mitchel S. Berger, and Manish K. Aghi. "Interfacility neurosurgical transfers: an analysis of nontraumatic inpatient and emergency department transfers with implications for improvements in care." Journal of Neurosurgery 131, no. 1 (July 2019): 281–89. http://dx.doi.org/10.3171/2018.3.jns173224.
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OBJECTIVEInterfacility neurosurgical transfers to tertiary care centers are driven by a number of variables, including lack of on-site coverage, limited available technology, insurance factors, and patient preference. The authors sought to assess the timing and necessity of surgery and compared transfers to their institution from emergency departments (ED) and inpatient units at other hospitals.METHODSAdult neurosurgical patients who were transferred to a single tertiary care center were analyzed over 12 months. Patients with traumatic injuries or those referred from skilled nursing facilities or rehabilitation centers were excluded.RESULTSA total of 504 transferred patients were included, with mean age 55 years (range 19–92 years); 53% of patients were women. Points of origin were ED in 54% cases and inpatient hospital unit in 46%, with a mean distance traveled for most patients of 119 miles. Broad diagnosis categories included brain tumors (n = 142, 28%), vascular lesions, including spontaneous and hypertensive intracerebral hemorrhage (n = 143, 28%), spinal lesions (n = 126, 25%), hydrocephalus (n = 45, 9%), wound complications (n = 29, 6%), and others (n = 19, 4%). Patients transferred from inpatient units had higher rates of surgical intervention (75% vs 57%, p < 0.001), whereas patients transferred from the ED had higher rates of urgent surgery (20% vs 8%, p < 0.001) and shorter mean time to surgery (3 vs 5 days, p < 0.001). Misdiagnosis rates were higher among ED referrals (11% vs 4%, p = 0.008). Across the same timeframe, patients undergoing elective admission (n = 1986) or admission from the authors’ own ED (n = 248) had significantly shorter lengths of stay (p < 0.001) and ICU days (p < 0.001) than transferred patients, as well as a significantly lower total cost ($44,412, $46,163, and $72,175, respectively; p < 0.001).CONCLUSIONSThe authors present their 12-month experience from a single tertiary care center without Level I trauma designation. In this cohort, 65% of patients required surgery, but the rates were higher among inpatient referrals, and misdiagnosis rates were higher among ED transfers. These data suggest that admitting nonemergency patients to local hospitals may improve diagnostic accuracy of patients requiring urgent care, more precisely identify patients in need of transfer, and reduce costs. Referring facilities may lack necessary resources or expertise, and the Emergency Medical Treatment and Active Labor Act (EMTALA) obligates tertiary care centers to accept these patients under those circumstances. Telemedicine and integration of electronic medical records may help guide referring hospitals to pursue additional workup, which may eliminate the need for unnecessary transfer and provide additional cost savings.
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Vaziri, Sasha, Jacob Wilson, Joseph Abbatematteo, Paul Kubilis, Saptarshi Chakraborty, Khare Kshitij, and Daniel J. Hoh. "Predictive performance of the American College of Surgeons universal risk calculator in neurosurgical patients." Journal of Neurosurgery 128, no. 3 (March 2018): 942–47. http://dx.doi.org/10.3171/2016.11.jns161377.
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OBJECTIVEThe American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) universal Surgical Risk Calculator is an online decision-support tool that uses patient characteristics to estimate the risk of adverse postoperative events. Further validation of this risk calculator in the neurosurgical population is needed; therefore, the object of this study was to assess the predictive performance of the ACS NSQIP Surgical Risk Calculator in neurosurgical patients treated at a tertiary care center.METHODSA single-center retrospective review of 1006 neurosurgical patients treated in the period from September 2011 through December 2014 was performed. Individual patient characteristics were entered into the NSQIP calculator. Predicted complications were compared with actual occurrences identified through chart review and administrative quality coding data. Statistical models were used to assess the predictive performance of risk scores. Traditionally, an ideal risk prediction model demonstrates good calibration and strong discrimination when comparing predicted and observed events.RESULTSThe ACS NSQIP risk calculator demonstrated good calibration between predicted and observed risks of death (p = 0.102), surgical site infection (SSI; p = 0.099), and venous thromboembolism (VTE; p = 0.164) Alternatively, the risk calculator demonstrated a statistically significant lack of calibration between predicted and observed risk of pneumonia (p = 0.044), urinary tract infection (UTI; p < 0.001), return to the operating room (p < 0.001), and discharge to a rehabilitation or nursing facility (p < 0.001). The discriminative performance of the risk calculator was assessed using the c-statistic. Death (c-statistic 0.93), UTI (0.846), and pneumonia (0.862) demonstrated strong discriminative performance. Discharge to a rehabilitation facility or nursing home (c-statistic 0.794) and VTE (0.767) showed adequate discrimination. Return to the operating room (c-statistic 0.452) and SSI (0.556) demonstrated poor discriminative performance. The risk prediction model was both well calibrated and discriminative only for 30-day mortality.CONCLUSIONSThis study illustrates the importance of validating universal risk calculators in specialty-specific surgical populations. The ACS NSQIP Surgical Risk Calculator could be used as a decision-support tool for neurosurgical informed consent with respect to predicted mortality but was poorly predictive of other potential adverse events and clinical outcomes.
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Dikshit, Vishesh, Abhaya Gupta, Prashant Patil, Geeta Kekre, Paras Kothari, and Apoorva Kulkarni. "Follow up of meningomyelocele and associated hydrocephalus, bladder and/or bowel incontinence and foot deformity in a developing country." International Surgery Journal 4, no. 10 (September 27, 2017): 3450. http://dx.doi.org/10.18203/2349-2902.isj20174514.
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Background: Meningomyelocele (MMC) and meningocele (MC) are the two most common types of neural tube defects (NTD) seen. Some of the problems associated with care of these patients are psychological stress is parents, average financial condition of caretakers, ignorance on the part of parents, local physicians for management of this condition, very few dedicated Spina bifida clinics and social stigma associated with this condition. The aim of treatment of meningomyelocele is to the patients with maximum mobility and social continence which is possible through multidisciplinary care involving paediatric surgeon, paediatrician, nursing staff, occupational therapist, physiotherapist, social worker, parents and patients themselves. The aim of this study is to discuss our experience in initial management of meningomyelocele (MMC) and hydrocephalus and long-term management of bladder/bowel incontinence and foot deformity in a tertiary care hospital of a developing country.Methods: A retrospective nonrandomized observational study was conducted in the department of pediatric surgery at a tertiary hospital, from August 2008 to October 2015. Overall 145 patients of meningomyelocele were included in the study. Patients were managed according to our institution protocol.Results: 68.2% MMC patients were repaired primarily. 24.1% of total patients needed Y-V plasty skin advancement flap. 7.5% patients needed synthetic patch for dural closure. 24.1% patients were incontinent since birth. 19.3% patients had decreased lower limb power since birth. 5.5% patients were incontinent after MMC repair. 8.2% patients had decreased lower limb power after MMC repair. 28.9% patients needed VP shunt for gross hydrocephalus before MMC repair. 51.03% patients needed VP shunt after MMC repair. 20% patients did not require VP shunt in the present series. 13.1% patients in the present series had urinary incontinence. 11.03% patients had fecal incontinence. 73.6% patients with urinary incontinence were successfully managed with conservative treatment. 87.5% patients with fecal incontinence responded to conservative treatment. Bladder augmentation was done in 26.3% of neurogenic bladder dysfunction patients. 60% of these patients had dry interval of more than 4 hours. MACE was done in 12.5% of neurogenic bowel dysfunction patients. 2 patients required simultaneous bladder augmentation, Mitrofanoff’s and MACE procedure. One of these patients achieved a dry interval of >4 hour.Conclusions: Successful rehabilitation of children with MMC can be achieved with parental education and support, dedicated clinicians, trained nursing staff, regular follow-up and low threshold for diagnosing clinical deterioration and proactive management to prevent further clinical deterioration.
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Stosor, Valentina, Julie Kruszynski, Terra Suriano, Gary A. Noskin, and Lance R. Peterson. "Molecular Epidemiology of Vancomycin-Resistant Enterococci: A 2-Year Perspective." Infection Control & Hospital Epidemiology 20, no. 10 (October 1999): 653–59. http://dx.doi.org/10.1086/501560.
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AbstractObjective:To determine the molecular epidemiology of vancomycin-resistant enterococci (VRE) at our medical center in order to identify the extent of strain clonality and possible transmission patterns of this pathogen.Design:An important facet of our infection control program includes molecular typing of all clinical and surveillance isolates of VRE to determine transmission patterns in the hospital. Molecular strain typing is performed by restriction endonuclease analysis (REA) of genomic DNA. REA patterns are visually compared to categorize VRE strains into type and subtype designations.Setting:A 588-bed, university-affiliated, tertiary-care hospital and a neighboring 155-bed rehabilitation facility.Results:From January 1995 through December 1996, 379 VRE isolates were collected from 197 patients. Thirty-three genotypes were determined by REA typing; 15 genotypes were implicated in 29 instances of potential nosocomial transmission. Three major clusters of VRE involving patients on multiple nursing units and two adjacent hospitals were identified. The remaining instances of nosocomial transmission occurred in small patient clusters.Conclusions:In conclusion, the VRE epidemic at this medical center is polyclonal. VRE transmission patterns are complex, and, while large clusters do occur, the usual pattern of nosocomial acquisition of this pathogen occurs in the setting of “mini-clusters”.
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Lucet, Jean-Christophe, Karine Grenet, Laurence Armand-Lefevre, Marion Harnal, Elisabeth Bouvet, Bernard Regnier, and Antoine Andremont. "High Prevalence of Carriage of Methicillin-ResistantStaphylococcus aureusat Hospital Admission in Elderly Patients: Implications for Infection Control Strategies." Infection Control & Hospital Epidemiology 26, no. 2 (February 2005): 121–26. http://dx.doi.org/10.1086/502514.
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AbstractBackground:Despite contact isolation precautions for patients with methicillin-resistantStaphylococcus aureus(MRSA), MRSA infections are increasing in many countries.Objective:To evaluate the role of a potential unrecognized reservoir of MRSA carried by patients in acute care wards, we determined the prevalence of MRSA at hospital admission, with special emphasis on screening-specimen yields.Setting:A 1,100-bed teaching hospital in Paris, France.Methods:Nasal screening cultures were performed at admission to a tertiary-care teaching hospital for patients older than 75 years.Results:MRSA was isolated from 63 (7.9%) of 797 patients. On the multivariate analysis, variables significantly associated with MRSA carriage were presence of chronic skin lesions (adjusted odds ratio [AOR], 5.10; 95% confidence interval [CI95], 2.52–10.33); transfer from a nursing home, rehabilitation unit, or long-term-care unit (AOR, 4.52; CI95, 2.23–9.18); and poor chronic health status (AOR, 1.80; CI95, 1.02–3.18). Without admission screening, 84.1% of MRSA carriers would have been missed at hospital admission and 76.2% during their hospital stay. Furthermore, 81.1% of days at risk for MRSA dissemination would have been spent without contact isolation precautions had admission screening not been performed.Conclusions:MRSA carriage at hospital admission is far more prevalent than MRSA-positive clinical specimens. This may contribute to failure of contact isolation programs. Screening cultures at admission help to identify the reservoir of unknown MRSA patients.
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Barnes, Jonathan Aaron, Mark A. Eid, Kayla Moore, Suvekshya Aryal, Eden Gebre, Jennifer Nicole Woodard, Napong Kitpanit, et al. "Use of real-world data and clinical registries to identify new uses of existing vascular endografts: combined use of GORE EXCLUDER Iliac Branch Endoprosthesis and GORE VIABAHN VBX Balloon Expandable Endoprosthesis." BMJ Surgery, Interventions, & Health Technologies 4, no. 1 (July 2022): e000085. http://dx.doi.org/10.1136/bmjsit-2021-000085.
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ObjectiveTo assess the feasibility of collecting, examining and reporting observational, real-world evidence regarding the novel use of the GORE EXCLUDER Iliac Branch Endoprosthesis (IBE) in conjunction with the GORE VIABAHN VBX Balloon Expandable Endoprosthesis (IBE+VBX stent graft).DesignMulticentre retrospective cohort study.SettingFour real-world data sources were used: a national quality improvement registry, a statewide clinical research network, a regional quaternary health system and two tertiary academic medical centres.ParticipantsIn total, 30 patients with 37 IBE+VBX stent graft were identified. Of those, the mean age was 72±10.2 years and 90% were male. The cohort was 77% white, 10% black, 3% Hispanic and 10% other.Main outcome measuresOutcome measures included: proportion of percutaneous vs open surgical access, intensive care admission, intensive care unit (ICU) length-of-stay (LOS), total LOS, postoperative complications, discharge disposition and 30-day mortality.ResultsThe majority (89%) of cases were performed percutaneously, 5% required surgical exposure following failed percutaneous access and 6% required open surgical exposure outright. Nearly half (43%) required intensive care admission with a median ICU LOS of 1 day (range: 1–2). Median total LOS was 1 day (IQR: 1–2). There were zero postoperative myocardial infarctions, zero reported leg embolisations and no reported reinterventions. Access site complications were described in 1 of 28 patients, manifesting as a haematoma or pseudoaneurysm. Ultimately, 97% were discharged to home and one patient was discharged to a nursing home or rehabilitation facility. There were no 30-day perioperative deaths.ConclusionsThis project demonstrates the feasibility of identifying and integrating real-world evidence, as it pertains to an unapproved combination of endovascular devices (IBE+VBX stent graft), for short-term outcomes analysis. This new paradigm of evidence has potential to be used for device monitoring, submission to regulatory agencies, or consideration in indication expansions and approvals with further efforts to systematise data collection and transmission mechanisms.
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Salas-Vega, Sebastian, Vikram B. Chakravarthy, Robert D. Winkelman, Matthew M. Grabowski, Ghaith Habboub, Jason W. Savage, Michael P. Steinmetz, and Thomas E. Mroz. "Late-week surgery and discharge to specialty care associated with higher costs and longer lengths of stay after elective lumbar laminectomy." Journal of Neurosurgery: Spine 34, no. 6 (June 2021): 864–70. http://dx.doi.org/10.3171/2020.11.spine201403.
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OBJECTIVE In a healthcare landscape in which costs increasingly matter, the authors sought to distinguish among the clinical and nonclinical drivers of patient length of stay (LOS) in the hospital following elective lumbar laminectomy—a common spinal surgery that may be reimbursed using bundled payments—and to understand their relationships with patient outcomes and costs. METHODS Patients ≥ 18 years of age undergoing laminectomy surgery for degenerative lumbar spinal stenosis within the Cleveland Clinic health system between March 1, 2016, and February 1, 2019, were included in this analysis. Generalized linear modeling was used to assess the relationships between the day of surgery, patient discharge disposition, and hospital LOS, while adjusting for underlying patient health risks and other nonclinical factors, including the hospital surgery site and health insurance. RESULTS A total of 1359 eligible patients were included in the authors’ analysis. The mean LOS ranged between 2.01 and 2.47 days for Monday and Friday cases, respectively. The LOS was also notably longer for patients who were ultimately discharged to a skilled nursing facility (SNF) or rehabilitation center. A prolonged LOS occurring later in the week was not associated with greater underlying health risks, yet it nevertheless resulted in greater costs of care: the average total surgical costs for lumbar laminectomy were 20% greater for Friday cases than for Monday cases, and 24% greater for late-week cases than for early-week cases ultimately transferred to SNFs or rehabilitation centers. A Poisson generalized linear model fit the data best and showed that the comorbidity burden, surgery at a tertiary care center versus a community hospital, and the incidence of any postoperative complication were associated with significantly longer hospital stays. Discharge to home healthcare, SNFs, or rehabilitation centers, and late-week surgery were significant nonclinical predictors of LOS prolongation, even after adjusting for underlying patient health risks and insurance, with LOSs that were, for instance, 1.55 and 1.61 times longer for patients undergoing their procedure on Thursday and Friday compared to Monday, respectively. CONCLUSIONS Late-week surgeries are associated with a prolonged LOS, particularly when discharge is to an SNF or rehabilitation center. These findings point to opportunities to lower costs and improve outcomes associated with elective surgical care. Interventions to optimize surgical scheduling and perioperative care coordination could help reduce prolonged LOSs, lower costs, and, ultimately, give service line management personnel greater flexibility over how to use existing resources as they remain ahead of healthcare reforms.
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Wilke, Vera, Mihaly Sulyok, Maria-Ioanna Stefanou, Vivien Richter, Benjamin Bender, Ulrike Ernemann, Ulf Ziemann, et al. "Delirium in hospitalized COVID-19 patients: Predictors and implications for patient outcome." PLOS ONE 17, no. 12 (December 22, 2022): e0278214. http://dx.doi.org/10.1371/journal.pone.0278214.
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Introduction Delirium is recognized as a severe complication of coronavirus-disease-2019 (COVID-19). COVID-19-associated delirium has been linked to worse patient outcomes and is considered to be of multifactorial origin. Here we sought to evaluate the incidence and risk factors of delirium in hospitalized COVID-19 patients, along with its impact on clinical outcome. Methods Consecutive adult COVID-19 patients admitted to a tertiary academic referral hospital between March 1st and December 31st, 2020 were included. Potential risk factors for delirium were evaluated, including: age, gender, disease severity (as per the highest WHO grading reached during admission), laboratory parameters for infection and renal function (as per their most extreme values), and presence of comorbidities. To assess the relative strength of risk factors for predicting the occurrence of delirium, we performed a random-forest survival analysis. Results 347 patients with positive COVID-19 PCR test and median age 68.2 [IQR 55.5, 80.5] years were included. Of those, 79 patients (22.8%) developed delirium, 81 (23.3%) were transferred to ICU, 58 (16.7%) died. 163 (73.8%) patients were discharged home, 13 (5.9%) to another hospital, 32 (14.5%) to nursing homes, 13 (5.9%) to rehabilitation with an overall median admission-to-discharge time of 53 [IQR 14, 195] days. The strongest predictors for the occurrence of delirium were blood urea nitrogen (minimal depth value (MD): 3.33), age (MD: 3.75), disease severity (as captured by WHO grading; MD: 3.93), leukocyte count (MD: 4.22), the presence of a neurodegenerative history (MD: 4.43), ferritin (MD: 4.46) and creatinine (MD: 4.59) levels. Conclusion The risk of delirium in COVID-19 can be stratified based on COVID-19 disease severity and–similar to delirium associated with other respiratory infections–the factors advanced age, neurodegenerative disease history, and presence of elevated infection and renal-retention parameters. Screening for these risk factors may facilitate early identification of patients at high-risk for COVID-19-associated delirium.
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Mokrusch, T. "Das Team in der Neurorehabilitation." Neurologie & Rehabilitation 27, no. 4 (December 2021): 215–22. http://dx.doi.org/10.14624/nr2104001.
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Neurological rehabilitation is rehabilitative therapy that is concerned with neurological patients in a multi-professional team under the leadership of a physician. The members of this interdisciplinary team work together closely with an intense exchange of knowledge and competence. This primary treatment team includes specialists in neuropsychology, speech therapy, occupational therapy and physiotherapy (including physical therapy), along with social workers and co-therapeutic nursing. Other forms of therapy may also be included. A secondary team is defined by the cooperation of the neurologist with other medical fields, e.g., neurosurgery, geriatrics, psychiatry, orthopedics and neuropediatrics. A tertiary team exists in the form of organizational cooperation between the medical und economic clinic management with insurance companies and political decision makers. Every kind of rehabilitation is basically multi-professional from an organizational viewpoint, and it is performed interdisciplinarily applying the methods of all therapeutic disciplines to create synergies. This particularly applies to neurorehabilitation, as in this field – generally following a disease or an injury to the brain as the central regulation organ – several different disorders occur in combination: sensorimotor symptoms and signs like paralysis, spasticity, dysphagia and loss of coordination; cognitive or speech disorders; or finally psychological alterations like depression or anxiety. Therefore it is particularly important that the professional team members match and coordinate their therapeutic procedures to reach common rehabilitative goals. »Multi-professional« in this context means that the representatives of the different therapeutic fields work with the patient on an advanced competency level, and »interdisciplinary« means that the members of the team work together closely with thorough cross-consultation between their disciplines. Transdisciplinary cooperation represents the highest level of team competency and includes regularly adopting the tasks and therapeutic procedures from other disciplines. All kinds of cooperation are performed under the supervision of a physician who assumes full responsibility for the rehabilitative therapy, including the prescription of medication and introduction of acute interventions, e.g., surgical procedures. This paper is only concerned with the primary – therapeutic – team. The secondary and tertiary forms of team cooperation are planned to be published separately.
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Di Santo, Luca. "The distinction between apathy and depression in neuroscience nursing practice." British Journal of Neuroscience Nursing 15, no. 4 (August 2, 2019): 164–68. http://dx.doi.org/10.12968/bjnn.2019.15.4.164.
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Apathy and depression are common neuropsychiatric disorders that can manifest themselves as comorbidities in patients affected by neurological diseases. Misdiagnosis may lead to unwanted clinical side effects, inappropriate rehabilitation, and may compromise the patient clinical outcome. The purpose of this article is to review features of apathy and depression, highlighting similarities and analysing discriminating factors between them. It also aims to raise nurses' awareness in relation to the management of apathy, highlighting a validated and consistent tool to be used during nursing assessment. A literature search was conducted in the MEDLINE, CINAHL, PsycINFO, Google Scholar, and Cochrane Library databases dating from 2014 to 2019. Publications were screened according to predetermined inclusion/exclusion criteria and reviewed. The relationship between apathy and depression is complex. Nurses could differentiate between them through education and a structured assessment, shaping the therapeutic/rehabilitative approach and ultimately making a difference in terms of patient wellbeing.
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Ibbotson, Jennifer L., Bijata Luitel, Bikash Adhikari, Kathryn R. Jagt, Erik Bohler, Robert Riviello, and Geoffrey C. Ibbotson. "Overcoming Barriers to Accessing Surgery and Rehabilitation in Low and Middle-Income Countries: An Innovative Model of Patient Navigation in Nepal." World Journal of Surgery 45, no. 8 (April 23, 2021): 2347–56. http://dx.doi.org/10.1007/s00268-021-06035-1.
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Abstract Background Injury and disability are prominent public health concerns, globally and in the country of Nepal. Lack of locally available medical infrastructure, socioeconomic barriers, social marginalization, poor health literacy, and cultural barriers prevent patients from accessing surgical and rehabilitative care. Overcoming these barriers is an insurmountable challenge for the most vulnerable and marginalized, resulting in absence of treatment or even death. Methods Sundar Dhoka Saathi Sewa (SDSS), a non-government organization, provides a patient navigation service which facilitates referrals to tertiary centers from Nepal’s most remote areas. Specific criteria ensure that patient referrals are appropriate in regard to clinical and socioeconomic need, while comprehensive counselling helps guide the patient and family. The SDSS staff meet patients upon arrival in Kathmandu and facilitate admission to the appropriate tertiary hospital. They advocate for the patient, provide medicine, supply food and cover all treatment costs. Results This project has enabled access to treatment for more than 1200 children for conditions leading to long-term disability and/or congenital heart disease. Interventions include a wide range of surgical and rehabilitative procedures such as complex orthopedics, cleft lip and palate, congenital talipes equinovarus, burn contractures, neurological cases, and cardiac surgery for valvular disease, septal defects and other congenital malformations. Discussion The SDSS model of patient navigation is effective in overcoming the barriers to access surgical care and rehabilitation in Nepal. The success is owed to committed international donors, capacity building, effective counselling, advocacy, compassion, and community. We believe that this model could be replicated in other LMICs.
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Lyne, Patricia A., and James Grenville. "Construct validity and sensitivity of an instrument commonly used to assess the clinical effectiveness of rehabilitative care." Clinical Effectiveness in Nursing 1, no. 3 (September 1997): 158–64. http://dx.doi.org/10.1016/s1361-9004(97)80057-x.
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Makam, Anil N., and David C. Grabowski. "Policy in Clinical Practice: Choosing Post-Acute Care in the New Decade." Journal of Hospital Medicine 16, no. 3 (February 17, 2021): 171–74. http://dx.doi.org/10.12788/jhm.3577.
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Nearly half of hospitalized Medicare patients in 2018 were discharged to post-acute care (PAC), accounting for approximately $60 billion in annual spending. There are four PAC settings, and these vary in the intensity and complexity of medical, skilled nursing, and rehabilitative services provided; each setting uses a separate payment system. Due to considerable variation in PAC use, with concerns that similar patients can be treated in different PAC settings, the Centers for Medicare & Medicaid Services (CMS) recently introduced several major policy changes. For home health agencies (HHAs) and skilled nursing facilities (SNFs), CMS implemented new payment models to better align payment with patients’ care needs rather than the provision of rehabilitation. For long-term acute care hospitals, CMS will now decrease payment for less medically ill patients. To choose PAC wisely, hospitalists and hospital leaders must understand how these new policies will change where patients can be discharged and the services these patients receive at these PAC settings.
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Banoo, Nargis, Khurshid Ahmad Wani, and Manzoor Hussain. "Clinical profile of neurological disorders in children: a hospital-based experience of a tertiary care centre in Kashmir." International Journal of Contemporary Pediatrics 9, no. 8 (July 25, 2022): 731. http://dx.doi.org/10.18203/2349-3291.ijcp20221855.
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Background: Neurological disorders in paediatric age group constitute a major cause of hospital visits both elective and emergent. Due to fast maturity of nervous system within the first few years of life they are more prone to neurological disorders, which mostly can be preventive and rehabilitative in nature. Purpose of this study was to know the pattern and spectrum of neurological disorders among children presenting to a tertiary health care facility in Kashmir.Methods: This was a retrospective analysis of the data of all the children in the age group 1 month to 18 years admitted with neurological disorders over a period of 12 month. Diagnosis was made on the basis of history, physical examination and relevant laboratory and radiological investigations.Results: Out of 21732 patients admitted during this study period, 562 patients had neurological disorders, an occurrence rate of 25 per 1000 hospitalized patients, with a male female ratio of 1.4:1. The most common neurological disorder was seizures followed by cerebral palsy and CNS infection.Conclusions: Neurological disorders constitute one of the common reasons for childhood hospitalization, implying a comprehensive must be set up in place to deal with these neurological problems as is existing elsewhere in our country, and in developed world for appropriate delivery of health care.
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Kim, Yeon Hee, Young Sun Jung, Jin Sun Choi, Hye Young Lee, Hye Ryun Jung, Ji-su Kim, and Kyunghee Kim. "Core nursing practice and educational requirements according to nursing unit and clinical career in tertiary hospital." Journal of Korean Academy of Fundamentals of Nursing 22, no. 1 (February 27, 2015): 35–48. http://dx.doi.org/10.7739/jkafn.2015.22.1.35.
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Paul, Fiona. "The Doctor of Nursing Practice-Prepared Clinical Expert." Clinical Scholars Review 8, no. 1 (2015): 80–83. http://dx.doi.org/10.1891/1939-2095.8.1.80.
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The Doctor of Nursing Practice (DNP) degree offers an alternative to research-focused curricula for nurses seeking a terminal degree with a focus on advanced clinical practice and leadership. The number of DNP programs and graduates has been growing since the onset of this degree. Some health care organizations have struggled with the best way to incorporate the advanced skills of the DNP graduates into their practice. This article reflects on the author’s experience as a DNP-educated advanced practice registered nurse in a tertiary pediatric hospital. A case study is presented to demonstrate how the DNP education has impacted the level of clinical practice.
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Swain-Cabriales, Suzanne, Laura Bourdeanu, Joyce Niland, Tracy Stiller, and George Somlo. "Enrollment onto breast cancer therapeutic clinical trials: A tertiary cancer center experience." Applied Nursing Research 26, no. 3 (August 2013): 133–35. http://dx.doi.org/10.1016/j.apnr.2013.01.003.
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Andone, Ioana, Ioana Elisei, Cristina Daia, Cristina Popescu, Aura Spînu, Aurelia Bichir, Elena Brumă, and Gelu Onose. "Favorable outcomes within a comprehensive therapeutic rehabilitative program in a complex case of severe polytrauma." Balneo and PRM Research Journal, Vol.13, no.2 (June 27, 2022): 506. http://dx.doi.org/10.12680/balneo.2022.506.
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A polytrauma patient after a car accident represents a challenge for the health care system due to the multiple traumatic injuries, at least one of them potentially being life threatening. Many of these injuries require intense nursing and rehabilitation treatment, because some of them can cause permanent disability, affecting the patient’s future quality of life. Materials and methods: With the permission of the THEBA Ethics Committee (no 24389 / 28.06.2021), this paper presents a case of a 37-year-old patient with a severe polytrauma due to a car accident (driver), occurred on October 18, 2020. The patient was hospitalized in the Intensive Care Unit of the Emergency County Hospital of Targoviste, in a severe condition, being orotracheal intubated and having a thoracic polytrauma (multiple bilateral costal fractures, anterior-superior flail chest with acute respiratory failure) and mandible fracture. After clinical and hemodynamic stabilization, he was transferred to Bucharest Emergency University Hospital and after specific paraclinical investigations, he was surgically treated with thoracic fixation with metal plates, sternal fixation with plate and screws, thoraco-abdominal skin grafting and mandibular stabilization. Afterwards he was transferred to THEBA at the Plastic Surgery Clinic Department for lumbar-sacral pressure sore, where he suffered multiple surgical interventions. In our Neuromuscular Rehabilitation Department, the patient was admitted in 16.02.2021 with pain and severe functional impairments in the right elbow and the right knee, surgically treated sacral pressure sore still in the process of healing and having a severe deficiency of self-care and locomotion. He initially followed a rehabilitative nursing program and continued with a recovery therapy according to clinical stages. The patient was functionally assessed using the following scales: Medical Research Council (MRC) Scale for Muscle Strength, Functional Independence Measure (FIM), Life Quality Assessment (QOL), FAC International Scale and Independence Assessment Scale in Daily Activities (ADL/IADL). Results: Although the patient's evolution was slow, he had favorable outcomes with an increase in the scores of the evaluated scales at discharge. He benefited from specific surgical care of the pressure sores and a complex neuro-muscular rehabilitative program. The patient’s final performance in our clinic was walking on medium distances with support from another person. Conclusion: The multidisciplinary team approach with the addition of complex nursing measures and a personalized rehabilitative program for a young patient with polytrauma caused by a car accident established neuro-locomotor improvements which led to an increase in patient’s quality of life. Keywords: neuro-muscular rehabilitation, polytrauma
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Grover, Sandeep, Neha Sharma, and Aseem Mehra. "Stigma for Mental Disorders among Nursing Staff in a Tertiary Care Hospital." Journal of Neurosciences in Rural Practice 11, no. 02 (March 17, 2020): 237–44. http://dx.doi.org/10.1055/s-0040-1702916.
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Abstract Objective This study aimed to evaluate the prevalence of stigma for mental disorders among nursing staff in a tertiary care hospital, and the secondary objective of the study was to assess the correlation of stigma with the socio-demographic profile and previous experience with mentally ill patients. Methods This cross-sectional study was performed among the 210 nurses working in a tertiary care multispecialty teaching public sector hospital in north India. They were evaluated on community attitudes toward the mentally ill (CAMI) scale. Results About two-thirds of the participants (67.1%) were females and had done graduation (64.2%) in nursing. Nearly 50% of the study participants had an experience of working with mentally ill patients. Female had a more significant positive attitude on the domain of social restrictiveness. Authoritarianism had a significant positive correlation with benevolence and social restrictiveness domains. The benevolence domain had a significant correlation with all other domains. Social restrictiveness domain also had a significant correlation with other domains. Conclusion Nurses have a positive attitude toward mentally ill patients.
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Alammar, Kamila, Muayyad Ahmad, Sultanah Almutairi, and Olfat Salem. "Nursing Students’ Perception of the Clinical Learning Environment." Open Nursing Journal 14, no. 1 (August 19, 2020): 174–79. http://dx.doi.org/10.2174/1874434602014010174.
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Introduction: Clinical learning environment placements provide opportunities for students to develop their skills, socialize to the profession and bridge the gap between academic and workplace learning. This study was conducted to investigate Saudi nursing students’ perceptions of their clinical learning environment and supervision in the hospital setting. Methods: A sample of 90 final year student nurses completing practicums at a tertiary hospital in Riyadh was included in this cross-sectional study utilizing the Clinical Learning Environment and Supervision plus Nurse Teacher scale. Results: Overall, students perceived their clinical learning environment positively. Among sub-scores, that for the leadership style of ward manager was the highest. Supervision types, nursing-teacher teacher-visit frequency and grade point average positively and significantly impacted student’s perceptions, while university type and practicum duration did not. Conclusion: Students confirmed the ward manager’s leadership style as the most significant influencing their perceptions. However, the nursing teacher’s role had the lowest mean score, suggesting the need for its enhancement and clarification and indicating the need for better communication and collaboration between nursing schools and the clinical training hospital.
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Saha, Sanchita, Susmita Ghosh, Sisir Chakraborty, Kaushik Ghosh, Amitava Acharyya, Piyali Kundu, Pasang Lahmu Sherpa, and Atanu Biswas. "A study on short term outcome of stroke in a rural tertiary care center of Sub Himalayan Terai." Asian Journal of Medical Sciences 9, no. 4 (July 2, 2018): 1–9. http://dx.doi.org/10.3126/ajms.v9i4.19684.
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Background: Stroke is the second most common cause of mortality in the world, causing immense morbidity and economic burden. The proper knowledge of the factors which influence the good clinical outcome in stroke is utmost strength of the clinicians in India, where post stroke rehabilitative measures are limited.Aims and Objective: To find out the association of outcome of stroke with different risk factors.Materials and Methods: A descriptive observational design study was formulated for a period of six months on hundred stroke patients in internal medicine unit of at North Bengal Medical College & Hospital, India. Patients were selected after proper screening by inclusion and exclusion criteria. The “In-hospital-outcome” of CVA patient was determined by Glasgow outcome scale. The neurological condition was determined by National Institute of Health Stroke Scale (NIHSS). The Modified Rankin Scale and Barthel Index were utilized to asses disability status of patient in different period of hospital admission. The data were analyzed by EPI INFO software.Results: Clinical outcome showed statistically significant (P<0.05) correlation with age, sex, level of consciousness, blood pressure, diabetes, past history, mass effect, size and depth of infarction and intra-ventricular extension of intra cerebral bleeding. Other parameters like type of stroke (ischemic or hemorrhagic), delay in admission, dyslipidemia, presence of heart disease, smoking, alcoholism, family history, depth and volume of intra cerebral bleeding, although showed poorer clinical outcome, their correlation was not statistically significant.Conclusion: In-hospital outcome of stroke as determined by Glasgow outcome scale correlates with diverse clinical parameters including various risk factors.Asian Journal of Medical Sciences Vol.9(4) 2018 1-9
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Wainwright, Craig, and Kylie M. Wright. "Nursing clinical handover improvement practices among acute inpatients in a tertiary hospital in Sydney." JBI Database of Systematic Reviews and Implementation Reports 14, no. 10 (October 2016): 263–75. http://dx.doi.org/10.11124/jbisrir-2016-003170.
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Timm, Jane A., and Julia G. Behrenbeck. "Implementing the Nursing Outcomes Classification in a Clinical Information System in a Tertiary Care Setting." Journal of Nursing Care Quality 12, no. 5 (June 1998): 64–72. http://dx.doi.org/10.1097/00001786-199806000-00010.
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Hyun, Sooin, and Taewha Lee. "Effects of Professional Autonomy and Teamwork on Clinical Performance of Nurses in Tertiary Hospitals." Journal of Korean Academy of Nursing Administration 27, no. 5 (2021): 301. http://dx.doi.org/10.11111/jkana.2021.27.5.301.
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Peters, Kathleen, Elizabeth J. Halcomb, and Susan McInnes. "Clinical placements in general practice: Relationships between practice nurses and tertiary institutions." Nurse Education in Practice 13, no. 3 (May 2013): 186–91. http://dx.doi.org/10.1016/j.nepr.2012.09.007.
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Kroeber, Eric Sven, Lucas Adam, Adamu Addissie, Alexander Bauer, Thomas Frese, Eva Johanna Kantelhardt, and Susanne Unverzagt. "Protocol for a systematic review on tertiary prevention interventions for patients with stroke in African countries." BMJ Open 10, no. 9 (September 2020): e038459. http://dx.doi.org/10.1136/bmjopen-2020-038459.
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IntroductionStroke is one of the common causes of mortality, morbidity and years of life lost worldwide. Baseline research on stroke epidemiology, prevention, acute and rehabilitative interventions in Africa is necessary to approach specific contexts and regional circumstances. Most studies on stroke have been conducted in high-income countries. This protocol describes the methodology to summarise the best available evidence on tertiary preventive strategies like rehabilitation interventions for patients with stroke in African contexts.Methods and analysisWe will include experimental studies and prospective cohort studies conducted in African countries. A protocol has been registered in PROSPERO. Systematic search will include eight electronic databases (MEDLINE, Embase, the Cochrane Library, CINAHL, Cab-Direct, Physiotherapy Evidence Database (PEDro), African Journals Online and African Index Medicus) and the International Clinical Trials Register Platform and base on predefined search terms. We will search from inception of each database and repeat this strategy 3 months prior to review submission. Details of all eligible studies will be extracted and risk of bias for outcomes on global disability or dependence in daily living will be assessed. Main aim of this systematic review is to provide a narrative description of evidence on tertiary prevention strategies (including rehabilitation) for stroke. This description will be visualised in structured tables to aid interpretation of study characteristics, intervention effects and certainty of the evidence.Ethics and disseminationNo ethical approval is necessary. Results will be presented in national and international conferences and published in a peer-reviewed journal.PROSPERO registration numberCRD42020159125.
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Schmidt, Aurélie, Chérif Heroum, Didier Caumette, Katell Le Lay, and Stève Bénard. "Acute Ischemic Stroke (AIS) Patient Management in French Stroke Units and Impact Estimation of Thrombolysis on Care Pathways and Associated Costs." Cerebrovascular Diseases 39, no. 2 (2015): 94–101. http://dx.doi.org/10.1159/000369525.
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Background: Stroke is the second leading cause of death and a first leading cause of acquired disability in adults worldwide. This study aims to evaluate the current management and associated costs of acute ischemic stroke (AIS) for patients admitted in stroke units in France and over a one-year follow-up period as well as to assess the impact of improved thrombolytic management in terms of increasing the proportion of patients receiving thrombolysis and/or treated within 3 h from the onset of symptoms. Methods: A decision model was developed, which comprises two components: the first corresponding to the acute hospital management phase of patients with AIS up until hospital discharge, extracted from the national hospital discharge database (PMSI 2011), and the second corresponding to the post-acute (post-discharge) phase, based on national treatment guidelines and stroke experts' advice. Five post-acute clinical care pathways were defined. In-hospital mortality and mortality at 3 months post-discharge was taken into account into the model. Patient journeys and costs were determined for both phases. Improved thrombolytic management was modeled by increasing the proportion of patients receiving thrombolysis from the current estimated level of 16.7 to 25% as well as subsequently increasing the proportion of patients treated within 3 h of the onset of symptoms post-stroke from 50 to 100%. The impact on care pathways was derived from clinical data. Results: Among 202,078 hospitalizations for a stroke or a transient ischemic attack (TIA), 90,528 were for confirmed AIS, and 33% (29,999) of them managed within a stroke unit. After hospitalization, 60% of discharges were to home, 25% to rehabilitative care and then home, 2% to rehabilitative care and then a nursing home, 7% to long-term care, and 6% of stays ended with patient death. Of a total cost over 1 year of €610 million (mean cost per patient of €20,326), 70% concern the post-acute phase. By increasing the proportion of patients being thrombolyzed, costs are reduced primarily by a decrease in rehabilitative care, with savings per additional treated patient of €1,462. By adding improved timing, savings are more than doubled (€3,183 per additional treated patient). Conclusions: This study confirms that the burden of AIS in France is heavy. By improving thrombolytic management in stroke units, patient journeys through care pathways can be modified, with increased discharges home, a change in post-acute resource consumption and net savings.
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Najjar, Hend Al, and Hawazen Rawas. "Factors Affecting the Clinical Practice of Nursing Interns at Tertiary Hospital Jeddah in Saudi Arabia." International Journal of Studies in Nursing 3, no. 3 (July 30, 2018): 45. http://dx.doi.org/10.20849/ijsn.v3i3.479.
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The shortage of nurses in Saudi Arabia like many other countries in the world is a problem. Additionally, there are a unique socio-cultural factor that causes the problem including but not limited to the negative perceptions and attitudes towards nurses. Unfortunately, the apprentices are subjected to a system that is inadequately represented by long working hours, negative images, and work pressures. In addition, several factors are attributed to the problems the students face during the initial year of clinical education. This study will analyze and evaluate the different factors that influence the clinical education of the bachelor nursing apprentices, particularly in the first year of experience.Aims and Objectives: The purpose of this study is to explore the factors affecting the clinical practice of nursing interns at tertiary hospital Jeddah.Methodology and Methods: The research was employed as a qualitative approach. Bachelor nursing students who are currently undertaking their internship program in a tertiary hospital Jeddah) were recruited as participant in this study.Findings: Data analyses regarding the factors affecting the clinical practice of nursing interns are summarized both positively and negatively. The major theme that emerged that reflects the positive experiences of intern students was “a time for reflection”. Further to this the major theme that emerged relating to the challenges experienced by student interns was “cold environment’.Conclusions: The findings of this research contribute to our understanding of factors affecting the clinical practice of nursing interns. Students identified their clinical learning as cold learning environment because they were treated unfairly, ignored by their instructors and were being embarrassed and feeling restricted. Moreover, students have also identified positive experiences for them during their internship program. The internship program is a great chance for the student for a reflection.
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Vincent, Heather K., and Kevin R. Vincent. "Poster 30: Obesity Influence on Clinical Outcomes in Cardiopulmonary Patients Receiving Rehabilitative Care in the Inpatient Rehabilitation or Skilled Nursing Facility Setting." Archives of Physical Medicine and Rehabilitation 89, no. 11 (November 2008): e29-e30. http://dx.doi.org/10.1016/j.apmr.2008.09.057.
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Luhanga, Florence L., Vivian A. Puplampu, Sherry Arvidson, and Adeyemi Ogunade. "Nursing students’ experiences of bullying in clinical practice." Journal of Nursing Education and Practice 10, no. 3 (December 10, 2019): 89. http://dx.doi.org/10.5430/jnep.v10n3p89.
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Bullying is a major concern in the nursing profession because of its implications for patients’ safety, the health of nurses and nursing students, as well as on the workforce in the healthcare system. The purpose of the study was to explain the incidence and state of bullying experienced by nursing students in the undergraduate nursing program during clinical practice. Fifty-five undergraduate nursing students participated in the mixed methods research conducted in a tertiary institution in Western Canada. Participants completed an online survey and an individual interview. Survey data were analyzed using descriptive statistics while thematic analysis was employed for the open-ended questions on the survey and individual interviews. The findings from the study showed that a small number of students four (7.7%) frequently experienced bullying in the clinical setting with clinical instructors and practicing nurses being the main perpetrators. Students reported anxiety connected with going for clinical practice however a unique finding from this study was that the affected students continued to go for clinical practice and decided to remain in the program because of their goal to become registered nurses. Peers from the program were one of the key support systems for the students when they experienced the negative behavior. Irrespective of the low incidence of bullying at the research site, the impact of the behavior aligns with the literature. The findings from this study has the potential to inform clinical practices and policies in undergraduate nursing programs.
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Liu, Hongpeng, Dawei Zhu, Jing Cao, Jing Jiao, Baoyun Song, Jingfen Jin, Yilan Liu, et al. "The effects of a standardized nursing intervention model on immobile patients with stroke: a multicenter study in China." European Journal of Cardiovascular Nursing 18, no. 8 (September 4, 2019): 753–63. http://dx.doi.org/10.1177/1474515119872850.
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Background: Immobility complications, including pressure injuries (PIs), deep vein thrombosis (DVT), pneumonia, and urinary tract infections (UTIs), affect the clinical outcomes of stroke patients. A standardized nursing intervention model (SNIM) was constructed and implemented to improve the quality of care and clinical outcomes among immobile patients with stroke. Aims: To assess the benefit of SNIM for immobility complication rates, including PIs, DVT, pneumonia, and UTIs, and mortalities in immobile patients with stroke. Methods: A before and after study design was used. Patients were divided into a pre- and post-SNIM training original cohort and matched for socioeconomic, demographic, and disease characteristics using propensity score. We fitted logistic regression models to examine the effect of SNIM, and whether the benefit differed between tertiary and non-tertiary hospitals. Results: In the original cohort, the rate of pneumonia, UTIs, and mortality was lower after SNIM training. Furthermore, in the matched cohort, the difference in PI rates was significant. Logistic regression analysis revealed that the probability of PIs, pneumonia, UTIs, and mortality were significantly reduced after SNIM training in the original cohort and this estimated value changed little in the matched cohort. Our results show that the decreased rates of pneumonia, UTIs, and mortality were mainly among non-tertiary hospitals. Conclusions: A structured and systematic SNIM benefited immobile stroke patients’ clinical outcomes, but mainly in non-tertiary hospitals in China. Standardized nursing training is needed in non-tertiary hospitals.
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Menon, Bindu, and Nikethana Remadevi. "Migraine in Nursing Students—A Study from a Tertiary Care Center in South India." Journal of Neurosciences in Rural Practice 12, no. 01 (January 2021): 129–32. http://dx.doi.org/10.1055/s-0040-1721556.
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Abstract Objective Nursing profession is subject to occupational stress, which can be a trigger for headaches. Our study aimed to study the prevalence of migraine, its characteristics, triggers, and relieving factors among nursing students in a tertiary care center. Materials and Methods This study was performed in a super-specialty hospital in South India. A structured questionnaire captured data on the occurrence of headache, demographics, aura, triggering factors, relieving factors, and lifestyle habits. Results are presented in numbers and percentage. Results A total of 20% of nursing students in the study had headache of which 85% had migraine. Weekly and daily attacks were reported in 12 and 4% students, respectively. Twenty-two percent had headache severity of more than 5 visual analogue scale. Most common accompanying symptoms were photophobia (80%), phonophobia (70%), nausea (75%), vomiting (71%), neck pain (25%), and vertigo (20%). Thirty-nine percent had auras. Ninety-five percent reported triggers with 70% students having more than one trigger. Sleep was the relieving factor in 69%, head massage in 50%, and relaxing from work in 48%. Conclusion The most common type of primary headache in nurses in our study was migraine. More than three-fourths nurses reported triggers and relieving factors. Addressing these factors could help in managing migraines and help in improving the quality of life and increased work productivity of nurses.
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Alfonso, Anna Liza R., Jocelyn B. Hipona, and Wilfredo Quijencio. "Nurse Managers’ Responsive Coaching To Facilitate Staff Nurses’ Clinical Skills Development in Public Tertiary Hospital." Journal Of Nursing Practice 5, no. 1 (October 1, 2021): 12–21. http://dx.doi.org/10.30994/jnp.v5i1.137.
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Background: Mentoring helps cultivate nurse leaders, retain nurses, and diversify the nursing workforce. By strengthening the nursing workforce, nursing mentorship improves the quality of patient care and outcomes. Widespread uses of nurse mentoring programs have been employed to produce positive outcomes and decrease turnover and assess job satisfaction.Purpose: The purpose of the study is to assess head nurse mentoring competency in relation to staff nurses’ career advancement in selected government hospitals to broaden the array of perspective among public hospitalsMethods: The researchers employed descriptive-correlational that glanced into the relationship of certain levels in the mentoring competency of head nurses in relation to staff nurses career advancement.Results: Majority of the nurse-respondents have indicated good remarks on the components of relationship building in public hospitals; and very good competency on the components of identifying areas for improvement; responsive coaching; advocating for an environment conducive to good patient care; and documentation/record keeping. Conclusion: Nurse manager-mentors in public hospitals are very good on mentoring in identifying areas for improvement, responsive coaching, advocating for an environment conducive to good patient care, and documentation/record keeping, but, good about relationship building.
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Atsalos, Christine, Karen Biggs, Sabine Boensch, Fiona Lee Gavegan, Susan Heath, Marlene Payk, and Grace Trapolini. "How clinical nurse and midwifery consultants optimise patient care in a tertiary referral hospital." Journal of Clinical Nursing 23, no. 19-20 (February 8, 2014): 2874–85. http://dx.doi.org/10.1111/jocn.12567.
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Joyce, L. "P. A. Lyne and J. Grenville Clinical Effectiveness in Nursing (1997), 1 158–164 Construct validity and sensitivity of an instrument commonly used to assess the clinical effectiveness of rehabilitative care." Clinical Effectiveness in Nursing 1, no. 3 (September 1997): 164. http://dx.doi.org/10.1016/s1361-9004(97)80058-1.
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Hollis, Sally. "P. A. Lyne and J. Grenville Clinical Effectiveness in Nursing (1997) I, 158–164 Construct validity and sensitivity of an instrument commonly used to assess the clinical effectiveness of rehabilitative care." Clinical Effectiveness in Nursing 1, no. 3 (September 1997): 165. http://dx.doi.org/10.1016/s1361-9004(97)80059-3.
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Sailahari, KakarlaV M., RV R. Abhinaya, and KV Ramireddy. "Study on perception towards psychiatry among nursing students in a tertiary care hospital." Archives of Mental Health 23, no. 1 (2022): 35. http://dx.doi.org/10.4103/amh.amh_114_21.
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Tang, (Anson) Chui-Yan. "Learning Experience of Chinese Nursing Students during Clinical Practicum: A Descriptive Qualitative Study." Nursing Reports 11, no. 2 (June 21, 2021): 495–505. http://dx.doi.org/10.3390/nursrep11020046.
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The change in clinical environment can have a significant impact on nursing students’ clinical learning and as a consequence, to their competency. Students’ learning experiences could provide important insights for improving the existing approach towards clinical education. This descriptive qualitative study aimed to explore nursing students’ clinical learning experience. Focus group interviews were conducted with 20 final year nursing students studying a bachelor nursing programme at a self-financing tertiary institution in Hong Kong. Thematic analysis was conducted. 16 female and four male students were recruited. Six themes were identified: Anxiety towards clinical practicum, expectations of roles and responsibilities in practicum, ward environment, adequacy of support, learning attitude, and practicum arrangement. The findings suggest that nursing students are more discontented with their clinical training than before. Nursing faculty must look for possible ways to improve the clinical learning environment.
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Park, Hyun Sook, Eun Hee Choi, Gyung Duck Kim, Young Hee Kim, Mi Yang Jeon, and Hyenam Hwang. "Development of Core Competency Scale for clinical nursing student educators." Journal of Korean Academic Society of Nursing Education 28, no. 4 (November 30, 2022): 345–56. http://dx.doi.org/10.5977/jkasne.2022.28.4.345.
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Purpose: This study aimed to develop a Core Competency Scale for clinical nursing student educators.Methods: In this study, we constructed a conceptual framework, selected initial items, verified the content validity, conducted two rounds of Delphi expert consultation, selected secondary and tertiary items, and extracted the final items. The study included 242 clinical educators for nursing students. Item analysis, factor analysis, criterion validity, and internal consistency were used for the data analyses.Results: For the final scale, 35 items were selected and 5 factors were categorized, which together explain 61.7% of the total variance. The factors were education and evaluation, research and cooperation, ethical/legal principles, presenting leadership, and clinical practice. The scores for the scale significantly correlated with the teaching efficacy scale for clinical nursing instructors. The Cronbach’s alpha coefficient for the 35 items was .96.Conclusion: The findings of this study demonstrated that the core competency scale has good validity and reliability. This scale can be used to assess the competency of clinical educators for nursing students; hence, it will help in evaluating the relationship between the skills of clinical educators for nursing students and the self-efficacy of those students.
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Xu, Ping, Yi Yun Hu, Hai Yan Yuan, Da Xiong Xiang, Yan Gang Zhou, Andrew J. Cave, and Hoan Linh Banh. "The Impact of a Training Program on Clinical Pharmacists on Pharmacy Clinical Services in a Tertiary Hospital in Hunan China." Journal of Multidisciplinary Healthcare Volume 12 (November 2019): 975–80. http://dx.doi.org/10.2147/jmdh.s228537.
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Birrell, Fiona, and Hing Y. Leung. "The Scottish prostate cryotherapy service–the role of the clinical nurse specialist." British Journal of Nursing 28, no. 18 (October 10, 2019): S12—S16. http://dx.doi.org/10.12968/bjon.2019.28.18.s12.
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This article outlines the role of the clinical nurse specialist in establishing a Scotland-wide national designated service for prostate cryotherapy for patients with radiation-recurrent prostate cancer. The service was established in 2009 and provides prostate cryotherapy across Scotland. This article reviews and discusses the challenges involved in setting up a new service for tertiary treatment as well as highlighting the key achievements of the service. The challenges have included introducing the cryotherapy procedure in a safe and quality assured manner, developing and refining the referral process, educating both primary and secondary care teams on salvage prostate cryotherapy as a treatment modality and surgical procedure, as well as managing of complications following salvage prostate cryotherapy. The article also outlines the achievements of both the service and the treatment as well as how the service has developed since 2009.
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Doran, Karen, Barbara Sampson, Ruth Staus, Cathy Ahern, and Donna Schiro. "Clinical Pathway Across Tertiary and Community Care After an Interventional Cardiology Procedure." Journal of Cardiovascular Nursing 11, no. 2 (January 1997): 1–14. http://dx.doi.org/10.1097/00005082-199701000-00004.
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Das, Subrata, Swapnil Wilson, Avinashi Kujur, and T. K. Sahu. "retrospective study on uterine rupture at a tertiary hospital, India." International journal of health sciences 6, S1 (March 22, 2022): 1885–96. http://dx.doi.org/10.53730/ijhs.v6ns1.4945.
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Objective: The study aims to understand the causes and the outcomes of uterine rupture in a 1-year retrospective study at a tertiary hospital in Raigarh, India. Methods: This study is a retrospective study of the patients who were diagnosed with the uterine rupture at the department of obstetrics (Gynecology) at GMC Raigarh Chhattisgarh from March 2015 to April2016.Data collection was done from the clinical assessments and with different exams of 61 participants following which the statistical analysis was done. Results: as per the findings, there were certain conditions such as the hemoperitoneum and the fetus outside uterus are the riskiest ones when it comes to uterine rupture. Conclusion: the most important findings were related to the frequent problems and risk factors associated rupture of uterus and certain age groups are more prone to this medical emergency which is why, right medical care is needed.
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Dordunoo, Dzifa, Minjeong An, Min Sun Chu, Eun Ja Yeun, Yoon Young Hwang, Miran Kim, and Yeonhu Lee. "The Impact of Practice Environment and Resilience on Burnout among Clinical Nurses in a Tertiary Hospital Setting." International Journal of Environmental Research and Public Health 18, no. 5 (March 3, 2021): 2500. http://dx.doi.org/10.3390/ijerph18052500.
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The purpose of this study was to examine practice environment, resilience, and burnout and to identify the impacts of practice environment and resilience on burnout among clinical nurses working at a tertiary hospital. A cross-sectional secondary data analysis was conducted using a convenience sample of 199 nurses. The nurses completed survey questionnaires regarding practice environment, resilience, and burnout. The majority of the nurses were below the age of 30, single, and worked in medical-surgical wards. Approximately, 92% of the nurses reported moderate to high burnout, with a mean practice environment score of 2.54 ± 0.34 and resilience score of 22.01 ± 5.69. Practice environment and resilience were higher in the low level of burnout than in the moderate to high level of burnout. After controlling for demographic and occupational characteristics, resilience and nursing foundations for quality of care were significant predictors of burnout (OR = 0.71, p = 0.001; OR = 0.01, p = 0.036, respectively), explaining 65.7% of the variance. In a mixed practice environment, increased resilience and nursing foundations for quality of care lowered nurses’ burnout. Our findings suggest that interventions focused on enhancing individual resilience and practice environment and building better nursing foundations for quality of care should be developed and provided to alleviate burnout in clinical nurses working at tertiary hospitals. Nursing and hospital administrators should consider the importance of practice environment and resilience in nurses in developing interventions to decrease burnout.
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Napolitano, Daniele, Federica Cioffi, Giannina Marocchini, Tiziana Bernabei, Alessia Leonetti, Caterina Fanali, Nicoletta Orgiana, et al. "Knowledge of perianal Crohn's disease among nurses in an Italian tertiary centre." Gastrointestinal Nursing 20, no. 9 (November 2, 2022): 30–37. http://dx.doi.org/10.12968/gasn.2022.20.9.30.
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Background: Patients with Crohn's disease can develop anal and perianal lesions, such as fistulas, ulcers, skin tags, perianal abscesses and strictures. Perianal Crohn's disease (PCD) is a condition that has a major impact on patients' quality of life. The multidisciplinary team includes a nurse who manages the patient according to evidence-based medicine. Clinical practice and post-registration training are the way forward for nurses to acquire the skills needed to deliver quality care. Aims: This study explored the assessment of nurses' knowledge of PCD. A cross-sectional survey was used to look at the nurses' knowledge. Methods: The questionnaire was administered over 2 months, between September and October 2019. The questionnaire was anonymous, validated by a panel of experts in the field and consisted of 30 questions to assess knowledge and two questions to assess the need for training. It was directed to 120 clinical nurses in the departments of medicine and abdominal surgery. Results: There were 120 nurses enrolled, and 64.2% of nurses had cared for patients with PCD at least once. The survey showed a fairly low level of knowledge of the diagnostic and therapeutic care pathways for patients affected by PCD. On the other hand, a high need for training and in-depth study of the subject emerged. Conclusion: The nurse, an integral part of the multidisciplinary team, plays an important role in the education of these patients. Nurses' present level of knowledge can certainly be improved thanks to their willingness to undertake training courses or to use information tools.
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Li, Zixiao, Yilong Wang, Xudong Ma, Xingquan Zhao, Liping Liu, Hongqiu Gu, Caiyun Wang, et al. "Abstract WP298: Achievement of Guideline-concordant Process of Care and 1-year Outcomes in Patients with Acute Ischemic Stroke in Secondary and Tertiary Hospitals: Results From China National Stroke Registry Ii." Stroke 48, suppl_1 (February 2017). http://dx.doi.org/10.1161/str.48.suppl_1.wp298.
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Background: Guideline-concordant processes of care improve longitudinal outcomes in patients with acute stroke. Little is known whether there are different processes of acute ischemic stroke (AIS) care or outcomes between secondary and tertiary hospitals. Methods: We analyzed 19 604 AIS patients across 219 hospitals in China National Stroke Registry II from June 2012 to January 2013. The primary outcome was guideline-concordant care, defined as compliance with 13 guideline-recommended performance metrics and composite score. Propensity score matching was used to balance the baseline characteristics. We used cox model and logistic regression with generalized estimating equation to compare the relationship between secondary and tertiary hospitals on quality measures and all caused death, stroke recurrence, and disability (modified Rankin Score ≥3) at 3, 6 and 12month after discharge. Results: Among 19 604 AIS patients, 6 038 (30.8%) and 13 566 (69.2%) were admitted to 66 (30.1%) secondary and 153 (69.9%) tertiary hospitals separately. After matching, 5959 pairs of patients in secondary and tertiary were analyzed. The composite score was higher at tertiary hospitals than secondary hospitals (77% versus 74%, P<0.001). Tertiary hospitals were more likely to perform early antithrombotic, carotid imaging, anticoagulation for atrial fibrillation, antihypertensive therapy, hypoglycemic medications, and rehabilitation (Figure 1). Furthermore, comparing to AIS patients among tertiary hospitals, those admitted to secondary hospitals had higher hazard of disability at 3 months (19.3% versus 21.5%) and 1-year stroke recurrence (4.4% versus 5.4%) after matching. Conclusions: In China, tertiary hospitals have better processes of AIS care and more favorable clinical outcomes than secondary hospitals. The quality of process of AIS care should be further increased to improve the patients’ clinical outcomes especially among secondary hospitals.
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Jabeen, Asma, Sumaira Maqbool, Abdul Basit, Idrees Ayoub, and Sakib Arfee. "Pattern of ophthalmological and orthopaedic manifestations in pediatric patients of torticollis presenting to the tertiary care hospital of north India." International journal of health sciences, July 18, 2022, 9379–86. http://dx.doi.org/10.53730/ijhs.v6ns4.10758.
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Introduction: Deformity of the neck and limited motion are commonly seen in pediatric orthopedics. The problem may be simply due to an intrinsic cervical issue or may be the manifestation of other underlying problems. To make a diagnosis of the nature and cause of neck deformity in the newborn is very important. Congenital torticollis is a condition that results in the deviation of a child’s head to one side, with accompanying limitation in the range of motion of the neck. Aims and objective: Objective: To investigate the clinical features and outcome of congenital muscular torticollis (CMT) with passive neck motion limitation according to whether the finding on ultrasonography (US) is normal or abnormal. Material and methods: A total of 32 patients with Congenital Muscular Torticollis (CMT) who met eligibility criteria were included: age at presentation 6 month to 1 year, limitation of passive neck rotation or lateral flexion were included in this study. Patients underwent physiotherapy and were followed-up monthly. The clinical research with torticollis at the Variety Center for Craniofacial Rehabilitation was done from 2019 to 2021 retrospectively. Clinical records, standardized medical photographs, and cephalometric radiographs of the affected patients were examined.