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SAYERS, G., D. IGOE, M. CARR, M. COSGRAVE, M. DUFFY, B. CROWLEY, and B. O'HERLIHY. "High morbidity and mortality associated with an outbreak of influenza A(H3N2) in a psycho-geriatric facility." Epidemiology and Infection 141, no. 2 (April 17, 2012): 357–65. http://dx.doi.org/10.1017/s0950268812000659.
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SUMMARYIn spring 2008, an influenza A subtype H3N2 outbreak occurred in a long stay psycho-geriatric ward and two wards in the intellectual disability services (IDS), part of a large psychiatric hospital. The attack rate in the index ward was 90% (18/20) for patients and 35% (7/20) for staff. It was 14% (1/7) and 17% (2/12) in the affected IDS wards for patients and 0% (0/20) and 4% (1/25) for staff. Many of the laboratory-confirmed cases did not have a fever >38 °C, a typical sign of influenza. Control measures included oseltamivir treatment for cases and prophylaxis for contacts, standard and droplet infection control precautions, active surveillance for early detection and isolation of potential cases. As a result, the outbreak did not spread throughout the hospital. Although the staff vaccination rate (10%) prior to the outbreak was low, we observed a much lower vaccine effectiveness rate in the patients (11%) than in the staff (100%) in the index ward. Vaccination of residents and staff of such facilities remains the key influenza prevention strategy.
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Erkkola, Maijaliisa, Maija Salmenhaara, Carina Kronberg-Kippilä, Suvi Ahonen, Tuula Arkkola, Liisa Uusitalo, Pirjo Pietinen, Riitta Veijola, Mikael Knip, and Suvi M. Virtanen. "Determinants of breast-feeding in a Finnish birth cohort." Public Health Nutrition 13, no. 4 (October 13, 2009): 504–13. http://dx.doi.org/10.1017/s1368980009991777.
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AbstractObjectiveTo assess milk feeding on the maternity ward and during infancy, and their relationship to sociodemographic determinants. The validity of our 3-month questionnaire in measuring hospital feeding was assessed.DesignA prospective Finnish birth cohort with increased risk to type 1 diabetes recruited between 1996 and 2004. The families completed a follow-up form on the age at introduction of new foods and age-specific dietary questionnaires.SettingType 1 Diabetes Prediction and Prevention (DIPP) project, Finland.SubjectsA cohort of 5993 children (77 % of those invited) participated in the main study, and 117 randomly selected infants in the validation study.ResultsBreast milk was the predominant milk on the maternity ward given to 99 % of the infants. Altogether, 80 % of the women recalled their child being fed supplementary milk (donated breast milk or infant formula) on the maternity ward. The median duration of exclusive breast-feeding was 1·4 months (range 0–8) and that of total breast-feeding 7·0 months (0–25). Additional milk feeding on the maternity ward, short parental education, maternal smoking during pregnancy, small gestational age and having no siblings were associated with a risk of short duration of both exclusive and total breast-feeding. In the validation study, 78 % of the milk types given on the maternity ward fell into the same category, according to the questionnaire and hospital records.ConclusionsThe recommendations for infant feeding were not achieved. Infant feeding is strongly influenced by sociodemographic determinants and feeding practices on the maternity wards. Long-term breast-feeding may be supported by active promotion on the maternity ward.
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LASKER, GABRIEL W. "THE HIERARCHICAL GENETIC STRUCTURE OF AN URBAN TOWN, KIDLINGTON, OXFORDSHIRE, EXAMINED BY THE COEFFICIENT OF RELATIONSHIP BY ISONYMY." Journal of Biosocial Science 31, no. 2 (April 1999): 279–84. http://dx.doi.org/10.1017/s0021932099002795.
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The surnames of the 3443 males registered to vote in Kidlington in 1977 yield a Coefficient of Relationship by Isonymy of 0·000564 {Ri=Σ(n(n–1))/2 N(N–1), in which n=the number of men of each surname and N=Σn}. Those of the four wards separately average 0·000722. However, if one includes only one male of any one surname in each residence, the values are, respectively, 0·000534 and 0·000535. That is, the only structure seen between the two levels is in the influence of men of the same surname resident in the same house. An analysis of relationship by residence on the same street yields a value of Ri somewhat higher than that for the ward as a whole, however, suggesting that even within a ward there may be a tendency for the house of relatives occasionally to lie close together.
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FAWLEY, W. N., and M. H. WILCOX. "Molecular epidemiology of endemic Clostridium difficile infection." Epidemiology and Infection 126, no. 3 (June 2001): 343–50. http://dx.doi.org/10.1017/s095026880100557x.
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This is the first study to provide a comprehensive insight into the molecular epidemiology of endemic Clostridium difficile and particularly that associated with a recently recognized epidemic strain. We DNA fingerprinted all C. difficile isolates from the stools of patients with symptomatic antibiotic-associated diarrhoea and from repeated samples of the inanimate ward environment on two elderly medicine hospital wards over a 22-month period. Notably, C. difficile was not recoverable from either ward immediately before opening, but was found on both wards within 1–3 weeks of opening, and the level of environmental contamination rose markedly during the first 6 months of the study period. C. difficile infection (CDI) incidence data correlated significantly with the prevalence of environmental C. difficile on ward B (r = 0·76, P < 0·05) but not on ward A (r = 0·26, P > 0·05). We found that RAPD and RS–PCR typing had similar discriminatory power, although, despite fingerprinting over 200 C. difficile isolates, we identified only six distinct types. Only two distinct C. difficile strains were identified as causing both patient infection and ward contamination. Attempts to determine whether infected patients or contaminated environments are the prime source for cross-infection by C. difficile had limited success, as over 90% of C. difficile isolates were the UK epidemic clone. However, a non-epidemic strain caused a cluster of six cases of CDI, but was only isolated from the environment after the sixth patient became symptomatic. The initial absence of this strain from the environment implies patient-to-patient and/or staff-to-patient spread. In general, routine cleaning with detergent was unsuccessful at removing C. difficile from the environment. Understanding the epidemiology and virulence of prevalent strains is important if CDI is to be successfully controlled.
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Hazarika, Bipan. "Second Order Ideal-Ward Continuity." International Journal of Analysis 2014 (March 5, 2014): 1–4. http://dx.doi.org/10.1155/2014/480918.
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The main aim of the paper is to introduce a concept of second order ideal-ward continuity in the sense that a function f is second order ideal-ward continuous if I-limn→∞Δ2f(xn)=0 whenever I-limn→∞Δ2xn=0 and a concept of second order ideal-ward compactness in the sense that a subset E of R is second order ideal-ward compact if any sequence x=(xn) of points in E has a subsequence z=(zk)=(xnk) of the sequence x such that I-limk→∞Δ2zk=0 where Δ2zk=zk+2-2zk+1+zk. We investigate the impact of changing the definition of convergence of sequences on the structure of ideal-ward continuity in the sense of second order ideal-ward continuity and compactness of sets in the sense of second order ideal-ward compactness and prove related theorems.
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Nurhaeni, Ni Luh Putu, Ketut Suarjana, and I. Made Ady Wirawan. "Electronic prescribing reduces prescription errors in Sanglah General Hospital Denpasar." Public Health and Preventive Medicine Archive 5, no. 2 (December 1, 2017): 84. http://dx.doi.org/10.15562/phpma.v5i2.19.
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Background and purpose: Medication error is any preventable event that may lead to inappropriate medication use or patient harm. Prescription error, one component of medication error, at Sanglah General Hospital Denpasar is high. An electronic prescribing has been piloted at Angsoka Ward, Sanglah General Hospital Denpasar to reduce prescription errors. However, the evaluation of such implementation is never been conducted. This study aims to evaluate the effect of electronic prescribing on prescription errors at Sanglah General Hospital Denpasar.Methods: An evaluation study was conducted by adopting pre and post control design at Sanglah General Hospital Denpasar. Prescription errors at Angsoka Ward where the electronic prescribing is implemented, were compared to Kamboja Ward that uses manual prescribing. Heterogeneity of patients in these two wards was comparable. Prescription samples were selected using a simple random sampling. Prescription samples prior to implementation of electronic prescribing were taken from June and July 2016, while samples after implementation were taken from March and April 2017. Prescription samples from the control group were also taken from the same periods. A total of 96 prescriptions were taken from each arm – leading to 384 prescription samples in total. Prescription error was evaluated using three requirements namely: administrative (9 components), pharmacy (5 components) and clinical (3 components).Results: Our study found that there was a significant difference of prescription errors between pre and post implementation of electronic prescribing at Angsoka Ward (p<0.05). The median values [IQR] for prescription error based on administrative requirements between pre and post intervention were 2 [3] vs. 0 [0] (p<0.001); based on pharmacy requirements were 1 [2] vs. 0 [0] (p<0.001); based on clinical requirements were 1 [2] vs 0 [0] (p<0,001). In contrast, prescription error based on administrative and pharmacy requirements in Kamboja Ward was insignificantly reduced. The median values [IQR] for prescription error based on administrative requirements between pre and post intervention were 2 [2] vs. 2 [2] (p=0.505) and based on pharmacy requirements were 1 [2] vs. 1 [1] (p=0.295). There was a significant difference of prescription errors (p<0.05) based on clinical requirements with median values [IQR] of 1 [1] vs. 1 [1]. Implementation of electronic prescribing reduced the proportion of prescription errors by 67.8%. After implementation of electronic prescribing, some errors were still apparent related to drug administration and order duplication.Conclusions: Implementation of electronic prescribing reduces prescription errors. Scaling-up of electronic prescribing followed by training on standardised prescribing practices are warranted.
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Cakalli, Huseyin, and Sibel Ersan. "Lacunary ward continuity in 2-normed spaces." Filomat 29, no. 10 (2015): 2257–63. http://dx.doi.org/10.2298/fil1510257c.
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In this paper, we introduce lacunary statistical ward continuity in a 2-normed space. A function f defined on a subset E of a 2-normed space X is lacunary statistically ward continuous if it preserves lacunary statistically quasi-Cauchy sequences of points in E where a sequence (xk) of points in X is lacunary statistically quasi-Cauchy if limr?1 1/hr |{k?Ir : ||xk+1 - xk, z||? ?}| = 0 for every positive real number ? and z ? X, and (kr) is an increasing sequence of positive integers such that k0 = 0 and hr = kr - kr-1 ? ? as r ? ?, Ir = (kr-1, kr]. We investigate not only lacunary statistical ward continuity, but also some other kinds of continuities in 2-normed spaces.
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GOKA, E. A., P. J. VALLELY, K. J. MUTTON, and P. E. KLAPPER. "Single, dual and multiple respiratory virus infections and risk of hospitalization and mortality." Epidemiology and Infection 143, no. 1 (February 24, 2014): 37–47. http://dx.doi.org/10.1017/s0950268814000302.
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SUMMARYRespiratory virus infections cause a significant number of hospitalization and deaths globally. This study investigated the association between single and multiple respiratory virus infections and risk of admission to a general ward, intensive care unit or death in patients aged 0–105 years (mean ± s.d. = 24·4 ± 24·1 years), from North West England, that were tested for respiratory virus infections between January 2007 and June 2012. The majority of infections were in children aged ⩽5 years. Dual or multiple infections occurred in 10·4% (1214/11 715) of patients, whereas single infection occurred in 89·6% (10 501/11 715). Rhinovirus was the most common co-infecting virus (occurring in 69·5%; 844/1214 of co-infections). In a multivariate logistic regression model, multiple infections were associated with an increased risk of admission to a general ward [odds ratio (OR) 1·43, 95% confidence interval (CI) 1·2–1·7, P < 0·0001]. On the other hand, patients with respiratory syncytial virus (RSV) and human parainfluenza virus types 1–3 (hPIV1–3), as a single infection, had a higher risk of being admitted to a general ward (OR 1·49, 95% CI 1·28–1·73, P < 0·0001 and OR 1·34, 95% CI 1·003–1·8, P = 0·05, respectively); admitted to an intensive-care unit or dying (OR 1·5, 95% CI 1·20–2·0, P = 0·001 and OR 1·60, 95% CI 1·02–2·40, P = 0·04, respectively). This result emphasizes the importance of RSV, hPIV and mixed infections and calls for research on vaccines, drugs and diagnostic tests targeting these respiratory viruses.
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Cakalli, Huseyin. "Abel statistical quasi Cauchy sequences." Filomat 33, no. 2 (2019): 535–41. http://dx.doi.org/10.2298/fil1902535c.
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In this paper, we investigate the concept of Abel statistical quasi Cauchy sequences. A real function f is called Abel statistically ward continuous if it preserves Abel statistical quasi Cauchy sequences, where a sequence (?k) of point in R is called Abel statistically quasi Cauchy if limx?1-(1-x) ?k:|??k|?? xk = 0 for every ? > 0, where ??k = ?k+1-?k for every k ? N. Some other types of continuities are also studied and interesting results are obtained. It turns out that the set of Abel statistical ward continuous functions is a closed subset of the space of continuous functions.
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Parvin, Most Morsheda, M. F. K. Al Mannah, and Esrat Jahan Sathi. "Nurses’ Knowledge Regarding Contraceptive Methods at Dinajpur Medical College Hospital." Randwick International of Social Science Journal 2, no. 2 (April 30, 2021): 106–12. http://dx.doi.org/10.47175/rissj.v2i2.220.
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This study was carried out on Nurses Knowledge Regarding Contraceptives Methods in Dinajpur Medical college Hospital, Dinajpur. The descriptive co relational design was used to explore the nurse’s knowledge and practice regarding contraceptives methods used in Dinajpur Medical college Hospital, Dinajpur. The study was conducted in thirty-two wards under four selected units, including 1) Gynae ward 2) Labour ward 3) Family planning centre. 50 nurses were selected for this study. The instrument developed by the researcher was divided into three sections, including 1) Demographic Questionnaire 2) Nurses’ knowledge regarding contraceptives methods Questionnaire 3) Nurses’ practice regarding contraceptives methods Questionnaire. The age of the participated nurses was 30-39 years 28%, 40-49 years 66%, 50+ above 4%. Of them, a male nurse was 12% and a female 88%. No unmarried nurse has participated, and 96% were married, and the remaining 4% were a widow. Professional qualification, Diploma in Nursing and Diploma in Midwifery 76%, B. Sc. in public Health 0%, M. Ph / M. Sc. 10%.
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Ersan, Sibel, and Hüseyin Çakalli. "Ward continuity in 2-normed spaces." Filomat 29, no. 7 (2015): 1507–13. http://dx.doi.org/10.2298/fil1507507e.
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In this paper, we introduce and investigate the concept of ward continuity in 2-normed spaces. A function f defined on a 2-normed space (X,?.,.?) is ward continuous if it preserves quasi-Cauchy sequences, where a sequence (xn) of points in X is called quasi-Cauchy if limn?1 ??xn,z? = 0 for every z ? X. Some other kinds of continuities are also introduced, and interesting theorems are proved in 2-normed spaces.
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Hyland, Declan, and Mohammed Uddin. "A survey of the level of knowledge and understanding of members of the inpatient team on the role of the physician associate on the general adult psychiatric wards." BJPsych Open 7, S1 (June 2021): S140. http://dx.doi.org/10.1192/bjo.2021.398.
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AimsPhysician Associates (PAs) are healthcare professionals with a general medical education background, having completed a two-year postgraduate degree. Whilst the number of PAs employed in healthcare trusts continues to increase, the number working in mental health settings remains small.Mersey Care NHS Foundation Trust employed two PAs two years ago. In August 2019, a third PA was recruited to work at Clock View Hospital, a general adult inpatient unit.This survey aims to establish what level of understanding different members of the inpatient teams across the inpatient wards have of the tasks PAs are permitted to undertake and those they are not.MethodA survey was designed, listing 37 tasks, e.g. completing an admission clerking. For each task, the participant was asked whether a PA is allowed to complete it or not, with three options provided – “can carry out the task”, “cannot carry out the task” and “do not know.” A score of + 1 was awarded if the correct answer was provided, –1 for an incorrect answer and 0 if the respondent didn't know. The highest possible score for a completed survey was + 37 points; the lowest possible score was –37 points.A sample of survey respondents was identified from the three general adult inpatient wards at Clock View Hospital and the Psychiatric Intensive Care Unit (PICU), comprising: senior doctors, junior trainees, Ward Manager, Deputy Ward Manager, Band 5 nurse and Assistant Practitioner.ResultTwenty-four members of staff completed the survey – 3 senior doctors, 4 junior trainees, 4 Ward Managers, 4 Deputy Ward Managers, 5 Band 5 nurses and 4 Assistant Practitioners. The respondents were distributed equally across the three general adult wards and the PICU. The highest survey score was 36 out of 37 (a Consultant); the lowest was 18 (a junior trainee). The lowest mean score was variable across the different grades of staff, with Consultants scoring highest at 29 and Assistant Practitioners and Ward Managers both scoring lowest at 25. There was little variability in mean score (only 2 points) across the three wards and PICU.ConclusionThe results from this survey demonstrate that different members of the inpatient team have a good understanding of what tasks PAs are and are not permitted to. There is still a need to provide further education to inpatient staff to ensure they utilise the PA at Clock View Hospital appropriately and that the PA is able to develop his skill set.
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Comeau, Jeannette L., Allana M. Ivany, Terry Romeo, Bridget S. Maxwell, Natalie Nymark, Belinda MacKinnon, Erin Doon, and Tim Mailman. "1261. Utility of a Multiplex Molecular Gastrointestinal Panel in Rapid Identification and Control of a Norovirus Outbreak in a Pediatric Tertiary Care Center." Open Forum Infectious Diseases 5, suppl_1 (November 2018): S384. http://dx.doi.org/10.1093/ofid/ofy210.1094.
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Abstract Background Norovirus is one of the most common viral pathogens implicated in gastroenteritis outbreaks in community and healthcare settings. The virus’ short incubation period and high attack rate allow its rapid spread through inpatient wards to patients (Patients), staff and visitors. Early identification and appropriate implementation of infection prevention and control measures is essential to interrupt transmission. Methods The IWK Health Centre is a 250-bed tertiary care Pediatric and Women’s hospital serving the Maritime Provinces, Canada. We describe a norovirus outbreak in our Pediatric Medical Unit, a 24-bed, single room ward with individual bathrooms for patients and families. Hospital-acquired norovirus definition: Patients admitted ≥48 hours with lab-confirmed norovirus AND ≥ 1 of: (1) acute onset diarrhea (no noninfectious cause) or (2) ≥2 of: nausea, vomiting, abdominal pain, fever, or headache. In 2017 the FilmArray Gastrointestinal (GI) Panel was introduced in the Clinical Microbiology Laboratory as part of a prospective post-implementation study. Since then, stool samples sent for viral, bacterial, or parasitic testing are evaluated by PCR. The panel tests for 22 GI analytes, including five viruses, with a 2-hour turnaround time. Previously, in-house stool viral testing was limited to adeno- and rotavirus antigen. Patient characteristics were collected and analyzed for this study. Results Patients 1, 2, and 3 had new onset diarrhea and emesis; Pt 1 on day 0, and Patients 2 and 3 on day 1. Patient 3’s parents (likely source) had had diarrhea and emesis on days 3 and 2, and used the ward kitchen. Two care-givers of Patient 2, and 1 medical resident developed diarrhea and emesis over days 0 to 2. The outbreak was declared over on day 7. Patients 1, 2, and 3 all tested positive for norovirus in stool on day 1. On days 2–3, six other patients with diarrhea tested norovirus negative. All symptomatic patients were immediately placed on contact precautions, room/ward cleaning frequency increased and proper hand hygiene was reinforced. Common areas (playroom/kitchen) were closed until the outbreak was over. All patients with loose stool were tested during the outbreak. Conclusion FilmArrayGI panel enabled same-day identification of norovirus in this single-ward outbreak and permitted real-time identification of the termination of the outbreak. Disclosures All authors: No reported disclosures.
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Giang, Thuy-Anh, Cheng Ling Jie, Chua Min Jia, and Philip Yap. "552 - Humanitude Care on Patients with Dementia and Delirium in Acute Hospital Improves Outcomes." International Psychogeriatrics 33, S1 (October 2021): 93. http://dx.doi.org/10.1017/s1041610221002477.
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Background/ Objectives:Older patients with dementia and/or delirium often have challenging behaviours such as refusal of care and aggression. These cause much distress to both healthcare staff and patients, increase burden of care and put older patients at risk of functional decline. Humanitude, a methodology of care developed by Gineste and Marescotti, is a relationship- centred and compassionate care approach that aims to enable patients. The aim of this study is to investigate the effectiveness of Humanitude on older patients’ well-being, mobility and activities of daily living (ADLs).Design:Quasi-experimental, non-equivalent controlled trial design.Setting:Acute care hospitalParticipants:Twenty patients diagnosed with dementia and/ or delirium were recruited from two geriatric wards. Ten were in the Humanitude ward and the other ten in a conventional ward received usual care for older patients served as concurrent controls.Intervention:Patients in Humanitude ward received Humanitude care by trained healthcare workers during day-to-day care, which is based on the 4 pillars of gaze, speech, touch and verticality (maintaining an upright position). Every patient encounter utilizing Humanitude techniques follow a structured care sequence that helps draw the patient into the care relationship.Measurements:The outcome measures include Modified Perme ICU Mobility Score, Bradford Well- being Profile and Modified Barthel Index (MBI).Results:There was significant improvement of median score within the Humanitude group from admission to discharge in mobility (admission: 9.0 [0-27] vs discharge 19.5 [1-36], p=0.002**), MBI (admission: 20 [0.0-46] vs discharge: 54.3 [3-81], p = 0.002**) and well-being (admission: 7.0 [1-15] vs discharge 20.0 [8-26], p=0.002**). The median increase in the score of Humanitude group was also significantly higher than usual care group in mobility (Humanitude: 8 [1-24] vs usual care 0 [-9-16], p= 0.02*), MBI (Humanitude: 17.5 [3-64] vs usual care 0 [-3-17], p= <0.001***), and well-being (Humanitude: 11 [6-20] vs usual care 0 [-5-4], p= <0.001 ***).Conclusion:Humanitude care improves outcomes in mobility, ADL function and well-being for patients with dementia and/ or delirium in the acute hospital.(Word count: 329)
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Cutler, Lee R. "From ward-based critical care to educational curriculum 1: a literature review." Intensive and Critical Care Nursing 18, no. 3 (June 2002): 162–70. http://dx.doi.org/10.1016/s0964-3397(02)00029-0.
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Fahrudin, Tresna Maulana, Prismahardi Aji Riyantoko, Kartika Maulida Hindrayani, and Made Hanindia Prami Swari. "Cluster Analysis of Hospital Inpatient Service Efficiency Based on BOR, BTO, TOI, AvLOS Indicators using Agglomerative Hierarchical Clustering." Telematika 18, no. 2 (October 4, 2021): 194. http://dx.doi.org/10.31315/telematika.v18i2.4786.
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Purpose: The research proposed an approach for grouping hospital inpatient service efficiency that have the same characteristics into certain clusters based on BOR, BTO, TOI, and AvLOS indicators using Agglomerative Hierarchical Clustering.Design/methodology/approach: Applying Agglomerative Hierarchical Clustering with dissimilarity measures such as single linkage, complete linkage, average linkage, and ward linkage.Findings/result: The experiment result has shown that ward linkage was given a quite good score of silhouette coefficient reached 0.4454 for the evaluation of cluster quality. The cluster formed using ward linkage was more proportional than the other dissimilarity measures. Ward linkage has generated cluster 0 consists of 23 members, cluster 1 consists of 34 members, while both of cluster 2 and 3 consists of only 1 member respectively. The experiment reported that each cluster had problems with inpatient indicators that were not ideal and even exceeded the ideal limit, but cluster 0 generated the ideal BOR and TOI parameters, both reached 52.17% (12 of 23 hospital inpatient) and 78.36% (18 of 23 hospital inpatient) respectively.Originality/value/state of the art: Based on previous research, this study provides an alternative to produce more proportional, representative and quality clusters in mapping hospital inpatient service efficiency that have the same characteristics into certain clusters using Agglomerative Hierarchical Clustering Method compared to the K-means Clustering Method which is often trapped in local optima.
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Tan, Thean Yen, Jasmine Shi Min Tan, Huiyi Tay, Gek Hong Chua, Lily Siew Yong Ng, and Nur Syahidah. "Multidrug-resistant organisms in a routine ward environment: differential propensity for environmental dissemination and implications for infection control." Journal of Medical Microbiology 62, no. 5 (May 1, 2013): 766–72. http://dx.doi.org/10.1099/jmm.0.052860-0.
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Multidrug-resistant organisms (MDROs) pose significant infection-control challenges in settings with high prevalence and limited isolation facilities. This observational study in an 800-bed hospital determined the prevalence, bacterial density and genetic relatedness of MDROs isolated from ward surfaces, medical devices and the hands of healthcare professionals. The targeted MDROs were meticillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), Escherichia coli and Klebsiella pneumoniae resistant to extended-spectrum cephalosporins, and carbapenem-resistant (CR) Acinetobacter baumannii. During a 2-month period, microbiological sampling and molecular typing were performed on environment isolates, clinical isolates and isolates recovered from the hands of healthcare professionals. The target MDROs were recovered from 79 % of sampled surfaces, predominantly MRSA (74 % of all tested surfaces) and CR A. baumannii (29 %) but also VRE (2 %) and K. pneumoniae (1 %). MRSA was recovered from most tested surfaces throughout the ward, whilst CR A. baumannii was significantly more likely to be recovered from near-patient surfaces. Hand sampling demonstrated infrequent recovery of MRSA (5 %), CR A. baumannii (1 %) and VRE (1 %). Molecular typing of the study isolates identified seven MRSA and five Acinetobacter clonal clusters, respectively, and typing identified similar strains from the environment, patients and hands. Thus, in a healthcare setting with endemic circulation of MDROs, MRSA and CR A. baumannii were the predominant organisms recovered from ward surfaces, with MRSA in particular demonstrating widespread environmental dissemination. Molecular typing demonstrated the presence of related strains in patients, in the environment and on the hands of healthcare workers.
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Patel, Sima, and Blanca Carioni. "IMPROVING ONGOING PATIENT CARE THROUGH GUIDING DOCUMENTATION OF WARD ROUNDS: A QUALITY IMPROVEMENT PROJECT IN A GENERAL SURGICAL UNIT WITHIN THE NATIONAL HEALTH SERVICE." International Journal of Advanced Research 10, no. 12 (December 31, 2022): 126–34. http://dx.doi.org/10.21474/ijar01/15817.
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Aim: Increasing pressures within the National Health Service has led to busier ward rounds. Documentation of information can be sacrificed to accommodate the pace of (ward) rounds. This quality improvement project aims to implement a user-friendly proforma for surgical ward rounds, with the view both improving patient safety via directing documentation and supporting the junior doctor. Methods: Plan, Do, Study, Act (PDSA) method was used for this quality improvement project. Primary and secondary parameters were established, and baseline assessment undertaken 1 month prior to intervention with repeat data collection 1 month and 6 months after introduction of a pre-printed ward round proforma. Results: A total of 106 entries were reviewed within the 6-month study period. Pre-printed ward round proforma led to an improvement in all assessed parameters. 80% of junior doctors (n=10) and 75% nursing staff (n=8) found the pre- printed proforma standardised documentation, improving communication of plans to the wider team. Antibiotic stewardship improved from 0% (N=50) to 98% (N=30) over the 6-month period. 100% of junior doctors (n = 10) and nursing staff (n = 8) found coloured paper facilitated and bettered identification of last consultant review. Conclusion: The introduction of a pre-printed proforma allowed for standardisation of documented information for ongoing ward rounds, improved antibiotic stewardship and was received positively by junior doctors. Colour paper allowed for quicker identification of the last ward round entry which makes reviews of an unwell patient more efficient. Further work is needed to optimise and incorporate proforma within other surgical specialities.
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Smith, Jane, John Green, Najma Siddiqi, Sharon K. Inouye, Michelle Collinson, Amanda Farrin, and John Young. "Investigation of ward fidelity to a multicomponent delirium prevention intervention during a multicentre, pragmatic, cluster randomised, controlled feasibility trial." Age and Ageing 49, no. 4 (April 18, 2020): 648–55. http://dx.doi.org/10.1093/ageing/afaa042.
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Abstract Background delirium is a frequent complication of hospital admission for older people and can be reduced by multicomponent interventions, but implementation and delivery of such interventions is challenging. Objective to investigate fidelity to the prevention of delirium system of care within a multicentre, pragmatic, cluster randomised, controlled feasibility trial. Setting five care of older people and three orthopaedic trauma wards in eight hospitals in England and Wales. Data collection research nurse observations of ward practice; case note reviews and examination of documentation. Assessment 10 health care professionals with experience in older people’s care assessed the fidelity to 21 essential implementation components within four domains: intervention installation (five items; maximum score = 5); intervention delivery (12 items; maximum score = 48); intervention coverage (three items; maximum score = 16); and duration of delivery (one item; maximum score = 1). Results the mean score (range) for each domain was: installation 4.5 (3.5–5); delivery 32.6 (range 27.3–38.3); coverage 7.9 (range 4.2–10.1); and duration 0.38 (0–1). Of the 10 delirium risk factors, infection, nutrition, hypoxia and pain were the most and cognitive impairment, sensory impairment and multiple medications the least consistently addressed. Overall fidelity to the intervention was assessed as high (≥80%) in two wards, medium (51–79%) in five wards and low (≤50%) in one ward. Conclusion the trial was designed as a pragmatic evaluation, and the findings of medium intervention fidelity are likely to be generalisable to delirium prevention in routine care and provide an important context to interpret the trial outcomes.
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Betsakos, Dimitrios, and Alexander Yu Solynin. "On the distribution of harmonic measure on simply connected planar domains." Journal of the Australian Mathematical Society 75, no. 2 (October 2003): 145–52. http://dx.doi.org/10.1017/s1446788700003682.
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AbstractFor a simply connected planar domain D with 0 ∈ D and dist(0, ∂D) = 1, let hD(r) be the harmonic measure of ∂ D ∩{|Z| ≤ r} evaluated at 0. The function hD(r) is the distribution of harmonic measure. It has been studied by B. L. Walden and L. A. Ward. We continue their study and answer some questions raised by them by constructing domains with pre-specified distribution.
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Christiansen, Nanna, Tayyaba Javid, Jasper Thomson, Heather Calvert, and Olapeju Bolarinwa. "P29 Impact of a medicines facilitation pharmacist on a paediatric ward." Archives of Disease in Childhood 103, no. 2 (January 19, 2018): e2.32-e2. http://dx.doi.org/10.1136/archdischild-2017-314585.38.
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AimRecruiting sufficient numbers of nurses can provide a challenge for hospitals. Pharmacists have been identified as being able to support nurses by taking on medicines management tasks alongside traditional nursing responsibilities such as medicines administration and discharge planning.1 At Barts Health NHS Trust there was increased pressure on nursing staff particularly on one of the complex medical wards during the winter pressure months. Paediatric pharmacists were identified as being able to support nurse:Safe nursing time by taking on some of nursing responsibilitiesActive discharge planning and coordinationReduce discharge prescription waiting timesImprove education and training for nurses, doctors and patients in relation to medicines management.MethodA pilot project on one paediatric medical ward was started in February 2016. The pharmacist is supernumerary to standard ward pharmacy service, reporting to the ward manager and lead pharmacist. Working hours are 9 am–5 pm Monday to Friday.Intensive training was provided over 2.5 weeks with subsequent sign off for administration of oral medication, 2nd checking for intravenous (IV) medication and IV giving.Drug listing for discharge prescription (TTA) was introduced, which involves a discussion with the doctor for medicines on discharge, transcribing these onto the TTA and using ward based dispensing where possible. Results were collected pre and post implementation.ResultsMedication administration activity:Nurse time – 60 hours/month (medication administration and 2nd checking) saved.Discharge information:Proportion of TTAs dispensed at ward level increased from 19% to 78% post implementation, avoiding delays in dispensary.Average time writing TTA to being ready for discharge reduced from 280 min to 91 min.Drug listing reduced discharge time further to 52 min.Missed and delayed doses:Random sample of 5 patients audited over 48 hour period, shown to reduce missed doses from 14% to 0%.Comments from staff:‘Because of skill mix and use of agency staff, assisting in preparing and giving IVABs has been a major help as on many days only 1 IV giver.’‘Junior staff value and support WFP and have felt has been useful to them.’‘Junior and agency staff feels better supported in understanding medicines usage’.‘Lot of complex patients with many drugs, the pharmacist has helped reducing delay in administration times’.‘TTAs for patients identified as going home have been validated sooner’.‘She helped us to reduce the number of incidents with expiry dates of medicines’.ConclusionThe role of the medicines facilitation pharmacist has been very well received by the nursing staff and the pharmacist is now an integral part of the ward team. The pharmacist was able to save a significant amount of nursing time and reduced risks of delayed and missed doses significantly and is able to provide continuous input into all aspects of medicines management. The average discharge time has reduced to substantially due to improved discharge planning, drug listing and ward based dispensing.ReferenceRobinson S. Hospital hires pharmacists for wards amid nurse shortage. Pharmaceutical Journal 23/30 May 2015;294(7863/4). [online] doi:10.1211/PJ.2015.20068544
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GAITHER, JEFFREY, GUY LOUCHARD, STEPHAN WAGNER, and MARK DANIEL WARD. "Resolution of T. Ward's Question and the Israel–Finch Conjecture: Precise Analysis of an Integer Sequence Arising in Dynamics." Combinatorics, Probability and Computing 24, no. 1 (October 2, 2014): 195–215. http://dx.doi.org/10.1017/s0963548314000455.
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We analyse the first-order asymptotic growth of \[ a_{n}=\int_{0}^{1}\prod_{j=1}^{n}4\sin^{2}(\pi jx)\, dx. \] The integer an appears as the main term in a weighted average of the number of orbits in a particular quasihyperbolic automorphism of a 2n-torus, which has applications to ergodic and analytic number theory. The combinatorial structure of an is also of interest, as the ‘signed’ number of ways in which 0 can be represented as the sum of ϵjj for −n ≤ j ≤ n (with j ≠ 0), with ϵj ∈ {0, 1}. Our result answers a question of Thomas Ward (no relation to the fourth author) and confirms a conjecture of Robert Israel and Steven Finch.
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Lesho, Emil P., Edward E. Walsh, Jennifer Gutowski, Lisa Reno, Donna Newhart, Stephanie Yu, Jonathan Bress, and Melissa Bronstein. "489. A Case-Control Approach to an Outbreak of SARS-CoV-2 on an Acute Stroke Unit in the U.S." Open Forum Infectious Diseases 7, Supplement_1 (October 1, 2020): S310—S311. http://dx.doi.org/10.1093/ofid/ofaa439.682.
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Abstract Background Detailed descriptions of hospital-acquired SARS-CoV-2 infections and transmission chains in healthcare settings are crucial to controlling outbreaks and improving patient safety. However, such reports are scarce. We sought to determine origins and factors associated with nosocomial transmission of SARS-CoV-2 in a 528-bed teaching hospital in Western New York. Methods The index patient, who had mental illness, wandered throughout the ward, would not wear a facemask, and was often kept seated at the nursing station, developed COVID-19 on day- 22 of hospitalization. A case-control approach was used, wherein all patients, staff, and 128 randomly selected environmental surfaces on the outbreak unit (case), and randomly selected patients, staff, and environmental surfaces on designated COVID-19 and non-COVID-19 units (control), were tested for SARS-COV-2 by RT-PCR and IgG SARS-COV-2 antibodies (SAR-Ab). Compliance with hand hygiene (HH) and COVID-specific personal protective equipment (PPE) was assessed. Results 145 staff and 26 patients were potentially exposed resulting in 25 secondary cases (14 staff and 11 patients). 4/14 (29%) of the staff and 7/11 (64%) of the patients who tested positive, and later became ill, were asymptomatic at the time of testing (Figures 1–2). There was no difference in mean cycle threshold for SARS-COV-2 gene targets between asymptomatic and symptomatic individuals. 0/32 randomly selected staff from the positive and negative control wards tested positive. PPE compliance based on 354 observations was not significantly different between wards. Environmental surface contamination with SARS-COV-2 RNA was not different between outbreak and control wards. Mean monthly HH compliance, based on 20,146 observations, was lower on the outbreak ward (p < 0.006) (Figure 3). 142 staff volunteered for serologic testing. The proportion staff with detectable SAR-Ab was higher on the outbreak ward (OR 3.78: CI 1.01–14.25). Figure 1 Figure 2 Figure 3 Conclusion The risk of staff exposure was higher in an outbreak setting than on a dedicated COVID-19 unit (Figure 4). Noncompliant patient behavior, decreased hand hygiene, and pre-symptomatic transmission can contribute to nosocomial spread and are important considerations for ongoing infection control efforts. Figure 4 Disclosures All Authors: No reported disclosures
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Chen, Yun-Bo, Si-Lan Gu, Ze-Qing Wei, Ping Shen, Hai-Sheng Kong, Qing Yang, and Lan-Juan Li. "Molecular epidemiology of Clostridium difficile in a tertiary hospital of China." Journal of Medical Microbiology 63, no. 4 (April 1, 2014): 562–69. http://dx.doi.org/10.1099/jmm.0.068668-0.
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Clostridium difficile infection (CDI) is caused by toxin-producing strains. It accounts for 20–30 % of antibiotic-associated diarrhoea and particularly accounts for 90 % of pseudomembranous colitis. The epidemiological study of C. difficile is thus important. In this study, we report the molecular epidemiology and ward distribution of C. difficile in a tertiary hospital of China. A total of 161 toxigenic strains were isolated from 1845 patients originating from different wards and the strains were characterized based on toxin profile and multilocus sequence typing. Variable isolation rates were observed in different wards and the occurrence was higher in intensive care unit and geriatric wards. Toxin gene profiling revealed that, out of the 161 isolates, 134 (83.2)% were positive for both toxin A (tcdA) and toxin B (tcdB) (A+B+) followed by toxin A-negative and B-positive (A−B+) (16.8 %) isolates. However, only three of the toxigenic strains (1.9 %) were positive for both the cdtA and cdtB genes. Based on the molecular epidemiology study, a total of 30 different sequence types (STs), including one new ST (ST-220), were distinguishable. ST-54 was the most prevalent (23.0 %), followed by ST-35 (19.3 %) and ST-37 (10.0 %). None of the isolates belonged to ST-1 (ribotype 027) or ST-11 (ribotype 078). Taken together, the toxin profile and the molecular epidemiological data showed that all the ST-37 clades were of toxin type A−B+, which accounted for 59.3 % of all type A−B+ isolates. Meanwhile the clade 1 genotype, ST-54, was widely distributed among the geriatric, infection and haematology wards. There was no outbreak of C. difficile infection during our study; however the possibility of prolonged outbreaks cannot be completely ignored.
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Ersan, Sibel. "A variation on strongly lacunary delta ward continuity in 2-normed spaces." Boletim da Sociedade Paranaense de Matemática 38, no. 7 (October 14, 2019): 195–202. http://dx.doi.org/10.5269/bspm.v38i7.45496.
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A sequence $(x_{k})$ of points in a subset E of a 2-normed space $X$ is called strongly lacunary $\delta$-quasi-Cauchy, or $N_\theta$-$\delta$-quasi-Cauchy if $(\Delta x_k)$ is $N_\theta$-convergent to 0, that is $\lim_{r\rightarrow\infty}\frac{1}{h_r}\sum_{k\in I_r}||\Delta^2 x_k, z||=0$ for every fixed $z\in X$. A function defined on a subset $E$ of $X$ is called strongly lacunary $\delta$-ward continuous if it preserves $N_{\theta}$-$\delta$-quasi-Cauchy sequences, i.e. $(f(x_{k}))$ is an $N_{\theta}$-$\delta$-quasi-Cauchy sequence whenever $(x_{k})$ is. In this study we obtain some theorems related to strongly lacunary $\delta$-quasi-Cauchy sequences.
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De Andrade, M. A., O. M. Del Cima, and L. P. Colatto. "N = 1 super-Chern-Simons coupled to parity-preserving matter from Atiyah-Ward space-time." Physics Letters B 370, no. 1-2 (March 1996): 59–64. http://dx.doi.org/10.1016/0370-2693(95)01562-0.
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Davis, CR. "Infection-free surgery: how to improve hand-hygiene compliance and eradicate methicillin-resistant Staphylococcus aureus from surgical wards." Annals of The Royal College of Surgeons of England 92, no. 4 (May 2010): 316–19. http://dx.doi.org/10.1308/003588410x12628812459931.
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INTRODUCTION Healthcare-associated infections cost the UK National Health Service £1 billion per annum. Poor hand hygiene is the main route of transmission for methicillin-resistant Staphylococcus aureus (MRSA), leading to increased mortality and morbidity for infected patients. This study aims to quantify MRSA infection rates and compliance of alcohol gel application at the entrance to a surgical ward and assess how a simple intervention affects compliance. SUBJECTS AND METHODS Compliance was assessed via a discretely positioned close-surveillance camera at the ward entrance, ootage was reviewed to monitor compliance of all persons entering the ward over a 12-month period. RESULTS For the initial 6 months, mean alcohol gel compliance was 24% for all persons entering the ward. After this period, a conspicuous strip of bright red tape was positioned along the corridor approaching the ward entrance. The red line continued up the wall to an arrow head pointing to the two alcohol gel dispensers on the wall. Mean compliance over the subsequent 6 months significantly improved to 62% (P< 0.0001). Compliance improved for all persons entering the ward as follows (before – after, significance): doctors (0% – 54%, P< 0.01); nurses (24% – 75%, P< 0.05); porters (21% – 67%, P< 0.05); visitors (35% – 68%, P< 0.01); patients (23% – 44%, P > 0.05). There were two cases of MRSA bacteraemia in the initial 6 months and no cases in the following 6 months with the red line in situ. CONCLUSIONS This study demonstrates how a simple intervention significantly improves hand-hygiene compliance with associated eradication of MRSA.
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HWANG, J., A. CHOW, D. C. LYE, and C. S. WONG. "Administrative data is as good as medical chart review for comorbidity ascertainment in patients with infections in Singapore." Epidemiology and Infection 144, no. 9 (January 13, 2016): 1999–2005. http://dx.doi.org/10.1017/s0950268815003271.
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SUMMARYThe Charlson comorbidity index (CCI) is widely used for control of confounding from comorbidities in epidemiological studies. International Classification of Diseases (ICD)-coded diagnoses from administrative hospital databases is potentially an efficient way of deriving CCI. However, no studies have evaluated its validity in infectious disease research. We aim to compare CCI derived from administrative data and medical record review in predicting mortality in patients with infections. We conducted a cross-sectional study on 199 inpatients. Correlation analyses were used to compare comorbidity scores from ICD-coded administrative databases and medical record review. Multivariable regression models were constructed and compared for discriminatory power for 30-day in-hospital mortality. Overall agreement was fair [weighted kappa 0·33, 95% confidence interval (CI) 0·23–0·43]. Kappa coefficient ranged from 0·17 (95% CI 0·01–0·36) for myocardial infarction to 0·85 (95% CI 0·59–1·00) for connective tissue disease. Administrative data-derived CCI was predictive of CCI ⩾5 from medical record review, controlling for age, gender, resident status, ward class, clinical speciality, illness severity, and infection source (C = 0·773). Using the multivariable model comprising age, gender, resident status, ward class, clinical speciality, illness severity, and infection source to predict 30-day in-hospital mortality, administrative data-derived CCI (C = 0·729) provided a similar C statistic as medical record review (C = 0·717, P = 0·8548). In conclusion, administrative data-derived CCI can be used for assessing comorbidities and confounding control in infectious disease research.
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Greenhalgh, Ben, Hina Anwar, Rosemary Hedley, Celine Perkins, and Rachel Shaw. "Are medications with anti-cholinergic properties prescribed and reviewed appropriately on a male older person's organic ward?" BJPsych Open 7, S1 (June 2021): S79—S80. http://dx.doi.org/10.1192/bjo.2021.250.
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AimsPatients admitted to Roker ward (male organic psychiatric ward) should have a decreased anticholinergic burden of medication on discharge compared to admission. This will be demonstrated by a reduced score on the Anticholinergic Cognitive Burden (ACB) scale on discharge compared to admission. Target: 80%.Where new medicines with anticholinergic burden are prescribed during admission, there should be evidence that the anticholinergic properties of these medications have been considered prior to prescribing (via documentation in care co-ordination reviews or progress notes). Target: 100%MethodElectronic records were searched for all discharges from Roker ward between 1/1/2019 – 31/12/2019. For each record the follwing information was recorded: demographics; primary diagnosis; total ACB score on admission; and total ACB score on discharge. For all new medications started with an ACB score of over zero, records were searched to establish whether there was evidence that the anticholinergic properties of these medications had been considered.Result47 patients were identified who were discharged over the time period in question. 30 patients had no difference in ACB score between admission and discharge; 10 patients had a reduction in ACB score and 5 patients had an increase. A total of 9 new medications with ACB scores over zero had been started during all admissions; there were no occasions where there was documented evidence to show that the anticholinergic burden of these medications had been considered.Conclusion27% of patients had a reduction in their total ACB score during admission; the target was 80%.The reasons for starting medications with an ACB score of greater than 1 were documented in 0% of cases; the target was 100%.As both targets were missed by a significant margin, it was recognised that there were significant areas for improvement. The following plan was therefore implemented: 1.Following discussion with the ward consultant and ward pharmacist, regular prescriber meetings have been set up which involve senior nursing staff, medical staff and pharmacy – anticholinergic burden is calculated for each patient as part of these meetings2.A re-audit is recommended after 6 months.
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PERRET, R. E. C. "A CLASSICAL N = 4 SUPER W ALGEBRA." International Journal of Modern Physics A 08, no. 20 (August 10, 1993): 3615–30. http://dx.doi.org/10.1142/s0217751x93001478.
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I construct classical superextensions of the Virasoro algebra by employing the Ward identities of a linearly realized subalgebra. For the N = 4 superconformal algebra, this subalgebra is generated by the N = 2 U (1) supercurrent and a spin 0 N = 2 superfield. I show that this structure can be extended to an N = 4 super W3 algebra, and give the complete form of this algebra.
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Kartikahadi, Lie Affendi, Soetjiningsih Soetjiningsih, I. Gusti Ayu Endah Ardjana, and I. Gusti Ayu Trisna Windiani. "Comparison of maternal anxiety scores in pediatric intensive care unit and general ward parents." Paediatrica Indonesiana 52, no. 2 (April 30, 2012): 95. http://dx.doi.org/10.14238/pi52.2.2012.95-98.
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Background Hospitalization of a child is known to be a dreadfuland stressful situation for parents. One study reported thatadmitting 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 whosechildren were admitted to the PICU to those of mothers whosechildren were admitted to the general ward.Methods A cross-sectional study was done on mothers ofchildren aged 1 month-12 years. Children were admitted toeither the intensive care unit or the general ward from October2010-January 2011. All subjects were assessed by Hamiltonanxiety scores and questioned for risk factors and other causesof maternal anxiety. Consecutive sampling was used to allocatethe subjects. Differences were considered statistically significantfor P < 0.05.Results Of the 72 subjects, the median Hamilton anxiety score inmothers of children admitted to the PICU was 20.5 (interquartilerange 14-29.75), higher than that of mothers of children admittedto the general ward (14, interquartile range 9-16.75). MannWhitneyU test revealed a statistically significant difference inscores between the two groups (P = 0.DO1). Ancova multivariateanalysis showed the admission location to be the only significantrelationship to Hamilton anxiety score (P = 0.0001).Conclusion Hamilton anxiety scores were higher for mothersof children admitted to the PICU than that of mothers withchildren admitted to the general ward. [Paediatr lndones.2012;52:95-8].
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Neubauer, Werner, Martina Kleber, Alf Zerweck, Veronique Thierry, Alexandra Goebel, Beate Lubrich, Hartmut Bertz, and Monika Engelhardt. "Analysis of Efficacy, Safety and Costs of Systemic Antifungal Agents in 159 Consecutive High-Risk Cancer Patients for the Establishment of Standardized Guidelines." Blood 112, no. 11 (November 16, 2008): 1313. http://dx.doi.org/10.1182/blood.v112.11.1313.1313.
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Abstract Introduction: Invasive mycoses (IM) show high morbidity and mortality rates in immunocompromised patients (pts), especially among allogeneic stem cell transplant (allo-SCT) recipients. Efficacy and safety profiles of currently available systemic antifungal drugs (SAD) have been derived from various clinical trials, which, however, do not reflect ‘everyday clinics’ and true SAD efficacy in cancer pts due to tight inclusion and exclusion study criteria. The aim of our analysis is the development of standard operating procedures (SOP) for SAD use also outside clinical trials, leading to less application errors (thereby enhancing treatment safety) and an economically appropriate SAD use. Methods: Since 11/06, we prospectively analyse the use of SAD on a general hematology ward (n=43) and SCT-unit (n=116) within our department. We assess pt characteristics, organ functions, side effects (SE), potential drug interactions (PDI), treatment outcomes and costs. Data is obtained by daily participation on ward rounds, consultation of ward physicians and review of pts’ medication charts. SAD were given according to EORTC-adapted guidelines, with use of fluconazole as primary prophylaxis in allo-SCT recipients and voriconazole or posaconazole as secondary prophylaxis after aspergillus or zygomycetes infection. Empirical therapy was implemented with liposomal amphotericin, preemptive therapy and therapy of aspergillus infections with voriconazole, caspofungin or liposomal amphotericin B. Results: So far, data from 159 consecutive pts have been obtained, showing a median age of 57 years (y; range 20–85) and a median Satariano index of 1 (comorbidity index; range 0–4). The underlying malignancies comprised leukemia (n=98), lymphoma (n=41), solid tumors (n=12) and other non-malignant diseases (n=8) with the majority of pts having undergone allo- (n=110) or autologous (n=31) SCT. Subgroup analyses showed that transplant pts were treated more frequently with intravenous (iv) SAD and with two or more consecutively applied SAD, compared with pts on the general hematology ward (Table 1). Transplant pts received SAD earlier with higher pt numbers being treated prophylactically and empirically. Due to often complex co-medication (e.g. antibiotics, immunosuppressive agents), PDI were detected more often among transplant pts. The median duration of SAD use was considerably longer and the median SAD costs exceeded those of the pts treated on the general hematological ward. Table 1. Use of systemic antifungal drugs (SAD) on a general hematology ward vs. SCT-unit All patients General hematology ward SCT-unit # pts 159 43 116 Median age (y) 57 62 54 Pts treated with iv SAD (%) 86 (54%) 11 (26%) 75 (65%) Pts treated consecutively with >2 SAD (%) 25 (16%) 1 (2%) 24 (21%) Pts treated prophylactically (%) 119 (75%) 22 (51%) 97 (84%) Pts treated empirically (%) 55 (35%) 12 (28%) 43 (37%) Pts with >1 PDI per SAD (%) 62 (39%) 6 (14%) 56 (48%) Median duration of SAD treatment (d) 30 10 32.5 Median SAD costs per hospital stay (US $) 1325 130 2997 Notable was also the comparison of pts receiving caspofungin vs. liposomal amphotericin B, whereby the echinocandin showed a more favorable safety profile, less SE and PDI (Table 2). Caspofungin was more frequently applied as preemptive and 2-line therapy, whereas liposomal amphotericin B was commonly used as empirical and 1-line therapy. Table 2. Therapeutical use of caspofungin vs. liposomal amphotericin B All patients Caspofungin lip. Ampho B # pts 82 21 61 Median age (y) 57 56 57 Pts with >1 SE (%) 12 (15%) 2 (10%) 11 (18%) Pts with >2 PDI (%) 30 (37%) 0 30 (49%) Pts treated empirically (%) 55 (67%) 9 (43%) 46 (75%) Pts treated preemptively (%) 21 (26%) 10 (48%) 11 (18%) Median therapy line 1 2 1 Posaconazole surprisingly showed an unfavorable toxicity profile in our hands and (mainly hepatic) SE in 5/5 pts. Conclusions: Earlier onset and longer SAD treatment duration lead to substantial costs on our SCT-unit compared to a general hematology ward. PDI emerge much more frequent due to complex co-medication. Caspofungin appears to be more favorably tolerated than liposomal amphotericin B concerning SE as well as PDI. Due to our detection of frequent SE and PDI with SAD, SOPs for their use should help to avoid errors and will impact on pts’ safety. Enrollment of additional pts, especially with induction/consolidation treatment for acute leukemia, is ongoing, which will be presented at the meeting.
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KIRKBRIDE, JAMES B., CRAIG MORGAN, PAUL FEARON, PAOLA DAZZAN, ROBIN M. MURRAY, and PETER B. JONES. "Neighbourhood-level effects on psychoses: re-examining the role of context." Psychological Medicine 37, no. 10 (May 2, 2007): 1413–25. http://dx.doi.org/10.1017/s0033291707000499.
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ABSTRACTBackgroundThe incidence of schizophrenia varies by individual-level characteristics and neighbourhood-level attributes. Few specific socio-environmental risk factors (SERFs) have been identified at the neighbourhood level. Cross-level interactions are poorly understood. We investigated these issues using data from the Aetiology and Ethnicity in Schizophrenia and Other Psychoses (AESOP) study.MethodAll incidence cases of ICD-10 schizophrenia (F20) and other non-affective psychoses (F21–29), aged 16–64 years, across 33 wards in Southeast London were identified over a 2-year period (1997–1999). Census data provided the denominator for each ward. Multilevel Poisson regression simultaneously modelled individual- and neighbourhood-level SERFs, including socio-economic deprivation, voter turnout (proxy for social capital), ethnic fragmentation (segregation) and ethnic density.ResultsA total of 218 subjects were identified during 565 576 person-years at risk. Twenty-three per cent of variance in incidence of schizophrenia across wards could be attributed to neighbourhood-level risk factors [95% confidence interval (CI) 9·9–42·2]. Thus, 1% increases in voter turnout [incidence rate ratio (IRR) 0·95, 95% CI 0·92–0·99] and ethnic segregation (IRR 0·95, 95% CI 0·92–0·99) were both independently associated with a reduced incidence of 5%, independent of age, sex, ethnicity, deprivation and population density. This was similar for other non-affective psychoses. There was some evidence that ethnic minority individuals were at greater risk of schizophrenia in areas with smaller proportions of minority groups (p=0·07).ConclusionSERFs at individual and neighbourhood levels were implicated in the aetiology of psychosis, but we were unable to determine whether these associations were causal. Individual risk may be mediated by social capital, which could operate as a protective factor, perhaps moderating social stress in the onset of psychoses.
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LAVROV, PETR M., JORGE ANANIAS NETO, and WILSON OLIVEIRA. "A PROPOSAL FOR A GENERALIZED CANONICAL osp(1, 2) QUANTIZATION OF DYNAMICAL SYSTEMS WITH CONSTRAINTS." Modern Physics Letters A 14, no. 08n09 (March 21, 1999): 569–74. http://dx.doi.org/10.1142/s0217732399000626.
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The aim of this letter is to consider the possibility of constructing a generalized canonical quantization method for arbitrary dynamical systems with first-class constraints based on the osp (1, 2) supersymmetry principle. This proposal can be considered as a counterpart to the osp (1, 2)-covariant Lagrangian quantization method introduced recently by Geyer, Lavrov and Mülsch. The gauge dependence of Green's functions is studied. It is shown that if the parameter m2 of the osp (1, 2) superalgebra is not equal to zero, then the vacuum functional and S-matrix depend on the gauge. In the limit m→0 the gauge independence of vacuum functional and S-matrix are restored. The Ward identities related to the osp (1, 2) symmetry are derived.
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KONG, LINGCHEN, and NAIHUA XIU. "EXACT LOW-RANK MATRIX RECOVERY VIA NONCONVEX SCHATTEN p-MINIMIZATION." Asia-Pacific Journal of Operational Research 30, no. 03 (June 2013): 1340010. http://dx.doi.org/10.1142/s0217595913400101.
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The low-rank matrix recovery (LMR) arises in many fields such as signal and image processing, quantum state tomography, magnetic resonance imaging, system identification and control, and it is generally NP-hard. Recently, Majumdar and Ward [Majumdar, A and RK Ward (2011). An algorithm for sparse MRI reconstruction by Schatten p-norm minimization. Magnetic Resonance Imaging, 29, 408–417]. had successfully applied nonconvex Schatten p-minimization relaxation of LMR in magnetic resonance imaging. In this paper, our main aim is to establish RIP theoretical result for exact LMR via nonconvex Schatten p-minimization. Carefully speaking, letting [Formula: see text] be a linear transformation from ℝm×n into ℝs and r be the rank of recovered matrix X ∈ ℝm×n, and if [Formula: see text] satisfies the RIP condition [Formula: see text] for a given positive integer k ∈ {1, 2, …, m – r}, then r-rank matrix can be exactly recovered. In particular, we obtain a uniform bound on restricted isometry constant [Formula: see text] for any p ∈ (0, 1] for LMR via Schatten p-minimization.
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McCann, C., A. Hall, J. Min Leow, A. Harris, N. Hafiz, K. Myers, A. Amin, and A. MacLullich. "113 Improving Intravenous Fluid Therapy to Reduce the Incidence of Acute Kidney Injury in Elderly Hip Fracture Patients." Age and Ageing 50, Supplement_1 (March 2021): i12—i42. http://dx.doi.org/10.1093/ageing/afab030.74.
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Abstract Background Acute kidney injury (AKI) in hip fracture patients is associated with morbidity, mortality, and increased length of stay. To avoid this our unit policy recommends maintenance crystalloid IV fluids of >62.5 mL/Hr for hip fracture patients. However, audits have shown that many patients still receive inadequate IV fluids. Methods Three prospective audits, each including 100 consecutive acute hip fracture patients aged >55, were completed with interventional measures employed between each cycle. Data collection points included details of IV fluid administration and pre/post-operative presence of AKI. Interventions between cycles included a revised checklist for admissions with a structured ward round tool for post-take ward round and various educational measures for Emergency Department, nursing and admitting team staff with dissemination of infographic posters, respectively. Results Cycle 1: 64/100 (64%) patients received adequate fluids. No significant difference in developing AKI post operatively was seen in patients given adequate fluids (2/64, 3.1%) compared to inadequate fluids (4/36, 11.1%; p = 0.107). More patients with pre-operative AKI demonstrated resolution of AKI with appropriate fluid prescription (5/6, 83.3%, vs 0/4, 0%, p < 0.05) Cycle 2: Fewer patients were prescribed adequate fluids (54/100, 54%). There was no significant difference in terms of developing AKI post operatively between patients with adequate fluids (4/54, 7.4%) or inadequate fluids (2/46, 4.3%; p = 0.52). Resolution of pre-operative AKI was similar in patients with adequate or inadequate fluid administration (4/6, 67% vs 2/2, 100%). Cycle 3: More patients received adequate fluids (79/100, 79%, p < 0.05). Patients prescribed adequate fluids were less likely to develop post-operative AKI than those receiving inadequate fluids (2/79, 2.5% vs 3/21, 14.3%; p < 0.05). Discussion This audit demonstrates the importance of administering appropriate IV fluid in hip fracture patients to avoid AKI. Improving coordination with Emergency Department and ward nursing/medical ward staff was a critical step in improving our unit’s adherence to policy.
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Sachs, Nimrod, Eran Rom, Tommy Schonfeld, Rachel Gavish, Itay Berger, and Irit Krause. "Short-Term High-Flow Nasal Cannula for Moderate to Severe Bronchiolitis Is Effective in a General Pediatric Ward." Clinical Pediatrics 58, no. 14 (September 26, 2019): 1522–27. http://dx.doi.org/10.1177/0009922819877881.
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We examined the clinical and physiological benefits of heated humidified high-flow nasal cannula (HHHFNC) in treating pediatric bronchiolitis in a general pediatric ward. Children aged 0 to 2 years, hospitalized with moderate to severe bronchiolitis, were connected to HHHFNC. Each child was evaluated at 4- to 10-hour intervals, both on and off the device, using the Wang et al Bronchiolitis Severity score and transcutaneous CO2 monitor. Sixteen children were included in the final analysis. The Bronchiolitis Severity score improved by 3 points during the first and second intervals ( P = .001). Transcutaneous CO2 values were reduced by an average 8.7 mm Hg ( P = .001). No adverse effects were noted in children connected to the device. The HHHFNC device used in a general pediatric ward setting served as a safe and efficacious tool in treating moderate to severe bronchiolitis. Immediate clinical and physiological improvement was observed and maintained 1 to 4 hours after disconnection from the device.
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Stevenson, Gary, Sharon Munro, Connor McIntyre, and Stephen Foster. "464 - SURVEY OF THE ADEQUACY OF HOSPITAL DISCHARGE LETTERS FROM OLDER ADULT MENTAL HEALTH (OAMH) WARDS IN A SCOTTISH HEALTH REGION." International Psychogeriatrics 32, S1 (October 2020): 186. http://dx.doi.org/10.1017/s1041610220003166.
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Background:One form of communication deficiency leading to patient harm is failure to keep colleagues informed and to share appropriate levels of clinical information. The production of discharge letters is a clinical and professional requirement, deficiencies of which contribute to clinical risks, while failure to observe standards may be a focus of medico-legal enquiry.Objectives:To examine the adequacy of clinical discharge letters from the OAMH inpatient wards in one Scottish Health region (Fife, population 370,000) against the 14-day discharge policy, with focus on medication advice and follow-up arrangements.Methods:All discharge notifications from the five OAMH wards were examined retrospectively against the electronic records and case-files for the 7-month period ending 31st January 2020.Results:169 discharge notifications inclusive of 14 deaths were reduced to 123 after excluding brief inter-ward transfers. Female:male ratio of 1.05:1; average age 77 (range 60 -99) years, average inpatient duration 120 (range 2-934) days. There was no identified discharge letter in 20.3%. Direct admissions from Care Homes died more often (30%) than those admitted directly from home (2%), presumably a reflection of greater frailty. 29% patients were discharged to (19% admitted from) Care Homes. 59% patients had dementia, 20% an affective disorder, 7% a psychotic disorder, with 20% having multiple diagnoses. Antidepressants were the commonest (49%) regularly prescribed psychotropic medication on discharge both for those with (47%) or without (52%) dementia. 32% of all patients (25% in dementia) were discharged on antipsychotics, often without advice on monitoring, prescribing restrictions or risks. The 98 verified letters took 27 (range 0-168) days to verify, 67% failing the production-time standard. 53% discharges had multiple follow-up arrangements. Variabilities were noted in letter production according to the discharge ward (range 53-100%) and between consultant teams (verification rates 50-100%) where delays ranged 6-109 days and ability to produce letters within the standard ranged from 0-92% (average 33%).Conclusions:There appear significant failings in the timely transfer of clinical details between OAMH inpatient services and primary care services in this region that require intervention to minimise clinical risk and maximise patient safety. There were identified factors that are amenable to quality improvement.
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Sturza, Felicia, Ștefan-Decebal Guță, and Gabriel-Adrian Popescu. "Antibiotics Used for COVID-19 In-Patients from an Infectious Disease Ward." Antibiotics 12, no. 1 (January 11, 2023): 150. http://dx.doi.org/10.3390/antibiotics12010150.
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Background: although the prevalence of bacterial co-infections for COVID-19 patients is very low, most patients receive empirical antimicrobial therapy. Furthermore, broad spectrum antibiotics are preferred to narrow spectrum antibiotics. Methods: in order to estimate the excess of antibiotic prescriptions for patients with COVID-19, and to identify the factors that were correlated with the unjustified antibiotic usage, we conducted an observational (cohort) prospective study in patients hospitalized with COVID-19 at the National Institute for Infectious Diseases “Prof. Dr. Matei Bals”, Bucharest, on an infectious disease ward, from November 2021 to January 2022. To evaluate the prevalence of bacterial co-infection in these patients, all positive microbiology results and concomitant suspected or confirmed bacterial co-infections, as documented by the treating doctor, were recorded. The patients were grouped in two categories: patients who received antibiotics and those who did not receive antibiotics, justified or not. Results: from the 205 patients enrolled in the study, 83 (40.4%) received antibiotics prior to being admitted to the hospital. 84 patients (41.0%) received antibiotics during their hospitalization; however, only 32 patients (15.6%) had signs and symptoms suggestive of an infection, 19 (9.3%) presented pulmonary consolidation on the computed tomography (CT) scan, 20 (9.7%) patients had leukocytosis, 29 (14.1%) had an increased procalcitonin level and only 22 (10.7%) patients had positive microbiological tests. It was observed that patients treated with antibiotics were older [70 (54–76) vs. 65 (52.5–71.5), p = 0.023, r = 0.159], had a higher Charlson index [4 (2–5) vs. 2 (1–4), p = 0.007, r = 0.189], had a severe/critical COVID-19 disease more frequently [61 (72.6%) vs. 38 (31.4%), p < 0.001, df = 3, X2 = 39.563] and required more oxygen [3 (0–6) vs. 0 (0–2), p < 0.001, r = 0.328]. Conclusion: empirical antibiotic treatment recommendation should be reserved for COVID-19 patients that also had other clinical or paraclinical changes, which suggest a bacterial infection. Further research is needed to better identify patients with bacterial co-infection that should receive antibiotic treatment.
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Bryan, Robert. "Patterson peaks. By Donald L. Ward. Pp. x + 727. Dayton: Polycrystal Book Service, 1999. Price US $59.95. ISBN 0-9601304-1." Acta Crystallographica Section B Structural Science 55, no. 6 (December 1, 1999): 1110. http://dx.doi.org/10.1107/s0108768199012811.
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Conway, John S. "The Protestant Evangelical Awakening. By W. R. Ward. Cambridge: Cambridge University Press. 1992. Pp. 360. $59.95. ISBN 0-521-41491-1." Central European History 25, no. 4 (December 1992): 461–62. http://dx.doi.org/10.1017/s0008938900021506.
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FEENSTRA, S. G., Q. NAHAR, D. PAHAN, L. OSKAM, and J. H. RICHARDUS. "Social contact patterns and leprosy disease: a case-control study in Bangladesh." Epidemiology and Infection 141, no. 3 (May 14, 2012): 573–81. http://dx.doi.org/10.1017/s0950268812000969.
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SUMMARYSocioeconomic and culturally defined social contact patterns are expected to be an important determinant in the continuing transmission of Mycobacterium leprae in leprosy-endemic areas. In a case-control study in two districts in Bangladesh, we assessed the association between social contact patterns and the risk of acquiring clinical leprosy. Social contacts of 90 recently diagnosed patients were compared to those of 199 controls. Leprosy was associated with a more intensive social contact pattern in the home [odds ratio (OR) 1·09, 95% confidence interval (CI) 1·00–1·19, P = 0·043] and in the nearby neighbourhood (OR 1·07, 95% CI 1·03–1·11, P = 0·001). Although it is known that M. leprae spreads most easily within households of infected persons, in endemic areas social contacts within the neighbourhood, village or urban ward, also appear to be important for transmission. We advise that disease control measures in leprosy-endemic areas should not be limited to households, but include high-risk groups in the nearby neighbourhood of patients.
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Castells, Maria Alicia, and Letícia Maria Furlanetto. "Validity of the CAGE questionnaire for screening alcohol-dependent inpatients on hospital wards." Revista Brasileira de Psiquiatria 27, no. 1 (March 2005): 54–57. http://dx.doi.org/10.1590/s1516-44462005000100012.
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OBJECTIVE: To verify the validity of the CAGE questionnaire in screening inpatients with alcohol dependence. METHODS: In a transversal study, 747 medical inpatients hospitalized on general medical wards in the Federal University of Santa Catarina University Hospital were evaluated. Sociodemographic and clinical data were collected and the following instruments were used: the CAGE questionnaire and the Mini International Neuropsychiatry Interview (MINI), the latter being a semi-structured interview used as the gold standard for diagnosing alcohol dependence (according to DSM-IV criteria). Validity indices (sensitivity and specificity) were assessed for the different possible CAGE cut-off points. The ROC curve was used to determine the best cut-off point. RESULTS: The sample was composed of 747 patients. Most were men (66%), white (85%) and married (61%). Mean age was 50 ± 17 years, and mean level of education was 6 ± 4 years. According to the MINI, 48 patients (6.6%) were diagnosed as having alcohol dependence. The CAGE questionnaire presented its highest sensitivity (93.8%) when the cut-off point of 0/1 (one or more "positive" responses indicating a positive test) was used. The specificity for this cut-off point was 85.5%. CONCLUSION: Using the 0/1 cut-off point, the CAGE questionnaire presented good sensitivity (93.8%) and specificity (85.5%) for use in general hospital ward patients. Since it is an easily applied, rapidly executed and inexpensive instrument, it could be useful in screening such patients for alcohol dependence.
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Wykes, Til, Emese Csipke, Diana Rose, Thomas Craig, Paul McCrone, Paul Williams, Leonardo Koeser, and Stephen Nash. "Patient involvement in improving the evidence base on mental health inpatient care: the PERCEIVE programme." Programme Grants for Applied Research 6, no. 7 (December 2018): 1–182. http://dx.doi.org/10.3310/pgfar06070.
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BackgroundDespite the movement towards care in the community, 40% of the NHS budget on mental health care is still attributed to inpatient services. However, long before the Francis Report highlighted grave shortcomings in inpatient care, there were reports by service user groups on the poor quality of these services in mental health. The programme provides a particular focus on the inclusion of the patient’s perspective in the development and evaluation of evidence.ObjectivesTo understand how changes to inpatient care affect the perceptions of the ward by service users and staff by using stakeholder participatory methods.DesignThe programme consisted of four work packages (WPs). (1) Lasting Improvements for Acute Inpatient SEttings (LIAISE): using participatory methods we developed two new scales [Views On Therapeutic Environment (VOTE) for staff and Views On Inpatient CarE (VOICE) for service users]. (2) Client Services Receipt Inventory – Inpatient (CITRINE): working with nurses and service users we developed a health economic measure of the amount of contact service users have with staff. The self-report measure records interactions with staff as well as the number of therapeutic activities attended. (3) Delivering Opportunities for Recovery (DOORWAYS): a stepped-wedge randomised controlled trial to test if training ward nurses to deliver therapeutic group activities would improve the perception of the ward by service users and staff. A total of 16 wards were progressively randomised and we compared the VOICE, VOTE and CITRINE measures before and after the intervention. A total of 1108 service users and 539 staff participated in this trial. (4) Bringing Emergency TreatmenT to Early Resolution (BETTER PATHWAYS) was an observational study comparing two service systems. The first was a ‘triage’ system in which service users were admitted to the triage ward and then either transferred to their locality wards or discharged back into the community within 7 days. The second system was routine care. We collected data from 454 service users and 284 nurses on their perceptions of the wards.Main outcome measuresThe main outcomes for the DOORWAYS and BETTER project were service user and staff perceptions of the ward (VOICE and VOTE, respectively) and the health economic measure was CITRINE. All were developed in WPs 1 and 2.ResultsWe developed reliable and valid measures of (1) the perceptions of inpatient care from the perspectives of service users and nurses (VOICE and VOTE) and (2) costs of interactions that were valued by service users (CITRINE). In the DOORWAYS project, after adjusting for legal status, we found weak evidence for benefit (standardised effect of –0.18, 95% CI 0.38 improvement to 0.01 deterioration;p = 0.062). There was only a significant benefit for involuntary patients following the staff training (N582, standardised effect of –0.35, 95% CI –0.57 to –0.12;p = 0.002; interactionp-value 0.006). VOTE scores did not change over time (standardised effect size of 0.04, 95% CI –0.09 to 0.18;p = 0.54). We found no evidence of an improvement in cost-effectiveness (estimated effect of £33, 95% CI –£91 to £146;p = 0.602), but resource allocation did change towards patient-perceived meaningful contacts by an average of £12 (95% CI –£76 to £98;p = 0·774). There were no significant differences between the triage and routine models of admission in terms of better perceptions by service users (estimated effect 0.77-point improvement in VOICE score on the triage ward;p = 0.68) or nurses (estimated effect of 1.68-point deterioration in VOTE on the triage ward;p = 0.38) or in terms of the cost of the length of care provided (£391 higher on triage;p = 0.77).Strengths and limitationsWe have developed measures using methods involving both service users and staff from mental health services. The measures were developed specifically for acute inpatient services and, therefore, cannot be assumed to be useful for other services. For instance, extensions of the measures are under construction for use in mother and baby units. The strength of the BETTER PATHWAYS and DOORWAYS projects is the large-scale data collection. However, we were testing specific services based in inner city areas and stretching to inner urban areas. It may be that different effects would be found in more rural communities or in different types of inpatient care.Future workOur database will be used to develop an understanding of the mediating and moderating factors for improving care quality.Trial registrationCurrent Controlled Trials ISRCTN06545047.FundingThis project was funded by the NIHR Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 6, No. 7. See the NIHR Journals Library website for further project information.
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Smithard, David, Dharinee Hansjee, Darrien Henry, Laura Mitchell, Arjun Sabaharwal, Jo Salkeld, Eirene Yeung, Osman Younus, and Ian Swaine. "Inter-Relationships between Frailty, Sarcopenia, Undernutrition and Dysphagia in Older People Who Are Admitted to Acute Frailty and Medical Wards: Is There an Older Adult Quartet?" Geriatrics 5, no. 3 (June 30, 2020): 41. http://dx.doi.org/10.3390/geriatrics5030041.
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Introduction: With increasing age the prevalence of frailty, sarcopenia, undernutrition and dysphagia increases. These are all independent markers of outcome. This study explores the prevalence of these four and explores relationships between them. Methods: A convenience sample of 122 patients admitted to acute medical and frailty wards were recruited. Each was assessed using appropriate screening tools; Clinical Frailty Score (CFS) for frailty, SARC-F for sarcopenia, Nutritional Risk Tool (NRT) for nutritional status and 4QT for dysphagia. Results: The mean age of the participants was 80.53 years (65–99 years), and 50.37% (68) were female. Overall, 111 of the 122 (91.0%) reported the presence of at least one of the quartet. The median CFS was 5 (1–9), with 84 patients (68.9%) having a score of ≥5 (moderate or severely frail); The median SARC-F was 5 (0–10), with 64 patients (52.5%) having a score of ≥5; The median NRT was 0 (0–8) and 33 patients (27.0%) scored ≥ 1. A total of 77 patients (63.1%) reported no difficulty with swallowing/dysphagia (4QT ≥ 1) and 29 (23.7%) had only one factor. Sixteen patients (13.1%) had all four. There was a significant correlation between nutritional status and dysphagia, but not with frailty or sarcopenia. There were significant correlations between frailty and both sarcopenia and dysphagia. Conclusions: In our sample of acute medical and frailty ward patients, there was a much higher prevalence than expected (91%) of either: frailty, sarcopenia, undernutrition or dysphagia. The prevalence of all four was present in 13% of patients. We suggest that frailty, sarcopenia, nutritional risk and dysphagia comprise an “Older Adult Quartet”. Further study is required to investigate the effect of the “Older Adult Quartet” on morbidity and mortality.
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Skevington Wood, A. "The Protestant Evangelical Awakening by W. R Ward (Cambridge: Cambridge University Press, 1992, xviii, 370 pp, £40. ISBN 0-521-41491-1)." Evangelical Quarterly: An International Review of Bible and Theology 66, no. 1 (October 6, 1994): 95–96. http://dx.doi.org/10.1163/27725472-06601021.
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Killeen, E., R. Doherty, M. Higgins, A. O'Reilly, and L. Brewer. "254 OPTIMISING COMMUNICATION WITH FAMILIES OF PATIENTS ON ACUTE STROKE AND GERIATRIC MEDICINE WARDS IN A LARGE TERTIARY HOSPITAL." Age and Ageing 50, Supplement_3 (November 2021): ii9—ii41. http://dx.doi.org/10.1093/ageing/afab219.254.
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Abstract Background Good communication with patients and families is important for older adults admitted to acute stroke or geriatric medicine wards, particularly with COVID19-related restricted visiting. These patients often have communication difficulties including aphasia, delirium, cognitive or hearing impairment, limiting their own communication with relatives. Using the Plan, Do, Study, Act (PDSA) approach we undertook a quality improvement project to optimise communication with families of patients on above wards in a large tertiary hospital. Methods PDSA cycle 1: Staff were surveyed to identify satisfaction level with communication and ways to optimise communication. Inpatients on study wards were identified, we recorded demographic and clinical details and prevalence of communication difficulties. We created a designated folder with individual ‘communication sheets’ in conjunction with ward doctors and the nurse manager. PDSA cycle 2: We performed a rapid interval audit of the communication folder use. ‘Outlier’ patients were excluded as their teams did not receive education about folder use. Results PDSA cycle 1: A total of 90 inpatients on three wards were included, mean age 78y (SD ±14.4y), 47% were male. Three-quarters (73%) had a communication difficulty noted, reported by nursing staff. Two patients were intubated and six had stroke-related aphasia. Half of surveyed staff reported communication with families was suboptimal. Most (86%) suggested a centrally-located communication logbook would be helpful. PDSA cycle 2: Over two weeks, communication sheets were reviewed for all included patients. Median frequency of calls to families was 4 days (range 0–14). Most (79%) had the name of the primary contact clearly documented. Many (52%) included no contact number. Only 9% had secondary contact information documented. Conclusion Communication with families of patients on acute stroke and geriatric medicine wards was suboptimal. Over a short interval this improved with regular phone calls using specific centrally-located communication folders. Further optimisation of their use is needed.
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Sari, Utari Mayang, A. Muri Yusuf, and Alwen Bentri. "Truancy and Implications in Guidance and Counseling." Konselor 5, no. 3 (September 30, 2016): 151. http://dx.doi.org/10.24036/02016536551-0-00.
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Truancy is an act of stay away from school without permission. . This study was conducted in SMPN 1 Nan Sabaris to ward students’ truant behavior. The purpose of this study describes the concept of the school, and the behavior which were shown, the causal factor truant behavior and the effort of guidance and counseling teacher in helping students who have truant behavior. This research was conducted under qualitative in term of case studies research. The purposive and snowball sampling techniques were used to take the sample. Thus the data were obtained from student, parents, friends of the sample student and subject teachers and guidance and counseling teacher. Interview, observation and document analysis were used to collect the data were analyzed through data reduction, presentation and conclusion or verification.
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EI-Shabshiry, M., SY EI Bakry, AH Moussa, and MA Abdel-Raouf. "Positron?Lithium Inelastic Scattering with Polarisation Potentials." Australian Journal of Physics 44, no. 6 (1991): 677. http://dx.doi.org/10.1071/ph910677.
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Positron-lithium inelastic scattering is studied at positron energies ranging from 0�005 to 20 eV using the coupled static model. Two channels are open namely the elastic and positronium formation. The polarisation potentials of the Li atom in the first channel and that of the positronium atom in the second channel are taken into consideration in calculating the corresponding cross sections. The partial cross sections in each channel are calculated for eight values of the total angular momentum (0 ~.e ~ 7). In the elastic channel the total cross section Ull has its maximum value at the lowest energy, and decreases with an increase in positron energy Ki. The total positronium formation cross section has a small dip at 0�1 eV, and maximum value at Ki = 1 �4 eV, and then decreases smoothly with e+ energy. We compare our results with those of Ward et al. (1989) where positronium formation is ignored. The agreement in elastic cross sections improves with e+ energy, while the total collisional cross sections have the closest agreement at 1�0 eV. From this comparison, we find that positronium formation is important in the very low energy region, and the role of the excitation cross section increases steadily with e+ energy.
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Razif, T., Yahya G. Lubis, T. Murad El-Fuad, Syahril Pasaribu, and Chairuddin P. Lubis. "The Spectrum of seven preventable Diseases at the Pediatric ward of Dr. Pirngadi Hospital Medan." Paediatrica Indonesiana 33, no. 3-4 (December 12, 2018): 46–51. http://dx.doi.org/10.14238/pi33.3-4.1993.46-51.
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A retrospective study on seven preventab!e diseasee was done in 1989. We found 137 (7.1%) cases of all admissions; they were distribued into 12 neonatal tetanus (8.8%), 57 tetanus (4 1.6%), 17 measles (72.1%), 15 diphtheria (10.9%), 35 pulmonary tuberculosis (25.6%), and 7 poliomyelitis (0. 7%). There was no admittance of pertussis; 62% of those cases consisted of under five-year-old children.
None of those patients had had measles immunization, and their mothers had not had tetanus toxoid immunization when they were pregnant.
The mortality were as follows: neonatal tetanus 4 (33.3%), tetanus 3 (5.3%), measles 1 (5.9%), pulmonary tuberculosis 9 (25.7%) and diphtheria 7 (46.7%).