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Elemi Agbor, Iwasam, Inyang Udeme Asibong, Ugochi Ogu Eyong, and Ernest Ikechukwu Ezeh. "Disparities in Vaccination Coverage and Timeliness among Children Aged 12 to 23 Months within Calabar South, Cross River State, Nigeria." Texila International Journal of Public Health 12, no. 1 (March 29, 2024): 1–10. http://dx.doi.org/10.21522/tijph.2013.12.01.art037.
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Immunization serves as a cost-effective shield against vaccine-preventable diseases, promoting population health and sustainable prosperity. This study aimed to determine vaccination coverage and assess the timeliness of vaccination (BCG, PENTA1, and measles vaccines) among children aged 12 to 23 months in the wards of Calabar South Local Government Area (LGA) in Cross River State. A community-based cross-sectional descriptive design was employed, with the number of children sampled being 460 to account for non-response and design. Information about children were obtained through interviews with proxy caregivers. Data analysis was performed using SPSS version 25.0. Ethical approval was obtained from the CRS Ministry of Health. There were 190 male children (41.3%) and 275 female children (58.7%) in the study. The age group of 12-15 months (55.2%) represents the largest category. The overall vaccination coverage was 88.3%, varying across wards (100% in ward 4, followed by 96.1% in ward 8, then 96% in ward 5, 91.6% in ward 12, and 80.8% in ward 11). The proportion of overall timely vaccination was 71.5%, with PENTA1 having the highest timeliness (88.3%). The proportions of timely vaccination for BCG and PENTA1 were highest in ward 4, followed by ward 5, but lowest in ward 11. Timeliness for all vaccines was also highest in ward 4, followed by ward 12, then ward 5, ward 8 and ward 11. Vaccination coverage and timeliness differed between locations, highlighting the need for Government interventions to be context-specific, addressing challenges within different ward locations rather than applying a one-size-fits-all approach.
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Das, Bishnu Dev, Ranjan Kumar Mishra, and Sunil Kumar Choudhary. "GROUNDWATER QUALITY IN BIRATNAGR OF MORANG DISTRICT, NEPAL." International Journal of Research -GRANTHAALAYAH 9, no. 5 (June 15, 2021): 368–77. http://dx.doi.org/10.29121/granthaalayah.v9.i5.2021.3961.
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A study was conducted to assess the groundwater quality in Biratnagar of Morang district of Nepal on the basis of some important physicochemical and microbiological analysis. During the study, the elevated value of turbidity ranged from 2.1±2.80 NTU (ward no. 8) to 81.46±44.28 NTU (ward no. 10), free-carbondioxide (FCO2) ranged from 12±2.45 mg /L (ward no. 21) to 17.2±3.03 mg/L (ward no. 8), arsenic ranged from nil (ward no. 3) to 0.17±0.21 mg /L (ward no. 1), iron (Fe) ranged from 0.45 mg/L (ward no. 7) to 3.67 mg/L (ward no. 4), manganese (Mn), ranged from 0.45 mg/L (ward no. 7) to 5.99 mg/L (ward no. 16) and fecal coliform bacteria were found positive in 10 wards (ward nos. 2, 3, 4, 9, 10, 11,14,15,20 and 21) constituting 45.45% of the total samples ranging from 3 to 25 MPN/100 ml . Out of the total analyzed samples, turbidity in 78 samples (70.90%), FCO2, Fe, and Mn in all samples (100%) and arsenic in 37 water samples (33.64 %) were crossed the permissible limit of WHO guideline. However, the value of pH, EC, DO, TH, PO4-P, NO3-N, Cd, Zn, and Pb were below the WHO guideline value. The status of fluoride was below detectable level in all the analyzed groundwater samples.
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McLaren, Emma, and Charles Maxwell-Armstrong. "Noise Pollution on an Acute Surgical Ward." Annals of The Royal College of Surgeons of England 90, no. 2 (March 2008): 136–39. http://dx.doi.org/10.1308/003588408x261582.
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INTRODUCTION This study was undertaken to measure and analyse noise levels over a 24-h period on five general surgical wards. PATIENTS AND METHODS Noise levels were measured on three wards with four bays of six beds each (wards A, B and C), one ward of side-rooms only (ward D) and a surgical high dependency unit (ward E) of eight beds. Noise levels were measured for 15 min at 4-hourly intervals over a period of 24 h midweek. The maximum sound pressure level, baseline sound pressure level and the equivalent continuous level (LEq) were recorded. Peak levels and LEq were compared with World Health Organization (WHO) guidelines for community noise. Control measurements were taken elsewhere in the hospital and at a variety of public places for comparison. RESULTS The highest peak noise level recorded was 95.6 dB on ward E, a level comparable to a heavy truck. This exceeded all control peak readings except that recorded at the bus stop. Peak readings frequently exceeded 80 dB during the day on all wards. Each ward had at least one measurement which exceeded the peak sound level of 82.5 dB recorded in the supermarket. The highest peak measurements on wards A, B, C and E also exceeded peak readings at the hospital main entrance (83.4 dB) and coffee shop (83.4 dB). Ward E had the highest mean peak reading during the day and at night – 83.45 dB and 81.0 dB, respectively. Ward D, the ward of side-rooms, had the lowest day-time mean LEq (55.9 dB). Analysis of the LEq results showed that readings on ward E were significantly higher than readings on wards A, B and C as a group (P = 0.001). LEq readings on ward E were also significantly higher than readings on ward D (P < 0.001). Day and night levels differ significantly, but least so on the high dependency unit. CONCLUSIONS The WHO guidelines state that noise levels on wards should not exceed 30 dB LEq (day and night) and that peak noise levels at night should not exceed 40 dB. Our results exceed these guidelines at all times. It is likely that these findings will translate to other hospitals. Urgent measures are needed to rectify this.
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Hossain, M., TJ Crook, and SR Keoghane. "Clostridium Difficile in Urology." Annals of The Royal College of Surgeons of England 90, no. 1 (January 2008): 36–39. http://dx.doi.org/10.1308/003588408x242358.
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INTRODUCTION The objective was to determine the incidence of Clostridium difficile infection in a UK urology ward from 2000 to 2005, and correlate and compare the data with other specialty wards and national figures. PATIENTS AND METHODS Urology patients with a positive stool culture for C. difficile between 2000 and 2005 were identified from a hospital database. The medical records of these patients were reviewed and data such as antibiotic use, urological diagnosis and elective/emergency status of the patient were recorded and analysed. The number of C. difficile cases on an elderly care ward, an acute medical ward and an acute surgical ward were also recorded for this period. Data on the number of admissions and occupied bed-days on all 4 wards were compared. RESULTS There were 33 cases of C. difficile on the urology ward between 2000 and 2005. The incidence of this infection varied between 10.2 and 48.4 cases per 10,000 patient episodes (mean 21.0). There was a significant difference between the number of C. difficile cases per 1000 patient days between the urology ward and the acute medical ward (P = 0.002) and the elderly care ward (P = 0.03). CONCLUSIONS There is no evidence to suggest that there has been an increase in the incidence of C. difficile in a UK urology ward. The rates on the urology ward were lower than the national average, and significantly lower than those rates on an acute medical ward and an elderly care ward. There is a 0.21% chance of a patient testing positive for C. difficile during their stay on a urology ward.
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Hyland, Declan, and Mohammed Uddin. "An analysis of the views of different 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—S141. http://dx.doi.org/10.1192/bjo.2021.399.
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AimsPhysician Associates (PAs) are healthcare professionals who have 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 analysis aimed to establish the views of different members of the team across the three general adult wards and the Psychiatric Care Unit (PICU) at Clock View Hospital on the role of the PA.MethodA sample of members of staff was identified from across the three general adult inpatient wards at and the PICU, comprising: senior doctors (Consultants and Specialty Doctor), junior trainees (Core Trainee and Foundation Trainees), Ward Manager, Deputy Ward Manager, Band 5 nurse and Assistant Practitioner. Each member of staff was asked to answer the question “On a scale of 1 to 10 (with “1” being completely unhappy, “10” being completely happy), how happy are you to have a PA working on your ward?” Each staff member was then asked to provide comments on their views on the role of the PA.ResultTwenty-three members of staff participated – 3 x senior doctors, 4 x junior trainees, 4 Ward Managers, 4 Deputy Ward Managers, 4 x Band 5 nurses and 4 x Assistant Practitioners. The respondents were distributed equally across the three general adult wards and the PICU. All 23 members of staff provided a score of 10 out 10 to the question about how happy they were to have a PA working on the ward. Many of the staff members provided some very positive comments on their respective views about the role of the PA at Clock View Hospital. No negative comments were provided by any members of staff.ConclusionIt is clear from the large sample of members of staff of different grade at Clock View Hospital that were surveyed that the PA has been a warmly received and welcome addition to the inpatient team and that the PA is viewed as having become an important and valued member of the inpatient team. This provides a strong argument for both Mersey Care NHS Foundation Trust, and other mental health trusts across the U.K., to consider employing more PAs to work in their inpatient units.
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Mohamad, Mas Linda, Li Yang, Xu Jin, Priscilla Tan Lee Eng, and Terence Kee Yi Shern. "Knowledge of immunosuppressive drugs used in kidney transplants." British Journal of Nursing 21, no. 13 (July 12, 2012): 795–800. http://dx.doi.org/10.12968/bjon.2012.21.13.795.
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Aim: A key role of renal nurses is the correct and safe administration of immunosuppressive drug therapy (ImmRx) to kidney transplant recipients. The authors sought to examine the knowledge and competency of ImmRx in kidney transplant patients and whether an annual kidney transplant nurse education programme had any beneficial effects. Methods: The study population was comprised of 63.2% (n=50/79) of all nurses from renal wards (ward A (n=17/35), ward B (n=21/32)) and 12 nurses from a high-dependency urology ward (ward C (n=12)). Kidney transplant patients usually receive inpatient care in wards A, B or C only as these wards specialise in urology and renal care. Each nurse completed a 35-question test that covered ImmRx in areas of indication, identification, interaction, pharmcokinetics/pharmacodynamics, therapeutic drug monitoring, administration and adverse effects. A minimum score of 70% was required to pass the test. Results: Only 46% of participants passed the test. The proportion of nurses who passed was not significantly different with respect to years of nursing experience, professional rank, postgraduate nursing qualifications or ward location. Unexpectedly, a greater proportion of nurses who did not attend the education programme passed the test (63.6%; n=14/22) than those who did attend it (32.1%; n=9/28]; p=0.03). Notably, 24% (n=12/50), 4% (n=2/50) and 4% (n=2/50) were unable to correctly answer any of the identification, interaction and therapeutic drug monitoring questions. Conclusion: These findings suggest that the nurses' understanding and knowledge of ImmRx is insufficient and they need to update their knowledge on ImmRx continually.
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Bracegirdle, B. "Lister ward." Endeavour 11, no. 3 (January 1987): 164. http://dx.doi.org/10.1016/0160-9327(87)90227-4.
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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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Zhou, Xuan, HuiXiao Fu, Guiqin Du, Xiaoyu Wei, BingBing Zhang, and Tao Zhao. "SARS-CoV-2 RNA detection on environmental surfaces in COVID-19 wards." PLOS ONE 18, no. 5 (May 25, 2023): e0286121. http://dx.doi.org/10.1371/journal.pone.0286121.
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This study monitored the presence of SARS-Cov-2 RNA on environmental surfaces in hospital wards housing patients with mild, severe, and convalescent Coronavirus Disease 2019 (COVID-19), respectively. From 29 October to 4 December 2021, a total of 787 surface samples were randomly collected from a General Ward, Intensive Care Unit, and Convalescent Ward at a designated hospital for COVID-19 patients in China. All of the samples were used for SARS-Cov-2 detection. Descriptive statistics were generated and differences in the positivity rates between the wards were analyzed using Fisher’s exact tests, Yates chi-squared tests, and Pearson’s chi-squared tests. During the study period, 787 surface samples were collected, among which, 46 were positive for SARS-Cov-2 RNA (5.8%). The positivity rate of the contaminated area in the Intensive Care Unit was higher than that of the General Ward (23.5% vs. 10.4%, P<0.05). The positivity rate of the semi-contaminated area in the Intensive Care Unit (4.5%) was higher than that of the General Ward (1.5%), but this difference was not statistically significant (P>0.05). In the clean area, only one sample was positive in the Intensive Care Unit (0.5%). None of the samples were positive in the Convalescent Ward. These findings reveal that the SARS-Cov-2 RNA environmental pollution in the Intensive Care Unit was more serious than that in the General Ward, while the pollution in the Convalescent Ward was the lowest. Strict disinfection measures, personal protection, and hand hygiene are necessary to limit the spread of SARS-Cov-2.
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McKnight, Rebecca, Neeti Singh, Imran Ali, and Robyn Hooley. "Clear Records: Exploring Patient and Staff Experience of Ward Rounds to Inform and Improve Ward Round Communication and Documentation." BJPsych Open 9, S1 (July 2023): S101. http://dx.doi.org/10.1192/bjo.2023.299.
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Aims1.To improve ward round efficacy and efficiency.2.To make ward rounds more patient informed and create an updated ward round patient “preparation sheet”.3.To improve collaboration and communication between the multidisciplinary team (MDT).4.To review and modify ward round/Care Programme Approach (CPA) proformas.Methods1.Quality Improvement training was delivered to the MDT.2.An anonymous Likert scale survey was completed by the MDT (n=10), to gather views on ward round experience and documentation.3.Patients: 2 interactive, breakout sessions (n=4) were facilitated to: •Explore their experience of ward rounds through discussion and Likert scale questionnaires (n=4).•Review the existing patient preparation sheet and coproduce a revised version.4.MDT: 4 interactive, breakout sessions were facilitated with staff (n=10) to create a: •Process map of ward rounds.•Fish bone diagram of the challenges within ward rounds.•Reverse fish bone diagram, to consider solutions.•Revised ward round and nursing proformas.5.A driver diagram was developed to generate change ideas.6.A scoping exercise was completed, comparing ward round proformas within the rehab division, to consider areas of best practice.7.A Plan Do Study Act (PDSA) cycle was initiated.Results1.Patient discussion and questionnaire feedback re: ward round experience was positive. Patients felt “respected”, “supported,” “understood team roles” and “plans” within ward rounds.2.Patients mostly agreed with the current format of the patient preparation sheet, however wanted a visual prompt, for their recovery areas. A diagram, “My recovery wheel”, was designed, to include diet, hobbies, mood, exercise, substances etc.3.Staff felt “respected”, and “listened to” and “understood their roles” in the staff survey; MDT proformas and time keeping were highlighted as requiring improvement.4.The fishbone diagram identified challenges within: staffing, procedural factors, time, resources/equipment, training and education, communication, proformas and patient engagement.5.New, succinct, MDT ward round proformas were designed, with focus on rehab goals, in order to facilitate the patient journey and discharge pathway.6.A ward round prompt sheet for the chair was created.Conclusion1.Both MDT and patients feel largely positive re: ward round experience.2.The improved patient preparation sheet is more patient centred, after being co-produced with patients.3.The MDT highlighted multifactorial challenges pertaining to ward rounds running in an efficacious and efficient manner.4.The next cycle of the project will focus on testing the new forms and change ideas.
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Coyle, Christina M., and Brian P. Currie. "Improving the Rates of Inpatient Pneumococcal Vaccination: Impact of Standing Orders Versus Computerized Reminders to Physicians." Infection Control & Hospital Epidemiology 25, no. 11 (November 2004): 904–7. http://dx.doi.org/10.1086/502317.
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AbstractObjective:To determine the impact of interventions using standing orders and computerized reminders to physicians on inpatient pneumococcal vaccination rates relative to a control group.Design:Open trial of the following approaches, each on a different ward: (1) standing orders for vaccination of eligible consenting patients, (2) computerized reminders to physicians, and (3) usual practice.Setting And Patients:Four hundred twenty-four patients were admitted to three 30-bed inpatient medical wards during a 4-month period in 1999 at one hospital. Unvaccinated patients 65 years or older and competent to give oral consent were included.Intervention:A pharmacist activated a standing orders protocol for vaccination of all eligible consenting patients on one ward and computerized reminders to physicians on a second ward. A third ward served as a control group.Results:Forty-two patients met inclusion criteria and accepted vaccination in the standing orders arm versus 35 patients in the computerized reminder arm. Vaccination rates on the standing orders ward included 98% of those eligible and accepting vaccination, 73% of eligible patients, and 28% of all patients admitted. Rates on the computerized reminder ward were 23%, 15%, and 7%, respectively. All of the rates from the standing orders ward were significantly greater than those from the computerized reminder ward (P < .0001). Only 0.6% of all patients on the control arm were vaccinated.Conclusion:Although both interventions were effective in increasing inpatient pneumococcal vaccination rates relative to baseline practice, physician independent initiation of standing orders was clearly more effective.
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Poynton-Smith, E., E. Colwill, and O. Sahota. "79 Do Medical Students Understand the Ward Environment? A Survey of Penultimate Year Medical Students Exploring How Well Healthcare Of Older People Placements Prepare Them for Working on Hospital Wards." Age and Ageing 49, Supplement_1 (February 2020): i25—i26. http://dx.doi.org/10.1093/ageing/afz191.04.
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Abstract Medical students are expected to know how to function on hospital wards; i.e. where to find things, other Health Care Professionals’ (HCPs’) roles, and how to use certain items of equipment (GMC, 2018). This ward-based knowledge indicates that a student is ‘ward smart’.1 Whilst being ‘ward smart’ is key for many aspects of medicine, it is particularly important for students learning geriatric medicine: older patients (who make up around 42% of all inpatients)2 are more likely to have communication difficulties and to require assistance. However, formal teaching in this area seems to be somewhat neglected, with students being left to ‘pick up’ this knowledge as they go along.3,4 In our sample of 41 students in their penultimate year (most of whom were undertaking their Healthcare of Older People placement), 98% did not know how to turn on a hearing aid and only 24% knew what a Waterlow score was. Furthermore, 88% did not know how to read an oxygen flowmeter, and only 59% knew where the CPR lever on the bed was situated. This is a significant gap in knowledge: Students may not be as prepared to work in a ward environment as expected. Students felt that their understanding would be improved by teaching sessions, more time on wards, formal ward inductions, and shadowing other HCPs: only 41.5% had had a ward induction or introduction, and less than 20% had shadowed a nurse. We propose specific teaching/practical sessions for students during their Healthcare of Older People placement centred around patient communication and understanding the ward environment. References 1. Walker, Wallace, Mangera, & Gill, The Clinical Teacher, 2017, 14(5), 336–9. 2. NHS Digital, 2018. 3. Prince, Bozhuizen, Van der Vleuten, & Scherpbier, Medical Education 2005; 39(7):704–12. 4. Monrouxe, et al., BMJ Open 2017; 7(1):e013656.
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O' Donnell, Desmond, Anne O'Mahony, Alice O' Donoghue, Clare McMahon, Marie Doyle, Millie O' Gorman, Riona Mulcahy, George Pope, and John Cooke. "244 Point Prevalence of Frailty and Confusion Exceeds the Capacity of a Single Ward - Specialist Geriatric Wards to Lead Best Practice." Age and Ageing 48, Supplement_3 (September 2019): iii17—iii65. http://dx.doi.org/10.1093/ageing/afz103.148.
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Abstract Background Our Model 4 Hospital will open a Specialist Geriatric Ward in the coming months. This ward will focus on the provision of evidence-based care to confused and frail older adults. Careful selection of patients who would most benefit from this care will be vital to ensure success. We aim to determine the prevalence of frailty and confusion in our inpatient cohort to determine expected demand on this new service and to inform admission criteria. Methods All adult inpatients were screened for frailty (pre-admission status) using the Rockwood Clinical Frailty Scale (CFS). Point prevalence of confusion (combination of pre-existing dementia and incident delirium) was calculated by measuring 4AT scores on all adult inpatients (>16 years of age), with the exclusion of obstetric, paediatric, critical care and psychiatric wards. Eleven wards were visited by a team of six experienced geriatric practitioners during a one-week period in April 2019. Results In total, 257 patients were assessed. The median age was 74 years (16-99). The majority were male (54.9 %). 152 patients resided on a dedicated medical ward (59.1%). The point prevalence of pre-morbid frailty (CFS Score ≥ 5) was 39.9%. The point prevalence of confusion (4AT score ≥4) was 24.4%. Conclusion Our data show that frailty and delirium are highly prevalent in hospital inpatients. It is not feasible for this number of frail and confused patients to be cohorted in a single specialist area. It is therefore important that each hospital determine admission criteria to identify those at greatest need. Clearly, given the prevalence outlined here, there will be a large number of patients likely to benefit from but unable to access a Specialist Geriatric Ward. These wards therefore need to also serve as exemplars of best practice so that evidence-based care for this vulnerable cohort can be disseminated within an institution.
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Ng Wong, Y. Karen, Heba Alhmidi, Thriveen Sankar Chittoor Mana, Annette Jencson, Jennifer Cadnum, and Curtis Donskey. "1213. How Often Is Portable Equipment Cleaned in an Acute Care Setting?" Open Forum Infectious Diseases 6, Supplement_2 (October 2019): S436. http://dx.doi.org/10.1093/ofid/ofz360.1076.
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Abstract Background Portable medical equipment that is shared among patients may frequently become contaminated with healthcare-associated pathogens. Cleaning of these devices may be suboptimal. Here, we aim to determine how frequently mobile equipment is cleaned after being used in an acute care setting. Methods Frequency of use and cleaning practices were surveyed by observation. Thirty pieces of mobile equipment from 4 wards including workstations, EKGs, vital signs monitor, and doppler ultrasounds were disinfected with a sporicidal disinfectant. Samples were taken before and after cleaning for recovery of methicillin-resistant Staphylococcus aureus (MRSA), C. difficile spores, and Gram-negative bacilli. After disinfection, each piece of equipment was tagged with a colored tag to indicate the ward location and a fluorescent gel marker (FGM) was applied to study the frequency of cleaning of portable equipment. Mobile equipment was checked for colored tags and fluorescent gel removal five, 12, and 20 days after application. Results Mobile equipment was infrequently cleaned and moved readily from ward to ward. In 9 of 10 observations, mobile equipment was used and not cleaned after use. Point prevalence sampling showed that 27.5% of mobile equipment had one or more pathogens on them. At day 5, only 30% of equipment marked with FGM had been cleaned and after 20 days, 23% of marked mobile equipment remained uncleaned (figure). 4 pieces of mobile equipment traveled from their original ward to a different ward. Conclusion Our findings demonstrate that portable equipment is frequently used and infrequently cleaned. These items can become contaminated with clinically relevant pathogens. We also saw that portable equipment frequently traveled from ward to ward. There is potential for contaminated portable equipment to serve as a vector for dissemination of pathogens. There is a need for effective strategies to disinfect portable equipment between patients. Disclosures All authors: No reported disclosures.
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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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Young, John, Claire Hulme, Andrew Smith, John Buckell, Mary Godfrey, Claire Holditch, Jessica Grantham, et al. "Measuring and optimising the efficiency of community hospital inpatient care for older people: the MoCHA mixed-methods study." Health Services and Delivery Research 8, no. 1 (January 2020): 1–100. http://dx.doi.org/10.3310/hsdr08010.
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Background Community hospitals are small hospitals providing local inpatient and outpatient services. National surveys report that inpatient rehabilitation for older people is a core function but there are large differences in key performance measures. We have investigated these variations in community hospital ward performance. Objectives (1) To measure the relative performance of community hospital wards (studies 1 and 2); (2) to identify characteristics of community hospital wards that optimise performance (studies 1 and 3); (3) to develop a web-based interactive toolkit that supports operational changes to optimise ward performance (study 4); (4) to investigate the impact of community hospital wards on secondary care use (study 5); and (5) to investigate associations between short-term community (intermediate care) services and secondary care utilisation (study 5). Methods Study 1 – we used national data to conduct econometric estimations using stochastic frontier analysis in which a cost function was modelled using significant predictors of community hospital ward costs. Study 2 – a national postal survey was developed to collect data from a larger sample of community hospitals. Study 3 – three ethnographic case studies were performed to provide insight into less tangible aspects of community hospital ward care. Study 4 – a web-based interactive toolkit was developed by integrating the econometrics (study 1) and case study (study 3) findings. Study 5 – regression analyses were conducted using data from the Atlas of Variation Map 61 (rate of emergency admissions to hospital for people aged ≥ 75 years with a length of stay of < 24 hours) and the National Audit of Intermediate Care. Results Community hospital ward efficiency is comparable with the NHS acute hospital sector (mean cost efficiency 0.83, range 0.72–0.92). The rank order of community hospital ward efficiencies was distinguished to facilitate learning across the sector. On average, if all community hospital wards were operating in line with the highest cost efficiency, savings of 17% (or £47M per year) could be achieved (price year 2013/14) for our sample of 101 wards. Significant economies of scale were found: a 1% rise in output was associated with an average 0.85% increase in costs. We were unable to obtain a larger community hospital sample because of the low response rate to our national survey. The case studies identified how rehabilitation was delivered through collaborative, interdisciplinary working; interprofessional communication; and meaningful patient and family engagement. We also developed insight into patients’ recovery trajectories and care transitions. The web-based interactive toolkit was established [http://mocha.nhsbenchmarking.nhs.uk/ (accessed 9 September 2019)]. The crisis response team type of intermediate care, but not community hospitals, had a statistically significant negative association with emergency admissions. Limitations The econometric analyses were based on cross-sectional data and were also limited by missing data. The low response rate to our national survey means that we cannot extrapolate reliably from our community hospital sample. Conclusions The results suggest that significant community hospital ward savings may be realised by improving modifiable performance factors that might be augmented further by economies of scale. Future work How less efficient hospitals might reduce costs and sustain quality requires further research. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 1. See the NIHR Journals Library website for further project information.
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Belitsky, A. V., S. Hohenegger, G. P. Korchemsky, and E. Sokatchev. "N=4 superconformal Ward identities for correlation functions." Nuclear Physics B 904 (March 2016): 176–215. http://dx.doi.org/10.1016/j.nuclphysb.2016.01.008.
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Sinclair, A. G., J. Ellick, M. Kehoe, L. Hall, J. Lamb, A. Norman, and M. D. Jones. "Service evaluation of the efficiency of moving discharge medicine request screening from the dispensary to hospital wards over a two-year period." International Journal of Pharmacy Practice 30, Supplement_1 (April 1, 2022): i47. http://dx.doi.org/10.1093/ijpp/riac019.066.
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Abstract Introduction It is a common patient perception that their discharge from hospital is delayed by waiting for medicines (1). However, it is important to consider the entire discharge process when addressing this problem (2). In our large tertiary referral hospital, clinical pharmacy services were moved from wards to the dispensary following a staffing crisis during 2018. Ward-based services were reintroduced in 2020, but doubts remained over the practicality and benefits of doing this. Aim To compare the efficiency of ward and dispensary based clinical pharmacy services in our hospital in terms of interventions made and time taken. Methods We completed an observational service evaluation. Data on the time taken to process discharge medication requests with the dispensary-based service were collected retrospectively from the hospital electronic discharge system for 12 months (2018) for five medical wards. Equivalent data for the ward-based service were collected prospectively over three days (2020) by pharmacists delivering the service to seven medical wards, as this was considered more accurate, and several process steps did not exist in the ward-based model. For example, prescriber sending request to pharmacy and pharmacy acknowledging receipt of a request. The prospective data collection period was curtailed by Covid-19. Descriptive statistics were produced using Excel. Results Using the dispensary-based service (2018), 4459 medicine requests were processed from 5 medical wards, during a 12-month period. The mean time between prescribing and reaching the screening pharmacist was 175 minutes [95%CI ± 25.4]. It took an estimated time of 62 minutes [95%CI ± 2.99] to screen and resolve an intervention, with a mean of 3 interventions/ward/day. In 2020, using the ward-based approach to clinical pharmacy which screened medicine requests on the ward, 142 requests were screened over three days from seven wards, with no delay between prescribing and clinical screening. It took a mean of 17 minutes [95%CI ± 10.63] to screen and resolve an intervention, with a mean of 15 interventions/ward/day. Conclusion Ward based pharmacy yielded five times more interventions, took an average of 45 minutes less to screen and resolve issues per request and removed 175 minutes of process time. The additional time required to resolve issues identified in the dispensary-based screening process was thought to be the delay in contacting either the appropriate member of the ward staff referencing a particular patient for information or identifying and contacting the prescriber, or a combination of both. This study is limited by the long delay between data collection periods and the small sample size in 2020, but the differences between the two systems were large and there had been few other changes to hospital systems. Other limitations include changes related to Covid-19 and the lack of a control group, so it is not possible to establish a causal relationship between the type of pharmacy service and study outcomes. References (1) Wright S, Morecroft CW, Mullen R, Ewing AB. UK hospital patient discharge: the patient perspective. Eur J Hosp Pharm. 2017 Nov;24(6):338-342. (2) Green CF, Hunter L, Jones L, Morris K. The TTO Journey: How much of it is actually in pharmacy? Pharm Man. 2015 Oct;31(4):16-20.
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Handiyani, Hanny. "HUBUNGAN ANTARA WAKTU MEMBERSIHKAN RUNGAN DENGAN PENINGKATAN JUMLAH MIKROORGANISME MELALUI ALIRAN UDARA." Jurnal Keperawatan Indonesia 5, no. 2 (April 24, 2014): 44–49. http://dx.doi.org/10.7454/jki.v5i2.106.
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Penelitian ini bertujuan untuk membuktikan adanya hubungan antara waktu membersihkan ruangan dengan peningkatan jumlah mikroorganisme melalui aliran udara. Metoda yang digunakn adalah deskriptif eksploratif yang diambil secara cross sectional. Studi dilakukan di dua ruang rawat yaitu ruangan yang menggunakan sistem terbuka da tertutup. Hasil studi menunjukkan adanya peningkatan jumlah mikroorganisme yang berarti pada ruang rawat yang menggunkan sistem tertutup dengan semakin lamanya rentang waktu sejak ruangan dibersihkan sampai saat diperiksa. Penelitian ini sangat merekomendasikan untuk mengatur jadwal kegiatan perawatan di ruang rawat agar dilakukan minimal setelah 15 menit ruangan dibersihkan dan ruangan dibersihkan kembali setelah 4 jam kemudian. The purpose of this study is to prove correlation between the time of ward cleaning and the increasing the number of microorganism through air steam. The methodology used descriptive explorative with cross sectional. This study was used two wards, the ward uses open system and the other uses closes system. The result revered that there is significant increasing number of microorganism on the close system word. This study recommended to regulate the word activity schedule at least 15 minutes after cleaning and the ward should be re-clean next 4 hour.
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Tanseng, Ketsara, Akeau Unahalekhaka, Nongyao Kasatpibal, and Nongkran Viseskul. "Effectiveness of Preventive Nursing Program for Multidrug-Resistant Organism Transmission: A Quasi-experimental Study." Pacific Rim International Journal of Nursing Research 27, no. 4 (September 28, 2023): 736–52. http://dx.doi.org/10.60099/prijnr.2023.262568.
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Multidrug-resistant organism infections are a major public health problem. Promoting nurses’ practice in preventing multidrug-resistant infections can reduce hospital transmission. This quasi-experimental study investigated the effectiveness of a preventive nursing program for multidrug-resistant organism transmission. The study was carried out in the Department of Internal Medicine in a tertiary hospital in south Thailand. Participants in this study were registered nurses. Two wards were randomly selected as the experimental ward and two as the control ward, then participants from each ward were purposively selected. Finally, there were 60 participants, n = 31 from the experiment wards and n = 29 from the control wards. The experimental group received a 4-week program, whereas the control group followed the usual practice. Then, the practices in preventing multidrug-resistant organism transmission of the experimental and control groups were assessed 4 and 12 weeks after the program ended. The instruments for data collection included a demographic data form and a preventive practice observation form. Data were analyzed using descriptive statistics and a chi-square test. The results showed that, at 4 and 12 weeks after completion of the program, nurses in the experimental group had a significantly higher proportion of correct practices (hand hygiene, use of personal protective equipment, patient placement, patient transport, patient care equipment management, environmental management, and linen and infectious waste management of multidrug-resistant organism transmission) than before receiving the program and in the control group. The findings suggest that the program effectively improves nurses’ correct practices in preventing multidrug-resistant organism transmission. The program can be applied to promote and support preventive practices among nurses. However, long-term follow-ups with the incidence of multidrug-resistant organism transmission should be further studied. In addition, as this study was conducted with nurses working in the internal medicine wards of a tertiary hospital, it is necessary to evaluate the program's effectiveness with different samples prior to its widerimplementation.
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Rasjid, Aliamran, H. A. M. Yusuf, Diwyo Soegondo, and Leonard Napitupulu. "Nosocomial Infection Control in the Children's and Maternity Hospital ''Harapan Kita''. Early Warning System." Paediatrica Indonesiana 28, no. 1-2 (July 15, 2019): 36–48. http://dx.doi.org/10.14238/pi28.1-2.1988.36-48.
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In a children's and maternity hospital, where many high risk patients are hospitalized, a comprehensive but cheap surveillance system is of paramount importance for the improvement of hospital administration, formulation of hospital policy on antibiotic use and the nosocomial infection control programmes.
The epidemiological data were primarily collected in a comprehensive built-in monitoring and surveillance programmes of this hospital, and had been distributed throughout the hospital periodically. The collected data had been broken down into (1) summary of ten leading infectious cases of hospitalized patient by tentative and final diagnosis; (2) types of culture by ward; (3) number of culture by sex and age group; (4) types of bacteria by ward; and (5) types of bacteria by culture. The classification of wards is indirectly inherent to the social- strata of the patients. For the refinement of information, they were broken down into data on bed-occupancy by ward, and data on hospitalized patients by sex and age groups as well.
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Nurlu, Derya, and Abdul Raoof. "Inpatient Ward Review Documentation Audit." BJPsych Open 9, S1 (July 2023): S172—S173. http://dx.doi.org/10.1192/bjo.2023.454.
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AimsGood medical records are essential to the continuity of patient care. The aims of this audit were to evaluate the quality of ward review documentation in 7 Psychiatry wards in Essex Partnership University NHS Foundation Trust, to identify areas of improvement, to recommend strategies to improve record keeping, and to measure their effectiveness by comparing records in the 1st and 2nd cycles of audit.MethodsA sample of 10 patients from each of the 7 wards was selected, for a total of 70 patients, in each of the 1st and 2nd cycles of the audit (Data were collected in the 1st cycle between 06-07-2021 and 22-07-2021, and 2nd cycle between 16-10-2022 and 07-11-2022). Samples were selected randomly among patients who were inpatient or discharged recently. The data were collected from the first, middle, and last ward reviews. If the patient was inpatient at the time of the data collection, data were collected from their first review, the last/most recent ward review, and one of the reviews in between. Patients who did not meet this criterion were excluded. Based on 1st cycle results, strategies were recommended to improve record keeping. After 15 months, 2nd cycle results were used to evaluate their effectiveness.ResultsThe results demonstrate significant areas of improvements in record keeping: a majority of questions did not meet the standard of 80% completion considered “satisfactory” in previous audits. In the 2nd cycle, 9 questions had a “satisfactory” completion rates. These were mandatory or automated questions and ones essential to immediate patient care. 7 questions had “average” completion rates above 45%. All (17) other questions and subquestions had “low” completion rates. Analysis of variations between cycles shows that question on “Responsible clinician” increased from 23.3% to 99.5% because it was automated. 4 other questions or sub-questions have seen a substantial increase in completion rate between the 1st and 2nd cycle. But our strategies’ effectiveness during the period of the audit has proven limited and difficult to trace.ConclusionIt can be concluded that more efforts should be dedicated to improving medical record in the psychiatry wards of Essex Partnership University NHS Foundation Trust. The most effective strategy to secure high ward review docummentation rates remains to make questions mandatory or auto-complete when possible. More research is necessary to demonstrate the effectiveness of other strategies such as the education of junior doctors in induction and awareness posters in wards.
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Wild, Adam, Praveen Kumar, Fiona Howells, Hamed Emara, and Phoebe Williams. "Comparison of Management (Non-Pharmalogical Approaches and Rapid Tranquilisation) of Older Adults (≫65 Years) With Dementia Between the Dementia Ward, Acute Medical Unit and the Geriatric Ward in a Rural Health Board." BJPsych Open 9, S1 (July 2023): S187. http://dx.doi.org/10.1192/bjo.2023.484.
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AimsTo investigate if current practices by nursing and medical staff in the dementia ward (New Craigs Psychiatric Hospital), acute medical unit and geriatric ward (Raigmore General Hospital) followed the local protocol for managing distress of non-pharmalogical approach and rapid tranquilisation (RT) in older adults (aged >65years). We believe the split between the general and psychiatric hospitals and the different time pressures experienced in these 3 wards will influence the management and RT of their older adult patients.MethodsData were collected from 17/09/2022 to 8/10/2022 from case notes and drug charts of older adult patients that received rapid tranquilisation from 3 wards: 1.Ruthven Ward, New Craigs Psychiatric Hospital2.Acute Medical Unit (AMU), Raigmore Hospital3.Ward 2C (Geriatrics), Raigmore HospitalFocus groups and informal discussions were made with the ward nurses and junior doctors to understand their point of view on managing distressing behaviours in patients with dementia using de-escalation techniques.A table was collated using Microsoft Excel. The parameters used were: 1.Patient Diagnosis and Legal status2.Administration•Date and time started•If de-escalation techniques were used•If discussed with a senior doctor•1st and/or 2nd line of drugs administered (route, drug and dosage)•If Haloperidol given and if ECG was doneResultsData collection showed the following: 1.Ruthven Ward- all 32 patients did not receive RT.2.AMU- only 1 out of 280 patients received 4 subsequent RT in 5 hours including 3x haloperidol (total 3mg) and 2mg of Midazolam despite an ECG showing prolonged QT interval. The latter prescribed after consultation with a senior doctor.3.Geriatric Ward – all 10 patients did not receive RT.ConclusionFocus groups and informal discussions with staff nurses from all three wards concluded that in spite of the stressful environment posed by issues of understaffing and high patient load, de-escalation techniques (recognition of early signs of agitation, distraction and calming techniques, recognising the importance of personal space) were prioritised before moving on to RT as per local protocol. Restraining was often used if patient was at risk to self or others by staff trained in violence and aggression management.Informal discussions with junior doctors rotating in and out of AMU showed limited awareness of the RT protocol. In general, it was evident that RT was a last resort when psychological and behavioural approaches failed but that further education was required to administer RT safely.
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Adelman, Richard C. "Response to Ward Dean." Experimental Gerontology 23, no. 2 (January 1988): 141–42. http://dx.doi.org/10.1016/0531-5565(88)90079-4.
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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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Saleh, Keenan, Jasjit Syan, Pavidra Sivanandarajah, Michael Wright, Sarah Pearse, Jodian Barrett, James Bird, Grant McQueen, and Sadia Khan. "Insights from a single centre implementation of a digitally-enabled atrial fibrillation virtual ward." PLOS Digital Health 3, no. 3 (March 20, 2024): e0000475. http://dx.doi.org/10.1371/journal.pdig.0000475.
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Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia and poses a significant public health burden. Virtual wards are a novel approach utilising digital solutions to provide hospital-level care remotely; their rollout has become a key priority for the UK National Health Service to expand acute care capacity. We devised and implemented a digitally-enabled AF virtual ward to monitor patients being established onto medical therapy following an AF diagnosis or an AF-related hospitalisation. Patients were onboarded either as outpatients to avoid admission or on discharge after an acute AF hospitalisation. Remote monitoring was undertaken using a clinically validated photoplethysmography-based smartphone app. Over a 1–2 week period, patients performed twice daily measurements of heart rate and rhythm and provided corresponding symptoms. A traffic light system guided frequency of telephone assessments by specialist practitioners. Red flag symptoms or abnormal heart rate parameters prompted an urgent care escalation. We report our experience of the first 73 patients onboarded to the AF virtual ward from October 2022 to June 2023 (mean age 65 years, median 68 years, IQR range 27–101 years; 33 females). Thirty-nine (53%) patients had red flag features requiring care escalation, of whom 9 (23%) were advised to attend ED (emergency department) for urgent assessment, 10 (26%) attended for expedited review and 14 (36%) required medication changes. By 3 months post-monitoring, only 3 patients (4%) had re-attended ED with an arrhythmia-related presentation. Virtual ward patients had an average 3-day shorter inpatient stay (mean duration 4 days) compared with AF patients hospitalised prior to virtual ward implementation (mean duration 7 days). Overall, 22 arrhythmia-related readmissions were prevented via the virtual ward model. In this study, we present a novel implementation of a digitally-enabled virtual ward for the acute management of patients with newly diagnosed or poorly controlled AF. Our pilot data indicate that this model is feasible and is potentially cost-effective. Further longitudinal study is needed to definitively evaluate long-term clinical utility and safety.
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Catrin, Barker, Bartlett Donna, Brown Pauline, Bracken Louise, Bellis Jenny, Kaehne Axel, Silverio Sergio, Cope Louise, and Peak Matthew. "SP8 Introducing a ward-based pharmacy technician to support the administration of paediatric medicines: an evaluation of parent and staff perspectives." Archives of Disease in Childhood 103, no. 2 (January 19, 2018): e1.50-e1. http://dx.doi.org/10.1136/archdischild-2017-314584.8.
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AimTo determine the impact of replacing a nurse with a ward-based pharmacy technician as the second checker, in the process of administering medicines to children in hospital by exploring the views and experiences of parents and staff involved in the change in practice.MethodHaving undertaken additional in-house training, a pharmacy technician replaced the second nurse on medication ward rounds (second checker) for 10 months over two wards. This took place on a neuro-medical ward and a medical specialty ward. The pharmacy technician undertook roles relating to medicines administration, including: attending day time medicine administration rounds; checking accuracy and appropriateness of prescriptions; preparing/administering prescribed medicines; independently undertaking dosage calculations; recording the administration of medicines. Using their specialist knowledge and skills, the role aimed to improve medicines optimisation for patients and their families during their inpatient stay.Research staff conducted semi-structured qualitative interviews with parents of patients who were administered medicines during the study period (n=12) and with staff involved with the change in practice, as well as an interview with the pharmacy technician themselves after leaving each ward. Families were recruited from the two wards. Semi-structured interviews with staff (n=14) gathered data on the perspectives and experiences of the contribution of the ward-based pharmacy technician across two wards. An exploratory approach was taken using Thematic Analysis.1 Interviews were transcribed verbatim and anonymised. The research team familiarised themselves with transcripts by reading in full and generating initial codes using text from the data. Themes were generated and discussed between the team to produce an overall story of the analysis. Interviews were conducted over a 4 month period.ResultsParents discussed the importance of communication about their child’s medicines in hospital. Some parents were aware of the pharmacy technician’s role as second checker. Parents recognised the benefits of the technician’s background and expertise, and their contribution to the ward team.Fourteen staff interviews were conducted including the ward based pharmacy technician (after leaving each ward), the Chief Pharmacist, the Director of Nursing, a Ward Manager, Nursing and Pharmacy staff. Staff commented how the pharmacy technician provided a link between the Pharmacy and Nursing teams, alleviating nurses of administration duties and allowing them to spend more time with patients. The role was also seen as educational allowing for nurses to refresh their knowledge on medication storage procedures and alternative methods of administration.ConclusionTo the research team’s knowledge, this is the first study of its kind to assess the potential benefits of introducing a ward-based pharmacy technician as a second checker. This novel role extension releases nursing staff time to undertake more patient-centred nursing duties. In addition, the specialist knowledge of the pharmacy technician at the point of medicine administration had a positive impact on medicines optimisation for children in hospital, providing more effective administration of medicines and contributing to wider patient safety in paediatric settings. Although further evaluation is required, our findings indicate that parental and staff support the future development of this service.ReferenceBraun V, Clarke V. Using thematic analysis in psychology. Qualitative Research in Psychology 2006;3(2):77–101.
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Gunasekaran, G. H. "The Effect of Pharmacist Intervention in Completing Docetaxel Infusion Within 4 Hours." Journal of Global Oncology 4, Supplement 2 (October 1, 2018): 71s. http://dx.doi.org/10.1200/jgo.18.13300.
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Background: Docetaxel is a cytotoxic drug that have stability of 4 hours after reconstitution. The infusion must be completed within 4 hour or will result in wastage or patient receiving subtherapeutic effect drug. Aim: This study aims to determine if there is any variable in time taken to complete docetaxel infusion within 4 hour with pharmacist monitoring. Methods: A data collection form was design to record start and end time of reconstitution, preparation collected by ward staff, infusion initiation and completion. This was to identify which process that had been causing a delay in initiating infusion. In preintervention phase (Jan 2015-Jun 2015), the baseline data were traced from pharmacy records and patients chemotherapy administration charts. In postintervention phase (Jul 2015-Dec 2015), the same variables as in preintervention was collected with an additional of pharmacist intervention. Results: Analysis of collected data shows that delay in initiation of infusion is mainly due to delay in collecting reconstituted preparation by ward staff (median 30 min, IQR 13.75-45 min) and delay in initiating infusion to patient after the preparation have been collected (median 77.50 min, IQR 45-150 min). After the implementation of pharmacist intervention, the median time for ward to collect the docetaxel preparation has decreased to 25 min (IQR 20-35 min) and the median time taken from collection to start of infusion have decreased to 55 min (IQR 40-80 min). There were significant relationship in completion of docetaxel infusion within 4 hours of pharmacist intervention, χ2=5.114, P = 0.024. Conclusion: According to this result, pharmacist monitoring can significantly improve completion of docetaxel infusion within 4 hours. This study also shows that there are improvement in collection and initiation of infusion in the ward. Pharmacist infusion checking service could improve better drug utilization in the ward.
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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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RPD, Cooke, Goddard SV, and Golland J. "Costing a major hospital outbreak of gastroenteritis due to Norovirus (Norwalk-like virus)." British Journal of Infection Control 4, no. 2 (April 2003): 18–21. http://dx.doi.org/10.1177/175717740300400207.
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O utbreaks of Norovirus infection in hospitals are common, but the financial impact is often poorly defined. Following a major outbreak, we propose a simple costing system. The key cost drivers identified were: 1. Lost bed days (LBDs) and cancelled elective surgical operations. The cost of an occupied or closed bed was £204 per day; 2. The period of staff sickness, estimated at an average of four days. Staff costs were estimated at £79.45 per day; 3. The employment of additional nurses; 4. Environmental cleaning (£200 per ward); 5. Additional microbiology costs (£8.27 per sample); 6. Ward consumable costs, estimated at £5 per ward per day. The outbreak involved 16 wards, affecting 139 patients and 124 staff (mainly nurses) over a two week period. LBDs due to inpatient sickness amounted to £85,068. Lost days due to staff sickness cost £39,407. 150 cancelled surgical operations equates with 525 LBDs, costing £107,100. The cost of employing additional nursing staff was £41,465. Further costs included £3,200 for 16 ‘deep cleans', £560 for ward consumables, £1,150 for microbiology specimens and £1,165 for additional infection control hours. The total cost of the outbreak was estimated at £279,115. The costing model described quickly identified key financial pressures and could be applicable to other Norovirus outbreaks.
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Leenen, Jobbe P. L., Henriëtte J. M. Rasing, Cor J. Kalkman, Lisette Schoonhoven, and Gijsbert A. Patijn. "Process Evaluation of a Wireless Wearable Continuous Vital Signs Monitoring Intervention in 2 General Hospital Wards: Mixed Methods Study." JMIR Nursing 6 (May 4, 2023): e44061. http://dx.doi.org/10.2196/44061.
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Background Continuous monitoring of vital signs (CMVS) using wearable wireless sensors is increasingly available to patients in general wards and can improve outcomes and reduce nurse workload. To assess the potential impact of such systems, successful implementation is important. We developed a CMVS intervention and implementation strategy and evaluated its success in 2 general wards. Objective We aimed to assess and compare intervention fidelity in 2 wards (internal medicine and general surgery) of a large teaching hospital. Methods A mixed methods sequential explanatory design was used. After thorough training and preparation, CMVS was implemented—in parallel with the standard intermittent manual measurements—and executed for 6 months in each ward. Heart rate and respiratory rate were measured using a chest-worn wearable sensor, and vital sign trends were visualized on a digital platform. Trends were routinely assessed and reported each nursing shift without automated alarms. The primary outcome was intervention fidelity, defined as the proportion of written reports and related nurse activities in case of deviating trends comparing early (months 1-2), mid- (months 3-4), and late (months 5-6) implementation periods. Explanatory interviews with nurses were conducted. Results The implementation strategy was executed as planned. A total of 358 patients were included, resulting in 45,113 monitored hours during 6142 nurse shifts. In total, 10.3% (37/358) of the sensors were replaced prematurely because of technical failure. Mean intervention fidelity was 70.7% (SD 20.4%) and higher in the surgical ward (73.6%, SD 18.1% vs 64.1%, SD 23.7%; P<.001). Fidelity decreased over the implementation period in the internal medicine ward (76%, 57%, and 48% at early, mid-, and late implementation, respectively; P<.001) but not significantly in the surgical ward (76% at early implementation vs 74% at midimplementation [P=.56] vs 70.7% at late implementation [P=.07]). No nursing activities were needed based on vital sign trends for 68.7% (246/358) of the patients. In 174 reports of 31.3% (112/358) of the patients, observed deviating trends led to 101 additional bedside assessments of patients and 73 consultations by physicians. The main themes that emerged during interviews (n=21) included the relative priority of CMVS in nurse work, the importance of nursing assessment, the relatively limited perceived benefits for patient care, and experienced mediocre usability of the technology. Conclusions We successfully implemented a system for CMVS at scale in 2 hospital wards, but our results show that intervention fidelity decreased over time, more in the internal medicine ward than in the surgical ward. This decrease appeared to depend on multiple ward-specific factors. Nurses’ perceptions regarding the value and benefits of the intervention varied. Implications for optimal implementation of CMVS include engaging nurses early, seamless integration into electronic health records, and sophisticated decision support tools for vital sign trend interpretation.
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Alinia, Meda. "Improving the Knowledge, Skills and Confidence of Clinicians Towards Mental Health: An Educational Intervention Based on Reflective Practice." BJPsych Open 9, S1 (July 2023): S12—S13. http://dx.doi.org/10.1192/bjo.2023.108.
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AimsMental illness-related stigma, including that which exists in the healthcare system creates serious barriers to access and quality care. People with lived experience of a mental illness commonly report feeling devalued, dismissed, and dehumanized by many of the health professionals with whom they come into contact. While working in the mental health liaison team in a local general hospital I have experienced first-hand these issues. We decided to organise regular reflective sessions for staff to reflect on what the barriers are to being able to manage patients with mental illness better on the wards, raise mental health awareness, improve staff communication skills, and offer teaching sessions to improve the staff knowledge of psychiatric pathology.MethodsBefore starting, we offered a feedback form to staff to ascertain the value of the project.To ascertain that the learning has taken place, we have delivered a post-session formative quiz to assess the staff's knowledge of managing patients with mental illness.To determine the effectiveness of the project, we decided to use Kirkpatrick's evaluation model and assess the first two levels of the programme outcome: (1) learner satisfaction- through staff feedback; (2) measures of learning- knowledge gained showed in the formative post-session quiz.ResultsThe sessions were carried out on 2 wards in the general hospital •Ward 1: 4 sessions; number of attendees: 12•Ward 2: 4 sessions; number of attendees: 5The student evaluation was done through a quiz offered to the participants at the end of each session.9 quiz questionnaires were completed on ward 1:Correct answers: Q1- 67%; Q2- 89%; Q3- 0%; Q4- 100%.5 quiz questionnaires were completed on ward 2:Correct answers: Q1- 20%; Q2- 60%; Q3- 0%; Q4- 40%.The programme evaluation was done through a feedback form offered to the participants at the end of each session.12 forms were completed on ward 1: 50% strongly agreed that the session was useful to their practice; 70% were quite confident in caring for patients with mental illness following the session.5 forms were completed on ward 2: 20% strongly agreed that the session was beneficial; 75% were quite confident in caring for patients with mental illness following the session.ConclusionDifficult to implement a culture change.Following a meeting with the stakeholders, we agreed on delivering monthly reflective sessions to the staff in their allocated “team time” where attendance is mandatory and we will also take part in a developmental teaching programme for band 5 nursing staffWe are in the process of extending our project to the Emergency department
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Dunajski, Maciej, and Nicholas S. Manton. "Reduced dynamics of Ward solitons." Nonlinearity 18, no. 4 (April 29, 2005): 1677–89. http://dx.doi.org/10.1088/0951-7715/18/4/014.
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López-Campos, J. L., C. García-Polo, and A. León-Jiménez. "Noninvasive Ventilation on the Ward." Archivos de Bronconeumología ((English Edition)) 42, no. 5 (May 2006): 255. http://dx.doi.org/10.1016/s1579-2129(06)60456-4.
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Wall, Michael. "The ward sisters survival guide." Nurse Education Today 10, no. 6 (December 1990): 470–71. http://dx.doi.org/10.1016/0260-6917(90)90112-4.
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Eng, Lawson, Amol A. Verma, Xin You, Afsaneh Raissi, Deva Thiruchelvam, Alejandro Berlin, Christine Brezden-Masley, et al. "The impact of admitting ward on resource utilization and outcomes among hospitalized cancer survivors." Journal of Clinical Oncology 42, no. 16_suppl (June 1, 2024): 1550. http://dx.doi.org/10.1200/jco.2024.42.16_suppl.1550.
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1550 Background: With improvements in the early detection and treatment of cancer, there is a growing population of cancer survivors; with a corresponding increase in acute care use among cancer survivors. However, models of inpatient care delivery for cancer survivors differ between hospitals and regions, which may impact resource use and outcomes. Understanding how different models influence outcomes may help define optimal models for inpatient care delivery for this population. Methods: We created a multicenter cohort of all cancer patients admitted to medical wards across 26 hospitals in Ontario, Canada from 2015 to 2022, and deterministically linked population-level administrative data including ambulatory oncology data, with each hospital’s patient-level electronic information (pharmacy, orders, notes, laboratory/imaging and results). Multivariable regression models compared characteristics and outcomes between patients admitted on oncology wards vs non-oncology wards adjusting for age, sex and co-morbidity scores. Results: In total, there were 370,118 hospitalizations from 191,990 unique patients. Among these hospitalizations, 38,075 episodes (10.3%) were on an oncology ward. The median time from cancer diagnosis to hospitalization was 4 years. The most common disease sites were genitourinary (21%), gastrointestinal (20%), breast (12%), and lung (10%). The most discharge diagnoses from oncology wards were inpatient chemotherapy (9%), febrile neutropenia (7%), non-Hodgkin’s lymphoma (4%), acute myeloid leukemia (4%), myeloma (3%); while for non-oncology wards were heart failure (5%), palliative care (4%), UTI (2%), pneumonia (2%), acute renal failure (2%). In general, cancer patients admitted on oncology wards were younger (64 vs 76), had shorter length of stay (LOS; 9.6 vs 10.1 days), less in-hospital mortality (7.5% vs 11.4%), greater 30-day re-admission rates (29% vs 14%) and were also more likely to undergo CTs (28% vs 21%), MRIs (11% vs 9%) and interventional procedures (8% vs 6%) (all comparisons, p<0.001). Subgroup analysis focusing on the top 5 discharge diagnoses from non-oncology wards, showed that despite higher in-hospital mortality rates (aOR 1.27 95% CI [1.15-1.40] p<0.001), admission to a non-oncology ward for those diagnoses was associated with a shorter LOS (aOR 0.96 [0.92-1.00] p=0.03), reduced 30-day re-admission rates (aOR 0.77 [0.69-0.87] p<0.001), and reduced use of CTs (aOR 0.74 [0.68-0.82] p<0.001), MRIs (aOR 0.80 [0.68-0.95] p=0.01), and interventional procedures (aOR 0.84 [0.69-1.01] p=0.07). Conclusions: There are differences in both resource use and outcomes for cancer survivors hospitalized on oncology versus non-oncology wards, including for patients with the same discharge diagnosis. To optimize inpatient cancer care delivery for hospitalized cancer survivors, further exploration is needed.
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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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Rajasoorya, C. "Clinical Ward Rounds—Challenges and Opportunities." Annals of the Academy of Medicine, Singapore 45, no. 4 (April 15, 2016): 152–56. http://dx.doi.org/10.47102/annals-acadmedsg.v45n4p152.
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Hospitalised patients’ needs are complex and the ward environment is demanding of time and resources that must be optimised. Clinical ward rounds in hospitalised patients are fundamental to patient care. Ward rounds in recent years have undergone changes which have contributed to reduced professionalism and opportunities to learn as well as increased distrust of patients of the care they receive. Calls for a revival of the traditional ward rounds have been sounded which we must contextualise in modern settings. This commentary calls for a clearer definition of the purpose of ward rounds, outlines the roles and responsibilities of those involved in rounds, defines a 4-step process in the conduct of a ward round, and seeks support from hospitals’ management in the facilitation and implementation of these. Key words: Patients, Process, Professionalism, Teaching
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Baeklund, Jonas. "Nurse rostering at a Danish ward." Annals of Operations Research 222, no. 1 (December 4, 2013): 107–23. http://dx.doi.org/10.1007/s10479-013-1511-4.
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Kunøe, Nikolaj, Hans Martin Nussle, and Anne-Marthe Indregard. "Protocol for the Lovisenberg Open Acute Door Study (LOADS): a pragmatic randomised controlled trial to compare safety and coercion between open-door policy and usual-care services in acute psychiatric inpatients." BMJ Open 12, no. 2 (February 2022): e058501. http://dx.doi.org/10.1136/bmjopen-2021-058501.
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IntroductionThe reduction of coercion in psychiatry is a high priority for both the WHO and many member countries. Open-door policy (ODP) is a service model for psychiatric ward treatment that prioritises collaborative and motivational measures to better achieve acute psychiatric safety - and treatment objectives. Keeping the ward main door open is one such measure. Evidence on the impact of ODP on coercion and violent events is mixed, and only one randomised controlled trial (RCT) has previously compared ODP to standard practice. The main objectives of the Lovisenberg Open Acute Door Study (LOADS) are to implement and evaluate a Nordic version of ODP for acute psychiatric inpatient services. The evaluation is designed as a pragmatic RCT with treatment-as-usual (TAU) control followed by a 4-year observational period.Methods and analysisIn this 12-month pragmatic randomised trial, all patients referred to acute ward care will be randomly allocated to either TAU or ODP wards. The primary outcome is the proportion of patient stays with one or more coercive measures. Secondary outcomes include adverse events involving patients and/or staff, substance use and users’ experiences of the treatment environment and of coercion. The main hypothesis is that ODP services will not be inferior to state-of-the art psychiatric treatment. ODP and TAU wards are determined via ward-level randomisation. Following conclusion of the RCT, a longitudinal observational phase begins designed to monitor any long-term effects of ODP.Ethics and disseminationThe trial has been approved by the Regional Committees for Medical and Health Research Ethics (REC) in Norway (REC South East #29238), who granted LOADS exemption from consent requirements for all eligible, admitted patients. Data are considered highly sensitive but can be made available on request. Results will be published in peer-reviewed journals and presented at scientific conferences and meetings.Trial registration numberISRCTN16876467.Protocol version1.4, 21 December 2021.
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ISHIKI, GORO. "MATRIX REGULARIZATION OF N = 4 SYM ON R × S3." International Journal of Modern Physics A 23, no. 14n15 (June 20, 2008): 2199–200. http://dx.doi.org/10.1142/s0217751x08040834.
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We revealed a relationship between the plane wave matrix model (PWMM) and N =4 super Yang-Mills (SYM) theory on R × S3: N =4 SYM on R × S3 is equivalent to the theory around a certain vacuum of PWMM. It is suggested from this relation that N =4 SYM on R × S3 is regularized by PWMM in the planar limit. Because PWMM originally possesses the gauge symmetry and SU(2|4) symmetry, this regularization also preserves these symmetries. In order to check the validity of this matrix regularization method, we calculate the Ward identity and the beta function at the 1-loop level. We find that the Ward identity is satisfied and the beta function vanishes in the continuum limit. The former result is consistent with the gauge symmetry of PWMM. The latter suggests the possibility that the conformal symmety is restored in the continuum limit.
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Barman, Dhiren. "Socio-Economic Condition of Slum Dwellers in Bankura Town: An Exploratory Analysis." Shanlax International Journal of Economics 12, no. 1 (December 1, 2023): 85–92. http://dx.doi.org/10.34293/economics.v12i1.6825.
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The word “slum” refers to informal settlements in which the condition of houses is bad and living conditions are very poor. In Bankura town, there are 295 total slums, which are home to 46,341 people. This represents around 33.73% of Bankura town’s overall population. The slum population in Bankura town is continuously increasing. The slum dwellers in Bankura town mainly deprived from education, metal road, water supply, drainage and sanitation system. Some basic amenities need urgent attention in slum area by ULB of Bankura town. i.e. water supply , drainage and sanitation, education, shelter and road etc. The highest number of slum population located in Ward nos. 4, 10, 12, 17, 19, and 20 and maximum number of BPL population is located in Ward no. 19 and 20. The highest number of illiterate slum population is found in Ward no. 4, 10, 12, 17, 19, 20 and 22. The highest number of households in Ward no. 19 is having remote access to drinking water; whereas in Ward no. 1 & 2 are having a lowest number of houses with remote access to drinking water sources. The highest number of houses with access road to house as kutcha road is found in Ward no. 19. The highest number of slum population identifying use of toilet as others, non-earning population, woman-earning member and drop out children in slum is observed in Ward no. 19. It is observed that slum population in Ward no. 19 and 20 are in worst condition in comparison to Ward no. 1 and 2. Development policies must be framed to prevent the formation of new slums and take necessary strategies for the development of socio-economic condition of slum dwellers in Bankura town.
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Lambe, Gerard, Niall Linnane, Ian Callanan, and Marcus W. Butler. "Cleaning up the paper trail – our clinical notes in open view." International Journal of Health Care Quality Assurance 31, no. 3 (April 16, 2018): 228–36. http://dx.doi.org/10.1108/ijhcqa-09-2016-0126.
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Purpose Ireland’s physicians have a legal and an ethical duty to protect confidential patient information. Most healthcare records in Ireland remain paper based, so the purpose of this paper is to: assess the protection afforded to paper records; log highest risk records; note the variations that occurred during the working week; and observe the varying protection that occurred when staff, students and public members were present. Design/methodology/approach A customised audit tool was created using Sphinx software. Data were collected for three months. All wards included in the study were visited once during four discrete time periods across the working week. The medical records trolley’s location was noted and total unattended medical records, total unattended nursing records, total unattended patient lists and when nursing personnel, medical students, public and a ward secretary were visibly present were recorded. Findings During 84 occasions when the authors visited wards, unattended medical records were identified on 33 per cent of occasions, 49 per cent were found during weekend visiting hours and just 4 per cent were found during morning rounds. The unattended medical records belonged to patients admitted to a medical specialty in 73 per cent of cases and a surgical specialty in 27 per cent. Medical records were found unattended in the nurses’ station with much greater frequency when the ward secretary was off duty. Unattended nursing records were identified on 67 per cent of occasions the authors visited the ward and were most commonly found unattended in groups of six or more. Practical implications This study is a timely reminder that confidential patient information is at risk from inappropriate disclosure in the hospital. There are few context-specific standards for data protection to guide healthcare professionals, particularly paper records. Nursing records are left unattended with twice the frequency of medical records and are found unattended in greater numbers than medical records. Protection is strongest when ward secretaries are on duty. Over-reliance on vigilant ward secretaries could represent a threat to confidential patient information. Originality/value While other studies identified data protection as an issue, this study assesses how data security varies inside and outside conventional working hours. It provides a rationale and an impetus for specific changes across the whole working week. By identifying the on-duty ward secretary’s favourable effect on medical record security, it highlights the need for alternative arrangements when the ward secretary is off duty. Data were collected prospectively in real time, giving a more accurate healthcare record security snapshot in each data collection point.
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Jalilian, Abdollah, Luigi Sedda, Alison Unsworth, and Martin Farrier. "Length of stay and economic sustainability of virtual ward care in a medium-sized hospital of the UK: a retrospective longitudinal study." BMJ Open 14, no. 1 (January 2024): e081378. http://dx.doi.org/10.1136/bmjopen-2023-081378.
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ObjectiveTo evaluate the length of stay difference and its economic implications between hospital patients and virtual ward patients.DesignRetrospective longitudinal study.SettingWrightington, Wigan and Leigh (WWL) Teaching Hospitals, National Health Service (NHS) Foundation Trust, a medium-sized NHS trust in the north-west of England.ParticipantsVirtual ward patients (n=318) were matched 1:1 to 1:4, depending on matching characteristics, to all hospital patients (n=350). All patients were admitted to the hospital during the calendar year 2022.Outcome measuresThe primary outcome is the length of stay as defined from the date of hospital admission to the date of discharge or death (hospital patients) and from the date of hospital admission to the date of admission in a virtual ward (virtual ward patients). The secondary outcome is the cost of a hospital bed day and the equivalent value of virtual ward savings in hospital bed days. Additional measures were 6-month readmission rates and survival rates at the follow-up date of 30 April 2023.Risk factorsAge, sex, comorbidities and the clinical frailty score (CFS) were used to evaluate the importance and effect of these factors on the main and secondary outcomes.MethodsStatistical analyses included logistic and binomial mixed models for the length of stay in the hospital and readmission rate outcomes, as well as a Cox proportional hazard model for the survival of the patients.ResultsThe virtual ward patients had a shorter stay in the hospital before being admitted to the virtual ward (2.89 days, 95% CI 2.1 to 3.9 days). Chronic kidney disease (CKD) and frailty were associated with a longer length of stay in the hospital (58%, 95% CI 22% to 100%) compared with patients without CKD, and 14% (95% CI 8% to 21%) compared with patients with one unit lower CFS. The frailty score was also associated with a higher rate of readmission within 6 months and lower survival. Being admitted to the virtual ward slightly improved survival, although when readmitted, survival deteriorated rapidly. The cost of a 24-hour period in a general hospital bed is £536. The cost of a day hospital saved by a virtual ward was £935.ConclusionThe use of a 40-bed virtual ward was clinically effective in terms of survival for patients not needing readmission and allowed for the freeing of three hospital beds per day. However, the cost for each day freed from hospital stay was three-quarters larger than the one for a single-day hospital bed. This raises concerns about the deployment of large-scale virtual wards without the existence of policies and plans for their cost-effective management.
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Subedi, Subash, Sheela Koirala, and Saraswati Neupane. "Diversity and occurrence of major diseases of vegetables and fruit crops during spring season at Aanbukhaireni rural municipality of Tanahun district, Nepal." Journal of Agriculture and Natural Resources 2, no. 1 (October 24, 2019): 60–74. http://dx.doi.org/10.3126/janr.v2i1.26043.
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A survey has been conducted to assess the diversity and occurrence of major vegetables and fruits cultivated in Aanbukhaireni rural municipality of Tanahun district, Nepal during spring season of 2019.The surveyed areas were Satrasayaphant, Baradiphant and Dumridanda villages of ward no 1, Yeklephant, Markichowk and Pateni villages of ward no2 , Gaadapani village of ward no 3, Saakhar village of ward no 4 and Ghummaune village of ward no. 5. The surveyed area consists of upper tropical and sub tropical climate. The total no of farmers field selected for the survey was 34, 32, 24, 17 and 21 from ward no 1,2,3,4 and 5 respectively.The major vegetables cultivated during survey period in the surveyed area were bean, bitter-gourd, brinjal, chilli, cowpea, cucumber, okra, pumpkin, sponge-gourd, tomato, snake-gourd and bottle-gourd. Similarly, the fruits found in the region were banana, papaya, grapes, mango, litchi, peach, guava, lemon, mandarin orange etc. The major diseases of vegetables noticed were early blight, late blight, cercospora leaf spot, powdery mildew, downey mildew, fruit rot, bacterial wilt, bacterial spot, leaf curl and mosaic. In case of fruits, sigatoka leaf spot, panama wilt, black rot, algal leaf spot, canker, root rot, foot rot, sooty mold, red rust, anthracnose, rust, mosaic, alternaria leaf spot, downey mildew and leaf curl were the major diseases. The higher disease incidence (70%) and severity (48%) in vegetables were recorded in ward no 2 where as the lower incidence (45.2%) and severity (37.71%) were found in ward no 4. Similarly, the higher fruit disease incidence (70.24%) and severity (51.27%) in ward no 1 followed by ward no 2 with disease incidence and severity of 66.79% and 45.14% respectively. The reasons for those results are low educational level, lack of best bet technology, no proper irrigation and fertilizer, unavailability of pesticides for controlling the diseases. This study will be useful to identify the major diseases of vegetables and fruits of terai and inner terai region of Nepal and applying control measure, looking for the best possible solutions.
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Elias, Elywn. "My ward: the story of St Thomas', Guy's and the Evelina Children's Hospitals and their ward names." Clinical Medicine 11, no. 4 (August 2011): 407. http://dx.doi.org/10.7861/clinmedicine.11-4-407.
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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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Clancy, C., R. Mahony, and V. Meighan. "52 AUDIT CYCLE EXAMINING QUALITY IMPROVEMENT POST EMERGENCY DEPARTMENT MULTI-DISCIPLINARY SIMULATION BASED MEDICAL EDUCATION TRAINING ON HIP FRACTURE CARE." Age and Ageing 50, Supplement_3 (November 2021): ii9—ii41. http://dx.doi.org/10.1093/ageing/afab219.52.
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Abstract Background The care of patients with hip fractures is a surrogate marker of trauma care. Irish hip Fracture Standard 1 involves patients with a hip fracture being admitted to an orthopaedic ward bed within 4 hours of attending the ED. We wanted to audit our current practice and introduce a quality improvement project to improve the timeliness and efficiency of care of our hip fracture patients compared with the gold standard IHFS 1. We introduced a 90 minute multidisciplinary simulation training programme on the hip fracture pathway to our ED in February 2021. All key stakeholders were represented; from Emergency Medicine, Orthopaedics, Nursing (EM and Orthopaedic), Radiology, Radiography, Porters (32 people overall). Because of COVID-19, the training was available in person and online via Zoom. Methods We performed a retrospective audit of patients presenting to TUH ED with a proximal third of femur fracture between 4th February and 31st March inclusive in 2020 and 2021, pre and post introduction of multidisciplinary simulation based medical education on the hip fracture pathway. Data was collected from the electronic record database (Symphony). We recorded the following data; Results 2020 n = 31. Average time to ward—8 hrs 29 mins. 26% patients reached ward <4 hours. (8/31). 2021 n = 25. Average time to ward—5 hrs 58 mins (32% reduction vs 2020). 72% patients reached ward <4 hours. (18/25) (46% increase vs 2020). Conclusion Simulation based medical education is a successful intervention to improve compliance with our hip fracture pathway, time from presentation to transfer to an orthopaedic ward bed and achieve IHFS 1.
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Kim, Chanhee, Geon Kang, Sun Gu Kang, and Heeyoung Lee. "COVID-19 outbreak response at a nursing hospital in South Korea in the post-vaccination era, including an estimation of the effectiveness of the first shot of the Oxford-AstraZeneca COVID-19 vaccine (ChAdOx1-S)." Osong Public Health and Research Perspectives 13, no. 2 (April 30, 2022): 114–22. http://dx.doi.org/10.24171/j.phrp.2021.0262.
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Objectives: We descriptively reviewed a coronavirus disease 2019 (COVID-19) outbreak at a nursing hospital in Gyeonggi Province (South Korea) and assessed the effectiveness of the first dose of the Oxford-AstraZeneca vaccine in a real-world population.Methods: The general process of the epidemiological investigation included a public health intervention. The relative risk (RR) of vaccinated and unvaccinated groups was calculated and compared to confirm the risk of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection, and vaccine effectiveness was evaluated based on the calculated RR.Results: The population at risk was confined to ward E among 8 wards of Hospital X, where the outbreak occurred. This population comprised 55 people, including 39 patients, 12 nurses, and 4 caregivers, and 19 cases were identified. The RR between the vaccinated and unvaccinated groups was 0.04, resulting in a vaccine effectiveness of 95.3%. The vaccination rate of the non-patients in ward E was the lowest in the entire hospital, whereas the overall vaccination rate of the combined patient and non-patient groups in ward E was the third lowest.Conclusion: The first dose of the Oxford-AstraZeneca vaccine (ChAdOx1-S) was effective in preventing SARS-CoV-2 infection. To prevent COVID-19 outbreaks in medical facilities, it is important to prioritize the vaccination of healthcare providers.
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Kowalczuk, Krystyna, Elżbieta Krajewska-Kułak, and Marek Sobolewski. "Factors Determining Work Arduousness Levels among Nurses: Using the Example of Surgical, Medical Treatment, and Emergency Wards." BioMed Research International 2019 (December 31, 2019): 1–12. http://dx.doi.org/10.1155/2019/6303474.
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Introduction. Staff shortages among nurses have been severely felt in most countries around the world for many years. In Poland, this problem is particularly visible due to the lowest nursing employment rate per 1000 inhabitants among 28 EU states and the high rate of leaving the profession. The average age of Polish nurses has been constantly growing for several years—in 2016 it was 50.79, while in 2008 it was 44.19. These data confirm that young nurses are the first to leave the profession. Diagnosis of the working conditions and psychosocial burden level among nurses should be subject to detailed analysis, so that leaving the profession will not additionally deepen the difficult staffing situation in health care. Aim. The aim of the study was to identify factors affecting the assessment of work arduousness levels among nursing personnel. Materials and Methods. The study was conducted among 573 nurses working on surgical, medical treatment, and emergency wards. A standardized job evaluation questionnaire was used to conduct the survey. Results. (1) Stress levels depended on the ward in which the surveyed person worked. Nurses working in the emergency ward assessed their conditions the best, with the lowest stress. The average general result in this group was 38.1 points versus 46 and 45.7 points in the surgical and medical treatment wards, respectively. (2) At the level of the whole studied group, both the nurses’ age and work experience did not differ statistically significantly in the total assessment of working conditions. Differences in the assessment of work arduousness in different age categories occurred at the level of individual wards. In the surgical ward, younger employees were characterized by higher stress levels, especially in the area of arduousness (p=0.0165). In the medical treatment wards, there was a similar age-to-stress ratio for the area of organizational uncertainty (p=0.0063). With age, employees of the emergency ward became more indifferent to stress related to unpleasant working conditions (p=0.0009), while stress related to organizational uncertainty increased (p=0.0495). (3) Nurses working in managerial positions assessed the overall stress related to their job higher than other nurses. They were particularly at risk for burdens related to haste, responsibility, and organizational uncertainty. The average overall assessment of work arduousness for this group was 44.6 points, while for surgical nurses it was 37.2 points. Correlations between the performed function and stress levels were found for almost all of the studied work characteristics (except for hazards). (4) Education had a statistically significant impact on the perception of working conditions in several dimensions. The people with the lowest education evaluated working conditions the best. The difference between people with a higher and those with a secondary education with a specialization was definitely smaller and often nonexistent. Education differentiated the work arduousness assessment depending on the ward. The most statistically significant correlations were obtained in surgical wards, and the least in medical treatment wards. Conclusions. (1) The study results indicate the need to diagnose problems related to work conditions in the context of occupational stress within individual hospital wards. To limit employee turnover, nursing staff managers should approach the issue of improving working conditions individually for each ward, due to differences in the nature of the work and level of stressogenicity. (2) In each hospital ward, employees at different stages of their career are sensitive to the psychosocial burden resulting from different work characteristics. These areas should be thoroughly diagnosed and the burden minimized to prevent departures from the profession—at early stages of the professional career as well as among experienced personnel. (3) Nurses working in managerial positions should receive the necessary substantive support, due to the higher stress burden associated with greater responsibility.