...Dykes PC1, Carroll DL, Hurley A, Lipsitz S, Benoit A, Chang F, Meltzer S, Tsurikova R, Zuyov L, Middleton B. Fall prevention in acute care hospitals: a randomized trial PubMed.gov 2010 Quantitative Cluster randomized study 4 urban United States hospitals in units that received typical care (4 units and 5104 patients) or the intervention of a fall prevention tool kit (4 units and 5160 patients). Patient fall rates in US hospitals was the focus of study. The primary outcome was patient falls per 1000 patient-days, adjusted for site and patient care unit. A secondary outcome was fall-related injuries to patients in these units. Number of patients that experienced a fall differed between the control (n = 87) and the intervention (n = 67) with...
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...approaches in developing acute skills for nurses in critical care wards. In this section of the literature review, we will discuss policies in the nursing profession, case studies and various approaches to work based acute skills learning programmes. For our purposes we conducted a literature search using popular medical databases and terms such as ‘acute skills’ ‘learning programmes’ and ‘critical care learning’. Our review highlights on the several important approaches to work based learning ranging from reflective practice to experiential learning and work based formal practical training to enhance professional skills. A learning programme for acute ward nurses responsible for caring of critically ill patients has been the central focus of nursing practice development. According to Coad et al (2002), a work-based learning approach has been found to empower ward staff with the necessary skills of nursing and the authors studied the efficacy of a five-day competency based high dependency skills course in enhancing professionalism and quality of care in nursing. The aims of comprehensive critical care are developing leadership potential and enhancing networking opportunities for nurses within critical care and acute ward areas. Critical care is the most challenging aspect of nursing care and acute skills in nursing are enhanced not just by work-based learning programs but also from first hand nursing and emergency experiences. Titchen (2003) describes emergency care in which one professional...
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...CLINICAL ISSUES Acute care management of older people with dementia: a qualitative perspective Wendy Moyle, Sally Borbasi, Marianne Wallis, Rachel Olorenshaw and Natalie Gracia Aim and objectives. This Australian study explored management for older people with dementia in an acute hospital setting. Background. As the population ages, increasing numbers of older people with dementia are placed into an acute care hospital to manage a condition other than dementia. These people require special care that takes into account the unique needs of confused older people. Current nursing and medical literature provides some direction in relation to best practice management; however, few studies have examined this management from the perspective of hospital staff. Design. A descriptive qualitative approach was used. Method. Data were collected using semi-structured audio-taped interviews with a cross section of thirteen staff that worked in acute medical or surgical wards in a large South East Queensland, Australia Hospital. Results. Analysis of data revealed five subthemes with the overarching theme being paradoxical care, in that an inconsistent approach to care emphasised safety at the expense of well-being and dignity. A risk management approach was used rather than one that incorporated injury prevention as one facet of an overall strategy. Conclusion. Using untrained staff to sit and observe people with dementia as a risk management strategy does not encourage an evidence-based approach...
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...critical care review Transfusion-Related Acute Lung Injury* A Review Mark R. Looney, MD; Michael A. Gropper, MD, PhD, FCCP; and Michael A. Matthay, MD, FCCP Transfusion-related acute lung injury (TRALI) is an underreported complication of transfusion therapy, and it is the third most common cause of transfusion-associated death. TRALI is defined as noncardiogenic pulmonary edema temporally related to transfusion therapy. The diagnosis of TRALI relies on excluding other diagnoses such as sepsis, volume overload, and cardiogenic pulmonary edema. Supportive diagnostic evidence includes identifying neutrophil or human leukocyte antigen (HLA) antibodies in the donor or recipient plasma. All plasma-containing blood products have been implicated in TRALI, with the majority of cases linked to whole blood, packed RBCs, platelets, and fresh-frozen plasma. The pathogenesis of TRALI may be explained by a “two-hit” hypothesis, with the first “hit” being a predisposing inflammatory condition commonly present in the operating room or ICU. The second hit may involve the passive transfer of neutrophil or HLA antibodies from the donor or the transfusion of biologically active lipids from older, cellular blood products. Treatment is supportive, with a prognosis substantially better than most causes of clinical acute lung injury. (CHEST 2004; 126:249 –258) Key words: ARDS; lung injury; pulmonary edema; transfusion; transfusion-related acute lung injury Abbreviations: ALI acute lung injury;...
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...1 Introduction to Clinical Applications Objectives In this chapter we will study • various approaches to the study of disease; • the role of the Centers for Disease Control and Prevention; • common causes of disease; • the distinction between signs and symptoms of disease; • terms used to describe the time course of a disease; and • common abbreviations for medical specialists and specialties. Homeostasis and Disease The body’s tendency to maintain internal stability is called homeostasis. Examples include the body’s relatively stable temperature, blood glucose concentration, hormone levels, acid-base balance, and electrolyte balance. When physiological variables deviate too much from their set point, the body activates negative feedback loops that tend to restore stability and maintain health. In some cases, such as the stoppage of bleeding, positive feedback loops are activated to bring about rapid change. If the attempt to regain homeostasis fails, disease results. There is a strong emphasis in medicine today on promoting wellness through prevention. However, this manual focuses on what happens when prevention fails, homeostasis is disrupted, and disease occurs. The Study of Disease Disease (illness) is any deviation from normal that interferes with correct, life-sustaining bodily function. Literally, the word means dis-ease, the opposite of ease (comfort and normal function). Disease may have underlying structural foundations, such as a broken bone, and its...
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...systematic review of nurses’ inter-shift handoff reports in acute care hospitals” 2013 Outline: A) Introduction. B) Article Analysis. C) Conclusion. Thesis: The present paper provides the analysis of the systematic review “A systematic review of nurses’ inter-shift handoff reports in acute care hospitals” by Poletick & Holly (2010). The influence of this review on clinical practice is discussed. The article “A systematic review of nurses’ inter-shift handoff reports in acute care hospitals” by Poletick & Holly (2010) provides the systematic review of the handoff reports between and among the nurses which ensure the quality exchange of information for the improved health care service. The continuity of care is the major concern for nurses, and the procedure of patient care transfer should take that into account. The objective of the review was stated clearly and mentioned the appraisal and synthesis of the qualitative evidence related to the nursing handoff report. Moreover, the authors aimed at recommending the improvements which would facilitate and enhance the information transfer. by reviewing the qualitative studies which dealt with the real experience of nurses with their inter-shift handoff reports. As the authors admit, this is likely to contribute to the improvement of the patient care. The conclusion on the potential impact of the article on clinical...
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...Review of Clinical Signs Murphy’s Sign of Cholecystitis Series Editor and Contributing Author: Frank L. Urbano, MD Contributing Author: MaryBeth Carroll, RN, BSN C holecystitis is a common condition that results from inflammatory, infectious, metabolic, neoplastic, and congenital disorders. The greatest incidence of acute cholecystitis occurs in adults 30 to 80 years of age. There is a 2 times greater incidence of gallstones in women than in men.1 Cholecystitis is characterized by a recurring mild-tomoderate, right upper quadrant and epigastric abdominal pain. Pain often radiates to the right posterior scapula and back. Nausea, vomiting, low-grade fever, and leukocytosis are often present. Symptoms are commonly associated with consumption of high-fat meals 1 or more hours prior to the onset of pain.1-4 Murphy’s sign may be a useful tool in establishing the diagnosis of cholecystitis. Confirmation of the diagnosis depends on a combination of physical findings and laboratory and imaging studies. A corollary, the sonographic Murphy’s sign, may be useful as well.1-5 SIGNS OF CHOLECYSTITIS MURPHY’S SIGN Elicitation: Palpate the right subcostal area while the patient inspires deeply Positive response: The patient feels pain upon this maneuver and may have an associated inspiratory arrest SONOGRAPHIC MURPHY’S SIGN Elicitation: Palpate the right subcostal area using an ultrasound transducer while the patient inspires deeply Positive response: The patient feels pain upon...
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...A review of evidence supporting the use of Anti-Biotics in the treatment of Acute Otitis Media in children to prevent Mastoiditis. Word count: 1469 Module Leaders Jeshni Amblum & Stuart Rutland Contents Page 1. Front Sheet 2. Contents Page 3. A review of evidence supporting the use of Antibiotics in the treatment of Acute Otitis Media in children to prevent Mastoiditis. 4. Reference List 5. Appendices: i. SECAMB Clinical Management Plan/Patient Group Directive ii. FIGURE 3 - Thompson et al (2009) A review of evidence supporting the use of Antibiotics in the treatment of Acute Otitis Media in children to prevent Mastoiditis. Student no 18830 Rationale The Paramedic Practitioner (PP) role has recently adopted a number of Clinical Management plans and Patient Group Directives (PGD) increasing the scope of practice. One such PGD (Appendix i) allows for the utilisation of antibiotics, namely Amoxicillin and Clarithromycin, for the treatment of Otitis Media (OM). This essay will look at the evidence supporting the use of these antibiotics, their efficacy and if early use prevents OM from developing in to Mastoiditis. Its primary aim is to enhance a PP’s knowledge and support education working towards clinical autonomy. Description Otitis Media literally means inflammation of the middle ear (Merriam-Webster 2011) and is predominantly caused by an effusion with in the middle ear caused by Eustachian tube dysfunction (Dhillon and East, 1994...
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... A Case Study on Acute Pancreatitis Secondary to Cholelithiasis Submitted by: Abad, Edryan Calara, Sharika Loradel Casul Mark Jury Corpuz, Trisha Dela Cruz, Marjori Gamboa, Jonalyn Lebico, Elmarie Lopez, Anica Tapawan, Ansherina Tuazon, Serleen March 09, 2012 Acknowledgement We would like to thank the following to the development of this case study. Mrs. Edna Oraye-Imperial, Dean, PCU – Mary Johnston College of Nursing, for her support and for allowing us to have our related learning experiences in the clinical area that hone our knowledge skills and attitude to be a competent, caring, Christian nurses. Ms. Ma. Lourdes Galima, Clinical Instructor, for continually guiding and supporting us throughout our duty at the Surgery ward, for helping us in enhancing and improving our skills in the area. For the patience that she showed us despite of our attitude and mistakes. Ms. Loreto Vicarme, School Librarian, for allowing us to utilize the library books and references for our case study. To the staff nurses on duty at the Surgery Intensive Care Unit and Ward of Mary Johnston Hospital for the support and providing us with enough information about the routines in the area which we were able to apply. To our fellow group members for their continuous support and sharing their knowledge and experiences for polishing this case study. To the patient, as well as her family members, for being cooperative and compliant to our nursing care and health...
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...Community Health Nursing Case Study Mr. Evans is a new patient to this nurse. This is the first home visit and upon presentation the patient has tachycardia and presumably newly diagnosed Atrial fibrillation, for which he takes Digoxin. According to records last Digoxin level was two months ago. Respiration are increased and adventitious breath sounds are noted. Patient states that this is his baseline. Patient has COPD and takes Proventil PRN and Theo-Dur twice a day. Patient reports he had a hospitalization for “congestion in his heart” and is currently on Lasix 40 BID. Patent denies any acute distress, home health aid reports recent weight loss, loose stools and complaint of nausea. This nurse in the field would interview the patient and his wife after the clinical assessment. I would ask about any anorexia, loose stools, nausea and or vomiting. Patient does take a stool softener daily. After assessing attend skin turgor and sign if dehydration, this nurse would investigate when the patient takes his medication, and if he has been missing any doses of meds. This nurse would ask when his next cardiology follow up is and when he is due for any labs including a BMP since 40 mg of Lasix twice a day is a higher dose, and for a current digoxin level. This nurse would ask how the patient is sleeping and how often he is using his rescue inhaler for shortness of breath and wheezing. This nurse would ask when his next follow up with oncology is and how long...
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...top 10 conditions for which most patients seek medical care for. Some physicians show considerable variability in describing the signs and symptoms when it is necessary to its diagnosis. A cough is also a most common symptom bringing patients to the primary care physician’s office, and bronchitis is usually the diagnosis in these patients. However, studies have indicated that many physicians treat bronchitis with antibiotics. These drugs have generally shown to become ineffective in patients with complicated bronchitis. A patient satisfaction with their treatment of bronchitis is related to the quality of the physician-patient interaction rather than to the prescription of an antibiotic. Bronchitis Bronchitis is an inflammation of the membrane that lines the air passages, or, bronchial tubes, of the lungs and results in the narrowing of these air passages. This disorder may be of either an acute or chronic type. Irritation of mucus-producing glands within the membrane results in the production of excess bronchial secretions. The main symptoms of bronchitis are cough and increased expectoration of sputum, with or without associated wheezing and shortness of breath. Men are more of a target to bronchitis then most women, men out numbering them 10 to 1 for reasons that are unclear. Acute bronchitis is a self-limited infection of the lower respiratory tract causing inflammation of the bronchi. Acute bronchitis is an acute illness lasting less than three weeks with coughing as...
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...Ethical Consideration Simarjeet Bassi Grand Canyon University July 28, 2013 Research Summary and Ethical Considerations “Nursing Staff’s Awareness of Keeping Beds in the Lowest Position to Prevent Falls and Fall Injuries In an Adult Acute Surgical Inpatient Care Setting” Huey-Ming Tzeng, Chang-Yi Yin, Allison Anderson, and AtuI Prakash Background: In medical care centers and in hospitals a major concern is falling of inpatients from their bed. This problem becomes more serious while dealing with old age patients in care for acute surgical or post op care. Presented study has addressed these issues and suggested that most of these fall related injuries [Anderson, Boshier and Hanna (2012)] could be prevented by examining the factors which could be controlled and applying measures to control them. Also those factors which could not be controlled measures to prevent them according to need of individual and specific medical setting should be applied. This study is very important and significant to nursing practice as according to Quigley and associates (2007) has pointed out that severity of injuries due to fall could be minimized with the help of an interdisciplinary team of which nurses are most important part. It help the nurse to provide the education how to prevent from fall and any serious injury through the falling time. On other...
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...Evolution of New and Old Communicable Diseases According to Gordis (2004), epidemiology is defined as “the study of the distribution and determinants of health related states and event of diseases in specified populations and the application of this study to control of health problems”. Severe acute respiratory syndrome (SARS) is contagious and potentially life threatening form of pneumonia which was first detected in February 2003 in Asia and it spread to various countries in Europe, North America and South America before it was declared as SARS 2003 global outbreak (Centers for Disease Control and Prevention, 2004). SARS is an acute respiratory tract illness caused by an infectious virus transmitted from person to person. Various pathogens that cause acute respiratory diseases are respiratory syncytical virus, parainfluenza virus, influenza virus and severe acute respiratory syndrome-associated coronavirus (SARS-CoV) (WHO, 2007). In 2003, various scientists across the world started investigating the virus with the help of electron microscopy and virus discovery microarrays. The new coronavirus was inoculated in monkeys which caused interstitial pneumonia similar to SARS (Holmes, 2003). This newly identified acute viral respiratory syndrome caused by a novel coronavirus is a positive-stranded RNA virus with genome containing nucleocapsid protein, membrane proteins and spike protein which forms the typical “coronavirus” structure (Lashley & Durham, 2007). Spreading...
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...THE AUSTRALIAN HEALTH CARE SYSTEM: THE POTENTIAL FOR EFFICIENCY GAINS A REVIEW OF THE LITERATURE Background paper prepared for the National Health and Hospitals Reform Commission June 2009 This paper was prepared at the Commission’s request by staff of the secretariat to the Commission. The lead author was Emily Hurley. Ian McRae Ian Bigg Liz Stackhouse Anne-Marie Boxall and Peter Broadhead provided some input and commented on drafts. This is a paper prepared as background for the NHHRC. The views and findings expressed in it should not be taken to be the views of the NHHRC or of the Australian Government. 2 TABLE OF CONTENTS Introduction ....................................................................................................4 International overview of efficiency .............................................................4 Health status – due to more than the health care system ............................7 An Australian focus ......................................................................................8 Summary ......................................................................................................8 A framework for efficiency............................................................................9 Operational Efficiency .................................................................................10 Health sub-sectors .....................................................................................11 Hospitals...........
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...Symptom Presentation and Treatment for Women Experiencing Acute Coronary Syndromes: Do They Differ from Men? Symptom Presentation and Treatment for Women Experiencing Acute Coronary Syndromes: Do They Differ from Men? There is an overwhelming cultural perception in the United States that coronary artery disease and heart attacks are a disease affecting men and that they are most deadly to the male species. In fact, Acute Myocardial Infarctions, or heart attacks, kill more women then all cancers combined and a female experiencing a heart attack is more likely to die from it than a man (Shirato & Swan 2010). Is there a difference between the way women and men experience an Acute Coronary Syndrome (ACS) whether it is Unstable Angina or a true Acute Myocardial Infarction (AMI)? Numerous studies have identified the symptoms females experience when they are suffering from a cardiac event and compared them to males resulting in noteworthy trends identified in the female symptoms. It is also noted that the perception of female cardiac symptoms by the lay community, the health care community and the patients themselves, contribute to the increased death rate in women with AMI. With improved public health education focused on what we’ve learned about the prevalence and seriousness of women experiencing an ischemic cardiac event and their unique symptoms, along with improved training for health care providers that promotes early recognition and aggressive medical...
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