scholarly journals A four-stage evaluation of the Paediatric Yorkhill Malnutrition Score in a tertiary paediatric hospital and a district general hospital

2010 ◽  
Vol 104 (5) ◽  
pp. 751-756 ◽  
Author(s):  
Konstantinos Gerasimidis ◽  
Orla Keane ◽  
Isobel Macleod ◽  
Diana M. Flynn ◽  
Charlotte M. Wright
Keyword(s):  
High Risk ◽  
General Hospital ◽  
Nursing Staff ◽  
Screening Tool ◽  
Nutritional Assessment ◽  
District General Hospital ◽  
Screening Tools ◽  
Lower Sensitivity ◽  
Tertiary Referral Hospital ◽  
Rater Reliability

Paediatric in-patients are at high risk of malnutrition but validated paediatric screening tools suitable for use by nursing staff are scarce. The present study aimed to assess the diagnostic accuracy of the new Paediatric Yorkhill Malnutrition Score (PYMS). During a pilot introduction in a tertiary referral hospital and a district general hospital, two research dietitians assessed the validity of the PYMS by comparing the nursing screening outcome with a full dietetic assessment, anthropometry and body composition measurements. An additional PYMS form was completed by the research dietitians to assess its inter-rater reliability with the nursing staff and for comparison with the Screening Tool for the Assessment of Malnutrition in Paediatrics (STAMP) and the Paediatric Subjective Global Nutritional Assessment (SGNA). Of the 247 children studied, the nurse-rated PYMS identified 59 % of those rated at high risk by full dietetic assessment. Of those rated at high risk by the nursing PYMS, 47 % were confirmed as high risk on full assessment. The PYMS showed moderate agreement with the full assessment (κ = 0·46) and inter-rater reliability (κ = 0·53) with the research dietitians. Children who screened as high risk for malnutrition had significantly lower lean mass index than those at moderate or low risk, but no difference in fat. When completed by the research dietitians, the PYMS showed similar sensitivity to the STAMP, but a higher positive predictive value. The SGNA had higher specificity than the PYMS but much lower sensitivity. The PYMS screening tool is an acceptable screening tool for identifying children at risk of malnutrition without producing unmanageable numbers of false-positive cases.

scholarly journals Discriminating levels of alcohol use associated with self-harm in individuals presenting to a district general hospital

2010 ◽  
Vol 34 (6) ◽  
pp. 226-230 ◽  
Author(s):  
Nicholas Holdsworth ◽  
Hugh Griffiths ◽  
David Crawford
Keyword(s):  
Alcohol Use ◽  
General Hospital ◽  
Screening Tool ◽  
District General Hospital ◽  
Alcohol Screening ◽  
Screening Tools ◽  
Psychosocial Assessment ◽  
Different Types ◽  
Self Harm ◽  
Problematic Alcohol Use

Aims and methodAlthough alcohol is reported as commonly associated with self-harm, there is nothing in the literature that bases the association on validated screening tools. We sought to discern the different types of alcohol use as discriminated by the Alcohol Use Disorders Identification Test (AUDIT). Completed AUDITs from a 2-year period were analysed, all relating to people who had presented to a district general hospital in Northumberland following self-harm.ResultsThe proportion of dependent, harmful and hazardous drinkers identified using AUDIT was many times higher than previously estimated in similar studies that had not used a validated alcohol screening tool.Clinical implicationsThe routine use of an alcohol screening tool should be part of any standard psychosocial assessment of self-harm, to guide appropriate interventions for problematic alcohol use that might otherwise be overlooked.

The problem with gentamicin: reducing administration and prescribing errors in neonates treated for early onset infection with gentamicin

2020 ◽  
pp. edpract-2019-318546
Author(s):  
Ashifa Trivedi ◽  
Elizabeth Lek ◽  
Sadhna Sharma ◽  
Shavindra Chellen
Keyword(s):  
Quality Improvement ◽  
General Hospital ◽  
Nursing Staff ◽  
Early Onset ◽  
District General Hospital ◽  
Moderate Level ◽  
Neonatal Unit ◽  
Prescribing Errors ◽  
Intervention Period ◽  
Low Level

We describe a quality improvement (QI) project to reduce the number of administration and prescribing errors with gentamicin on a local neonatal unit in a district general hospital, from January 2017 to August 2019. Baseline data collected showed seven errors in the first 16 months of the project (from 1999 doses). The aim of this QI project was to have no low-level, moderate-level or severe level harm errors in the intervention period. A number of interventions were carried out including a change to local guidelines and teaching sessions for staff. All Datix reports for gentamicin were reviewed as well as data collected from the pharmacy team for a further 16 months. One low harm error was reported in this period (from 1938 doses). Education of the medical and nursing staff has been a key intervention in reducing our gentamicin errors as well as changing the way we prescribe gentamicin.

A pilot study of tele-oncology in Scotland

1998 ◽  
Vol 4 (2) ◽  
pp. 113-119 ◽  
Author(s):  
Ian H. Kunkler ◽  
Paul Rafferty ◽  
David Foreman ◽  
David Hill ◽  
Maureen Henry
Keyword(s):  
Cost Effectiveness ◽  
Pilot Study ◽  
General Hospital ◽  
Nursing Staff ◽  
Patient Management ◽  
Pilot Trial ◽  
District General Hospital ◽  
Outpatient Services ◽  
Teleradiology System ◽  
The Uk

A pilot study of tele-oncology linking a cancer centre with a rural district general hospital was carried out; it involved patients, physicians, surgeons, radiologists and nursing staff. Its purpose was to complement the existing on-site outpatient services, providing oncological advice on non-clinic days. During the six months of the trial, 18 videoconferences were conducted. Their median duration was 17 min range 7-40 . Eight videoconferences involved patients directly. Acceptability of videoconferencing to doctors, nurses and patients was assessed by a questionnaire. Patients and staff found the technique acceptable and were satisfied with the results. The addition of a teleradiology system to teleconsultations was found to be important when decisions on patient management were taken. Following the success of this pilot trial, larger studies of tele-oncology in the UK with measures of cost-effectiveness are needed.

Is weekend surgery a risk factor for post-tonsillectomy haemorrhage?

2016 ◽  
Vol 130 (8) ◽  
pp. 763-767 ◽  
Author(s):  
A Patel ◽  
N Foden ◽  
A Rachmanidou
Keyword(s):  
Risk Factor ◽  
High Risk ◽  
General Hospital ◽  
General Surgery ◽  
District General Hospital ◽  
Low Risk ◽  
Morbidity And Mortality ◽  
The Uk

AbstractBackground:Tonsillectomy is a common, low-risk procedure. Post-tonsillectomy haemorrhage remains the most serious complication. Recent nationwide studies in the UK have identified an increased morbidity and mortality for both high-risk and low-risk elective general surgery performed at the weekend.Methods:Data for tonsillectomies performed at a district general hospital over a three-year period were retrospectively reviewed. The same group of surgeons performed elective tonsillectomies on both weekends and weekdays. All patients who developed a post-tonsillectomy haemorrhage were identified and the day of original operation was noted.Results:Between 2010 and 2013, 2208 (94.00 per cent) elective tonsillectomies were performed on a weekday and 141 (6.00 per cent) were performed on the weekend. Post-tonsillectomy haemorrhages occurred in 104 patients (4.71 per cent) who underwent their procedure on a weekday and in 10 patients (7.09 per cent) who had their surgery at the weekend (p = 0.20).Conclusion:There is no difference in the rate of post-tonsillectomy haemorrhage for procedures performed on a weekday or weekend.

scholarly journals Development and administration of a screening tool for cardiovascular risk assessment in community pharmacy

2010 ◽  
pp. 133-134
Author(s):  
Dónal Óg O’Donovan
Keyword(s):  
Myocardial Infarction ◽  
Risk Assessment ◽  
High Risk ◽  
Cause Of Death ◽  
Heart Attack ◽  
Screening Tool ◽  
Screening Tools ◽  
Foreseeable Future ◽  
Cardiovascular Risk Assessment ◽  
Fatal Myocardial Infarction

Cardiovascular disease (CVD) was the leading cause of death in 2005, causing 17.5 million deaths globally. In Ireland, 2006 figures indicate that CVD was responsible for 43% of all deaths, and 49% of deaths in people aged less than 65 years. It is predicted to remain the largest cause of death for the foreseeable future. It has been estimated that at least 25% of CVD patients have sudden death or non-fatal myocardial infarction without prior symptoms. It is important to try to develop a method for screening these asymptomatic people. If people at high risk of CVD can be identified early then they can be treated to reduce their risk. This will in turn reduce their incidences of cardiovascular instances (heart attack, stroke, etc.) and their burden on the health service. Screening tools are used to identify those people at high risk of developing CVD. These screening tools take a ...

O003. Validity and acceptability of the Swahili pGALS screening tool at a tertiary referral hospital in Kenya

Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_5) ◽  
Author(s):  
Kawishe Jacqueline ◽  
Ngugi Anthony ◽  
Migowa Angela
Keyword(s):  
Median Time ◽  
Sensitivity And Specificity ◽  
Gold Standard ◽  
Screening Tool ◽  
Clinical Skills ◽  
Lower Sensitivity ◽  
African Countries ◽  
Tertiary Referral Hospital ◽  
Paediatric Rheumatologist

Abstract Background A common reason implicated in the severity of presentation and mortality caused by most rheumatic conditions among children is the delay of presentation to a paediatric rheumatologist. Evidence suggests poor practice of paediatric musculoskeletal clinical skills could be a cause for delay and that history suggestive of musculoskeletal disease alone has poor sensitivity in detecting rheumatological conditions. The paediatrics gait, arms, legs and spine (pGALS) musculoskeletal screening tool was therefore developed to encourage early detection of paediatric rheumatological conditions. It has been validated and translated successfully in other countries. Swahili is well understood and spoken in Kenya and other East African countries and for the pGALS to be incorporated in our setting, we needed to translate and asses its validity in Swahili. The objective is todetermine the sensitivity and specificity of the translated Swahili pGALS screening tool in detecting abnormal joints among children aged 5-16 years. To measure the acceptability of the Swahili pGALS screening tool with reference to time taken performing the examination and the discomfort as perceived by the children and their guardians. Methods We conducted a diagnostic utility study. The three English pGALS screening questions were translated into Swahili according to the WHO standard of translation of a tool and the manoeuvres were performed by a ‘copy me’ approach. The ‘copy me’ approach entailed asking the participants to imitate the research assistants as various manoeuvres were done. Children between the ages of 5–16 years seen at the Aga Khan University Accident and emergency department and family medicine clinic who spoke Swahili and had symptoms suggestive of musculoskeletal conditions were enrolled using systematic random sampling. Children who were already on follow up with the Aga Khan paediatric rheumatologist were excluded. Children had the Swahili pGALS and gold standard review (with the paediatric rheumatologist) on the same day. Guardians were asked to answer questions on acceptability with regards to time taken to perform the tool and level of discomfort. Those with possible rheumatological condition as per the gold standard were offered follow up. Results We enrolled one hundred children with a median age of the children was nine years (IQR 7–11). The sensitivity and specificity of the Swahili pGALS screening tool were 76.8% (CI 63.6–87.0%) and 40.0% (CI 23.9–57.9%). The diagnostic accuracy was 62.7% (CI 52.1–72.1%) and the ROC area was 0.58 (CI 0.48–0.68). The median time taken to perform the Swahili pGALS was 5.0 minutes (IQR 3.5-6.0 minutes). Ninety percent of the guardians found the practice of pGALS to have ‘no’ to ‘some’ discomfort. Conclusions This study had a lower sensitivity and specificity than what was seen with similar studies. Although the sensitivity seen was low, it was still within acceptable range for a screening tool and may still be applicable in Kenya and other Swahili speaking countries if used in conjunction with good rheumatological history to refer early the 76% of children picked up by the screening tool. However, the low specificity implies that relatively large number of false positives would still need to be reviewed by a rheumatologist if the tool is adapted for use. The median time taken to perform the tool was also longer than observed in previous studies but the tool was overall deemed acceptable by majority of the guardians/ parents. Keywords pGALS, Kenya, Swahili, Paediatric, Rheumatology

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