Topographische Orientierung bei Patienten mit erworbener Hirnschädigung

1999 ◽  
Vol 10 (2) ◽  
pp. 77-86
Author(s):  
Martina Kindsmüller ◽  
Andrea Kaindl ◽  
Uwe Schuri ◽  
Alf Zimmer

Topographical Orientation in Patients with Acquired Brain Damage Abstract: A study was conducted to investigate the abilities of topographical orientation in patients with acquired brain damage. The first study investigates the correlation between wayfinding in a hospital setting and various sensory and cognitive deficits as well as the predictability of navigating performance by specific tests, self-rating of orientation ability and rating by staff. The investigation included 35 neuropsychological patients as well as 9 control subjects. Several variables predicted the wayfinding performance reasonably well: memory tests like the one introduced by Muramoto and a subtest of the Rivermead Behavioral Memory Test, the Map Reading Test and the rating by hospital staff. Patients with hemianopia experienced significant difficulty in the task.

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S692-S692
Author(s):  
Jon P Furuno ◽  
Brie N Noble ◽  
Vicki Nordby ◽  
Bo Weber ◽  
Jessina C McGregor ◽  
...  

Abstract Background Nursing homes (NHs) are required by the Centers for Medicare and Medicaid Services to maintain antimicrobial stewardship programs. Hospital-initiated antibiotics may pose a barrier to optimizing antibiotic prescribing in this setting. Our objective was to characterize hospital-initiated antibiotic prescriptions among NH residents. Methods We collected electronic health record data on antibiotic prescribing events within 60 days of residents’ admission to 17 for-profit NHs in Oregon, California, and Nevada between January 1, and December 31, 2017. We characterized antibiotics prescribed, administration route, and proportion initiated in a hospital setting. Results Over the one-year study period, there were 4350 antibiotic prescribing events among 1633 NH residents. Mean (standard deviation) age was 77 (12) years and 58% were female. Approximately 45% (1,973/4,350) of antibiotics prescribed within 60 days of NH admission were hospital-initiated. The most frequently prescribed hospital-initiated antibiotics were cephalosporins (27%; 1st gen: 54%, 2nd gen: 6%, 3rd gen: 34%, 4th gen: 5%, 5th gen: 1%), fluoroquinolones (20%), and penicillins (14%; natural penicilins: 4%, semisynthetic penicillins: 3%, aminopenicillans: 57%, β-lactam/β-lactamase inhibitors: 21%, and antipseudomonal penicillins: 15%). Additionally, 24% of antibiotics were parenteral and the median (interquartile range) duration of therapy was 6 (3–10) days. Over 15% of residents with hospital-initiated antibiotics were readmitted to the hospital within 30 days. Conclusion Approximately 45% of antibiotic prescribing in a multistate sample of NHs were hospital-initiated, of which roughly 40% was broad-spectrum. Interventions specifically targeting antibiotic prescribing during and following the transition from hospitals to NHs are needed. Disclosures All authors: No reported disclosures.


Author(s):  
Abera Kenay Tura ◽  
Yasmin Aboul-Ela ◽  
Sagni Girma Fage ◽  
Semir Sultan Ahmed ◽  
Sicco Scherjon ◽  
...  

With postpartum hemorrhage (PPH) continuing to be the leading cause of maternal mortality in most low-resource settings, an audit of the quality of care in health facilities is essential. The purpose of this study was to identify areas of substandard care and establish recommendations for the management of PPH in Hiwot Fana Specialized University Hospital, eastern Ethiopia. Using standard criteria (n = 8) adapted to the local hospital setting, we audited 45 women with PPH admitted from August 2018 to March 2019. Four criteria were agreed as being low: IV line-setup (32 women, 71.1%), accurate postpartum vital sign monitoring (23 women, 51.1%), performing typing and cross-matching (22 women, 48.9%), and fluid intake/output chart maintenance (6 women, 13.3%). In only 3 out of 45 women (6.7%), all eight standard criteria were met. Deficiencies in the case of note documentation and clinical monitoring, non-availability of medical resources and blood for transfusion, as well as delays in clinical management were identified. The audit created awareness, resulting in self-reflection of current practice and promoted a sense of responsibility to improve care among hospital staff. Locally appropriate recommendations and an intervention plan based on available resources were formulated.


2020 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Stephanie Petty ◽  
Amanda Griffiths ◽  
Donna Maria Coleston ◽  
Tom Dening

Purpose Improving hospital care for people with dementia is a well-established priority. There is limited research evidence to guide nursing staff in delivering person-centred care, particularly under conditions where patients are emotionally distressed. Misunderstood distress has negative implications for patient well-being and hospital resources. The purpose of this study is to use the expertise of nurses to recommend ways to care for the emotional well-being of patients with dementia that are achievable within the current hospital setting. Design/methodology/approach A qualitative study was conducted in two long-stay wards providing dementia care in a UK hospital. Nursing staff (n = 12) were asked about facilitators and barriers to providing emotion-focused care. Data were analysed using thematic analysis. Findings Nursing staff said that resources existed within the ward team, including ways to gather and present personal information about patients, share multidisciplinary and personal approaches, work around routine hospital tasks and agree an ethos of being connected with patients in their experience. Staff said these did not incur financial cost and did not depend upon staffing numbers but did take an emotional toll. Examples are given within each of these broader themes. Research limitations/implications The outcome is a short-list of recommended staff actions that hospital staff say could improve the emotional well-being of people with dementia when in hospital. These support and develop previous research. Originality/value In this paper, frontline nurses describe ways to improve person-centred hospital care for people with dementia.


Author(s):  
Isadora Cristina Ribeiro ◽  
Joao Paulo Borin

The training of a motor skill promotes physical performance and depends on several variables. For women, the menstrual cycle is the one to be highlighted. Studies have focused on the analysis motor skills during this period and emphasize hormonal issues with low attention to the physcal performance. Thus, the objective of this study was to verify the physical performance in different motor skills during the phases of the menstrual cycle in two different cycles. During eight weeks, twelve women, divided into a trained and begginer group, underwent training for different motor skills, and at each stage of the menstrual cycle performed performance tests. The results suggest a higher strength of the lower limbs and a greater capacity of endurance in the Luteal phase in relation to the Follicular phase, but for the flexibility there were no significant differences, suggesting that there is no influence of the menstrual cycle on this motor skill.


2010 ◽  
Vol 15 (20) ◽  
Author(s):  
M Grgic-Vitek ◽  
T Frelih ◽  
V Ucakar ◽  
K Prosenc ◽  
J Tomažič ◽  
...  

After ten years of being measles free, Slovenia experienced a cluster with secondary transmission in a hospital setting in March 2010. The index case, a resident of Ireland, was hospitalised on the day after his arrival to Slovenia and diagnosed with measles two days later. After his discharge, two cases of measles were notified, a hospital staff member and a visitor to the clinic, suggesting transmission in a hospital setting.


2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S678-S678
Author(s):  
Marco Villanueva Reza ◽  
Lorena Lanz-Zubiria ◽  
Israel Rojas de Ita ◽  
Paulo Castañeda-Méndez ◽  
Esperanza Aleman Aguilar ◽  
...  

Abstract Background Hospital-acquired multi-drug-resistant organisms (HA-MDRO) infections are associated with increased cost, length of stay, morbidity, and mortality. The prevalence of HA-MDRO has been increasing worldwide. We look to describe how the implementation of local guidelines as an app available for tablets or cellphones in our hospital in 2014 decrease the prevalence of HA-MDRO. Methods Local guidelines were implemented as an electronic application available and intended for hospital staff only. This app gives local patterns of resistance for bacteria with treatment recommendations alongside suggested antimicrobial drugs for empiric treatment. Descriptive statistics were performed. Results In 2013, before implementing the app, HA-MDRO were reported in 25% of hospital-acquired infection. After the introduction of the app, compliance in 2014 was 56.7% with HA-MDRO reported in 20%, 2015 use was 60.7% and HA-MDRO in 18%, 2016 compliance 68.7% and HA-MDRO in 16%, 2017 compliance in 73.7% and HA-MDRO in 14%, lastly in 2018 prevalence was 15% of HA-MDRO while use of local guidelines was 78.7%. Different type of infections (VAP, HAP, UTI, SSI, BSI) also decreased while following guidelines recommendations. Conclusion These programs are needed as a part of the healthcare program to control the HA-MDRO morbidity and complications. Simple friendly-user electronic applications such as the one implemented in our hospital led to higher compliance and lower hospital-acquired infections. Antimicrobial stewardship programs and local guidelines should be part of the standard of care of all hospitals. Disclosures All authors: No reported disclosures.


2016 ◽  
Vol 29 (3) ◽  
pp. 467-474 ◽  
Author(s):  
Joanne Tropea ◽  
Dina LoGiudice ◽  
Danny Liew ◽  
Carol Roberts ◽  
Caroline Brand

ABSTRACTBackground:Best practice dementia care is not always provided in the hospital setting. Knowledge, attitudes and motivation, practitioner behavior, and external factors can influence uptake of best practice and quality care. The aim of this study was to determine hospital staff perceived barriers and enablers to implementing best practice dementia care.Methods:A 17-item survey was administered at two Australian hospitals between July and September 2014. Multidisciplinary staff working in the emergency departments and general medical wards were invited to participate in the survey. The survey collected data about the respondents’ current role, work area, and years of experience, their perceived level of confidence and knowledge in dementia care and common symptoms of dementia, barriers and enablers to implementing best practice dementia care, job satisfaction in caring for people with dementia, and to rate the hospital's capacity and available resources to support best practice dementia care.Results:A total of 112 survey responses were received. The environment, inadequate staffing levels and workload, time, and staff knowledge and skills were identified as barriers to implementing best practice dementia care. Most respondents rated their knowledge of dementia care and common symptoms of dementia, and confidence in recognizing whether a person has dementia, as moderate or high dementia. Approximately, half the respondents rated access to training and equipment as low or very low.Conclusion:The survey findings highlighted hospital staff perceived barriers to implementing best practice dementia care that can be used to inform locally tailored improvement interventions.


2020 ◽  
Author(s):  
Lai Meng Ow Yong ◽  
Xiaohui Xin ◽  
Jennifer Mei Ling Wee ◽  
Ruban S/O Poopalalingam ◽  
Kenneth Yung Chiang Kwek ◽  
...  

Abstract Background: Emergency risk communication is a critical component in emergency planning and response. It has been recognised as significant for planning for and responding to public health emergencies. While there is a growing body of guidelines and frameworks on emergency risk communication, it remains a relatively new field. There has also been limited attention on how emergency risk communication is being performed in public health organisations, such as acute hospitals, and what the associated challenges are. This article seeks to examine the perception of crisis and emergency risk communication in an acute hospital in response to COVID-19 in Singapore and to identify its associated enablers and barriers. Methods: A 13-item Crisis and Emergency Risk Communication (CERC) Survey, based on the US Centers for Disease and Control (CDC) CERC framework, was developed and administered to hospital staff during February 24-28, 2020. The survey also included an open-ended question to solicit feedback on areas of CERC in need of improvement. Chi-square test was used for analysis of survey data. Thematic analysis was performed on qualitative feedback. Results: Of the 1154 participants who responded to the survey, most (94.1%) reported that regular hospital updates on COVID-19 were understandable and actionable. Many (92.5%) stated that accurate, concise and timely information helped to keep them safe. A majority (92.3%) of them were clear about the hospital’s response to the COVID-19 situation, and 79.4% of the respondents reported that the hospital had been able to understand their challenges and address their concerns. Sociodemographic characteristics such as occupation, age, marital status, work experience, gender, and staff’s primary work location influenced the responses to hospital CERC. Local leaders within the hospital would need support to better communicate and translate hospital updates in response to COVID-19 to actionable plans for their staff. Better communication in executing resource utilisation plans, expressing more empathy and care for their staff, and enhancing communication channels, such as through the use of secure text messaging rather than emails would be important. Conclusions: CERC is relevant and important in the hospital setting to managing COVID-19 and should be considered concurrently with hospital emergency response domains.


2021 ◽  
Author(s):  
Geoffrey Canet ◽  
Charleine Zussy ◽  
Célia Hernandez ◽  
Nathalie Chevallier ◽  
Nicola Marchi ◽  
...  

Introduction: Among the risk factors identified in the sporadic forms of Alzheimer’s disease (AD), environmental and lifestyle elements are of growing interest. Clinical observations suggest that stressful events can anticipate AD onset, while stress-related disorders can promote AD. Here, we tested the hypothesis that a chronic treatment with glucocorticoids, is sufficient to trigger or exacerbate AD molecular hallmarks. Methods: We first validated a rat model of experimental chronic glucocorticoids consumption (corticosterone in drinking water for 4 weeks). Then, to evaluate the consequences of chronic glucocorticoids consumption on the onset of amyloid-β (Aβ) toxicity, animals chronically treated with glucocorticoids were intracerebroventricularly injected with an oligomeric solution of Aβ25-35 (oAβ) (acute model of AD). We evaluated AD-related cognitive deficits and pathogenic mechanisms, with a special emphasis on neuroinflammatory markers. Results: Chronic corticosterone consumption caused the inhibition of the non-amyloidogenic pathways, the impairment of Aβ clearance processes and the induction of amyloidogenic pathways in the hippocampus. The principal enzymes involved in glucocorticoid receptor (GR) activation and Tau phosphorylation were upregulated. Importantly, the AD-like phenotype triggered by chronic corticosterone was analogous to the one caused by oAβ. These molecular commonalities across models were independent from inflammation, as chronic corticosterone was immunosuppressive while oAβ was pro-inflammatory. When chronic corticosterone consumption anticipated the induction of the oAβ pathology, we found a potentiation of neuroinflammatory processes associated with an exacerbation of synaptic and memory deficits but also an aggravation of AD-related hallmarks. Discussion/Conclusion: This study unravels new functional outcomes identifying chronic corticosterone consumption as a main risk factor for AD and suggests that glucocorticoid-based therapies should be prescribed with caution in populations with AD risk.


Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Stephanie M Teixeira-Poit ◽  
Jacqueline Amoozegar ◽  
Joanna Elmi ◽  
Megan Chambard ◽  
Kyle Emery ◽  
...  

Introduction: Between 2012-2015 the Centers for Disease Control and Prevention’s (CDC) Paul Coverdell National Acute Stroke Program (PCNASP) funded 11 state health departments to improve the quality of stroke care across the continuum, beginning with the initial signs and symptoms of stroke through the transition from hospital to post-hospital setting. Hypothesis: We assessed the hypothesis that PCNASP quality improvement activities enhanced the quality of pre-hospital stroke care transitions. Methods: We conducted 72 semi-structured telephone interviews with stakeholders of the 11 PCNASP grantees, including program administrators, epidemiologists, quality improvement consultants, partners, emergency medical services (EMS) and hospital staff. Using grounded theory (Glaser and Strauss), we developed and applied a coding scheme to the interview transcripts to identify emerging themes related to pre-hospital quality improvement activities. Results: Many PCNASP grantees provided training and support for EMS and hospital staff that improved calling of a stroke code team and recognition of stroke, improved EMS pre-notifications about suspected stroke patients, advanced hospital holding of CT scanners in anticipation of suspected stroke patients, and reduced door-to-CT and door-to-needle time. PCNASP grantees had different approaches to balancing timeliness and quality of care. Some grantees developed statewide destination protocols that required EMS to bypass proximate hospitals for certified stroke care hospitals. Other grantees had challenges implementing statewide destination protocols because EMS agencies were decentralized with local authority to determine where to transport patients. In other cases, grantees promoted a “drip and ship” model where EMS transported patients to proximate hospitals for IV-tPA and then to a primary stroke center and focused on increasing the reach of stroke telemedicine. Conclusion: PCNASP grantees developed promising practices to improve the quality of pre-hospital stroke care transitions that accounted for their unique state context. These approaches may become the basis for best practices for improving pre-hospital transitions of stroke care across the nation.


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