scholarly journals 49 A Quality Improvement Project to Assess and Refine the Handover Process at Morning Trauma Meetings

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
S Sadiq ◽  
M Tahir ◽  
I Nur ◽  
S Elerian ◽  
A Malik
Keyword(s):  
Categorical Variables ◽  
Next Of Kin ◽  
Chi Square ◽  
Neck Of Femur ◽  
Improvement Project ◽  
Handover Process ◽  
Neck Of Femur Fracture ◽  
The Impact ◽  
Standard Operating Protocol

Abstract Introduction Poor handover between shifts can result in patient harm. This study was designed to evaluate the impact of implementing a handover protocol on the quality of information exchanged in the trauma handover meetings in a UK hospital. Method A prospective single-centre observational study was performed at an NHS Trust. Ten consecutive weekday trauma meetings, involving 43 patients, were observed to identify poor practices in handover. This data was used in conjunction with the Royal College of Surgeons’ recommendations for effective handover (2007) to create and implement a standard operating protocol (SOP). Following its implementation, a further 8 consecutive meetings, involving a further 47 patients, were observed. The data was analysed using t-test for quantitative variables and chi-square or Fisher’s exact tests for categorical variables. Results An improvement was demonstrated in multiple aspects of trauma handover including past medical history, injury date, results, diagnosis, consent, mark, and starvation status (all p < 0.001). Subgroup analyses showed that handover of neck-of-femur fracture patients including information on baseline mobility (p = 0.04), Nottingham-Hip-Fracture Score (p = 0.01), next-of-kin discussion (p = 0.075) and resuscitation status (p = 0.001) all improved following the intervention. Conclusions These results demonstrate that the implementation of a well-structured handover protocol can improve the transmission of critical information in trauma meetings.

scholarly journals Study for the Design of a Protocol to Assess the Impact of Stress in the Quality of Life of Workers

2021 ◽  
Vol 18 (4) ◽  
pp. 1413
Author(s):  
Patricia Concheiro-Moscoso ◽  
Betania Groba ◽  
Francisco José Martínez-Martínez ◽  
María del Carmen Miranda-Duro ◽  
Laura Nieto-Riveiro ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Occupational Stress ◽  
Categorical Variables ◽  
Complete Study ◽  
Stress Coping Strategies ◽  
Personal Level ◽  
Stress Influences ◽  
The Impact ◽  
Positive Effect

(1) Background: Work stress is one of the most relevant issues in public health. It has a significant impact on health, especially the development of mental disorders, causing occupational imbalance. There is a growing interest in the development of tools with a positive effect on workers. To this end, wearable technology is becoming increasingly popular, as it measures biometric variables like heartbeat, activity, and sleep. This information may be used to assess the stress a person is suffering, which could allow the development of stress coping strategies, both at a professional and personal level. (2) Methods: This paper describes an observational, analytical, and longitudinal study which will be set at a research center in A Coruña, Spain. Various scales and questionnaires will be filled in by the participants throughout the study. For the statistical analysis, specific methods will be used to evaluate the association between numerical and categorical variables. (3) Discussion: This study will lay the foundation for a bigger, more complete study to assess occupational stress in different work environments. This will allow us to begin to understand how occupational stress influences daily life activity and occupational balance, which could directly enhance the quality of life of workers if the necessary measures are taken.

scholarly journals 1487. Pneumonia due to Co-Infection in the ICU: Detection and Clinical Significance

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S745-S746
Author(s):  
Casey S Zelus ◽  
Michael Blaha ◽  
Kaeli Samsom ◽  
Jasmine R Marcelin ◽  
Trevor C Van Schooneveld ◽  
...  
Keyword(s):  
Clinical Significance ◽  
Diagnostic Testing ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Categorical Variables ◽  
Chi Square ◽  
Mechanically Ventilated ◽  
Critical Care Units ◽  
Outcomes Measures ◽  
The Impact

Abstract Background Pneumonia is a significant cause of morbidity and mortality, with increasing interest in the detection and clinical significance of co-infection. However, the impact of methodology to obtain lower respiratory samples along with the utility of various microbiological diagnostic testing remains unclear. Methods A single-center retrospective analysis was performed on bronchoalveolar lavage (BAL) samples obtained from mechanically ventilated adults treated in critical care units from August 2012 to December 2017. BAL methodology (bronchoscopic vs blinded), microbiological diagnostic testing, and outcomes measures were obtained. Associations between categorical variables were assessed using Chi-Square or Fisher’s exact tests. Kruskal Wallace tests analyzed differences in distributions of measures between categories based on number of organism types detected. SAS software version 9.4 (SAS Institute Inc., Cary, NC). Results Analysis of the 803 samples that met inclusion criteria found a significant linear association between mortality and number of organism types detected by BAL, with 30 day mortality rates of 43.0%, 47.8%, and 58.3% among those with zero, one, and two or more organisms respectively (p = 0.003). Comparing BALs with at least one organism isolated, the detection of viruses specifically was associated with increased mortality, with the presence and absence of viral organisms corresponding to 56.3% and 46.5% mortality at thirty days (p = 0.03). No association was found between mortality and isolation of acid-fast bacilli, bacteria, or fungi. Co-infection was detected more frequently among bronchoscopic BALs than blinded BALs (26.3% vs 8.6%, p < 0.0001), with more viruses detected bronchoscopic BALs (41.9% vs 13.1%, p < 0.0001), and more bacteria in blinded BALs (41.8% vs 33.0%, p = 0.01). 30 Day Mortality vs Isolation of Specific Organism Types from BAL Number of Organism Types Isolated from BAL Compared to BAL Methodology BAL Methodology vs Isolation of Specific Organism Types Conclusion Co-infection in mechanically ventilated adult patients with pneumonia appears to be a significant risk factor for mortality, with the detection of viral organisms potentially playing an independent role. Within this population, bronchoscopic BALs may have a valuable diagnostic and prognostic methodology. Disclosures All Authors: No reported disclosures

Impact of Training on Livestock Technology Transfer for Rural Poor Farmers Livelihood Improvement in Bangladesh

2021 ◽  
Vol 19 (1) ◽  
pp. 223-235
Author(s):  
MA Hossain ◽  
MS Islam ◽  
A Akhter ◽  
M Rashiduzzaman
Keyword(s):  
Baseline Survey ◽  
Rural Poor ◽  
Flock Size ◽  
Improvement Project ◽  
Feeding Management ◽  
Livelihood Improvement ◽  
Logistic Support ◽  
The Impact ◽  
Farming Households

The study was conducted to evaluate the impact of training facilitated by Nuton Jibon Livelihood Improvement Project (NJLIP) under Social Development Foundation (SDF) for transfer livestock technologies and livelihood improvement for rural poor farmers in Bangladesh. A total of 650 farming households were selected by baseline survey during January 2018 to June 2018.The training and non-training beneficiaries were primary level educated and their family size (4.52) was little lower than the national average (4.9). Average age was 36.73 and 35.12 years for training and non-training farmers, respectively. The rate and amount of loan was found higher with respondent received training than without training. Adoption rate of technologies was higher than the level of idea on the concept of housing, feeding, breeding and marketing. The training beneficiaries improved knowledge and skill on feeding, management and health care of livestock and poultry. Training and demonstration are considered two strong tools for adoption and dissemination of livestock technology. Herd and flock size was increased by training beneficiaries than non-training beneficiaries. Beneficiaries having training on various IGAs have expanded their land and asset possession to a greater extent compared to non-training beneficiaries. Housing and sanitation condition of training beneficiaries were higher than non-training beneficiaries. Increased annual income of training and non-training households was 19.43% and 13.30% where income from different IGAs of livestock was 32.19% and 14.53%, respectively. Livestock were not extremely price sensitive but more sensitive on non-price factors logistic support like institutional support, quality of input and availability of input. Thus, training was treated as vital tools for transfer livestock technologies to influence the poor farmer’s livelihood improvement of training household than non-training household. SAARC J. Agric., 19(1): 223-235 (2021)

scholarly journals A PROSPECTIVE STUDY ON IMPACT OF PATIENT COUNSELLING ON QUALITY OF LIFE AND MEDICATION ADHERENCE IN EPILEPTIC PATIENTS

2016 ◽  
Vol 10 (1) ◽  
pp. 67
Author(s):  
Sathesh Kumar Sukumaran ◽  
Ayswarya P
Keyword(s):  
Quality Of Life ◽  
Medication Adherence ◽  
Patient Counseling ◽  
Chi Square ◽  
Patient Counselling ◽  
T Score ◽  
Epileptic Patients ◽  
A Prospective Study ◽  
The Impact

ABSTRACTObjective: To study the impact of patient counseling on medication adherence and quality of life (QOL) in epileptic patients and to assess the factorsaffecting medication adherence.Methods: This study is a prospective observational study involving 100 patients with an age limit of 8-60 years and those taking Antiepilepticdrugs for at least 3 months. The study population received patient counseling during their first visit. The impact of patient counseling on QOL andmedication adherence was assessed using self-reported questionnaire QOLIE-31 and MMAS-8 between the first visit and the second visit. Statisticalanalysis (Paired t-test and Paired Chi-square test) was performed to analyze the impact of patient counseling on QOL and medication adherence inepileptic patients.Results: A total of 100 patients were included in the study. After providing patient counseling, it was observed that there was a statistically significant(p<0.05) improvement in all domains of QOLIE-31 and MMAS-8 scores. Before counseling, mean overall T-score of QOLIE-31 was 44.08±2.07whichwas changed to 49.14±1.27 after patient counseling with a mean change of 5.06 in overall T-score. In the case of medication adherence, beforecounseling 77% subjects were nonadherent to therapy, after counseling it was reduced to 41%. The common reasons for medication adherence wereforgetfulness, unawareness, therapy related, and economics related. Out of which forgetfulness along with unawareness was the major one.Conclusion: The study described that patient counseling plays a major role in improving QOL and medication adherence.Keywords: QOLIE-31, MMAS-8, Epilepsy, Antiepileptic drugs, Patient counseling.

scholarly journals Vulnerabilidade social e a cárie dentária na primeira infância

2021 ◽  
Vol 2 (6) ◽  
pp. 1550-1562
Author(s):  
Amanda Albuquerque Diniz ◽  
Isabelle Monteiro Da Silva Lima ◽  
Karyne Barreto Gonçalves Marques ◽  
Luiz Carlos Costa Madeira Alves ◽  
Ingrid Cordeiro Monte ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Early Childhood ◽  
Social Vulnerability ◽  
Descriptive Statistics ◽  
Categorical Variables ◽  
Chi Square ◽  
Cross Sectional ◽  
The Social ◽  
Chi Square Test

Objetivo: Estimar a prevalência da cárie em crianças na primeira infância sob vulnerabilidade social. Métodos: Pesquisa do tipo transversal realizada no Instituto da Primeira Infância - Iprede, com crianças sob vulnerabilidade social em Fortaleza, Ceará. A coleta de dados foi realizada, em dezembro de 2018 a abril de 2019, com 363 crianças aleatoriamente, por meio de exame bucal e questionário. Os dados foram analisados através de estatística descritiva e do teste qui-quadrado para variáveis categóricas. Resultados: Observou-se uma prevalência de cárie de 35,6%, e que de 1 a 4 lesões representavam a maior porcentagem (23,7%). Elevado percentual de crianças nunca foi ao dentista (81,3%); semelhante percentual nunca sentiu dor de dente (82,3%). Conclusão: Apesar da vulnerabilidade social, a prevalência de cárie foi baixa, e sugere-se realização de ações para minimizar os efeitos da doença na qualidade de vida e desenvolvimento infantil.   Objective: To estimate the prevalence of caries in children in early childhood under social vulnerability. Methods: Cross-sectional research conducted at the Instituto da Primeira Infância - Iprede, with children under social vulnerability in Fortaleza, Ceará. Data collection was carried out, from December 2018 to April 2019, with 363 children randomly, through oral examination and questionnaire. The data were analyzed using descriptive statistics and the chi-square test for categorical variables. Results: There was a prevalence of caries of 35,6%, with 1 to 4 caries representing the highest percentage (23,7%). A high percentage of children never went to the dentist (81,3%); a similar percentage never experienced toothache (82,3%). Conclusion: Despite the social vulnerability, the prevalence of caries was low, and actions to minimize the effects of the disease on quality of life and child development are suggested.

scholarly journals Improving quality and assessment of referrals to the Enfield Crisis Resolution and Home Treatment Team (ECRHTT)

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S202-S202
Author(s):  
Margarita Kousteni ◽  
John Cousins ◽  
Ajay Mansingh ◽  
Maja Elia ◽  
Yumnah Ras ◽  
...  
Keyword(s):  
Home Treatment ◽  
Absolute Difference ◽  
List Type ◽  
Treatment Team ◽  
Crisis Resolution ◽  
Post Intervention ◽  
Improvement Project ◽  
Consultant Psychiatrist ◽  
The Impact

AimsTriaging referrals to crisis resolution and home treatment teams is a significant undertaking requiring experienced and dedicated staff. We observed that the volume of inappropriate referrals to ECRHTT was high, and that staff processing these often felt inexperienced or lacking in confidence to discharge them back to the referrers and signpost them to appropriate services.The aims of this quality improvement project (QIP) were: a)to reduce the number of inappropriate referrals received by the teamb)to reduce the number of inappropriate referrals accepted by the teamThis would significantly improve access and flow to the service and facilitate better patient care.MethodA pilot study was first completed of the quality (appropriateness/ inappropriateness) and source of all referrals to ECRHTT in January 2019 (n = 177).Subsequently, the consultant psychiatrist for ECRHTT based himself within the assessment team. He was able to closely monitor the referrals, at the same time as providing medical input to patients at their first point of contact. To evaluate the impact of this intervention, the percentage of inappropriate referrals accepted pre- and post-change was compared by re-auditing all referrals received in February 2019 (n = 175).Further interventions were instigated to improve referral quality. These included continuation of psychiatric medical input to the assessment team, teaching sessions for GPs and the crisis telephone service, and weekly meetings with psychiatric liaison and community mental health teams (CMHTs). Change was measured by reassessing the quality of all referrals made to ECRHTT in February 2020 (n = 215).Result46.9% of inappropriate referrals to ECRHTT were accepted in January 2019 compared to 16.9% in February 2019 following the addition of medical input to the assessment team. The absolute difference was 30% (95% CI: 14%–44%, p < 0.001).71% of referrals from GPs were inappropriate in January 2019 compared to 36% in February 2020 post-intervention (difference 35%, 95% CI: 8.84%–55.4%, p < 0.05). Inappropriate referrals from CMHTs decreased from 55.5% to 12% (difference 43.5%, 95% CI: 9.5%–70.3%, p < 0.05). Overall, the percentage of inappropriate referrals fell from 38% to 27.4%, a difference of 10.6% (95% CI: 1.3%–19.8%, p < 0.05). The percentage of inappropriate referrals from liaison teams did not change significantly.ConclusionThis piece of work shows that better engagement with referral sources significantly improved the quality of referrals made to ECRHTT. Interventions included medical input at the point of referral, teaching sessions for general practitioners as well as ongoing liaison with referring teams.

23 Reaudit and Completing the Audit Cycle of Quality of Informed Consent for Surgery on Neck of Femur Fracture in Royal Stoke University Hospital

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
T Khaleeq ◽  
U Hanif ◽  
Y Maqsood ◽  
K Ahmed ◽  
A Patel
Keyword(s):  
Informed Consent ◽  
Femur Fracture ◽  
Limb Length Discrepancy ◽  
University Hospital ◽  
Junior Doctors ◽  
Neck Of Femur ◽  
Audit Cycle ◽  
Neck Of Femur Fracture ◽  
British Orthopaedic Association

Abstract Using guidelines highlighted by the British Orthopaedic Association an reaudit was performed within our department to assess the adequacy of informed consent for NOF fractures to complete the audit cycle. 50 patients were included in the Audit and reaudit. Risk was classified as common, less common, rare and ‘other’. The adequacy of informed consent was evaluated by assessing the quality and accuracy of documentation. Infection, bleeding risks, clots and anaesthetic risks were documented in all patients (100%). Areas of improvement were seen in the documentation of neurovascular injuries (98%), pain (90%) and altered wound healing (87%). There was no significant change in the documentation of failure of surgery (83%) and neurovascular injuries (98%). The Poorly documented risk factors from the initial audit were seen to improve which included mortality (70%), prosthetic dislocation (90%) and limb length discrepancy (50%). There has been a significant improvement in the quality of Informed consent in the department and this could be attributed to the installation of ward posters and verbal dissemination of information to junior doctors. Recommendation for interventions would be to present in the next clinical governance meeting and presenting at the new junior doctors’ induction at August.

scholarly journals Evaluation of the quality of fixed prosthesis impressions in private laboratories in a sample from Yemen

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Nusaiba M. Al-Odinee ◽  
Mohsen Al-Hamzi ◽  
Ibrahim Z. Al-shami ◽  
Ahmed Madfa ◽  
Abdulwahab I. Al-Kholani ◽  
...  
Keyword(s):  
High Frequency ◽  
Categorical Variables ◽  
Chi Square ◽  
Finish Line ◽  
Factors Affecting ◽  
Fixed Prosthodontics ◽  
Impression Technique ◽  
Impression Materials ◽  
Fixed Prosthesis

Abstract Background Fixed prosthodontics require an accurate impression for the teeth and the area to be restored for the laboratory to fabricate the desired restoration without mistakes. This study evaluated the quality of impressions received by private laboratories for the fabrication of fixed prosthesis by describing the frequency of clinically detectable errors and by analyzing association between the various factors involved. Methods 165 impressions were collected from four dental laboratories. Jaw involved, type of tray, size of tray, number of prepared units, type of impression materials, techniques and viscosity in case of elastomeric impressions and type of prosthesis requested were recorded. Data referring to errors and visible defects including errors in finish line, in preparation area, in silicone impression technique and blood in impression were also documented. Factors affecting errors present were also assessed. Association between dentist gender and experience years and impression errors was assessed. Chi square and Fisher exact tests used to examine the association between categorical variables and outcomes. Results The total of error considering not immediately pouring as an error. Alginate was the most impression used. of impressions evaluated (50.9%), 97% were have at least one visible error; 92.1% had errors in finish line, 53.9% had errors in preparation area and (72.8%) of elastomeric impressions were have at least one error in technique. Blood in impression was detected in 52.1% of impressions. Significant association was found between material type and errors in finishing line and preparation area. Significant relationships were found between gender and errors in silicone impression technique (p < 0.05). Conclusion Within the limitations of this study, high frequency of detectable errors was found in fixed prosthesis impressions received by private dental laboratories. This high frequency is of serious concern, as this will result in poor fitted fixed prosthesis provided to patients.

Analysis of an intervention on discharge summary quality and timeliness

2015 ◽  
Vol 3 (3) ◽  
pp. 362 ◽  
Author(s):  
Natalie Rose Mourra ◽  
Jason S Fish ◽  
Michael Adam Pfeffer
Keyword(s):  
Hospital Discharge ◽  
Discharge Summary ◽  
Monetary Incentive ◽  
Regression Modeling ◽  
Improvement Project ◽  
Patient Demographics ◽  
Time To Completion ◽  
The Impact ◽  
Discharge Summaries

Objective: Deficits in communication between inpatient and outpatient physicians in the post-hospital discharge period are common and potentially detrimental to person-centered doctor-patient relationships and to patient health. This study assesses the impact of a hospital discharge improvement project implemented at an urban academic hospital, aimed at improving the timeliness and quality of discharge summaries using a standardized discharge template, education and a small monetary incentive. Methods: A random sample of 624 charts from an academic, urban hospitalist medicine service was analyzed from the pre- and post-project implementation time periods: 2009-2010 and 2010-2011. The sampling was evenly distributed throughout the months of the year. Ordinary linear regression modeling was used to evaluate the impact of the intervention on time to completion; logistic regression modeling was used to assess the impact on the quality of the discharge summaries. Both models control for patient characteristics, hospitalization acuity and in-hospital continuity of care.Results: Unadjusted time to discharge summary completion rates decreased by 2.4 days (p<0.001) between the pre- and post-implementation times. Controlling for patient demographics, acuity of hospitalization and hand-offs between physicians, time to completion of discharge summaries was decreased by 2.17 days (p< 0.001). The odds of including at least 50% of the recommended information into a discharge summary post-intervention was 6.44 (p<0.001) compared to the odds before the intervention, controlling for patient demographics, acuity of hospitalization and hand-offs between physicians. Conclusion: The use of education, a simple formatted recommended discharge template and a small monetary incentive improved both the timeliness and quality of the information exchanged between inpatient and outpatient providers and contributes significantly to a person-centered healthcare.

Anticoagulation in cancer patients in hospice

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e20509-e20509
Author(s):  
H. M. Holmes ◽  
K. T. Bain ◽  
R. Luo ◽  
A. Zalpour ◽  
E. Bruera ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Patient Characteristics ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Length Of Service ◽  
Chi Square ◽  
Patients With Cancer ◽  
Hospice Patients ◽  
The Mean ◽  
The Impact

e20509 Background: Low-molecular weight heparin (LMWH) is preferred over warfarin in patients with thromboembolic disease and active cancer, but no guidelines exist in hospice. Although warfarin may be less safe in hospice patients, hospices may prefer to provide warfarin due to lower cost and less invasiveness compared to LMWHs. We sought to identify disparities in the use of warfarin vs. LMWHs in cancer patients enrolled in hospice. Methods: We analyzed a dataset from a national pharmacy provider for more than 800 hospices. We identified patients with a terminal diagnosis of cancer who were enrolled and died in hospice in 2006 and who were prescribed warfarin or LMWH. Patient characteristics included age, gender, race, cancer diagnosis, length of hospice service, and number of comorbidities. For descriptive comparisons, the Kruskal-Wallis test was used for continuous variables, and the Chi-square test was used for categorical variables. Results: Of 54,764 patients with cancer admitted and deceased in 2006, 3874 (7.1%) were prescribed warfarin, and 1137 (2.1%) were prescribed LMWH. Patients prescribed warfarin (n=576) or enoxaparin (n=5) for treatment of atrial arrhythmias were excluded. The mean age was 70.6 years for warfarin and 64.8 years for LMWH (p<0.0001). The mean and median lengths of service, respectively, were 43.6 days and 23.0 days for warfarin and 35.0 and 18.0 days for LMWH, (p<0.0001). There were no differences for gender, and a higher proportion of white patients were prescribed warfarin. Patients prescribed warfarin had an average of 2.1 comorbid conditions, versus 1.6 conditions for LMWH (p<0.0001). Cancer diagnoses were significantly different between the two groups, with a higher proportion of patients with lung and prostate cancer taking warfarin. Conclusions: Patients prescribed warfarin were older, had more comorbidities, and a longer length of service than patients prescribed LMWHs. Further research is needed to determine the impact of anticoagulation on outcomes, especially cost and quality of life, for cancer patients in hospice. This study raises the need to establish guidelines for the appropriateness of anticoagulation in hospice patients with cancer. No significant financial relationships to disclose.

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