Life on the wards

This chapter discusses life on the wards. It includes the medical team, the multidisciplinary team, daily ward duties, ward rounds, being on-call, night shifts, writing and common symbols in the notes, anatomical terms and planes, discharge summaries (TTOs/TTAs), fitness to work notes, referrals, referral letters, investigation requests, radiology, common ward dilemmas, pain, thinking about death, palliative care, the dying patient, death, nutrition, nutritional requirements, difficult patients, aggression and violence, needle-stick injuries, surgery, pre-op assessment, bowel preparation, surgical terminology, preparing in-patients for surgery, booking theatre lists, surgical instruments, the operating theatre, post-op care, post-op problems, wound management, common elective operations, and stomas.

Download Full-text

Life on the wards

10.1093/med/9780199683819.003.0002 ◽

2014 ◽

Author(s):

Tim Raine ◽

James Dawson ◽

Stephan Sanders ◽

Simon Eccles

Keyword(s):

Multidisciplinary Team ◽

Medical Team ◽

Ward Rounds ◽

Referral Letters ◽

Night Shifts ◽

Fitness To Work ◽

Discharge Summaries

The medical teamThe multidisciplinary teamDaily ward dutiesWard roundsBeing on-callNight shiftsWriting in the notesCommon symbols in the notesAnatomical terms and planesFormsDischarge summaries (TTOs/TTAs)Fitness to work notesReferralsReferral lettersInvestigation requestsRadiologyCommon ward dilemmas...

Download Full-text

A Narrative Review of the History of Skin Grafting in Burn Care

Medicina ◽

10.3390/medicina57040380 ◽

2021 ◽

Vol 57 (4) ◽

pp. 380

Author(s):

Deepak K. Ozhathil ◽

Michael W. Tay ◽

Steven E. Wolf ◽

Ludwik K. Branski

Keyword(s):

Donor Site ◽

Subsequent Development ◽

Skin Grafting ◽

Human Condition ◽

Surgical Instruments ◽

Wound Management ◽

Burn Wound ◽

Medical Progress ◽

Burn Care ◽

History Of

Thermal injuries have been a phenomenon intertwined with the human condition since the dawn of our species. Autologous skin translocation, also known as skin grafting, has played an important role in burn wound management and has a rich history of its own. In fact, some of the oldest known medical texts describe ancient methods of skin translocation. In this article, we examine how skin grafting has evolved from its origins of necessity in the ancient world to the well-calibrated tool utilized in modern medicine. The popularity of skin grafting has ebbed and flowed multiple times throughout history, often suppressed for cultural, religious, pseudo-scientific, or anecdotal reasons. It was not until the 1800s, that skin grafting was widely accepted as a safe and effective treatment for wound management, and shortly thereafter for burn injuries. In the nineteenth and twentieth centuries skin grafting advanced considerably, accelerated by exponential medical progress and the occurrence of man-made disasters and global warfare. The introduction of surgical instruments specifically designed for skin grafting gave surgeons more control over the depth and consistency of harvested tissues, vastly improving outcomes. The invention of powered surgical instruments, such as the electric dermatome, reduced technical barriers for many surgeons, allowing the practice of skin grafting to be extended ubiquitously from a small group of technically gifted reconstructive surgeons to nearly all interested sub-specialists. The subsequent development of biologic and synthetic skin substitutes have been spurred onward by the clinical challenges unique to burn care: recurrent graft failure, microbial wound colonization, and limited donor site availability. These improvements have laid the framework for more advanced forms of tissue engineering including micrografts, cultured skin grafts, aerosolized skin cell application, and stem-cell impregnated dermal matrices. In this article, we will explore the convoluted journey that modern skin grafting has taken and potential future directions the procedure may yet go.

Download Full-text

Perception of Fatigue Among Surgeons During Night Shifts

Bulletin of The Royal College of Surgeons of England ◽

10.1308/147363513x13690603821026 ◽

2013 ◽

Vol 95 (7) ◽

pp. 1-5 ◽

Cited By ~ 3

Author(s):

I Amirian ◽

AK Danielsen ◽

J Rosenberg

Keyword(s):

Time Pressure ◽

Night Shift ◽

Sleep Time ◽

Work Hours ◽

Impaired Performance ◽

Impaired Cognition ◽

Long Work Hours ◽

Call Night ◽

Night Shifts ◽

Increase In Risk

It is well known that sleep deprivation induces fatigue and that fatigue induces impaired cognition. Studies have demonstrated that long work hours, restricted sleep, time pressure and high demands may cause impaired performance in physicians. Some studies have shown through laparoscopic simulation that surgeons, when deprived of sleep, take longer to perform the procedure, make more unnecessary movements with their instruments and significantly more mistakes. Surgeons with an opportunity for sleep of less than 6 hours on the previous on-call night shift had an 83% increase in risk of postoperative complications when working the following day.

Download Full-text

The International Committee in Algeria

International Review of the Red Cross ◽

10.1017/s0020860400012912 ◽

1962 ◽

Vol 2 (16) ◽

pp. 362-365 ◽

Cited By ~ 1

Keyword(s):

International Committee ◽

Surgical Instruments ◽

The Other ◽

Red Cross ◽

Medical Team ◽

Powdered Milk ◽

New Born ◽

Concentrated Milk ◽

French Red Cross

The ICRC actively developed its relief operation in Algeria in June. Acute medical and sanitary problems are facing its delegates, especially in Oran. As reported earlier the ICRC has sent a medical team of three to the Moslem city of Oran, where medicines, surgical instruments and equipment, and dietetic milk for new-born children, are most urgently needed. Following urgent requests by its delegates on the spot the ICRC immediately despatched by air two tons of dietetic powdered milk: Two further shipments were also sent by the French Red Cross, one of eight crates of sugared concentrated milk, the other of one and a half tons of standardised milk.

Download Full-text

Practices of patient participation: Getting a turn during hospital ward rounds

Discourse Studies ◽

10.1177/14614456211037452 ◽

2021 ◽

pp. 146144562110374

Author(s):

Inkeri Lehtimaja ◽

Salla Kurhila

Keyword(s):

Health Care ◽

Conversation Analysis ◽

Patient Participation ◽

Fundamental Principle ◽

Ward Round ◽

Hospital Ward ◽

Medical Team ◽

Ward Rounds

Patient participation is a fundamental principle in modern Western health care, but not necessarily simple to achieve. During hospital ward rounds, patient participation is further hindered by the multi-party nature of the encounter: at times, members of the medical team talk with each other rather than with the patient. This article examines patients’ opportunities to participate in ward round conversations when the patient is not the addressed recipient. The data consist of 3 hours of video-recorded ward rounds in a Finnish hospital. Using conversation analysis, we study patients’ practices for getting a turn in different sequential environments. The patients monitor the ongoing conversation and exploit its sequential organisation by producing responsive turns and repair initiations, thus becoming active participants. They also produce their own initiatives, although sequential and multimodal constraints affect their possibilities for modifying the participation framework. The results of this study can be exploited to promote patient participation.

Download Full-text

Prevalence and Reporting of Needle Stick Injuries: A Survey of Surgery Team Members in Kermanshah University of Medical Sciences in 2012

Global Journal of Health Science ◽

10.5539/gjhs.v8n3p245 ◽

2015 ◽

Vol 8 (3) ◽

pp. 245 ◽

Cited By ~ 3

Author(s):

Alireza Khatony ◽

Alireza Abdi ◽

Faranak Jafari ◽

Kamran Vafaei

Keyword(s):

Working Hours ◽

Surgical Instruments ◽

Medical Sciences ◽

Cross Sectional ◽

Team Members ◽

Needle Stick ◽

Number Of Patients ◽

High Prevalence ◽

Needle Stick Injuries ◽

Safety Guidelines

BACKGROUND: Surgeons are one of the groups, most highly exposed to the risk of needle stick injuries at work. The present study aims to determine the prevalence and reporting of needle stick injuries during the first 6 months of 2012, in faculty surgeons affiliated to the Kermanshah University of Medical Sciences. METHODS: In a cross-sectional descriptive-analytical survey, 29 surgeons were studied based on the census method. A reliable and valid questionnaire was used as a research instrument to collect the data. Data was analyzed using SPSS v.16 and based on descriptive and inferential statistics. RESULTS: Among 29 recruited surgeons, 5 (17.2%) had needle stick injuries during the 6 months, only one of whom had followed the established guidelines about reporting and following treatment. The most common instrument causing injury was the suture needle (60%). Significant differences were found in both groups of the injured and non-injured in term of gender (X2=5.612, P= 0.003), and number of patients (Z= 2.40, P=0.016) and daily working hours (Z=2.85, P=0.04). CONCLUSIONS: In relation to the relatively high prevalence of needle stick injuries among the surgeons and their lack of reporting, it is suggested that the Safety Guidelines in the operating room are carefully observed. Moreover, safer and lower risk surgical Instruments should be used.

Download Full-text

Clinical pharmacist interventions during clinical rounding in a psychiatric hospital: Positive evidence for pharmacists in interdisciplinary rounding at psychiatric hospital

10.21203/rs.3.rs-343442/v1 ◽

2021 ◽

Author(s):

Matej Stuhec ◽

Valentina Tement

Keyword(s):

European Union ◽

Psychiatric Hospital ◽

Clinical Pharmacist ◽

Psychiatric Hospitals ◽

Acceptance Rate ◽

Medical Team ◽

The European Union ◽

Ward Rounds ◽

The Impact ◽

Very High

Abstract Clinical pharmacists have not yet become an integral part of interdisciplinary ward rounds in most psychiatric hospitals across the European Union. This retrospective study examined the impact of the recommendations from a clinical pharmacist during hospital rounds as part of an interdisciplinary medical team in a psychiatric hospital. This retrospective observational pre-post study included all patients in a Slovenian psychiatric hospital who were hospitalized in 2019–2020. The clinical pharmacist made 315 recommendations for a total of 244 participants (average age M = 59.4, median = 56). Psychiatrists accepted 295 (93.7%) of the recommendations. After the recommendations, the number of expressed DRPs decreased in 166 interventions (93.8%) and the number of potential DRPs in 129 interventions (93.8%). Three months after discharge, 222 accepted recommendations were continued (70.5%). The most common recommendations were related to antipsychotics (19.4%, N = 61) followed by antidepressants (16.8%, N = 53). Including a clinical pharmacist in the interdisciplinary ward rounds in a psychiatric hospital reduced the number of expressed and potential DRPs with a very high recommendation acceptance rate. These results are the first in the European Union to show the benefits of including a clinical pharmacist in ward rounding.

Download Full-text

Patient's Death From the Perspective of Nursing Students

Frontiers in Public Health ◽

10.3389/fpubh.2021.636582 ◽

2021 ◽

Vol 9 ◽

Author(s):

Magdalena Szczupakowska ◽

Patrycja Stolarek ◽

Katarzyna Głodowska ◽

Magdalena Roszak ◽

Ewa Baum

Keyword(s):

Nursing Students ◽

Subjective Assessment ◽

Survey Method ◽

Spearman Correlation ◽

Patient Death ◽

Contingency Coefficient ◽

Second Year ◽

The Relationship ◽

Dying Patient ◽

Satisfactory Manner

Introduction: An exceedingly small amount of scientific research concerns the response to patient death among nursing students. There was a need to examine their perspective on patient death with which they experience during their studies. The authors wanted to check the subjective assessment of students' preparation for patient death and their perception of classes conducted in this area.Methods: The research used the diagnostic survey method and was conducted in May 2019 using Google Form on social media. The 467 nursing students answered 14 questions in the original questionnaire about their experience with patient death. The analyzed data were expressed as median, minimum and maximum values, or percentage, as appropriate. Comparison of groups was performed using the Mann–Whitney U-test or the Kruskal–Wallis test. The relationship between variables was analyzed with Spearman correlation coefficient or contingency coefficient (the χ2-test).Results: The authors analyzed 452 responses of nursing students, and 86.3% of them encountered death of a patient in the course of their studies. In the second-year master's studies, this value reached 99.3%. Among the most frequently mentioned accompanying emotions, students mentioned “reflection on the fragility of life” and “compassion.” Students do not feel sufficiently prepared for the death of a patient.Conclusions: Nursing students encounter the death of a patient very often and very early. Although the curriculum includes content related to the care of a dying patient, students believe that there is still too little of it and that it does not prepare it in a satisfactory manner. Students feel different, often negative emotions related to patient death, and also have various methods of dealing with such a situation. They also feel the need to increase education in this area.

Download Full-text